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[Syndrome of perforating lateral branches of the subcostal and ilio-hypogastric nerves. An unrecognized cause of hip pain].

The authors report 10 cases of pain in the outer surface of the hip related to damage of the perforating lateral branch of the subcostal or ilio-hypogastric nerve, which innervate this region. Anatomic investigation showed that there was a possibility of canal neuropathy, the possible mechanisms and signs of which are discussed. In general, treatment consisted of local infiltrations, but one patient underwent surgery with highly successful results.

Arthritis↗

Sources of innervation of the neuromuscular spindles in sternomastoid and trapezius.

The sources of innervation of neuromuscular spindles in sternomastoid and trapezius have been investigated in rats and mice, by degeneration experiments. The entire motor supply, both extrafusal and intrafusal, to both muscles, was from the spinal accessory nerve. The sensory supply to the spindles in sternomastoid and rostral trapezius was from cervical spinal nerves, and to those in the caudal trapezius was from thoracic spinal nerves.

Acromion↗

Experimental model of nervous anastomosis between intercostal and lumbar nerves in the rabbit.

The authors propose a new experimental model of nervous anastomosis between intercostal and lumbar nerves in rabbit with the purpose of providing a technique to by-pass a spinal lesion. Before carrying out the surgical experiments, an histological study has been performed on the donor and receiver nerves which demonstrated the great difference in number of nervous fiber between these two nerves. The purpose of the method is thus to reinnerve a lumbar nerve by means of two intercostal nerves. Histological controls are performed on the 120th day.

Animals↗

Intercostal nerve block: a roentgenographic anatomic study of technique and absorption in humans.

Roentgenograms of iothalamate meglumine 60% (Conray) injected bilaterally into the intercostal grooves of the ninth or tenth ribs in 30 surgical patients showed extensive spread of the contrast central and peripherally from the site of injection within 30 seconds, with almost complete absorption within 10 minutes 30 seconds. The spread was visualized in two patients for diagnosis using CT (computed tomography) following injection of iothalamate. It was also confirmed by injecting liquid latex into two corpses prior to autopsy. These findings help to explain why the peak plasma level occurs more rapidly and is higher following intercostal nerve block than from other regional nerve blocks when comparable doses are injected. Also, the study revealed that the optimal site for blocking an intercostal nerve is at the angle of the rib and that the optimal needle is one with a short bevel.

Absorption↗

Interchondral subluxation or "clicking rib syndrome".

A case history of the interchondral subluxation syndrome is presented, the anatomy as related to the symptoms discussed and the literature of this so-called "clicking-rib syndrome" reviewed. Unfortunately, this syndrome is not widely recognized but it is hoped that this article will bring it to the attention of those most likely to encounter it-the primary-care physician-and so save numerous unnecessary investigations and consultations. Once one is aware of its existence, the condition is easily diagnosed by careful history and examination alone.

Adult↗

Spinal segmental sympathetic outflow to cervical sympathetic trunk, vertebral nerve, inferior cardiac nerve and sympathetic fibres in the thoracic vagus.

The spinal segmental localization of preganglionic neurons which convey activity to the sympathetic nerves, i.e. vertebral nerve, right inferior cardiac nerve, sympathetic fibres in the thoracic vagus and cervical sympathetic trunk, was determined on the right side in chloralose anaesthetized cats. For that purpose the upper thoracic white rami were electrically stimulated with a single pulse, suprathreshold for B and C fibres, and the evoked responses were recorded in the sympathetic nerves. The relative preganglionic input from each segment of the spinal cord to the four sympathetic nerves was determined from the size of the evoked responses. It was found that each sympathetic nerve receives a maximum preganglionic input from one segment of the spinal cord (dominant segment) and that the preganglionic input gradually decreased from neighbouring segments. The spinal segmental preganglionic outflow to the cervical sympathetic trunk, thoracic vagus, right inferior cardiac nerve and vertebral nerve gradually shifted from the most rostral to the most caudal spinal cord segments. In some cases, a marked postganglionic component was found in the cervical sympathetic trunk. It was evoked by preganglionic input from the same spinal cord segments which transmitted activity to the vertebral nerve. These results indicate that there is a fixed relation between the spinal segmental localization of preganglionic neurons and the branch of the stellate ganglion receiving the input from these neurons.

Animals↗

Intra-SA-nodal pacemaker shifts induced by autonomic nerve stimulation in the dog.

Pacemaker shifts in the canine heart were inferred during stimulation of thoracic cardiac nerves and following norepinephrine from changes in the initial site of activation of bipolar electrodes sutured over the rostral, middle, and caudal regions of the sinus node, over the internodal pathways, and His bundle. During control periods, pacemaker activity was localized within the sinoatrial (SA) node 87% of the time, with the middle electrode most frequently showing initial activation. Stimulation of the right-sympathetic nerves enhanced sinus node pacemaker dominance, shifting it rostrally within the node. Right-vagal stimulation shifted the pacemaker caudally within the SA node, to nonnodal sites, and to the lower atrioventricular node and His bundle. Left-sympathetic stimulation shifted the pacemaker caudally within the sinus node and enhanced pacemaker activity in the vicinity of the internodal pathway electrodes and His bundle. Dispersion of pacemaker activity was particularly apparent during stimulation of the ventrolateral cervical cardiac nerve. Stimulation of the left-vagal nerves produced effects similar to those of the left-sympathetic nerves. Norepinephrine enhanced pacemaker activity particularly in the rostral region of the sinus node. Slight shifts in pacemaker activity within the sinus node produced changes in pattern of atrial excitation.

Animals↗

Full-length phrenic nerve transfer by means of video-assisted thoracic surgery in treating brachial plexus avulsion injury.

Phrenic nerve transfer has been widely used in treating brachial plexus avulsion injury. However, the present method crosses the thoracic part of the phrenic nerve, and nerve graft is needed, resulting in a long period of regeneration and partly irreversible muscle atrophy. We present our early experience of using video-assisted thoracic surgery to harvest a full length of phrenic nerve for transfer. Fifteen patients (mean age, 28 years) were treated. The thoracic part of the phrenic nerve was freed by means of video-assisted thoracic surgery and taken out of the thoracic cavity, and a full-length phrenic nerve was transferred to the musculocutaneous nerve to recover elbow flexion. The patients were followed. Another 29 patients with long-term follow-up who underwent traditional cervical phrenic nerve to musculocutaneous nerve transfer in our institute between 1994 and 1997 were selected. The period of newborn potential appearing in the biceps and the period for biceps to achieve M3 between two groups were compared. The operation was safe and no complications occurred. The additional length of phrenic nerve was 12.3 +/- 4.5 cm. Eleven patients received sufficient follow-up. Eight patients achieved biceps recovery to M3 (elbow flexion against gravity), and mean time was 198.8 +/- 36.0 days, much earlier than that of the traditional method (p < 0.01). Pulmonary function recovered to the preoperative level 9 months after operation. This new method is safe and minimally invasive. The result of full-length phrenic nerve transfer is much better than that of the traditional method. It obviously shortens the time required for nerve reinnervation, and offers a promising method for patients who have had a long interval from injury to operation and for forearm muscle reconstruction by phrenic nerve transferred to the median nerve or combined with free-muscle transfer.

Adolescent↗

Thoracic paravertebral analgesia.

Thoracic paravertebral nerve blockade, although once widely practised, has now only a few centres which contribute to the literature. Data production has, however, continued and this review correlates this new information with existing knowledge. Its history, taxonomy, anatomy, indications, techniques, mechanisms of analgesia, efficacy, contraindications, toxicity, side effects and complications are reviewed. Thoracic paravertebral analgesia is advocated for surgical procedures of the thorax and abdomen, especially wherever the afferent input is predominantly unilateral eg. thoracotomy, cholecystectomy and nephrectomy. It is also of benefit in the prevention and management of chronic pain. It is a simple undertaking with impressive efficacy. Plasma local anaesthetic levels are acceptable and its side effect and complication rates are low. No mortality has been reported. For unilateral surgery of the chest or truck, thoracic paravertebral analgesia should be considered as the afferent block of choice. For bilateral surgery, its efficacy may be limited by the doses of local anaesthetic which could safely be used and further study in this area in particular is required. This form of afferent blockade deserves greater consideration and investigation.

Analgesia↗