Safe method of supraclavicular brachial-plexus anesthesia

Using the needle direction we devised, we applied brachial-plexus anesthesia in the supraclavicular approach originated by Kulenkampff to 561 patients 6 to 85 years of age. In this method, 20 ml of anesthetic was enough to obtain more than 95% anesthetic effect without any complications such as pneumothorax. Moreover, by using a long-acting drug (bupivacaine), we could get an effect lasting for more than 10 h, so that it was useful for long operations such as digital replantations, or for operations with severe postoperative pain.

Multipotent hemopoietic progenitors (CFUMIX) in human fetal liver

Colony formation by multipotent hemopoietic precursors (CFUMIX) from human fetal liver was studied in a methylcellulose culture system containing erythropoietin (Ep) and media conditioned by leukocytes in the presence of phytohemagglutinin (PHA-LCM). The 15 fetal livers used were obtained from 13-23-week-old abortuses. Morphologic characteristics of the fetal mixed colonies were similar to those of colonies derived from adult marrow cells. The number of colonies reached a maximum at about 15-17 days. Fetal liver CFUMIX was apparently more sensitive to added Ep than progenitors from adult bone marrow. Frequency of fetal liver precursors was higher than frequency of adult marrow precursors. Number of mixed colonies tended to increase with fetal age from 13 to 23 weeks of gestation (r = 0.547, P less than 0.05).

Electrophysiological study of nerve grafting

After using the sural nerve for cable grafting in three children with nerve defects of the upper limb, we conducted electrophysiological studies on the regeneration of the nerve. After nerve grafting, nerve regeneration was delayed as compared to that of the end-to-end suture, but muscle power recovered to 80% of normal. Electromyography showed isolated motor unit potentials with high amplitude and polyphasic waves at maximum voluntary contraction. The motor conduction velocity recovered to about 70% of the normal level, but the sensory conduction velocity was less than this. The motor conduction velocity was delayed in the graft site, which, for measurement purposes, included the two suture lines.

Digital nerve grafts in replanted digits

In most cases where digits have been amputated by avulsion and the digital nerve extensively injured, primary nerve suture cannot be performed. For such a digit when replanted, secondary nerve grafting was done under the operating microscope using a lateral femoral cutaneous nerve. Two years after operation, two-point discrimination of these cases proved to be 10.5 mm on average. And in the case of the transplanted three strand cable graft, using a lateral femoral cutaneous nerve yielded the most favourable results. The replacement was superior to the side receiving primary crushed nerve suture. Sensory nerve action potentials indicate that the regenerated nerve does not necessarily mature sufficiently. The recovery of sensitivity even to this degree however was sufficient for the replanted digits to be useful in all cases.

Some methods for bone fixation for digital replantation

Solid bone fixation constitutes one of the important factors in obtaining good function after replantation of amputated digits. Comparison has been made of various methods of bone fixation including a newly designed ceramic intramedullary screw which we have found useful for cases of amputation of a middle or proximal phalanx around its middle.

Antimicrobial characteristic of insoluble alkylpyridinium iodide

Insoluble and soluble alkylpyridinium iodides (C8 to C18) were synthesized. The insoluble agents were quaternized 4-vinylpyridine-divinylbenzene copolymers. The insoluble agent [C12(50)] that contained 50% divinylbenzene and had a C12 alkyl chain was selected as the most suitable insoluble agent. C12(50) showed poor durability of the antibacterial activity, but C12(50), which had lost the activity, was refreshed by washing with ethanol. This washing became ineffective after a few cycles of antibacterial treatment and refreshment. Such C12(50) recovered the activity upon 1.0 N NaOH treatment. The antibacterial activity of C12(50) depended on its surface area. It showed high antimicrobial activity against gram-positive bacteria and also showed activity against gram-negative bacteria and yeasts. But the activities of C12(50) and laurylpyridinium iodide solution were different against some microbes. The antibacterial activities of the agents were investigated against Escherichia coli and Micrococcus luteus under various conditions. The activity of C12(50) was higher at a higher temperature or at a lower cell concentration. The activity of C12(50) decreased on addition of NaCl, glucose, or bovine albumin to the cell suspension or in 0.01 M sodium-potassium phosphate buffer. C12(50) showed less activity when cells were mixed with dead cells or the supernatant of dead cells killed in an autoclave. The mode of action of the laurylpyridinium iodide solution against E. coli and M. luteus was similar to that of C12(50) except for the influence of E. coli cell concentration.

Experimental study of interfascicular grafts in the peroneal nerve of the rabbit

To elucidate the nerve, especially motor nerve, regeneration after interfascicular grafting, the method most often used clinically, the nerve grafting was performed on 40 adult rabbits. By resecting 2.0 cm of the right peroneal nerve, the sural nerve was made into 4 interfascicular grafts under a operating microscope. The cross section area of the grafts was about the same as that of peroneal nerve. Histological and evoked electromyographic observations were conducted on the maturation of regenerating nerves of up to 24 post-operative months, when the maturation would have been completed. The present histological and evoked electromyographic observations revealed that about 70% of nerve, especially motor nerve, recovery was attained after interfascicular grafts as compared with normal nerve. In the nerve regeneration after interfascicular grafts, several factors differing from the case of suture are involved, and these factors were considered from the experimental findings.

Diagnosis and operative treatment for the brachial plexus injury

It is shown that the electrophysiological diagnosis of brachial plexus injury is becoming more precise than ever. The intraoperative use of electrodiagnosis especially aids the obtaining of better results for brachial plexus injuries. When nerve transfer is undertaken, biceps function is more usefully restored by the accessory nerve than by the intercostal nerves. Protective sensation was achieved in almost all cases by intercostal nerve transfer. When nerve grafting was undertaken, functional motor restoration was regained in the upper arm muscles in one case, but not in the forearm.

Disc herniation of cervical spine

The so-called soft disc herniation (the extruded or sequestered type) of cervical spine is relatively rare. For such a diagnosis precise neurological examination, myelography and discography are employed, but among them the specific reproduction of the patient's symptoms and the radiographic appearance of the disc by discography are especially important. Our 8 cases of soft disc herniation have been classified into central-paracentral and posterolateral types by the direction of extruded material from discographic pictures. Every type shows the complications of root pain. Discussion relates to the pain that accompanies this soft disc herniation. In half of the cases extruded disc material has been removed but others have been improved by conservative treatment.

Electrodiagnosis of compression of individual nerve roots of the cauda equina

Segmental electrodiagnosis of compression of individual nerve roots of the cauda equina has been attempted in 45 patients, including cases of disc hernia, spondylsis and spondylolisthesis. The needle electrode was inserted into the nerve root either just lateral to the intervetebral foramen or through the posterior sacral foramen. The recordings made on stimulating a single nerve root were somatosensory evoked potential, the cauda equina action potential and the M and H waves. Mixed spinal nerve root action potentials were also recorded by stimulating the sciatic, peroneal and tibial nerves. It was shown that a diagnosis could be made from the somatosensory evoked potential, the H wave and root pain reproduction, and also the diagnosis of a subclinical compression involvement. In other words, the neurophysiological state of dysfunction of individual roots in each aspect of compression can be expressed.