Articles: peripheral-nerve-injuries.
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Review Historical Article
The surgery of peripheral nerves (including tumors).
Surgical pathology of the peripheral nervous system includes traumatic injury, entrapment syndromes, and tumors. The recent significant advances in the understanding of the pathophysiology and cellular biology of peripheral nerve degeneration and regeneration has yet to be translated into improved surgical techniques and better outcome after peripheral nerve injury. ⋯ Surgery continues to be the primary treatment modality for peripheral nerve tumors and advances in adjuvant oncological treatment has improved outcome after malignant peripheral nerve tumors. The present chapter provides background knowledge of surgical peripheral nerve disease and some general and practical guidance toward its clinical management.
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Peripheral nerve injuries are largely preventable injuries that can result from incorrect patient positioning during surgery. Patients who are diabetic, are extremely thin or obese, use tobacco, or undergo surgery lasting more than four hours are at increased risk for developing these injuries. When peripheral nerve injuries occur, patients may experience numbness, burning, or tingling and may have difficulty getting out of bed, walking, gripping objects, or raising their arms. ⋯ Signs and symptoms of peripheral nerve injury may appear within 24 to 48 hours of surgery or may take as long as a week to appear. Careful attention to body alignment and proper padding of bony prominences when positioning patients for surgery is necessary to prevent peripheral nerve injury. The use of a preoperative assessment tool to identify at-risk patients, collaboration between physical therapy and OR staff members regarding patient positioning, and neurophysiological monitoring can help prevent peripheral nerve injuries.
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Extracellular purine nucleotides and nucleosides play important roles in the nervous system, e.g., neurotransmission, neuromodulation, chemoattraction and acute inflammation. Extracellular nucleotides act through ATP receptors (P2 receptors). P2 receptors are classified into two families: the P2X receptors are ionotropic ligand-gated ion channels and the P2Y receptors are metabotropic G-protein-coupled receptors. ⋯ A prominent signaling pathway in the development of neuropathic pain involves ATP acting on microglial purinergic receptors. This review focuses on the expression of P2X and P2Y receptors mRNAs in the pain transmission pathway, i.e., in the dorsal root ganglion (DRG) and spinal cord. Furthermore, we suggest that the multiple microglial P2Y receptors activated by peripheral nerve injury may play a key role in the development of neuropathic pain.
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Cochrane Db Syst Rev · Dec 2012
Review Meta AnalysisDecompressive surgery for treating nerve damage in leprosy.
Leprosy causes nerve damage which may result in nerve function impairment and disability. Decompressive surgery is used for treating nerve damage, although the effect is uncertain. This is an update of a review first published in 2009 and previously updated in 2010. ⋯ Decompressive surgery is used for treating nerve damage in leprosy but the available evidence from RCTs is of very low quality and does not show a significant added benefit of surgery over steroid treatment alone. Well-designed RCTs are needed to establish the effectiveness of the combination of surgery and medical treatment compared to medical treatment alone.
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The author summarizes the most important data about the development of reconstructive techniques of nerve injuries in the hand based on literature references and the author's own experience in the past decades. A new bulk of knowledge turned into a common property related to the micro- and macroanatomic structure of peripheral nerves, the process of nerve regeneration, and the technical conditions of nerve reconstructive operations. ⋯ After a critical review of literature data, the author reports his own experience and sketches the coming possible roads. A detailed list of references is also provided for those who are interested in the field.