Peripheral Diseases Research Articles

I018 Short and long lasting action of shear stress changes on diameter of conduit arteries in patients with arterial hypertension

Aim of the study was to investigate short and long lasting actions of shear stress changes on vascular diameter of brachial artery in patients with arterial hypertension. 57 patients with arterial hypertension (mean age±SD, 51.26±1.94; 30 men and 27 women) and 17 healthy controls (mean age±SD, 51±5.41 ; 9 men and 8 women) were included in the study. All the subjects underwent to the investigation of vascular characteristics via high resolution vascular dopplerechography and clinical blood pressure investigations. Patients with cardiovascular, peripheral and cerebrovascular diseases, diabetes mellitus, smokers, pregnant, obese as well as those with secondary forms of hypertension, ischemic heart disease and heart failure were excluded from the study. Compared with normotensive control subjects, initial vascular diameter (D0), was higher in hypertensive subjects (3.76±0.28 vs. 4.32±0.14, P<0.01). Initial shear stress was not significantly different between the two groups. Therefore, after reactive hyperemia test (RHtest) shear stress as well as changes of shear stress were higher in hypertensive population compared with healthy control subjects (5.86±0.32 vs. 5.15±0.32, P<0.05 and -0.35±0.09 vs. -0.71±0.09; P<0.001). Initial vascular diameter was in a negative correlation with initial shear stress, as well as with after RHtest shear stress, but there was appeared positive correlation between initial vascular diameter and changes of it. Arterial hypertension is associated with permanent changes of vascular wall diameter via neuro-humoral factors. Therefore, obtained results confirm an opinion that different from the short action of the changes of shear stress, vascular diameter of conduit arteries increases in response to the chronic increase of the shear stress.

Validation of the Italian version of the Neuropathic Pain Symptom Inventory in peripheral nervous system diseases

The aim of this study was to validate the Italian version of the Neuropathic Pain Symptom Inventory (NPSI) in patients with neuropathic pain due to peripheral nerve diseases, and also to evaluate the validity of a new NPSI score: a frequency weighted NPSI score (NPSI-FW). First, the original version of the NPSI was translated into Italian. Then the validity and reliability of the Italian NPSI (I-NPSI) were tested in 392 Italian patients consecutively referred to 16 Italian outpatient services for peripheral nerve diseases, by correlating the I-NPSI scores with other pain scales. The repeatability and responsiveness were assessed. A significant correlation between the I-NPSI scores and all the other pain measures was seen. Reproducibility and responsiveness were good. Our study shows the validity of the I-NPSI and demonstrates its reliability for assessing neuropathic pain in patients with peripheral nerve diseases. The I-NPSI scores represent reliable measurements to assess neuropathic symptoms and effectiveness of treatment on them.

Detection and analysis of Borna disease virus in Chinese patients with neurological disorders

Borna disease virus (BDV) is a neurotropic RNA virus that is known to cause neurological disturbances in various animal species, potentially even humans. However, the association between BDV infection and human neurological disorders remains unclear. Between August 2005 and March 2006, 65 patients with neurological disorders were enrolled into our study. The presence of BDV p24 RNA from peripheral blood mononuclear cells (PBMCs) was investigated by using nested reverse transcriptase PCR (RT-PCR) assay. Borna disease virus p24 RNA was detected from PBMCs in six patients with viral encephalitis by using nested RT-PCR assay. However, BDV p24 RNA was not detected in patients with multiple sclerosis or peripheral nerve diseases. There might be possible associations between BDV infection and human viral encephalitis.

High-resolution ultrasonography in evaluating peripheral nerve entrapment and trauma

High-resolution ultrasonography is a noninvasive, readily applicable imaging modality, capable of depicting real-time static and dynamic morphological information concerning the peripheral nerves and their surrounding tissues. Continuous progress in ultrasonographic technology results in highly improved spatial and contrast resolution. Therefore, nerve imaging is possible to a fascicular level, and most peripheral nerves can now be depicted along their entire anatomical course. An increasing number of publications have evaluated the role of high-resolution ultrasonography in peripheral nerve diseases, especially in peripheral nerve entrapment. Ultrasonography has been shown to be a precious complementary tool for assessing peripheral nerve lesions with respect to their exact location, course, continuity, and extent in traumatic nerve lesions, and for assessing nerve entrapment and tumors. In this article, the authors discuss the basic technical considerations for using ultrasonography in peripheral nerve assessment, and some of the clinical applications are illustrated.

Books

Acta Neurologica ScandinavicaVolume 72, Issue 1 p. 76-78 Books First published: July 1985 https://doi.org/10.1111/j.1600-0404.1985.tb01553.xAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Abstract Pediatric head injuries caused by traffic accident A prospective study with 5 year follow-up Non-functional stereotaxy Erik-Olof Backlund Alexander B. Todorov (ed.): Clinical neurology, the residents guide. Leontino Battistin, George A. Hashim & Abel Lajtha (eds.): Clinical and biological aspects of peripheral nerve diseases. David M. Barrett & Allan J. Wein: Controversies in neuro-urology. A. E. Harding: The hereditary ataxias and related disorders. Roberg R. Schmith (ed.): Stroke and the extracranial vessels. Robert B. Aird, Richard L. Masland & Dixon M. Woodbury: The epilepsies. A critical review. James F. Tole: Cerebrovascular disorders. 3rd ed. G. Racagni, R. Paoletti & P. Kielholz (eds): Clinical neuropharmacology. A. Bernsmeier, A. Schrader, A. Struppler (eds): Bodechtes's Differential-diagnose neurologischer Krankenheits-bilder. J. M. S. Pearce: Dementia. A clinical approach. D. Voth & P. Krauseneck (eds): Chemotherapy of gliomas. Basic research, experiences and results. R. Bannister (ed.): Brain's Clinical Neurology. Volume72, Issue1July 1985Pages 76-78 RelatedInformation

Needle electromyography

Physiologic assessment of diseases of the motor unit from the anterior horn cells to the muscles relies on a combination of needle electromyography (EMG) and nerve conduction studies (NCS). Both require a unique combination of knowledge of peripheral nervous system anatomy, physiology, pathophysiology, diseases, techniques, and electricity is necessary. Successful, high-quality, reproducible EMG depends on the skills of a clinician in patient interaction during the physical insertion and movement of the needle while recording the electrical signals. These must be combined with the skill of analyzing electric signals recorded from muscle by auditory pattern recognition and semiquantitation.1052 This monograph reviews the techniques of needle EMG and waveform analysis and describes the types of EMG waveforms recorded during needle EMG.

Clinical statistics of recent vertigo and dizziness cases at Kumamoto university hospital

We compiled the clinical statistics of recent vertigo and dizziness cases at Kumamoto university hospital. Peripheral vestibular diseases accounted for 53.7% of the cases, while central vestibular disorders accounted for 29.3%. In regard to the frequency of diagnosis of each disease, the most commonly encountered peripheral vestibular disease was benign paroxysmal positional vertigo (BPPV) (21.1%), followed by Meniere's disease (18.4%), similar to the case at other institutions. In regard to the affected part in the patients with BPPV, the most frequently encountered type was the lateral canal type BPPV (cupulolithiasis type), followed by the posterior canal type , lateral canal type (canalolithiasis type) and anterior canal type BPPV, in that order. There was a significantly high percentage of patients with lateral canal type BPPV (cupulolithiasis type) in which the period until healing was prolonged, in comparison with the statistics reported from the city hospital. Many of the patients with Meniere's disease showed involvement of the lateral semicircular canal function. There was also a significantly high percentage of patients with bilateral canal paresis (22.2%). There was a significantly large number of patients with intractable vertigo and dizziness at the university hospital. Focus on the management of these diseases will be necessary in the future.

PERIPHERAL NERVE DISORDERS AND TREATMENT STRATEGIES ACCORDING TO AVICENNA IN HIS MEDICAL TREATISE, CANON OF MEDICINE

The written transmission of knowledge has played a great part in the advancement of medicine, and historical documents hold the key to a full exploration of the history of medicine. Some fields, including disciplines that deal with peripheral nerve disorders, have received little benefit from such valuable material. In particular, peripheral nerve surgery lacks perspectives from historical data. For many years, physicians have obtained positive results in the surgical treatment of peripheral nerve diseases. Relevant documents reveal that the first author who described the surgical repair of damaged peripheral nerves was Avicenna, a leading figure of the medieval era who lived in the Middle East. In his primary medical work, the Canon, he provides a description, albeit sketchy, of a suture procedure for peripheral nerve transection. This treatise influenced physicians for several centuries. In this presentation, we analyze excerpts from the Canon that concern peripheral nerve disorders and strategies for their management.

Erythropoietin in amyotrophic lateral sclerosis: A pilot, randomized, double-blind, placebo-controlled study of safety and tolerability

Preclinical studies demonstrated that erythropoietin is neuroprotective in different models of peripheral and central nervous system diseases. We investigated safety and tolerability of recombinant human erythropoietin (rhEPO) in amyotrophic lateral sclerosis (ALS). We performed a phase II double-blind, randomized, placebo-controlled study. After screening, 23 patients were randomly assigned to rhEPO or placebo arm. Patients were examined during a six-month lead-in period, and then they received fortnightly either 40,000 units of rhEPO or placebo for 24 months. Primary outcomes were adverse events, safety, and death or tracheotomy. Treatment was safe and well tolerated. One patient in the rhEPO arm dropped out for a superficial phlebitis. Median values of haematocrit, haemoglobin, red cells, and reticulocytes were non-significantly higher in rhEPO than placebo arm. Haemoglobin did not increase >1 g/dl between subsequent doses. Anti-rhEPO antibodies were not detected. Survival and slope of ALSFRS-R curves did not significantly differ between treatment groups. RhEPO treatment was safe and well tolerated in ALS patients. Our results suggest that larger studies are warranted to confirm safety of treatment and to investigate different dose schedule and efficacy.

Peripheral nerve diseases

Peripheral nerve diseases are surprisingly common. Population-based studies indicate a prevalence of symmetrical polyneuropathy of about 2.4%, more in the elderly. Carpal tunnel syndrome is present in 5% of women...

Effects of lisinopril on diabetic peripheral neuropathy: experiment with rats

To investigate the effects of lisinopril, an angiotensin-converting enzyme inhibitor, on diabetic peripheral neuropathy (DNP). Twenty-five Wistar rats underwent intravenous injection of streptozocin to establish diabetes models and 10 rats were injected with sodium citrate solution as normal controls. The diabetic rats were randomly divided into 2 groups: lisinopril group treated with gastric perfusion of lisinopril daily for 8 weeks, and diabetic control group. The diabetic controls and normal controls were treated with gastric perfusion of water. Sciatic nerve electrode penetration method was used to measure the motor nerve conduction velocity (MNCV) and sensory nerve conduction velocity (SNCV). Light and heat pain measuring apparatus was used to measure the pain threshold. Then the sciatic nerves were isolated. Electron microscopy was used to observe the ultra-structure. The contents of superoxide dismutase (SOD) and malonyldialdehyde (MDA), and Na(+)K(+)-ATPase activity were detected by chemical colorimetry. Immunohistochemistry was used to detect the CD34 in the sciatic nerve. The capillary density of sciatic nerve was calculated. The MNCV and SNCV levels of the lisinopril group were both lower than those of the 2 control groups (all P < 0.01). The potency of heat pain leg retraction response of the lisinopril group was significantly shorter than that pf the diabetic control group (P < 0.05). The pathological changes of the lisinopril group were milder than those of the other groups. The SOD level and the Na(+)K(+)-ATPase activity of the diabetic group were significantly lower than those of the normal control group, and the MDA of the diabetic group was significantly higher than those of the other 2 groups (all P < 0.05). And the SOD level and Na(+)K(+)-ATPase activity of the lisinopril group were significantly higher than those of the diabetic control group, and the MDA level of the lisinopril group was significantly lower than that of the diabetic control group. The capillary density of sciatic nerve of the diabetic control group was lower and the normal control group, and that of the lisinopril group was significantly higher than that of the diabetic control group (P < 0.01). ACE inhibitors effectively prevent and treat DPN.

Insulin-Like Growth Factors in the Peripheral Nervous System

IGF-I and -II are potent neuronal mitogens and survival factors. The actions of IGF-I and -II are mediated via the type I IGF receptor (IGF-IR) and IGF binding proteins regulate the bioavailability of the IGFs. Cell viability correlates with IGF-IR expression and intact IGF-I/IGF-IR signaling pathways, including activation of MAPK/phosphatidylinositol-3 kinase. The expression of IGF-I and -II, IGF-IR, and IGF binding proteins are developmentally regulated in the central and peripheral nervous system. IGF-I therapy demonstrates mixed therapeutic results in the treatment of peripheral nerve injury, neuropathy, and motor neuron diseases such as amyotrophic lateral sclerosis. In this review we discuss the role of IGFs during peripheral nervous system development and the IGF signaling system as the potential therapeutic target for the treatment of nerve injury and motor neuron diseases.

Treating nerves: a call to arms

The process of proving that new treatments for peripheral nerve diseases work has often been slow and inefficient. The lack of adequate evidence for some existing treatments has been highlighted by Cochrane systematic reviews. This article uses four different conditions to illustrate the need for more research. Both corticosteroid injections and surgical decompression of the median nerve are efficacious in carpal tunnel syndrome, but whether corticosteroid injections avoid the need for operation needs to be discovered. Corticosteroids are efficacious for Bell's palsy, but the role of antiviral agents needs clarification, which should come from ongoing trials. Intravenous immunoglobulin (IVIg) and plasma exchange are both efficacious in Guillain-Barré syndrome, but corticosteroids are not. More trials are needed to discover the best dose of IVIg in severe cases and whether mild cases need treatment. In chronic inflammatory demyelinating polyradiculoneuropathy, corticosteroids, IVIg and plasma exchange are all efficacious, at least in the short term, but trials are needed to discover whether and which other immunosuppressive agents help. The Peripheral Nerve Society has formed a standing committee, the Inflammatory Neuropathy Consortium (http://pns.ucsd.edu/INC.htm), to facilitate the trials needed to answer the remaining questions in the inflammatory neuropathies.

The clinical value of high frequency ultrasound in diagnosis of peripheral nerve diseases

To evaluate the clinical value of high frequency ultrasound in diagnosing peripheral nerve diseases (PNDs). From January 2003 to December 2006, 64 cases of PNDs were analyzed retrospectively. The ultrasound diagnosis was compared with the operative and pathological diagnosis. Based on the operative and histopathological results, in 38 patients with trauma or entrapment, 38 among 45 traumatic nerves were rightly diagnosed by ultrasound. The coincidence rate was 84.4%. In 26 patients with original peripheral nerve tumors (PNTs), including 20 neurilemmomas, 4 neurofibromas and 2 malignant neurilemmomas, 16 cases were diagnosed by ultrasound with a coincidence rate of 61.5%. The coincidence rates in limbs and trunk were 86.7% (13/15) and 27.3% (3/11) respectively. The study suggests that high frequency ultrasound can locate peripheral nerve trauma precisely, assess the impair degree correctly and provide useful information for clinic diagnosis. The high frequency ultrasound brings better diagnosis outcome in limbs nerve tumors than in trunk.

Modeling the influence of risk factors and chronic diseases on the development of strokes and peripheral arterial-vascular disease

Several chronic diseases and risky lifestyles have become an important social burden in many countries around the world, a problem which should not be underestimated. The situation is even more worrying when we take into account their influence on serious health complications that can threaten patients’ lives or significantly reduce their quality of life. The presented modeling-and-simulation study enables us to estimate the number of patients with type-2 diabetes, hypercholesterolemia and hypertension, obese and smoking people and the influence of these conditions on the development of strokes and peripheral arterial-vascular diseases. In addition, an estimate of treatment costs makes it possible to evaluate the social burden and provide information about the potential savings resulting from treating intensive chronic diseases.

MRI Shows Dorsal Lesions and Spinal Cord Atrophy in Chronic Sensory Neuronopathies

Sensory neuronopathies (SN) represent a specific subgroup of peripheral nervous system diseases, characterized by degeneration of dorsal root ganglia (DRG) and its projections. We tried to estimate the frequency and extent of spinal cord MRI abnormalities in a group of patients with SN and correlate these with clinical and neurophysiological features. We performed spinal cord MRI scans in 16 chronic SN patients. Images were analyzed for the presence of posterior hyperintense lesions on T2WI and cord areas at C3 level were obtained using a previously validated method. A group of 14 healthy controls with similar age and gender distribution was used for comparison. ANOVA was employed for statistical analysis. Posterior T2WI lesions were found in 13 out of 16 patients. Cord areas were significantly smaller in SN patients than controls (84.3 x 97.2 mm(2), P < .05). Atrophy correlated with severity of sensory ataxia and neurophysiologic abnormalities but not with duration of disease. These findings support volumetric spinal cord MRI as a useful tool in the assessment of chronic SN.

Role of thoracic ultrasound in the assessment of pleural and pulmonary diseases

Although numerous studies have been conducted on the use of ultrasonography (US) for the examination of thoracic structures, this procedure is not as widely accepted as abdominal US. The newer portable scanners can be used at the bedside to detect pleural malignancies and effusions, as well as peripheral lung nodules of the lung, even in seriously ill patients. Focal thickening of the pleura can be easily detected with US and further investigated with a US-guided biopsy. US guidance can also be used during percutaneous drainage of pleural effusion or transthoracic biopsy of peripheral lung lesions, thus reducing the incidence of procedure-related pneumothorax to almost zero. We review the current literature on thoracic US and present our clinical experience with the technique in large groups of patients with pleural and peripheral lung diseases.

Anti-Ca 2+ channel antibody attenuates Ca 2+ currents and mimics cerebellar ataxia in vivo

Voltage-gated Ca(2+) channels (VGCCs) are membrane proteins that determine the activity and survival of neurons, and mutations in the P/Q-type VGCCs are known to cause cerebellar ataxia. VGCC dysfunction may also underlie acquired peripheral and central nervous system diseases associated with small-cell lung cancer, including Lambert-Eaton myasthenic syndrome (LEMS) and paraneoplastic cerebellar ataxia (PCA). The pathogenic role of anti-VGCC antibody in LEMS is well established. Although anti-VGCC antibody is also found in a significant fraction of PCA patients, its contribution to PCA is unclear. Using a polyclonal peptide antibody against a major immunogenic region in P/Q-type VGCCs (the extracellular Domain-III S5-S6 loop), we demonstrated that such antibody was sufficient to inhibit VGCC function in neuronal and recombinant VGCCs, alter cerebellar synaptic transmission, and confer the phenotype of cerebellar ataxia. Our data support the hypothesis that anti-VGCC antibody may play a significant role in the pathogenesis of cerebellar dysfunction in PCA.

Modalities for Diagnosis of Peripheral Lung Diseases

Modalities for Diagnosis of Peripheral Lung Diseases

Modalities for Diagnosis of Peripheral Lung Diseases

Modalities for Diagnosis of Peripheral Lung Diseases