Imaging of peripheral nerve lesions in the lower limb

Lower limb peripheral neuropathy may have a variety of causes. This article focuses on focal neural lesions because of neural entrapment associated with static mechanical compression or dynamic compression/stretching. Mechanical compression may relate to direct blunt trauma, surgical injury, mass effect associated with adjacent mass lesions, and frictional effects associated with fibrous bands. Stretching neural injury may be associated with abnormalities in alignment such as plano-valgus hindfoot and hindfoot pronation. Recurrent inversion ankle injuries may also cause neural injury. Neural injury may be associated with denervation of the muscles supplied by the nerve. Electromyography (EMG) remains the gold standard for diagnosis of denervation. Diagnostic imaging plays a complementary role to EMG in difficult cases, the anticoagulated patient, and in clarifying the etiology of an EMG-demonstrated neuropathy. Magnetic resonance imaging and ultrasound can be used in peripheral nerve imaging to demonstrate extrinsic compressive lesions, focal neural lesions such as neural edema and swelling, focal neural scarring (posttraumatic neuroma in continuity) and intraneural ganglia. Imaging can also demonstrate the effects of muscle denervation. Focal areas of tenderness can be highlighted using skin markers for magnetic resonance imaging and by transducer palpation on ultrasound. Ultrasound can be particularly useful in assessing for intrinsic lesions in small peripheral nerves because of the superior spatial resolution of ultrasound in assessing superficial structures. Plain x-rays (and sometimes computed tomography scanning) may show significant bone changes and should be the initial imaging modality.     

Cryoanalgesia for painful peripheral nerve lesions

Twelve patients with chronically painful peripheral nerve lesions were treated with cryoanalgesia. The pain was relieved in 6 patients for 1–12 months. Although the pain eventually recurred, the patients resumed normal activities during remission. It is necessary to improve the techniques of nerve localization and to determine the proper mode of nerve freezing.     

Lipofibromatous hamartoma and related peripheral nerve lesions

Three unusual cases of a rare, tumor-like condition, lipofibromatous hamartoma, are reported. This lesion is composed of fibrous and fatty tissue that infiltrates peripheral nerves, typically on the volar aspect of the upper extremities of children and young adults. All three patients had a painless soft tissue mass of the wrist and/or hand, which followed nerve distribution, and only one patient had neurologic symptoms due to compression. Diagnosis was made by open biopsy and histologic examination.     

强度－时间曲线在周围神经损伤中的应用价值

目的探讨强度－时间(I/t)曲线对周围神经损伤的诊断意义。方法测定86例周围神经损伤患者的I/t曲线102条,同时比较31例手术探查情况。结果102条周围神经损伤的I/t曲线,正常神经支配32条,部分失神经支配39条,完全失神经支配31条。在判断I/t曲线时,曲线的形状和位置具有诊断价值,时值和最短反应时有参考价值,而基强度无诊断意义(P>0.05)。结论I/t曲线测定对周围神经损伤具有一定的诊断及指导治疗的价值。     

Prognostic factors for the surgical management of peripheral nerve lesions

Although the evaluation and treatment of patients with peripheral nerve injuries has evolved and improved over the years, there are still some arguments on the methods and results of surgery. We reviewed retrospectively the clinical, electrophysiological and surgical characteristics of peripheral nerve lesions for 1,636 nerves in 1,565 patients who had been managed in our department in a 10-year period. The most common cause of injuries was gunshot wound in 56.3% of all patients, followed by sharp lacerations (20.6%), fractures (10.6%) and tractions (5.1%). Among 1,636 cases of nerve injuries, the most frequently wounded nerve was median nerve (32.3%), followed by ulnar (24.1%), radial (12.1%), sciatic (10.7%) and peroneal nerves (7.7%), and brachial plexus (7.7%). Simple decompression was the most preferred technique for nerve repair in 27.8%. The electrophysiological improvement was observed in 66.8%, as assessed by electromyography. Clinical improvement was found in 58.4%, as judged by muscle strength grading. If the nerve is compressed or contused, but remains intact, the improvement is satisfactory after surgery. The type of injury, its time of occurrence, initial deficit, and degree of recovery expected are important issues in establishing the treatment plan, which may range from skilled observation to extensive surgical intervention.     

Factors that affect the duration of antimicrobial therapy for cellulitis

Background

The recommended duration of antibiotic therapy for patients hospitalized with cellulitis is 5–14 days. However, factors that affect the duration of treatment have rarely been examined.

Bladder dysfunction after spinal and peripheral nerve lesions

Disturbances in bladder function might occur as consequence of multiple neurological diseases involving any neurological pathways connecting the brain to the peripheral organ. Bladder dysfunction, especially resulting incontinence leads to impaired quality of life, if not adequately treated. Moreover, impaired voiding function might result in renal damage and finally in renal insufficiency. In this paper various causes of neurogenic bladder dysfunction, resulting from spinal cord disease or peripheral nerve damages are described. Neurogenic voiding disorders secondary to cortical lesions or diseases at the level of the basal ganglia or brainstem have been voluntarily omitted.     

超声诊断外周神经病变的临床价值

目的探讨高频超声在外周神经病变和损伤中的诊断价值。方法应用高频超声检查15例正常查体肢体外周神经、12例外周神经损伤及6例神经肿瘤，术前超声检查与术中探查结果作比较分析。结果正常神经纵切面声像图为多条线性的平行较强回声；横切面为圆形中等回声结构，中心为点状强回声。2例外周神经完全离断，显示连续性中断，近端形成神经瘤；7例外周神经部分损伤，显示连续性部分中断；3例卡压性损伤，神经水肿增粗，内部呈束状低回声不清晰。6例神经肿瘤与神经相连续。结论高频超声可作为外周神经病变和损伤首选的检查方法，值得临床推广应用。     

Factors that influence lymphocyte yields in lymphocytapheresis

The recent use of lymphocytapheresis to treat immune-mediated diseases such as rheumatoid arthritis prompted a study of factors that influence the cell composition of lymphocytapheresis concentrates. Following single cytapheresis procedures, using protocols recommended by manufacturers, lymphocyte yields were significantly higher with the model 2997 (IBM) and CS-3000 (Fenwal) cell separators as compared to the model 30 (Haemonetics) separator (9.8 +/- 1.1 and 7.1 +/- 1.2 X 10(9) lymphocytes, respectively, versus 4.6 +/- 1.1 X 10(9); p less than 0.01). The lymphocyte concentrate obtained with the CS-3000 separator contained the smallest number of monocytes (0.6 +/- 0.4 X 10(9) versus 1.4 +/- 1.6 and 1 +/- 0.3 X 10(9) for the model 2997 and 30 cell separators, respectively). Platelet contamination of the lymphocyte concentrate was highest with the CS-3000 (6.5 +/- 2.4 X 10(11], and erythrocyte contamination was highest when the model 30 was used (21 +/- 3.0%). Studies using the model 2997 indicated that lymphocyte yields were significantly influenced by donor pre-apheresis absolute lymphocyte counts, and for this cell separator by specific operating variables, such as channel centrifugation speed and positioning of the red cell interface during lymphocyte collection. Maximal yields were obtained when the channel centrifugation speed was 800 to 1000 rpm (equivalent to 100-150 X g) and the red cell interface was adjusted to yield a cell concentrate with a hematocrit less than 4 percent. These results suggest that it will be necessary to standardize lymphocytapheresis collection protocols in future studies to assess the role of lymphocytapheresis in the management of immune-mediated diseases such as rheumatoid arthritis.     

Factors that influence nurses' customer orientation

BACKGROUND: Hospital care mostly involves complex processes that are continuously adjusted to match individual client needs. As most patients cannot evaluate the technology used, they focus on personal interactions with care providers when making judgements about the care received. Nurses are the care team members that primarily provide ongoing care. AIMS: This study aims to further understand factors that influence the way nursing staff relate to their patients. A model is presented of the contextual and self-perceptual factors that influence the level of customer/client orientation of nursing services in an Australian hospital setting along with details of a quantitative study. METHODS: Nurses completed an anonymous questionnaire, which was then mailed directly to the researchers. Analysis of the data included factor analysis, regression and path analysis. FINDINGS: The results show that contextual elements such as management commitment to service quality and self-perceptual factors such as role stress impact on the nurses' client service orientation. However, the variables being studied commonly have both direct and indirect effects with feelings about commitment to the organization having a notable mediating influence. The scales adapted from use in other industries are able to measure the perceptual and outcome variables in a health institutional setting. CONCLUSIONS: The managerial implications are that both a comprehensive programme of organizational culture and individual staff member development is needed if an enhanced customer orientation and the consequent improvement in client satisfaction with nursing care is to occur.     

Factors that influence nurses' job satisfaction

OBJECTIVE: To examine factors affecting the job satisfaction of registered nurses (RNs). BACKGROUND: A growing recognition of job dissatisfaction among RNs in South Carolina hospitals has contributed to current problems with recruitment and retention. If administrators identify factors influencing RNs' job satisfaction in hospitals and implement strategies to address these factors, RN turnover rates will decrease and recruiting and retention rates will increase. METHODS: A cross-sectional study of secondary data was designed to identify the individual, work, and geographic factors that impact nursing job satisfaction at the state level. A 27-question self-administered survey was sent to 17,500 RNs in South Carolina with postage-paid envelopes for their responses. Surveys from 3472 nurses were completed anonymously. Univariate statistics were used to describe the study sample. One-way and multivariable Analysis of Variance were used to determine which variables contributed the most to job satisfaction. RESULTS: For about two thirds of the RNs, job satisfaction remained the same or had lessened over the past 2 years. In addition, statistically significant differences were found between job satisfaction and years of service, job position, hospital retirement plan, and geographic area. CONCLUSIONS: The findings have implications for nurse managers and hospital administrators for planning and implementing effective health policies that will meet the unique needs of their staffs and organizations. Such research is particularly relevant in this difficult time of nursing shortages throughout the healthcare industry.     

Autotomy following peripheral nerve lesions: experimental anaesthesia dolorosa

(1) When hindlimb peripheral nerves are cut across in rats and mice, there is a tendency for the animal to attack the anaesthetic limb. We have called this attack "autotomy". In this paper we describe the time course and degree of autotomy following various types of nerve injury. (2) Four different types of lesion were applied to the sciatic nerve of rats. The most serious autotomy was produced by section of the nerve and encapsulation of its cut end in a polythene tube. Section followed by immediate resuturing also produced serious autotomy. Simple ligation of the nerve end was followed by less autotomy than encapsulation or cut and resuture. A crush lesion caused only minimal attack. (3) Section of the saphenous branch of the femoral nerve produced no autotomy. However, if the saphenous and sciatic nerves were ligated at the same time so that the entire foot became anaesthetic there was a great increase of autotomy over that seen when the sciatic nerve alone was ligated. This increase with the double lesion occurred even if the saphenous nerve was ligated more than 100 days after the sciatic nerve had been cut. (4) Mice showed autotomy very similar to that seen in rats but the onset was somewhat faster. (5) Reasons are given to propose that autotomy is triggered by an abnormal afferent barrage generated in the cut end of the nerve. Autotomy from peripheral nerve lesions is a different phenomenon from that seen after dorsal root section. Autotomy occurs under conditions which produce anaesthesia dolorosa in man. This simple model may be suitable for studies of the prevention of irritations originating from chronic lesions of peripheral nerves.     

影响我国腹膜透析开展的原因分析

目的 腹膜透析具有多种优点，但是在我国大部分地区，腹膜透析的使用率很低。因此就腹膜透析在我国的发展现状及影响腹膜透析开展的原因进行调查。方法 采用自拟的调查表，调查参加全国肾脏病主任学习班的51名肾科主任对腹膜透析的看法及影响腹膜透析开展的因素。结果 所有参加调查的医院都开展了血液透析，68．6％的医院开展了腹膜透析，54．9％开展肾移植治疗。5．9％的被调查者认为腹膜透析比血液透析优越，29．4％认为腹膜透析不如血液透析优越，而多数(64．7％)则表示一种透析方式的优缺点需视患者而异。有70．6％表示对腹膜透析有信心，88％调查对象都对腹膜透析表现出兴趣。90．2％的被调查者表示将会开展腹膜透析(包括已开展者)。对于腹膜透析在透析总人数中应占的百分比，大多数(52．9％)被调查者认为是30％-50％，但事实上在多数地区(58．8％)腹膜透析在透析中所占的比例小于10％，有21．6％的地区腹膜透析所占比例为10％-20％。关于影响腹膜透析开展的原因，从高到低排列为：经济因素(51％)，医患双方认识不足(27．5％)，腹膜炎(21．7％)，腹膜透析效果不好(15．7％)，患者不接受(7．8％)，宣教随访困难(3．9％)，营养不良、腹膜透析没进公费医疗、需要满足血液透析患者数和没有人员(各占2．O％)。结论 腹膜透析治疗在我国的开展严重不足，医患双方认识不足及腹膜透析目前的价格结构是影响目前我国腹膜透析发展的主要因素。     

影响平板运动试验结果的因素分析

目的探讨影响平板运动试验结果的各种因素。方法选择我院2005～2006年临床拟诊为冠心病并行平板运动试验（TET）及冠状动脉造影（CAG）的住院患者278例,对TET阳性与CAG诊断进行对比研究。结果假阳性（TET阳性而CAG阴性）32例,其中自主神经功能紊乱11例,高血压病9例,糖尿病6例,其他疾病6例。假阴性（TET阴性而CAG阳性）14例。其中冠状动脉单支病变12例,双支和三支病变各1例。结论TET如能排除自主神经功能紊乱、高血压病、糖尿病等因素的影响,对诊断冠心病有较高的价值,实际诊断过程中应结合冠状动脉造影才能达到准确的诊断结果。     

A prospective study of peripheral nerve lesions occurring in traumatic brain-injured patients

The purpose of this study was to determine the frequency and severity of peripheral nerve lesions occurring in patients with traumatic brain injury. A prospective study of 132 patients was conducted. Patients fulfilling research criteria (flaccidity, areflexia, abnormal motor patterns) underwent neurodiagnostic examination. Fifteen electromyograph/NCV studies were performed, yielding positive findings in 13 patients (10%); 3 patients were found to have preventable lesions. Many patients had permanent impairment or attendant complications from the peripheral nerve injury that adversely affected eventual recovery.     

Factors that influence Medical Reserve Corps recruitment

The Medical Reserve Corps (MRC) is a key strategy used in the United States to assure an adequate surge capacity healthcare workforce for response to disasters. A survey of Hawaiian healthcare providers (n = 1,057) was conducted to identify factors that influence interest, ability, and willingness to join the MRC; 468 (44.3%) healthcare providers responded. Overall, females were more likely to demonstrate an interest in joining the MRC, while physicians and dentists reported lower levels of ability and willingness, in addition to a lower level of interest in joining the MRC than the other professional groups. The most important motivating factor in joining the MRC was altruism and the ability to help one's own community. Respondents reported a number of factors that would influence their decision to join or remain a MRC member. These included: (1) time commitment required; (2) MRC organization and management; (3) provision of MRC-sponsored training or education sessions and continuing education credits; (4) concerns regarding the safety of family members during a disaster; (5) professional liability protection for work performed during MRC operations; and (6) competing personal obligations. Strategies targeting these factors probably will be most effective in recruitment and retention of MRC volunteers as well as members of other public health surge capacity volunteer groups.     

Factors that influence therapeutic anticoagulation control.

A wide range of variables can influence warfarin anticoagulation control. This report summarizes the effects of medication, alcohol, diet, and other factors on prothrombin times. Useful summary tables are included.