Degree Of Nerve Damage Research Articles

Consecutive assessment of recovery after peripheral nerve injury of the sciatic nerve within the same rat using PET/MRI.

Positron emission tomography (PET) has been reported as effective in diagnosing peripheral nerve injury (PNI). However, there is a lack of studies evaluating different degrees of PNI using PET within the same individual to reduce errors due to interindividual differences. To evaluate the recovery process in the same rat after sciatic nerve injury using PET/magnetic resonance imaging (MRI). Crushing nerve injuries were induced in the left sciatic nerves of six male rats, preserving the right ones. The degree of nerve damage was measured at one, two, three, four, and five weeks postoperatively using three assessment methods: paw withdrawal threshold test (RevWT); PET (SUVR); and MRI (MRSIR). All the representing values of each method are presented as ratio values of the right and left sides in each rat. Significant gradual recovery of all rats was observed over time in all the methods. No significant differences in RevWT and MRSIR were observed between before and more than four weeks after injury, whereas a significant difference in SUVR was still observed between before and five weeks after injury (P = 0.0007). The parameters of all methods decreased significantly over time (P = 0.000, all), and the explanatory power was significant in RevWT, SUVR, and MRSIR. PET and MRI could be valuable non-invasive techniques for diagnosing neuropathic pain resulting from PNI. PET/MRI would be expected to be a more accurate and informative diagnostic tool for PNI than MRI alone.

The evaluation value of intracranial magnetic resonance angiography combined with carotid ultrasound in cerebral infarction.

To explore the evaluation value of intracranial magnetic resonance angiography (MRA) combined with carotid ultrasound (CU) in patients with cerebral infarction (CI). A retrospective analysis was conducted on 122 patients with CI who underwent intracranial MRA combined with CU examination in Shengzhou People's Hospital from January 2021 to October 2022. Vascular stenosis rate and CU parameters of patients with different degrees of nerve damage (ND) and size of CI lesion were analyzed. The rate of vascular stenosis and ultrasound parameters significantly varied between patients with different degrees of ND and different sizes of CI lesion. Spearman test showed a significant positive correlation between vascular stenosis, pulsatile index (PI), and resistance index (RI) with the degree of ND and the size of CI lesions in patients. There was a significant negative correlation between peak systolic velocity (PSV) and end-diastolic velocity (EDV) and the degree of ND and the size of CI lesions (P<0.05). Intracranial MRA combined with CU can clarify the vascular stenosis and hemodynamic characteristics of patients with CI, and the combined approach closely correlates with the characteristics of CI, which can be used for disease assessment.

Functional alterations of the brain default mode network and somatosensory system in trigeminal neuralgia

Mapping the localization of the functional brain regions in trigeminal neuralgia (TN) patients is still lacking. The study aimed to explore the functional brain alterations and influencing factors in TN patients using functional brain imaging techniques. All participants underwent functional brain imaging to collect resting-state brain activity. The significant differences in regional homogeneity (ReHo) and amplitude of low frequency (ALFF) between the TN and control groups were calculated. After familywise error (FWE) correction, the differential brain regions in ReHo values between the two groups were mainly located in bilateral middle frontal gyrus, bilateral inferior cerebellum, right superior orbital frontal gyrus, right postcentral gyrus, left inferior temporal gyrus, left middle temporal gyrus, and left gyrus rectus. The differential brain regions in ALFF values between the two groups were mainly located in the left triangular inferior frontal gyrus, left supplementary motor area, right supramarginal gyrus, and right middle frontal gyrus. With the functional impairment of the central pain area, the active areas controlling memory and emotion also change during the progression of TN. There may be different central mechanisms in TN patients of different sexes, affected sides, and degrees of nerve damage. The exact central mechanisms remain to be elucidated.

Long Relationship of Seeking Help with Severity of Stroke Patients

Long seeking help for stroke patients to health services plays an important role in the successful treatment of stroke patients. The golden period of stroke treatment is ± 3 hours from the beginning of the attack. Patients must immediately get comprehensive and optimal therapy so that the degree of nerve damage is not too severe. The purpose of the study was to determine the relationship between the length of seeking help and the severity of stroke patients at RSUD dr. Loekmono Hadi Kudus. This research is an analytical descriptive research with a cross sectional approach. Purposive sampling was used in sampling, and a sample of 65 respondents was obtained. The instruments used are observation sheets and NIHSS questionnaires. Test statistics using Spearman Rank. There was a significant relationship between the length of seeking help and the severity of stroke patients with (p-value &lt;0.05). More than half of respondents sought help to health care past the golden period (&gt;3 hours) and more than half of respondents had a major stroke. Ignorance of respondents or families about the signs and symptoms of stroke, as well as consideration of the cost of hospital care are the causes of patients missing the golden period. Education to the public about stroke, especially signs of stroke symptoms, is something that needs to be done, so that they can immediately take patients to the hospital when they find the appropriate symptoms. Further researchers are expected to conduct qualitative research to dig deeper into family knowledge and family response factors to stroke.

Intervention effects of miR-125b-5p on cognitive dysfunction induced by traumatic brain injury in rats and its mechanisms

To investigate the effects and molecular mechanisms of miR-125b-5p on cognitive dysfunction caused by traumatic brain injury (TBI). The rats were randomly divided into control group, TBI group (model group), NC Agomir group (false negative group) and miR-125b-5p agomir group (high expression group), with 5 rats in each group. The false negative group and the high expression group were injected with NC agomir and miR-125b-5p agomir, respectively. The brain injury model was established by modified Feeney method except control group. Animal behavioral experiments were utilized for evaluation of the motor coordination, learning and memory and the degree of nerve damage in rats; and enzyme-linked immunosorbent assays (ELISA) and Western blot (WB) were used for determination of the expression levels of inflammatory factors and nerve-related factors in the hippocampus of rats in each group respectively. Finally, combined with bioinformatics, downstream target genes of miR-125b-5p were predicted and verified by reverse transcription polymerase chain reaction (RT-PCR) and WB. Compared with control group, mir-125b-5p expression level, motor coordination ability, learning and memory ability, brain-derived neurotrophic factor(BDNF) and nerve growth factor(NGF) expression levels of rats in model group and false negative group were decreased significantly, the MNSS score, the expressions of interleukins (IL-1β, IL 6), tumor necrosis factor-α(TNF-α) and glial fibrillary acid protein(GFAF) were increased significantly (P＜0.01);However, compared with model group and false negative group, the above situation of rats in high expression group was opposite (P＜0.01). Bioassay showed that MMP-15 was the downstream target gene of miR-125b-5p. Compared with the control group, the expression of MMP-15 in model group and false negative group was increased significantly (P＜0.01);Compared with model group and false negative group, the expression of MMP-15 in high expression group was decreased significantly (P＜0.01) . miR-125b-5p can improve cognitive dysfunction induced by TBI in rats, which may be related to regulating the expression level of MMP-15, thereby inhibiting the neuroinflammatory response after TBI and promoting neuronal regeneration.

Comprehensive approach to the diagnosis, treatment and rehabilitation of patients with facial nerve neuropathy at different periods of the disease

Diagnosis, treatment and rehabilitation of patients with facial neuropathy (FN) is a significant medical problem. The aim of the work was to create, implement and evaluate the effectiveness of an internal algorithm for working with patients suffering from FN.Material and methods. The study included 53 patients: group 1 (n = 27) — treatment in the first 2 weeks from the moment of development of symptoms, group 2 (n = 11) — for more than 2 weeks to 3 months, group 3 (n = 15) — for more than 1 year. The algorithm of diagnosis and treatment were created in the N.V. Sklifosovskii Research Institute of Emergency Medical Care. It includes a multidisciplinary approach, teamwork and continuity.Results. In patients with FN diff erent genesis, at the beginning of treatment in the acute period, complete restoration of the function of the facial nerve and facial muscles occurred in 74% of cases in the period from 2 weeks to 9 months, the period depended on the severity of clinical manifestations (House–Brackmann scale) (r = 0.539, p = 0.014), the degree of nerve damage according to electroneuromyography (ENMG) (r = 0.595, p = 0.006), the severity of complications (contractures and synkinesias) (r = 0.524, p = 0.018). In patients with idiopathic FN, at the beginning of treatment in the acute period, complete recovery was observed in 81.3% of cases. At the beginning of treatment of patients with a disease period of more than a year, conservative tactics led to an improvement in 67% of cases.There was an incomplete correspondence between the clinical (House–Brackmann scale) and degree of nerve damage according to ENMG (r = 0.620, p = 0.004). ENMG should be performed when the House–Brackmann is VI degree. In cases of a decrease in the amplitude of the M-response by 90% or more compared to the healthy side, needle myography (IMG) is indicated. In the absence of motor unit potentials (PDE), it is necessary to consider the issue of surgical treatment, which is indicated in the acute period of FN to every 10 patients, and after a year in cases of lack of recovery — to every second.FN should be considered a progressive disease due to the development of complications, such as the consequences of lagophthalmos, contracture, synkinesia. Lagophthalmos occurs in 73.5% of patients with various consequences — from dry eye syndrome to corneal ulcers, so it is important to use local protective and regenerating drugs early to prevent the development of keratopathies, even with a mild degree of lagophthalmos. Hypertonus of facial muscles is formed already on the 7th day of the disease on the healthy side of the face in an average of 67% of patients, and in the absence of timely treatment — in more than 90% of patients. Synkinesia develops in the period from 4 months to a year in every fifth patient. Timely detection and correction of complications prevents their further development and leads to a complete restoration of the facial nerve function.The success of recovery in FN depends more on identifying the risks of complications and carrying out their prevention. Risk factors for the development of contractures and synkinesias are: prosoplegia, facial nerve damage by more than 90% according to ENMG and gross exercises. FN, despite the different causes of its development, clinically has similar sanogenetic mechanisms, which should be used in rehabilitation.

PRZEBIEG POWROTU FUNKCJI KRTANI U PACJENTA PO REKONSTRUKCJI NERWÓW KRTANIOWYCH WSTECZNYCH

BackgroundAccording to the literature, the rate of laryngeal paralysis after thyroid surgery is as high as several percent. For oncolog-ical operations the rate can reach 20%. The return of laryngeal function depends on the degree of nerve damage. Surgical procedures are required to increase the likelihood of nerve function recovery. Three methods of phonosurgery are currently used. The first is based on injecting auto or alloplastic materials into the vocal fold. The second interferes with the skeleton of the laryngeal cartilages; according to the Isshiki clas-sification, it includes type I thyreoplasty (medialisation thyreoplasty), optionally with complementary arytenoid adduction. The third method reconstructs the laryngeal nerves. Combinations of the three methods are increasingly used. Conservative treatment including phoniatric voice rehabilitation should be started as early as possible.Case reportThe paper presents a case report of a patient after thyroid surgery due to papillary carcinoma, complicated by bilateral laryn-geal paralysis and aphonia.ConclusionsFunctional Voice Therapy started just after healing of the postoperative wound in the neck eliminated abnormal compensatory mechanisms of phonation. Reconstruction of the laryngeal nerves is an opportunity to quickly return laryngeal function and prevents unwanted secondary functional mechanisms within the vocal organ.

Investigation of grey matter abnormalities in multiple sclerosis patients by combined use of double inversion recovery sequences and diffusion tensor MRI at 3.0 Tesla

To investigate the grey matter abnormalities in multiple sclerosis (MS) patients by combined use of double inversion recovery (DIR) sequences and diffusion tensor (DTI) magnetic resonance imaging (MRI) at 3 T. Twenty relapsing-remitting MS (RRMS) patients and 20 healthy control were enrolled in this study. All participants underwent DIR and DTI MRI and completed the Mini-Mental State Examination (MMSE) and Expanded Disability Status Scale (EDSS). The cortical lesions and normal-appearing grey matter (NAGM) of the patient group, as well as the NAGM of the control group were quantitatively analysed using the DIR and DTI images. The average NAGM mean diffusion (MD) and fractional anisotropy (FA) values of the patient group and control group were measured and compared. The correlation between NAGM MD and FA values and the number of cortical lesions, cognitive impairment, as well as the degree of nerve damage were analysed. The NAGM of the patient group had average MD and FA values that were significantly different compared with the control group. In addition, the NAGM FA values of the MS patients were negatively correlated with the MMSE score, but positively correlated with the EDSS score. The NAGM MD values of the MS patients were also negatively correlated with the MMSE score, but positively correlated with the EDSS score. The NAGM of MS patients has microstructural damages. The extent of such damage was correlated with the number of cortical lesions. The severity of the damage also correlated with increased severity of cognitive impairment and neural defects.

Sciatic Nerve Injuries from Gluteal Intramuscular Injection According to Records of the High Health Council.

To analyze the cases discussed at the High Health Council (HHC) and to determine the solutions for problems related to gluteal intramuscular injection (IMI) applications. In a 10-year period, the cases of IMI-related sciatic nerve injury (SNI) referred for an opinion from the HHC of Turkey were reviewed. The cases were analyzed based on demographic features, degree of nerve damage, side of gluteal injection, injected drugs, primary disease, appropriateness of parenteral therapy indications, and management. There were 107 SNIs from gluteal IMI during the 103 months. Eight of the 107 cases were male and 99 female. The mean age was 28 years. The left sciatic nerve was more commonly injured (41 right, 65 left side). SNI was partial in 48.5% of the cases. The most commonly injected drug was diclofenac sodium (29.9%), and 23.3% of cases were injected more than one drug together. Conservative management was performed in all cases, except one. Based on our findings, indications of parenteral therapies were exaggerated and nurses injected the drug while the patient"s position was inappropriate for IMI. However, an IMI into the gluteal region is potentially devastating. For those reasons, we conclude that physicians should be restricted in their indications for IMI, and continuous education courses should be organized for nurses. Injured patients should be managed according to their neurological damage.

Effect of Cornus officinalis glycosides on the myelin basic protein in blood serum and the nerve function in Balb/c mice after sciatic nerve injury

Objective: to explore the effect of cornus officinalis glycosides(COG) on the myelin basic protein(MBP) in blood serum andthe nerve function in Balb/c mice after sciatic nerve injury. Methods : Adult male Balb/c mice were randomly divided into high-dose, middle-dose, low-dose COG groups,.Transecting and inosculating the right sciatic nerve; testing the concentration of MBP by ELISA in 3, 5 days, 1, 2, 4, 8 weeks and having electroneurophysiological detection in 4, 8 and 12 weeks after surgery respectively; making statistical analysis of the results. Results: The MBP concentration and results of lectroneurophysiological detection have clear dose-effect relationship with the COG dose. Conclusion: Through inhibiting the demyelination of the sciatic nerve , COG can lower the degree of nerve damage so that accelerating the nerve regeneration.

Retrospective case series with one year follow-up after radial nerve palsy associated with humeral fractures

PurposeThe purpose of this study was to assess recovery and clinical outcome in patients with primary or secondary radial nerve palsy following humeral shaft fracture.MethodsWe retrospectively assessed 102 patients (45 female and 57 male) with humeral shaft fracture and concomitant radial nerve palsy, who were followed up for 12 months. Patients were divided into two groups with primary or secondary radial nerve palsy depending on the onset. Muscle function was measured according to Daniels classification and degree of nerve damage was assessed by the Sunderland classification.ResultsThe average time for onset of recovery after primary RNP was 10.5 ± 3.31 weeks, in the case of secondary RNP it was 8.9 ± 7.98 weeks (p < 0.05). Full recovery or significant improvement was achieved with average of 26.7 ± 8.86 weeks and 23.9 ± 6.04 weeks respectively (p < 0.05). Trauma mechanism and type of treatment had no significant influence on time of onset of recovery or time to full recovery (p < 0.904).ConclusionSecondary RNP shows tendency for earlier recovery and is more commonly associated with ORIF.

Renal sympathetic nerve denervation using intraluminal ultrasound within a cooling balloon preserves the arterial wall and reduces sympathetic nerve activity.

Circumferential ablation of renal sympathetic nerves using catheter-based ultrasound energy was studied in a preclinical in vivo model. The aim was to investigate the benefit of cooling the arterial wall and the extent of renal nerve injury based on histopathology, and to correlate the injury with kidney norepinephrine levels. Computer simulations of the ultrasound transducer within the cooling balloon demonstrated a circumferentially uniform heating profile. In vivo characterisation was performed in 10 normotensive pigs. Nine were treated bilaterally with ultrasound and survived for seven days (n=8) or were sacrificed acutely (n=1). Acutely, TTC staining of the renal arteries treated with ultrasound energy in the presence of cooling demonstrated viable tissue consistent with preservation of the arterial medial layer. Histological studies demonstrated no endothelial injury and minimal to no injury to the media of the renal arterial wall at seven days. Overall, circumferential nerve damage with up to 76% of nerve bundles affected within 7.5 mm of the arterial lumen was observed. Kidney norepinephrine (NEPI) levels were significantly reduced in all animals compared to a non-treated control animal (n=1) and correlated with the degree of nerve damage. A greater reduction in NEPI and a greater percentage of affected nerves was observed in arteries treated with two or three bilateral ultrasound emissions. Catheter-based ultrasound delivered within a cooling balloon is effective at targeting the majority of the renal nerves circumferentially, resulting in significantly decreased kidney NEPI levels without damaging the arterial wall in a porcine model.

Sulfatide levels correlate with severity of neuropathy in metachromatic leukodystrophy.

ObjectiveMetachromatic leukodystrophy (MLD) is an autosomal recessive lysosomal storage disorder due to deficient activity of arylsulfatase A (ASA) that causes accumulation of sulfatide and lysosulfatide. The disorder is associated with demyelination and axonal loss in the central and peripheral nervous systems. The late infantile form has an early-onset, rapidly progressive course with severe sensorimotor dysfunction. The relationship between the degree of nerve damage and (lyso)sulfatide accumulation is, however, not established.MethodsIn 13 children aged 2–5 years with severe motor impairment, markedly elevated cerebrospinal fluid (CSF) and sural nerve sulfatide and lysosulfatide levels, genotype, ASA mRNA levels, residual ASA, and protein cross-reactive immunological material (CRIM) confirmed the diagnosis. We studied the relationship between (lyso)sulfatide levels and (1) the clinical deficit in gross motor function (GMFM-88), (2) median and peroneal nerve motor and median and sural nerve sensory conduction studies (NCS), (3) median and tibial nerve somatosensory evoked potentials (SSEPs), (4) sural nerve histopathology, and (5) brain MR spectroscopy.ResultsEleven patients had a sensory-motor demyelinating neuropathy on electrophysiological testing, whereas two patients had normal studies. Sural nerve and CSF (lyso)sulfatide levels strongly correlated with abnormalities in electrophysiological parameters and large myelinated fiber loss in the sural nerve, but there were no associations between (lyso)sulfatide levels and measures of central nervous system (CNS) involvement (GMFM-88 score, SSEP, and MR spectroscopy).InterpretationNerve and CSF sulfatide and lysosulfatide accumulation provides a marker of disease severity in the PNS only; it does not reflect the extent of CNS involvement by the disease process. The magnitude of the biochemical disturbance produces a continuously graded spectrum of impairments in neurophysiological function and sural nerve histopathology.

Treatment of thoracolumbar fracture by posterior reduction combined with H-shaped bone grafting and spinous process replantation for reconstruction of spinal structures

Objective To detect the clinical effect of posterior reduction combined with H-shaped bone grafting and spinous process replantation for reconstruction of spinal structures in treatment of thoracolumbar fracture.Methods Forty-three patients with thoracolumbar burst fracture treated surgically from February 2008 to June 2012 were reviewed retrospectively.There were 30 male and 13 female patients aged 23 to 55 years (mean,38 years).Fracture resulted from high falls in 21 patients,traffic accidents in 16 patients,and a crush by heavy objects in 6 patients.Denis system was used for classification of fracture and Frankel rating for assessing the degree of nerve damage and recovery.After posterior reduction combined with H-shaped bone grafting and spinous process replantation for all patients,visual analogue scale (VAS) was utilized to assess symptom improvement and Cobb' s angle and sagittal spinal canal diameter were measured to help assess the treatment outcome.Results Pain was apparently eased at a 24-month follow-up (range,12-46 months).Cobb' s angle improved from preoperative 43.56° to postoperative 8.23° (t =1.33,P ＜ 0.01).CT findings showed mean spinal canal stenosis rate was 56.3％ before surgery and that mean sagittal canal diameter of the injured spine was larger than that of adjacent segments at follow-up,with the mean ratio of 116.3％ (range,111.3％-120.3％).Rate of spinal canal stenosis was negative for all patients and posterior canal with bone grafts healed.Spinal cord injury improved at least one Frankel grade.Conclusion Posterior reduction combined with H-shaped bone grafting and spinous process replantation is worthy of clinical application,for the procedure can restore the fractured thoracolumbar spine and posterior canal structure,but also effectively avoid the iatrogenic spinal stenosis. Key words: Spinal fractures ; Thoracic vertebrae ; Lumbar vertebrae ; Spinal canal

Urodynamic Study of Bladder Function for Patients with Lumbar Spinal Stenosis Treated by Surgical Decompression

Lumbar spinal stenosis usually leads to different degrees of nerve damage, presenting with back and leg pain, and/or neurogenic bladder symptoms. To determine whether lumbar decompression improved urological function, bladder dysfunction was evaluated in this retrospective study of 26 patients with lumbar spinal stenosis who had undergone lumbar decompression surgery. Urodynamic study procedures were performed pre-operatively and 6 months post-operatively. The Japanese Orthopaedic Association score rating system and Oswestry Disability Index were employed for clinical evaluation. Following surgery, post-voiding residual urine, maximum cystometric capacity and maximum flow rate improved significantly. There was no statistically significant improvement in voided volume, bladder compliance, maximum detrusor pressure or upper urinary tract damage. Urodynamic study was important in the diagnosis of neurogenic bladder dysfunction, prevention of renal deterioration and assessment of post-operative effects after surgical decompression for patients with lumbar spinal stenosis.

Severity of Carpal tunnel syndrome assessed with high frequency ultrasonography

Although nerve conduction study (NCS) is the method most frequently used in daily clinical practice to confirm clinical diagnosis of Carpal tunnel syndrome (CTS), ultrasonographic (US) measurement of the median nerve cross-sectional area is both sensitive and specific for the diagnosis of CTS. Moreover, an algorithm evaluating CTS severity based on CSA of median nerve was suggested. This study is aimed to investigate the clinical usefulness of this algorithm in assessing CTS severity. The patients underwent a full clinical examination, including Tinel and Phalen test, and questioned about symptoms and the secondary causes of CTS. All of the patients refilled a Turkish version Levine Boston Carpal tunnel syndrome questionnaire (BQ) and the visual analog scale for pain (VAS 0-100 mm) A MyLab 70 US system (Esaote Biomedica, Genoa, Italy) equipped with a broadband 6-18 MHz linear transducer was used for US examination. The cross-sectional area of the median nerve was measured at the proximal inlet of the carpal tunnel (US cut-off points that discriminate between different grades of CTS severity as 10.0-13.0 mm(2) for mild symptoms, 13.0-15.0 mm(2) moderate symptoms and >15.0 mm(2) for severe patients). Nerve conduction studies were carried out, and severity of electrophysiological CTS impairment was reported as normal, mild, moderate, severe and extreme. The agreement between NCS and US in showing CTS severity (normal, mild, moderate and severe) was calculated with Cohen's kappa coefficient. Ninety-nine wrists of 54 patients (male/female: 4/50) were included in the study. Mean ages of patients were (+/-SD) 43.3 +/- 11 years. Forty-nine patients had idiopathic CTS, whereas five had secondary CTS (4 had diabetes mellitus and 1 had hypothyroidism). Symptoms were bilateral in 45 patients (83.3%). There were statistical differences between the groups according to electrophysiologic severity scale in terms of age (P < 0.001), body-mass index (P = 0.034), VAS (P = 0.014), Boston symptom severity (P = 0.013) and CSA of median nerve (P < 0.001). The identification of CTS severity showed substantial agreement (Cohen's kappa coefficient = 0.619) between the US and NCS. Also the four groups based on US CTS severity classification were significantly different in VAS (P = 0.017) and Boston symptom severity (P = 0.021). The median nerve swelling detected by calculation of the CSA reflects in itself the degree of nerve damage as expressed by the clinical picture. In addition to CTS diagnosis, sonographic measurement of CSA could also give additional information about severity of median nerve involvement. Using of US may cost-effectively reduce the number of NCS in patients with suspected CTS.

Neurosensory recovery following the mandibular bilateral sagittal split osteotomy

Purpose: This prospective study evaluated the neurosensory recovery pattern of the inferior alveolar nerve following the bilateral sagittal split osteotomy (BSSO). Patients and Methods: Forty-two consecutive patients undergoing BSSO were studied using five neurosensory tests: 1) static light touch, 2) moving touch discrimination, 3) two-point discrimination, 4) nociception, and 5) thermoreception. Intraoperative assessment of inferior alveolar nerve damage was made; other variables recorded included type of fixation, age, concomitant procedures, advancement vs setback, and magnitude of the movement. A subjective questionnaire was completed by the patient. Results: The variables that affected neurosensory function following BSSO were degree of nerve damage and the amount of time elapsed following surgery. Larger myelinated fibers (A-α) recovered slower and to a lesser degree at all time intervals up to 2 years when compared with small myelinated and unmyelinated nerve fibers. The magnitude of nerve damage directly correlated with early neurosensory deficit, but equalized over time. Conclusion: The long term (6 months and greater) chance for neurosensory recovery is good despite intraoperative nerve manipulation. Patients seem to adapt and report normal neurosensory function even though objective testing indicates continued neurosensory deficit.

Pelvic Floor Damage and Childbirth

Ninety six nulliparous women were investigated to establish whether childbirth causes damage to the striated muscles and nerve supply of the pelvic floor. The techniques used were concentric needle electromyography (EMG), pudendal nerve conduction tests and assessment of pelvic floor contraction using a perineometer. There was EMG evidence of re-innervation in the pelvic floor muscles after vaginal delivery in 80% of those studied. Women who had a long active second stage of labour and heavier babies showed the most EMG evidence of nerve damage. Forceps delivery and perineal tears did not affect the degree of nerve damage seen. We conclude that vaginal delivery causes partial denervation of the pelvic floor (with consequent re-innervation) in most women having their first baby. In a few this is severe and is associated with urinary and faecal incontinence. For some it is likely to be the first step along a path leading to prolapse and/or stress incontinence.

Flexor-Tendon Grafts in the Fingers and Thumb

A study of 1000 consecutive grafts of flexor tendons in the fingers and thumbs has allowed us to develop a consistent technique and a system of evaluation. The first 300 were reported previously. Detailed analysis of the last 700 grafts, 607 in the fingers and ninety-three in the thumb, permits the following conclusions. Scarring from injury or additional scarring from inept previous surgery, or failed primary reparative procedures, compromised the results of secondary tendon grafting. Fingers in which joints had been damaged or in which the interphalangeal joints had become stiffened from neglect did not respond well to tendon grafting, even though the joints were mobilized well before surgery. In fingers with minimum scarring and only one nerve injured, the results were not impaired, but fingers with both nerves damaged had much less motion. The level of tendon injury, whether in the proximal, middle, or distal portion of no-man's land was not a determining factor on the result, nor was the time from injury to operation. Injury of the tendons in more than one digit in itself was not important. The condition of the individual digit determined the outcome for each finger. Other things being equal, patients over forty years of age did not obtain as much motion from tendon grafts as did the patients in younger age groups. The palmaris longus tendon was the best donor tendon, but there was little difference noted when a good superficialis tendon was used. The superficialis of the littie finger and the plantaris tendons are not recommended because of their small size and tendency to rupture. Pulley reconstruction done at the same time as the tendon grafting does not compromise the result. Loss of a few degrees of extension of the interphalangeal joints is not detrimental, but if the total loss of the two joints exceeds 40 degrees in the index or long fingers and 60 degrees in the ring or little fingers, the limitation of extension is significant. When a graft separates at the palmar junction or at its insertion, prompt resuture will salvage at least one-half of the digits. In flexor-tendon grafting in the thumb, the source of the donor tendon, the site of injury, and the presence of considerable scar do not affect the result adversely. The degree of nerve damage had only a minor effect on the result. Grafts extending from the musculotendinous juncture to the terminal phalanx gave better results than the shorter ones. Fingers treated by primary wound closure and insertion of a tendon graft as a secondary procedure had significantly better results than those treated by grafting after an attempted primary tendon repair had failed.