ارزش تشخيصی پتانسيل های بر انگيخته سوماتوسنسوری در بيماری مرآلژی پارستتيکا(Meralgia paresthetica)

زمينه و هدف : تشخيص بيماری مرآلژی پارستتيکا ( Me ralgia Paresthetica ( MP) ) عمدتا بر اساس علايم بالينی صورت می گيرد، اما انجام مطالعات الکتروفيزيولوژيک و تصويربرداری در جهت تاييد تشخيص و رد تشخيص های افتراقی ضروری است. يکی از روش های تشخيصی مورد توجه، استفاده از پتانسيل های بر انگيخته سوماتوسنسوری ( Somatosensory Evoked Potentials SEPs= ) عصب پوستی طرفی ران( LFCN=Lateral Femoral Cutaneous Nerve of thigh ) می‌باشد که در گذشته مطالعات کمی در خصوص کارايی اين روش در تشخيص بيماری مرآلژی پارستتيک به انجام رسيده است. روش کار : شرکت ‌کنندگان در اين مطالعه مقطعی شامل 60 نفر از بيماران دارای تشخيص بالينی مرآلژی پارستتيکا می باشند،که به صورت متوالی( Consecutive ) به بيمارستان لقمان حکيم تهران در سال های 1388 و 1389 مراجعه کرده‌اند. پتانسيل های بر انگيخته سوماتوسنسوری ران طرف درگير و سالم در تمامی بيماران با استفاده از آزمايش SEPs که بر مبنای تحريک الکتريکی عصب پوستی طرفی ران و ثبت پاسخ برانگيخته سوماتوسنسوری در محل قرار گرفتن کورتکس پاريتال حسی طرف مقابل تحريک روی جمجمه بيمار می باشد؛ انجام گرفته است. يافته‌ها : حساسيت آزمون SEPs در تشخيص بيماری مرالژی پارستتيکا برابر با 3/53 درصد، با فاصله اطمينان 95 درصد(3/66- 0/40) می باشد. ويژگی اين آزمون نيز 3/98 درصد، با فاصله اطمينان 95 درصد(9/99- 0/91) است. نتيجه گيری : اگر چه توانايی آزمون SEPs درتشخيص ( Ruling in ) بيماران مبتلا به مرآلژی پارستتيکا کم است، ولی نتايج آزمون درتشخيص ( Ruling out ) افراد سالم از بيمار بسيار مفيد واقع می گردد

Meralgia paresthetica affecting parturient women who underwent cesarean section -A case report-

Meralgia paresthetica is commonly caused by a focal entrapment of lateral femoral cuteneous nerve while it passes the inguinal ligament. Common symptoms are paresthesias and numbness of the upper lateral thigh area. Pregnancy, tight cloths, obesity, position of surgery and the tumor in the retroperitoneal space could be causes of meralgia paresthetica. A 29-year-old female patient underwent an emergency cesarean section under spinal anesthesia without any problems. But two days after surgery, the patient complained numbness and paresthesia in anterolateral thigh area. Various neurological examinations and L-spine MRI images were all normal, but the symptoms persisted for a few days. Then, electromyogram and nerve conduction velocity test of the trunk and both legs were performed. Test results showed left lateral cutaneous nerve injury and meralgia paresthetica was diagnosed. Conservative treatment was implemented and the patient was free of symptoms after 1 month follow-up

Variability of the lateral femoral cutaneous nerve: An anatomic basis for planning safe surgical approaches

Current surgical assumptions identify the lateral femoral cutaneous nerve (LFCN) running just under the inguinal ligament two fingerbreadths medial to the anterior superior iliac spine (ASIS). On the basis of the increasing incidence of Meralgia Paresthetica associated with various surgical procedures, it is clear that surgeons are relying on an inadequate description of the nerve's course. This study provides a better understanding of the variability of the LFCN with regards to its relationship to the ASIS and the depth at which it passes deep to the inguinal ligament. A total of 35 bodies were examined yielding 65 sets of data. Dissections were performed on 26 formalin fixed cadavers and 9 fresh morgue specimens. Measurements and calculations were made with regard to the distance from the LFCN to the ASIS along the inguinal ligament, the depth of the LFCN as it crossed the inguinal ligament, and the length of the inguinal ligament. The LFCN was observed to cross the inguinal ligament 1.4 ± 0.4 cm medial to the ASIS with a standard deviation of 1.5 cm. The LFCN traversed the inguinal ligament 1.0 ± 0.1 cm deep to the ligament with a standard deviation of 0.6 cm. The LFCN runs approximately one fingerbreadth medial to the ASIS. The nerve may be found far more medial or lateral than expected with several distinct branching patterns. In addition, the LFCN crosses deeper to the inguinal ligament than previously described in the literature, with a high variability of depth between specimens. Clin. Anat. 23:304–311, 2010. © 2010 Wiley-Liss, Inc.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/69161/1/20943_ftp.pd

Ultrasound-guided Lateral Femoral Cutaneous Nerve Block in Meralgia Paresthetica

Meralgia paresthetica is a rarely encountered sensory mononeuropathy characterized by paresthesia, pain or sensory impairment along the distribution of the lateral femoral cutaneous nerve (LFCN) caused by entrapment or compression of the nerve as it crossed the anterior superior iliac spine and runs beneath the inguinal ligament. There is great variability regarding the area where the nerve pierces the inguinal ligament, which makes it difficult to perform blind anesthetic blocks. Ultrasound has developed into a powerful tool for the visualization of peripheral nerves including very small nerves such as accessory and sural nerves. The LFCN can be located successfully, and local anesthetic solution distribution around the nerve can be observed with ultrasound guidance. Our successfully performed ultrasound-guided blockade of the LFCN in meralgia paresthetica suggests that this technique is a safe way to increase the success rate

A túlsúly és az elhízás mozgásterápiás és étrendi kezelésének lehetősége a Magyar Honvédségben = The opportunity of excercise therapy and dietetic guidelines of the obes-related chronic diseases

A témaválasztás a hazai adatokat figyelembe véve még mindig aktuális,és tekintettel a trendre valószínűleg a hatékony intervenció hiányában az is marad. Az OTÁP 2014. vizsgálatok rámutattak arra, hogy a magyarországi felnőtt lakosság 65%-a túlsúlyos vagy már elhízott. Az elhízással összefüggő krónikus betegségek kialakulása súlyos terhet jelent nemcsak az egyénre, de a megváltozott munkaképesség miatt a társadalomra is. A túlsúly és az elhízás problémaköre a Magyar Honvédségben is tetten érhető, ennek kezelésére a jogszabályban meghatározott Honvéd Testalkati Program keretében a személyi állománynak is lehetősége nyílik. A Program egyik résztvevőjének esettanulmánya alapján mutatjuk be a mozgásterápiás és étrendi kezelések hatását a testalkati mutatók megváltozására. The choice of subject is still relevant considering the Hungarian values and probably still remain in default of effective intervention in view of the trend. In 2014 Hungarian Food Safety Office performed that 65% of the Hungarian adult population is overweight or already obes. All of this on the grounds of obes-related chronic diseases development means a serious burden not only the individual but by the reason of the changing work ability the society also. The problem of the overweight and obes is detected within the Hungarian Defence Forces. Defined by law the Hungarian Army Body Composition Program what is available in order to the weight rehabilitaton for the military person. Introduce by the Program’s members’ positive effects on the physical changes by the excercise therapy and the dietetic guidelines

Peripheral Nerve Entrapment and their Surgical Treatment

Nerves pass from one body area to another through channels made of connective tissue and/or bone. In these narrow passages, they can get trapped due to anatomic abnormalities, ganglion cysts, muscle or connective tissue hypertrophy, tumours, trauma or iatrogenic mishaps. Nearly all nerves can be affected. The clinical presentation is pain, paraesthesia, sensory and motor power loss. The specific clinical features will depend on the affected nerve and on the chronicity, severity, speed and mechanism of compression. Its incidence is higher under some occupations and is some systemic conditions: diabetes mellitus, hypothyroidism, acromegaly, alcoholism, oedema and inflammatory diseases. The diagnosis is suspected with the clinical presentation and provocative clinical test, being confirmed with electrodiagnostic and/or ultrasonographic studies. Magnetic Resonance Studies (MRI) rule out ganglion cysts or tumours. Conservative medical treatment is often sufficient. In refractory ones, surgical decompression should be performed before nerve damage and muscle atrophy are irreversible. The ‘double crash’ syndrome happens when a peripheral nerve is compressed at more than one point along its trajectory. In cases with marked muscle atrophy, a ‘supercharge end‐to‐side’ nerve transfer can be added to the decompression. After decompression in those few cases with refractory pain, a nerve neurostimulator can be applied