Feasibility of the Oberlin Procedure in Late Presentation Cases of C5-C6 and C5-C7 Brachial Plexus Injuries in Adults

Hand ◽  
2020 ◽  
pp. 155894472091832
Author(s):  
Álvaro B. Cho ◽  
Carlos H. V. Ferreira ◽  
Fernando Towata ◽  
Gabriel C. Almeida ◽  
Luiz Sorrenti ◽  
...  
Keyword(s):  
Brachial Plexus ◽  
Nerve Transfer ◽  
Elbow Flexion ◽  
Late Presentation ◽  
Significant Difference ◽  
Group A ◽  
The Mean ◽  
Group B ◽  
Flexion Strength

Background: Oberlin et al presented a new technique for nerve transfer that completely changed the prognosis of patients with brachial plexus injury. Currently, most of the literature addresses cases submitted to early surgical intervention, before 12 months from injury, showing consistent good results. The aim of this study was to evaluate the feasibility of the Oberlin procedure in late presentation cases (≥12 months), comparing the elbow flexion strength with patients operated earlier. Methods: We retrospectively reviewed 49 patients with partial brachial plexus injuries submitted to the Oberlin procedure. They were divided into 2 groups. Group A included 39 patients operated with <12 months of injury. The mean postoperative follow-up was 22.53 months. The interval from injury to surgery varied from 4 to 11 months (±8.45 months). Group B included 10 patients with surgery ≥12 months after injury. The mean postoperative follow-up was 32 months. The interval from injury to surgery ranged from 12 to 19 months (±15.4 months). Patients were evaluated monthly after surgery and the elbow flexion strength was measured using the British Medical Research Council scale. Results: In Group A, 24 patients presented with either good (M3) or excellent (M4) elbow flexion strength. In Group B, 9 patients presented with either good (M3) or excellent (M4) elbow flexion strength. A significant difference was not seen in the postoperative elbow flexion strength among the 2 groups. Conclusion: Biceps reinnervation with the Oberlin procedure is still feasible and should be attempted after more than 12 months of injury in partial brachial plexus injuries.

Minimum Ten-Year Outcomes of Partial Ulnar Nerve Transfer for Restoration of Elbow Flexion in Patients with Upper Brachial Plexus Injury

2019 ◽  
Vol 24 (03) ◽  
pp. 283-288
Author(s):  
Yusuke Nagano ◽  
Daisuke Kawamura ◽  
Alaa Terkawi ◽  
Atsushi Urita ◽  
Yuichiro Matsui ◽  
...  
Keyword(s):  
Muscle Strength ◽  
Brachial Plexus ◽  
Ulnar Nerve ◽  
Functional Outcomes ◽  
Brachial Plexus Injury ◽  
Nerve Transfer ◽  
Elbow Flexion ◽  
The Mean ◽  
Flexion Strength

Background: Partial ulnar nerve transfer to the biceps motor branch of the musculocutaneous nerve (Oberlin’s transfer) is a successful approach to restore elbow flexion in patients with upper brachial plexus injury (BPI). However, there is no report on more than 10 years subjective and objective outcomes. The purpose of this study was to clarify the long-term outcomes of Oberlin’s transfer based on the objective evaluation of elbow flexion strength and subjective functional evaluation of patients. Methods: Six patients with BPI who underwent Oberlin’s transfer were reviewed retrospectively by their medical records. The mean age at surgery was 29.5 years, and the mean follow-up duration was 13 years. The objective functional outcomes were evaluated by biceps muscle strength using the Medical Research Council (MRC) grade at preoperative, postoperative, and final follow-up. The patient-derived subjective functional outcomes were evaluated using the Quick Disability of the Arm, Shoulder, and Hand (QuickDASH) questionnaire at final follow-up. Results: All patients had MRC grade 0 (M0) or 1 (M1) elbow flexion strength before operation. Four patients gained M4 postoperatively and maintained or increased muscle strength at the final follow-up. One patient gained M3 postoperatively and at the final follow-up. Although one patient achieved M4 postoperatively, the strength was reduced to M2 due to additional disorder. The mean score of QuickDASH was 36.5 (range, 7–71). Patients were divided into two groups; three patients had lower scores and the other three patients had higher scores of QuickDASH. Conclusions: Oberlin’s transfer is effective in the restoration of elbow flexion and can maintain the strength for more than 10 years. Patients with upper BPI with restored elbow flexion strength and no complicated nerve disorders have over ten-year subjective satisfaction.

Comparison Between Supraclavicular Versus Video-Assisted Intrathoracic Phrenic Nerve Section for Transfer in Patients With Traumatic Brachial Plexus Injuries: Case Series

2020 ◽  
Vol 19 (3) ◽  
pp. 249-254
Author(s):  
Mariano Socolovsky ◽  
Marcio de Mendonça Cardoso ◽  
Ana Lovaglio ◽  
Gilda di Masi ◽  
Gonzalo Bonilla ◽  
...  
Keyword(s):  
Brachial Plexus ◽  
Phrenic Nerve ◽  
Case Series ◽  
Nerve Transfer ◽  
Elbow Flexion ◽  
Nerve Section ◽  
Video Assisted ◽  
Significant Difference ◽  
Flexion Strength

Abstract BACKGROUND The phrenic nerve has been extensively reported to be a very powerful source of transferable axons in brachial plexus injuries. The most used technique used is supraclavicular sectioning of this nerve. More recently, video-assisted thoracoscopic techniques have been reported as a good alternative, since harvesting a longer phrenic nerve avoids the need of an interposed graft. OBJECTIVE To compare grafting vs phrenic nerve transfer via thoracoscopy with respect to mean elbow strength at final follow-up. METHODS A retrospective analysis was conducted among patients who underwent phrenic nerve transfer for elbow flexion at 2 centers from 2008 to 2017. All data analysis was performed in order to determine statistical significance among the analyzed variables. RESULTS A total of 32 patients underwent supraclavicular phrenic nerve transfer, while 28 underwent phrenic nerve transfer via video-assisted thoracoscopy. Demographic characteristics were similar in both groups. A statistically significant difference in elbow flexion strength recovery was observed, favoring the supraclavicular phrenic nerve section group against the intrathoracic group (P = .036). A moderate though nonsignificant difference was observed favoring the same group in mean elbow flexion strength. Also, statistical differences included patient age (P = .01) and earlier time from trauma to surgery (P = .069). CONCLUSION Comparing supraclavicular sectioning of the nerve vs video-assisted, intrathoracic nerve sectioning to restore elbow flexion showed that the former yielded statistically better results than the latter, in terms of the percentage of patients who achieve at least level 3 MRC strength at final follow-up. Furthermore, larger scale prospective studies assessing the long-term effects of phrenic nerve transfers remain necessary.

Double fascicular nerve transfer to the biceps and brachialis muscles after brachial plexus injury: clinical outcomes in a series of 29 cases

2011 ◽  
Vol 114 (6) ◽  
pp. 1520-1528 ◽  
Author(s):  
Wilson Z. Ray ◽  
Mitchell A. Pet ◽  
Andrew Yee ◽  
Susan E. Mackinnon
Keyword(s):  
Brachial Plexus ◽  
Clinical Outcomes ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Nerve Transfer ◽  
Elbow Flexion ◽  
Study Results ◽  
The Mean ◽  
Flexion Strength

Object The clinical outcomes of patients with brachial plexus injuries who underwent double fascicular transfer (DFT) using fascicles from the median and ulnar nerves to reinnervate the biceps and brachialis muscles were evaluated. Methods The authors conducted a retrospective chart review of 29 patients with brachial plexus injuries that were treated with DFT for restoration of elbow flexion. All patients underwent pre- and postoperative clinical evaluation using the Medical Research Council grading system. Results The mean patient age was 37 years (range 17–68 years), and there was a mean follow-up of 19 ± 12 months (range 8–68 months). At the most recent follow-up, all but 1 patient (97%) had regained elbow flexion. Eight patients recovered Grade M5, 15 patients recovered Grade M4, and 4 patients recovered Grade M3 elbow flexion strength. There was no evidence of functional deficit in the donor nerve distributions. Conclusions Study results demonstrated the reliable restoration of M4–M5 elbow flexion following double fascicular transfer in patients with brachial plexus injuries.

scholarly journals Comparison Between With Kirschner-wires Only And Combined Screw Fixation in Proximal Reverse Chevron osteotomy(PCMO) For Hallux Valgus Deformity

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0002
Author(s):  
Hwa Jun Kang ◽  
Hong-Geun Jung ◽  
Jong-Soo Lee ◽  
Sungwook Kim ◽  
Mao Yuan Sun
Keyword(s):  
Hallux Valgus ◽  
Screw Fixation ◽  
Fixation Method ◽  
Kirschner Wires ◽  
Significant Difference ◽  
Group A ◽  
The Mean ◽  
Group B ◽  
Severe Hallux Valgus

Category: Bunion Introduction/Purpose: Kirschner-wires fixation, sometimes we have encountered pin irritation or pull-out. This is the reason why we consider additional fixation. Moreover, there are few reports according to comparison of fixation method, and Most of them focused on comparison K-wires or screw fixation only. Purpose of study is to compare clinical and radiographic outcome between Kirschner-wires only and combined screw fixation. Methods: The study included two different groups according to fixation methods. One with Kirschner-wires fixation (KW group) included 117 feet(of 98 patients), the other with combined screw fixation (KWS group) 56 feet (of 40 patients) with moderate to severe hallux valgus. Clinically, the preoperative and final follow-up visual analog scale (VAS) pain scores, the preoperative and final follow-up American Orthopaedic Foot & Ankle Society (AOFAS) hallux metatarsophalangeal (MTP)-interphalangeal (IP) scores, and patient satisfaction after the surgery were evaluated. Radiographically, the hallux valgus angle (HVA), intermetatarsal angle (IMA), medial sesamoid position (MSP), and first to fifth metatarsal width (1-5MTW) were analyzed before and after surgery. Results: The mean AOFAS score improved preoperative 65.5 to 95.3 at final follow up in group A, while preoperative 56.5 to 88.6 at final follow up. Pain VAS decreased from 5.7 to 0.5 in group A, whereas from 6.2 to 1.6 in group B. The mean HVA all improved from preoperative 38.5 to 9.3 at final follow up in group A and 34.7 to 9.1 in group B. The mean IMA and MSP also improved significantly at final follow up. In comparative analysis, the IMA did not show significant difference between postoperative and final state in group A, while showed significant increase in group B. Conclusion: We achieved favorable clinical and radiographic outcomes with minimal complications in patient with moderate to severe hallux valgus in both groups. However, this study shows no statistically significant difference in IMA during follow-up period and lower recurrence rate. Therefore we need to consider combined fixation method to provide better stability and can expect lower recurrence rate.

scholarly journals Correlation of compound muscle action potential generated by donor nerves with the recovery of elbow flexion in Oberlin transfer in brachial plexus injury

2018 ◽  
Vol 51 (02) ◽  
pp. 137-144
Author(s):  
Mukund Ramchandra Thatte ◽  
Binita Bharat Raut ◽  
Amita Shivyogi Hiremath ◽  
Sushil Ramesh Nehete ◽  
Nayana Somala Nayak
Keyword(s):  
Action Potential ◽  
Brachial Plexus ◽  
Brachial Plexus Injury ◽  
Compound Muscle Action Potential ◽  
Nerve Transfer ◽  
Elbow Flexion ◽  
Muscle Action ◽  
Muscle Action Potential ◽  
Group A ◽  
Group B

ABSTRACT Objective: To study the correlation of compound muscle action potential of donor nerves with the recovery of elbow flexion in Oberlin transfer in brachial plexus injury. Introduction: Distal nerve transfer using motor fascicle of ulnar or median nerve to restore elbow flexion is a part of reconstructive surgery after upper brachial plexus injury, first described by Oberlin et al. However, one of the most critical influences on functional outcome is number of functioning motor axons in donor fascicle which is reflected by its compound muscle action potential. We studied whether nerve transfers with donor nerves showing higher amplitudes will yield better reinnervation of muscle and therefore better function as estimated by clinical examination. Methods: We prospectively studied 30 cases of upper brachial plexus injury, of which were treated with Oberlin transfer using ulnar or median or both nerves. The prerequisites were no elbow flexion and hand and wrist flexors showing the power of more than Medical research Council MRC Grade 4. Donor nerves selected either ulnar or median having CMAP >4 mv in our electrophysiology laboratory during nerve conduction study. Patients were followed up for 1 year and assessed clinically for restoration of elbow flexion, weight tolerance. Results: A total of 30 patients of Oberlin transfer were evaluated for improvement power of biceps and elbow flexion. (MRC) grading was done at 1 year. Twenty-seven patients had a good result (MRC grade ≥3), i.e., 90% of patients. Based on the MRC grades, we categorised the patients into two groups as follows: Group A and Group B. Group A included patients with MRC Grade 4–5 and Group B included Grades 3–3.5. We tried to establish a correlation between CMAP and MRC scores by comparison of MRC grade patients for their pre CMAPs which revealed a statistically significant higher CMAPs between the groups. (Mann–Whitney U-test, P = 0.028). This indicates the association of higher pre-CMAPs with higher MRC grades. Conclusion: We conclude that higher the compound muscle action potential of donor nerves, better the recovery of elbow flexion in Oberlin transfer in brachial plexus injury.

Clinical results of Visian implantable collamer lens implantation according to various sizes and implantation angles

2021 ◽  
pp. 112067212110334
Author(s):  
Bu Ki Kim ◽  
Young Taek Chung
Keyword(s):  
Case Series ◽  
Clinical Results ◽  
Implantable Collamer Lens ◽  
Retrospective Case ◽  
Significant Difference ◽  
Lens Implantation ◽  
Group A ◽  
The Mean ◽  
Group B

Purpose: To investigate the clinical outcomes of Visian implantable collamer lens (ICL) implantation according to lens size and implantation angle. Setting: Onnuri Smile Eye Clinic, Seoul, Republic of Korea. Design: Retrospective case series. Methods: This study included 566 eyes of 283 patients treated with ICL implantation. Patients were divided into three groups: horizontally implanted same-sized ICL (group A), horizontally implanted different sized-ICL (group B: large ICL and small ICL) and same sized-ICL implanted with a different implantation angle (group C: horizontal and vertical). Results: At 12-month follow-up, the mean vault was 0.78 ± 17, 0.48 ± 0.13, 0.71 ± 0.18 and 0.44 ± 0.16 mm when large and small sized ICL was used in group B ( p < 0.001), and when ICL was horizontally and vertically implanted in group C ( p = 0.021), respectively. And the mean SE was −0.11 ± 0.30, −0.34 ± 0.42, −0.3 ± 0.56 and −0.64 ± 0.66 dioptres (D), when the large and the small sized ICL was used group B ( p = 0.039), and when the ICL was horizontally and vertically implanted in group C ( p = 0.036), respectively. No significant difference in UDVA, IOP and ECD between both eyes in groups B and C was observed. No statistical difference was found in the vault between both eyes for groups B and C. Conclusions: The vault was significantly higher and the SE was significantly more hyperopic when a larger-sized ICL was used or the ICL was horizontally implanted compared to when the ICL was vertically implanted.

scholarly journals COMPARATIVE EVALUATION OF THE EFFICACY OF 4% MANGOSTEEN GEL AND 1% CHLORHEXIDINE DIGLUCONATE GEL IN MANAGEMENT OF PATIENTS WITH CHRONIC GINGIVITIS: A RANDOMIZED CLINICAL TRIAL

2022 ◽  
Vol 12 (6) ◽  
pp. 6-11
Author(s):  
Vinayaka A.M. ◽  
Gayathri G.V. ◽  
Triveni M.G.
Keyword(s):  
Clinical Trial ◽  
Plaque Index ◽  
Age Group ◽  
Chlorhexidine Digluconate ◽  
Gingival Index ◽  
Significant Difference ◽  
Group A ◽  
The Mean ◽  
Group B

To clinically evaluate & compare the efficacy of 4% Mangosteen Gel and 1% chlorhexidine digluconate gel in managing patients with chronic gingivitis. Materials and Methods: A total of 50 patients with an age group of 20-45 years diagnosed with generalized plaque-induced gingivitis were selected for this clinical trial once attaining their informed consent. A thorough case history was chronicled comprising plaque index (P.I.), gingival index (G.I.) and Sulcus bleeding index (SBI) at baseline; then full-mouth scaling and polishing (SAP) was performed by a solitary attuned examiner. Patients were then randomly assigned into two groups using a computer-generated random numbering sequence system. Patients in group A received 4% Mangosteen Gel, and group B received 1% chlorhexidine digluconate gel for home application. The post-treatment follow-up examination for P.I., G.I. and SBI changes were assessed after 14 days and 21 days and compared with baseline data. Results: In both the groups, the mean plaque index, gingival index and sulcus bleeding index scores were significantly decreased after the 14th and 21st day compared to baseline scores. There was no significant difference between the groups, but only in group B, there was a substantial difference in SBI scores observed on day 21. Conclusion: 4% Mangosteen Gel and 1% chlorhexidine digluconate gel were clinically effective when used as an adjunct to SAP in managing patients with gingivitis. Hence, 4% Mangosteen Gel can be considered an alternative to 1% chlorhexidine digluconate gel without any side effects in managing generalized plaque-induced gingivitis.

PROSPECTIVE RANDOMIZED STUDY ON TWO DOSE FRACTIONATION REGIMENS OF HIGH DOSE RATE BRACHYTHERAPY FOR CARCINOMA CERVIX: COMPARISON OF CLINICAL RESPONSE AND COMPLICATIONS IN ORGANS AT RISK

2017 ◽  
Vol 2 (01) ◽  
Author(s):  
Saurabh Goswami ◽  
Piyush Kumar ◽  
Arvind Kumar Chauhan ◽  
Jitendra Nigam ◽  
D. P. Singh
Keyword(s):  
External Beam Radiotherapy ◽  
Equivalent Dose ◽  
Dose Fractionation ◽  
External Beam ◽  
Cancer Cervix ◽  
Significant Difference ◽  
Group A ◽  
The Mean ◽  
Group B

Introduction: Cancer Cervix is treated with a combination of external beam radiotherapy and intracavitary brachytherapy. With the recent American Brachytherapy Society consensus guidelines for locally advanced carcinoma of the cervix, at least Equivalent Dose 2 > 80 Gy for patients with complete response or partial response with residual disease less than 4cm is recommended. For non responders or those with tumors larger than 4cm at the time of brachytherapy, tumor dose escalation to an Equivalent Dose 2 of 85-90 Gy is recommended to point A. Present study was designed to see the feasibility of these guidelines in terms of local tumor control and toxicities to rectum and bladder in our group of patients. Material and Methods: Fifty patients of biopsy proven cancer cervix were enrolled. After pre-treatment evaluation all patients were delivered external beam radiotherapy 50 Gy in 25 fractions at 200 cGy/day with concurrent cisplatin on weekly basis. Patients were then randomized into three applications (Group A), four applications (Group B) of HDR Brachytherapy of 6 Gy each so that total treatment time does not exceed 8 weeks. BED and LQED were calculated and assessment of response and complications were assessed. Statistical analysis was done using Chi square test. Results: Mean age of the patients was 50 years. No significant hematological toxicities and radiation reactions were seen during external beam radiotherapy. The mean BED of group A for tumor, rectum and bladder was 137.3 Gy, 112.53 Gy and 103.23 Gy respectively and of group B was 155.3 Gy, 120.98 Gy and 111.95 Gy respectively. The mean EQD2 in group A at tumor, rectum and bladder was 74 Gy, 54.08 Gy and 61.94 Gy respectively and in group B was 82 Gy, 59.18 Gy, and 66.60 Gy respectively. There was no statistically significant difference in local response and early and late bladder reactions in both the groups. Conclusion: In a follow up of six months we did not find any significant difference in toxicities of rectum and bladder. Long term follow up is needed to see for late rectal and bladder toxicities.

scholarly journals Comparison of microdebrider-assisted endoscopic sinus surgery and conventional endoscopic sinus surgery for chronic rhinosinusitis with nasal polyps

2019 ◽  
Vol 9 (34) ◽  
pp. 91-95
Author(s):  
Ramiya Ramachandran Kaipuzha ◽  
Nirmal Coumare Venkataramanujam ◽  
Padmanabhan Karthikeyan ◽  
Davis Thomas Pulimoottil
Keyword(s):  
Endoscopic Sinus Surgery ◽  
Mucosal Injury ◽  
Sinus Surgery ◽  
Significant Difference ◽  
Group A ◽  
The Mean ◽  
Group B ◽  
Mean Time ◽  
Sinonasal Polyposis

AbstractOBJECTIVE. To study and compare the benefits of microdebrider-assisted endoscopic sinus surgery and conventional endoscopic sinus surgery in terms of subjective and objective improvement in symptoms of nasal polyposis.MATERIAL AND METHODS. This study involved 60 patients with bilateral sinonasal polyposis scheduled to undergo Endoscopic Sinus Surgery. The patients were randomized into two groups: Group A -Conventional endoscopic sinus surgery and Group B -Microdebrider-assisted endoscopic sinus surgery.RESULTS. There was a significant difference in the mean VAS at 3 months postoperatively in Group B, but no significant difference at 6 months postoperatively following either of the two methods. The mean time for surgery (p<0.01) and the mean intraoperative blood loss (p<0.01) were significantly lower in Group B.CONCLUSION. A well-trained surgeon with proper anatomical knowledge, good instruments, hypotensive anaesthesia, minimal mucosal injury and regular proper follow-up will have similar postoperative results with both methods.

scholarly journals Role of Zinc in Patients Presenting with Recurrent Hepatic Encephalopathy in Medical Unit of Tertiarycare Hospital Lahore

Esculapio ◽  
2020 ◽  
Vol 16 (03, july 2020-Septmber 2020) ◽  
Author(s):  
Asma Kamal ◽  
Asifa Kamal ◽  
Naeem Afzal ◽  
Shazia Siddique ◽  
Khadija Tahir
Keyword(s):  
Hepatic Encephalopathy ◽  
Zinc Supplementation ◽  
Mean Value ◽  
Significant Difference ◽  
Group A ◽  
The Mean ◽  
Group B ◽  
Improved Outcome

Abstract Objective: To observe the effects of zinc replacement on hepatic encephaopahty. To reducce hospital admission and heath burden by reducing episodes of recurrent hepatic encephalopathy. Methods: This study was carried out on 160 patients presenting with hepatic encephalopathy in medical ward of services hospital Lahore. The aim of the study was to assess the role of zinc in the improvement of encephalopathy. Results: The mean age of patients in group A was 55.78 and that in group B was 56.88years.There was significant difference in mean value of hepatic encephalopathy grade in both groups A and B after 3 months of follow up (p.value 0.027) indicating zinc is beneficial in treatment of hepatic encephalopathy. Conclusion: Our study showed that zinc replacement improved outcome in patients with Hepatic encephalopathy. Key words: Hepatic encephalopathy, zinc supplementation, chronic liver disease.

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