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At least 613 records · Page 34Linked to original sources

PubMed2002

Results of treatment of the extensive volar wrist lacerations: 'the spaghetti wrist'.

'Spaghetti wrist' describes a volar wrist laceration in which at least 10 structures, inclusive of tendons, at least one major nerve and usually one major vessel are divided. This retrospective study, was performed between January 1990 and December 1995 at the Department of Orthopaedic and Traumatology of Erciyes University Medical School. The outcome of 21 patients who sustained simultaneous laceration of the median and ulnar nerves as well as flexor tendons at the wrist is described. The mean follow-up was 6.4 years. The flexor tendons were assessed using criteria from Lister et al. Vascular status was assessed clinically. Ulnar and median nerve repair results at the final control were assessed according to Seddon's criteria. Furthermore, the ulnar nerve was assessed according to the power of the first dorsal interosseous muscle, and the median nerve assessed by the function of abductor pollicis brevis and sensory function modality. Primary nerve repair yielded satisfactory results, the median nerve repair achieving a better outcome than the ulnar nerve. Most patients regained a functional range of wrist movement at the final control.

Adolescent↗

PubMed1995

Anterior spinal artery syndrome. Paraplegia following segmental ischaemic injury to the spinal cord after oesophagectomy.

A case of unexpected paraplegia after oesophageal resection under general anaesthesia combined with epidural analgesia and intra-operative intercostal block is described. Patients with compromised cardiovascular and respiratory function undergoing thoracic or major abdominal surgery can benefit significantly intra-operatively from a combination of general anaesthesia and regional analgesia. The continued use of regional analgesia into the postoperative period offers even more advantages. General anaesthesia administered before regional analgesia may, however, mask complications related to the regional technique and delay the instigation of corrective measures. The blood supply to the anterior part of the spinal cord, through the artery of Adamkiewicz, may be impaired intra-operatively leading to neurological sequelae known as the anterior spinal artery syndrome, characterised by loss of motor function with intact or partially intact sensory function. Patients at risk of developing the syndrome can be identified pre-operatively.

Aged↗

PubMed1996

Management of epilepsy in the elderly.

Epilepsy in elderly patients is a growing worldwide challenge; as the population ages, the prevalence of epilepsy increases. Management of epilepsy in elderly patients requires an understanding of their unique medical and pharmacologic characteristics. Accurate assessment of seizures, thorough neurologic assessment to define etiology, and evaluation of concomitant illnesses and living situations are necessary for comprehensive treatment planning and informed management. Expect elderly patients to present challenges to treatment that include concomitant diseases, obligatory polypharmacy with accompanying drug interactions, and age-related changes in renal and hepatic physiology that alter drug metabolism and elimination. Elderly patients have declining intellectual function, motor impairment, or altered special sensory function that make them susceptible to dose-related CNS side effects of antiepileptic drugs (AEDs). When AEDs are added to the medical regimen of an elderly patient, the physician must review all prescribed drugs. Drugs prescribed for concomitant illnesses such as behavioral problems, cardiovascular disease, hypertension, and infection may alter the distribution and metabolism of AEDs, with an impact on efficacy and occurrence of adverse effects. AEDs tend to induce metabolism of other drugs, leading to a decline in target response. Optimal care of elderly patients with epilepsy includes use of free levels to monitor AED concentrations, careful dose selection, and physician sensitivity to patients' social problems.

Age Factors↗

PubMed2004

[Functional evaluation of the selective neck dissection in patients with carcinoma of head and neck].

OBJECTIVE: To investigate comparatively the shoulder function, sensory and cosmetic changes after selective neck dissection (SND), modified neck dissection (MND) or radical neck dissection (RND). METHODS: 157 questionnaires, which involving shoulder function, skin numbness and cosmetic changes were sent to patients with SCC of head and neck who were treated with SND, MND or RND between January 1997 and May 2001. 32 eligible questionnaires were collected which included 32 patients had 43 neck dissection. Among them, SNDs were performed in 23 necks, MNDs in 11 necks and RNDs in 9 necks. RESULTS: The shoulder disability was least in SND necks (13.0%), followed by MND necks (36.6%) and RND necks (66.7%). Similarly, permanent neck anesthetic were found in 17.4% of SND necks, 36.6% of MND necks, and 88.9% of RND necks. Last, only 17.4% of SND necks had cosmetic changes after surgery, while 90.9% of MND necks and 100% of RND necks had cosmetic changes after surgery. CONCLUSION: Patients underwent selective neck dissection had the least damage to the shoulder function, skin sensory and cosmetic.

Carcinoma, Squamous Cell↗

PubMed1992

Treatment of symptomatic diabetic neuropathy by surgical decompression of multiple peripheral nerves.

Symptomatic diabetic sensorimotor polyneuropathy is considered progressive and irreversible. The hypothesis that symptoms of diabetic neuropathy may be due to entrapment of peripheral nerves was investigated in a prospective study from 1982 to 1988 in which diabetics (38 type I, 22 type II) had surgical decompression of 154 peripheral nerves in 51 upper extremities and 31 lower extremities. Mean postoperative follow-up was 30 months (range 6 to 83 months). Considering the entire series, an excellent final result was noted for motor function in 44 percent and for sensory function in 67 percent of the decompressed nerves. Ten percent of the patients were not improved, and 2 percent were worse in sensorimotor function. Upper extremity nerve decompressions achieved better results than lower extremity nerve decompressions. Improvement in postoperative electrodiagnostic studies varied in relationship to the preoperative electrodiagnosis. Improvement was noted in 100 percent of those nerves with the preoperative diagnosis of "localized entrapment," 80 percent for "peripheral neuropathy with superimposed entrapment," and 50 percent for "peripheral neuropathy." Progressive neuropathy occurred in a nontreated limb of 50 percent of those patients whose surgically treated limb maintained improvement. The results of this study suggest that symptoms of sensorimotor diabetic neuropathy may be due partly to compression of multiple peripheral nerves. The results further suggest that surgical decompression of such nerves may result in symptomatic improvement.

Adult↗

PubMed1993

Neural mechanisms of joint pain.

Joint pain is a common symptom in various forms of arthritis. Unfortunately, the mechanisms involved in the pathogenesis of joint pain are not well understood, but probably include peripheral and central neural mechanisms. The sympathetic system appears to interact with sensory afferents under pathological conditions, and this may be mediated directly via receptors on sensory neurons, or indirectly via inflammatory mediators. Classical inflammatory mediators such as serotonin and bradykinin appear to activate some nociceptive afferents and serotonin may sensitise these afferents to non-noxious stimuli in an inflamed joint. A purely sensory function has traditionally been ascribed to sensory afferents, but unmyelinated C fibres have in addition a neurosecretory role and release peptides such as substance P which may contribute to inflammation. Lastly, central sensitisation in the spinal cord may play an important role in the pathogenesis of joint pain. Activation of N-Methyl-D-Aspartate (NMDA) receptors and the wind-up phenomenon may be involved in central sensitisation.

Afferent Pathways↗

PubMed1993

[A form of dopa-responsive dystonia of late onset with diurnal fluctuations].

We report a case of a 67-year-old woman who had dopa-responsive dystonia of late onset with diurnal fluctuations. She was well until the age of 65 years, when she noted the insidious onset of involuntary movements mainly involving the neck and trunk. She had no family history of movement disorders and had never received neuroleptics. Two years after her symptoms began, she visited our clinic. Neurological examination revealed slow repetitive extension and flexion movements of the neck and trunk, and irregular slow movements involving the mouth, tongue and limbs. The cranial nerves, cerebellar function, muscle strength, deep reflexes and sensory function were intact. Clinically and electromyographically, dystonia was characteristic of her involuntary movements. No parkinsonian features were present. The involuntary movements showed diurnal fluctuations that improved after sleep and the administration of L-DOPA and trihexyphenidyl. Dopamine receptor blocking agents aggravated her condition. Routine blood chemistry including copper metabolism, cerebrospinal fluid findings, and brain CT scan were all normal. Dopa-responsive dystonia is characterized by onset in childhood or adolescence and is frequently associated with parkinsonian features. Our patient had non-hereditary neck and trunk dystonia of late onset that responded to L-DOPA. Her disorder may constitute a specific form of dopa-responsive dystonia.

Age Factors↗

PubMed1999

Sensory impairments and delayed regeneration of sensory axons in interleukin-6-deficient mice.

Interleukin-6 (IL-6) is a multifunctional cytokine mediating inflammatory or immune reactions. Here we investigated the possible role of IL-6 in the intact or lesioned peripheral nervous system using adult IL-6 gene knockout (IL-6(-/-)) mice. Various sensory functions were tested by applying electrophysiological, morphological, biochemical, and behavioral methods. There was a 60% reduction of the compound action potential of the sensory branch of IL-6(-/-) mice as compared with the motor branch in the intact sciatic nerve. Cross sections of L5 DRG of IL-6(-/-) mice showed a shift in the relative size distribution of the neurons. The temperature sensitivity of IL-6(-/-) mice was also significantly reduced. After crush lesion of the sciatic nerve, its functional recovery was delayed in IL-6(-/-) mice as analyzed from a behavioral footprint assay. Measurements of compound action potentials 20 d after crush lesion showed that there was a very low level of recovery of the sensory but not of the motor branch of IL-6(-/-) mice. Similar results of sensory impairments were obtained with mice showing slow Wallerian degeneration (Wlds) and a delayed lesion-induced recruitment of macrophages. However, in contrast to WldS mice, in IL-6(-/-) mice we observed the characteristic lesion-induced invasion of macrophages and the upregulation of low-affinity neurotrophin receptor p75 (p75LNTR) mRNA levels identical to those of IL-6(+/+) mice. Thus, the mechanisms leading to the common sensory deficiencies were different between IL-6(-/-) and WldS mice. Altogether, the results suggest that interleukin-6 is essential to modulate sensory functions in vivo.

Action Potentials↗

PubMed2004

Functional organization of sensory input to the olfactory bulb glomerulus analyzed by two-photon calcium imaging.

Glomeruli in the olfactory bulb are anatomically discrete modules receiving input from idiotypic olfactory sensory neurons. To examine the functional organization of sensory inputs to individual glomeruli, we loaded olfactory sensory neurons with a Ca(2+) indicator and measured odorant-evoked presynaptic Ca(2+) signals within single glomeruli by using two-photon microscopy in anaesthetized mice. Odorants evoked patterns of discrete Ca(2+) signals throughout the neuropil of a glomerulus. Across glomeruli, Ca(2+) signals occurred with equal probability in all glomerular regions. Within single glomeruli, the pattern of intraglomerular Ca(2+) signals was indistinguishable for stimuli of different duration, identity, and concentration. Moreover, the response time course of the signals was similar throughout the glomerulus. Hence, sensory inputs to individual glomeruli are spatially heterogeneous but seem to be functionally indiscriminate. These results support the view of olfactory glomeruli as functional units in representing sensory information.

Animals↗

PubMed2002

Brain imaging studies of the functional organization of human olfaction.

It is believed that sensory functions are organized in a hierarchical and parallel manner. The sense of smell differs in several aspects from other senses: odors can immediately elicit emotional evocations, they are remembered after a long time, and they are difficult to label. This raises the question of whether odorous stimuli may be processed differently from the other sensory stimuli. New data from brain imaging studies suggest that this is not the case and that the specific characteristics of the sense of smell can be attributed to the engagement of limbic structures at an early stage in the signal processing.

Animals↗

PubMed2002

Functional weakness and sensory disturbance.

In the diagnosis of functional weakness and sensory disturbance, positive physical signs are as important as absence of signs of disease. Motor signs, particularly Hoover's sign, are more reliable than sensory signs, but none should be used in isolation and must be interpreted in the overall context of the presentation. It should be borne in mind that a patient may have both a functional and an organic disorder.

Conversion Disorder↗

PubMed1997

Recovery of function after sciatic nerve crush lesion in rats selected for diverging locomotor activity in the open field.

The relation between recovery of function following a sciatic nerve crush lesion and an individual behavioural characteristic, the locomotor activity in an open field, was investigated in rats. Ten high-active (HA) and ten low-active (LA) rats were selected from a stock of sixty male, random-bred Wistar rats, by measuring travelled distance in an open field. Subsequently, both HA and LA rats underwent an unilateral sciatic nerve crush. Recovery of motor function revealed no significant differences between both groups, whereas recovery of sensory function in HA rats was significantly more rapid than in the LA rats (P < 0.01). These observations suggest the existence of a relationship between individual behavioural characteristics, and the sensory recovery of nerve function following crush lesion in rats.

Adrenal Glands↗

PubMed2002

Sensation and gas dynamics in functional gastrointestinal disorders.

Our current knowledge of motor and sensory functions in the human gut is critically reviewed, showing how the two may interact to produce symptoms in patients with functional gastrointestinal disorders. A local stimulus is necessary to activate the pathogenetic symptom generation process, and in many patients abnormal pooling of gas at various or extensive sites in the bowel and focal gut distension may provide the local stimulus, compounded by spatial summation phenomena and conscious visceral hypersensitivity. The interplay of these mechanisms results in the clinical expression of symptoms.

Colonic Diseases, Functional↗

PubMed1994

Long-term effects of deprivation of cell support in the distal stump on peripheral nerve regeneration.

The distal stump of an injured peripheral nerve supports regenerating axons by offering a favourable growth substratum and several cell-produced growth factors. Deprivation of cellular factors alone has been shown not to prevent fairly rapid axonal elongation after nerve injury if the growth substratum was preserved. The present study examined possible long-term untoward effects of cell support deprivation during an early phase of nerve regeneration. Rat sciatic nerve was crushed and a 25 mm long distal nerve segment was made acellular by freezing-thawing, while the integrity of the growth substratum for the regenerating axons was preserved. Toe-spreading reflex and skin sensitivity to pinch in the foot were monitored to follow recovery of motor and sensory function, respectively. The number of myelinated axons was determined in the sciatic nerve proximally to the lesion site, and distally in the predominantly sensory sural nerve as well as in the mixed motor nerve to the soleus muscle. Except for a short delay in the onset of recovery, explainable by the reduced elongation rate of axons growing through the acellular nerve segment, we found no deleterious effect of cell support deprivation on sensory or motor function recovery after nerve crush. Most of regenerating sensory neurons did not critically depend on the distal stump cell support. However, a 15% and 25% loss of myelinated axons both proximally to the lesion and distally in the sensory sural nerve, respectively, indicated that a corresponding minor loss of injured sensory neurons occurred when they were deprived of such cell support even if provided with a favourable growth substratum for successful regeneration.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

PubMed1990

[Late results of treatment of mandibular fractures].

In a group of 1246 patients treated in the Department of Maxillofacial Surgery-Institute of Stomatology, Medical Academy in Warsaw, in a period of 3 years (1984-1986) late results of treatment of mandibular fractures were assessed. In the assessment the range of mandible abduction, function of temporomandibular joints, occlusal abnormalities, the sensory function in the area innervated by the mental nerves and the condition of posttraumatic scars changing the morphology and aesthetic appearance of the face were considered. Limitation of mandibular abduction after treatment was found in 39 cases. Functional disturbances of temporomandibular joints developed in 58 cases, and various occlusal complications were found in 130 out of 1246 patients. In 56 patients various sensory loss was noted in the innervation area of the mental nerves. Posttraumatic scars in 89 patients affected in various degree facial morphology and aesthetic appearance.

Cicatrix↗

PubMed1999

Foot and ankle sensory neuropathy, proprioception, and postural stability.

Foot and ankle sensory neuropathy may result from a variety of pathologic conditions, especially diabetes mellitus. Decreased sensation, particularly on the plantar surface of the feet, leads to obvious risks of cutaneous injury. Less obvious are the risks of fall-related injury associated with changes in other sensory systems of the foot and ankle, such as the receptors involved in joint movement and position perception. The results of a number of studies demonstrate that the neuropathic process affects these receptors in individuals with diabetes mellitus. Associated with the decreased sensory function of the foot and ankle is decreased performance on tests of static and dynamic postural stability. Subjective feelings of instability and an increased incidence of fall-related injuries have also been reported. The reduced postural stability in persons with diabetic neuropathy cannot be attributed exclusively to loss of plantar cutaneous sensation; it appears to be the result of a general loss of peripheral sensory receptor function in the lower legs, including that of the muscle spindles. During the evaluation of an individual with foot and ankle sensory neuropathy, the possibility of balance deficits should be given proper attention. Assessment of balance deficits could be particularly important when planning the course of rehabilitation for individuals with foot and ankle neuropathy who use modified footwear or have an amputation of a section of the foot or lower extremity.

Ankle↗

PubMed1986

Neurobehavioural effects of occupational exposure to lead.

A set of neurobehavioural tests selected on the basis of information processing theory was used to study the effect of low level occupational lead exposure on 59 lead workers compared with a matched control group of the same number. Only one of the lead exposed group had a blood lead concentration above the current threshold limit value of 3.81 mumol/l at the time of testing (mean 2.36 mumol/l, range 1.19-3.92 mumol/l) and none had been detected above that level in the previous three years. Nevertheless, most neurobehavioural functions tested showed some impairment in the lead workers. Visual sensory function was affected and, perhaps as a consequence, sustained attention and psychomotor tasks were performed more slowly by the lead exposed group. Cognitive functions were also impaired, with sensory store memory, short term memory, and learning abilities all showing deficits in lead workers. Such cognitive deficits may also be partly due to initial degradation of the visual input. Long term memory performance compared equally with control levels possibly because of development of a compensatory strategy such as rehearsal by the lead exposed subjects. Multiple linear regression analysis relating to lead workers test performance and their lead exposure showed that performance on the sensory store memory test alone was significantly related to exposure. This was probably due to the homogeneity of the lead exposed group with regard to blood lead concentrations and the use of blood lead as a measure of chronic lead exposure.

Adolescent↗

PubMed1998

Infraorbital nerve function following treatment of orbitozygomatic complex fractures. A multitest approach.

Sensory disturbance following orbitozygomatic complex fractures was studied in 65 patients in relation to type of fracture and method of treatment. The fracture-type-dependent treatments were: no surgical intervention (n = 20), closed reduction with or without wire fixation (n = 17), open reduction with miniplate fixation (n = 15) and/or reconstruction of the orbital floor (n = 13). Several methods were applied to assess sensory function, on average 6.3 months after treatment, i.e. the patient's report and tests regarding touch, two methods of two-point discrimination, and cold, all applied on the cheek and upper lip. The various examinations indicated that, on average, the long-term sensory disturbance was most pronounced and severe in patients who underwent closed reduction without miniplate fixation. As the sensory disturbance of patients with open reduction and miniplate fixation approached the base-line level of patients for whom surgical intervention was not indicated, open reduction with miniplate fixation can be recommended as treatment for frontozygomatic suture fractures. The degree of sensory disturbance of patients who underwent orbital floor reconstruction was intermediate compared to patients with closed and open reduction respectively.

Adolescent↗