Peripheral Nerve Injury and Current Treatment Strategies

Neuronal cells are the main fundamental anatomic unit of the system. Nerve injuries are generally divided into three categories as neuropraxia, axonotmesis and neurotmesis. Neurotmesis is the most severe form. Schwann cells are activated within 24 hours of the injury and the healing cascade continued with the cells, which are stimulated by Schwann cells. And neurotrophic factors like nerve growth factor (NGF) have a crucial role in regeneration and degeneration processes. Additionally, Schwann cells upregulate the expression of some proteins, such as fibronectin, which are crucial for axonal regeneration. All this information about nerve healing sheds light on treatment studies. Iatrogenic nerve injury has an important place in peripheral nerve injury. Causes may be direct surgical damage, wrong intraoperative patient positioning, anaesthesia-related reasons or limb tourniquets. Typical symptoms are motor or sensory deficits such as paraesthesia, weakness, paralysis and pain. Many of the traumatic nerve injuries require surgical repair. Direct nerve repair and autologous nerve grafts are still gold-standard treatment options. Additionally, nerve conduits are very successful to provide an ideal peripheral support for neuronal recovery but are still insufficient. In recent years, research efforts have focused on the neurotrophic factors and cell-based therapies to perform better microenvironment for neuronal healing

Evaluation of the relationship between the topographical anatomy in the axillary region of the brachial plexus and the body mass index

WOS: 000439345200023PubMed ID: 28871408To investigate the topographic anatomy of the median, musculocutaneous, radial and ulnar nerves with respect to the axillary artery and to seek whether these configurations are associated with baseline descriptive data including age, gender, and body-mass index. This cross-sectional trial was carried out on 199 patients (85 women, 114 men; average age: 46.78 +/- 15.45 years) in the department of anaesthesiology and reanimation of a tertiary care center. Topographic anatomy of the median, musculocutaneous, radial and ulnar nerves was assessed with ultrasonography. Localization of these nerves with respect to the axillary artery was marked on the map demonstrating 16 zones around the axillary artery. Frequencies of localizations of every nerve in these zones were recorded, and the correlation of these locations with descriptive data including age, gender and BMI was investigated. There was no difference between women and men for the distribution of the median (p = 0.74), ulnar (p = 0.35) and radial (p = 0.64) nerves. However, the musculocutaneous nerve was more commonly located in Zone A13 in men compared to women (p = 0.02). The localization of the median (p = 0.85), ulnar (p = 0.27) and radial (p = 0.88) nerves did not differ remarkably between patients with BMI < 25 kg/m(2) and patients with BMI 25 kg/m(2). Notably, the musculocutaneous nerve was more often determined in Zone A10 in cases with BMI 25 kg/m(2) (p = 0.001). Our results imply that the alignment of the musculocutaneous nerve may vary in men and overweight people. This fact must be considered by the anaesthetist before planning the axillary block of brachial plexus. All these informations may enlighten the planning stages of the brachial plexus blockade

The beneficial effects of ozone therapy in acetaminophen-induced hepatotoxicity in mice

Background: The aim of the present study was to determine the therapeutic effects of medical ozone therapy on acute acetaminophen (APAP)-induced hepatotoxicity which were not clearly demonstrated in prior studies

Locomotor stimulation by acute propofol administration in rats: Role of the nitrergic system

Tezcan, Aysu Hayriye/0000-0001-7779-6965WOS: 000362156100024PubMed: 26398394Background: The addictive potential of propofol has been scientifically discussed. Drugs' psychostimulant properties that can be assessed via measurements of locomotor activity are linked to their addictive properties. No studies that have investigated the effects of propofol on locomotor activity have been reported to date. The present study sought to investigate the effects and possible mechanisms of action of propofol on locomotor activity in rats. Methods: Adult male albino Wistar rats (250-330 g) were used as subjects. The locomotor activities of the rats were recorded for 30 min immediately following intraperitoneal administration of propofol (20 and 40 mg/kg), saline or vehicle (n = 8 for each group). NG-nitro arginine methyl ester (L-NAME, 15-60 mg/kg), a nitric oxide (NO) synthase inhibitor, and haloperidol (0.125-5 mg/kg), a non-specific dopamine receptor antagonist, were also administered to other groups of rats 30 min prior to the propofol (40 mg/kg) injections, and locomotor activity was recorded for 30 min immediately after propofol administration (n = 8 for each group). Results: Propofol produced significant increases in the locomotor activities of the rats in the first 5 min of the observation period [F(2,21) = 9.052; p <0.001]. L-NAME [F(4,35) = 3.112; p = 0.02] but not haloperidol [F(4,35) = 2.440; p = 0.067] pretreatment blocked the propofol-induced locomotor hyperactivity. L-NAME did not cause any significant change in locomotor activity in naive rats [F(2,21) = 0.569; p = 0.57]. Conclusions: Our results suggest that propofol might cause a short-term induction of locomotor activity in rats and that this effect might be related to nitrergic but not dopaminergic mechanisms. (C) 2015 Institute of Pharmacology, Polish Academy of Sciences. Published by Elsevier Sp. z.o.o. All rights reserved.Scientific and Technological Research Council of Turkey Turkish Scientific and Technological Research Council (TUBITAK, Turkey)Turkiye Bilimsel ve Teknolojik Arastirma Kurumu (TUBITAK) [105S387, SBAG-3194]This study was partially funded and supported by the Scientific and Technological Research Council of Turkey Turkish Scientific and Technological Research Council (TUBITAK, Turkey; Project No: 105S387, SBAG-3194)

Impacts of Ozone Treatment and Its Relationship with IGF-1 Levels After Injury of Soft Tissue: An Experimental Study in Rats Model

To investigate the effects of ozone treatment on soft tissue injury and to observe whether there is an alteration in serum IGF-1 levels after ozone treatment in an experimental rat model. Twenty-four adult Wistar albino 240-350 g male rats were randomly allocated into two groups. A standardized, experimental soft tissue injury was created on left hind limbs of animals. Group 1 underwent daily ozone treatment intraperitoneally (20 mu g/mL), while Group 2 received only nutrition and routine care. All rats were evaluated regarding body weight and sensory and motor function on 5th and 15th days after experimental trauma. Blood samples were drawn from intracardiac in group 1 and group 2 serum levels of IGF-1 level were measured at the day of 15th. During follow-up period after formation of soft tissue injury, three rats in Group 2 had cutaneous infection that responded well to topical tetracycline treatment. Two groups displayed similar results regarding sensory and motor functions on 5th and 15th days. Serum IGF-1 level in Group 1 was significantly higher than that of Group 1 (P=0.03). Serum IGF-1 level was correlated with motor function on day 15 in Group 1 (P=0.04) and with motor function on day 5 in Group 2 (P=0.011). Ozone treatment may have favorable impacts on healing and regeneration process in connective and muscle tissues and these beneficial effects may be mediated by IGF-1. Further research is warranted to elucidate the role of IGF-1 in repair process and to provide additional new insights to the treatment strategies

Torasik kaviteye gömülü bıçak: ilginç bir olgu

Bu olgu sunumunda delici kesici alet yaralanması nedeniyle acil servise başvuran hastaya uygulanan farklı entübasyon ve tedavi yönetimi anlatılmaktadır. Yetmiş beş yaşında bir erkek hasta sırtına saplı bir bıçakla acil servise getirildi. Hastaya anteroposterior akciğer grafisi çekildikten sonra sağ lateral dekübit pozisyonunda tek lümenli tüple endotrakeal entübasyon yapıldıktan sonra torakotomi yapılarak toraksa invaze olan bıçak çıkartıldı. Bu tip yabancı cisimlerin sternotomi veya torakotomi yardımı ile kontrollü olarak çıkartılmasını önermekteyizIn this case report we present an alternative intubation method and treatment of a patient who had admitted to the emergency department with a stab wound in his thorax. A 75-year-old man was brought to the emergency department with a knife in the posterior side of the thorax. After the anteroposterior lung x-ray was obtained, endotracheal intubation was done with a single-lumen tube in the right lateral decubitus position and the knife which was penetrated to the thorax was pulled out via a thoracotomy. We suggest that such foreign bodies should be withdrawn out with a controlled manner via sternotomy or thoracotom

Effect of ozone and methylprednisolone treatment following crush type sciatic nerve injury

PURPOSE: To assess and compare the histopathological effects of ozone therapy and/or methylprednisolone (MPS) treatment on regeneration after crush type sciatic nerve injury

Abuse potential assessment of propofol by its subjective effects after sedation

Tezcan, Aysu Hayriye/0000-0001-7779-6965; Ornek, Dilsen/0000-0002-3300-4839WOS: 000346112400015PubMed: 25674117Objective: In this study, we examined the euphoric effect of propofol and its high satisfaction ratio regarding its liability to be abused, particularly in painless procedures, such as colonoscopy. Methods: Fifty subjects aged between 18 and 65 years who fulfilled the criteria for ASA 1-2 and were prepared for colonoscopy were enrolled into this study. For intravenous sedation induction, 2 mg/kg propofol was used, and additional injections were administered according to BIS values. After colonoscopy, the subjects were taken to a recovery room and observed for 30 minutes. Patients were interviewed with the modified Brice questionnare regarding the incidence and the content of dreams. A 5-point Likert scale was used to classify their dreams, and the content of the dreams was also recorded. To assess the subjective effects of propofol, the patients were asked to use the Hall and Van der Castle emotion scale; their biological states were also assessed. The patients' feelings regarding propofol were each rated as absent or present. We used the Morphine-Benzedrine Group scale to measure the euphoric effects of propofol. At the end of the study, subjects scored their satisfaction on a five-point scale. Results: There were no statistically significant differences in sex age, weight, propofol dose, or satisfaction ratio (p > 0.05) in the groups, although male patients received a higher dose of propofol and had higher satisfaction ratio. Patients reported no residual after-effects. The incidence of dreaming was 42%. There was no statistically significant difference in dreaming between the sexes, but male patients had a higher dreaming ratio. Dreamers received higher propofol doses and had a higher satisfaction ratio (p > 0.05). All dreamers reported happy dreams regarding daily life, and their mean MBG score was 10.5. There was no correlation between MBG scores and propofol doses (r = -0.044, p = 0.761). Conclusions: We conclude that propofol functions as a reward; that patients enjoy its acute effects; and that no residual after-effects should arise. We suggest that propofol may carry potential for abuse, and further abuse liability testing is indicated

Post-thoracotomy pain relief with subpleural analgesia or thoracic epidural analgesia: randomized clinical trial

ABSTRACT CONTEXT AND OBJECTIVE: Post-thoracotomy pain is a severe and intense pain caused by trauma to ribs, muscles and peripheral nerves. The current study aimed to compare subpleural analgesia (SPA) with thoracic epidural analgesia (TEA) in patients undergoing thoracotomy. DESIGN AND SETTING: Randomized study at Ankara Numune Education and Research Hospital, in Turkey. METHODS: Thirty patients presenting American Society of Anesthesiologists physical status I-III were scheduled for elective diagnostic thoracotomy. The patients were randomized to receive either patient-controlled SPA or patient-controlled TEA for post-thoracotomy pain control over a 24-hour period. The two groups received a mixture of 3 µg/ml fentanyl along with 0.05% bupivacaine solution through a patient-controlled analgesia pump. Rescue analgesia was administered intravenously, consisting of 100 mg tramadol in both groups. A visual analogue scale was used to assess pain at rest and during coughing over the course of 24 hours postoperatively. RESULTS: In the SPA group, all the patients required rescue analgesia, and five patients (33%) required rescue analgesia in the TEA group (P < 0.05). Patients who received subpleural analgesia exhibited higher visual analogue scores at rest and on coughing than patients who received thoracic epidural analgesia. None of the patients had any side-effects postoperatively, such as hypotension or respiratory depression. CONCLUSION: Thoracic epidural analgesia is superior to subpleural analgesia for relieving post-thoracotomy pain. We suggest that studies on effective drug dosages for providing subpleural analgesia are necessary