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1.
《The Journal of emergency medicine》2020,58(6):e237-e241
BackgroundThe anatomic course of the phrenic nerve runs in the fascia covering the anterior scalene muscle. Interscalene blocks are commonly performed by an anesthesiologist for shoulder surgery, such as a rotator cuff repair, total shoulder replacement, humeral fracture, or other arm surgery. Phrenic nerve palsy or paralysis is a known complication from interscalene block and is covered in multiple case reports and series in both Anesthesia and Neurosurgical literature, but only one case report in the Emergency Medicine literature.Case ReportThis case involves a 57-year-old man who had an uncomplicated arthroscopic rotator cuff repair with placement of interscalene block under care of anesthesia. He was discharged with a pain pump in place and then subsequently presented to the Emergency Department (ED) later that same day for evaluation of dyspnea. Using point-of-care ultrasound, his right diaphragm did not appear to be moving. Chest x-ray study revealed an elevated right hemidiaphragm. He was diagnosed with iatrogenic right phrenic nerve paralysis from interscalene block.Why Should an Emergency Physician Be Aware of This?Emergent diagnosis of phrenic nerve paralysis in the ED is complicated by a distressed patient and need for quick intervention. Most formal tests for this diagnosis are not immediately available to emergency physicians. Ultrasound is a rapid and reproducible, noninvasive resource with high sensitivity and specificity, making it an ideal imaging modality for the emergent evaluation of possible phrenic nerve palsy or paralysis. 相似文献
2.
目的:探讨先天性膈疝的产前超声表现。材料和方法:回顾性分析6例先天性膈疝胎儿声像图表现特征,并与病理结果相对照。结果:左侧膈疝5例,右侧膈疝1例,其中2例伴有其它复杂畸形。超声显示胎心、纵隔受压移位,心轴偏移明显。疝入器官见有胃泡、肠管、肝脏,胎儿呼吸样运动可致疝入器官运动幅度增加。结论:先天性膈疝的特征性声像图表现,可作为诊断的重要依据。 相似文献
3.
Dr. Ravinder K. Mittal MD 《Digestive diseases and sciences》1991,36(9):6S-13S
The principles of infusion manometry in the measurement of lower esophageal sphincter (LES) pressure were laid down in the mid-1960s by L.D. Harris and his coworkers. Dodds and his colleagues were largely responsible for the improvements and advent of the low-compliance manometry. Using side-hole manometry, it is possible to detect accurate LES pressure that correlates with the strength of the antireflux barrier. The LES pressure as measured by the side-hole manometry, shows respiration-induced pressure oscillations. These pressure oscillations were initially thought to be due to the influence of abdominal and thoracic pressures on the LES. However, it was later pointed out that these pressure oscillations were due to the relative motion of the point pressure sensor (side hole of the manometric catheter) and the LES during respiration. Recent studies suggest that active contraction of the crural diaphragm during inspiration is responsible for the pressure oscillations observed in the cat LES pressure tracings. The use of the sleeve device in the measurement of LES pressure during contraction of the diaphragm has been described recently. Using the principles of manometry and sleeve device, it is now possible to identify two lower esophageal sphincters: the smooth muscle LES, traditionally known as the LES, and crural diaphragm, which we have referred to as the external lower esophageal sphincter. The purpose of the following paper is to summarize the general principles of the infusion manometry in the measurement of intraluminal pressure, specifically the LES pressure. The recently developed technique of detection of the sphincteric function of the crural diaphragm by the sleeve device will be discussed. In the last paragraph the limitations of manometry in detection of the muscular contractile activity are described. 相似文献
4.
Claude Clément MD Roberto Ruiz MD Bogdan Costa-Foru MD Hubert Nicaise MD 《Annals of vascular surgery》1990,4(3):305-308
Extrinsic compression of the renal artery due to a fibromuscular band originating from the diaphragm was encountered in a 26-year-old patient who had systemic hypertension associated with stenosis and kinking of one of her renal arteries. After surgical decompression, the renal artery assumed a normal expansion with disappearance of hypertension. Six other cases of extrinsic compression of the renal artery have been found in the literature. Surgical treatment is mandatory in all cases because the mechanism that causes the lesion makes percutaneous transluminal angioplasty illusory. 相似文献
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Diaphragmaticmuscleisanimportantrespiratorymuscle,anddiaphragmaticfatiguecanleadtomanydisorders .Onlyintherecent 2 0 yearshavethesys temicresearchesbeen performedtoinvestigatethefunctionofdiaphragmanditspathophysiology .Di aphragmaticfatiguecanbeinducedby… 相似文献
8.
[目的]探讨副神经移位膈神经重建高位颈髓损伤大鼠呼吸功能后膈肌的病理学变化及膈肌运动诱发电位(motion evoked potential,MEP)的特点。[方法]健康雄性SD大鼠60只。随机分为1~6个月6个时间组。取下颈部正中切口,将双侧副神经在锁骨下水平发出内、外侧支之前切断,移位缝接膈神经干起始部。术后第1~6个月各组样本取颈后正中切口,切除C3全椎板充分显露颈髓并于C3、4水平锐性横断。证实胫前肌MEP完全消失后,于两侧腋前线肋下缘作切口,显露该处膈肌腹腔侧。直视下将同心针电极于腋前线第9肋骨下缘垂直胸壁插入膈肌肋部,监测其MEP的变化。然后完整取出膈肌,于电子天平称重。并于右侧腋前线顺膈肌肌纤维方向切取2 mm宽肌条行HE染色。分析膈肌肌纤维截面积的变化。[结果]神经移位后随着时间延长,大鼠膈肌MEP潜伏期逐渐缩短,波幅逐渐增大。6个月组MEP波幅为(6.35±0.51)mV,潜伏期为(3.41±0.36)m s。同时,膈肌逐渐饱满,肌重逐渐恢复,6个月为正常对照组的(97.23±4.07)%。肌纤维截面积也逐渐增大,6个月组达(1 741±439)μm2为正常对照组(1 809±461)μm2的(98.28±3.65)%。6个月组的各数据与对照组比无显著差异(P>0.05)。[结论]从电生理及病理学来看副神经可作为运动神经移位膈神经重建高位颈髓损伤后呼吸功能。 相似文献
9.
JORGEN EKSTR
M 《Acta physiologica (Oxford, England)》1975,93(4):525-530
When the function of salivary glands was abolished by applying ligatures to their ducts and the function of one half of the diaphragm muscle was abolished by sectioning of its phrenic nerve, the choline acetyltransferase activity was found to be increased in not duct-ligated glands and in the intact hemidiaphragm 4 weeks later. The increase was not seen within the first week. The increase in activity appears to be particularly manifested in the nerve endings, since it was seen in the hemidiaphragm but not in the phrenic nerve. Increased stream of impulses in the efferent nerves is thought to be the cause of this increase in choline acetyltransferase activity. 相似文献
10.
V. A. Lopatin M. L. Finkel' V. V. Barannikov O. V. Terekhov 《Bulletin of experimental biology and medicine》1978,85(1):112-114
To record the hysteresis loop and electromyogram of the diaphragm simultaneously it is recommended that a standard probe of the sort used to record the intraesophageal pressure, on which silver electrodes are mounted, be used. This method provides fuller information on the work of the respiratory muscles.Institute of Obstetrics and Gynecology, Academy of Medical Sciences of the USSR, Leningrad. (Presented by Academician of the Academy of Medical Sciences of the USSR V. G. Baranov.) Translated from Byulleten' Éksperimental'noi Biologii i Meditsiny, Vol. 85, No. 1, pp. 95–96, January, 1978. 相似文献