scholarly journals Electrophysiological patterns of sciatic nerve in patients with arthrosis deformans of the hip

2021 ◽  
Vol 28 (2) ◽  
pp. 47-54
Author(s):  
Vladimir V. Ostrovskij ◽  
Galina A. Korshunova ◽  
Sergey P. Bazhanov ◽  
Andrey A. Chekhonatskij ◽  
Vladimir S. Tolkachev

BACKGROUND: Neurological complications in sciatic nerve (SN) after a total hip replacement (THR) are observed in 0.93.2% of cases in patients with arthrosis deformans and age-related morphologic changes in SN. These cause the need for SN evaluation before THR. This research was aimed at the evaluation of the initial SN capacity with electrophysiological findings in patients with arthrosis deformans of the hip. MATERIALS AND METHODS: Electroneuromyography (ENMG) was used to evaluate fibular and tibial nerves M-responses as well as F-waves in 66 patients with dysplastic coxarthrosis and 12 patients with posttraumatic coxarthrosis. The findings were compared to those of the controls. RESULTS: Changes in ENMG findings for fibular nerve in 49 patients with dysplastic coxarthrosis were bilateral and showed significant difference only from the norm. In 19 of 66 cases (27.9%) low M-responses (р 0.02) were found in the side subject to THR. In 87.3% of cases, the signs of a decrease in the conductivity of proximal segments of the tibial nerve were revealed. In patients with posttraumatic coxarthrosis, the significant decrease in ENMG findings from both fibular and tibial nerves was observed in the affected side, they made up just 42-50% of those in the opposite side. Asymptomatic progress of denervation damage in hip and tibia muscles sometimes required needle EMG to fund the signs of motor innervation disorder. A-waves revealed in 65% of patients suggested local damage to one or both portions of SN. CONCLUSION: ENMG findings in patients with dysplastic arthrosis of the hip enabled revealing of the signs of neuropathy before surgeries and decreasing the risk of neurologic post-surgery complications.

2021 ◽  
Vol 11 (1) ◽  
pp. 129-134
Author(s):  
Tiecheng Wang ◽  
Shaochong Bu ◽  
Fang Tian ◽  
Hong Zhang

The present study sought to investigate and compare the accuracy of two third-generation intraocular lens calculation formulas contrasted against three new-generation intraocular lens calculation formulas regarding their ability to predict postoperative refraction following cataract surgery. A retrospective case study following 172 patients (172 eyes) exhibiting age-related cataracts in their eyes who were subject to phacoemulsification between September 2017 and September 2018 at the Department of Cataracts, Tianjin Medical University Eye Hospital, was carried out. Based upon ocular axial length, the sampled patients were grouped into a short axis group (ocular axial length ≤ 22 mm; 17 cases; 17 eyes), a normal axis group (22 mm < ocular axial length ≥ 24.5 mm; 132 cases; 132 patients), and a long axis group (ocular axial length > 24.5 mm; 23 cases; 23 eyes); mean absolute prediction error (MAE) postoperative refraction in each group was determined using five formulas, and the percentage of eyes displaying postoperative myopic shift symptoms, postoperative hyperopic shift symptoms, alongside the percentage of eyes displaying postoperative refractive shift symptoms in the range of (−0.25 to 0.25 D, −0.50 to 0.50 D, −1.00 to 1.00 D), were all calculated following the procedures of the five selected formulas. The MAE of the 172 patient cases was compared within the five selected formulas, and SRK/T possessed the highest prediction accuracy, exhibiting a significant difference from the other four formulas (P < 0.05), with accuracy levels subsequently followed by the Holladay 1 and Barrett Universal II formulas-however, the two formulas lacked a significant difference between them (P > 0.05). In addition, the MAE of the normal axial group was compared and analyzed within the five formulas, with analysis revealing that the SRK/T, Holladay 1, and Barrett Universal II formulas exhibited strong prediction accuracy, with no significant difference present among these three formulas (P > 0.05), and also revealing a significantly difference between the aforementioned formulas and remaining two formulas (P < 0.05). For further analysis, the MAE of the short axis group was compared, and the SRK/T and Haigis (Holladay 1, and Barrett Universal II) demonstrated stronger prediction accuracy when compared to the Olsen formula (P < 0.05). Finally, the MAE of the long axis group was compared, and it was found that the SRK/T and Barrett Universal II formulas exhibits the best prediction accuracy, followed by the Haigis and Holladay 1 formulas, with no significant difference (P > 0.05) between the former two formulas or the latter two. The majority of patients exhibited hyperopic shift post-surgery. Of the five formulas studied, the SRK/T and Barrett Universal II formulas possessed strong accuracy capable of predicting postoperative refraction. However, more long-term observation, including large patient samples, is necessary in order to corroborate our result.


2014 ◽  
Vol 31 (04) ◽  
pp. 199-201
Author(s):  
M. Sinha ◽  
R. Gupta ◽  
A. Aggarwal ◽  
D. Sahni ◽  
H. Sinha

Abstract Background: We studied the bifurcation of sciatic nerve into two components which change their position throughout the early period of life. We proposed dimensions that would help reducing failure rates of anesthesia in popliteal fossa region and screening of malignancy related to sciatic nerve. Methods: The back of thigh and popliteal fossa of both sides of 50 fetuses (24 male and 26 female) were dissected. Skin over the gluteal region was dissected upto back of the knee. Sciatic nerve was traced from gluteal region to back of the thigh. The level where common fibular nerve and tibial nerve diverge from sciatic nerve and the diameter of sciatic nerve at various levels were evaluated. Results: In 97.7% (41/42) specimens,the bifurcation was above (5.1-20.86 mm) and in 2.3% (1/42) specimens, it was below (2.37 mm) the lateral condyle of femur. In 66% cases, sciatic nerve splits into two at or within 11 mm proximal to lateral condyle, while in 75% cases within 13mm, and in 100% cases within 21mm proximal to lateral condyle. Conclusion: This study provides quantitative data about the sciatic nerve in the gluteal region and back of the thigh. This data has a significant implication in diagnostic and anesthetic practice.


2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Gregor S. Reiter ◽  
Luca Schwarzenbacher ◽  
Daniel Schartmüller ◽  
Veronika Röggla ◽  
Christina Leydolt ◽  
...  

AbstractThe aim of this study is to investigate the impact of age-related lens opacities and advanced cataract, quantified by LOCS III grading, on quantitative autofluorescence (qAF) measurements in patients before and after cataract surgery. Images from a randomized controlled trial evaluating the impact of femtosecond-laser assisted cataract surgery (FLACS) on retinal thickness were analyzed post-hoc. One-hundred and twenty eyes from 60 consecutive patients with age-related cataract were included and assessed with qAF and optical coherence tomography (OCT) before, 1, 3 and 6 weeks after cataract surgery (randomized 1:1 to FLACS or phacoemulsification). LOCS III grading was performed before surgery. Pre- to post-surgical qAF values, as well as the impact of LOCS III gradings, surgery technique, gender, axial length and age on post-surgery qAF values was investigated using generalized linear mixed models. For this analysis, 106 eyes from 53 patients were usable. No difference in qAF was found between FLACS and phacoemulsification (p > 0.05) and results were pooled for the total cohort. Mean pre-surgical qAF was 89.45 ± 44.9 qAF units, with a significant mean increase of 178.4–191.6% after surgery (p < 0.001). No significant difference was found between the three follow-up visits after surgery (p > 0.05). Higher LOCS III cortical opacity quantifications were associated with a significantly greater increase in qAF after surgery (estimate: 98.56, p = 0.006) and nuclear opacities showed a trend toward an increased change (estimate: 48.8, p = 0.095). Considerable interactions were identified between baseline qAF and cortical opacities, nuclear opacities and posterior subcapsular opacities, as well as nuclear opacities and cortical opacities (p = 0.012, p = 0.064 and p = 0.069, respectively). Quantitative autofluorescence signals are significantly reconstituted after cataract surgery and LOCS III gradings are well associated with post-surgical qAF values. Careful consideration of age-related lens opacities is vital for the correct interpretation of qAF, especially in retinal diseases affecting the elderly.ClinicalTrials.gov Identifier: NCT03465124.


2009 ◽  
Vol 65 (suppl_6) ◽  
pp. ons218-ons225 ◽  
Author(s):  
Leandro Pretto Flores

Abstract Objective: The results of surgical repair of the fibular division of the sciatic nerve have been considered unsatisfactory, especially if grafts are necessary to reconstruct the nerve. To consider the clinical application of the concept of distal nerve transfer for the treatment of high sciatic nerve injuries, this study aimed to determine detailed anatomic data about the possible donor branches from the tibial nerve that are available for reinnervation of the deep fibular nerve at the level of the popliteal fossa. Methods: An anatomic study was performed that included the dissection of the popliteal fossa in 12 lower limbs of 6 formalin-fixed adult cadavers. It focused on the detailed anatomy of the tibial nerve and its branches at the level of the proximal leg as well as the anatomy of the common fibular nerve and its largest divisions at the level of the neck of the fibula, i.e., the deep and superficial fibular nerves. Results: The branches of the tibial nerve destined to the lateral and medial head of the gastrocnemius had a mean length of 43 mm and 35 mm, respectively. The branch to the posterior soleus muscle had a mean length of 65 mm. Intraneural dissection of the common fibular nerve, isolating its deep and superficial fibular divisions, was possible to a proximal mean distance of 71 mm. A tensionless direct suture to the deep fibular nerve was made possible by using the nerve to the lateral head of the gastrocnemius and the nerve to the posterior soleus muscle in all specimens. Direct suture of the nerve to the medial head of the gastrocnemius was possible in all cases except 1. Conclusion: The nerve to the lateral and medial heads of the gastrocnemius and the nerve to the posterior soleus muscle can be used as donors to restore function of the deep fibular nerve in cases of high sciatic nerve injury. However, proximal intraneural dissection of the deep fibular division of the common fibular nerve must also be performed. We recommend that the nerve to the posterior soleus muscle should be the first choice for a donor in the proposed transfer.


2021 ◽  
Author(s):  
Tata Touré ◽  
Babou Ba ◽  
Adoul Kader Moussa ◽  
Abdoulaye Kanté ◽  
Falé Traoré ◽  
...  

Abstract Background: The sciatic nerve is the largest nerve in body. It is the only terminal branch of the sacral plexus. It emerges under the piriformis muscle, descends into the gluteal region, then into the posterior compartment of the thigh. It ends in the popliteal fossa by dividing into the tibial and common peroneal nerve. It is the most frequently injured nerve. The aim of this work was to study the mode of termination of the sciatic nerve by cadaveric dissection in a Malian population.Materials and methods: This was a cross-sectional study, carried out at the anatomy laboratory of the Faculty of Medicine and Odontostomatology of Bamako, ranging from December 2019 to April 2021. The sciatic nerve was dissected 74 times in 37 cadaveric subjects (29 men and 8 women).Results: The classic termination mode (the sciatic nerve terminates giving the tibial nerve and common peroneal nerve) was most frequently encountered with a prevalence of 82.43%. Anatomical variations were noted in 17.57%. Among these variations, trifurcation (termination in three branches) of the sciatic nerve was observed in 16.22%. Hexafurcation (six-branch termination) of the sciatic nerve was observed in 1.35%. The termination mode showed a significant difference being more frequently bilateral than unilateral (P˂0.05)Conclusion: Anatomical variations in the mode of termination of the sciatic nerve are not uncommon. The most common of these variations is the trifurcation in which the sciatic nerve ends up giving the tibial nerve, the common peroneal nerve and a third branch which is variable. Knowledge of these variations is important for surgeons when treating popliteal artery aneurysm, popliteal vessel fistula and popliteal fossa cysts.


Author(s):  
A. E. Chernikova ◽  
Yu. P. Potekhina

Introduction. An osteopathic examination determines the rate, the amplitude and the strength of the main rhythms (cardiac, respiratory and cranial). However, there are relatively few studies in the available literature dedicated to the influence of osteopathic correction (OC) on the characteristics of these rhythms.Goal of research — to study the influence of OC on the rate characteristics of various rhythms of the human body.Materials and methods. 88 adult osteopathic patients aged from 18 to 81 years were examined, among them 30 men and 58 women. All patients received general osteopathic examination. The rate of the cranial rhythm (RCR), respiratory rate (RR) heart rate (HR), the mobility of the nervous processes (MNP) and the connective tissue mobility (CTM) were assessed before and after the OC session.Results. Since age varied greatly in the examined group, a correlation analysis of age-related changes of the assessed rhythms was carried out. Only the CTM correlated with age (r=–0,28; p<0,05) in a statistically significant way. The rank dispersion analysis of Kruskal–Wallis also showed statistically significant difference in this indicator in different age groups (p=0,043). With the increase of years, the CTM decreases gradually. After the OC, the CTM, increased in a statistically significant way (p<0,0001). The RCR varied from 5 to 12 cycles/min in the examined group, which corresponded to the norm. After the OC, the RCR has increased in a statistically significant way (p<0,0001), the MNP has also increased (p<0,0001). The initial heart rate in the subjects varied from 56 to 94 beats/min, and in 15 % it exceeded the norm. After the OC the heart rate corresponded to the norm in all patients. The heart rate and the respiratory rate significantly decreased after the OC (р<0,0001).Conclusion. The described biorhythm changes after the OC session may be indicative of the improvement of the nervous regulation, of the normalization of the autonomic balance, of the improvement of the biomechanical properties of body tissues and of the increase of their mobility. The assessed parameters can be measured quickly without any additional equipment and can be used in order to study the results of the OC.


2002 ◽  
Vol 87 (4) ◽  
pp. 1763-1771 ◽  
Author(s):  
Antoni Valero-Cabré ◽  
Xavier Navarro

We investigated the changes induced in crossed extensor reflex responses after peripheral nerve injury and repair in the rat. Adults rats were submitted to non repaired sciatic nerve crush (CRH, n = 9), section repaired by either aligned epineurial suture (CS, n = 11) or silicone tube (SIL4, n = 13), and 8 mm resection repaired by tubulization (SIL8, n = 12). To assess reinnervation, the sciatic nerve was stimulated proximal to the injury site, and the evoked compound muscle action potential (M and H waves) from tibialis anterior and plantar muscles and nerve action potential (CNAP) from the tibial nerve and the 4th digital nerve were recorded at monthly intervals for 3 mo postoperation. Nociceptive reinnervation to the hindpaw was also assessed by plantar algesimetry. Crossed extensor reflexes were evoked by stimulation of the tibial nerve at the ankle and recorded from the contralateral tibialis anterior muscle. Reinnervation of the hindpaw increased progressively with time during the 3 mo after lesion. The degree of muscle and sensory target reinnervation was dependent on the severity of the injury and the nerve gap created. The crossed extensor reflex consisted of three bursts of activity (C1, C2, and C3) of gradually longer latency, lower amplitude, and higher threshold in control rats. During follow-up after sciatic nerve injury, all animals in the operated groups showed recovery of components C1 and C2 and of the reflex H wave, whereas component C3 was detected in a significantly lower proportion of animals in groups with tube repair. The maximal amplitude of components C1 and C2 recovered to values higher than preoperative values, reaching final levels between 150 and 245% at the end of the follow-up in groups CRH, CS, and SIL4. When reflex amplitude was normalized by the CNAP amplitude of the regenerated tibial nerve, components C1 (300–400%) and C2 (150–350%) showed highly increased responses, while C3 was similar to baseline levels. In conclusion, reflexes mediated by myelinated sensory afferents showed, after nerve injuries, a higher degree of facilitation than those mediated by unmyelinated fibers. These changes tended to decline toward baseline values with progressive reinnervation but still remained significant 3 mo after injury.


2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 923.3-923
Author(s):  
S. Boussaid ◽  
M. Mrabet ◽  
S. Jemmali ◽  
H. Sahli ◽  
H. Ajlani ◽  
...  

Background:Tuberculosis (TB) is no longer a disease limited to developing nations and is still a major cause of significant morbidity and mortality worldwide. It can affect the different parts of the spine.Objectives:The aim of this study was to determine the preferred spinal location of TB.Methods:We conduct a retrospective and descriptive study in a single rheumatology department. Data were collected from observations of patients hospitalized in the past 20 years (2000-2020) who have been diagnosed with tuberculous spondylodiscitis (TS).Results:Fifty-two patients were included (37F/15M). Their mean age was 55.21 years ± 17.79 [19-91]. TS was more frequently unifocal (75%) than multifocal (25%). Lumbar spine involvement was the most common (57.7%) and more frequent in women (63.3%) but with no statistically significant difference (p = 0.2). Other localizations were described such as: dorso-lumbar (21.2%), dorsal (15.4%), lumbosacral (3.8%) and cervical (1.9%). Lumbar pain was present in 34 patients (65.4%) and 29 patients (55.8%) suffered from segmental lumbar stiffness. Imaging was contributive by showing the vertebral location using standard X-rays, computed tomography and magnetic resonance imaging. Disc pinch, erosion of vertebral plateaus and vertebral collapse were the major signs (82.7%, 65.4% and 67.3%, respectively).Conclusion:TS is a rare but serious clinical condition which may lead to severe deformity and early or late neurological complications. Spinal involvement is often unifocal and mostly diagnosed with lumbar pain or stiffness. Multifocal forms, touching several parts of the spine, however remain rare. Our findings remain consistent with those of the literature.Disclosure of Interests:None declared


Cancers ◽  
2021 ◽  
Vol 13 (6) ◽  
pp. 1417
Author(s):  
Binafsha M. Syed ◽  
Andrew R. Green ◽  
Emad A. Rakha ◽  
David A.L. Morgan ◽  
Ian O. Ellis ◽  
...  

As age advances, breast cancer (BC) tends to change its biological characteristics. This study aimed to explore the natural progression of such changes. The study included 2383 women with clinically T0-2N0-1M0 BC, managed by primary surgery and optimal adjuvant therapy in a dedicated BC facility. Tissue micro-arrays were constructed from their surgical specimens and indirect immunohistochemistry was used for analysis of a large panel (n = 16) of relevant biomarkers. There were significant changes in the pattern of expression of biomarkers related to luminal (oestrogen receptor (ER), progesterone receptors (PgR), human epidermal growth factor receptor (HER-2), E-cadherin, MUC1, bcl2 CK7/8, CK18 and bcl2) and basal (CK5/6, CK14, p53 and Ki67) phenotypes, lymph node stage, histological grade and pathological size when decade-wise comparison was made (p < 0.05). The ages of 40 years and 70 years appeared to be the milestones marking a change of the pattern. There were significantly higher metastasis free and breast cancer specific survival rates among older women with ER positive tumours while there was no significant difference in the ER negative group according to age. Biological characteristics of BC show a pattern of change with advancing age, where 40 years and 70 years appear as important milestones. The pattern suggests <40 years as the phase with aggressive phenotypes, >70 years as the less aggressive phase and 40–70 years being the transitional phase.


2021 ◽  
pp. 1-10
Author(s):  
Christiane Völter ◽  
Lisa Götze ◽  
Imme Haubitz ◽  
Janine Müther ◽  
Stefan Dazert ◽  
...  

<b><i>Introduction:</i></b> Age-related hearing loss affects about one-third of the population worldwide. Studies suggest that hearing loss may be linked to cognitive decline and auditory rehabilitation may improve cognitive functions. So far, the data are limited, and the underlying mechanisms are not fully understood. The study aimed to analyze the impact of cochlear implantation on cognition in a large homogeneous population of hearing-impaired adults using a comprehensive non-auditory cognitive assessment with regard to normal-hearing (NH) subjects. <b><i>Material and Methods:</i></b> Seventy-one cochlear implant (CI) candidates with a postlingual, bilateral severe or profound hearing loss aged 66.3 years (standard deviation [SD] 9.2) and 105 NH subjects aged 65.96 years (SD 9.4) were enrolled. The computer-based neurocognitive tool applied included 11 subtests covering attention (M3), short- and long-term memory (recall and delayed recall), working memory (0- and 2-back, Operation Span [OSPAN] task), processing speed (Trail Making Test [TMT] A), mental flexibility (TMT B), inhibition (cFlanker and iFlanker), and verbal fluency. CI patients underwent a neurocognitive testing preoperatively as well as 12 months postoperatively. Impact of hearing status, age, gender, and education on cognitive subdomains was studied. Additionally, after controlling for education and age, cognitive performance of CI subjects (<i>n</i> = 41) was compared to that of NH (<i>n</i> = 34). <b><i>Results:</i></b> CI users achieved significantly better neurocognitive scores 12 months after cochlear implantation than before in most subtests (M3, [delayed] recall, 2-back, OSPAN, iFlanker, and verbal fluency; all <i>p</i> &#x3c; 0.05) except for the TMT A and B. A significant correlation could be found between the postoperative improvement in speech perception and in the attentional task M3 (<i>p</i> = 0.01). Hearing status (<i>p</i> = 0.0006) had the strongest effect on attention, whereas education had a high impact on recall (<i>p</i> = 0.002), OSPAN (<i>p</i> = 0.0004), and TMT A (<i>p</i> = 0.005) and B (<i>p</i> = 0.003). Inhibition was mainly age-dependent with better results in younger subjects (<i>p</i> = 0.016). Verbal fluency was predicted by gender as females outperformed men (<i>p</i> = 0.009). Even after controlling for age and education NH subjects showed a significantly better performance than CI candidates in the recall (<i>p</i> = 0.03) and delayed recall (<i>p</i> = 0.01) tasks. Postoperatively, there was no significant difference between the 2 groups anymore. <b><i>Conclusion:</i></b> Impact of cochlear implantation on neurocognitive functions differs according to the cognitive subdomains. Postoperatively, CI recipients performed as good as age- and education-matched NH subjects.


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