scholarly journals Intraoperative infrared fluorescence angiography in surgery of peripheral nerve injuries

2021 ◽  
Vol 23 (1) ◽  
pp. 59-66
Author(s):  
Dmitriy V. Svistov ◽  
Dzhamaludin M. Isaev ◽  
Aleksey I. Gaivoronskiy ◽  
Leonid I. Churikov ◽  
Kirill V. Belyakov
Keyword(s):  
Blood Flow ◽  
Peripheral Nerve ◽  
Blood Supply ◽  
Nerve Trunk ◽  
Tension Force ◽  
Fluorescence Angiography ◽  
Green Is ◽  
Surgical Interventions ◽  
Peripheral Nerve Damage

Often, when performing reconstruction of nerve trunks, between the ends of the damaged nerve, the presence of diastasis is noted, which requires significant nerve tension in order to overcome it. This, in turn, can lead to a violation of the blood supply to the nerve and damage to its ultrastructures, which leads to unsatisfactory treatment results. The possibility of using intraoperative infrared fluorescence angiography in reconstructive surgical interventions for peripheral nerve damage, in order to assess the degree of blood flow disturbance in the nerve trunk, is considered. In patients with a complete anatomical break during the operation, an attempt was made to overcome diastasis by measuring the tension force (up to 3 N) with which the nerve was affected. Infrared fluorescence angiography with indocyanine green was performed simultaneously. The obtained angiograms were analyzed, and the effect of the tension force on the change in blood flow in the nerve trunk was determined. It was found that when exposed to a force of up to 2 N, there is no significant change in the intraneural blood flow. At the same time, the effect of a force of 3 N is manifested on angiograms by a significant decrease in the volume of blood flow, which is usually due to constriction of the vessels due to their stretching. After reconstruction (microsurgical epineural suture), repeated angiography was performed to assess the safety and adequacy of blood supply to the nerve. It was revealed that the use of intraopreational angiography with indocyanin green is an affordable and easily feasible technique that allows to determine the safety and, equally important, the adequacy and efficiency of blood flow in the nerve trunk. This technique makes it possible to monitor the safety of blood flow in the nerve trunk, to study the mechanisms of compensation of blood supply to the nerve after microsurgical epineural suture, to assess the quality of comparison of nerve stumps along the axis, excluding the possibility of their "twist".

Intraoperative fluorescent angiography with indocyanine green in surgery of peripheral nerve injuries

2021 ◽  
pp. 224-234
Author(s):  
Dmitry Vladimirovich Svistov ◽  
Dzhamaludin Magomedrasulovich Isaev ◽  
Alexey Ivanovich Gaivoronsky ◽  
Leonid Igorevich Churikov ◽  
Kirill Vladimirovich Belyakov
Keyword(s):  
Blood Flow ◽  
Peripheral Nerve ◽  
Indocyanine Green ◽  
Blood Supply ◽  
Nerve Trunk ◽  
Point Of View ◽  
Intraoperative Angiography ◽  
Surgical Interventions ◽  
The Moment ◽  
Nerve Surgery

Despite the widespread introduction of microsurgical techniques in peripheral nerve surgery, a relatively high percentage of unsatisfactory results remains. Often, when treating patients with traumatic neuropathies, the surgeon faces the problem of diastasis between the ends of the damaged nerve. As a rule, in the presence of diastasis greater than 5 cm, it is recommended to perform inter-bundle autoneuroplasty. However, overcoming diastasis less than 5 cm may be accompanied by tension of the nerve trunk, which leads to a violation of its blood supply. In this case, the outcome of the intervention may be unsatisfactory, despite the operation performed perfectly from a technical point of view. An important factor of the outcome of surgical treatment of neuropathies of various origins is the preservation of adequate blood supply to the nerve trunk in the intraoperative period. In order to assess the blood flow in the nerve trunk, the possibility of using intraoperative fluorescent angiography for reconstructive surgical interventions on nerves was considered. In patients with a complete anatomical break of the large nerve trunk, at the moment of overcoming diastasis, intraoperative angiography of the nerve trunk was performed by intravenous administration of indocyanine green, with simultaneous registration of the tension force with which the nerve trunk was affected. In addition, fluorescent angiography was performed after the restoration of the integrity of the nerve trunk, thus assessing the safety, adequacy and effectiveness of blood flow in it. It was found that intraoperative angiography is an accessible and easily implementable technique to determine the safety and, not least, the adequacy and effectiveness of the blood flow in the nerve trunk, to study the mechanisms of compensation of blood supply to the nerve after microsurgical epineural suture, and to assess the quality of matching the stumps of the nerve axis, preventing the possibility of «torsion».

Exogenous opioids influence the microcirculation of injured peripheral nerves

1997 ◽  
Vol 272 (1) ◽  
pp. H76-H82
Author(s):  
L. Schaafsma ◽  
H. Sun ◽  
D. Zochodne
Keyword(s):  
Blood Flow ◽  
Peripheral Nerve ◽  
Peripheral Nerves ◽  
Nerve Trunk ◽  
Local Blood Flow ◽  
Vasa Nervorum ◽  
Perfusion Flow ◽  
Sciatic Nerves ◽  
Microelectrode Measurements ◽  
Hydrogen Clearance

Local microvessels of peripheral nerve trunks (vasa nervorum) dilate following capsaicin-induced inflammation or local nerve trunk injury. In previous work, we observed that morphine blocked capsaicin-induced dilation of vasa nervorum presumably through the action of local opioid receptors. In the present work, we studied injury-related hyperemia of the rat sciatic vasa nervorum using laser Doppler and hydrogen clearance microelectrode measurements of local perfusion. Systemic morphine reversed hyperemia by vasoconstricting both extrinsic and intrinsic microvessels supplying 48-h-old “neuroma” preparations or crush zones of peripheral nerve trunks. Morphine did not constrict microvessels of contralateral uninjured or sham exposed but uninjured sciatic nerves. In contrast to the injured nerves, contralateral uninjured nerves exposed to morphine frequently had a rise in local perfusion, indicating vasodilation. The vasoconstrictive actions of morphine were blocked by pretreatment with naloxone and were not mimicked by saline injections alone. Systemic doses of selective opioid agonists to mu-, kappa-, and delta-receptors also selectively constricted microvessels of injured nerves. Local blood flow in older experimental neuromas at 7 days had partial sensitivity to morphine, whereas at 14 days perfusion flow was not influenced by morphine. Exogenous opioids dampen early but not later inflammatory microvasodilation and could have important influences on the nerve regenerative milieu.

Innervation of endoneurial microvessels in human sural nerve

1992 ◽  
Vol 50 (1) ◽  
pp. 920-921
Author(s):  
John L. Beggs ◽  
Peter C. Johnson ◽  
Astrid G. Olafsen ◽  
C. Jane Watkins
Keyword(s):  
Blood Flow ◽  
Blood Vessels ◽  
Blood Supply ◽  
Peripheral Nerves ◽  
Sural Nerve ◽  
Nerve Fibers ◽  
Arterial Supply ◽  
Autonomic Nerve ◽  
Vasa Nervorum ◽  
Endoneurial Blood Flow

The blood supply (vasa nervorum) to peripheral nerves is composed of an interconnected dual circulation. The endoneurium of nerve fascicles is maintained by the intrinsic circulation which is composed of microvessels primarily of capillary caliber. Transperineurial arterioles link the intrinsic circulation with the extrinsic arterial supply located in the epineurium. Blood flow in the vasa nervorum is neurogenically influenced (1,2). Although a recent hypothesis proposes that endoneurial blood flow is controlled by the action of autonomic nerve fibers associated with epineurial arterioles (2), our recent studies (3) show that in addition to epineurial arterioles other segments of the vasa nervorum are also innervated. In this study, we examine blood vessels of the endoneurium for possible innervation.

METHODOLOGICAL ASPECTS OF VISUALIZATION OF CORONARY ARTERIES WITH TRANSTHORACIC ECHOCARDIOGRAPHY

2018 ◽  
pp. 26-35
Author(s):  
Z. A. Agaeva ◽  
K. B. Baghdasaryan
Keyword(s):  
Blood Flow ◽  
Coronary Blood Flow ◽  
Coronary Arteries ◽  
Transthoracic Echocardiography ◽  
Second Harmonic ◽  
Anatomic Reconstruction ◽  
High Quality ◽  
Acoustic Window ◽  
Methodological Aspects

The transthoracic echocardiography made by multifrequency probes with support of the mode of the second harmonic imaging, is a competitive method for visualization of the main coronary arteries and allows to estimate coronary blood flow with high quality. Of course, the method has considerable restrictions, most important of which is the low spatial resolution of a method, due to small acoustic window. Because of this the transthoracic visualization of coronary arteries perhaps will not become the leading method of anatomic reconstruction of separately taken coronary artery and especially all coronary arteries system. However uniqueness and indisputable advantage of this method is an opportunity to noninvasively estimate a coronary blood flow both once, and in dynamics.

Individual mechanisms underlying peripheral nerve damage when exposed to metallic mercury

2020 ◽  
Vol 60 (12) ◽  
pp. 918-924
Author(s):  
Dina V. Rusanova ◽  
Oleg L. Lakhman ◽  
Galina M. Bodienkova ◽  
Irina V. Kudaeva ◽  
Natalya G. Kuptsova
Keyword(s):  
Peripheral Nerve ◽  
Peripheral Nerves ◽  
Blood Circulation ◽  
The State ◽  
Contact Period ◽  
Peripheral Nerve Damage ◽  
Demyelinating Disorders ◽  
Peripheral Blood Circulation ◽  
Antibodies To Dna

Introduction. There is a lack of knowledge of the pathophysiological mechanisms that form peripheral nerve disorders in mercury lesions of professional origin. The study aims to reveal the mechanisms underlying peripheral nerve damage in the long-term post-contact period of chronic mercury intoxication (CMI). Materials and methods. Fifty-one people had the diagnosis of a long-term period of CMI. The post-contact period was 8.5±2.6 years. The authors compared the results with a control group of 26 healthy men who had no contact with toxic substances. Stimulating electroneuromyography was performed. We studied the body systems that could contribute to the formation of disorders in the peripheral nerves. Changes in peripheral hemodynamics were studied using reovasography. The content of autoantibodies, neuron-specific enolase, serotonin, histamine, catecholamines (epinephrine, dopamine), metanephrine, and neurotrophin-3 was reviewed. The content of ceruloplasmin, secondary products of lipid peroxidation processes, reduced glutathione, the activity of superoxide dismutase and the content of nitric oxide levels were determined. Results. The study established pathogenetic structural links of peripheral nerve disorders. The autoimmune process's role was to increase the range of antibodies to the MAG protein and increase the level of antibodies to DNA. Violations of elastic-tonic properties of peripheral vessels could be associated with the functional state of motor axons. The increased content of neurotransmitters is related to the state of peripheral blood circulation; the most pronounced changes were on the legs, which could contribute to the occurrence and maintenance of vasoconstriction. The role of oxidative stress in the formation of demyelinating disorders in patients' peripheral nerves in the long-term period of CRI is possible. Conclusion. Neuroimmunological processes has an essential role in the development of peripheral nerve demyelination was shown, which consists in an increase in the content of antibodies to the MAG protein expressed on Schwann cells of peripheral nerves and in an increase in the level of antibodies to DNA involved in the formation of demyelinating changes when exposed to metallic mercury. The revealed pathological changes in the state of the peripheral blood circulation, characterized by a violation of the vessels' elastic-tonic properties, leading to demyelination of motor axons in patients in the long-term period of CMI. The increased content of neurotransmitters in the examined is of great importance in the state of peripheral circulation. Pronounced changes in blood circulation are established on the lower extremities, which may be associated with the predominance of α-adrenergic receptors in the arterial bed and may contribute to the occurrence and maintenance of vasoconstriction in the legs. The relationship between changes in indicators of oxidative stress, consisting of a decrease in the value of superoxide dismutase and reduced glutathione, and the formation of demyelinating disorders of peripheral nerves in patients in the long-term period of CMI has been proved.

Quality of life after anti-reflux surgical interventions: possible solutions to the problem

2020 ◽  
pp. 3-25
Author(s):  
D. Lukanin ◽  
G. Rodoman ◽  
M. Klimenko ◽  
A. Sokolov ◽  
A. Sokolov
Keyword(s):  
Quality Of Life ◽  
Hiatal Hernia ◽  
Antireflux Surgery ◽  
Nissen Fundoplication ◽  
Laparoscopic Nissen Fundoplication ◽  
Partial Fundoplication ◽  
Surgical Interventions ◽  
Number Of Patients ◽  
Laparoscopic Nissen

The article presents the results of a prospective controlled parallel clinical study of a new modification of laparoscopic antireflux surgery in the treatment of gastroesophageal reflux disease in combination with a hiatal hernia compared with laparoscopic Nissen fundoplication in terms of assessing quality of life after surgery. Clinical and instrumental examination of patients was carried out a year after surgical interventions. In accordance with the results of instrumental examination after surgery, the proposed modification of laparoscopic partial fundoplication is not inferior to laparoscopic Nissen fundoplication both, in terms of relief of reflux esophagitis symptoms and in relation to the recurrence of hiatal hernia. Clinical monitoring indicates a significantly higher quality of life for patients after the modified antireflux surgery, which is associated with a number of factors. The implementation of this fundoplication led to a decrease in the number of patients with complaints of dysphagia, the development of which is directly related to the surgery performance, as well as to a statistically significant reduction of bloating in the upper abdomen. Another advantage of the modified surgery is a significantly smaller number of cases of gas-bloat syndrome. In addition, the disorders developing in the framework of the gas bloat syndrome after laparoscopic Nissen fundoplication are more severe.

scholarly journals SWE and SMI ultrasound techniques for monitoring needling treatment of ankylosing spondylitis: study protocol for a single-blinded randomized controlled trial

Trials ◽  
2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Mengyu Wang ◽  
Wen Fu ◽  
Lingcui Meng ◽  
Jia Liu ◽  
Lihua Wu ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Blood Flow ◽  
Ankylosing Spondylitis ◽  
Outcome Measures ◽  
Healthy Subjects ◽  
Acupuncture Group ◽  
Musculoskeletal Ultrasound ◽  
Sham Control ◽  
Post Intervention

Abstract Background Ankylosing spondylitis (AS) is a high-incidence disease in young men that interferes with patients’ physical and mental wellbeing and overall quality of life (QoL). It is often accompanied by arthralgia, stiffness, and limited lumbar flexibility. Acupuncture is safe and effective for reducing the symptoms of AS, but the underlying mechanisms by which it does so are not fully understood. Therefore, to objectively assess acupuncture efficacy, which is critical for patients making informed decisions about appropriate treatments, we will use shear-wave elastography (SWE) and superb microvascular imaging (SMI) ultrasound techniques to evaluate elasticity of lumbar paraspinal muscles and blood flow to the sacroiliac joint (SIJ) in AS. Methods We will recruit a total of 60 participants diagnosed with AS and 30 healthy subjects. Participants will be randomly allocated 1:1 to either an acupuncture group or a sham control acupuncture group. Primary-outcome measures will be musculoskeletal ultrasound, Ankylosing Spondylitis Quality of Life Scale (ASQoL), Bath Ankylosing Spondylitis Metrology Index (BASMI), and the Visual Analogue Scale (VAS) for pain. Secondary outcome measures will be the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Function Index (BASFI), and Fatigue Scale-14 (FS-14). We will monitor the effect of acupuncture or sham acupuncture on blood flow and SIJ inflammation using SMI, lumbar-muscle stiffness using SWE and the lumbar paraspinal-muscle cross-sectional area (CSA) using a two-dimensional (2D) grayscale imaging. QoL, physical function, and fatigue will be assessed using an evaluation scale or questionnaire developed for this study, with outcomes measured by the ASQoL, BASMI, BASDAI, BASFI, and FS-14. Healthy subjects will not receive acupuncture but undergo only musculoskeletal ultrasound at baseline. Acupuncture and sham control acupuncture interventions will be conducted for 30 min, 2–3 times/week for 12 weeks. Musculoskeletal ultrasound will be conducted at baseline and post-intervention, while other outcomes will be measured at baseline, 6 weeks, and post-intervention. The statistician, outcome assessor, and participants will be blinded to treatment allocation. Discussion The results of this single-blinded, randomized trial with sham controls could help demonstrate the efficacy of acupuncture and clarify whether musculoskeletal ultrasound could be used to evaluate AS. Trial registration ClinicalTrials.gov ChiCTR2000031476. Registered 3 April 2020.

scholarly journals Inappropriate surgery in a patient with misdiagnosed Robert’s uterus

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Iori Kisu ◽  
Kanako Nakamura ◽  
Tetsuro Shiraishi ◽  
Tomoko Iijima ◽  
Moito Iijima ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Uterine Wall ◽  
Septate Uterus ◽  
Case Presentation ◽  
Surgical Interventions ◽  
Unicornuate Uterus ◽  
Uterine Malformation ◽  
Mullerian Anomaly ◽  
Future Pregnancy

Abstract Background Robert’s uterus is a rare Mullerian anomaly, which can be described as an asymmetric, septate uterus with a non-communicating hemicavity. Herein, we present the case of a misdiagnosed Robert’s uterus, resulting in an invasive and disadvantageous surgery. Case presentation A 16-year-old woman was referred to our department because of dysmenorrhea and suspicion of uterine malformation. We misdiagnosed Robert’s uterus as a unicornuate uterus with a non-communicating rudimentary horn and hematometra, and performed laparoscopic hemi-hysterectomy. Although the patient’s symptoms were relieved, our surgical procedure left the lateral uterine wall weak, making the patient’s uterus susceptible to uterine rupture in any future pregnancy. Conclusions Although the early diagnosis of Robert’s uterus is challenging, it is important in order to determine appropriate surgical interventions and management for maintaining the quality of life and ensuring safety in future pregnancies.

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