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PubMed1976

Cells of origin of entorhinal cortical afferents to the hippocampus and fascia dentata of the rat.

The pathway from the entorhinal cortical region to the hippocampal formation has previously been shown to be comprised of two sub-systems, one of which projects predominantly to the ipsilateral fascia dentata and regio inferior of the hippocampus proper, and a second which projects bilaterally to regio superior. The goal of the present investigation was to determine if these two pathways might originate from different cell populations within the entorhinal area. The cells of origin of these entorhinal pathways were identified by retrograde labeling with horseradish peroxidase (HRP). Injections which labeled the entorhinal terminal fields in both the fascia dentata and regio superior resulted in the retrograde labeling of two populations of cells in the entorhinal area. Ipsilateral to the injection, HRP reaction product was found in the cells of layer II (predominantly stellate cells) and the cells of layer III (predominantly pyramidal cells). Contralateral to the injections, however, the reaction product was found almost exclusively in the cells of layer III. With selective injections of the entorhinal terminal field in regio superior, only the cells of layer III were labeled, but these were labeled bilaterally. Selective injection of the entorhinal terminal field in the fascia dentata, however, resulted in the labeling of cells of layer II, but not of layer III, and these cells of layer II were labeled almost exclusively ipsilaterally. A very small number of labeled cells in layer II were, however, found contralateral to the injection as well. No labeled cells were found either in the presubiculum or parasubiculum following injections of the hippocampal formation. These cell populations were found capable of retrograde transport of HRP, however, since cells in both presubiculum and parasubiculum were labeled following HRP injections into the contralateral entorhinal area. These results suggest that the projections to the fascia dentata originate from the cells of layer II, while the projections to regio superior originate from the cells of layer III of the entorhinal region proper. The very slight crossed projection from the entorhinal area to the contralateral area dentata probably originates from the small population of cells in layer II which are labeled following HRP injections in the contralateral area dentata.

Afferent Pathways↗
PubMed1981

Lesion-induced sprouting of hippocampal mossy fiber collaterals to the fascia dentata in developing and adult rats.

A lesion-induced formation of an abnormal projection of hippocampal mossy fiber collaterals to the molecular layer of the fascia dentata was studied in rats. Both immature (1--30 days old) and adult rats were subjected to hippocampal and entorhinal lesions which alone or in combination removed one or more of the major afferents to the dentate molecular layer (commissural, associational, and perforant path). Some lesions in addition transected the main part of the mossy fibers en route from the dentate granule cells to the hippocampal pyramidal cells in regio inferior (CA3). The formation of aberrant mossy fiber terminals in fascia dentata (supragranular mossy fibers) was monitored by the histochemical Timm sulphide silver method, but the presence of aberrant terminals was also observed in the electron microscope. Abnormal amounts of supragranular mossy fiber terminals were found following entorhinal lesions of both immature and adult rats, but not following commissural lesions. Even larger amounts of aberrant terminals were, however, found in immature and adult rats subjected to lesions which removed most of the associational hippocampodentate projection by isolating columns of fascia dentata from major parts of the hilus (CA4). Pure transections of the fascia dentata perpendicular to its longitudinal septotemporal axis did not in itself cause aberrant supragranular terminals, although such lesions partially damaged the associational afferents. When the transections were combined with commissural lesions or entorhinal lesions or both, large amounts of supragranular terminals did, however, form at the denervated levels septal to the transection. After comparison of the amounts and distributions of the aberrant terminals found after the different lesions and in transplants of dentate tissue with different amounts of afferent input, we conclude that it is deafferentation of the dentate molecular layer, and not axotomy of the mossy fibers in the hilus of CA3 (pruning), that causes the aberrant growth of mossy fiber collaterals. Moreover, simultaneous removal of more than one afferent system seems to have a potentiating rather than a simple additive effect on the formation of supragranular mossy fibers.

Afferent Pathways↗
PubMed1986

Intracerebral transplants of the rat fascia dentata: a Golgi/electron microscope study of dentate granule cells.

In the present study we describe the morphological characteristics of dentate granule cells in intracerebral allografts of the rat fascia dentata. Blocks of hippocampal tissue containing the fascia dentata were taken from late embryonic and newborn rats and transplanted to the hippocampal region of other newborn and young adult rats. After survival periods of several months the recipient brains were fixed by perfusion and serially sectioned on a Vibratome. Some sections were stained with thionin to determine the localization and general histological organization of the transplants, while others were Golgi stained with a modification of the section Golgi technique. Well-impregnated transplant granule cells were gold-toned and deimpregnated thus allowing a correlated, light and electron microscopic analysis of identified neurons to be done. At the light microscopic level the morphology of the dentate granule cells in the transplants was very similar to Golgi-impregnated, gold-toned granule cells in the fascia dentata of normal rats (controls). A few irregular, more obliquely curved dendrites occurred, but basal dendrites passing into the hilar region were never observed. Following an initial spine-free segment granule cell dendrites were densely covered with spines. The axon, the mossy fiber, originated as usual from the basal pole of the cell body. In the electron microscope, both small and larger complex spines (v and w types) were seen to emerge from the gold-toned dendrites of the identified granule cells. The thin unmyelinated granule cell axons gave rise to giant mossy fiber boutons in the dentate hilus, but in addition numerous aberrant mossy fiber terminals were found innermost in the dentate molecular layer just above the granule cell layer. The results demonstrate that dentate granule cells that have gone through the major part of their differentiation after transplantation develop characteristic dendritic and axonal elements very similar to those of granule cells in the fascia dentata in situ. The minor changes observed correspond to the redistribution of intrinsic connections that results from the absence of major extrinsic afferents.

Animals↗
PubMed1986

Synaptic connections of cholecystokinin-immunoreactive neurons and terminals in the rat fascia dentata: a combined light and electron microscopic study.

We report here on the fine structure and synaptic connections of neurons and axon terminals in the rat fascia dentata displaying immunoreactivity to antibodies against cholecystokinin octapeptide (CCK). In the fascia dentata and hilar region, CCK-immunoreactivity was confined to nonpyramidal neurons that were similar in appearance to basket cells known to use gamma-aminobutyric acid (GABA) as neurotransmitter. These neurons exhibited dense accumulations of endoplasmic reticulum and infolded nuclei, and established asymmetric and symmetric synaptic contacts with presynaptic terminals. Among those terminals that formed asymmetric synaptic contacts, giant mossy fiber boutons arising from granule cell axons were identified. Cholecystokinin-immunoreactive terminals established symmetric synaptic contacts on the cell bodies and dendrites of granule cells. Similar contacts were formed on nonimmunoreactive hilar neurons. Some of these hilar cells were identified as commissural neurons by retrograde filling with horseradish peroxidase (HRP) following injection of the tracer into the contralateral fascia dentata. Synaptic contacts were rarely observed between immunolabeled pre- and postsynaptic elements. The results are discussed with regard to inhibitory processes in the fascia dentata since other studies have shown that CCK is coexistent with GABA in hippocampal nonpyramidal neurons.

Animals↗
PubMed1990

Axo-axonic chandelier cells in the rat fascia dentata: Golgi-electron microscopy and immunocytochemical studies.

Synaptic transmission can be blocked very efficiently by inhibitory synapses on axon initial segments. Inhibitory chandelier cells forming synapses on the axon initial segment of pyramidal neurons have been found in the neocortex and hippocampus proper. Here we describe an axo-axonic local circuit neuron in the rat fascia dentata that establishes synaptic contacts with axon initial segments of numerous dentate granule cells. Examination of a large number of Golgi-impregnated nongranule cells in the fascia dentata of rats revealed a group of neurons with characteristics of chandelier cells. Thus these cells exhibited an extensive axonal plexus within the granular layer that characteristically formed vertical aggregations of axonal varicosities. The cell bodies of these neurons were located in the inner molecular layer or in the outer part of the granular layer. Their dendrites invaded the molecular layer, suggesting an afferent innervation similar to that of the granule cells. Well impregnated putative axo-axonic cells were gold-toned for an electron microscopic analysis. The cell bodies and dendrites of these neurons exhibited characteristic ultrastructural features of nongranule cells, i.e., large amounts of perinuclear cytoplasm, infoldings of the nuclear membrane, and a large number of synaptic contacts on the perikaryon and on the smooth dendritic shafts. The axon originating from the cell body or from a proximal dendrite gave rise to numerous vesicle-filled varicosities that almost exclusively formed symmetric synaptic contacts with axon initial segments. A semiquantitative study of five axonal complexes demonstrated that 92.3% of identified postsynaptic elements were initial segments of granule cell axons. Immunostaining with antibodies against glutamate decarboxylase (GAD) and parvalbumin (PARV) revealed a subpopulation of neurons that very much resembled the Golgi-impregnated axo-axonic cells with regard to cell body location, dendritic arborization, and fine structural characteristics of perikarya and dendrites. GAD and PARV were found to be coexistent in these cells. Moreover, we found GAD- and PARV-immunoreactive terminals in symmetric synaptic contact with axon initial segments of granule cells. The present study has shown a hitherto unknown axo-axonic cell in the rat fascia dentata. On the basis of our immunocytochemical findings, we hypothesize that this cell exerts a strong inhibitory effect on dentate granule cells. This way, signal transmission from the fascia dentata to the hippocampus proper within the "trisynaptic pathway" can efficiently be controlled by a group of highly specialized neurons.

Animals↗
PubMed1986

Non-cholinergic afferents determine the distribution of the cholinergic septohippocampal projection: a study of the AChE staining pattern in the rat fascia dentata and hippocampus after lesions, X-irradiation, and intracerebral grafting.

The acetylcholinesterase (AChE) activity of the rat hippocampus and fascia dentata depends on an intact septohippocampal connection, and histochemical staining for AChE is commonly used to monitor the distribution of the cholinergic septohippocampal projection. It is also characteristic that the laminae of low or moderate to dense AChE staining in the hippocampus and fascia dentata coincide with the terminal fields of the major non-cholinergic, afferent pathways. While studying lesion-induced collateral sprouting and aberrant axonal growth of these pathways we observed that the AChE staining pattern changed in accordance with the reorganized distribution of the non-cholinergic pathways, and this occurred even without direct interfering with the septohippocampal projection itself. Widening and narrowing of the medial perforant path and mossy fiber terminal zones thus resulted in corresponding changes in the bands of AChE staining normally associated with these zones. Expansion of the commissural-associational hippocampodentate projections and the lateral perforant path was in a similar way paralleled by a widening of the AChE-poor zones which normally overlap with the termination of these projections. Observations of the same kind were made in intracerebral transplants of fascia dentata innervated by various host afferents, and in rats subjected to neonatal X-irradiation, where the mossy fiber projection is reduced and aberrant perforant pathways project into CA3 due to a reduced formation of granule cells. The observed sets of changes with linkage between the different non-cholinergic projections and the activity of AChE in their respective terminal fields were accordingly reproduced under several different experimental conditions. It could not be explained alone by interaction between the septal afferents and their target cells. We therefore conclude that the density and laminar distribution of the AChE activities within the hippocampus and fascia dentata are determined at least in part by the major afferent, non-cholinergic nerve connections. We suggest that the effect occurs through direct axonal interaction or through changes in the receptiveness of the common dentate and hippocampal target cells.

Acetylcholinesterase↗
PubMed1982

Autoradiographic evidence that septohippocampal fibers reinnervate fascia dentata denervated by entorhinal lesion during development.

The projection from the ventromedial septum to the fascia dentata was investigated autoradiographically in normal adult rats and in adult rats whose entorhinal cortex had been removed unilaterally at the age of 11 days. In the fascia dentata of normal rats and in the fascia dentata contralateral to the entorhinal lesion septohippocampal fibers and terminals were distributed just below and, to a lesser extent, just above the granular layer. The molecular layer above the supragranular zone was lightly and more or less uniformly innervated. Ipsilateral to the entorhinal lesion, however, the outer part of the dentate molecular layer received an anomalously dense septal projection (average 3-4 times the contralateral projection). The entorhinal lesion did not consistently affect the density of this projection in any other lamina. These results confirm that septohippocampal fibers increase their density of innervation when synaptic sites are made available by degeneration of lateral perforant path fibers during development. This represents a net increase in total septal innervation of the fascia dentata, not merely a change in the distribution of the projection among its target zones.

Afferent Pathways↗
PubMedDate not supplied

New use for the temporalis superficialis fascia in the facial contour: lip sculpture.

Since 1989, the author has been using autologous grafts of the temporalis superficialis fascia, with a total of 303 areas grafted. The grafts are readily acquired; they do not present any problem to the donor area and they eliminate peribucal wrinkles in particular, contribute to the filling in and increase of the turgidity of the lips by hardening them, and produce the projection of the cutaneous vermillion line. The fascia are interposed between the skin and the muscles by dominating the action in the skin and having an exceptional integration of a definitive character with no absorption. We visualize the placement of the pieces of fascia with the assistance of a Reverdin needle, as there are no incisions, but rather just small holes. Its use is also applied to the fading of the naso-labial furrow and the glabellar wrinkles. The same material is used in correcting rhinoplasty sequelae and the increase of volume in the congenital or acquired sunken-in face. The contribution with the definitive use of grafted fascia offers refinement in the filling in the facial contour at the centripetal sunken-in areas of the face, as an ancillary procedure in the musculo-cutaneous facelift stretching.

Adult↗
PubMed2004

Surgical reinforcement of support for the vagina in pelvic organ prolapse: concurrent iliococcygeus fascia colpopexy (Inmon technique).

To reinforce the support of the vagina, concurrent use of iliococcygeus fascia colpopexy with the McCall culdeplasty was scheduled for primary uterine prolapse. Forty-five women with primary uterine prolapse without stress urinary incontinence were treated by McCall culdeplasty alone or McCall culdeplasty plus iliococcygeus fascia colpopexy for suspension of the upper portion of the vagina. Recurrence of vaginal support defects were carefully followed for 15-50 months. Additional iliococcygeus fascia colpopexy did not change with the axis of the vagina obtained by McCall culdeplasty, although it prolonged total operation time by 32 min and increased blood loss by 94 ml. Two cases (8.3%) had postoperative vaginal defects in the group undergoing combined procedures and seven recurrent cases (33.3%) were observed in the group undergoing McCall culdeplasty alone. The durability of the combined procedures was superior to that of the modified McCall culdeplasty alone by Kaplan-Meier analysis. These results suggest that iliococcygeus fascia colpopexy is reasonably safe and strengthens not only the attachment of the upper part of the vagina but also that of the anterolateral vaginal wall.

Aged↗
PubMed2006

The membranous layer of superficial fascia: evidence for its widespread distribution in the body.

A discrete membranous layer, "stratum membranosum", in human subcutaneous tissue is classically described as confined to the lower anterior abdominal wall and perineum and referred to as Scarpa's and Colles' fasciae, respectively. Evidence for its existence elsewhere in the body is scanty and therefore the present study was undertaken. Dissection of six embalmed adult cadavers, along with ultrasound imaging on four living subjects, were carried out to determine the existence, topography, and thickness of the membranous layer of superficial fascia in different regions of the body. In all six cadavers, a continuous layer of fibrous membrane in the superficial fascia was found consistently in all the dissected regions of the body and was also confirmed by ultrasonography. The arrangement and thickness of this membranous layer varied according to body region, body surface, and gender. It was thicker in the lower than in the upper extremity, on the posterior than anterior aspect of the body, and in females than in males. The mean thickness of the membranous layer ranged from 39 to 189 mum, being thickest in the leg and thinnest over the dorsum of the hand. The membranous layer was observed to have two or even three components in regions such as the breast, back, thigh, and arm and was seen to split, forming special compartments around subcutaneous major veins of upper and lower extremities, with fibrous septa extending to attach to the vessel wall. Functionally, the membranous superficial fascia may play a role in the integrity of the skin and support for subcutaneous structures particularly veins, by ensuring their patency. Understanding the topographic anatomy of this fascial layer may help explain body-contour deformities and provide the anatomic basis for surgical correction.

Abdominal Wall↗
PubMed1983

Cellular, histochemical and connective organization of the hippocampus and fascia dentata transplanted to different regions of immature and adult rat brains.

The aims of the present study were to examine the survival and the cellular and connective differentiation of intracerebral transplants of fascia dentata and hippocampus. Pieces of immature dentate and hippocampal tissue were taken from late embryonic (E18) and early postnatal (1-9 days old) rats and transplanted into the brains of 1- to 13-day-old and adult rats. After survival times from 4 days to 2 years the cellular and connective organization of the transplants was monitored in parallel series of sections stained with thionin (cell bodies), Timm's sulphide silver method (terminal fields). Nauta and Fink-Heimer methods (normal and degenerating fibers) and a method for AChE activity (cholinergic afferents). The transplants survived well in all combinations of donor and recipient ages used, and they survived and differentiated in all parts of the recipient brains, although relations to pial and ventricular surfaces appeared to be optimal. Cell differentiation continued after transplantation, and a characteristic laminar organization was retained, although least in embryonic donor tissues. The distribution of intrinsic connections was determined by the types of subfields present in the transplants and interaction with ingrown host afferents. All aberrant intrinsic connections observed corresponded to aberrant connections formed in the hippocampus and fascia dentata denervated in situ and included supragranular mossy fibers in the fascia dentata, aberrant infrapyramidal mossy fibers in CA3, spread of CA4-associated afferents beyond the normal commissural-associational zone in the dentate molecular layer together with ingrowth of CA3-associated and CA1-subiculum-associated afferents. Most transplants received a cholinergic input of host origin irrespective of the localization in the host brain, but also non-cholinergic host pathways innervated the transplants, in particular when the transplants were in close contact with host fiber tracts, and when the recipients were immature. At various transplant locations the non-cholinergic host afferents belonged to the commissural hippocampo-dentate system, the commissural hippocampal system and the callosal system. Other cases suggested innervation of dentate transplant by host entorhinal afferents. The formation and distribution of intrinsic transplant connections and connections between transplant and host appeared to be regulated by the same factors that regulate the development and reorganization of fiber connections in the normal and the in situ denervated hippocampus and fascia dentata. As a special variety of this, the distribution of cholinergic afferents adjusted to the distribution of the major intrinsic and extrinsic non-cholinergic pathways.

Acetylcholinesterase↗
PubMed1992

Hippocampal kindling leads to different changes in paired-pulse depression of local evoked field potentials in CA1 area and in fascia dentata.

Monosynaptic evoked field potentials (EPs) in response to paired-pulse stimulation (20 ms interval) were recorded in area CA1 and fascia dentata of the same animal in the course of development of a kindled focus in the CA1 region. A significant reduction of paired pulse depression in response to medium and high stimulation intensity was found in CA1. A similar change was found in the fascia dentata in response to medium intensity stimulation of the angular bundle. In contrast, at high intensity, paired pulse depression was enhanced in the fascia dentata in the course of kindling. These results indicate that kindling epileptogenesis is accompanied by regionally different changes in recurrent inhibition: a reduction in CA1 and intensity dependent changes in fascia dentata.

Animals↗
PubMed2005

Release of oral submucous fibrosis and reconstruction using superficial temporal fascia flap and split skin graft--a new technique.

Long standing oral submucous fibrosis is associated with involvement of the oral submucosa and the muscles of mastication leading to difficulty in mouth opening. Various surgical modalities are mentioned for release but each has its own limitations. This article introduces a new technique of release of submucous fibrosis and reconstruction using superficial temporal fascia flap and split skin graft. The surgical technique involves a pre-auricular incision extending into the temporal region with dissection carried out in the sub follicular plane to develop the superficial temporal fascia flap to its maximum extent. The masseter muscle origin is released from the zygomatic arch and the temporalis muscle insertion is released from the coronoid process through an external approach. The entire fibrosed mucosa is released intraorally to create a mucomuscular defect thus achieving full mouth opening. The superficial temporal fascia flap is then brought in and sutured to the intraoral defect, which is then covered with a split thickness skin graft. This procedure is performed bilaterally. A total of five patients were treated with this new technique and all of them showed good mouth opening in long term follow up. There was no donor site morbidity. The incision line is well hidden in the hair bearing area. A well vascularised superficial temporal fascia flap brings in good blood supply to the area of affected muscle and mucosa to improve its function.

Fasciotomy↗
PubMed2004

Effects of prenatal protein malnutrition and acute postnatal stress on granule cell genesis in the fascia dentata of neonatal and juvenile rats.

Although postnatal genesis of granule cells in the hippocampal fascia dentata is known to be influenced by prenatal protein deprivation or by stress, the combined effects of prenatal protein malnutrition and stress on these cells are unknown. This study was designed to examine this combined effect. Well-nourished and prenatally malnourished pups on postnatal day 7 (P7) were stressed by maternal separation and reduction of body temperature and on postnatal day 30 (P30) by immobilization with restraint. Bromodeoxyuridine (BrDU) was injected at the time of stress, and 2 h later, the numbers of immunolabeled cells were quantified by standard stereological techniques. In comparison to controls, prenatally malnourished rats showed a significantly lower number of cells tagged in the fascia dentata on P7 (p < or =0.05), and a significantly higher number of cells (p < or =0.05) on P30. In both age groups, control rats exposed to acute stress showed a significantly decreased number of cells tagged in the fascia dentata (p < or =0.05). In contrast, neurogenesis in malnourished rats was not significantly affected by acute stress at either age. Thus, the pattern of neurogenesis in the fascia dentata and its response to stress has been fundamentally altered by prenatal protein deprivation.

Acute Disease↗
PubMed1998

Use of a prefabricated tunica vaginalis fascia flap to reconstruct the tunica albuginea after recurrent penile prosthesis extrusion.

PURPOSE: Although a penile prosthesis usually perforates into the urethra, it can extrude through the glans or corporeal shaft. Various materials have been used to reconstruct tunica albuginea but no method of repair has been satisfactory in such difficult cases. Repair of the weakened tunica albuginea should ideally be performed with autogenous tissues. Inasmuch as the scarred tissue bed is inadequate to ensure graft survival and no local flaps are available for this purpose, prefabrication of a local flap has been designed. MATERIALS AND METHODS: We present 2 cases in which the distal corpus was reconstructed with a prefabricated tunica vaginalis fascia flap. The first stage involves grafting rectus fascia onto the external tunica vaginalis of the testicle. At the second stage the prefabricated tunica vaginalis fascia flap is transposed to the distal corpus, placing it as a buttress between the cylinder and urethra medially or between the cylinder and thin lateral and distal tunica albuginea. The flap also replaces part of the tunica albuginea. RESULTS: In both patients repair of the tunica albuginea was successful and each has a functioning inflatable penile prosthesis at 2 1/2 1 1/2 years postoperatively, respectively. CONCLUSIONS: Reconstruction of the weak tunica albuginea with a prefabricated tunica vaginalis fascia flap is an excellent procedure in these difficult cases.

Adult↗
PubMed1998

Initial dissection of the lateral fascia reduces the positive margin rate in radical prostatectomy.

OBJECTIVES: Positive margins predict an adverse outcome after radical retropubic prostatectomy (RRP). The effect of initial incision of the lateral pelvic fascia prior to urethral transection on positive margins rates is assessed. METHODS: The rate of positive margins in 350 consecutive RRPs is compared in two groups without hormonal pretreatment. In group 1 (n = 198), RRP was performed in standard fashion with apical dissection and urethral transection preceding dissection of the lateral pelvic fascia and mobilization of the prostate from the anterior rectal surface. In group 2 (n = 1 52), the initial step consisted of incision of the lateral pelvic fascia along the perirectal surface with prostatic mobilization off the rectum prior to urethral transection. The bladder neck and seminal vesicle dissection was identical in both groups. Specimens were step-sectioned for histologic analysis. Differences in rates of positive margins were analyzed by Fisher's exact test and logistic regression. RESULTS: The rate of positive margins was reduced from 37.4% in group 1 to 15.8% in group 2. In the logistic regression model, surgical technique, Gleason sum, serum prostate-specific antigen (PSA), and the presence of extracapsular extension were independent predictors of margin status, with group 1 being more than twice as likely to have positive margins than group 2 (P = 0.0076; odds ratio 2.198; 95% confidence interval 1.23 to 3.92). The rate of positive margins was reduced from 45.5% in group 1 to 16.7% in group 2 (P = 0.0046) for non-nerve-sparing RRP and from 33.3% to 15.5% (P = 0.0012) for nerve-sparing RRP. There were no differences in functional outcomes between groups and no rectal injuries in group 2. CONCLUSIONS: Initial dissection of the lateral pelvic fascia during RRP results in a lower rate of positive margins independent of tumor grade, clinical stage, extracapsular extension, and preoperative PSA level.

Confidence Intervals↗
PubMedDate not supplied

Comparison of continuous 3-in-1 and fascia Iliaca compartment blocks for postoperative analgesia: feasibility, catheter migration, distribution of sensory block, and analgesic efficacy.

BACKGROUND AND OBJECTIVES: Efficacy and technical aspects of continuous 3-in-1 and fascia iliaca compartment blocks were compared. METHODS: Forty-four patients scheduled for cruciate ligament repair or femur surgery were randomly divided into 2 groups. After surgery with the patient anesthetized, catheters were placed for continuous 3-in-1 blocks by means of a nerve stimulator (group 1). In group 2, the catheter was inserted for continuous fascia iliaca compartment block without the use of a nerve stimulator. In both groups, a 5-mg/kg bolus of 0.5% ropivacaine was administered followed by continuous infusion of 0.1 mL/kg/h of 0.2% ropivacaine for 48 hours. In the postoperative period, all the patients received parenteral propacetamol (6 g daily) and ketoprofen (200 mg daily) and 0.1 mg/kg of subcutaneous morphine as rescue analgesia if the visual analog scale (VAS) pain values were greater than 30 mm. We evaluated the technical difficulties relative to catheter placement, the location of the catheter, the analgesic efficacy, and the distribution of the sensory block at 1 hour, 24 hours, and 48 hours. RESULTS: Catheter placement was faster in group 2, and the absence of nerve stimulation decreased material costs (P <.05). No significant difference was observed between groups concerning location of the catheter tip under the fascia iliaca. In both groups, the distribution of the sensory block and its course were similar except for those of the obturator nerve (more sensory blocks in group 1, P <.05). No significant difference was noted between the groups regarding median VAS pain values and consumption of morphine during the 48-hour period. No major side effect was observed. CONCLUSIONS: The authors conclude that a catheter for continuous lumbar plexus block can be placed more quickly and at lesser cost using the fascia iliaca technique than the perivascular technique with equivalent postoperative analgesic efficacy.

Aged↗
PubMed2001

Limited joint mobility and plantar fascia function in Charcot's neuroarthropathy.

AIM: The aim of this study was to investigate the prevalence of limited joint mobility at the first metatarsophalangeal joint (MPJ) and dysfunction of the plantar fascia in people with diabetes mellitus and Charcot's neuroarthropathy and a control group. METHODS: Fifteen subjects with a history of mid-foot Charcot's neuroarthropathy and 26 controls with sensory neuropathy but no Charcot's neuro arthropathy were recruited. Ranges of ankle and first MPJ dorsiflexion were measured for each participant. Plantar fascia function was assessed using Jack's test. RESULTS: The range of dorsiflexion at the first MPJ was significantly reduced in the subject group compared with the control group (51.2 vs. 64.8; P < 0.001). Jack's test demonstrated the plantar fascia to be ruptured or dysfunctional in all feet in the subject group and to be functioning in all feet in the control group. CONCLUSIONS: It is not possible to determine from this study if the limited joint mobility at the first MPJ and dysfunction of the plantar fascia preceded or followed the development of Charcot's neuroarthropathy; however, these results are a previously unreported finding in Charcot's neuroarthropathy. Diabet. Med. 18, 558-561 (2001)

Arthropathy, Neurogenic↗