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Journal of Pharmacological Sciences Apr 2009This study was conducted to make a new mouse model of neuropathic pain due to injury to a branch of the sciatic nerve. One of three branches (sural, tibial, and common...
This study was conducted to make a new mouse model of neuropathic pain due to injury to a branch of the sciatic nerve. One of three branches (sural, tibial, and common peroneal nerves) of the sciatic nerve was tightly ligated, and mechanical and cool stimuli were applied to the medial part (tibial and common peroneal nerve territories) of the plantar skin. The three types of nerve injuries produced behavioral mechanical hypersensitivities, and the extent of the hypersensitivities after sural and tibial nerve ligation was larger than that of common peroneal nerve ligation. Sural nerve ligation did not affect motor function of the affected hind paw, but tibial and common peroneal nerve ligation produced motor dysfunction. These results suggest that the ligation of the sural nerve is the most suitable for behavioral study. Sural nerve ligation induced behavioral hypersensitivities to mechanical and cool stimuli, which were almost completely inhibited by gabapentin (30 mg/kg). Sural nerve ligation increased spontaneous activity and responses of the wide-dynamic range neurons in the lumbar dorsal horn, which were also almost completely inhibited by gabapentin (30 mg/kg). Sural nerve ligation provides a new mouse model of neuropathic pain, which is easy to prepare and sensitive to gabapentin.
Topics: Amines; Analgesics, Non-Narcotic; Animals; Behavior, Animal; Cold Temperature; Cyclohexanecarboxylic Acids; Data Interpretation, Statistical; Electrophysiology; Gabapentin; Ligation; Male; Mice; Mice, Inbred ICR; Pain; Pain Measurement; Peripheral Nervous System Diseases; Physical Stimulation; Posterior Horn Cells; Sciatic Nerve; Sciatic Neuropathy; Sural Nerve; gamma-Aminobutyric Acid
PubMed: 19346671
DOI: 10.1254/jphs.08319fp -
Journal of Neurology, Neurosurgery, and... Oct 2000
Topics: Biopsy; Humans; Peripheral Nervous System Diseases; Sural Nerve
PubMed: 10990498
DOI: 10.1136/jnnp.69.4.431 -
Revista Do Colegio Brasileiro de... 2019The equinus deformity causes changes in the foot contact and may affect more proximal anatomical regions, such as the knee, hip and trunk, potentially leading to gait... (Review)
Review
The equinus deformity causes changes in the foot contact and may affect more proximal anatomical regions, such as the knee, hip and trunk, potentially leading to gait disorders. The equinus is usually secondary to retraction, shortening and/or spasticity of the triceps surae, and it may require surgical correction. Surgery for the correction of equinus is one of the oldest procedures in Orthopedics, and it was initially performed only at the calcaneus tendon. The technique has evolved, so that it could be customized for each patient, depending on the degree of deformity, the underlying disease, and patient´s profile. The aim is to correct the deformity, with minimal interference in muscle strength, thus reducing the incidence of disabling complications such as crouch gait and calcaneus foot. We conducted a literature search for the most common surgical techniques to correct the equinus deformity using classic books and original articles. Further, we performed a database search for articles published in the last ten years. From the anatomical perspective, the triceps surae presents five anatomical regions that can be approached surgically for the equinus correction. Due to the complexity of the equinus, orthopedic surgeons should be experienced with at least one procedure at each region. In this text, we critically approach and analyze the most important techniques for correction of the equinus, mainly to avoid complications.
Topics: Achilles Tendon; Equinus Deformity; Foot; Humans; Muscle, Skeletal; Sural Nerve; Tenotomy
PubMed: 31017177
DOI: 10.1590/0100-6991e-20192054 -
Journal of Orthopaedic Surgery and... Jul 2020Minimally invasive repair is a better option for Achilles tendon rupture with low re-rupture and wound-related complications than conservative treatment or traditional...
BACKGROUND
Minimally invasive repair is a better option for Achilles tendon rupture with low re-rupture and wound-related complications than conservative treatment or traditional open repair. The major problem is sural nerve injury. The purpose of this study was to evaluate the effect and advantage of the intraoperative ultrasonography assistance for minimally invasive repair of the acute Achilles tendon rupture.
METHODS
A retrospective study was performed on 36 cases of acute Achilles tendon rupture treated with minimally invasive repair assisted with intraoperative ultrasonography from January 2015 to December 2017. The relationship of the sural nerve and small saphenous vein was confirmed on the preoperative MRI. The course of the small saphenous vein and the sural nerve was identified and marked by intraoperative ultrasonography. The ruptured Achilles tendon was repaired with minimally invasive Bunnell suture on the medial side of the small saphenous vein (SSV).
RESULTS
All patients were followed up for at least 12 months. No sural nerve injury or other complications was found intraoperatively and postoperatively. All the patients returned to work and light sporting activities at a mean of 12.78 ± 1.40 weeks and 17.28 ± 2.34 weeks, respectively. The Mean American Orthopaedic Foot & Ankle Society (AOFAS) scores improved from 59.17 ± 5.31 preoperatively to 98.92 ± 1.63 at the time of 12 months follow-up. There was a statistically significant difference (P < 0.001). No patient complained of a negative effect on their life.
CONCLUSIONS
The minimally invasive repair assisted with intraoperative ultrasonography can yield good clinical outcomes, less surgical time, and less complications, especially sural nerve injury. It is an efficient, reliable, and safe method for acute Achilles tendon (AT) rupture.
Topics: Achilles Tendon; Adult; Female; Follow-Up Studies; Humans; Intraoperative Period; Male; Middle Aged; Minimally Invasive Surgical Procedures; Peripheral Nerve Injuries; Postoperative Complications; Retrospective Studies; Rupture; Saphenous Vein; Sural Nerve; Surgery, Computer-Assisted; Suture Techniques; Tendon Injuries; Time Factors; Treatment Outcome; Ultrasonography
PubMed: 32653002
DOI: 10.1186/s13018-020-01776-6 -
BMC Complementary and Alternative... Oct 2013Injury to a nerve is the most common reason of acquired peripheral neuropathy. Therefore, searching for effective substance to recover of nerve after injury is need of...
BACKGROUND
Injury to a nerve is the most common reason of acquired peripheral neuropathy. Therefore, searching for effective substance to recover of nerve after injury is need of present era. The current study investigates the protective potential of Standardized Fruit Extract of Punica granatum L (PFE) [Ellagic acid (41.6%), Punicalagins (10%), Granatin (5.1%)] in Tibial & Sural Nerve Transection (TST) induced neuropathic pain in rats.
METHODS
TST was performed by sectioning tibial and sural nerve portions of the sciatic nerve and leaving the common peroneal nerve intact. Acetone drop, pin-prick, hot plate, paint brush & Walking Track tests were performed to assess cold allodynia; mechanical heat, hyperalgesia and dynamic mechanical allodynia & tibial functional index respectively. The levels of TNF-α, TBARS, GSH and Nitrite were measured in the sciatic nerve as an index of inflammation & oxidative stress.
RESULTS
TST led to significant development of cold allodynia; mechanical and heat hyperalgesia; dynamic mechanical allodynia; functional deficit in walking along with rise in the levels of TBARS, TNF-α, GSH and Nitrite. Administrations of PFE (100 & 300 mg/kg oral), significantly attenuate TST induced behavioral & biochemical changes. Pretreatments of BADGE (120 mg/kg IP) a PPAR-γ antagonist and nitric oxide precursor L-arginine (100 mg/kg IP) abolished the protective effect of PFE. Whereas, pretreatment of L-NAME (5 mg/kg IP) a NOS inhibitor significantly potentiated PFE's protective effect of PFE.
CONCLUSION
PFE shown to have attenuating effect in TST induced neuropathic pain which may be attributed to potential PPAR-gamma agonistic activity, nitric oxide inhibitory, anti-inflammatory and anti oxidative actions.
Topics: Animals; Anti-Inflammatory Agents; Arginine; Female; Fruit; Humans; Lythraceae; Male; Neuralgia; Oxidative Stress; Plant Extracts; Rats; Rats, Wistar; Sural Nerve; Tibial Nerve; Tumor Necrosis Factor-alpha
PubMed: 24499201
DOI: 10.1186/1472-6882-13-274 -
Journal of Ultrasound Sep 2022During an ICU stay, changes in muscles and nerves occur that is accessible via neuromuscular sonography.
PURPOSE
During an ICU stay, changes in muscles and nerves occur that is accessible via neuromuscular sonography.
METHODS
17 patients recruited from the neurological and neurosurgical ICU (six women; 66 ± 3 years) and 7 healthy controls (three women, 75 ± 3 years) were included. Muscle sonography (rectus abdominis, biceps, rectus femoris and tibialis anterior muscles) using gray-scale values (GSVs), and nerve ultrasound (peroneal, tibial and sural nerves) analyzing the cross-sectional area (CSA) were performed on days 1 (t1), 3 (t2), 5 (t3), 8 (t4), and 16 (t5) after admission.
RESULTS
Time course analysis revealed that GSVs were significantly higher within the patient group for all of the investigated muscles (rectus abdominis: F = 7.536; p = 0.011; biceps: F = 14.761; p = 0.001; rectus femoris: F = 9.455; p = 0.005; tibialis anterior: F = 7.282; p = 0.012). The higher GSVs were already visible at t1 or, at the latest, at t2 (tibialis anterior muscles). CSA was enlarged in all of the investigated nerves in the patient group (peroneal nerve: F = 7.129; p = 0.014; tibial nerve: F = 28.976, p < 0.001; sural nerve: F = 13.051; p = 0.001). The changes were visible very early (tibial nerve: t1; peroneal nerve: t2). The CSA of the motor nerves showed an association with the ventilation time and days within the ICU (t1 through t4; p < 0.05).
DISCUSSION
We detected very early changes in the muscles and nerves of ICU-patients. Nerve CSA might be a useful parameter to identify patients who are at risk for difficult weaning. Therefore our observations might be severity signs of neuromuscular suffering for the most severe patients.
Topics: Female; Humans; Intensive Care Units; Muscle, Skeletal; Sural Nerve; Tibial Nerve; Ultrasonography
PubMed: 34870825
DOI: 10.1007/s40477-021-00621-8 -
Archives of Pathology & Laboratory... Jan 2000Amyloidosis is a well-recognized but uncommon cause of peripheral neuropathy. Our objectives were to determine the overall prevalence of peripheral nerve amyloidosis in...
OBJECTIVE
Amyloidosis is a well-recognized but uncommon cause of peripheral neuropathy. Our objectives were to determine the overall prevalence of peripheral nerve amyloidosis in sural nerve biopsies and to evaluate the clinical and pathologic features of these lesions.
METHODS
All available histologic and ultrastructural materials on biopsy tissue from 13 cases of peripheral nerve amyloidosis were examined. Muscle biopsies performed at the same time as the nerve biopsy were reviewed when available. Clinical data were collected on all patients.
RESULTS
The prevalence of amyloidosis in sural nerve biopsies at our institution was 13 (1.2%) of 1098 cases over a 15.8-year period. These patients ranged in age from 41 to 82 years (median, 61 years) at initial presentation and included 10 men and 3 women. Presenting neuropathy symptoms were sensory in 6 of the 13 patients, motor in 2 cases, and mixed in 5 cases. Cardiac, renal, or gastrointestinal involvement was present in 7 of 13 cases. Two patients had myeloma and 7 had systemic autonomic symptoms. Two patients had probable familial amyloid polyneuropathy, and 1 patient demonstrated an alanine 60 point mutation. Amyloid, identified as amorphous eosinophilic extracellular deposits demonstrating apple green birefringence on Congo red stain or recognized by its characteristic fibrillar ultrastructure by electron microscopy, was identified in the endoneurium in 12 nerves, perineurium in 2 nerves, and epineurium in 9 nerves. Chronic inflammation was identified in 5 nerves. Axonal loss was recorded as mild (<25%) in 1 nerve, moderate (25% to 75%) in 8 nerves, and severe (>75%) in 4 nerves. Axonal degeneration predominated over demyelination in 8 of 10 cases that could be evaluated. Concomitant muscle biopsies contained amyloid deposits in 8 of 9 cases.
CONCLUSIONS
Amyloidosis is a rare (1.2% in our series) cause of peripheral neuropathy with a distinct microscopic and ultrastructural appearance. Just over half the patients in our study had visceral organ involvement and systemic autonomic symptoms. The peripheral neuropathy was associated with axonal degeneration and a moderate to severe axonal loss in the majority of cases. Amyloid deposition was present in 8 out of 9 muscle biopsies performed at the same time.
Topics: Adult; Aged; Aged, 80 and over; Amyloid; Amyloidosis; Biopsy, Needle; Congo Red; Female; Humans; Male; Microscopy, Electron; Middle Aged; Muscle, Skeletal; Peripheral Nervous System Diseases; Sural Nerve
PubMed: 10629141
DOI: 10.5858/2000-124-0114-PNAISN -
The Journal of Physiology Apr 19911. The proportion of primary afferent nerve fibres in a skin nerve of the rat that responded or failed to respond to mechanical or thermal stimulation of the skin in the...
1. The proportion of primary afferent nerve fibres in a skin nerve of the rat that responded or failed to respond to mechanical or thermal stimulation of the skin in the noxious and non-noxious range was analysed. 2. Activity of afferent nerve fibres was recorded from the dorsal roots. Units projecting into the sural nerve were selected using supramaximal electrical stimulation of the nerve stem. All other hindleg nerves were cut. 3. The receptive fields were searched by carefully examining the hindleg skin with noxious and innocuous mechanical, cooling and warming stimuli. Probing of the intrinsic foot muscles and manipulation of the ankle and toe joints was employed to recruit units projecting to deeper tissues. 4. In a first series of twenty-two experiments, eighty-nine rapidly conducting myelinated A beta units, thirty slowly conducting myelinated A delta units and 101 unmyelinated C units were investigated. Most units were identified as belonging to one of the established classes of cutaneous sensory units and this was also ascertained by a collision test. 5. Two A beta, eight A delta and forty-six C fibres did not respond to any one of the stimuli. Electrical thresholds and conduction velocities of the unresponsive C fibres were not significantly different from those of the units responding to natural stimulation of their receptive fields. In the A delta group unresponsive and high threshold mechanoreceptive units were preferentially found among the units with the slowest conduction velocities. 6. In a second series of seven experiments, one single nerve filament containing responsive and unresponsive C fibres was tested repetitively at 30 min intervals. Twenty unresponsive units and seven units responding to noxious mechanical and/or heat stimuli were studied. Ten of the twenty initially unresponsive units became activated by mechanical and/or heat stimuli after observation times of 30-150 min. Some of these units had mechanical thresholds as low as 64 mN (tested with calibrated von Frey hairs), or thermal thresholds down to 42 degrees C. 7. Two of the ten C units which became responsive in the course of an experiment later lost their responsiveness again. On the other hand, two of the C units which were initially responsive to noxious heat and/or noxious mechanical stimuli became completely unresponsive after repetitive stimulation, whereas one unit initially only responding to noxious heat became responsive to mechanical stimuli, suggesting that mechanical and heat responsiveness may be separately gained or lost by sensory C fibres.(ABSTRACT TRUNCATED AT 400 WORDS)
Topics: Animals; Hot Temperature; Mechanoreceptors; Nerve Fibers; Neural Conduction; Physical Stimulation; Rats; Rats, Inbred Strains; Skin; Sural Nerve
PubMed: 1770437
DOI: 10.1113/jphysiol.1991.sp018507 -
BioMed Research International 2014One of the most common complications of diabetes mellitus is diabetic neuropathy. It may be provoked by metabolic and/or vascular factors, and depending on duration of...
One of the most common complications of diabetes mellitus is diabetic neuropathy. It may be provoked by metabolic and/or vascular factors, and depending on duration of disease, various layers of nerve may be affected. Our aim was to investigate influence of diabetes on the epineurial, perineurial, and endoneurial connective tissue sheaths. The study included 15 samples of sural nerve divided into three groups: diabetic group, peripheral vascular disease group, and control group. After morphological analysis, morphometric parameters were determined for each case using ImageJ software. Compared to the control group, the diabetic cases had significantly higher perineurial index (P < 0.05) and endoneurial connective tissue percentage (P < 0.01). The diabetic group showed significantly higher epineurial area (P < 0.01), as well as percentage of endoneurial connective tissue (P < 0.01), in relation to the peripheral vascular disease group. It is obvious that hyperglycemia and ischemia present in diabetes lead to substantial changes in connective tissue sheaths of nerve, particularly in peri- and endoneurium. Perineurial thickening and significant endoneurial fibrosis may impair the balance of endoneurial homeostasis and regenerative ability of the nerve fibers. Future investigations should focus on studying the components of extracellular matrix of connective tissue sheaths in diabetic nerves.
Topics: Aged; Connective Tissue; Diabetes Mellitus; Diabetic Neuropathies; Humans; Hyperglycemia; Peripheral Nerves; Sural Nerve
PubMed: 25147820
DOI: 10.1155/2014/870930 -
Journal of Neurology, Neurosurgery, and... Oct 1996To characterise cultured T lymphocytes from nerve biopsies in patients with Guillain-Barré syndrome and chronic inflammatory demyelinating polyneuropathy (CIDP).
OBJECTIVES
To characterise cultured T lymphocytes from nerve biopsies in patients with Guillain-Barré syndrome and chronic inflammatory demyelinating polyneuropathy (CIDP).
METHODS
Sural nerve biopsies, obtained from six patients with Guillain-Barré syndrome, four with CIDP, and six controls with other neuropathies, were cultured with 20 U/ml recombinant interleukin-2 (IL-2) for eight weeks. Flow cytometry was used to determine the phenotype of cultured T lymphocytes. Their proliferative responses to a range of bacterial antigens were also examined.
RESULTS
T cell lines were established from four of six patients with Guillain-Barré syndrome, one of four with CIDP, one patient with peripheral nerve vasculitis, and none of five controls with non-inflammatory neuropathies. One of these T cell lines from a patient with Guillain-Barré syndrome, preceded by Campylobacter jejuni infection, consisted entirely of gamma delta TCR+ T lymphocytes. The peripheral blood of this patient also contained an increased frequency of gamma delta T cells when stimulated with C jejuni. The nerve derived T cell lines failed to show a proliferative response to bacterial antigens or to a preparation of myelin proteins.
CONCLUSIONS
A new technique to isolate T cells from nerve biopsies in patients with Guillain-Barré syndrome and CIDP is reported. This technique may prove to be a useful tool in the investigation of the pathogenesis of other inflammatory neuropathies such as peripheral nerve vasculitis. The isolation of a gamma delta TCR+ nerve T cell line is of interest because of the possibility that these cells might respond to glycolipid epitopes common to C jejuni and peripheral nerve gangliosides.
Topics: Antigens, CD; Campylobacter jejuni; Cell Culture Techniques; Cell Movement; Cytomegalovirus; Demyelinating Diseases; Enzyme-Linked Immunosorbent Assay; Humans; Polyradiculoneuropathy; Sural Nerve; T-Lymphocytes
PubMed: 8890774
DOI: 10.1136/jnnp.61.4.362