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Biomedical subjects

A Narakas

Publications and source records attributed to A Narakas.

At least 37 records · Page 2Linked to original sources
PubMed1983

Nerve anastomoses with human fibrin. Preliminary clinical report (56 cases).

Since 1980, 56 peripheral nerve repairs have been done with fibrin. For technical reasons, combined anastomoses have been chosen in brachial plexus repairs (23 cases), fibrin alone being used in most other cases (8 free flaps, 17 main trunks, 8 digital nerves). As a whole, results compare evenly with the so-called classical repair methods using stitches. The adhesive method's main advantage is the gain in operative time, without impairing precision. Secondary benefits, such as hemostasis and easier stabilization of small grafts, can be achieved. One question remains: what becomes of fibrin? The survey of present cases would tend to prove that axonal growth through the second anastomosis is impeded proportionally to the length of the graft. The possible action of fibrin in the alteration process leading to a sclerotic diaphragm is not elucidated to this day. Experimental as well as clinical research must be carried on, in order to improve this new way of repairing nerves.

Adolescent↗
PubMed1982

[Etiological and clinical considerations of traumatic mutilating lesions of the hand and their prevention].

The author presents shortly the causes and some clinical aspects of mutilating injuries of the hand based on the experience gathered in two of the major hand-surgery centers of the State of Vaud (population 550,000). It is noted that injuries at work with hydraulic presses and hot-pressing machines tend to diminish drastically, while more and more often mutilating lesions are caused by lawn-mowers, "do-it-yourself" and domestic gadgets. While direct mutilating injuries to the hand are seldom seen in traffic accidents, the high incidence of brachial plexus injuries in young motorcycle drivers cripples the hand beyond repair. Some ideas concerning prevention are ventured.

Accidents↗
PubMed1982

Neurotization or nerve transfer for brachial plexus lesions.

Neurotization is one of the methods available for treating avulsive lesions of the brachial plexus. It has to be inserted into a series of other procedures when all the roots are not avulsed when all of them are avulsed but represents the only chance. It can only hope to restore some simple function to replace the very complex ones which have been lost. It has limited applications but is fully justified when one is dealing with a totally paralyzed limb. Finally, it can improve the trophicity of the limb and relieve the severe pain which is present in some 40% of cases of avulsive lesions, a problem which cannot be developed here. It is necessary that the patients and the surgeons realize its limits in order to avoid disappointment.

Adult↗
PubMed1978

Surgical treatment of traction injuries of the brachial plexus.

A series of 508 patients with traction injuries of the brachial plexus (birth trauma excluded) has been investigated over a period of 11 years. Severe cases with root avulsions, ruptures of nervous pathways or severe disorganization of funiculi do not heal spontaneously or heal poorly. Whether these patients can benefit from modern microsurgical techniques (neurolyses, autologous nerve grafts and neurotizations with intercostal or other nerves) is presently under investigation. Operations were performed on 164 patients of whom 114 had root avulsions and 16 had 2 level injuries. Surgical treatment was planned according to the severity of the lesion. In about 10% no reconstruction was possible, or was of doubtful value. There is a striking difference in results of supraclavicular and distal, infraclavicular lesions. Only 55% positive of 58 patients of the first group were improved while 85% of 20 patients of the second group were benefited to some extent. None of the patients belonging to the first or second group recovered hand intrinsic function if pathways coming from C8 and T1 were injures. None recovered tactile gnosis. The effect on pain was sometimes ameliorative, but generally unpredictable.

Adolescent↗
PubMed1976

[The fibrolipomatous hypertrophy of the main nerves of the upper extremity].

10 cases of lipofibromatous hypertrophy of the main nerves in the upper limb in 7 female and 3 male patients are described. In 1 case at the level of the middle third of the upper arm and in 6 cases at the level of the wrist and neighboring areas. In 2 patients these pathological changes were found in the ulnar nerve, in 1 case the hypertrophy was limited to the upper arm, in the other it extended all along the extremity from below the axilla to the wrist. Finally, in 1 case a 20 cm long hypertrophy was found at the level of the deep branch of the radial nerve (posterior interosseus nerve) in the lower arm below the elbow. The fibrous and lipomatous tissue snugly surrounds the fascicles and cannot be separated from them without damaging them, even if the finest microsurgical techniques are used. As the disease has been diagnosed in children as young as five years a congenital etiology has to be considered. The condition is distinct though from the disease of DEJERINE-SOTTAS or from that of von RECKLINGHAUSEN. The hypertrophic nerve is progressively submitted to a chronic compression in the naturally narrow passages (carpal tunnel, ulnar grove at the elbow, arcade of FROHSE) or it becomes painful and paretic after even minor trauma which leads probably to local oedema, intraneural bleeding and epineural compression. An external and internal decompression has to be carried out. Resection or defatting of the hypertrophic fascicles, however, should be avoided. In 2 of our cases the disease was anamnestically present for 45-50 years and clinically followed in another case for 18 years. The disease does not seem progressive. These cases show, that this disorder, which first appeared in the medical literature in 1964 and have been described by several authors in the median nerve, exists as well in the two other main nerves of the upper extremity.

Adult↗
PubMed1975

[Contusion of the ulnar nerve with fibro-lipomatous hypertrophy. A case report].

The autor describes a case of compression syndrom of the ulnar nerve at the elbow after a blow-injury. At the operation the nerve presented a considerable fibro-lipomatous intraneural hypertrophy with extention over almost the whole length of the extremity. Furthermore, a similar case of the deep branch of the radial nerve is mentioned, presenting the same pathological condition. Till now, only cases affecting the median nerve, have been described in the world literature.

Adult↗
PubMed1969

[Nerve grafts].

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Humans↗