Intraoperative fluorescent angiography with indocyanine green in surgery of peripheral nerve injuries

2021 ◽  
pp. 224-234
Author(s):  
Dmitry Vladimirovich Svistov ◽  
Dzhamaludin Magomedrasulovich Isaev ◽  
Alexey Ivanovich Gaivoronsky ◽  
Leonid Igorevich Churikov ◽  
Kirill Vladimirovich Belyakov
Keyword(s):  
Blood Flow ◽  
Peripheral Nerve ◽  
Indocyanine Green ◽  
Blood Supply ◽  
Nerve Trunk ◽  
Point Of View ◽  
Intraoperative Angiography ◽  
Surgical Interventions ◽  
The Moment ◽  
Nerve Surgery

Despite the widespread introduction of microsurgical techniques in peripheral nerve surgery, a relatively high percentage of unsatisfactory results remains. Often, when treating patients with traumatic neuropathies, the surgeon faces the problem of diastasis between the ends of the damaged nerve. As a rule, in the presence of diastasis greater than 5 cm, it is recommended to perform inter-bundle autoneuroplasty. However, overcoming diastasis less than 5 cm may be accompanied by tension of the nerve trunk, which leads to a violation of its blood supply. In this case, the outcome of the intervention may be unsatisfactory, despite the operation performed perfectly from a technical point of view. An important factor of the outcome of surgical treatment of neuropathies of various origins is the preservation of adequate blood supply to the nerve trunk in the intraoperative period. In order to assess the blood flow in the nerve trunk, the possibility of using intraoperative fluorescent angiography for reconstructive surgical interventions on nerves was considered. In patients with a complete anatomical break of the large nerve trunk, at the moment of overcoming diastasis, intraoperative angiography of the nerve trunk was performed by intravenous administration of indocyanine green, with simultaneous registration of the tension force with which the nerve trunk was affected. In addition, fluorescent angiography was performed after the restoration of the integrity of the nerve trunk, thus assessing the safety, adequacy and effectiveness of blood flow in it. It was found that intraoperative angiography is an accessible and easily implementable technique to determine the safety and, not least, the adequacy and effectiveness of the blood flow in the nerve trunk, to study the mechanisms of compensation of blood supply to the nerve after microsurgical epineural suture, and to assess the quality of matching the stumps of the nerve axis, preventing the possibility of «torsion».

scholarly journals Intraoperative infrared fluorescence angiography in surgery of peripheral nerve injuries

2021 ◽  
Vol 23 (1) ◽  
pp. 59-66
Author(s):  
Dmitriy V. Svistov ◽  
Dzhamaludin M. Isaev ◽  
Aleksey I. Gaivoronskiy ◽  
Leonid I. Churikov ◽  
Kirill V. Belyakov
Keyword(s):  
Blood Flow ◽  
Peripheral Nerve ◽  
Blood Supply ◽  
Nerve Trunk ◽  
Tension Force ◽  
Fluorescence Angiography ◽  
Green Is ◽  
Surgical Interventions ◽  
Peripheral Nerve Damage

Often, when performing reconstruction of nerve trunks, between the ends of the damaged nerve, the presence of diastasis is noted, which requires significant nerve tension in order to overcome it. This, in turn, can lead to a violation of the blood supply to the nerve and damage to its ultrastructures, which leads to unsatisfactory treatment results. The possibility of using intraoperative infrared fluorescence angiography in reconstructive surgical interventions for peripheral nerve damage, in order to assess the degree of blood flow disturbance in the nerve trunk, is considered. In patients with a complete anatomical break during the operation, an attempt was made to overcome diastasis by measuring the tension force (up to 3 N) with which the nerve was affected. Infrared fluorescence angiography with indocyanine green was performed simultaneously. The obtained angiograms were analyzed, and the effect of the tension force on the change in blood flow in the nerve trunk was determined. It was found that when exposed to a force of up to 2 N, there is no significant change in the intraneural blood flow. At the same time, the effect of a force of 3 N is manifested on angiograms by a significant decrease in the volume of blood flow, which is usually due to constriction of the vessels due to their stretching. After reconstruction (microsurgical epineural suture), repeated angiography was performed to assess the safety and adequacy of blood supply to the nerve. It was revealed that the use of intraopreational angiography with indocyanin green is an affordable and easily feasible technique that allows to determine the safety and, equally important, the adequacy and efficiency of blood flow in the nerve trunk. This technique makes it possible to monitor the safety of blood flow in the nerve trunk, to study the mechanisms of compensation of blood supply to the nerve after microsurgical epineural suture, to assess the quality of comparison of nerve stumps along the axis, excluding the possibility of their "twist".

scholarly journals Extended latissimus dorsi chimeric thoracoplasty with a vascular supercharge for Aspergillus empyema

2019 ◽  
Vol 30 (3) ◽  
pp. 491-492
Author(s):  
Masanori Shimomura ◽  
Yoshihiro Sowa ◽  
Ryo Yamochi ◽  
Masayoshi Inoue
Keyword(s):  
Blood Flow ◽  
Indocyanine Green ◽  
Intravenous Injection ◽  
Blood Supply ◽  
Latissimus Dorsi ◽  
Serratus Anterior

Abstract The latissimus dorsi and serratus anterior muscles are available for reconstruction coverage of thoracic defects. We performed extended latissimus dorsi-serratus anterior chimeric thoraco-myoplasty with a vascular supercharge to maintain sufficient blood supply to the flaps because of a deficiency in the distal blood flow to the flap revealed by an intravenous injection of indocyanine green and simultaneous endobronchial embolization for refractory Aspergillus empyema.

Exogenous opioids influence the microcirculation of injured peripheral nerves

1997 ◽  
Vol 272 (1) ◽  
pp. H76-H82
Author(s):  
L. Schaafsma ◽  
H. Sun ◽  
D. Zochodne
Keyword(s):  
Blood Flow ◽  
Peripheral Nerve ◽  
Peripheral Nerves ◽  
Nerve Trunk ◽  
Local Blood Flow ◽  
Vasa Nervorum ◽  
Perfusion Flow ◽  
Sciatic Nerves ◽  
Microelectrode Measurements ◽  
Hydrogen Clearance

Local microvessels of peripheral nerve trunks (vasa nervorum) dilate following capsaicin-induced inflammation or local nerve trunk injury. In previous work, we observed that morphine blocked capsaicin-induced dilation of vasa nervorum presumably through the action of local opioid receptors. In the present work, we studied injury-related hyperemia of the rat sciatic vasa nervorum using laser Doppler and hydrogen clearance microelectrode measurements of local perfusion. Systemic morphine reversed hyperemia by vasoconstricting both extrinsic and intrinsic microvessels supplying 48-h-old “neuroma” preparations or crush zones of peripheral nerve trunks. Morphine did not constrict microvessels of contralateral uninjured or sham exposed but uninjured sciatic nerves. In contrast to the injured nerves, contralateral uninjured nerves exposed to morphine frequently had a rise in local perfusion, indicating vasodilation. The vasoconstrictive actions of morphine were blocked by pretreatment with naloxone and were not mimicked by saline injections alone. Systemic doses of selective opioid agonists to mu-, kappa-, and delta-receptors also selectively constricted microvessels of injured nerves. Local blood flow in older experimental neuromas at 7 days had partial sensitivity to morphine, whereas at 14 days perfusion flow was not influenced by morphine. Exogenous opioids dampen early but not later inflammatory microvasodilation and could have important influences on the nerve regenerative milieu.

Innervation of endoneurial microvessels in human sural nerve

1992 ◽  
Vol 50 (1) ◽  
pp. 920-921
Author(s):  
John L. Beggs ◽  
Peter C. Johnson ◽  
Astrid G. Olafsen ◽  
C. Jane Watkins
Keyword(s):  
Blood Flow ◽  
Blood Vessels ◽  
Blood Supply ◽  
Peripheral Nerves ◽  
Sural Nerve ◽  
Nerve Fibers ◽  
Arterial Supply ◽  
Autonomic Nerve ◽  
Vasa Nervorum ◽  
Endoneurial Blood Flow

The blood supply (vasa nervorum) to peripheral nerves is composed of an interconnected dual circulation. The endoneurium of nerve fascicles is maintained by the intrinsic circulation which is composed of microvessels primarily of capillary caliber. Transperineurial arterioles link the intrinsic circulation with the extrinsic arterial supply located in the epineurium. Blood flow in the vasa nervorum is neurogenically influenced (1,2). Although a recent hypothesis proposes that endoneurial blood flow is controlled by the action of autonomic nerve fibers associated with epineurial arterioles (2), our recent studies (3) show that in addition to epineurial arterioles other segments of the vasa nervorum are also innervated. In this study, we examine blood vessels of the endoneurium for possible innervation.

Peripheral Nerve Surgery - View through Multidiciplinary Approch Window

2014 ◽  
Vol 75 (S 01) ◽  
Author(s):  
L. Rasulic ◽  
M. Samardzic ◽  
V. Bascarevic ◽  
M. Micovic ◽  
I. Cvrkota ◽  
...  
Keyword(s):  
Peripheral Nerve ◽  
Peripheral Nerve Surgery ◽  
Nerve Surgery

Chelovek.RU/Человек.RU

Chelovek RU ◽  
2020 ◽  
pp. 18-53
Author(s):  
Sergei Avanesov ◽  
Keyword(s):  
Family History ◽  
Great Distance ◽  
Point Of View ◽  
The Past ◽  
Russian Philosopher ◽  
True Meaning ◽  
The Future ◽  
Pavel Florensky ◽  
The Moment

Abstract. The article analyzes the autobiography of the famous Russian philosopher, theologian and scientist Pavel Florensky, as well as those of his texts that retain traces of memories. According to Florensky, the personal biography is based on family history and continues in children. He addresses his own biography to his children. Memories based on diary entries are designed as a memory diary, that is, as material for future memories. The past becomes actual in autobiography, turns into a kind of present. The past, from the point of view of its realization in the present, gains meaning and significance. The au-thor is active in relation to his own past, transforming it from a collection of disparate facts into a se-quence of events. A person can only see the true meaning of such events from a great distance. Therefore, the philosopher remembers not so much the circumstances of his life as the inner impressions of the en-counter with reality. The most powerful personality-forming experiences are associated with childhood. Even the moment of birth can decisively affect the character of a person and the range of his interests. The foundations of a person's worldview are laid precisely in childhood. Florensky not only writes mem-oirs about himself, but also tries to analyze the problems of time and memory. A person is immersed in time, but he is able to move into the past through memory and into the future through faith. An autobi-ography can never be written to the end because its author lives on. However, reaching the depths of life, he is able to build his path in such a way that at the end of this path he will unite with the fullness of time, with eternity.

The Revolutionizing of the Revolution

2017 ◽  
Author(s):  
R. R. Palmer
Keyword(s):  
French Revolution ◽  
Point Of View ◽  
Strict Sense ◽  
French Government ◽  
Thing In Itself ◽  
Set Up ◽  
The Moment ◽  
The French Revolution ◽  
The Revolution

In 1792, the French Revolution became a thing in itself, an uncontrollable force that might eventually spend itself but which no one could direct or guide. The governments set up in Paris in the following years all faced the problem of holding together against forces more revolutionary than themselves. This chapter distinguishes two such forces for analytical purposes. There was a popular upheaval, an upsurge from below, sans-culottisme, which occurred only in France. Second, there was the “international” revolutionary agitation, which was not international in any strict sense, but only concurrent within the boundaries of various states as then organized. From the French point of view these were the “foreign” revolutionaries or sympathizers. The most radical of the “foreign” revolutionaries were seldom more than advanced political democrats. Repeatedly, however, from 1792 to 1799, these two forces tended to converge into one force in opposition to the French government of the moment.

Basic principles of Russian foreign policy under Vladimir Putin

Upravlenie ◽  
2020 ◽  
Vol 8 (4) ◽  
pp. 116-122
Author(s):  
Sadeghi Elham Mir Mohammad ◽  
Ahmad Vakhshitekh
Keyword(s):  
Foreign Policy ◽  
International Relations ◽  
World Order ◽  
Policy Decision ◽  
Point Of View ◽  
Russian Foreign Policy ◽  
National Interests ◽  
Basic Principles ◽  
Interstate Relations ◽  
The Moment

The article considers and analyses the basic principles and directions of Russian foreign policy activities during the presidency of V.V. Putin from the moment of his assumption of the post of head of state to the current presidential term. The authors determine the basic principles of Russia's foreign policy in the specified period and make the assessment to them. The study uses materials from publications of both Russian and foreign authors, experts in the field of political science, history and international relations, as well as documents regulating the foreign policy activities of the highest state authorities. The paper considers the process of forming the priorities of Russia's foreign policy both from the point of view of accumulated historical experience and continuity of the internal order, and in parallel with the processes of transformation of the entire system of international relations and the world order. The article notes the multi-vector nature of Russia's foreign policy strategy aimed at developing multilateral interstate relations, achieving peace and security in the interstate arena, actively countering modern challenges and threats to interstate security, as well as the formation of a multipolar world. The authors conclude that at present, Russia's foreign policy activity is aimed at strengthening Russia's prestige, supporting economic growth and competitiveness, ensuring security and implementing national interests. Internal political reforms contribute to strengthening the political power of the President of the Russian Federation and increasing the efficiency of foreign policy decision-making.

L’absence chez Michel Butor. L’Emploi du temps et Degrés

2012 ◽  
pp. 66-80
Author(s):  
Michał Mrozowicki
Keyword(s):  
Human Memory ◽  
Point Of View ◽  
Narrative Discourse ◽  
The Novel ◽  
Michel Butor ◽  
Starting Point ◽  
One Year ◽  
The Moment ◽  
Narrative Mode ◽  
The City

Michel Butor, born in 1926, one of the leaders of the French New Novel movement, has written only four novels between 1954 and 1960. The most famous of them is La Modification (Second thoughts), published in 1957. The author of the paper analyzes two other Butor’s novels: L’Emploi du temps (Passing time) – 1956, and Degrés (Degrees) – 1960. The theme of absence is crucial in both of them. In the former, the novel, presented as the diary of Jacques Revel, a young Frenchman spending a year in Bleston (a fictitious English city vaguely similar to Manchester), describes the narrator’s struggle to survive in a double – spatial and temporal – labyrinth. The first of them, formed by Bleston’s streets, squares and parks, is symbolized by the City plan. During his one year sojourn in the city, using its plan, Revel learns patiently how to move in its different districts, and in its strange labyrinth – strange because devoid any centre – that at the end stops annoying him. The other, the temporal one, symbolized by the diary itself, the labyrinth of the human memory, discovered by the narrator rather lately, somewhere in the middle of the year passed in Bleston, becomes, by contrast, more and more dense and complex, which is reflected by an increasinly complex narration used to describe the past. However, at the moment Revel is leaving the city, he is still unable to recall and to describe the events of the 29th of February 1952. This gap, this absence, symbolizes his defeat as the narrator, and, in the same time, the human memory’s limits. In Degrees temporal and spatial structures are also very important. This time round, however, the problems of the narration itself, become predominant. Considered from this point of view, the novel announces Gerard Genette’s work Narrative Discourse and his theoretical discussion of two narratological categories: narrative voice and narrative mode. Having transgressed his narrative competences, Pierre Vernier, the narrator of the first and the second parts of the novel, who, taking as a starting point, a complete account of one hour at school, tries to describe the whole world and various aspects of the human civilization for the benefit of his nephew, Pierre Eller, must fail and disappear, as the narrator, from the third part, which is narrated by another narrator, less audacious and more credible.

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