Peripheral nerve disorders--clinical pathological approaches]

Clinical pathological approach is defined as combination of neurological, neurophysiological and neuroradiological findings for the interpretation of the morphology of the sural nerve. For this purpose, first, the usefulness of simultaneous biopsy of sural nerve and ipsilateral short peroneal muscle was presented. This method has helped establish the diagnosis of angitis or amyloidosis in some cases. Furthermore, motor-dominant clinical picture was ascertained by relative preservation of sural nerve in contrast with severe changes in intramuscular nerve fascicles. Second, histochemistry using UEA-1 lectin to detect somatic sensory C fibers was discussed. UEA-1 specifically binds to unmyelinated axons and small neurons in dorsal root ganglia as well as substantia gelatinosa of the spinal cord. Serial semithin and ultrathin sections were obtained. The semithin section was removed of epon and stained histochemically with UEA-1. Positive fibers in the semithin section was compared with the counterpart in the ultrathin sections. UEA-1 positive fibers were found to comprise 20% of all unmyelinated fibers and be randomly distributed among the entire nerve fascicles. The application of this technique to pathological specimens is now undergoing. Third, an autopsy case with sarin intoxication was reported as an example of systemic study of the peripheral nervous system. The patient was a 51-year-old man who inhaled sarin in the attack of Tokyo Subway. He fell into vegetative state and was passively maintained for 13 months. Peripheral sensory nerve showed typical pattern of dying back-type distal peripheral axonopathy. It might be indicated that peripheral nerve be carefully checked among the sarin victims. In conclusion, the aim of our approach is to combine all clinical information, introduce recent advance in neuroscience, and try to find possible cure to intractable neurological disorders.     

Peripheral nerve entrapment in Paget''s disease

Thirteen anthropometric measurements of Kaffa district schoolchildren in Ethiopia were factor analysed. Two factors emerged which may be interpreted as (a) body size and (b) fat mass.     

Successful surgical removal of an asymptomatic optic nerve hemangioblastoma in von Hippel-Lindau disease

Image space reconstruction algorithm (ISRA) is a new kind of method for ECT reconstruction. Unlike the ML-EM algorithm which maximizes likelihood function of Possion distribution, ISRA searches for the minimum non-negative mean square solution. In this paper, an improved ISRA (IISRA) algorithm is proposed. A comparison between the algorithms (ISRA and IISRA) demonstrates that the result of IISRA is closer to the test image than that of ISRA. In addition, the IIRSA inherits some properties of ISRA such as convergence.     

Peripheral nerve injection injury with antiemetic agents

Antiemetics are widely used drugs, frequently administered to alleviate postoperative and postchemotherapeutic nausea and vomiting. While antiemetics do not induce peripheral neurotoxicity when administered systemically, it is not known whether peripheral nerve injury can occur as a result of inadvertent intraneural injection during intramuscular administration. The purpose of this study was to characterize the neurotoxic effect of three commonly used antiemetic agents (promethazine, dimenhydrinate, and prochlorperazine) as compared to saline in the rat sciatic nerve model. Intrafascicular and extrafascicular injection as well as direct application of the antiemetic drugs were performed. Nerves were harvested at 2 weeks postoperatively for histology and morphometry, with an additional sacrifice point at 8 weeks for the intrafascicular injection group. Injection injuries caused by antiemetic drugs differed depending on the agent injected and the location of injection. Extrafascicular injection and direct application caused no damage. Intrafascicular injection caused diffuse axonal injury in the promethazine and dimenhydrinate groups, while prochlorperazine caused only focal injury. Regeneration was prominent at 8 weeks in all intrafascicular injection groups in this rat model. Prochlorperazine thus appears to be less neurotoxic when injected intraneurally and should preferentially be used for intramuscular injections.     

Peripheral nerve stimulation by time-varying magnetic fields

PURPOSE: A study was performed to assess the stimulation threshold for healthy adults using sinusoidally oscillating gradients. METHOD: One hundred thirteen healthy adults were examined in the study. ECG and physiological parameters were measured. All measurements were performed of both the head and the abdomen. The subjects were measured in the supine position with the region of interest positioned in the center of the gradient coils. The measurement was performed for three orthogonal, four oblique, and double oblique orientations. RESULTS: No volunteer reported painful, severe stimulation. The mean thresholds for peripheral stimulation in head and body measurement were similar: 85.5% of stimulation during examination of the head and 87.6% during measurements of the abdomen were reported when the y-gradient was used. CONCLUSION: The greatest frequency of reported stimulations occurs when the y-gradient is used. This was confirmed by the results and supports the hypothesis that orthogonal to the y-axis the body has its largest conductive loop, resulting in the strongest peripheral stimulation.     

Peripheral nerve conduction following recovery from Guillain-Barre syndrome

The material comprises 10 cases with a history of Guillain-Barré syndrome within the last several years in which clinical investigations failed to demonstrate any abnormalities. Electrophysiological investigations of peripheral nerves including conduction velocity in motor fibres--maximal and minimal, sensory fibres, standardized terminal latency--showed presence of changes evidencing slight but persisting subclinical lesion to peripheral nerves, especially in subjects affected in early childhood. Slowing of conduction involved motor as well as sensory fibres in these nerves and was more pronounced in the ulnar nerve than in the remaining nerves (peroneal, axillary, musculocutaneous and facial).     

Peripheral nerve vascular changes in spontaneously hypertensive rats

Circulation to the brain is affected by hypertension. Hypertension-dependent cerebrovascular changes were documented primarily in brain pial arteries, whereas no information is so far available concerning changes of peripheral nerve vascularization in hypertension. This study was designed to assess the occurrence of structural changes of interfascicular and intrafascicular arteries supplying peripheral nerves (the so called vasa nervorum) in spontaneously hypertensive rats (SHR). The investigation was performed in 8-month-old SHR, by using standard microanatomical techniques associated with quantitative image analysis. In SHR a significant increase of systolic pressure values accompanied by thickening of the arterial wall, narrowing of the lumen and increase of the wall-to-lumen ratio were observed in comparison with age-matched normotensive Wistar-Kyoto rats. Hypertension-related structural changes involved primarily interfascicular arteries and to a lesser extent intrafascicular arteries. These findings indicate that similarly as documented for cerebral arteries, the vascular supply to peripheral nerves is impaired in hypertension. Structural changes of interfascicular and intrafascicular arteries of SHR could lead to ischemia of peripheral nerves. Further work is in progress to evaluate the functional relevance of hypertensive changes to peripheral nerve vasculature.     

Peripheral nerve revascularization: a current literature review

Gene therapy of human cancer is likely to be most effective when it is directed at targets that are expressed in cancer cells but are lacking from other cells. Human papillomaviruses can provide such targets, since these viruses are present in many cervical and oral cancers, and are likely to be etiological agents of the tumor. Continued expression of human papillomavirus genes is probably necessary for the growth of these cancers, and effective gene therapy could consist of antisense or ribozyme molecules directed against these genes. Some human papillomavirus gene products are antigenic, and immunotherapy based upon these antigens might prove clinically beneficial. Human papillomaviruses have specific promoters, are linked to toxin genes, the toxin may be selectively expressed by tumor cells where the virus genes are active. Thus, there are several approaches for the development of specific gene therapy for human cancers that contain human papillomaviruses.     

Peripheral nerve glycoproteins and myelin fine structure during development of rat sciatic nerve

Developmental changes in relative amounts of peripheral nerve proteins and glycoproteins have been correlated with the degree of morphological myelination at various ages during the first 25 postnatal days in rat sciatic nerve. At birth there is virtually no major myelin glycoprotein (P0), but there is a protein which migrates to the same point on sodium dodecyl sulphate (SDS) polyacrylamide gels as the small myelin basic protein (P2). During the time myelin is being formed in the nerve, the P0 protein increases and the P2 protein appears to decrease in relative amount in the nerve. The accumulation of P0 protein in the nerve correlates extremely well with the degree of myelination in sciatic nerve. At 4-6 days postnatal, smooth membrane profiles are observed which are located within axons and in the inner Schwann cell cytoplasm. Such profiles are also observed to fuse with the axolemma-Schwann cell interface. The profiles may represent membrane material being added to or deleted from the axolemma or myelin during myelination.     

Peripheral nerve injury as a complication from orthopedic operation

We report a case of pulmonary carcinosarcoma. Surgery is required for this rare mixed type, biphasic tumor. It is generally considered to be a malignant formation issuing from a single cell line but with a two-way differentiation into epithelial and conjunctive components. There is a differentiation continuum between spindle-cell carcinomas (also called monophasic sarcomatoid carcinoma) and carcinosarcoma (or biphasic sarcomatoid carcinoma) leading to debate concerning the immunohistochemical and ultrastructural features.     

Peripheral nerve regeneration: the effects of postoperative irradiation

Our purpose is to review recent data and provide a clinical opinion on the use of antibiotics to prevent preterm birth or related maternal-neonatal complications. A literature review and a synthesis of opinion are provided. During prenatal care, standard practices should be applied regarding Neisseria gonorrhoeae, Chlamydia trachomatis, and bacteriuria. In addition, screen for and treat bacterial vaginosis in patients at high risk for preterm birth but do not treat Ureaplasma urealyticum or group B streptococci genital colonization. With preterm labor and intact membranes, standard practices should be applied regarding group B streptococci prophylaxis. Do not give antibiotics routinely to prolong pregnancy, but in patients with bacterial vaginosis and Trichomonas vaginalis specific treatment should be given. With preterm premature rupture of membranes, standard practices should be applied regarding group B streptococci prophylaxis, but additional antibiotics should also be given to prolong pregnancies at 24 to 32 weeks' gestation. Reported adverse effects have been few to date. However, increased diligence is needed for resistant organisms. In selected clinical settings antibiotic therapy is now indicated to prolong pregnancy and prevent maternal-neonatal complications associated with preterm birth.     

Peripheral nerve stimulation in a whole-body echo-planar imaging system

Echo-planar techniques in MRI use a rapidly oscillating frequency-encoding gradient with the potential to produce peripheral nerve stimulation. To evaluate the incidence, type, and location of stimulation in a commercial whole-body scanner, we studied two groups: (a) 173 consecutive individuals scanned by echo-planar imaging for other purposes and (b) seven subjects who were scanned with an extensive set of 36 echo-planar sequences (with prompting after each scan to report any peripheral nerve stimulation) to test the effects of various parameters. Although only 5% of group A reported symptoms of peripheral nerve stimulation, all in group B experienced some type of stimulation, dependent primarily on direction of the oscillating gradient and location of the body within the gradient coil. Maximum stimulation typically occurred 30 to 40 cm from isocenter in the region of maximum dB/dt. Generally, y gradients produced truncal stimulation, and x gradients produced stimulation in the head. When hands were clasped over the abdomen, a tingling in the hands occasionally was felt. Patients should be instructed to keep their hands apart.     

Peripheral nerve blocks improve analgesia after total knee replacement surgery

Using an in vitro cell system and Cs+ NMR techniques we were able to show that porcine aortic endothelial cells (PAEC) reduce their Na(+)-K(+)-ATPase activity upon an increase in intracellular cAMP. Reduction in the pump rate was due to phosphorylation of the alpha-subunit of the ATPase as shown by immunoprecipitation. Apart from a pump inhibiton using 8-Br-cAMP and IBMX, we were also able to show that changes in the Na(+)-K(+)-ATPase activity could be mediated by the adenosine-A2 and prostaglandin receptor agonists 5'-N-Ethylcarboxamidoadenosine and Iloprost, respectively. Parallel to a decrease in pump activity we also observed a decrease in intracellular Cs+, indicating opening of K+ channels.     

Peripheral nerve allograft preservation improves regeneration and decreases systemic cyclosporin A requirements

Peripheral nerve allografting is limited by the need for long-term systemic immunosuppression. The purpose of this study was to determine if nerve allograft preservation reduced the requirements for systemic Cyclosporin A (CsA) immunosuppression. One hundred twenty Lewis rats were randomized to one of seven experimental groups. Group 1 received a 2-cm Lewis posterior tibial nerve autograft. Groups 2-7 received 2-cm ACI posterior tibial nerve allografts. The allograft group was then further subdivided into three groups of two receiving daily subcutaneous injections of 0, 2.5, or 5.0 mg/kg of CsA for 12 weeks. Within each CsA dose, one group received a fresh while the other received a preserved allograft. Preserved grafts were stored in University of Wisconsin solution for 7 days at 5 degrees C prior to implantation. Animals from each group were sacrificed at 6, 12, and 20 weeks postoperatively. Evaluations included histomorphometry, electrophysiology, and serial walking track analysis. Histology revealed varying degrees of nerve regeneration in all groups at 6, 12, and 20 weeks. For a given CsA dose, the group receiving the preserved graft revealed evidence of better nerve regeneration by all histomorphometric parameters including fiber width and density, percentage neural tissue, and total fiber number. There was no statistical difference in walking track analysis between groups at 4 weeks. By 20 weeks, functional recovery statistically poorer than autograft was seen only in the fresh allograft groups receiving 0 or 2.5 mg/kg of CsA. Identical electrophysiologic findings were seen at 20 weeks. These results suggest that nerve graft preservation may decrease systemic immunosuppression requirements while improving functional recovery. As well, storage of nerve grafts is feasible and would facilitate elective surgery and less costly reconstructive repair.     

Peripheral nerve repair in the hand with and without motor sensory differentiation

To investigate the value of motor sensory differentiated nerve repair, we examined a group of 9 patients with motor sensory differentiated nerve repair and a group of 13 patients without motor sensory differentiated nerve repair. The clinical and electroneurographic findings were compared. For the clinical examination, Millesi's scoring system was used. The hand function after motor sensory differentiated median nerve repair was 72% +/- 16% compared with 57% +/- 14% without motor sensory differentiation. The hand function after motor sensory differentiated median and ulnar nerve repair was 53% +/- 12% compared with 43% +/- 24% without motor sensory differentiation. After ulnar nerve repair the achieved values for hand function were high even without motor sensory differentiation. Our results indicate that intraoperative motor sensory differentiation of injured nerves is helpful to reestablish particularly the sensory function in median nerve injuries.     

Peripheral nerve maturation in English, West Indian and Turkish newborn infants

Forty-five patients who underwent a 14 by 4 inch jejunoileal bypass for morbid obesity were studied before the operation and at periodic intervals after operation to determine the complications and changes in body composition resulting from this procedure. Body composition studies were determined using 3H2O and 42K. Rapid weight loss occurred in the first 3 months, with a mean loss of 30 percent of excess weight. This weight loss was accompanied by a decrease in exchangeable potassium (Ke) and total body water (TBW) during this interval by 14 and 10 percent, respectively. Although most patients continued to lose excess weight Ke and TBW stabilized at the end of the first year and returned to preoperative values in six patients at the end of 24 months. Analysis of the ratios of body cell mass and total body water to weight shows an improvement of body composition 12 months after operation. Body composition studies permit a quantitative assessment of the nutritional status in patients undergoing jejunoileal bypass. In spite of significant complications (23 percent), surgery for morbid obesity appears to satisfy the objective of allowing desirable loss of fat with relative sparing of muscle and other supporting tissues.     

Peripheral nerve insult induces NMDA receptor-mediated, delayed degeneration in spinal neurons

Injury of a peripheral nerve gives rise to adaptive functional and structural alterations in spinal neurons. We report that the rearrangement of the spinal circuitry in response to sciatic nerve transection in adult rats involves a delayed mode of degeneration of lumbar spinal cord neurons. Nuclear fragmentation was detected by the TUNEL technique 7 days after sciatic neurectomy but not after 3 or 14 days. Dying cells were preferentially located in the ipsilateral superficial dorsal horn and expressed the neuronal cytoskeletal marker SMI-31. Degeneration was prevented by continuous systemic treatment with the NMDA receptor-antagonist MK-801. These data are supportive that apoptosis is induced in spinal neurons in a transsynaptic manner by an early signal from injured afferent fibres via activation of spinal NMDA receptors.     

Peripheral nerve changes in thiamine deficiency and starvation. An electron microscopic study

The treatment of iatrogenic esophageal perforation is still today subject of discussion. The present work relates our experience on 16 cases seen between 1955 and 1976, and compares the results with the 1,310 collected by French and English literature. The etiology of perforation is: endoscopy (50.5%), dilatation (19.5%), foreign bodies (14%), surgery and other causes (16%). The mortality rate of cervical perforations is 14.5% (7.3% with medical treatment, 18% with drainage, 12.6% with suture). In the thoracic esophagus it is 32.5% (50% with medical treatment, 40% with drainage, 18% with suture). The data demonstrate that the best results are obtained with surgical treatment, that may be simple drainage when the perforation is cervical, but must be the suture in the thoracic esophagus. We must emphasize that the operation must be performed within 24 hours, because, in the cases operated on after 24 hours, the mortality rate is nearly double.     

Peripheral sensory nerve dysfunction in children and adolescents with type 1 diabetes mellitus

The aim of the present study was to investigate peripheral sensory nerve function in diabetic children and adolescents without neurological symptoms. Ninety-two children and adolescents with Type 1 (insulin-dependent) diabetes mellitus (mean +/- SD age: 14.2 +/- 2.1 years, diabetes duration: 5.8 +/- 3.0 years) and 80 healthy control subjects (age: 13.8 +/- 2.2 years) matched for age, sex, body mass index, and height standard deviation score were involved in the study. Using a sine-wave transcutaneous stimulator, current perception threshold (CPT) testing at 2000, 250 and 5 Hz was performed on the left median and peroneal nerves. Diabetic children had increased CPT at 2000 Hz on both nerves as compared to the control group (median (interquartile range), median nerve: 2.43 (2.20-3.43) vs 1.80 (1.51-2.60) mA, p = 0.02; peroneal nerve: 3.51 (2.81-4.82) vs 2.70 (2.04-3.70) mA, p = 0.01). Twenty-one (23%) of patients had CPT values higher than that of any healthy individual. Of these, elevated CPT was observed in 9 (9.8%) patients on the median nerve, in 8 (8.7%) patients on the peroneal nerve, and in 4 (4.3%) patients on both median and peroneal nerves. Using multiple logistic regression analysis, worse long-term metabolic control and advanced puberty were independently predictive of peripheral sensory nerve dysfunction as the dependent variable (adjusted OR (95% CI): 3.4 (1.2-6.2), p = 0.01, and 2.8 (1.1-5.6), p = 0.03, respectively). In conclusion, evidence of peripheral sensory nerve dysfunction is not rare in children and adolescents with diabetes and can be demonstrated by CPT testing in asymptomatic patients. Poor metabolic control is a risk factor for such subclinical neuropathy, and pubertal development may be involved in the pathogenesis of diabetic peripheral neuropathy.