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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 -
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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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