Timing of operation for blowout fractures with extraocular muscle entrapment

Abstract

Many authors have advocated early surgical intervention to avoid muscle degeneration in patients with blowout fractures with evidence of extraocular muscle entrapment imaged under computed tomography. However, there is still no golden standard with regard to the target timing of operations for releasing extraocular muscle. Between January 2002 and December 2011, the authors treated eight cases of blowout fracture with extraocular muscle entrapment. Notes from presumed cases of blowout fracture were retrospectively reviewed for information relating to surgical treatment and prognosis. In this series, a patient who was operated on 7 hours after injury showed the quickest recovery from diplopia. In contrast, a patient who was operated on 18 days after injury showed persistent diplopia for 2 years. Nevertheless, in patients who were operated on 3–11 days after injury, there was no obvious correlation between the outcome and the number of days between injury and the operation. It is concluded that, when emergency surgical intervention within several hours is not possible, it should be performed as soon after the injury as possible in order to prevent the increase of predictive fibrosis around the extraocular muscle.     

Ultrasound diagnosis of bony nerve entrapment: Case series and literature review

Introduction: Nerve entrapment due to osseous callus formation is a rare complication after bone fracture. Electrodiagnostic studies and routine radiographic imaging often fail to demonstrate the pathology. The diagnosis is difficult and is often made incidentally upon surgical exploration. Nerve ultrasonography has not been used routinely to assess such lesions. Methods: We report 5 cases of nerve entrapment in osseous callus after fractures that occurred in 2011 and 2012. The diagnosis was made by ultrasound (US). We then performed a review of the relevant literature. Conclusions: US is becoming an invaluable tool for diagnosing peripheral nerve entrapments. The current cases suggest that nerve US should be strongly considered as an adjunctive diagnostic tool for nerve palsies developing after trauma. Muscle Nerve 48 : 445–450, 2013     

Ulnar nerve lesion at the wrist related to pisotriquetral joint arthropathy

Introduction: Ulnar nerve lesions at the wrist (UNLW) are always difficult to localize clinically and sometimes electrophysiologically. Finding conduction block when studying ulnar motor nerve conduction (CB) across the wrist is sometimes the only way to demonstrate that the ulnar deep motor branch (UDMB) is entrapped. Methods: An elderly woman who had bilateral carpal tunnel syndrome (CTS) and thumb osteoarthritis for many years experienced worsening of left hand impairment recently. Results: Electrodiagnostic and ultrasound examinations revealed an acute and severe UDMB lesion related to pisotriquetral joint effusion. The patient received a local injection of a corticosteroid that provided rapid recovery. Conclusions: The diagnosis of UDMB lesion is especially difficult when CTS coexists, but CTS may allow for early diagnosis, if CB at the wrist is not overlooked. Chondrocalcinosis was responsible for the systemic inflammation, the CTS, the pisotriquetral joint effusion, and the UDBM compression, which has not been reported previously. Muscle Nerve, 2013     

Exercise-induced leg pain in athletes: diagnostic,assessment, and management strategies

The purpose of this review is to describe and critically evaluate current knowledge regarding diagnosis, assessment, and management of chronic overload leg injuries which are often non-specific and misleadingly referred to as ‘shin splints’. We aimed to review clinical entities that come under the umbrella term ‘Exercise-induced leg pain’ (EILP) based on current literature and systematically searched the literature. Specifically, systematic reviews were included. Our analyses demonstrated that current knowledge on EILP is based on a low level of evidence. EILP has to be subdivided into those with pain from bone stress injuries, pain of osteo-fascial origin, pain of muscular origin, pain due to nerve compression and pain due to a temporary vascular compromise. The history is most important. Questions include the onset of symptoms, whether worse with activity, at rest or at night? What exacerbates it and what relieves it? Is the sleep disturbed? Investigations merely confirm the clinical diagnosis and/or differential diagnosis; they should not be solely relied upon. The mainstay of diagnosing bone stress injury is MRI scan. Treatment is based on unloading strategies. A standard for confirming chronic exertional compartment syndrome (CECS) is the dynamic intra-compartmental pressure study performed with specific exercises that provoke the symptoms. Surgery provides the best outcome. Medial tibial stress syndrome (MTSS) presents a challenge in both diagnosis and treatment especially where there is a substantial overlap of symptoms with deep posterior CECS. Conservative therapy should initially aim to correct functional, gait, and biomechanical overload factors. Surgery should be considered in recalcitrant cases. MRI and MR angiography are the primary investigative tools for functional popliteal artery entrapment syndrome and when confirmed, surgery provides the most satisfactory outcome. Nerve compression is induced by various factors, e.g., localized fascial entrapment, unstable proximal tibiofibular joint (intrinsic) or secondary by external compromise of the nerve, e.g., tight hosiery (extrinsic). Conservative is the treatment of choice. The localized fasciotomy is reserved for recalcitrant cases.     

坚骨胶囊联合关节镜和尺神经松解术治疗肘关节骨关节炎伴尺神经卡压综合征的临床研究

目的探讨坚骨胶囊联合关节镜和尺神经松解术治疗肘关节骨关节炎伴尺神经卡压综合征的临床疗效。 方法选择河北省沧州中西医结合医院2018年1月至2021年5月收治的80例肘关节骨关节炎伴尺神经卡压综合征患者作为研究对象,采用随机数字表法分成观察组与对照组各40例。对照组给予关节镜和尺神经松解术治疗;在此基础上,观察组口服坚骨胶囊治疗。连续治疗6个月后采用顾玉东建议的肘管综合征功能评定标准进行疗效评定。治疗前后对两组患者进行Mayo肘关节功能评分（Mayo elbow performance score,MEPS）、视觉模拟量表（visual analogue scale,VAS）评分,测量肘关节活动度,进行肌电图检查。并统计两组患者副反应情况。 结果观察组肘管综合征功能评定优良率为75.00%（30/40）,与对照组的52.50%（21/40）相比显著升高（P<0.05）。两组治疗后MEPS评分均较治疗前显著升高（P<0.05）,疼痛VAS评分均较治疗前显著降低（P<0.05）;且治疗后,观察组MEPS评分显著高于对照组（P<0.05）,疼痛VAS评分显著低于对照组（P<0.05）。两组治疗后肘关节旋前度数、旋后度数以及屈伸度数均较治疗前显著增加（P<0.05）,且均以观察组改善更显著（P<0.05）。两组治疗后尺神经神经传导速度（nerve conduction velocity,NCV）、小指展肌复合肌肉动作电位（compound muscle action potential,CMAP）均较治疗前显著增加（P<0.05）,小指展肌运动诱发电位潜伏期（motor evoked potential latent period,MEPLP）均较治疗前显著缩短（P<0.05）;治疗后,观察组尺神经的NCV、小指展肌的CMAP显著高于对照组（P<0.05）,小指展肌的MEPLP显著短于对照组（P<0.05）。所有对象均无明显副反应发生。 结论坚骨胶囊联合关节镜和尺神经松解术治疗肘关节骨关节炎伴尺神经卡压综合征能安全有效地改善患者的手、肘功能,提高关节活动度,减轻疼痛程度。     

葡聚糖凝胶微柱结合高效液相色谱法测定奥沙利铂脂质体包封率

目的：对奥沙利铂脂质体进行质量评价,建立奥沙利铂脂质体包封率的测定方法。方法：采用凝胶微柱离心法分离游离药物与脂质体,以HPLC法测定奥沙利铂的药物含量,计算脂质体的包封率。结果：奥沙利铂浓度在0.02~1mg.mL-1范围内线性关系良好（r=0.9999）,结果3批次奥沙利铂脂质体的包封率分别为56.6%,57.5%,60.0%。结论：该方法简便、迅速,可准确地测定出奥沙利铂脂质体的包封率。     

Neurolysis for Failed Tarsal Tunnel Surgery

The purpose of the present study was to investigate the causes of failure after tarsal tunnel release and the operative findings in the secondary interventions and the outcomes. The data from 8 patients who had undergone revision surgery for failed tarsal tunnel release at least 12 months earlier were evaluated retrospectively. Only the patients with idiopathic tarsal tunnel syndrome were included, and all had unilateral symptoms. Neurophysiologic tests confirmed the clinical diagnosis of failed tarsal tunnel release in all patients. Magnetic resonance imaging revealed varicose veins within the tarsal tunnel in 1 patient (12.5%) and tenosynovitis in another (12.5%). Open tarsal tunnel release was performed in all patients, and the tibialis posterior nerve, medial and lateral plantar nerves (including the first branch of the lateral plantar nerve), and medial calcaneal nerve were released in their respective tunnels, and the septum between the tunnels was resected. The outcomes were assessed according to subjective patient satisfaction as excellent, good, fair, or poor. During revision surgery, insufficient release of the tarsal tunnel, especially distally, was observed in all the patients, and fibrosis of the tibialis posterior nerve was present in 1 (12.5%). The outcomes according to subjective patient satisfaction were excellent in 5 (62.5%), good in 2 (25%), and fair in 1 (12.5%). The fair outcome was obtained in the patient with fibrosis of the nerve. Insufficient release of the tarsal tunnel was the main cause of failed tarsal tunnel release. Releasing the 4 distinct tunnels and permitting immediate mobilization provided satisfactory results in patients with failed tarsal tunnel release.     

The Hypotonic Environmental Changes Affect Liposomal Formulations for Nose-to-Brain Targeted Drug Delivery

Systemic administration of drugs is ineffective in the treatment of central nervous system disorders because of the blood-brain barrier. Nasal administration has been suggested as an alternative administration route as drugs absorbed in the olfactory epithelium bypass the blood-brain barrier and reach the brain within minutes. However, the nasal mucosa properties (e.g., tonicity, pH) are not constant because of physiological and environmental factors, and this might limit the therapeutic outcome of nanocarrier-based formulations. To shine light on the impact of environmental ionic strength on nanocarrier-based formulations, we have studied how liposomal formulations respond to the change of tonicity of the external environment. Large unilamellar vesicles loaded with 6 different drugs were exposed to different hypotonic environments, creating an osmotic gradient within the inner core and external environment of the liposomes up to 650 mOsm/kg. Both size and polydispersity of liposomes were significantly affected by tonicity changes. Moreover, the release kinetics of hydrophilic and lipophilic drugs were largely enhanced by hypotonic environments. These results clearly demonstrate that the environmental ionic strength has an impact on liposomal formulation stability and drug release kinetics and it should be considered when liposomal formulations for nose-to-brain targeted drug delivery are designed.     

Entrapment syndrome of multiple nerves in graft‐versus‐host disease

Introduction: Peripheral nerve entrapment syndromes are associated with hereditary neuropathy with liability to pressure palsies and a variety of rheumatic and endocrinological diseases. Methods: We report a patient with entrapment syndromes of multiple nerves associated with chronic graft‐versus‐host‐disease (GVHD) after allogeneic hematopoietic stem cell transplantation. Nerve ultrasound, histology, and ultrastructural changes were assessed. Results: The 51‐year‐old man had developed severe deep dermal sclerosis due to chronic GVHD with a progressive polyneuropathy and entrapment syndromes of multiple nerves. Pre‐stenotic enlargement was shown by nerve ultrasound. Histology demonstrated fibrosis of the epineurium with scarce infiltration of macrophages. Electron microscopy demonstrated alterations of the myelin sheaths and marked depletion of normal‐sized myelinated nerve fibers. Conclusions: In addition to polyneuropathy, chronic GVHD can be associated with peripheral nerve entrapment syndromes and should be added to the differential diagnosis of compressive neuropathies. Muscle Nerve 49 : 138–142, 2014