Biomedical subjects

G A Brunelli

Publications and source records attributed to G A Brunelli.

29 records · Page 2Linked to original sources

PubMed1995

Tissue changes at different periods of ischemia.

A multidisciplinary study was done to examine the following: (a) pathophysiological changes in muscle and nerve response following different periods of normothermic and cold ischemia; (b) alterations in the release of enzymes (K, LDH), CA++, K=and lactate under these conditions; and (c) histological alterations of vessels, nerves and muscles after different periods of normothermic and cold ischemia. The results demonstrate that hypothermic ischemia greatly reduces both the leakage of enzymes, cellular damage and pathological responses. We infer that amputated parts containing muscular masses may be replanted with good prognosis for satisfactory functional results within 4-5 hours at room temperature. By reducing the temperature, the time between cooling and revascularization may be doubled. Parts without muscles may be replanted 10-12 hours after normothermic ischemia and up to 24 hours or even longer after cold ischemia.

Animals↗

PubMed1994

Different conduits in peripheral nerve surgery.

A considerable amount of research is being undertaken regarding the possibility of bridging loss of nerve substance with different guiding tubes, in order to improve functional outcome, reduce the surgical time, and reduce damage at donor nerve sites. A review of the literature and personal research allows us to state that: for short gaps, biological tubes (autologous veins) may give good results and also allow chemotactic attraction with selective arrangements of motor and sensory axons. Gaps longer than 1 cm do not allow tropism and are associated with failure to support axonal regrowth. Artificial biodegradable conduits still show results that are controversial; they may give good results provided that the material of which they are made is perfectly tolerated. Empty tubes, longer than 8-10 mm, besides being deprived of the chemotactic attraction, may collapse or be partially reabsorbed and replaced by scar. Probably in the near future biological or biodegradable tubes, containing laminin-like substances or muscle scaffold, will allow us to bridge increasingly large defects in nerves.

Humans↗

PubMed1993

Bridging nerve defects with combined skeletal muscle and vein conduits.

The use of vein or muscle grafts to bridge nerve defects longer than 1-1.5 cm gives poor results. Veins collapse and in muscle grafts axons may regrow outside the graft. We used veins (to guide regeneration) filled with muscle (to avoid vein collapse). Nerve regeneration through 1 and 2 cm grafts made of vein plus muscle was compared with similarly long traditional nerve grafts, free fresh muscle grafts, and empty vein grafts. Regeneration was assessed clinically and histologically (qualitative and quantitative evaluation) in the graft and distal nerve stumps. Vein plus muscle grafts were superior to vein and fresh muscle grafts both functionally and histologically. Functional results were similar to those found in traditional nerve grafts, but axon number was superior in the veins filled with muscle. This suggests that vein filled with muscle might serve as a grafting conduit for the repair of peripheral nerve injuries and could give better results than traditional nerve grafting.

Animals↗

PubMed1993

Direct muscle neurotization.

The results of experimental research, as well as of a large clinical series (n = 51) of direct muscle neurotization, have been encouraging enough to warrant extending the indications for the procedure to patients in whom traditional repair by direct nerve suture or nerve graft is impossible, because of the lack of a distal nerve segment, or because of destruction of the neural portion of one or more muscle groups. Prerequisites include a satisfactory volume of muscle with sufficient vascularity and adequate postoperative joint and muscle immobilization.

Animals↗

PubMed1992

Anatomy of the extensor pollicis brevis muscle.

52 hands have been dissected to check the anatomy and function of the extensor pollicis brevis. Various abnormalities were found: absence of the E.P.B. (two), insertion on the distal phalanx (four), absence of bony insertion on the base of the first phalanx and insertion on the extensor hood (36). In ten cases (in addition to the two with absence of E.P.B.), no function was elicited by pulling the tendon which inserted upon the extensor hood.

Cadaver↗

PubMed1992

A fourth type of brachial plexus injury: middle lesion (C7).

The authors describe a fourth type of traumatic brachial plexus lesion which was found in 11% of injuries to the spinal nerve roots, trunks and cords. This lesion consists of isolated or predominant lesion of the middle elements. While high lesions are caused by shoulder trauma in a downward direction and low lesions by trauma in abduction, middle lesions are produced by trauma in an anteroposterior direction. The high incidence of this type of lesion led the authors to propose the following new classification: high lesions (C5, C6)(Duchenne-Erb); middle lesions (C7); low lesions (C8, T1) (Dejerine-Klumpke); complete lesions.

Brachial Plexus↗

PubMed1992

Reconstruction of traumatic absence of the thumb in the adult by pollicization.

Amputation of the thumb is a severe handicap. In an emergency situation, thumb amputation must be treated by means of reimplantation when possible. If reimplantation cannot be performed or fails, several methods of thumb reconstruction can be used according to various factors. These include the number of surviving fingers and the level of the thumb amputation. Pollicization is the first choice for amputations proximal to the metacarpophalangeal joint when four and even three fingers are present. It is the easiest and safest operation that supplies the best results both from the motor and sensory points of view. Pollicization can be done even in an emergency situation in selected patients. The index finger is preferred because it can be pollicized without palmar scar or tendons, vessels, or nerves crossing over. If a damaged finger is present, it is preferred to the index finger to leave one more sound finger; a damaged finger can frequently be used, because the thumb is shorter than the other fingers, and although its mobility is very important at the trapeziometacarpal joint, it is less important at the metacarpophalangeal and interphalangeal joint levels. It is preferable to take as much second metacarpal bone as necessary to place the transferred second metacarpophalangeal joint at the position of the thumb metacarpophalangeal joint so that the tendons of the index interosseous muscles can be sutured to the intrinsic muscles of the thumb. According to this concept, the distal phalanx of the transferred finger should be amputated. In this manner, the new thumb will have a normal size, only two phalanges, only one extrinsic flexor, and normal insertion of the muscles of the thumb.

Adult↗

PubMed1991

A fourth type of brachial plexus lesion: the intermediate (C7) palsy.

A new type of brachial plexus lesion has been defined to be added to the classical types, i.e. the upper (Duchenne Erb), the lower (Dejerine Klumpke) and the total type. This new type is the intermediate palsy. The lesion is a partial involvement of the plexus, the predominant lesion of which involves C7 with a variable involvement of the upper or lower plexus. By observations during operation, and in cadavers, three different mechanisms are considered responsible for the three different types of lesion. A trauma with downwards traction principally involves the upper plexus. Trauma in abduction first involves the lower plexus while a traumatic force acting from an anterior to a posterior direction involves firstly and predominantly the C7 spinal nerve which in an anterior position and less oblique than the other roots. Avulsion from the cord or rupture are possible. 33 cases have been observed.

Brachial Plexus↗

PubMed1991

A personal technique for treatment of scaphoid non-union.

We describe a personal technique for the treatment of scaphoid non-union, consisting of styloidectomy of the radius associated with axial perforation of the scaphoid, emptying of the bone, filling it again by cancellous bone taken from the styloid and securing it with a peg obtained from the cortex of the same styloid. 52 patients out of 77 operated on with this technique were reviewed. Results are shown and seem to be better than those found in literature.

Adolescent↗

PubMed1991

Anatomical study of distal insertion of the abductor pollicis longus. Concept of a new musculo-tendinous unit: the abductor carpi muscle.

Having performed 100 anatomical dissections we found that in the first dorsal compartment of the wrist besides other tendons there are one or two tendons belonging to a musculo-tendinous unit, not yet described, inserting in the trapezium and acting almost together with the other units going to the first metacarpal. This is present in 71% of cases. Its function is to abduct the carpus. Therefore we suggest to call this unit the "abductor carpi" muscle. If it is missing, which is "abnormal", instability and arthritis of the trapezio-metacarpal joint occur in a higher percentage because the other abducent forces pull the base of the first metacarpal with a shearing effect on the TM joint. Besides other less frequent variants, other "anomalies" such as the presence of a tendon going to the abductor pollicis brevis (59%) or to the opponents muscle (15%) have been found.

Carpal Bones↗

PubMed1988

Neurolized nerve padding in actinic lesions: omentum versus muscle use. An experimental study.

Free microvascular greater omentum flap to pad brachial plexus after neurolysis for actinic lesions is a major operation. Thus several authors have suggested a simple padding by means of traditional muscle flaps. As contouring the brachial plexus elements is difficult using muscle, we wished to evaluate the formation of perineural fibrosis with either omentum or muscle, following neurolysis. An experimental model in rats was set up, dividing the two femoral nerves and wrapping one of them with the greater omentum and the other with abdominal muscles. The degree of perineural fibrosis at light microscopy observation was fivefold greater when muscle, rather than omentum, was used.

Animals↗