A patient planned for RS6 resection. We first cut A6, then inflated the lungs. Without waiting for deflation, we cut B6, ligating the proximal stump ligating but leaving the distal stump open. The complete intersegmental plane appeared.

ASVIDE ◽  
2021 ◽  
Vol 8 ◽  
pp. 073-073
Author(s):  
Changchun Wang ◽  
Lei Cai ◽  
Xiaofang Xu ◽  
Jinxiao Liang ◽  
Weimin Mao ◽  
...  
Keyword(s):  
Distal Stump ◽  
Proximal Stump ◽  
Intersegmental Plane

DOZ047.124: Thoracoscopic anatomy of long-gap esophageal atresia. What can we predict?

2019 ◽  
Vol 32 (Supplement_1) ◽  
Author(s):  
M Rasiewicz ◽  
K Świątek ◽  
S Gerus ◽  
D Patkowski
Keyword(s):  
Esophageal Atresia ◽  
Gold Standard ◽  
Distal Stump ◽  
Thoracic Vertebrae ◽  
Long Gap ◽  
Thoracoscopic Repair ◽  
Proximal Stump ◽  
Long Gap Esophageal Atresia ◽  
Vertebral Bodies ◽  
Traction Group

Abstract Since the very beginning in 1999, thoracoscopic repair of esophageal atresia has become a gold standard in many pediatric surgery centers worldwide. Despite the advances in surgical technique, treatment of long-gap esophageal atresia still remains a challenge. The aim of this study is to assess whether the localization of esophageal stumps can predict number of stages needed to perform anastomosis. We analyzed video records of 21 patients who underwent staged thoracoscopic repair of long-gap esophageal atresia using internal traction technique. All procedures were performed by the same surgeon. We divided patients into two groups: first requiring single internal traction procedure, second who underwent multiple procedures. We assessed esophageal stump position in relation to thoracic vertebrae. The distance between stumps was measured in vertebral bodies. Mean distance between esophageal ends was 5.8 in single traction group. The distance between the stumps was significantly greater in multiple procedures group: 7.33 (P = 0.003). Patients who required multiple procedures had significantly lower localization of distal stump. Localization of proximal stump did not affect the possibility for anastomosis after single traction. Distance between both ends after internal traction was also significantly longer in multiple procedures group. Patients with lower localization of distal esophageal stump assessed during primary thoracoscopy are at higher risk for requiring multiple surgical procedures.

Neuromuscular regeneration by buccal motoneuron B15 after peripheral nerve crush in Aplysia californica

1994 ◽  
Vol 72 (4) ◽  
pp. 1897-1910 ◽  
Author(s):  
T. L. Ross ◽  
C. K. Govind ◽  
M. D. Kirk
Keyword(s):  
Cross Sections ◽  
Time Course ◽  
Light And Electron Microscopy ◽  
Distal Stump ◽  
Nerve Crush ◽  
Neuromuscular Synapses ◽  
Electrophysiological Recordings ◽  
Cellular Debris ◽  
Proximal Stump ◽  
Ultrathin Sections

1. We studied regeneration of neuromuscular connections by identified buccal motoneuron B15 after axotomy produced by crushing nerve 4; the intact contralateral nerve 4 served as control. Electrophysiological recordings, intracellular dye injections, and light and electron microscopy were used to characterize the nature and time course of neuromuscular reinnervation as well as the fate of the isolated distal stump of the motor axon. 2. Axonal outgrowth or sprouting in the form of numerous “regenerites” occurred from the proximal stump of the transected B15 axon, and these regenerites projected through the crush site along the length of the nerve to innervate target muscles at the periphery. 3. Reinnervation of one of the target muscles, the accessory radula closer (I5), was first detected 3 wk after nerve crush. Neuromuscular excitatory postsynaptic potentials measured in individual I5 muscle fibers were initially small and approached control amplitudes by 8 wk postlesion. Newly regenerated neuromuscular synapses displayed facilitation and depression to repeated B15 stimulation with properties similar to those of control synapses, even at early times postlesion. 4. Reinnervation of other buccal muscles by B15, such as I4, appeared slightly delayed relative to that observed for I5. No evidence of abnormal or enlarged fields of innervation were observed, and as in control preparations, regenerated neuromuscular connections were strictly limited to muscles ipsilateral to the B15 cell body. 5. Physiological evidence suggested that the distal axon stumps of B15, although isolated from their cell bodies, survive for several weeks after axotomy. In addition, several large axon profiles indicative of motor axons were seen in cross-sections of nerve 4 taken close to the muscle and distal to the crush site, indicating survival of distal axon stumps. 6. When B15 was selectively stimulated, the newly formed regenerites failed to fire the distal axon stump of B15, demonstrating that the regenerites do not reinnervate the distal stump. 7. Degeneration of axons in nerve 4 distal to the crush site was observed in cross-sections of the nerve at 8 wk postlesion; using ultrathin sections we found cellular debris in individual axon profiles as well as large acellular masses within nerve 4, the latter likely representing the concretion of many axons. Additional evidence for such degenerative changes appeared in the form of autofluorescing spherical bodies or “spheroids” both in individual axons and the nerve distal to the crush site.(ABSTRACT TRUNCATED AT 400 WORDS)

Evidence for end-to-side sensory nerve regeneration in a human

1998 ◽  
Vol 89 (6) ◽  
pp. 1055-1057 ◽  
Author(s):  
Allan J. Belzberg ◽  
James N. Campbell
Keyword(s):  
Sensory Nerve ◽  
Neuronal Cell ◽  
Distal Segment ◽  
Distal Portion ◽  
Distal Stump ◽  
Content Type ◽  
Wrong Side ◽  
Nerve Sprouting ◽  
Neuronal Cell Bodies ◽  
Proximal Stump

✓ Division of a peripheral nerve produces an axotomy leading to neurite outgrowth from the proximal stump and wallerian degeneration in the distal stump. Because there is no longer a connection between the distal stump and neuronal cell bodies in the anterior spinal cord or dorsal root ganglion, it is assumed that no neurites should exist in the distal stump. The authors present the case of a patient who unexpectedly had a neuroma on the proximal end of the distal segment of a previously severed nerve. The lateral antebrachial cutaneous nerve had been surgically severed. Innervated by the radial nerve, a neuroma subsequently formed in the distal segment. Our hypothesis is that the proximal end of the distal portion of a severed nerve may be innervated by collateral sprouts of axons that branch at points of more distal plexus formation. This invokes a similar pathophysiology to the controversial notion of end-to-side nerve sprouting. Neuromas that develop on the “wrong side” of a nerve become an additional potential source of pain in patients with injured nerves.

SIMULTANEOUS GRADUAL LENGTHENING OF PROXIMAL AND DISTAL NERVE STUMPS FOR REPAIR OF CHRONIC PERIPHERAL NERVE DEFECT IN RATS

Hand Surgery ◽  
2012 ◽  
Vol 17 (01) ◽  
pp. 1-11 ◽  
Author(s):  
Yoshiko Nakajima ◽  
Yasumasa Nishiura ◽  
Yuki Hara ◽  
Sharula ◽  
Naoyuki Ochiai
Keyword(s):  
Nerve Regeneration ◽  
Schwann Cells ◽  
Immunohistochemical Analysis ◽  
Distal Stump ◽  
Nerve Stump ◽  
Chronic Injury ◽  
Segmental Nerve ◽  
Proximal Stump ◽  
Distal Nerve ◽  
End To End

We investigated nerve regeneration of rat sciatic nerves after chronic injury of 15 mm-defect by the gradual lengthening of proximal and distal nerve stumps. Thirty days after the primal injury, both stumps were grasped and lengthened at a rate of 1 mm per day using external nerve-lengthening devices for 15 days. Then end-to-end neurorrhaphy was performed. After the lengthening, both stumps were evaluated by immunohistochemical analysis. Nerve regeneration was evaluated by electrophysiological and histological studies at 12 weeks after the repair. In the lengthened proximal stump, Schwann cells and axons existed along the whole nerve stump. In the lengthened distal stump, Schwann cells exist along the overall length. The whole nerve trunk was lengthened. The nerve regeneration was comparable with the delayed end-to-end suture without nerve defect. We showed the feasibility of direct gradual lengthening of proximal and distal nerve stumps for the treatment of chronic segmental nerve defect.

PROTEIN-BOUND PHOSPHORUS COMPOUNDS IN THE PROXIMAL STUMP OF PERIPHERAL NERVE AFTER NERVE SECTION OR AFTER NERVE CRUSH

1952 ◽  
Vol 30 (6) ◽  
pp. 457-462
Author(s):  
J. E. Logan
Keyword(s):  
Nucleic Acid ◽  
Nucleic Acids ◽  
Cellular Proliferation ◽  
Phosphorus Compounds ◽  
Distal Stump ◽  
Total Nucleic Acid ◽  
Nerve Section ◽  
Nerve Crush ◽  
Proximal Stump ◽  
Soluble P

The concentration of acid-soluble P, lipid P, protein-bound P, total nucleic acid, DNA (desoxypentosenucleic acid), PNA (pentosenucleic acid), PP (“phosphoprotein”), and “inositide P” was determined in the proximal stump of the sciatic nerve of the cat at 16, 32, and 96 days after nerve section and at 2, 4, 8, 16, 32, and 96 days after nerve crush. There was an increase in the concentration of acid-soluble P at 16 days after nerve section and a decrease in the concentration of PP at 96 days after either nerve section or nerve crush. The lipid P decreased slightly at 96 days after nerve section and the “inositide P” increased somewhat at 96 days after nerve crush, but both of these fractions remained normal at the other time intervals. The greatest changes, however, were observed in the concentration of the nucleic acids. The concentration of total nucleic acid, DNA, and PNA increased after nerve section, the DNA concentration reaching a maximum at 96 days and the PNA at 16 days. The increase in the concentration of nucleic acid after nerve crush was smaller than that observed after nerve section, the greatest difference being noted at 96 days. These increases in the concentration of nucleic acids, which are not so marked as those in the distal stump, suggest that some cellular proliferation occurs, not only in the distal stump, but also in the proximal stump following either nerve section or nerve crush.

Funicular Orientation by Electrical Stimulation and Internal Neurolysis in Peripheral Nerve Suture

HAND ◽  
1980 ◽  
Vol os-12 (1) ◽  
pp. 65-74 ◽  
Author(s):  
Yukio Nakatsuchi ◽  
Takeshi Matsui ◽  
Yasunobu Handa
Keyword(s):  
Electrical Stimulation ◽  
Peripheral Nerve ◽  
Nerve Graft ◽  
Distal Stump ◽  
Nerve Suture ◽  
Internal Neurolysis ◽  
Proximal Stump ◽  
Electrophysiological Method ◽  
Sensory Functions

Eleven peripheral nerve lacerations around the wrists of ten patients were treated with funicular suture or nerve graft. In three freshly lacerated nerves funicular orientation could be made only by electrical stimulation to both cut ends. The electrophysiological method was also utilised to obtain funicular orientation of a proximal stump in eight old nerve lacerations. However, funicular orientation of the distal stump of old lacerations, which was not responsive to electrical stimulation, was performed anatomically by internal neurolysis from a terminal branching area up to a distal stump. By six months after the operation, motor and sensory functions of the patients with funicular suture had recovered to an excellent degree with rapid reinnervation.

Use of a Multiple Lumen Cuff for Nerve Regeneration

1993 ◽  
Vol 331 ◽  
Author(s):  
Raymond Greer ◽  
John Daniel ◽  
Etsuro Uemura ◽  
Raymond Kudej ◽  
Yueh-Sheng Chen ◽  
...  
Keyword(s):  
Axonal Regeneration ◽  
Distal Stump ◽  
Sprague Dawley ◽  
Nerve Cuff ◽  
Sprague Dawley Rats ◽  
Distal Side ◽  
Proximal Stump ◽  
The Individual ◽  
And Control ◽  
Post Implantation

AbstractInitial studies using the rat sciatic nerve demonstrated the ability to adapt a multiple lumen cuff face to a nerve stump repair site. The neurons in the proximal stump grew through the individual conduits of the silicone rubber cuff, crossed a 5 mm gap, and continued into the distal stump. The effect of the cuff design on axonal regeneration was studied by comparing macroscopic and microstructural results for experimental groups of Sprague-Dawley rats with controls at 8, 12, 16, and 24 weeks post-implantation. The several individual nerve bundles which formed within the cuff lumens during these periods maintained their alignment on the distal side of the gap. The use of the multiple lumen system provided suitable scaffolding support and control of orientation and direction for fibers and established a sized, controlled environment for regeneration within each of the separate nerve cuff compartments.

Repair of Chronic Rupture of the Achilles Tendon using 2 Intratendinous Flaps from the Proximal Gastrocnemius-Soleus Complex

2009 ◽  
Vol 37 (8) ◽  
pp. 1570-1577 ◽  
Author(s):  
Mohamed Taha El Shewy ◽  
Hassan Magdy El Barbary ◽  
Hisham Abdel-Ghani
Keyword(s):  
Achilles Tendon ◽  
Case Series ◽  
Distal Stump ◽  
Level Of Evidence ◽  
Chronic Rupture ◽  
Level Of Activity ◽  
Proximal Stump ◽  
The Mean ◽  
Distally Based

Background Chronic rupture of the Achilles tendon is a surgical challenge, owing to the presence of a gap between the retracted ends, which renders direct repair almost impossible. Purpose In this study, 2 intratendinous distally based flaps fashioned from the proximal gastrocnemius-soleus complex are used to bridge the gap between the retracted edges of the ruptured Achilles tendon. The flaps are placed in the same line of pull of the ruptured tendon, in an effort to make the graft mimic the original biomechanics as much as possible. Study Design Case series; Level of evidence, 4. Methods Eleven patients (9 male and 2 female) with neglected ruptures of the Achilles tendon with retracted ends were included in this study. Two flaps fashioned from the proximal gastrocnemius-soleus complex were rotated over themselves, passed through the proximal stump, and then securely inserted into a previously prepared bed in the distal stump. Results The patients were followed up for a period of 6 to 9 years. At the final follow-up, all patients were able to return to their preinjury level of activity within a period of 6 to 9 months. The mean preoperative American Orthopedic Foot and Ankle Society score was 42.27, whereas it was 98.91 at the final follow-up, with a range of 88 (in 1 patient) to 100 points (in 10 patients). All 11 patients showed statistically significant improvement according to the Holz rating system. Conclusion This technique allows for a bridging of the defect present in chronic ruptures of Achilles tendons, with a minimum of complications and a good final outcome.

IS THE REGENERATIVE ABILITY OF A SEVERED MOTOR NERVE IN A RAT MODEL MAINTAINED OVER TIME?

Hand Surgery ◽  
1998 ◽  
Vol 03 (02) ◽  
pp. 185-190 ◽  
Author(s):  
Masato Morohashi ◽  
Yutaka Maki ◽  
Takae Yoshizu ◽  
Naoto Tsubokawa
Keyword(s):  
Rat Model ◽  
Motor Nerve ◽  
Distal Stump ◽  
Anterior Tibial Muscle ◽  
Nerve Suture ◽  
Anterior Tibial ◽  
Proximal Stump ◽  
Wet Weight ◽  
Regenerative Ability ◽  
Rat Nerve

We observed the change in the regenerative ability of a severed motor nerve at different time lapses using the cross nerve suture method in a rat model. A left tibial rat nerve was severed 15 mm distal to the divergent point of the sciatic nerve, and its proximal stump was covered with a silicon cap to prevent reinnervation. Zero, 1, 3, and 6 months after the initial operation, the proximal stump of the tibial nerve was anastomosed with the freshly severed distal stump of the peroneal nerve by a silicone cuff technique. Three and 6 months after the second operation, the tetanic isometric contraction force, wet weight, and minor axis of transversely sectioned reinnervated anterior tibial muscle fiber were measured. The regenerative ability of the severed motor nerve was maintained fairly well even 6 months after severance.

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