A comparative study of autologous peripheral nerve grafts

Forty-five Sprague-Dawley rats were divided into four groups. The first two groups were subjected to primary epineural anastomoses, with and without tension. In the remaining two groups, sciatic nerve defects were produced and femoral cable grafts were then performed with and without making an epineural sheath defect on the edge of the recipient nerves. Five functional evaluation criteria (sensation, push-off, fanning of claws, cubital ulcer, and leg atrophy) were used along with histological findings. It has been found that the recovery of sensation was the least in the tension group, as was other functional recovery. Animals with epineural and fascicular sutures ranked highest in functional recovery while cable grafts followed at 4th, 10th, and 12th week of observation.

[Experimental neuropathy induced by DDT: analysis of the nerves by microdissection of the fibers]

The genito-femoral nerves of ten albinic rats chronically intoxicated with DDT (5 mg/kg day during 180 days) was studied by teased fibers examination. It was found 85,37% types A + B fibers, 13,63% type C and 1% of types D, E, F and G. It is concluded that there occurs an axonal degeneration of myelin induced by chronic DDT intoxication.

An autopsy case of acute porphyria with a decrease of both uroporphyrinogen I synthetase and ferrochelatase activities

An autopsy case of a 37-year-old woman with acute porphyria is reported. The patient began to complain of severe menstrual pains, and later developed serious peripheral neuropathy and various autonomic nervous symptoms. The autopsy revealed a marked loss and degeneration of axons and myelin sheaths in the peripheral nervous system (PNS), and prominent central chromatolysis of the spinal anterior horn cells. The predominant process of the peripheral neuropathy appeared to be axonal degeneration. Biochemical analysis showed a marked increase of delta-aminolevulinic acid (ALA), porphobilinogen, uroporphyrin, and coproporphyrin in the urine, and an increase of coproporphyrin and protoporphyrin in the stools and blood. In the analysis of the enzymatic activities of the liver and bone narrow, the activity of ALA synthetase (ALA-S) was markedly increased, and the activities of both uroporphyrinogen I synthetase (URO-S) and ferrochelatase were decreased. It was characteristic in this case that the enzymatic abnormalities found in both acute intermittent porphyria (AIP) and variegate porphyria (VP) coexisted. Biochemical analysis of the sciatic nerve showed an increase of ALA-S activity and a decrease of both URO-S and ALA dehydrase activities. This was the first report that indicated the presence of abnormal activities of the heme biosynthetic enzymes in the peripheral nerves of porphyric patients. The possibility was discussed that these enzymatic abnormalities of the heme biosynthesis in the peripheral nerve itself might be strongly related to the pathogenesis of the porphyric neuropathy.

Femoral neuropathy due to common iliac artery occlusion

A patient with an atherosclerotic common iliac artery occlusion had acute onset of femoral neuropathy, which resolved after revascularization. This case indicates that ischemia can cause femoral neuropathy and that ischemia may be the explanation for some previously unexplained postoperative femoral neuropathies.

Cryogenic damage to peripheral nerves and blood vessels in the rat

The effects of cryogenic injury on femoral blood vessels and nerves were studied in 28 rats. The femoral neurovascular bundles were dissected out bilaterally and the vessels and nerves subjected to cryogenic injury. The rats were sacrificed at intervals of up to 2 weeks. Damage to the nerves and to a number of femoral vessels was severe and included necrosis and thrombus formation. The results indicate that significant vascular damage can occur during cryotherapy, and the possible complications of this should be considered.

[Fascia compartment syndrome of the iliac-psoas compartment]

The iliacus compression syndrome has a kind of exceptional position--as to genesis, development and therapy--in comparison with the other compartment-compression syndromes of the limbs. Indeed there exist similar pathophysiological, rules, but the special anatomic facts enlarge the etiological, differential-diagnostic and therapeutic spectrum. Thus, concerning the frequency of causes, not the trauma but the spontaneous bleeding in coagulation disturbances takes the first place, and unusual causes, such as rupturing aortic aneurysms, have to be included in the differential diagnostic discussion. The finest diagnostic sign besides pain is the palsy of the Nervus Femoralis. As to the treatment, operative measures are possible. The exact knowledge of the anatomy is important for the understanding of the specialties mentioned above.

[Anatomical and clinical study on the femoral nerve lesion]

Neuralgic and paralytic symptoms due to lesions of the femoral nerve or its related nerve roots are not infrequently encountered and therefore, clinically important. In order to clarify their pathomechanism the author has done anatomical, kinesiologic, and clinical studies. The topographic course of the femoral nerve was carefully observed in 40 cadavers (80 nerves) and transverse sections of 4 cadavers cut horizontally at various levels. The interrelation between the nerve and its surrounding organs was thus analysed. The 81 cases (87 nerves) of femoral nerve lesion, including lumbar radiculopathy, femoral neuropathy, and saphenous nerve lesion, were clinically followed up and the mechanism of their production was analysed. Besides, kinesiologic studies using electromyograms of the trunk and lower extremity muscles were performed in 8 cases (9 lesions) and 20 normal male controls. The main results obtained are as follows: 1. From the embryologic and morphologic points of view, the femoral nerve runs a peculiar course and has characteristic shapes in its transverse sections at various levels. 2. As the nerve lies closely adjacent to several pelvic organs, it can easily be influenced by their pathological conditions. 3. When the adjacent organs are treated surgically, it may be rare that the nerve is injured, constituting a complication. 4. The pathomechanism of the femoral neuropathy occurring at the inguinal ligament is quite similar to that of entrapment neuropathy of the peripheral nerve that occurs at a fibro-osseous tunnel. 5. Even if the quadriceps femoris muscle is totally paralysed, extention of the knee joint is possible to some extent because of a compensatory action of the tensor fasciae latae muscle.

Chronic recurrent demyelinating encephalomyelitis associated with hemophagocytic lymphohistiocytosis

A man aged 31 with remittent fever, leukopenia, polyuria, and splenomegaly in addition to chronic and recurrent episodes of neurologic abnormalities was examined pathologically. A chronic type of perivenous encephalomyelitis was found in the CNS, and chronic inflammatory lesions were noticed in the infundibulo-hypophyseal system and also in the peripheral nerves. Moreover, hemophagocytic lymphohistiocytosis predominated in the reticuloendothelial system. This seemed to be the first adult case of demyelinating disease with hemophagocytic lymphohistiocytosis.

Meralgia paresthetica as a complication of the groin flap

Meralgia paresthetica is not well known in the plastic surgery literature, and consequently the diagnosis of this entity may be overlooked. In view of the frequency with which the groin flap is presently employed, the possibility of damage to the lateral femoral cutaneous nerve of the thigh should be borne in mind. In this paper the clinical picture as well as the anatomy and pathophysiology of this disorder are described.

Subclinical entrapment of the lateral femoral cutaneous nerve: an autopsy study

Five out of 12 lateral femoral cutaneous nerves, removed at routine autopsies, showed pathologic changes in myelinated nerve fibers in the vicinity of the inguinal ligament. These changes included both local demyelination and Wallerian degeneration, particularly affecting the fibers with the largest diameters. The presence of polarized internodal swellings on single nerve fibers from two specimens suggested that mechanical factors were involved in pathogenesis. Endoneurial vascular thickening confined to the region of the inguinal ligament was also seen and may be implicated in the production of some of the symptoms of meralgia paresthetica (MP).

Peripheral polyneuropathy associated with primary malignant lymphoma of the brain

A patient with a primary malignant lymphoma of the brain manifested a peripheral polyneuropathy during his illness that could not be accounted for by the usual causes. The polyneuropathy is considered to be a nonmetastatic complication of the primary brain tumor. A review of the literature did not uncover a similar case.

Why can't you achieve adequate regional anesthesia in the presence of infection?

Observed in this study were morphologic changes in inflamed nerves, along with biochemical changes, which appear to act concurrently to deactivate or prevent activation of the local anesthetic solution. Morphologic changes were observed along the nerve fiber distant from the inflammatory site. These neuro-degenerative changes were seen at the axon and myelin sheaths level. The biochemical data support the presence in the inflamed nerve of amino acids which may be the product of lysosomal rupture and proteolytic enzyme release. These inflammatory mediators may affect either the local anesthetic or the environment of the nerve fiber. The precise mechanism of action of these catalytic products cannot be determined from this study.

Meralgia paresthetica. An anatomical interpretation

One hundred and ten lateral femoral cutaneous nerves of the thigh were dissected in 90 adult and 20 fetal cadavers. In 51 per cent of adult cases a significant enlargement or pseudoganglion was present in the area of the nerve where it passed under the guinal ligament to turn sharply downward onto the thigh. The histological examination of these pseudoganglions showed a thickened epineurium, perineurium and endoneurium. No pseudoganglions and no histological abnormalities were found in the fetal nerves. It is proposed that erect human posture, combined with the particular course of the lateral femoral cutaneous nerve are the causes of tension, mechanical friction, and irritation of the nerve, and contribute to the development of the pseudoganglion and play a role in the pathogenesis of idiopathic meralgia paresthetica.

Strümpell's familial spastic paraplegia: genetics and neuropathology

Uncomplicated Strümpell's disease (Strümpell's familial spastic paraplegia) with a dominant mode of inheritance is recorded in six families. The neuropathological findings in two cases from these families are given, bringing the total of similar histologically documented reports in the literature to 11. It is concluded that, although exact classification and identification of the many different hereditary neurological degenerative diseases is not yet practicable, cases conforming to the picture described by Strümpell can be separated from larger general group of familial spastic paraplegias, show a consistent clinical picture, and have a standard pathology. It is suggested that, since the lesions are confined to the longest fibre tracts in the central nervous system, the pathological process may be different from that found in the `system' degenerations.

Pathology of ther peripheral nerves in leprosy: report of a case

Peripheral nerve trunks were examined from a case of lepromatous leprosy. M. leprae was seen in the nerves in several types of cells. Isolated nerve fibre preparations showed demyelinating lesions due to Schwann cell damage and complete nerve fibre degeneration. The causes of this mixed pattern of damage may involve both a direct effect of the bacilli on nerve fibres and various epiphenomena.