Brachial plexus injuries.
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Brachial Plexus↗
Biomedical subjects
R Birch
Publications and source records attributed to R Birch.
Protein quality and urea kinetics in prepubertal Chilean schoolboys.
Urea kinetics were measured non-invasively in 12 Chilean schoolboys aged 8-10 years who were receiving one of two diets, either predominantly animal protein or predominantly vegetable protein. Both the diets provided an equivalent level of gross protein, 1.2 g/kg/day. The study diets were given for 10 days to enable adaptation to take place. On the eighth day a single oral dose of 15N15N-urea, 100 mg, was given and the amount of label excreted as 15N15-urea in urine over the subsequent 48 hours was measured. There was little difference in any aspect of urea kinetics between the two diets with urea production (animal, 173 +/- 50 mgN/kg/day; vegetable 179 +/- 53 mgN/kg/day), urea excretion (animal, 86 +/- 19 mgN/kg/day; vegetable, 105 +/- 13 mgN/kg/day), urea nitrogen hydrolysis (animal, 87 +/- 49 mgN/kg/day; vegetable, 74 +/- 42 mgN/kg/day), and the salvaged urea-nitrogen derived from hydrolysis which returned to urea formation (animal, 12 +/- 5 mgN/kg/day; vegetable, 17 +/- 9 mgN/kg/day) all being similar. A very high proportion of the salvage nitrogen derived from urea hydrolysis was maintained within the metabolic pool, about 80%, which was equivalent to 0.4 g protein/kg/day. This is the first time urea kinetics have been measured in children of this age and shows that 57% of the ura produced is excreted in urine on average with about 43% of the urea-nitrogen being salvaged for further metabolic interaction. It is concluded that the vegetable based protein diet taken habitually by Chilean children is metabolically equivalent in terms of urea kinetics to a diet based upon animal protein at this level of intake, but that high rates of salvage of urea nitrogen are found on both diets.
Aging↗
Deep venous thrombosis prophylaxis with low molecular weight heparin and elastic compression in patients having total hip replacement. A randomised controlled trial.
Seventy-eight patients having elective total hip replacement were randomised into 3 groups A) control; B) low molecular weight heparin: (enoxaparin 40 mg once daily) and C) enoxaparin (40 mg once daily) plus graduated elastic compression (TEDR stockings) for 8-12 days. All patients had a preoperative perfusion lung scan and chest X-Ray and a postoperative perfusion/ventilation scan together with bilateral ascending venography on days 8-12. A blood sample was taken preoperatively, on the 1st, 3rd and 5th postoperative day and at the end of the study. The control group received placebo injections. The venograms and V/Q scans were reported blindly by an independent panel of three and one radiologists respectively. An independent panel of assessors stopped entry in the control group when a total of 45 patients were admitted according to Ethics Committee directives. The study continued with groups B and C. The incidence of DVT (including isolated asymptomatic calf thrombi) was as follows: Group A (n = 14) 93%; Group B (n = 32) 38%; Group C (n = 32) 25% (chi 2; p < 0.001 for group A versus B or C). The incidence of proximal DVT was: Group A 57%; group B 28%; group C 13% (chi 2; p = 0.057 for group A versus B and p < 0.005 for group A versus C). The incidence of silent pulmonary embolism (PE) (new defect on V/Q scan) was 28% (8 out of 29) in patients with and 5% (2 out of 43) in patients without DVT (chi 2; p < 0.02). The combination of high TAT and low anti-Xa activity on the 1st postoperative day identified a high risk group of patients who had a 56% incidence of proximal DVT on the 8th to 12th postoperative day. Further studies are needed to confirm the suggested increased efficacy in prophylaxis by the combination of LMWH and GEC as compared with LMWH alone.
Aged↗
Pain relief from preganglionic injury to the brachial plexus by late intercostal nerve transfer.
We performed intercostal nerve transfer in 19 patients to relieve pain from preganglionic injury to the brachial plexus. The procedure was successful in 16 patients at a mean of 28.6 months (12 to 68) after the injury.
Activities of Daily Living↗
The posterior triangle and the painful shoulder: spinal accessory nerve injury.
Forty-three cases of accessory nerve injury referred to the Peripheral Nerve Injury Unit have been reviewed. Accessory nerve injury results in a characteristic group of symptoms and signs. Referral for treatment is usually delayed, the average time being 11.3 months. Surgical treatment resulted in improvement of symptoms in almost all cases.
Accessory Nerve↗
An analysis of engraftment kinetics as a function of the CD34 content of peripheral blood progenitor cell collections in 692 patients after the administration of myeloablative chemotherapy.
The CD34 antigen is expressed by committed and uncommitted hematopoietic progenitor cells and is increasingly used to assess stem cell content of peripheral blood progenitor cell (PBPC) collections. Quantitative CD34 expression in PBPC collections has been suggested to correlate with engraftment kinetics of PBPCs infused after myeloablative therapy. We analyzed the engraftment kinetics as a function of CD34 content in 692 patients treated with high-dose chemotherapy (HDC). Patients had PBPCs collected after cyclophosphamide based mobilization chemotherapy with or without recombinant human granulocyte colony-stimulating factor (rhG-CSF) until > or = 2.5 x 10(6) CD34+ cells/kg were harvested. Measurement of the CD34 content of PBPC collections was performed daily by a central reference laboratory using a single technique of CD34 analysis. Forty-five patients required a second mobilization procedure to achieve > or = 2.5 x 10(6) CD34+ cells/kg and 15 patients with less than 2.5 x 10(6) CD34+ cells/kg available for infusion received HDC. A median of 9.94 x 10(6) CD34+ cells/kg (range, 0.5 to 112.6 x 10(6) CD34+ cells/kg) contained in the PBPC collections was subsequently infused into patients after the administration of HDC. Engraftment was rapid with patients requiring a median of 9 days (range, 5 to 38 days) to achieve a neutrophil count of 0.5 x 10(9)/L and a median of 9 days (range, 4 to 53+ days) to achieve a platelet count of > or = 20 x 10(9)/L. A clear dose-response relationship was evident between the number of CD34+ cells per kilogram infused between the number of CD34+ cells per kilogram infused and neutrophil and platelet engraftment kinetics. Factors potentially influencing the engraftment kinetics of neutrophil and platelet recovery were examined using a Cox regression model. The single most powerful mediator of both platelet (P = .0001) and neutrophil (P = .0001) recovery was the CD34 content of the PBPC product. Administration of a post-PBPC infusion myeloid growth factor was also highly correlated with neutrophil recovery (P = .0001). Patients receiving high-dose cyclophosphamide, thiotepa, and carboplatin had more rapid platelet recovery than patients receiving other regimens (P = .006), and patients requiring 2 mobilization procedures versus 1 mobilization procedure to achieve > or = 2.5 x 10(6) CD34+ cells/kg experienced slower platelet recovery (P = .005). Although a minimal threshold CD34 dose could not be defined, > or = 5.0 x 10(6) CD34+ cells/kg appears to be optimal for ensuring rapid neutrophil and platelet recovery.
Adolescent↗
High-dose chemotherapy and autologous stem cell transplantation for breast cancer.
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Antineoplastic Agents↗
V/Q defects and deep venous thrombosis following total hip replacement.
Seventy-two patients undergoing elective total hip replacement were studied with bilateral venography, pre-operative and post-operative lung scans. Twelve belonged to a control group that received placebo injections and 60 patients to treatment groups that received low molecular weight heparin. The incidence of deep venous thrombosis was 11 (92%) of 12 patients in the control group and 18 (30%) of 60 patients in the treatment group (X2: P < 0.001). The incidence of pulmonary embolism (new unmatched perfusion defects) was five (42%) of the 12 patients in the control group and five (8.3%) of the 60 patients in the treatment groups (X2: P < 0.002). The incidence of pulmonary embolism (new unmatched perfusion defects) was eight (27.5%) of 29 patients with deep venous thrombosis and two (4.6%) of 43 without deep venous thrombosis (X2: P < 0.02). Of the ten patients who had pulmonary embolism according to this study's criteria (one or more new defect on perfusion, unmatched on the ventilation scan), eight would have been classified as high probability by the Biello criteria, and only five by the PIOPED criteria, if the pre-operative scans were not available. We conclude that having a pre-operative lung scan improves ability to interpret the postoperative lung scans in high risk patients.
Elective Surgical Procedures↗
A slowly evolving brachial plexus injury following a proximal humeral fracture in a child.
The association of fractures and neurological injuries is well recognized, especially with certain upper limb fractures. Typically, the nerve injury occurs at the time of initial fracture displacement. A case is reported of an unusual combination of fracture and nerve injury in a child, with the extremely rare occurrence of a slowly evolving nerve injury. The potential for delayed nerve injury following a fracture needs to be appreciated to prevent delays in diagnosis and treatment.
Brachial Plexus↗
Flexor to extensor tendon transfers in the hand.
We reviewed 49 cases of flexor to extensor tendon transfer following injury to the radial nerve (22) or brachial plexus (27). Post-operative follow-up average 5.6 years (0.5-12.5). Function was improved in 84% (41) of patients. 16% (8) reported no improvement; of these, four (50%) had associated vascular injuries. In those with improvement, impaired coordination and dexterity were reported by 79% (15 of 19) of the plexus injuries and in 64% (14 of 22) of the radial nerve palsies. Premature fatigue was noted by 89% (17 of 19) of plexus injuries and in 82% (18 of 22) of radial nerve palsies. The power of wrist extension averaged 22% of the contralateral side (8% to 80%), power of digital extension was 31% (5% to 130%), and power grip was reduced to 40% (5% to 86%).
Adolescent↗
The effect of unilateral intercostal nerve transfer upon lung function.
Intercostal nerve transfer is a well-established technique in the treatment of some severe brachial plexus lesions in adults. There is, however, concern that in the presence of an ipsilateral phrenic nerve palsy it may lead to a significant compromise of respiratory function. 20 patients having intercostal nerve transfers had their lung function assessed pre-operatively and 6 weeks post-operatively. The patients were subsequently questioned about symptoms of respiratory dysfunction. There was no evidence that intercostal nerve transfer leads to a significant reduction in respiratory function in adults. It therefore appears safe to perform intercostal nerve transfers in adults following brachial plexus injuries even in the presence of an ipsilateral phrenic nerve palsy.
Adolescent↗
Repair of the common peroneal nerve.
Elective repair of lesions of the common peroneal nerve was carried out in 27 patients between 1982 and 1992. Twenty-three have been reviewed of whom 11 recovered power sufficient to prevent foot drop and 13 recovered protective sensation or better.
Adolescent↗
The influence of dietary creatine supplementation on performance during repeated bouts of maximal isokinetic cycling in man.
The effect of dietary creatine (Cr) supplementation on performance during 3, 30 s bouts maximal isokinetic cycling and on plasma ammonia and blood lactate accumulation during exercise was investigated. Placebo (P) ingestion had no effect on peak power output (PPO), mean power output (MPO) and total work output during each bout of exercise. Cr ingestion (4 x 5 g.day-1 for 5 days) significantly increased PPO in exercise bout 1 (p < 0.05) and MPO and total work output in exercise bouts 1 (p < 0.05, p < 0.05, respectively) and 2 (p < 0.05, p < 0.05, respectively). Cr ingestion had no effect on any of the measures of performance during exercise bout 3. No difference was observed in peak plasma ammonia accumulation before (146 + 30 mumol.l-1) and after (122 +/- 17 mumol.l-1) P ingestion, however the corresponding concentration was lower following Cr ingestion (129 +/- 22 mumol.l-1) compared with before Cr ingestion (160 +/- 18 mumol.l-1, p < 0.05), despite subjects performing more work. No difference in peak blood lactate accumulation was observed before and after P or Cr ingestion. The results demonstrate that Cr ingestion can increase whole body exercise performance during the initial two, but not a third, successive bout of maximal exercise lasting 30 s. The lower accumulation of plasma ammonia under these conditions suggests this response is achieved by an effect on muscle ATP turnover.
Adenosine Triphosphate↗
Brachial plexus block and cervical rib.
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Brachial Plexus↗
Relationship between amniotic fluid and maternal blood nutrient levels.
To study the relationships between amniotic fluid and maternal blood nutrient concentrations, we obtained amniotic fluid and blood samples simultaneously from 76 pregnant women at around 17 weeks gestation. Folate and vitamin B-12 levels were measured by microbiological assay and radioassay, respectively, and zinc, copper and iron levels by atomic absorption spectrophotometry. Mean concentrations of plasma and red blood cell (RBC) folate and plasma copper of the pregnant women were 38 (+/- 1, SD), 1,501 (+/- 374) nmol/L, and 32.7 (+/- 4.8) mumol/L, respectively, all of which were higher than those of healthy non-pregnant controls (p < 0.001). Mean concentrations of plasma vitamin B-12, zinc and iron levels and RBC zinc were 320 (+/- 130) pmol/L, 12.2 (+/- 2.3), 21.7 (+/- 6.1) and 177 (+/- 30) mumol/L and these were similar to those of non-pregnant controls. Amniotic fluid folate, zinc, copper and iron concentrations were 21 (+/- 13) nmol/L, 1.4 (+/- 0.6), 1.7 (+/- 0.6) and 6.8 (+/- 2.1) mumol/L, respectively, which were significantly lower than plasma levels (p < 0.001). However, this relationship was reversed for vitamin B-12 (650 +/- 420 pmol/L). Significant correlations were found between amniotic fluid and maternal plasma and RBC for folate, and between amniotic fluid and maternal plasma for vitamin B-12 (p < 0.001). No such correlations were observed for zinc, copper and iron. There was no correlation between amniotic fluid and/or blood nutrient concentrations and pregnancy outcome including birth weight of infants.
Adult↗
Freeze-thawed muscle grafting for painful cutaneous neuromas.
We used freeze-thawed muscle grafts to restore continuity to the affected nerve in 22 painful cutaneous neuromas. In 11 of the 15 neuromas in the upper limb, pain was partially or completely relieved; in six of these there was some recovery of distal sensation. Partial pain relief was achieved in only two of the seven neuromas in the lower limb. The difference is attributed to the longer grafts required in the lower limb.
Adult↗
Inpatient continuous-infusion interleukin-2 in 788 patients with cancer. The National Biotherapy Study Group experience.
BACKGROUND: Interleukin-2 (IL-2), used alone or in combination with adoptive cellular therapy, is one of the most promising biologic therapeutic agents for cancer treatment. METHODS: The National Biotherapy Study Group conducted 15 trials of continuous-infusion IL-2 involving 788 patients with cancer, 638 of whom were evaluable for tumor response. The protocols included administration of IL-2 and lymphokine-activated killer (LAK) cells, IL-2 and cyclophosphamide, IL-2 and tumor-infiltrating lymphocytes, IL-2 and alpha-interferon (IFN), IL-2 and tumor necrosis factor, and IL-2 and LAK alternating with combination chemotherapy. RESULTS: Responses were detected in 33 of 188 patients (18%) with melanomas, 13 of 167 (8%) with renal cell carcinomas, and 1 of 76 (1%) with colorectal cancers. The median survival times in patients with melanoma and renal cell cancer were 9.6 and 9.3 months, respectively. The proportion of patients surviving 1 year were 35% and 43%, respectively. There were responses in 8 of 51 patients (16%) with lung cancer, but many of these patients received IL-2 and LAK alternating with platinum-based chemotherapy. Four of 23 patients (17%) responded who had breast cancer and received IL-2 and IFN. The protocols involving IL-2 plus adoptive cellular therapy produced a higher response rate than those not involving activated cells (48 of 312 [15%] versus 24 of 326 [7%], P = 0.003); however, there was no difference in survival. There was a 1.8% mortality rate attributed to the complications of IL-2 itself. CONCLUSIONS: IL-2 produces durable tumor responses in some patients, especially in those with melanoma and renal cell carcinoma. Because the drug's toxicity is significant and the overall response rates are low, patient selection may be the most important factor in the clinical use of continuous-infusion IL-2 therapy.
Adolescent↗
Brachial plexus injury: when to amputate?
Amputation of the upper limb was performed in 20 out of 750 patients with traction lesions of the brachial plexus between August 1969 and June 1991. Urgent amputation was necessary in three patients with irreparable vascular injury and in two more because of overwhelming sepsis. Thirteen patients chose amputation of their flail and useless arm. Two patients have been lost to follow-up. Urgent amputation is indicated when perfusion of the limb cannot be restored, for sepsis, and for a limb which is so severely injured that there can be no prospect for a return of any function. Elective amputation is performed at the patient's request and may be considered as an element of rehabilitation. The pain of preganglionic injury of the brachial plexus is not relieved by amputation.
Accidents, Traffic↗