Thermographic imaging of cutaneous sensory segment in patients with peripheral nerve injury

1985 ◽  
Vol 62 (5) ◽  
pp. 716-720 ◽  
Author(s):  
Sumio Uematsu
Keyword(s):  
Peripheral Nerve ◽  
Skin Temperature ◽  
Nerve Injury ◽  
Peripheral Nerve Injury ◽  
Cost Effective ◽  
Subjective Assessment ◽  
The Body ◽  
Content Type ◽  
Thermographic Imaging ◽  
Fine Print

✓ Sensory examination based on the patient's subjective assessment of symptoms may raise difficult questions about whether the individual's expressed complaint is based on organic nerve damage, psychogenic factors, or even malingering. A prototype computerized telethermograph has allowed clinical quantification of peripheral nerve injury. The system makes possible mapping and imaging of the damaged area, as well as skin temperature measurements. In normal persons, the skin temperature difference between sides of the body was only 0.24° ± 0.073°C. In contrast, in patients with peripheral nerve injury, the temperature of the skin innervated by the damaged nerve deviated an average of 1.55°C (p < 0.001). The new technique requires further refinement, but it appears that use of this method may be cost-effective in helping to resolve medicolegal conflicts concerning peripheral nerve injury.

Convection-enhanced delivery in intact and lesioned peripheral nerve

2001 ◽  
Vol 95 (6) ◽  
pp. 1001-1011 ◽  
Author(s):  
John K. Ratliff ◽  
Edward H. Oldfield
Keyword(s):  
Spinal Cord ◽  
Peripheral Nerve ◽  
Nerve Regeneration ◽  
Nerve Injury ◽  
Peripheral Nerve Injury ◽  
Extracellular Space ◽  
Clinical Applications ◽  
Convection Enhanced Delivery ◽  
Content Type ◽  
Fine Print

Object. Although the use of multiple agents is efficacious in animal models of peripheral nerve injury, translation to clinical applications remains wanting. Previous agents used in trials in humans either engendered severe side effects or were ineffective. Because the blood—central nervous system barrier exists in nerves as it does in the brain, limited drug delivery poses a problem for translation of basic science advances into clinical applications. Convection-enhanced delivery (CED) is a promising adjunct to current therapies for peripheral nerve injury. In the present study the authors assessed the capacity of convection to ferry macromolecules across sites of nerve injury in rat and primate models, examined the functional effects of convection on the intact nerve, and investigated the possibility of delivering a macromolecule to the spinal cord via retrograde convection from a peripherally introduced catheter. Methods. The authors developed a rodent model of convective delivery to lesioned sciatic nerves (injury due to crush or laceration in 76 nerves) and compared the results to a smaller series of five primates with similar injuries. In the intact nerve, convective delivery of vehicle generated only a transient neurapraxic deficit. Early after injury (postinjury Days 1, 3, 7, and 10), infusion failed to cross the site of injury in crushed or lacerated nerves. Fourteen days after crush injury, CED of radioactively-labeled albumin resulted in perfusion through the site of injury to distal growing neurites. In primates, successful convection through the site of crush injury occurred by postinjury Day 28. In contrast, in laceration models there was complete occlusion of the extracellular space to convective distribution at the site of laceration and repair, and convective distribution in the extracellular space crossed the site of injury only after there was histological evidence of completion of nerve regeneration. Finally, in two primates, retrograde infusion into the spinal cord through a peripheral nerve was achieved. Conclusions. Convection provides a safe and effective means to deliver macromolecules to regenerating neurites in crush-injured peripheral nerves. Convection block in lacerated and suture-repaired nerves indicates a significant intraneural obstruction of the extracellular space, a disruption that suggests an anatomical obstruction to extracellular and, possibly, intraaxonal flow, which may impair nerve regeneration. Through peripheral retrograde infusion, convection can be used for delivery to spinal cord gray matter. Convection-enhanced delivery provides a promising approach to distribute therapeutic agents to targeted sites for treatment of disorders of the nerve and spinal cord.

Associated change in plantar temperature and sweating after transthoracic endoscopic T2–3 sympathectomy for palmar hyperhidrosis

2001 ◽  
Vol 95 (1) ◽  
pp. 58-63 ◽  
Author(s):  
Han-Jung Chen ◽  
Cheng-Loong Liang ◽  
Kang Lu
Keyword(s):  
Skin Temperature ◽  
Temperature Change ◽  
The Body ◽  
Palmar Hyperhidrosis ◽  
Compensatory Sweating ◽  
Content Type ◽  
Postoperative Changes ◽  
The Face ◽  
The Difference ◽  
Fine Print

Object. Transthoracic endoscopic T2–3 sympathectomy is currently the treatment of choice for palmar hyperhidrosis. Compensatory sweating of the face, trunk, thigh, and sole of the foot was found in more than 50% of patients who underwent this procedure. The authors conducted this study to investigate the associated intraoperative changes in plantar skin temperature and postoperative plantar sweating. Methods. One hundred patients with palmar hyperhidrosis underwent bilateral transthoracic endoscopic T2–3 sympathectomy. There were 60 female and 40 male patients who ranged in age from 13 to 40 years (mean age 21.6 years). Characteristics studied included changes in palmar and plantar skin temperature measured intraoperatively, as well as pre- and postoperative changes in plantar sweating and sympathetic skin responses (SSRs). In 59 patients (59%) elevation of plantar temperature was demonstrated at the end of the surgical procedure. In this group, plantar sweating was found to be exacerbated in three patients (5%); plantar sweating was improved in 52 patients (88.1%); and no change was demonstrated in four patients (6.8%). In the other group of patients in whom no temperature change occurred, increased plantar sweating was demonstrated in three patients (7.3%); plantar sweating was improved in 20 patients (48.8%); and no change was shown in 18 patients (43.9%). The difference between temperature and sweating change was significant (p = 0.001). Compared with the presympathectomy rate, the rate of absent SSR also significantly increased after sympathectomy: from 20 to 76% after electrical stimulation and 36 to 64% after deep inspiration stimulation, respectively (p < 0.05). Conclusions. In contrast to compensatory sweating in other parts of the body after T2–3 sympathetomy, improvement in plantar sweating was shown in 72% and worsened symptoms in 6% of patients. The intraoperative plantar skin temperature change and perioperative SSR demonstrated a correlation between these changes.

Nerve allotransplantation following severe tibial nerve injury

1996 ◽  
Vol 84 (4) ◽  
pp. 671-676 ◽  
Author(s):  
Susan E. Mackinnon
Keyword(s):  
Peripheral Nerve ◽  
Nerve Injury ◽  
Clinical Experience ◽  
Tibial Nerve ◽  
Posterior Tibial Nerve ◽  
Content Type ◽  
Posterior Tibial ◽  
Successful Recovery ◽  
Fine Print

✓ The successful recovery of sensibility across a long peripheral nerve allograft in a 12-year-old boy who sustained a severe posterior tibial nerve injury is reported. The historical clinical experience with nerve allotransplantation is also reviewed. It is concluded that in the carefully selected patient with severe nerve injury, consideration for nerve allotransplantation can be given.

Spatial pattern of type I collagen expression in injured peripheral nerve

1997 ◽  
Vol 86 (5) ◽  
pp. 866-870 ◽  
Author(s):  
Rahul K. Nath ◽  
Susan E. Mackinnon ◽  
John N. Jensen ◽  
William C. Parks
Keyword(s):  
Peripheral Nerve ◽  
Nerve Injury ◽  
Collagen Type ◽  
Collagen Type I ◽  
Type I ◽  
Collagen Production ◽  
Content Type ◽  
Spatial Expression ◽  
Sciatic Nerves ◽  
Fine Print

✓ The authors studied the spatial expression and regulation of messenger RNA for the a 1 subunit of collagen type I in crushed rat sciatic nerve to provide a basis for future therapeutic manipulation. Sciatic nerves in 20 male or female adult Lewis rats were crushed for 60 seconds; the unharmed contralateral sciatic nerves served as controls. Twenty-one days after injury the experimental animals were killed and their tissue was harvested. The spatial expression of collagen type I was determined by using in situ hybridization techniques. Quantification of fibroblast number and total signal was performed through computerized morphometry. Collagen upregulation was evident in epineurial and perineurial layers, with the epineurium displaying higher activity. The cells responsible for procollagen type I production were fibroblasts. No activity was seen in the endoneurium. Morphometric findings indicated that collagen upregulation in the epineurium and perineurium occurred at both pretranscriptional and posttranslational levels when compared to controls; a paired t-test analysis confirmed statistical significance for all comparisons between injured and control tissues. Epineurial fibroblasts are responsible for the collagen production associated with crushed peripheral nerve injury in the rat. Regulation occurs pretranscriptionally as well as posttranslationally. It is interesting to speculate that the delivery of agents directed against collagen production (such as neutralizing antibodies to growth factors) into epineurial tissues proximate to the time and location of clinical nerve injury might mitigate later deleterious effects of excess collagen production in axonal regeneration.

Spontaneous activity of ventral root axons following peripheral nerve injury

1985 ◽  
Vol 62 (3) ◽  
pp. 408-413 ◽  
Author(s):  
Kim J. Burchiel ◽  
Lisa C. Russell
Keyword(s):  
Sciatic Nerve ◽  
Peripheral Nerve ◽  
Spontaneous Activity ◽  
Nerve Injury ◽  
Peripheral Nerve Injury ◽  
Ventral Root ◽  
Root Activity ◽  
Spontaneous Discharge ◽  
Sprague Dawley ◽  
Content Type

✓ In 18 Sprague-Dawley rats, the left sciatic nerve was divided at the mid-femur level. Seven to 9 days later, microfilament recordings were made from the ipsilateral L-5 ventral root. Spontaneous activity in the ventral root, ranging from 0.1 to 6.1 Hz, was recorded in 12 of the 18 animals. Conduction velocity determinations showed this activity to be in A-beta and A-delta fibers. Recordings in 10 normal L-5 ventral roots from five control rats showed no spontaneous activity. In the rats with sciatic nerve division, the ongoing discharge appeared to originate in the cut end of the nerve since mechanical stimulation of the neuroma produced synchronous ventral root activity. Furthermore, cooling of the neuroma inhibited the spontaneous discharge, whereas with rewarming it returned. Spontaneous ventral root activity was also increased by systemic application of epinephrine. This activity was qualitatively similar to spontaneous activity that has been recorded in dorsal root microfilaments after peripheral nerve injury. The observation of an ongoing discharge in potentially nociceptive ventral root axons subsequent to nerve injury may be relevant to the mechanism of chronic pain of peripheral origin.

Peripheral nerve injury by chymopapain injection

1984 ◽  
Vol 61 (1) ◽  
pp. 1-8 ◽  
Author(s):  
Susan E. Mackinnon ◽  
Alan R. Hudson ◽  
Faustino Llamas ◽  
A. Lee Dellon ◽  
David G. Kline ◽  
...  
Keyword(s):  
Peripheral Nerve ◽  
Nerve Fiber ◽  
Peripheral Nerve Injury ◽  
Neurotoxic Effect ◽  
Disc Disease ◽  
Intervertebral Disc Space ◽  
Disc Space ◽  
Content Type ◽  
Fiber Damage ◽  
Fine Print

✓ Chymopapain injected into the intervertebral disc space (chemonucleolysis) has been used clinically in patients with disc disease with success. Neurosurgical complications secondary to the procedure have, however, been reported. In this study, the authors have investigated the possible neurotoxic effect of chymopapain on the peripheral nerve in rat and primate models. While the extrafascicular injection caused no nerve fiber damage, the intrafascicular injection caused dose-related nerve fiber damage in both species.

scholarly journals Hollowfiber Polyurethane-Collagen Coating Chitosan as Nerve Graft for Therapy of Peripheral Nerve Injury in Extreme Paralysis

2016 ◽  
Vol 28 ◽  
pp. 78-84 ◽  
Author(s):  
Hendita Nur Maulida ◽  
Fitriyatul Qulub ◽  
Azizah Fresia Rosdiani ◽  
Disca Sandyakala Purnama ◽  
Karina Dwi Saraswati ◽  
...  
Keyword(s):  
Peripheral Nerve ◽  
Nerve Injury ◽  
Peripheral Nerves ◽  
Peripheral Nerve Injury ◽  
Nerve Graft ◽  
The Body ◽  
Membrane Pore ◽  
Collagen Coating ◽  
Membrane Pore Size ◽  
Test Result

Peripheral nerve injury with gaps between 5 and 30 mm can result in permanent paralysis because axons are cut. The distance between axons, which is more than 1-2 cm, needs graft in the form of nerve connecting pipe in order to repair the defects. A synthesis of hollowfiber polyurethane-collagen coated by chitosan was carried out to identify its potential as treatment accelerator for peripheral nerve injury. The result of Fourier Transform Infrared (FTIR) analysis showed multiple links between chitosan and glutaraldehyde, which can be seen in wavenumber shift from 1080-1100 cm-1 to 1002 cm-1. The degradation test result revealed that the sample displayed mass loss after it was soaked in simulated body fluid(SBF) for seven days. Polyurethanecan be degraded in the body after 30 days. This converges with the nerve mechanism that regenerates at the rate of 1 mm/day or 1 inch/month. The result of tensile test indicated that modulus values of chitosan coating variation of 1%, 1.5%, and 2% were 4.75 MPa, 4.74 MPa, and 7.67 Mpa respectively. The outcome of scanning electron microscope(SEM)showed that hollow fiberhas a diameter of 2.021-2.032 mm, which matches the diameter of peripheral nerves ranging from 1.5 to 3 mm and the membrane pore size of 31.33-39.65 μm. The result of MTT assay demonstrated that the percentage of viable fibroblastBHK-21cells was exceeding 50%, which means that the sample does not have toxic properties. The result of this study is expected to provide theoretical basis for the utilization of polyurethane-collagen coating chitosan as nervegraft for theraphy of peripheral nerve injury. The utilization is possible due to the fact that the composite exhibits biocompatible, regenerative, and easily degradable characteristics. Moreover, it could become an alternative solution to answer the need of a more affordable and easier-to-produce nerve graft, so it can be mass-produced in Indonesia.

scholarly journals Potential Hollowfiber Polyurethane-Collagen of Chitosan Coatings As a Nerve Graft for the Therapy of Peripheral Nerve Injuries in Limb Paralysis

2019 ◽  
Vol 2 (2) ◽  
Author(s):  
Hendita Maulida
Keyword(s):  
Peripheral Nerve ◽  
Nerve Injury ◽  
Peripheral Nerve Injury ◽  
Sem Analysis ◽  
Nerve Graft ◽  
The Body ◽  
Peripheral Nerve Injuries ◽  
Nerve Injuries ◽  
Nerve Grafts ◽  
Collagen Coating

Peripheral nerve injury with a gap of 5–30 mm can cause permanent paralysis because it causes an axon to break up. The distance between axons of more than 1-2 cm requires a graft in the form of a nerve connector to fix it. Synthesis of chitosan coated polyurethane-collagen hollowfiber has been carried out as an accelerator for healing peripheral nerve injury. The results of Fourier Transform Infra Red (FTIR) analysis showed a cross link between chitosan and glutaraldehyde seen in the shift of wave numbers from 1080-1100 cm-1 to 1002 cm-1. The degradation test results showed that the sample experienced a decrease in mass after being immersed in Simulated Body Fluid (SBF) for 7 days. Polyurethane can be degraded in the body after 30 days. This is in accordance with the mechanism of the nerve which regenerates 1 mm per day or 1 inch per month. Scanning Electron Microscope (SEM) analysis showed that the diameter of the hollowfiber was 2.021-2.032 mm which corresponds to the peripheral nerve diameter of 1.5-3 mm and the pore size of the wall is 31.33-39.65 μm. The results of this study are expected to provide the theoretical basis for the use of chitosan polyurethane-collagen coating composites as nerve grafts for the treatment of peripheral nerve injuries that have biocompatible properties, can regenerate and are easily degraded and provide alternative solutions for nerve graft needs that are more economical and easier to manufacture so widely produced in Indonesia.

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