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1
المؤلفون: Robert E. Wells, John R. Halliwill, Stephen W. Carmichael, Mark A. Warner, Jonathan P. Litwiller
المصدر: Clinical Anatomy. 17:45-49
مصطلحات موضوعية: medicine.medical_specialty, Histology, Posture, Strain (injury), Pelvis, Cadaver, medicine, Humans, Anterior compartment of thigh, Aged, Aged, 80 and over, Pain, Postoperative, business.industry, General Medicine, Anatomy, Middle Aged, Nerve injury, medicine.disease, Hip abduction, Surgery, Lithotomy position, body regions, medicine.anatomical_structure, Lower Extremity, Sprains and Strains, Urologic Surgical Procedures, Female, Obturator nerve, medicine.symptom, Obturator Nerve, business, Femoral Nerve
الوصف: The purpose of this study was to determine if various lithotomy positions increase strain on the obturator and lateral femoral cutaneous nerves in fresh adult cadavers. A static load cell was used to record strain changes of the obturator and lateral femoral cutaneous nerves in the pelvis and anterior thigh when the lower limbs were placed in three sets of positions of varying hip abduction and flexion. The means of the strain measurements, which were measured in grams in all positioning angles were compared to the baseline 0 degrees measurements. Analysis of variance was calculated for the differences. Flexion of the hip did not increase strain on either nerve. Abduction to 30 degrees or 45 degrees increased strain by more than 30 g on the obturator nerve (P0.05) but not the lateral femoral cutaneous nerve. The addition of 45 degrees or more of flexion to abduction negated the strain increase on the obturator nerves seen with abduction alone. Nerve strain30 g has been associated consistently with nerve dysfunction, disrupting axonal transmission, and causing structural neural damage. Our findings suggest that concomitant hip flexion should be used when placing anesthetized patients in a lithotomy position that includes abduction of the lower limbs to30 degrees to decrease the risk for perioperative neuropathy of the obturator nerve.
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2
المؤلفون: M. Spinner, Stephen W. Carmichael, Robert J. Spinner
المصدر: The Journal of Hand Surgery. 16:236-244
مصطلحات موضوعية: Adult, Male, medicine.medical_specialty, Elbow, Fingers, Tendons, Anterior interosseous syndrome, Entrapment, medicine, Paralysis, Humans, Orthopedics and Sports Medicine, Bicipital aponeurosis, Skin, Paresis, Electromyography, business.industry, Nerve Compression Syndromes, Anatomy, Middle Aged, musculoskeletal system, medicine.disease, Median nerve, Median Nerve, Surgery, medicine.anatomical_structure, Arm, Upper limb, medicine.symptom, business
الوصف: We present a newly described entrapment of the median nerve caused by compression in the distal arm because of an accessory bicipital aponeurosis. It is characterized by the paresis or paralysis of muscles innervated by the anterior interosseous branch of the median nerve--the flexor pollicis longus, the flexor digitorum profundus, and the pronator quadratus--as well as other more proximal median nerve innervated muscles, namely, the pronator teres and flexor carpi radialis. Sensibility is intact. The site of the Tinel's sign in the distal arm and the clinical appearance of an accessory bicipital aponeurosis help to localize the lesion. Electrodiagnostic studies are also important in establishing the site of the entrapment. The clinical and surgical findings are correlated with the internal topography of the median nerve at its site of compression. It is important to differentiate this syndrome from the classic anterior interosseous syndrome and other nerve entrapments at the elbow and arm. Surgical exploration is indicated if there is no clinical or electromyographic improvement in three to four months after the onset of symptoms.
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3
المؤلفون: Wojciech Pawlina, Joshua P. Kollars, Anil N. Kurup, Catharine A. Kral Kollars, Aletta P. Houwink, Stephen W. Carmichael
المصدر: Clinical anatomy (New York, N.Y.). 17(4)
مصطلحات موضوعية: Adult, Male, medicine.medical_specialty, Histology, Medical psychology, Students, Medical, media_common.quotation_subject, education, Emotions, Anxiety, Surveys and Questionnaires, medicine, Humans, media_common, business.industry, Dissection, General Medicine, Disgust, Surgery, Sadness, Feeling, Physical therapy, Gross anatomy, Grief, Female, medicine.symptom, Anatomy, business
الوصف: The assistance of third-year medical students (MS3) may be an easy, inexpensive, educational method to decrease physical and emotional stress among first-year medical students (MS1) on the first day of gross anatomy dissection. In the academic years 2000-2001 and 2001-2002, a questionnaire on the emotional and physical reactions on the first day of dissection was distributed to 84 MS1 at Mayo Medical School (Rochester, MN); 74 (88%) responded. Student perceptions were assessed on a 5-point Likert scale. The 42 second-year medical students (MS2) whose first academic year was 1999-2000 were used as a control group, because they had not had assistance from MS3. MS2 completed the same questionnaire (59% response rate). Data were collected from MS1 on the day of their first gross anatomy dissection. The most frequent reactions were headache, disgust, grief or sadness, and feeling light-headed. Significant differences (alpha < 0.05) were found with use of the chi(2) test to compare the emotional and physical reactions of MS1 and MS2. MS1 had significantly fewer physical reactions (64% vs. 88%), reporting lower levels of anxiety (23% vs. 48%), headache (14% vs. 36%), disgust (9% vs. 20%), feeling light-headed (11% vs. 24%), and reaction to the smell of the cadaver and laboratory (8% vs. 52%). MS1 commented that having MS3 at the dissection table was extremely helpful. They relied less on their peers and felt they learned more efficiently about the dissection techniques and anatomical structures. Using MS3 as assistants is one method to reduce fear and anxiety on the first day of gross anatomy dissection.
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4
المصدر: The Journal of hand surgery. 23(1)
مصطلحات موضوعية: Male, medicine.medical_specialty, Electromyography, Extensor digitorum muscle, Fingers, Postoperative Complications, Peripheral Nerve Injuries, Paralysis, medicine, Cadaver, Humans, Orthopedics and Sports Medicine, Intraoperative Complications, Muscle, Skeletal, Palsy, medicine.diagnostic_test, business.industry, Anatomy, Fascicle, Middle Aged, Surgery, Forearm, medicine.anatomical_structure, Posterior interosseous nerve, Upper limb, Female, medicine.symptom, business, Radius Fractures, Extensor Digitorum Communis
الوصف: Seven patients presented with an isolated extensor digitorum communis (EDC) palsy immediately after undergoing surgery in which the posterior (Thompson) approach to the proximal radius was used. All had normal neurologic examination findings documented prior to surgery. In an attempt to localize this lesion, the authors studied the arborization of the terminal motor branches of the posterior interosseous nerve (PIN) at the distal edge of the supinator. A common innervation pattern to the superficial extensor muscles was observed in 29 of 30 cadaveric limbs. In 10 of 10 specimens, when the EDC was subdivided into its individual bellies, a reproducible pattern emerged: the proximal EDC muscles of the middle and ring fingers were supplied primarily by the recurrent nerve branch(es) and the EDC muscles of the index and little fingers, by separate nerve branches. Consistent with our anatomic findings, perioperative stimulation of the recurrent branch in 1 neurologically intact patient resulted in middle and ring finger extension. Electromyography in 8 normal limbs showed that the middle and ring fingers could be activated together without the index and little fingers in all cases. We believe that these patients with isolated EDC nerve palsy may have sustained an iatrogenic injury to EDC motor branches, distal to the supinator rather than to a PIN fascicle near the proximal supinator.
URL الوصول: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::aade081d0bc8f2ae9e8a3ec7cd39b8bd
https://pubmed.ncbi.nlm.nih.gov/9523967 -
5
المؤلفون: Peter Gloviczki, Stephen W. Carmichael, Geza Mozes, Anna Kádár
المصدر: Atlas of Endoscopic Perforator Vein Surgery ISBN: 9781447115298
مصطلحات موضوعية: business.industry, Great saphenous vein, Anatomy, Human body, Surgical procedures, body regions, Medial malleolus, Surgical anatomy, Varicose veins, Medicine, Gross anatomy, Perforating veins, medicine.symptom, business
الوصف: A thorough knowledge of topographical anatomy is essential for learning new surgical procedures. Operations on the venous system of the legs require understanding the anatomy of the main groups of veins, their location and relationship to adjacent structures within the different compartments of the leg. Veins in few regions of the human body have more variability than in the lower limbs, and few areas in the body have a more complex topographical anatomy than the subfascial leg compartments.
URL الوصول: https://explore.openaire.eu/search/publication?articleId=doi_________::217c7cb14a8150b9cf40eb6f83780d92
https://doi.org/10.1007/978-1-4471-1527-4_2 -
6
المؤلفون: Stephen W. Carmichael, Patrick J. Kelly, Susan L. Stoddard, J. Eric Ahlskog, Jon A. van Heerden, Gaye N. Bell
المصدر: Mayo Clinic Proceedings. 64:282-290
مصطلحات موضوعية: Adult, Male, Dyskinesia, Drug-Induced, medicine.medical_specialty, Levodopa, Parkinson's disease, Caudate nucleus, Placebo, Stereotaxic Techniques, Postoperative Complications, medicine, Humans, business.industry, Carbidopa, Parkinson Disease, General Medicine, Perioperative, Middle Aged, medicine.disease, Surgery, Transplantation, Drug Combinations, Dyskinesia, Adrenal Medulla, Caudate Nucleus, medicine.symptom, business, Somnolence, Follow-Up Studies, medicine.drug
الوصف: In eight patients with advanced Parkinson's disease, we performed autograft transplantation of adrenal medulla to the head of the caudate nucleus. Our technique was similar to that developed by Madrazo and co-workers in Mexico City. No major perioperative complications occurred except for somnolence in one patient for 8 days postoperatively. The follow-up period has been at least 6 months in seven of the patients, and only limited benefit has been apparent. The early morning Parkinson examination score in the "off" (unmedicated) state was significantly improved in one patient and slightly better in the other six. Diary card entries suggested a mild trend toward improvement (not statistically significant). Four of the seven patients were taking less levodopa 6 months after the operation than they had been preoperatively; three of five patients were no longer taking dopamine agonists postoperatively. We cannot exclude a placebo effect contributing to any of this improvement. A reduction in medication-induced dyskinesia was also noted, but this result may have been due to adjustments in doses or a slightly less potent effect of medication (or both factors). In summary, we have not yet been able to replicate the dramatic success reported for adrenal medullary transplantation by Madrazo's group, although our patients may have experienced mild to moderate improvement. We continue to maintain follow-up surveillance of these patients.
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7
المؤلفون: Gertrude M. Tyce, Stephen W. Carmichael, Tony L. Yaksh, Dorothee M. Gaumann, Susan L. Stoddard
المصدر: Journal of the autonomic nervous system. 23(2)
مصطلحات موضوعية: Male, medicine.medical_specialty, Physiology, Urinary Bladder, Blood Pressure, Hyperreflexia, Norepinephrine, Catecholamines, Dopamine, Internal medicine, Physical Stimulation, Heart rate, medicine, Animals, Decerebrate State, business.industry, General Neuroscience, Sciatic Nerve, Electric Stimulation, Autonomic nervous system, medicine.anatomical_structure, Endocrinology, Epinephrine, Spinal Cord, Adrenal Medulla, Anesthesia, Acute Disease, Chronic Disease, Catecholamine, Cats, Neurology (clinical), medicine.symptom, Adrenal medulla, business, medicine.drug
الوصف: Eight cats were spinally transected at T3. After an acute (0-5 days) or chronic (15-37 days) period, animals were rendered decerebrate and the effects of visceral (bladder distention) and somatic (sciatic nerve stimulation) stimuli were examined. Epinephrine, norepinephrine and dopamine levels were measured in plasma collected from the left adrenolumbar vein; heart rate and blood pressure were continuously monitored. In chronic animals both visceral and somatic stimuli most frequently evoked prominent increases in blood pressure and the secretion of adrenal medullary catecholamines; the same stimuli caused little change in these parameters in acute animals. These data indicate that a condition similar to the clinical syndrome of autonomic hyperreflexia may be elicited in the chronic spinally transected cat, and that this condition is accompanied by a notable activation of the adrenal medulla.
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