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BACKGROUND: Evidence of the relationship between periodic limb movements during sleep (PLMS) and cerebral small vessel disease (cSVD) is limited and inconsistent. Here, we aimed to assess the independent association between PLMS and the different neuroimaging signatures of cSVD. METHODS: Atahualpa residents aged more than or equal to 60 years enrolled in the Atahualpa Project undergoing polysomnography and MRI with time intervals less than or equal to 6 months were included. MRI readings focused on white matter hyperintensities (WMH) of presumed vascular origin, deep cerebral microbleeds (CMB), silent lacunar infarcts (LI), and more than 10 enlarged basal ganglia-perivascular spaces (BG-PVS). Data from single-night polysomnograms were interpreted according to recommendations of the American Academy of Sleep Medicine. Associations between the PLMS index and neuroimaging signatures of cSVD (as dependent variables) were assessed by means of logistic regression models, adjusted for relevant confounders. RESULTS: A total of 146 individuals (mean age: 71.4 ± 7.5 years; 64% women) were included. A PLMS index more than or equal to 15 per hour were noted in 48 (33%) participants. Moderate-to-severe WMH were present in 33 individuals (23%), deep CMB in 9 (6%), silent LI in 16 (11%), and more than 10 BG-PVS in 44 (30%). In univariate analyses, silent LI (P = .035) and the presence of more than 10 enlarged BG-PVS (P = .034) were significantly higher among participants with a PLMS index more than or equal to 15 per hour. However, fully-adjusted multivariate models showed no significant association between PLMS index more than or equal to 15 per hour and any of the neuroimaging signatures of cSVD. CONCLUSIONS: This study shows no independent association between the PLMS index and neuroimaging signatures of cSVD in stroke-free community-dwelling older adults.
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Enfermedades de los Pequeños Vasos Cerebrales/diagnóstico por imagen , Vida Independiente , Extremidad Inferior/inervación , Imagen por Resonancia Magnética , Movimiento , Neuroimagen/métodos , Síndrome de Mioclonía Nocturna/fisiopatología , Sueño , Anciano , Anciano de 80 o más Años , Enfermedades de los Pequeños Vasos Cerebrales/epidemiología , Enfermedades de los Pequeños Vasos Cerebrales/fisiopatología , Ecuador/epidemiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Síndrome de Mioclonía Nocturna/diagnóstico , Síndrome de Mioclonía Nocturna/epidemiología , Polisomnografía , Valor Predictivo de las Pruebas , Medición de Riesgo , Factores de Riesgo , Salud RuralRESUMEN
Objective To analyze the combined effects of the silk protein sericin and swimming exercise on histomorphometry of the plantar muscle in Wistar rats. Methods Forty adult rats were randomly allocated into 5 groups comprising 8 animals each, as follows: Control, Injury, Sericin, Swim, and Swim plus Sericin. Three days after crushing of the sciatic nerve the rats in the Swim and Swim plus Sericin Groups were submitted to swimming exercise for 21 days. Rats were then euthanized and the plantar muscle harvested and processed. Results Cross-sectional area, peripheral nuclei and muscle fiber counts, nucleus/fiber ratio and smallest muscle fiber width did not differ significantly between groups. Morphological analysis revealed hypertrophic fibers in the Swim Group and evident muscle damage in the Swim plus Sericin and Injury Groups. The percentage of intramuscular collagen was apparently maintained in the Swim Group compared to remaining groups. Conclusion Combined treatment with sericin and swimming exercise did not improve muscle properties. However, physical exercise alone was effective in maintaining intramuscular connective tissue and preventing progression of deleterious effects of peripheral nerve injury.
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Extremidad Inferior/inervación , Músculo Esquelético/inervación , Condicionamiento Físico Animal/fisiología , Sericinas/farmacología , Natación/fisiología , Animales , Modelos Animales de Enfermedad , Extremidad Inferior/lesiones , Extremidad Inferior/patología , Músculo Esquelético/lesiones , Músculo Esquelético/patología , Compresión Nerviosa , Distribución Aleatoria , Ratas , Ratas WistarRESUMEN
Abstract Objective To analyze the combined effects of the silk protein sericin and swimming exercise on histomorphometry of the plantar muscle in Wistar rats. Methods Forty adult rats were randomly allocated into 5 groups comprising 8 animals each, as follows: Control, Injury, Sericin, Swim, and Swim plus Sericin. Three days after crushing of the sciatic nerve the rats in the Swim and Swim plus Sericin Groups were submitted to swimming exercise for 21 days. Rats were then euthanized and the plantar muscle harvested and processed. Results Cross-sectional area, peripheral nuclei and muscle fiber counts, nucleus/fiber ratio and smallest muscle fiber width did not differ significantly between groups. Morphological analysis revealed hypertrophic fibers in the Swim Group and evident muscle damage in the Swim plus Sericin and Injury Groups. The percentage of intramuscular collagen was apparently maintained in the Swim Group compared to remaining groups. Conclusion Combined treatment with sericin and swimming exercise did not improve muscle properties. However, physical exercise alone was effective in maintaining intramuscular connective tissue and preventing progression of deleterious effects of peripheral nerve injury.
RESUMO Objetivo Analisar o efeito da proteína sericina associada ao exercício físico de natação na histomorfometria do músculo plantar de ratos Wistar. Métodos Foram utilizados 40 ratos adultos divididos aleatoriamente em 5 grupos, com 8 animais cada: Controle, Lesão, Sericina, Natação, Natação e Sericina. Três dias após a compressão do nervo isquiático, os Grupos Natação e Exercício e Sericina foram submetidos ao exercício físico de natação durante 21 dias. Após, os animais foram sacrificados, e o músculo plantar foi processado. Resultados Não houve diferença da área da secção transversa entre os grupos, quantidade de núcleos periféricos, quantidade de fibra, relação núcleo/fibra e diâmetro menor. A análise morfológica revelou que no Grupo Natação ocorreu hipertrofia das fibras, assim como nos Grupos Exercício e Sericina e Lesão, o dano muscular foi evidente. O percentual de conjuntivo intramuscular parece ter sido mantido no Grupo Exercício em relação aos demais grupos. Conclusão A associação da proteína sericina e exercício físico de natação não foi eficiente na melhora das propriedades musculares, embora a aplicação do exercício físico tenha sido eficiente na manutenção do conjuntivo intramuscular, e no não agravamento dos efeitos deletérios consequentes da lesão nervosa periférica.
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Animales , Ratas , Condicionamiento Físico Animal/fisiología , Natación/fisiología , Músculo Esquelético/inervación , Extremidad Inferior/inervación , Sericinas/farmacología , Distribución Aleatoria , Ratas Wistar , Músculo Esquelético/lesiones , Músculo Esquelético/patología , Extremidad Inferior/lesiones , Extremidad Inferior/patología , Modelos Animales de Enfermedad , Compresión NerviosaRESUMEN
BACKGROUND: The use of surface electromyography (sEMG) to evaluate muscle activation when executing whole body vibration exercises (WBVE) in studies provide neuromuscular findings, in healthy and diseased populations. OBJECTIVES: Perform a systematic review of the effects of WBVE by sEMG of lower limbs in non-healthy populations. METHODS: The search using the defined keywords was performed in PubMed, PEDRo and EMBASE databases by three independent researchers. Applying the PRISMA statement several studies were selected according to eligibility criteria and organized for the review. Full papers were included if they described effects of WBVE for the treatment of illnesses, evaluated by sEMG of lower limbs independently on the year of the publication; in comparison or associated with other treatment and evaluation techniques. RESULTS: Seven publications were selected; two in spinal cord injury patients, one in Friedreich's ataxia patients, three in stroke patients and one study in breast cancer survivors. Reported effects of WBV in were muscle activation by sEMG and also on strength, blood flow and exercise resistance; even in paretic limbs. CONCLUSION: By the use of sEMG it was verified that WBVE elicits muscle activation in diseased population. These results may lead to the definition of exercise protocols to maintain or increase muscular activation. However, due to the heterogeneity of methods among studies, there is currently no consensus on the sEMG signal processing. These strategies might also induce effects on muscle strength, balance and flexibility in these and other illnesses.
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Extremidad Inferior/inervación , Fuerza Muscular/fisiología , Enfermedades Neuromusculares/rehabilitación , Modalidades de Fisioterapia , Vibración/uso terapéutico , Bases de Datos Bibliográficas , Electromiografía , Femenino , Humanos , Masculino , Enfermedades Neuromusculares/etiologíaRESUMEN
BACKGROUND: Repetitive transcranial magnetic stimulation (rTMS) has been investigated as a new tool in neurological rehabilitation of individuals with spinal cord injury (SCI). However, due to the inconsistent results regarding the effects of rTMS in people with SCI, a randomized controlled double-blind crossover trial is needed to clarify the clinical utility and to assess the effect size of rTMS intervention in this population. Therefore, this paper describes a study protocol designed to investigate whether the use of rTMS can improve the motor and sensory function, as well as reduce spasticity in patients with incomplete SCI. METHODS: A double-blind randomized sham-controlled crossover trial will be performed by enrolling 20 individuals with incomplete SCI. Patients who are at least six months post incomplete SCI (aged 18-60 years) will be recruited through referral by medical practitioners or therapists. Individuals will be randomly assigned to either group 1 or group 2 in a 1:1 ratio, with ten individuals in each group. The rTMS protocol will include ten sessions of high-frequency rTMS (5 Hz) over the bilateral lower-limb motor area positioned at the vertex (Cz). Clinical evaluations will be performed at baseline and after rTMS active and sham. DISCUSSION: rTMS has produced positive results in treating individuals with physical impairments; thus, it might be promising in the SCI population. The results of this study may provide new insights to motor rehabilitation thereby contributing towards the better usage of rTMS in the SCI population. TRIAL REGISTRATION: ClinicalTrials.gov, NCT02899637 . Registered on 25 August 2016.
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Extremidad Inferior/inervación , Traumatismos de la Médula Espinal/terapia , Médula Espinal/fisiopatología , Estimulación Magnética Transcraneal/métodos , Adolescente , Adulto , Brasil , Protocolos Clínicos , Estudios Cruzados , Método Doble Ciego , Femenino , Humanos , Masculino , Persona de Mediana Edad , Actividad Motora , Espasticidad Muscular/fisiopatología , Espasticidad Muscular/prevención & control , Plasticidad Neuronal , Recuperación de la Función , Proyectos de Investigación , Umbral Sensorial , Traumatismos de la Médula Espinal/diagnóstico , Traumatismos de la Médula Espinal/fisiopatología , Factores de Tiempo , Estimulación Magnética Transcraneal/efectos adversos , Resultado del Tratamiento , Adulto JovenRESUMEN
In brain cortex-ablated cats (BCAC), hind limb motoneurons activity patterns were studied during fictive locomotion (FL) or fictive scratching (FS) induced by pinna stimulation. In order to study motoneurons excitability: heteronymous monosynaptic reflex (HeMR), intracellular recording, and individual Ia afferent fiber antidromic activity (AA) were analyzed. The intraspinal cord microinjections of serotonin or glutamic acid effects were made to study their influence in FL or FS During FS, HeMR amplitude in extensor and bifunctional motoneurons increased prior to or during the respective electroneurogram (ENG). In soleus (SOL) motoneurons were reduced during the scratch cycle (SC). AA in medial gastrocnemius (MG) Ia afferent individual fibers of L6-L7 dorsal roots did not occur during FS Flexor digitorum longus (FDL) and MG motoneurons fired with doublets during the FS bursting activity, motoneuron membrane potential from some posterior biceps (PB) motoneurons exhibits a depolarization in relation to the PB (ENG). It changed to a locomotor drive potential in relation to one of the double ENG, PB bursts. In FDL and semitendinosus (ST) motoneurons, the membrane potential was depolarized during FS, but it did not change during FL Glutamic acid injected in the L3-L4 spinal cord segment favored the transition from FS to FL During FL, glutamic acid produces a duration increase of extensors ENGs. Serotonin increases the ENG amplitude in extensor motoneurons, as well as the duration of scratching episodes. It did not change the SC duration. Segregation and motoneurons excitability could be regulated by the rhythmic generator and the pattern generator of the central pattern generator.
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Potenciales Evocados Motores , Locomoción , Neuronas Motoras/fisiología , Músculo Esquelético/fisiología , Tractos Piramidales/fisiología , Animales , Gatos , Decorticación Cerebral , Pabellón Auricular/inervación , Pabellón Auricular/fisiología , Femenino , Ácido Glutámico/farmacología , Extremidad Inferior/inervación , Extremidad Inferior/fisiología , Masculino , Corteza Motora/fisiología , Neuronas Motoras/efectos de los fármacos , Músculo Esquelético/inervación , Tractos Piramidales/efectos de los fármacos , Reflejo Monosináptico , Serotonina/farmacologíaRESUMEN
Femoral neuropathy associated with lower limb is treated by surgical intervention through activation/regeneration/grafting of nerve fibers by a nerve cuff electrode implant or neuro-prosthesis. These procedures require detailed and precise knowledge of neuro-anatomical variants of the femoral nerve and its fascicular anatomy so that the nerve injury can be investigated and treated more efficiently. The aim of the study is to uncover the variations both in the femoral nerve and its branches, to classify them and to bring out corresponding fascicular anatomy using a hypothesis based on the principle of consistency, continuity and traceability of fascicles. The study was carried out in the Department of Anatomy AIIMS Rishikesh using 13 matched lower limbs (26 femoral nerves) from 13 cadavers. The femoral nerve was exposed in the femoral triangle and traced to the posterior abdominal wall. Variations in the shape, size and course of the femoral nerve and its branches were analyzed. The fascicular arrangement was also conceptualized based on the hypothesis. Seven classes, high division, trunk anomaly, semi-scattered, scattered branching pattern, pectocutaneous, lateral cutaneous nerve of thigh and nerve to sartorius anomalies were detected. The corresponding fascicular organizations were modeled. The seven classes along with corresponding fascicular pattern will be very useful for neurosurgeons, radiologists, anesthetists and anatomists in diagnosis and treatment of femoral neuropathy.
La neuropatía femoral asociada con el miembro inferior es tratada por intervención quirúrgica a través de activación, regeneración e injerto de fibras nerviosas mediante un implante de electrodo de manguito de nervios o neuro-prótesis. Estos procedimientos requieren un conocimiento detallado y preciso de las variantes neuro-anatómicas del nervio femoral y su anatomía fascicular de modo que la lesión del nervio pueda ser investigada y tratada de manera más eficiente. El objetivo del estudio fue descubrir las variaciones tanto en el nervio femoral y sus ramas y clasificarlos a partir de la anatomía fascicular utilizando una hipótesis basada en el principio de la continuidad y trazabilidad de los fascículos correspondientes. El estudio se llevó a cabo en el Departamento de Anatomía AIIMS Rishikesh utilizando 13 miembros inferiores pareados (26 nervios femorales) de 13 cadáveres. El nervio femoral se expuso en el triángulo femoral y fue trazado en la pared abdominal posterior. Se analizaron las variaciones en la forma, tamaño y trayecto del nervio femoral y sus ramas. El patrón fascicular fue conceptulizado de acuerdo a la hipótesis planteada. Se detectaron anomalías clasificadas en: siete clases, división alta, anomalías de tronco, semi-dispersos, patrón de ramificación dispersa, pectocutáneo, nervio cutáneo lateral y nervio del músculo sartorio. Las clasificaciones junto con el patrón fascicular correspondientes serán de gran utilidad para los neurocirujanos, radiólogos, anestesistas y anatomistas en el diagnóstico y tratamiento de la neuropatía femoral.
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Humanos , Masculino , Femenino , Anciano , Anciano de 80 o más Años , Nervio Femoral/anomalías , Extremidad Inferior/inervación , Variación Anatómica , Cadáver , Nervio Femoral/anatomía & histología , Plexo Lumbosacro/anatomía & histologíaRESUMEN
The resting sensory discomfort transiently relieved upon movement of the affected area in restless legs syndrome suggests that sensorimotor integration mechanisms, specifically gating, may be altered in the disease. The authors sought to determine the effects of prepulse auditory and tactile stimulation applied to lower limbs on the blink reflex of patients with restless legs syndrome and healthy subjects. Seventeen patients with restless legs syndrome and 17 age- and sex-matched healthy controls were investigated. Auditory stimuli and tactile lower limb stimulation were applied as prepulses. The R2 response of the blink reflex induced by electrical stimulation applied to the right supraorbital nerve was selected as the test stimulus. Time intervals between prepulses and response-eliciting stimuli were 40, 70, 90, 110, and 200 milliseconds. There were no differences in either the auditory or tactile prepulse conditions between patients and controls and no differences between these measures within subject groups. We concluded that the tactile lower limb and the auditory prepulse effects on the brainstem interneurons mediating the blink reflex share common neural pathways. Because forebrain interneurons mediate these prepulse effects, they are likely not involved in the disordered sensorimotor interaction of restless legs syndrome.
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Parpadeo/fisiología , Extremidad Inferior/inervación , Inhibición Prepulso/fisiología , Síndrome de las Piernas Inquietas/fisiopatología , Tacto/fisiología , Estimulación Acústica , Adulto , Estudios de Casos y Controles , Estimulación Eléctrica , Femenino , Humanos , Masculino , Persona de Mediana Edad , Tiempo de Reacción/fisiología , Factores de TiempoRESUMEN
BACKGROUND: The estimated prevalence of lumbar radiculopathy has been described as 9.8 per 1,000 cases of low back pain. There are various surgical and nonsurgical modalities for treating lumbar disc herniation or radicular pain, including epidural injections. Epidural injection administration routes include transforaminal, interlaminar, and caudal approaches. The transforaminal approach requires the smallest volume to reach the primary site of pathology. Systematic reviews have yielded highly variable results, but a recent systematic review showed no significant difference among the 3 approaches. STUDY DESIGN: A randomized, controlled, double blind, active control trial. SETTING: An interventional pain management practice, a private specialty referral center in the United States. OBJECTIVES: To assess the effectiveness of transforaminal epidural injections of local anesthetic with or without steroids in managing chronic low back and lower extremity pain in patients with disc herniation and radiculitis. METHODS: One hundred twenty patients were randomly assigned to 2 groups: Group I received 1.5 mL of 1% preservative-free lidocaine, followed by 0.5 mL of sodium chloride solution. Group II received 1% lidocaine, followed by 3 mg, or 0.5 mL of betamethasone. The sodium chloride solution and betamethasone were either clear liquids or were provided in opaque-covered syringes. OUTCOMES ASSESSMENT: The primary outcome measure was significant improvement (at least 50%) measured by the average Numeric Rating Scale (NRS) and the Oswestry Disability Index 2.0 (ODI). Secondary outcome measures were employment status and opioid intake. RESULTS: At 2 years there was significant improvement in all participants in 65% who received local anesthetic alone and 57% who received local anesthetic and steroid. When separated into non-responsive and responsive categories based on initial relief of at least 3 weeks with 2 procedures, significant improvement (at least 50% improvement in pain and function) was seen in 80% in the local anesthetic group and 73% in the local anesthetic with steroid group. LIMITATIONS: Presumed limitations of this evaluation include the lack of a placebo group. CONCLUSION: Transforaminal epidural injections of local anesthetic with or without steroids might be an effective therapy for patients with disc herniation or radiculitis. The present evidence illustrates the lack of superiority of steroids compared with local anesthetic at 2-year follow-up.
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Anestésicos Locales/administración & dosificación , Glucocorticoides/administración & dosificación , Inyecciones Epidurales/métodos , Desplazamiento del Disco Intervertebral/complicaciones , Dolor de la Región Lumbar/tratamiento farmacológico , Adulto , Betametasona/administración & dosificación , Dolor Crónico , Método Doble Ciego , Femenino , Estudios de Seguimiento , Humanos , Lidocaína/administración & dosificación , Dolor de la Región Lumbar/etiología , Extremidad Inferior/inervación , Vértebras Lumbares , Masculino , Persona de Mediana Edad , Radiculopatía/tratamiento farmacológico , Radiculopatía/etiologíaRESUMEN
OBJECTIVE: To assess whether sensorimotor peripheral nerve function is associated with muscle power in community-dwelling older men. DESIGN: Longitudinal cohort study with 2.3±0.3 years of follow-up. SETTING: One clinical site. PARTICIPANTS: Participants (n=372; mean age ± SD, 77.2±5.1y; 99.5% white; body mass index, 27.9±3.7kg/m(2); power, 1.88±0.6W/kg) at 1 site of the Osteoporotic Fractures in Men Study (N=5994). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: A nerve function ancillary study was performed 4.6±0.4 years after baseline. Muscle power was measured using a power rig. Peroneal motor nerve conduction amplitude, distal motor latency, and mean f-wave latency were measured. Sensory nerve function was assessed using 10-g and 1.4-g monofilaments and sural sensory nerve conduction amplitude and distal latency. Peripheral neuropathy symptoms at the leg and feet were assessed by self-report. RESULTS: After adjustments for age, height, and total body lean and fat mass, 1 SD lower motor (ß=-.07, P<.05) and sensory amplitude (ß=-.09, P<.05) and 1.4-g (ß=-.11, P<.05) and 10-g monofilament insensitivity (ß=-.17, P<.05) were associated with lower muscle power/kg. Compared with the effect of age on muscle power (ß per year, -.05; P<.001), this was equivalent to aging 1.4 years for motor amplitude, 1.8 years for sensory amplitude, 2.2 years for 1.4-g monofilament detection, and 3.4 years for 10-g detection. Baseline 1.4-g monofilament detection predicted a greater decline in muscle power/kg. Short-term change in nerve function was not associated with concurrent short-term change in muscle power/kg. CONCLUSIONS: Worse sensory and motor nerve function were associated with lower muscle power/kg and are likely important for impaired muscle function in older men. Monofilament sensitivity was associated with a greater decline in muscle power/kg, and screening may identify an early risk for muscle function decline in late life, which has implications for disability.
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Extremidad Inferior/fisiología , Fuerza Muscular/fisiología , Conducción Nerviosa/fisiología , Nervio Peroneo/fisiología , Nervio Sural/fisiología , Potenciales de Acción/fisiología , Anciano , Anciano de 80 o más Años , Envejecimiento/fisiología , Estudios de Cohortes , Humanos , Modelos Lineales , Estudios Longitudinales , Extremidad Inferior/inervación , MasculinoRESUMEN
We report an unusual clinical presentation of dorsal root ganglionopathy in a hepatitis C patient with negative cryoglobulins characterized by both motor and sensory symptoms. This mixed clinical picture in a hepatitis C patient is rare but should be considered a potential complication of HCV infection.
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Ganglios Espinales/fisiopatología , Hepatitis C/complicaciones , Extremidad Inferior/inervación , Enfermedades del Sistema Nervioso Periférico/etiología , Adulto , Femenino , Hepatitis C/diagnóstico , Humanos , Inmunoglobulinas Intravenosas/uso terapéutico , Actividad Motora , Enfermedades del Sistema Nervioso Periférico/diagnóstico , Enfermedades del Sistema Nervioso Periférico/tratamiento farmacológico , Enfermedades del Sistema Nervioso Periférico/fisiopatología , Sensación , Esteroides/uso terapéutico , Resultado del TratamientoRESUMEN
Conocer el origen y distribución de las arterias circunflejas femorales (AaCF) en el hombre, es importante en el momento quirúrgico de la reconstrucción vascular. Se disecó el contenido del triángulo femoral en 92 miembros inferiores de cadáveres formolizados, adultos, de sexo masculino y diferentes grupos étnicos, descubriéndose la arteria femoral (AF) y sus ramas originadas a nivel del triángulo femoral. Se localizó el origen de cada una de las AaCF determinándose el tipo y lugar de origen. La arteria circunfleja femoral medial (ACFM) se originó en 43 casos (46,7 por ciento) desde la AF; en 41 casos (44,6 por ciento) desde la arteria femoral profunda (AFP); en 7 casos (7,6 por ciento) en un tronco común formado por la AFP y AaCF y en un caso (1,1 por ciento) desde la arteria circunfleja femoral lateral (ACFL). La ACFM tenía en 75 casos (81,5 por ciento) un origen más proximal que la ACFL y en 9 casos (9,8 por ciento) su origen era al mismo nivel. La ACFL se originó en 68 casos (73,9 por ciento) desde la AFP; en 17 casos (18,5 por ciento) desde la AF; en 7 casos (7,6 por ciento) en un tronco común formado por la AFP y AaCF. El origen de la ACFL fue considerado independientemente si su ramo descendente se originaba desde ella o lo hacía desde la AF. Debido a la presencia de una serie de elementos nobles, conocer el origen preciso de las arterias y sus eventuales variaciones, adquiere especial importancia en los procedimientos realizados en la región.
It is important to identify the origin and distribution of the circumflex femoral arteries (CFA) at the time of vascular reconstructive surgery. The femoral triangle contents in 92 lower extremities of formolized adult male cadavers of different ethnic groups, were dissected uncovering the femoral artery (FA) and its branches originating at the level of the femoral triangle. The origin of each CFA was identified determining the origin type and location. The medial circumflex femoral artery (MCFA) originated from the FA in 43 cases (46.7 percent); from the profunda femoris artery (PFA) in 41 cases (44.6 percent); from a common trunk formed by the PFA and CFA in 7 cases (7.6 percent), and in one case (1.1 percent) from the lateral circumflex femoral artery (LCFA). In 75 cases (81.5 percent) the MCFA was most proximal than the LCFA, and in 9 cases (9.8 percent) it originated at the same level. The LCFA originated at the PFA in 68 cases (73.9 percent); from the FA in 17 cases (18.5 percent); from a common trunk formed by the PFA and CFA in 7 cases (7.6 percent). The origin of the LCFA was considered regardless, whether the descending branch originated therein or from the FA. Considering the presence of a number of important elements it is essential to identify the precise origin of the arteries and its eventual variations in procedures carried out in that area.
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Humanos , Masculino , Adulto , Extremidad Inferior/inervación , Arteria Femoral/anatomía & histología , CadáverRESUMEN
OBJETIVO: Evaluar el efecto del autotrasplante de células madre por vía intraarterial en pacientes con insuficiencia arterial crónica de los miembros inferiores en estadio II, desde el punto de vista clínico y hemodinámico.MÉTODOS: Se trataron 15 pacientes de uno y otro sexos, con insuficiencia arterial crónica de los miembros inferiores, sin criterio de revascularización. A todos se les administró un concentrado de células madre mononucleares hematopoyéticas por vía intra-arterial. Se evaluó la sintomatología clínica, la distancia de claudicación y los índices de presiones en el período preimplante y cada tres meses hasta los seis meses.RESULTADOS: No se observaron efectos adversos secundarios al tratamiento. Se observó una mejoría en el primer mes (N = 13; 86,67 por ciento), situación que se mantuvo a los tres (93,0 por ciento) y a los seis meses de implantados (100,0 por ciento). En el período preimplante, el 100 por ciento de los pacientes presentaban una claudicación cerrada (10 y 200 m), en el primer mes el 66,67 por ciento de los enfermos mostró un incremento en los valores promedios de las distancias de claudicación, que se mantuvo a los tres y seis meses. Se constató que el 93,33 por ciento de los casos tuvo un aumento en valores de los índices de presiones del miembro implantado y en la mitad de ellos (46,66 por ciento) también se observó en el miembro contra-lateral.CONCLUSIÓN: El uso de células madre por vía intra-arterial en pacientes con insuficiencia arterial crónica en estadio II de Fontaine resulta eficaz, al lograrse incrementar la distancia de claudicación y los índices de presiones(AU)
OBJETIVE: To assess the effect of stem cells intra-arterial autotransplantation in patients presenting with stage II chronic arterial insufficiency of lower extremities from the clinical and hemodynamic point of view.METHODS: A total of 15 patients of both sexes presenting chronic arterial insufficiency of lower extremities without revascularization criterion were treated. All of them received by intra-arterial route a concentrate of hematopoietic mononuclear stem cells. The clinical symptomatology, the claudication distance and the pressures rates during the pre-implantation period and each three months until six months.RESULTS: There were not adverse effects secondary to treatment but an improvement during the first month (N = 13: 86,67 percent), situation remaining at three (93,0 percent) and at six months post-implantation (100,0 percent). During pre-implantation period, the 100percent of patients had a closed claudication (10 and 200 m) over the first month the 66,67 percent of ill persons showed an increase in the values of pressure rates of implantation limb and in the half of them (46,66 percent) also it was observed in the contralateral limb.CONCLUSIONS: The use of intra-arterial stem cells in patients presenting chronic arterial insufficiency in Fontaine's stage II is effective achieving to increase the claudication and the pressure rates(AU)
Asunto(s)
Humanos , Masculino , Femenino , Trasplante de Células Madre , Arterias/lesiones , Extremidad Inferior/inervaciónRESUMEN
INTRODUCTION: The placement of a vascularized nervous graft is an option for acute nervous injuries treatment, as this has demonstrated a longer viability. OBJECTIVE: To carry out a macroscopic and microscopic analysis of the vascularity of the main lower limb nerves used as vascularized nervous grafts. MATERIALS AND METHODS: It was followed out a descriptive, transversal and non-comparative study to analyse the saphenous, the sural, the deep peroneal and the superficial peroneal nerves vascularity. This study was performed in two stages: 1) an in situ vascularity study and 2) a morphometric study. RESULTS: By the in situ study, it was demonstrated the following: the total length of the lower limb nerves used as graft, was in a decrease order: sural nerve (micro = 29.26 cm, +/- 4.05 cm), superficial peroneal nerve (micro = 28.61 cm, +/- 3.97 cm), deep peroneal nerve (micro = 26.64 cm, +/- 5.21 cm) and saphenous nerve (micro = 25.12 cm, +/- 4.42 cm). The morphometric study demonstrated that the dominant artery with the major diameter belongs to the saphenous nerve, with a diameter of 1.13 mm; then we have the superficial peroneal nerve with a 1.01 mm diameter, followed by the deep peroneal nerve with 0.91 mm, and finally the sural nerve with the smallest diameter, 0.85 mm. CONCLUSIONS: The saphenous nerve has the most appropriated morphological characteristics to be used as a vascularized graft; by the contrary the deep peroneal nerve represents the last option from all the nerves included in this study.
Asunto(s)
Extremidad Inferior/inervación , Nervios Periféricos/irrigación sanguínea , Nervios Periféricos/trasplante , Adulto , Anciano , Cadáver , Estudios Transversales , Humanos , Persona de Mediana EdadRESUMEN
Popliteal sciatic block is considered a good alternative analgesia for performing leg, ankle or foots fracture reduction at an emergency room. We hypothesized that performing the procedure in prone position rather than supine is better tolerated by the patients. Since 1995, we have used popliteal sciatic block carried out in both positions. Our study consists in 507 patients with fractures of the involved segment of the lower limb who presented at the emergency room from 1998 to 2008. All of them were treated with closed reduction and immobilization under popliteal sciatic block analgesia. The Procedure was performed by orthopedic surgeons guided by an anesthesiologist. 22.5 ml of lidocaine at 1.33 percent was used for obtaining paresthesia. Pain outcome was evaluated using the Visual Analog Scale (VAS) and by patient and surgeon questionnaire. Patient and surgeons satisfaction was 90 percent and 94 percent, respectively. Our series reports a simple, reliable and safe analgesia technique for closed fractures reduction of the lower limb at the emergency department.
Para reducciones de fracturas de pierna, tobillo y pie generalmente basta un bloqueo ciático, que realizado en la posición prona, produce dolor e incomodidad al paciente. Desde el año 1995 utilizamos en nuestro hospital el bloqueo poplíteo vía posterior en posición supina para estos procedimientos. Se analiza la experiencia de 10 años con 507 pacientes con lesiones del segmento a los cuales se les practicó reducción de su fractura con bloqueo poplíteo realizado por residentes de Ortopedia y Traumatología capacitados y supervisados por anestesiólogos. Se utilizó lidocaína 22,5 ml al 1,33 por ciento obteniéndose parestesias. La evaluación se realizó mediante escala EVA y encuesta al operador y paciente. El 90 por ciento de los pacientes y el 94 por ciento de los operadores dan una evaluación positiva del procedimiento. La técnica siendo simple, confiable y segura proporciona una excelente anestesia para reducciones de la extremidad inferior.
Asunto(s)
Humanos , Masculino , Adolescente , Adulto , Femenino , Persona de Mediana Edad , Anciano de 80 o más Años , Bloqueo Nervioso/métodos , Extremidad Inferior/inervación , Extremidad Inferior/lesiones , Procedimientos Ortopédicos , Nervio Ciático , Luxaciones Articulares , Dimensión del Dolor , Estudios Prospectivos , Pierna/inervación , Posición Supina , Tobillo/inervación , Traumatismos de la Pierna/terapia , Traumatismos del Tobillo/terapiaRESUMEN
Introdução: O calcanhar exerce importante função em suportar o peso do organismo e propiciara deambulação. As lesões nesta área são graves e de difícil reconstrução, implicandogeralmente em longos períodos de internação hospitalar, altos custos hospitalares e prejuízosfuncionais significantes para as vítimas. A reconstrução de partes moles do calcâneo representaum desafio devido ao alto grau de especialização dos tecidos envolvidos, escassez epouca mobilidade relativa dos tecidos vizinhos. Método: Didaticamente, as lesões do calcâneoforam classificadas basicamente em duas: lesão anterior ou plantar e lesão posterior.As lesões anteriores foram reconstruídas preferencialmente pelo retalho em ilha baseado naartéria plantar medial e nas outras foi utilizado preferencialmente o retalho sural reverso.Resultados: Em um total de onze casos, oito foram submetidos a reconstrução pelo retalhosural reverso e quatro pelo retalho plantar medial. As lesões foram na maioria dos casosdevido a acidente automobilístico. Apenas um caso foi devido à ressecção neoplásica. Conclusão:Os retalhos fasciocutâneos regionais em ilha se mostraram bastantes eficazes parao uso proposto, além de exigirem menor tempo cirúrgico e melhor relação custo/benéfico,se comparado a reconstrução microcirúrgica.
Introduction: The heel has the important function of supporting the weight of the personand to propitiate the ability of walking. The lesions in this area are serious and difficultto reconstruction properly, usually implicating in long periods of internment in a hospital,high hospital costs and significant functional damages for the victims. The reconstructionof soft parts of the heel represents a challenge due to the high degree of specialization ofthe involved tissue and relative immobility of the surrounding tissue. Method: The lesionswere classified basically in two: anterior lesions or plantar lesions and posterior lesions.The anterior lesions were rebuilt preferentially using the plantar medial flap based on theplantar medial artery and the posterior lesions was used the reverse sural flap preferentially.Results: In a total of eleven cases, eight were submitted to reconstruction with reversesural flap and four with plantar medial flap. The lesions were in most of the cases due tocar accident. Only one case was due to the neoplasic resection. Conclusion: The regionalfascio-cutaneous flaps in island were shown plenty effective for the proposed use, besidesthey demand smaller surgical time and better relationship cost/beneficial compared to amicrosurgical reconstruction.
Asunto(s)
Humanos , Masculino , Femenino , Niño , Adolescente , Adulto , Persona de Mediana Edad , Calcáneo/cirugía , Calcáneo/lesiones , Epidermólisis Ampollosa , Extremidad Inferior/cirugía , Extremidad Inferior/inervación , Complicaciones Intraoperatorias , Trasplante de Piel , Colgajos Quirúrgicos , Traumatismos de los Pies/cirugía , Accidentes de Tránsito , Métodos , Procedimientos de Cirugía Plástica , Pruebas Cutáneas , Técnicas y Procedimientos DiagnósticosRESUMEN
During gait acquisition, children learn to use their changing resources to meet the requirements of the task. Compared to typically developing toddlers (TD), toddlers with Down syndrome (DS) have functionally different musculoskeletal characteristics, such as hypotonia, and joint and ligament laxity, that could produce a reduced passive stiffness. The interplay between this inherently lower passive stiffness and the demands of walking may result in different strategies during gait acquisition. This study compared normalized global stiffness and lower limb's co-contraction indices (CCI) used by toddlers with TD (n=12) and with DS (n=12), during the early stages of gait acquisition. Stiffness and CCI were normalized by gravitational torque (mLg) in both phases of gait (stance, swing). Five longitudinal evaluations were conducted from the onset of locomotion until three months post-acquisition. All children were video taped and had electromyographic (EMG) recordings from muscle pairs of one leg, which were used to calculate CCI of hip, knee, ankle, and total leg CCI. Body and lower limb stiffness were calculated according to a hybrid pendulum resonance equation. Results from ANOVAs revealed no group differences on stiffness or on CCI's during stance but children with DS showed greater CCI during swing. Despite the structural musculoskeletal differences between toddlers with TD and with DS, the similarities observed in their processes of gait development suggest functional equivalences.
Asunto(s)
Síndrome de Down/fisiopatología , Marcha/fisiología , Aprendizaje , Locomoción/fisiología , Extremidad Inferior/inervación , Extremidad Inferior/fisiopatología , Contracción Muscular/fisiología , Preescolar , Gravitación , HumanosRESUMEN
Los mapas de dermatomas, miotomas y esclerotomas son usados por los neurólogos y por los anestesiólogos regionalistas en su práctica clínica habitual. La determinación de la sensibilidad de las diferentes estructuras del cuerpo humano se inició en el siglo 19, continúa hasta nuestros días y en general los nuevos métodos empleados para la determinación de la sensibilidad han corroborado las investigaciones de los primitivos autores. Al analizar la historia de la confección de mapas de sensibilidad de piel, músculo y hueso encontramos a todas las grandes figuras de la Neurología involucradas de una u otra forma en la investigación de este tema fascinante y observamos como el ingenio, la investigación sistemática y también el análisis de enfermedades y malformaciones, que permiten objetivar dermatomas y esclerotomas de otra manera invisibles, han permitido avanzar cada vez más en la confección de estos mapas. Debe tenerse presente que todos los mapas de dermatomas están compuestos de muchas observaciones individuales, ya que en cada persona se determinan sólo unos pocos dermatomas. Por esta razón todos los mapas que muestran dermatomas para todo el cuerpo deben ser vistos como aproximaciones que no toman en cuenta las variaciones individuales. Además a pesar de que generalmente se asume el dermatoma como una definición anatómica los mapas en uso han sido determinados por métodos fisiológicos. Todo lo anterior unido al hecho que se han usado métodos diferentes por cada investigador puede explicar las variaciones que se observan entre diferentes autores.
Asunto(s)
Humanos , Músculo Esquelético/inervación , Músculo Esquelético/lesiones , Piel/inervación , Piel/lesiones , Somitos , Extremidad Inferior/inervación , Extremidad Superior/inervaciónRESUMEN
This cross-sectional study investigated electrophysiological abnormalities in type 2 diabetics with normal and reduced insulin-like growth factor I (IGF-I) levels. Sixty patients and 20 non-diabetic controls were included in the study. The fasting serum glucose was measured and IGF-I levels were determined by radioimmunoassay in all patients. Nerve conduction tests were performed in all the study participants on the ulnar nerve and lower extremities. Compared with the controls, all the patients showed a reduction in the peak amplitude of the motor response, 58% showed a reduction in the motor conduction velocity and 55% showed a reduction in the sensory conduction velocity. There was no statistically significant correlation between the electrophysiological changes and the glucose or IGF-I levels. In conclusion, there does not appear to be a correlation between serum glucose or IGF-I levels and electrophysiological abnormalities in patients with type 2 diabetes mellitus.