On the rami intermedii of the spinal nerves and their equivalent offshoots. A contribution to classification of the trunk muscles.
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Autopsy↗
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An electron microscopic study of normal bovine spinal ganglia and nerves.
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Animals↗
Video-assisted thoracoscopic sympathectomy for palmar hyperhidrosis: results in 102 cases.
The purpose of this retrospective study was to evaluate the immediate and long-term outcome of video-assisted thoracoscopic sympathectomy for idiopathic palmar hyperhidrosis. Between January 1996 and December 2000, a total of 67 patients underwent 102 sympathectomy procedures with excision of the sympathetic chain between the second and fourth sympathetic ganglion. The mean duration of hospitalization was 1.7 +/- 0.6 days. Five patients were lost to follow-up. Mean duration of follow-up for the 96 sympathectomy procedures in the remaining 62 patients was 38 +/- 6.3 months. Patient outcome showed that video-assisted thoracoscopic sympathectomy is the treatment of choice for idiopathic palmar hyperhidrosis. Long-term patient satisfaction is excellent.
Adolescent↗
Serratus anterior disruption: a complication of rheumatoid arthritis.
Pathology influencing the serratus anterior muscle contributes to classical medial winging of the scapula. Serratus anterior weakness or injury interferes with regular shoulder movement as this muscle stabilizes the medial border of the scapula against the thorax and rotates the scapula upward and laterally with arm elevation. Traumatic injury to the serratus anterior muscle without electrodiagnostic evidence of neurogenic involvement has only been reported once previously. We report an unusual case of disruption of the serratus anterior as a complication of rheumatoid arthritis. Involvement of the long thoracic nerve was ruled out by electromyography and nerve conduction studies. The injury occurred during routine activities of daily living and was complicated by a recurring subscapular hematoma. Contributing factors of shoulder joint contractures and coagulation abnormalities were associated with the course and treatment of rheumatoid arthritis. Initial treatment was by joint immobilization and reversal of coagulation abnormalities. Later treatment was directed toward joint protection and gradually increasing range of motion exercises.
Arthritis, Rheumatoid↗
Collateral sprouting of sensory axons in the hairy skin of the trunk: a morphological study in adult rats.
The capacity of sensory axons in the hairy skin of adult rats to extend branches into adjacent denervated skin has been studied by anterograde tracing with wheat germ agglutinin-horseradish peroxidase conjugate. In one series of experiments the Th10 intercostal nerve area was isolated and the distribution of sensory axons from the lateral cutaneous nerve was examined in control experiments and at various times after the denervation. In a second series of experiments, the entire Th10 was isolated, and the caudal extension of sensory axons from the Th10 spinal nerve was examined in control experiments and at various times after the denervation. The findings indicate that thin as well as coarse cutaneous sensory nerve axons can extend collateral sprouts within their 'own' dermatome as well as outside their normal segmental territory. Thus the dermatomal border does not seem to be a limit for collateral sprouting of coarse sensory nerve axons.
Animals↗
Free serratus anterior muscle transplantation for hand reconstruction.
Free transplantation of the serratus anterior muscle has allowed salvage or reconstruction of difficult hand injuries with advantages compared to traditional methods. Free muscle tissue adds vascularity to poorly vascularised and potentially infected wounds and allows hand elevation and early mobilisation. Dynamic reinnervation is possible with segmental preservation of the long thoracic nerve. The serratus anterior muscle is easily harvested and has a long, reliable vascular pedicle. It is thin, easily contoured to the defect and can be separated into its component slips. The muscle provides stable coverage when covered with a meshed split thickness skin graft. Scapular winging does not occur since only the lower two or three slips of muscle are used. The muscle has been used in 15 complex hand wounds, three within a week of revascularisation or digital replantation for hand salvage. Three dynamic muscle transfers were performed to restore thumb opposition with one simultaneous toe-to-thumb transplantation.
Adolescent↗
Time course of intercostal afferent termination of the inspiratory process.
The influence exerted by several somatic nerves on the inspiratory off-switch mechanism has been assessed in decerebrate cats. These animals were paralyzed, artificially ventilated, and bilaterally vagotomized. Inspiratory activity was monitored by a phrenic neurogram. Brief stimulation of either the superficial radical nerve or the sciatic nerve had an inconsistent effect on both the depth of inspiration and the timing of the respiratory cycle. However, stimulation of the T6 intercostal nerve during inspiration elicited a premature phase switch to expiration. Distinct, repeatable thresholds were determined for 10 delays in 100 msec increments after the onset of inspiration. As the delay increased, the threshold current was observed to decrease in all 30 decerebrate cats studied. An increase in the end-expiratory %CO2 caused an elevation of the stimulus threshold. These results correspond to the known characteristics of the inspiratory off-switch. Also, since the intercostal afferents are not normally a major determinant of respiratory rhythmicity in eupnea, this work establishes intercostal nerve stimulation as a very useful technique in the study of inspiratory to expiratory phase switching mechanisms.
Afferent Pathways↗
Neurotoxicity and protein binding of 2,5-hexanedione in the hen.
Previous studies in this laboratory have demonstrated 2,5-dimethylpyrrole adduct formation during in vitro exposure of protein amino groups to the neurotoxic n-hexane metabolite 2,5-hexanedione (2,5-HD). The present investigation reports in vivo pyrrole adduct formation in neural and nonneural protein from 2,5-HD-treated animals. Adult, White-Leghorn hens were given daily doses of either 200 or 70 mg 2,5-HD/kg, po, for up to 55 or 135 days, respectively. Additional animals were given 70 mg/kg for 63 days and then allowed to recover for 72 more days. Protein separation by gel electrophoresis followed by staining with a pyrrole-specific reagent yielded evidence of widespread adduct formation in protein from serum, liver, kidney, brain, and purified myelin. Binding was particularly strong in serum albumin nd myelin basic protein. Quantitation of the adduct in these tissues revealed that its formation reached peak levels at 20 days in high dose and 30 days in low-dose animals. Levels subsequently declined, suggesting the presence of a clearance mechanism capable of removing altered protein during continuing 2,5-HD exposure. Protein from animals on the recovery regimen contained no detectable pyrrole adduct. Pyrrole adduct formation was also detected in neurofilament protein preparations, although protein yields were too low to allow assessment of clearance. Hens at both dosages displayed clinical signs indicative of CNS and PNS neuropathy. Histologic findings included axonal swelling and degeneration in peripheral nerve and some spinal cord nerve tracts. A hypothesis is proposed involving differential clearance of pyrrole adduct from neural vs nonneural tissue to explain the mechanism of action and target organ specificity of 2,5-hexanedione.
Animals↗
Sympathetic peripheral chemoreflex is independent of expiratory output neurons in the cat.
Previously we reported that activities of certain chemoreflex sensitive cervical preganglionic sympathetic nerves (PSN) were augmented by carotid chemoreceptor stimulation independently of phrenic nerve (PN) activity in the cat. To test the hypothesis that the PSN carotid chemoreflex could have been mediated by the expiratory neuron activity, we studied the relationship between PSN, internal intercostal expiratory nerve (IICEN) and PN activities in vagotomized, anesthetized, paralysed and artificially ventilated cats. We made the following observations. (1) Hypoxia often inhibited IICEN activity while the PN and PSN activities were stimulated. (2) during normoxia, cyanide strongly stimulated PN and PSN discharges but only moderately IICEN discharges. (3) Hyperventilation hypocapnia suppressed or eliminated PSN and PN rhythms and activities, but made some IICEN fibers fire continuously. (4) During hypocapnic apnea, cyanide stimulated PSN activity before PN and IICEN activities, although some PSN fibers were stimulated simultaneously with PN fibers. Accordingly we conclude that IICEN activity does not significantly influence chemoreflex stimulation of PSN activity and that a direct chemoreflex stimulation of IICEN is minimal in the cat. Thus, the chemoreflex PSN response is in part independent of respiratory chemoreflex pathways.
Action Potentials↗
Biogenic amines: their occurrence, biosynthesis and metabolism in the locust, Schistocerca gregaria, by gas chromatography-negative-ion chemical ionisation mass spectrometry.
Extraction-derivatisation techniques have been developed for the unambiguous identification of biogenic amines, and their putative amino acid precursors and metabolites (both major and minor), in single ventral thoracic nerve cords of the locust. Schistocerca gregaria, by the use of gas chromatography-negative-ion chemical ionisation mass spectrometry with selected ion monitoring. In addition the configuration of that enantiomer of p-octopamine present in the thoracid nervous system of the locust was established as R using the chiral derivatisation reagent, (-)-heptafluorobutyrylphenylalanyl chloride.
Acetylation↗
Tissue ATPase activity and recovery in the freshwater crab Oziotelphusa senex senex exposed to a sublethal concentration of endosulfan for varying periods of time.
1. Na(+)-K+ and Mg(2+)-tissue ATPases of the freshwater crab Oziotelphusa senex senex showed increasing inhibition when exposed to a sublethal concentration (1.86 mg/l = 0.1 of LC50) of endosulfan for 1-30 days. 2. Na(+)-K(+)-ATPase activity in all tissues (thoracic nerve mass, gill, hepatopancreas and claw muscle) was higher than Mg(2+)-ATPase activity. 3. After 30 days exposure tissue Mg(2+)-ATPase was less affected than Na(+)-K(+)-ATPase. 4. Crabs exposed to endosulfan and then returned to uncontaminated water showed greater recovery of Mg(2+)-ATPase than Na(+)-K(+)-ATPase with 90-95% recovery after 1 day exposure and 60-65% recovery after 30 days exposure. 5. Changes in behaviour of the crabs were noted after 7 days exposure to endosulfan with progressive loss of coordination, decreased activity and increased exudation of mucus.
Adenosine Triphosphatases↗
Upper thoracic sympathectomy for axillary osmidrosis or bromidrosis.
The difference between axillary osmidrosis (AO) and axillary bromidrosis (AB) is the degree of odor and quantity of sweat, which is associated with selection of therapeutic modality theoretically. Upper thoracic sympathectomy has been used for both diseases but its effect needs to be further evaluated with more clinical data. We collected 108 patients with AO or AB treated by upper thoracic sympathectomy from July 1995 to July 2002. Of these patients, 42 suffered AO alone, 17 had AB (AO with axillary hyperhidrosis [AH]), and 49 had AO with palmar hyperhidrosis (PH). Ninety-two patients (183 sides) received anterior subaxillary transthoracic endoscopic sympathectomy (TES) and 17 patients (33 sides) received posterior percutaneous thoracic phenol sympathicolysis (PTPS). The levels of sympathectomy or sympathicolysis were T3-4 for AO and AB, and T2-4 for AO with PH. Mean follow-up period was 45.2 months (13-97 months). The satisfaction rates of patients were 52.4%, 70.6% and 61.2% for AO, AB and AO with PH, respectively. The rates of patients with improvement and satisfaction were 78.6%, 88.2% and 85.7% for AO, AB, and AO with PH, respectively. These results suggest that upper thoracic sympathectomy may be an acceptable treatment for AB or AO with PH rather than AO only.
Adolescent↗
A randomized trial of T3-T4 versus T4 sympathectomy for isolated axillary hyperhidrosis.
INTRODUCTION: Video-assisted thoracic sympathectomy (VATS) is one minimally invasive definitive treatment for axillary hyperhidrosis. Different techniques exist for controlling axillary sudoresis, but they are temporary and have high cost. This study was conducted to compare the initial results from sympathectomy using two distinct levels for treating axillary sudoresis: T3-T4 vs T4. METHODS: Sixty-two patients with axillary hyperhidrosis were prospectively randomized for denervation of T3-T4 or T4 alone. All patients were examined preoperatively and were followed-up at 1 and 6 months postoperatively. Evaluated were the axillary hyperhidrosis treatment, the presence, location, and severity of compensatory hyperhidrosis, and the quality of life. RESULTS: All the patients said that their axillary hyperhidrosis was successfully treated by the surgery after 6 months. There was no treatment failure. Compensatory hyperhidrosis was present in 29 patients (90.6%) of the T3-T4 group and in 17 T4 patients (56.7%) after 1 month. After 6 months, all the T3-T4 patients presented some degree of compensatory hyperhidrosis vs 13 T4 patients (43.3%). The severity of the compensatory hyperhidrosis was also lower in the T4 patients (P < . 01). The quality of life was poor in both groups before the surgery, and was equally improved in both groups after 1 and 6 months of follow-up. There were no deaths or significant postoperative complications nor a need for conversion to thoracotomy. CONCLUSION: Both techniques are effective for treating axillary hyperhidrosis, but the T4 group presented milder compensatory hyperhidrosis and had a greater satisfaction rate.
Adult↗
Reflexes evoked in human erector spinae muscles by tapping during voluntary activity.
We studied the stretch reflexes, an early R1 and a late R2, by tapping the voluntarily contracted erector spinae muscles and recording from the same spinal level with the subject in the prone position. The onset latencies increased progressively towards the caudal level from 8.8 +/- 0.7 ms at T5-6 to 15.9 +/- 1.1 ms at L4-5 for R1, and from 33.3 +/- 2.7 ms at T5-6 to 49.1 +/- 2.8 ms at L4-5 for R2. The latency changed significantly (P < 0.05) between two adjacent segments from T5-6/T6-7 through L1-2/L2-3 for R1 and T5-6/T6-7 through L3-4/L4-5 for R2. When recorded remote from the stimulus site, R1, considered segmental in origin, showed, as expected, only a small latency change consistent with the time required for the mechanical event to propagate to the recording site. In contrast R2 was shorter in latency with more rostral stimulation irrespective of the distance to the recording sites. This finding implies a centripetal propagation of the afferent impulse along the central pathway, which shortens with more rostral site of stimulation. Of the two components, the more reproducible R1 has a potential diagnostic value for segmental evaluation of thoracic nerve root compression and truncal neuropathies.
Adult↗
Quantitative structure-activity studies of octopaminergic 2-(arylimino)thiazolidines and oxazolidines against the nervous system of Periplaneta americana L.
The quantitative structure-activity relationship (QSAR) of octopaminergic 2-(arylimino)thiazolidines (AITs) and 2-(arylimino)oxazolidines (AIOs) against the thoracic nerve cord of the American cockroach, Periplaneta americana L., was analysed using reported physicochemical parameters and regression analysis. The more electron-donating, the less bulky at m-position, and the more hydrophobic the substituent, the greater the activity. The plots of observed log Vmax values against calculated log Vmax values having substituents on the m-position deviated downwards from those of compounds having substituents at the 0- and/or p-positions. The more hydrophobic and the more electron-withdrawing the substituent, the greater the activity. AIO with a 2, 3, 4-trichlorophenyl group (58) was more active than its thiazolidine derivative, 2-(2,3,4-trichlorophenylimino)thiazolidine (38) in terms of Vmax:Vmax of 58 was 30% relative to octopamine (OA), whereas that of 38 has been 9% relative to OA, respectively. Superimposition of energy-minimized OA and 58 revealed structural and conformational similarities that might account for the high activity of 58.
Animals↗
Quantitative structure-activity studies of octopaminergic agonists and antagonists against nervous system of Locusta migratoria.
The quantitative structure activity relationship (QSAR) of octopaminergic agonists and antagonists against the thoracic nerve cord of the migratory locust, Locusta migratoria L., was analyzed using physicochemical parameters and regression analysis. The hydrophobic effect, dipole moment, and shape index were important in terms of Ki: the more hydrophobic, the greater dipole moment, and the smaller shape index of the molecules, the greater the activity. A receptor surface model (RSM) was generated using some subset of the most active structures. Three-dimensional energetics descriptors were calculated from RSM/ligand interaction and these three-dimensional descriptors were used in QSAR analysis. This data set was studied further using molecular shape analysis.
Animals↗
A comparative study of structures comprising the thoracic outlet in 250 human cadavers and 72 surgical cases of thoracic outlet syndrome.
OBJECTIVE: We have hypothesized that variations in fibrous, muscular and osseous structures with the potential to entrap the brachial plexus occur within the thoracic outlet of the normal population; and that these variations are different in pattern and frequency from those in patients presenting with thoracic outlet syndrome (TOS). METHODS: Structural anomalies with potential for entrapping elements of the brachial plexus were examined following dissections of the posterior triangle of the neck in 250 human cadavers (N = 500 thoracic outlet dissections) and catalogued jointly by an anatomist and a thoracic surgeon. The pattern and frequency of anomalies in the 250 cadavers was compared to that encountered in 72 surgical cases of removal of the first rib for relief of symptomatic TOS (N = 72 procedures, 55 patients). RESULTS: Relevant structural variations were encountered in 46% of cadavers, exhibiting no left right or gender preference overall. When compared with the surgical group in which 100% exhibited structurally relevant anomalies, significant differences in pattern of anomalous structures and gender distribution were revealed. Anomalies posterior to the brachial plexus, ranging from fibrous bands to cervical ribs in both groups, were prevalent in the surgical group. A 'scissors-like' pattern, with neural entrapment by anterior and posterior anomalies was frequently encountered in females. CONCLUSIONS: Based on these data and embryological considerations, we propose a revised and simplified classification of impingement mechanisms within the anatomic thoracic outlet. Comparing these data to radiological imaging and observations at surgery, we offer a new perspective for the investigation and management of patients with TOS.
Cadaver↗
Endoscopic axillary lymph node dissection: an experimental study in human cadavers.
BACKGROUND: The role of axillary lymph node dissection in the staging of patients with breast carcinoma is currently under evaluation. As a result of recent advances in minimally invasive techniques, an endoscopic approach to axillary lymph node dissection may be an attractive alternative to lymphadenectomy performed via a standard "open" axillary incision. The purpose of the present study was to evaluate the technical feasibility and safety of such an approach in human cadavers. STUDY DESIGN: Twelve axillary dissections (right in seven, left in five) were performed in seven cadavers. A 2.5-cm incision was made along the lateral chest wall 12 cm inferior to the apex of the axilla. The subcutaneous axillary space was expanded with a balloon dissector, and exposure was maintained with a prototype external lift device. Endoscopic dissection was performed with three or four 5-mm ports inserted into this space. Histologic analysis was performed to document the number of lymph nodes removed. RESULTS: The mean dissection time for endoscopic axillary lymphadenectomy was 56.7+/-19 minutes (range, 30-90 minutes). Structures visualized endoscopically included the axillary vein (12 of 12 patients), the long thoracic nerve (12 of 12 patients), the thoracodorsal nerve (10 of 12 patients), and the intercostobrachial nerve (11 of 12 patients). An average of 9.9+/-7.2 lymph nodes (range, 2-22 nodes) was removed from each axilla. Open exploration of the axilla after the endoscopic dissection confirmed no injuries to any neurovascular structures. Residual lymph nodes were removed from the axilla in 7 of 12 dissections (58%; average, 4.2+/-4.0 nodes per specimen). CONCLUSIONS: These results suggest that endoscopic axillary dissection is feasible with currently available technology. Clinical trials in patients with breast carcinoma may be warranted to evaluate this technique further.
Axilla↗