Showing 21 results for Nerve
Tak Zareh N, Jamaly M, Yarmohammadi K, , , ,
Volume 59, Issue 1 (4-2001)
Abstract
The nervous system has an important and vital role in the human body, but unfortunately the repairment of damaged nervous tissue is very slowly. For a long time, the scientists have been involved in finding ways to speed up this process. Radiation of low power He-Ne laser has been suggested to as a way to improve this issue. In this study, 20 rats were divided randomly into control and case groups. The sciatic nerves of all these rats were damaged under general anesthesia and sterile conditions. The day of surgery was considered as the day zero. Rats of case group received every day laser radiation (?=65 mm). At 27th day rats were killed by ether and the sciatic nerve was studied histologically. Data was analysed and the difference was significant. In the case group the repairment was faster. We concluded that low power He-Ne laser radiation on crushed sciatic nerve of the rats has accelerated the nerve repairment process.
Naraghy Ma, Ragerdy Kashani I, Barbarestani M, Abdolvahhabi A, Pasbakhsh P,
Volume 59, Issue 1 (4-2001)
Abstract
This study was conducted on 48 specimens of Rectus abdominis muscles for recognition and definition of passage and ramification of lower intercostal nerves. The main results of this study are as follows: 1- The seventh and eight intercostal nerves penetrated to posterior layer of the Rectus sheath while other intercostal nerves perforated to dorsal layer of internal oblique abdominis aponeurosis. 2- Distance between lateral border of the Rectus abdominis muscle till penetrate point for all nerves were 18±1 mm, but the subcostal nerve was 16±1 mm. 3- Each intercostal nerve was ramified in thickness of muscle and formed many branches that maximum of this was middle longitudinal region and minimum of that was lateral longitudinal region. In addition we did not observe the nerve anastomosis between intercostal nerves. 4- The lower primary branch of the intercostal nerve after piercing of anterior layer of the Rectus sheath was named anterior cutaneous branch and terminated to abdominal skin. 5- All of intercostal nerves at first was placed right angle to muscle fibers but immediately decrease its and was placed parallel to muscle fibers. 6- The entrance, passage and ramification of intercostal nerves in both male and female cadavers were similar.
Farzan M, Mostafavi A,
Volume 59, Issue 1 (4-2001)
Abstract
Between 1371 to 1379, of 10 patients with radial tunnel syndrome, 9 patients were treated by decompression of the posterior interosseous nerve. 8 patients were followed up more than 10 months. One patient improved without surgery. Half of the patients suffered from pain and all of them had variable degrees of paralysis in muscles innervated by deep branch of the radial nerve. The syndrome was diagnosed after an average of 26 months after onset of symptoms. 3 patients had associated endocrine disease and 2 patients suffered from another accompanied compression neuropathy. 8 patients performed strenuous, repetitive upper extremity tasks. EMG confirmed the diagnosis in all patients. The source of nerve entrapment was identified as the arcade of Frohse in 4 patients. Malignant soft tissue tumor was responsible for nerve compression in one patient. More than one pathologic site was responsible for nerve entrapment in another 4 patients. Of 8 patients with enough follow-up after operation, pain was improved in all, but paralysis was improved in only half of them. According to ritts criteria, results were good in 50% of patients and in 50% of patients results were bad. All bad results were due to persistence of paralysis in affected muscles. One of four patients who had no improvement in paralysis, was satisfied with surgical result because tendon transfer was performed at the time of nerve decompression. It is recommended that all possible sites of nerve compression in the radial tunnel be explored and released.
Motasaddi Zarandy M, Amirabadi M, Ramazani H3,
Volume 60, Issue 1 (4-2002)
Abstract
Chronic otitis media and mastoiditis is a common otologic condition. Although it does not occur as frequently as acute otitis media, but remains a persistent and perplexing problem. Nowadays, although with improved access to medical care , advanced technology of imaging and entrance of new powerful antimicrobials, dangerous and deathful complications of c.o.m have become less common significantly, but unfortunately more of less serious complications is seen continuously.
Materials and Methods: A retrospective study of 1500 patients with C.O.M that had been operated during the years 1991 - 97 in Amir hospital was conducted.
Results: patients had ages between 8 months to 78 years old with a peak incidence at 3rd decade of life. Among that patients, 56 patients (3.7 percent) had one of major C.O.M complications. Over ally, in order of frequency, we found: facial nerve paralysis 27 pt (1.8 percent) labyrinthitis and perilymphatic fistula 16 pt (1.06 percent) Intracranial abscess 5 pt (0.33 percent), lateral sinus thrombosis 4 pt (0.26 percent) Meningitis 2 pt (0.13 percent) and Bezold's abscess 2 pt (0.13 percent) peak - age incidence of complications was 3rd decade of life and M/F incidence of complications was 3/2.
Conclusion: The early diagnosis and treatment of C.O.M complications are very important (specially intracranial complications), but it can be possible if the physician thinks about it.
Ghini Mr, Ghaffari S, Banki Ma,
Volume 61, Issue 5 (8-2003)
Abstract
Because of high prevalence of upper limbs pain and carpal tunnel sndrome and the need of proofing of diagnosis by nerve conduction study (NCS) testing of edian nerve is one of the most common exams in electro-diagnostic centers. In interpretation of findings of nerve conduction study presence of a normal range for findings is one of the most important points.
Materials and Methods: In this study we obtained the findings of nerve conduction study of median nerve in 60 normal persons.
Results: The mean of motor distal latency was 3.09 ms (SD: 0.35). The mean of sensory distal latency measured to peak of response was 3.04 ms (SD: 0.28) with increasing age mean of motor and sensory distal latencies increased. Most of findings had no significant difference with other references.
Conclusion: There is no problem in using of the normal ranges of the other countries for Iranian patients.
Farzan M, Espandar R, Fallah Y, Farhoud Ar,
Volume 67, Issue 9 (12-2009)
Abstract
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Background: Nerve
entrapment neuropathies are relatively frequent in the upper limb. Significant
costs related to resultant disability and treatment, and also simultaneous
occurrence of some of these syndromes can result in alteration in the treatment
approach. The aim of this study was to evaluate the frequency of these
syndromes, the rate of concurrence of carpal tunnel syndrome as the most
prevalent syndrome with others, related risk factors, and accordance of
clinical and electrophysiological findings.
Methods: In a retrospective study, data of
the 170
affected patients to these syndromes operated during a period of 10 years in a
referral center were searched using recorded documents. Information about patient's gender, age, occupation and
associated co-morbidities, clinical and surgical findings and their accordance
to the EMG-NCV findings, and also concurrence of these syndromes
were assessed.
Results: Patients' range of age was 10-91 year (mean:
48.09
year) and 74.5% of them were female. In this study carpal tunnel and
cubital tunnel syndrome were the most frequent (81.7% and 15.8%
respectively). In 23.5% of patients with carpal tunnel syndrome,
electrophysiological findings were negative but there was no false positive
result. Concurrent carpal tunnel syndrome with other syndromes were found in three
cases of cubital tunnel syndrome, two cases of thoracic outlet syndrome and one
case of Guyon's canal syndrome.
Conclusion: Constellation of symptoms, physical examination and electrophysiologic-al
findings altogether should be considered for correct diagnosis of nerve
entrapment syndromes in the upper extremity. Simultaneous entrapment in the
other regions of the same nerve or other nerves in the same extremity is a
probable condition
Ali Ghafouri, Zhamak Khorgami, Saadat Moulanaei,
Volume 67, Issue 12 (3-2010)
Abstract
Background: Intraabdominal schwannomas are rare tumors mostly occur in patients with neurofibromatosis. Tumors arisen from vagus nerve are rarer especially in sporadic cases.
Case: A 34-year-old man admitted in surgery ward Milad Hospital, in Tehran, Iran with long-lasting vomiting, dysphagia, and cachexia for four years. Multiple previous paraclinical assessments were normal, he had been treated as anorexia nervosa for three years without improvement. Our evaluations showed a mass in diaphragmatic hiatus. Explorative laparotomy revealed a mass parallel to distal esophagus, which was resected completely. Immunohistochemical examinations revealed a benign schwannoma. After surgery, the patient&aposs symptoms recovered and he returned to normal life.
Conclusions: Vagus nerve schwannoma can present with dysphagia and cachexia with normal endoscopic evaluations. It is important to rule out physical causes in patients with cachexia who are treated with psychiatric diagnoses.
Alizade Khatir A, Panahkhahi M, Khage Nasiri A, Ramim T, Toghae M,
Volume 70, Issue 5 (8-2012)
Abstract
Background: Medication overuse headaches (MOH) include headaches that last more than 15 days a month and usually occur after long-term use of analgesic. Most methods of medical treatment are ineffective. In some studies, great occipital nerve block is used to treat the headaches.
Methods: This double-blind experimental study was performed in adult patients with MOH who attended Sina Hospital in Tehran from June 2009 to June 2011. Greater occipital nerve (GON) block was done in the two groups of patients by administering a combination of 3 ml of 0.5% bupivacaine and 2 ml of 5% saline or 3 ml of 0.5% bupivacaine and 80 mg of methyl prednisolone. We evaluated headache severity by Visual analog scale (VAS) and recorded days without headache. If patients were taking pain medications, preventive medications were given as usual before and after the injection. Student's t-test was performed for statistical analysis and a P<0.05 was considered significant.
Results: Overall, 13 male and 19 female patients with a mean age of 39.88±8.76 years participated in the study. The mean reduction in headache severity one hour after injection was 5.56±1.03 and 4.63±1.92 in the first and second groups, respectively. Average days without headache one month after injection were 8.75 and 4.75 days in the first and second groups, respectively. There were no significant differences between the two groups.
Conclusion: Both methods seem to be effective in medication overuse headaches treatment. This finding is important as non-responders to conventional methods will otherwise have a decreased quality of life.
Akbari H, Fatemi Mj, Shakour Z, Mousavi Sj, Madani P, Pedram Ms,
Volume 70, Issue 10 (1-2013)
Abstract
Background: Autograft is the best option in nerve defects when end-to-end repair can not sufficiently preserve nerve continuity. Theoretically, if the severed nerve is reversely grafted, it may prevent axonal growth into nerve branches, and larger amounts of axons will reach the target organ and more satisfactory results will be obtained. In this study we aimed to compare conventional versus reverse nerve grafting.
Methods: This study was performed in Animal laboratory of Hazrat Fatemeh Hospital from April till August 2011. We randomly divided 40 Wistar rats into two groups. We excised 1.5 cm of the right sciatic nerve and anastomosed it conventionally between the proximal and distal ends of the nerve in rats in group A and in a reverse manner in rats in group B. The rats’ footprints were recorded in the first and 16th weeks after surgery. In week 16, the grafted nerves were removed under anesthesia for pathological examination and axon count. Subsequently, the results were compared clinically by sciatic functional index (SFI) through footprint analysis and paraclinically by axon count. A p-value smaller than 0.05 was considered statistically significant.
Results: Conventional and reverse nerve grafting no had statistically significant differences in clinical assessment in the first and 16th weeks (P=0.87) post-surgically and also no difference in paraclinical assessment in week 16 (P=0.68).
Conclusion: We had no significant clinically or para clinically differences between two approaches. It should be considered that the diameter and length of nerves and muscles in human is larger than rats, so the results of nerve repair may differ in human. We suggest a study in animal model which is anatomically more similar to human.
Seyed Masoud Hashemi , Mahshid Nikooseresht , Farshad Hassanzadeh Kiyabi ,
Volume 71, Issue 6 (9-2013)
Abstract
Background: Ischaemic pain counts among the most difficult to treat pains in palliative care. Ischemic pain is frequently severe, and usually resistant to available analgesics. Treatment of this condition is difficult, especially when the condition is inoperable.
Case presentation: A 36-year-old woman with the diagnosis of systemic lupus erythematosus with severe ischemic pain in the lower leg due to vascular problems presented to Akhtar Hospital. The patient was arranged for lumbar sympathetic block which was performed in two stages with one week interval. In the procedure, a long needle with No. 22 gauge and the length of 15 cm was used. Under view of fluoroscopy guide, 10 cc marcaine 0.125% was injected. In the second stage, 5 cc of marcaine 0.25% and 5 cc of phenol 0.6% were used. Pain improvement was observed immediately after neurolytic lumbar sympathetic block. Three-month follow up period revealed improvement of quality of life.
Conclusion: Lumbar sympathetic block is considered as a safe and useful technique. Clinically, the technique is effective for pain relief in patients who develop lower leg pain due to vasculitis.
Mehdi Moghtadaei , Hossein Farahini , Hamid Reza Faiz , Farzam Mokarami , Razieh Nabi ,
Volume 71, Issue 7 (10-2013)
Abstract
Background: Pain is one of the greatest concerns of patients undergoing total knee arthroplasty (TKA) which is severe and intolerable within 72 hours post-surgery. Appropriate pain management is a key factor in patient's early mobilization, launching physiotherapy, less hospital length of stay and more importantly, patient's satisfaction. New studies with the infiltration of combined analgesic agents peri and intra-articularly has shown encouraging results in pain reduction, good clinical outcome and patient's satisfaction. The purpose of this study was to compare the analgesic effect of locally infiltrated analgesia (I) compared with single injection femoral nerve block (F) and its impact on pain relief, patient's satisfaction, morphine consumption and clinical outcome.
Methods: This research was a double-blind randomized clinical trial on 36 consecutive patients undergone TKA divided into group (F) in which the ipsilateral femoral nerve in the inguinal area was blocked by a single injection of 20 ml ropivacaine (10 mg/ml) and group (I) which a combination of ketorolac, ropivacaine and epinephrine was injected peri and intra-articularly on the knee during TKA. Pain intensity measured by visual analog scale (VAS), clinical outcome (based on range of motion), morphine consumption and patient's satisfaction of pain management after TKA were compared between the two groups.
Results: Pain intensity score (VAS) and Morphine consumption were statistically less in group I than group F during the first 6 hours and 24 hours post surgery respectively (P< 0.05) however, group F had 12-hour VAS score of 5 which was less than group (I) by 1 grade in pain scale (VAS) (P< 0.05). Other parameters were not statistically different in the two groups and patients' response to our pain management protocols proved to be satisfactory in both groups.
Conclusion: Lower level of pain and morphine consumption in group (I) during the first 24 hours post-surgery in contrast to group (F) and its ease of use by a surgeon intra-operatively, introduce local infiltration analgesia as an effective method to decrease the patient's pain and improve patient's satisfaction in early post-surgery period after total knee arthroplasty.
Arezo Nahavandi , Fatemeh Bakhtiarzadeh , Mansureh Soleimani ,
Volume 72, Issue 11 (2-2015)
Abstract
Background: Depression, as one of the most prevalent and disabling disorders in the world, has a complex and yet not well-known pathophysiology. Genetic, hormonal, neurotransmitter, inflammatory and neurodegenerative theories are all responsible. Studies show that depression leads to structural changes in the hippocampus, prefrontal cortex, amygdala, anterior cingulate, and basal bodies. Hippocampal volume loss is observed due to the death of nerve cells, neurons, and glial cells, and reduced neurogenesis. The hippocampus is a part of the limbic system. The limbic system is the area in the brain that is associated with memory, emotions, and motivation. The limbic system is located just above the brain stem and below the cortex. Despite the many studies related to the reduced hippocampal neurogenesis in depressed patients, no study has compared the amount of neurodegeneration between the left and right hippocampus. In this study, we compared neurodegeneration levels in the right and left hippocampus of the rats.
Methods: Twenty male Sprague-Dawley rats that were purchased Razi Institute, Karaj, Iran, were evaluated in the study. This study was conducted in cellular and molecular center in Iran University of Medical Sciences, from June 2012 to June 2013. Half of them had unpredictable chronic mild stress (UCMS) for 21 days to develop depression. The forced-swimming test (FST) was used to measure the immobility time (IB), a symptom of depression. One week after the behavioral test, the rats were prepared for transcardial perfusion. Then, paraffin fixed brain was excised and the hippocampus was prepared for Nissl staining. All above-mentioned procedures were performed for the control group too except inducing UCMS.
Results: Our results increased IB in the UCMS group, 68.8 second in stress group and 15.1 second in control group. Nissl staining showed prominent neural degeneration in the hippocampus of the rats in the UCMS group. Comparison of the left and right hippocampal cells revealed that the right hippocampus (mean= 49.166) was more vulnerable to stress than the left hippocampus (mean= 76.6).
Conclusion: Our study showed different manifestations of depression after UCMS. It showed that UCMS could lead to mental depression. This study showed that the right hippocampus was more sensitive to stress than the left hippocampus. In fact, UCMS resulted in depression. The study showed that the right hippocampus was more sensitive to stress than the left hippocampus. Therefore, the main function of the right hemisphere, which is adaptation to the new environment, is disturbed more.
Mohammad Javad Fatemi , Farzin Pakfetrat , Mohammad Reza Akhoondinasab Akhoondinasab , Kourosh Mansouri , Seyed Jaber Moosavi , Seyed Aboozar Hosseini , Mitra Niazi ,
Volume 73, Issue 10 (1-2016)
Abstract
Background: Peripheral nerve injury is one of the most challenging of modern surgical problem. Recent advances in understanding the physiological and molecular pathways demonstrated the important role of growth factors in peripheral nerve regeneration. Platelet-rich plasma (PRP) is a biological product that has many growth factors. The aim of this study was to investigate the effect of PRP in the regeneration of sciatic nerve crush in the rat model.
Methods: In this experimental study that established in the animal lab of the Hazrat Fatemeh Hospital in Tehran from September to October 2013, Twenty-four healthy male Sprague-Dawley rats (200-250 g) were randomly divided into two groups. In all rats the sciatic nerve was cut and then carefully repaired by the tension free method under a light microscope. In group 1, after the repair, 0.05 µL of PRP was injected below the epineurium to the proximal and distal parts of the repaired area. In group 2 the same amount of normal saline was injected to the proximal and distal of the repaired area. After six weeks footprint analysis, neurophysiologic and histopathology evaluations were performed.
Results: Significant differences existed between the two groups footprint analysis (P= 0.001). Also the nerve conduction latency test was significantly shorter in PRP group. (1.0233 ms in PRP group and 1.7375 ms in control) (P< 0.001). The average amplitude in the first group and the second group was 7.6250 mv (control) 6.3667 mv that does not show a statistically significant difference (P= 0.093). Significant differences between the two groups in the number of axons of the proximal portion of the study was not seen (P= 0.29). The parameters included number of axons of the proximal and the distal part of axons, the diameter of the distal and proximal axons in the two groups were compared. In the two groups there was statistically significant difference between the above parameters. (P= 0.298).
Conclusion: It seems that PRP may have an important role in peripheral nerve regeneration and functional recovery after nerve laceration and repair. Further clinical evaluation recommended.
Farideh Zafari Zangeneh, Mohammad Mehdi Naghizadeh , Masoumeh Masoumi ,
Volume 74, Issue 7 (10-2016)
Abstract
Background: Polycystic ovary syndrome (PCOS) is a common complex condition in women associated with reproductive and metabolic systems and also psychological disorders. There is considerable evidence to suggest that the sympathetic nervous system is involved in PCO and metabolic syndromes. Noradrenalin (NA), corticotrophin releasing hormone (CRH) and nerve growth factor (NGF) are the strong stimulants for two axes: hypothalamic-pituitary-adrenal (HPA) and hypothalamic-pituitary-ovarian (HPO) axes which are regulators for the female reproductive system. Following previous studies on sympathetic nervous system over activity in PCOS, the main purpose of this study is to evaluate the role of CRH and NGF as two important findings from the perspective of the psycho-emotional.
Methods: This case-control study was conducted in Reproductive Health Research Center of Imam Khomeini Hospital, Tehran, Iran in the September of 2011. 170 women participated in this study. The diagnosis of PCOS was made according to the joint criteria of the European Society of Human Reproduction and Embryology and the American Society of Reproductive Medicine (ESHRE/ASRM). All women have 20-40 years of age and body mass index (BMI) of less than 28. Demographic questionnaire was used in this study and blood sample was obtained from all participants before 8AM. All analysis was done in SPSS software, version 19 (IBM SPSS, Armonk, NY, USA). P-value less than 0.05 considered as significant level.
Results: Serum levels of CRH and NGF in patients with polycystic ovary was significantly lower than the control group (P< 0.001). This reduction can disrupt two neural axes: the sympathetic nervous system (SAS) and hypothalamus-pituitary-adrenal (HPA). These axes have a fundamental role in psycho-emotional reactions in women with PCOS. Moreover, using demographic questionnaire quantitative and qualitative characteristics of the population studied, the results of which are reported in the regression model.
Conclusion: The results of this study confirmed previous studies. This reduction in serum levels of CRH and NGF shows the hyperactivity of sympathetic nervous system in polycystic ovary syndrome can be one of the causes of mental disorders in women with PCOS.
Arash Abdolmaleki, Mohammad-Bagher Ghayour, Saber Zahri, Asadollah Asadi , Morteza Behnam-Rassouli ,
Volume 77, Issue 2 (5-2019)
Abstract
Background: Tissue engineering is a developing multidisciplinary and interdisciplinary field involving the use of bioartificial implants for tissue remodeling with the target for repair and enhancing tissue or organ function. Acellular nerve has been used in experimental models as a peripheral nerve substitute. The purpose of the present study was to evaluate the mechanical and histological characteristics of acellular nerve scaffolds compared to the fresh nerve for application in environmental nerve repair.
Methods: This experimental study was conducted in Ferdowsi University of Mashhad Regeneration Research Laboratory, Mashhad, Iran, from May 2017 to October 2018. In this study for preparing the scaffold. The rats were sacrificed by intraperitoneal anesthesia with 10 % Chloral Hydrate solution. Then sciatic nerve fragments of the rats were removed above the nerve branching site and after cleansing of the tissues were decellularized by Sondell method, briefly nerves were treated with a series of detergent baths consisting of distilled water for 8 h, Triton X-100 for 12 h, and sodium deoxycholate for 24 hours according to the Sondell protocol. All acellularization steps were performed at room temperature. Then decellularized scaffolds were evaluated histologically and mechanically.
Results: The results of tissue evaluations showed that decellularization of scaffolds were done completely, this was demonstrated by hematoxylin and eosin staining and DAPI staining. Also the specialized tissue evaluations by picro-fuchsin staining and evaluation the scaffolds by scanning electron microscopy (SEM) micrographs showed that the collagen and elastin strands are relatively preserved in the extracellular matrix in comparison with control groups. As well as mechanical examination of scaffolds in tensile test showed that extracellular matrix of scaffolds was relatively preserved the main components of tissue compared to control group and scaffolds have good mechanical resistance quality for use in tissue engineering.
Conclusion: The results of the present study showed that decellularized scaffolds that prepared with Sondell decellularization method by preserving the main components of the tissue can be a good platform for investigating cellular behaviors.
Mohammadreza Emamhadi , Ashkan Asgari-Gashtroudkhani , Roxana Emamhadi , Samaneh Ghorbani-Shirkouhi , Sasan Andalib,
Volume 78, Issue 2 (5-2020)
Abstract
Background: Cubital tunnel syndrome, a neuropathy of ulnar nerve, is the second most common entrapping syndrome in the upper limb surpassing carpal tunnel syndrome. This syndrome arises from a high pressure decompressing the nerve for a long time. Patients with cubital tunnel syndrome show numbness in the ring and small fingers. The aim of this study was to evaluate the etiology of cubital tunnel syndrome in patients who underwent surgery for treatment of the syndrome.
Methods: In this retrospective study, medical records of 100 patients who underwent surgery for treatment of cubital tunnel syndrome at Department of Neurosurgery, Poursina Hospital, Rasht, Iran from March 2008 to March 2017, were checked. The etiology of cubital tunnel syndrome including inflammatory, tumoral, vascular, orthopedic causes and anomalies in nerve site and information about age, gender, job, and weight were collected and analyzed.
Results: In this study, the mean±SD of age was 33.8±11.5 years. Females and males constituted 21% and 79% of the cases, respectively. Idiopathic and orthopedic etiologies were seen in 84% and 13% of the operated cases, respectively. Vascular, tumoral, and inflammatory causes were found in 1% of the cases. Regarding location of nerve involvement, 57% of the cases had the ulnar nerve entrapment between MCL (medial collateral ligament) and Osborne ligaments; and in 22% of the cases, the cubital tunnel was involved. Arcade of Struthers and medial epicondyle and medial intermuscular septum were involved in 8%, 8%, and 5% of the patients, respectively. Forty-five percent of the cases performed a repetitive manual task by hand and 1.9% of cases were vibrator workers. Moreover, 12.4% of cases had a history of cubitus valgus or cubitus varus. Finally, 20.9% and 18% of the cases suffered from obesity (BMI>30) and diabetes mellitus, respectively. Furthermore, one patient had a history of head injury with contractions of upper limb flexion and one patient had arthritis of medial epicondylitis.
Conclusion: The evidence from the present study indicates that the idiopathic cubital tunnel syndrome constituted the bulk of involvement on ulnar nerve in the patients. Job, obesity, and diabetes were the most important accompanying factors with cubital tunnel syndrome.
Fakhroddin Aghajanpour, Reza Soltani, Azar Afshar, Hojjat Allah Abbaszadeh, Reza Mastery Farahani, Mohsen Nourozian,
Volume 79, Issue 4 (7-2021)
Abstract
Background: The median nerve is one of the most important branches of the brachial plexus. Due to the role of the median nerve in sensory and motor innervation of the forearm and hand in the upper limbs, its blood supply is very important. Awareness of variations in the blood supply pattern to this nerve reduces the incidence of necrosis and ischemia of the nerve during surgical and diagnostic procedures.
Case Presentation: During routine dissection of the cadaver of a 65-year-old man fixed in formalin (10%), in the Department of Anatomy and Reproductive Biology, Shahid Beheshti University of Medical Sciences, a rare variation was observed in the median nerve nutritional artery at the distal end of the left forearm. After dissection of the skin, superficial and deep fascia, anterior compartment forearm muscles, nerves and blood vessels were exposed from surrounding tissues. The median nerve passed through the two heads of the pronator teres muscle and left the cubital fossa in the depth of the flexor digitorum superficialis and the surface of the flexor digitorum profundus in the forearm. It was observed that at the distal end of the left forearm between the flexor carpi radialis and the flexor digitorum superficialis, a relatively thick branch originates from the radial artery and supplies blood to the median nerve. This branch was separated from the radial artery (before the artery enters the anatomical snuffbox) and crossed the surface of the flexor carpi radialis muscle and inserted into the median nerve sheath. In the forearm, this branch was the only artery supplying blood to the median nerve.
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Conclusion: Due to the superficial position of the median nerve at the distal end of the forearm, physical damage to the nerve and its nutritional artery leads to necrosis and ischemia of the nerve, and ultimately disturbed the transmission of sensory and motor messages.
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Kambiz Javadzadeh Siahkelrodi , Shahpour Shoja, Karim Naseri, Farzad Sarshivi, Shahrokh Ebnerasouli, Mohamad Aziz Rasouli , Shaho Shoja ,
Volume 79, Issue 7 (10-2021)
Abstract
Background: Bier block is a reliable technique used in extremity surgeries. Typically, angiocatheters are palced in the distal portion of the extremity that is going to be operated. Although, it is not the case in every operation. Therefore, determining the effectiveness of the local anesthetic injection site on the quality of the upper-extremity block can be helpful.
Methods: In this double-blinded randomized clinical trial that took place in Kowsar Hospital (Sanandaj, Iran) at 2020, 60 patients after complete monitoring and sedation were assigned randomly into proximal bier block (32 in experimental) and distal bier block (28 in control) groups. 10ml/kg Ringer serum was prescribed for patients in both groups on the non-surgical hand. Depending on the patients’ placement in either group, an angiocatheter (22 or 24) was attached to the ante-cubital area (proximal bier block group) or on the back of the patient's hand (distal bier block group). Respectively, after blood was drained by a Smarch band from the extremity that was to be operated, the tourniquet was inflated up to 150mmHg above the patient’s systolic pressure and the smarch band is untied from the hand. For every patient regarding the group they were assigned, 3mg/kg lidocaine 0.5% was administered through an angiocatheter. After 5 minutes, the depth of patient's anesthesia and pain intensity were measured. Sensory and motor recovery was assessed every 10 minutes after surgery. Patient satisfaction with anesthesia was measured after the surgery and characterized by excellent, good, moderate (pain relief), and unsuccessful (need for pain medications) indicators. In case insufficient depth was reached, intravenous Remifentanil was injected.
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Results: According to the results of the chi-squared test, there were no significant differences in gender distribution (p=0.063), anesthesia class type (p=0.964), type of surgery (p=0.694), anesthesia satisfaction (p=0.578), sensory block of hand (p=0.529), motor block of hand (p=0.059), pain intensity (p= 0.634), pain relief medication requesting (p=0.755) and also body mass index (T-test used P=0.099) variables comparing both groups together. Additionally; according to the T-test results no significant differences were reported in the mean systolic pressure, mean diastolic pressure and mean heart rate variable in designated times.
Conclusion: There is no significant difference between the two groups. Therefore, using a distal Bier block can be an alternative if needed.
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Somayeh Nazari , Raheleh Rafaiee, Hamed Ghazvini , Elmira Beirami , Sara Chavoshinezhad , Seyedeh Masoumeh Seyedhosseini Tamijani ,
Volume 80, Issue 4 (7-2022)
Abstract
The vagus nerve (VN), the longest cranial nerve and an essential part of the parasympathetic system, connects the central nervous system to respiratory, cardiovascular, immune, gastrointestinal, and endocrine systems and is involved in the maintenance of homeostasis by controlling these systems. Vagus nerve stimulation (VNS) is related to any method that would stimulate the vagal nerve via electrical stimulation. VNS is a Food and Drug Administration (FDA)-approved treatment for medication-resistant depression, drug-resistant epilepsy, and migraine. However, VNS has also been studied for various other conditions, such as Alzheimer's disease and tinnitus, by targeting the VN in the neck and ear. Currently, there are two methods for VNS: a) invasive-VNS (iVNS), which requires surgical implantation of a pulse generator under the anterior chest wall, that is linked through a wire to an electrode cuff that wraps around a cervical vagus nerve, b) non-invasive transcutaneous VNS which is separated into cervical transcutaneous vagal nerve stimulation (ctVNS) and auricular transcutaneous vagal nerve stimulation (atVNS). The non-invasive transcutaneous VNS techniques are well tolerated and have no significant side effects, making them effective in clinical research for brain diseases. Because with these newer methods, the electrical stimulation is carried out through the skin.
The results of this study were collected using the advanced search in Scientific Information Database (SID), Google Scholar, PubMed, and Scopus between 2011 to 2021. Out of 671 articles surveyed, we used 53 articles in the study after the evaluation. Medical Subject Headings (MeSH) and Keyword Searching was carried out through the MeSH database. VNS has been shown to alter neural activity in multiple areas of the brain related to the regulation of the affective states. However, the precise mechanism of VNS action on the clinical consequences is still unknown. This study aimed to review the therapeutic effect of both methods of VNS in neuropsychiatric and neurological disorders such as depression, migraine, seizure, tinnitus and Alzheimer's disease and discuss several hypotheses on the mechanism of VNS, as a new approach, in the treatment of such disorders. It considers that a brain-mapping approach is needed to discover the therapeutic mechanisms of VNS in brain diseases.
Maryam Motamer, Maryam Kadivar,
Volume 81, Issue 2 (5-2023)
Abstract
Background: Colorectal cancer (CRC) is one important cause of mortality in the world. In the common staging systems of CRC, many biological behaviors of the tumor that determine the prognosis are not defined. Risk stratification is becoming increasingly important in low-stage CRC, because these patients do not undergo adjuvant therapy unless poor prognostic factors such as vascular invasion (VI), perineural invasion (PI) and serosal involvement (SI) are present. Accurate evaluation of these factors in CRC specimens is still challenging.
Methods: In this study, we evaluated the detection rate of VI, PI and SI in 180 patients of CRC who underwent surgical resection based on basic pathology reports, review of hematoxylin and eosin (H&E) slides with considering morphologic clues such as “protruding tongue” and “orphan artery” signs, and elastin stain for detection of VI. In addition, the stage of the disease, pT stage, tumor location, tumor type and grade were categorized, separately. We used the Fisher’s exact test for comparing variables between the two groups. P<0.05 was considered significant. All data analyzed using SPSS version 26.
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Results: Overall, the detection rate of VI was significantly increased in review of H&E slides with considering morphologic clues (P=0.019) and also using elastin stain (P<0.05) than basic pathology reports, but no significant differences observed in PI (P=0.118) and SI (P=1.00) between the first basic pathology reports and review of H&E slides. Also, significant differences observed in VI, PI and SI based on AJCC stage, pT stage and grade of tumor (P<0.05).
Conclusion: Considering the prognostic importance of VI detection in the treatment of patients of CRC, Slide review with attention to the morphologic clues such as “protruding tongue” and “orphan artery” signs and elastin staining could be used for better detection of VI in patients of CRC in routine surgical specimens.
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