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We report a case of microsurgical replantation of traumatic self-amputation of penis after prolonged warm ischemia as a result of delayed presentation. At 12 weeks postoperative follow-up evaluation, the patient exhibited good urinary flow, spontaneous erection, and a normal response to pharmacological stimulation.
Successful microsurgical replantation of a penis amputated at the level of the pubis is a rare occurrence worldwide. Moreover, the use of hyperbaric oxygen (HBO) for a postoperative replant Pseudomonas wound infection has not been reported. There is also disagreement regarding the importance of microsurgical repair of only the dorsal arteries or only the profundi arteries of the penis. A case is reported of penile replantation with a postoperative Pseudomonas wound infection treated with HBO to prevent potential replant loss, with a worldwide literature review. At 1-year postoperative follow-up, the patient has normal urinary flow and reports spontaneous erection, with the ability for intromission and a sensate glans. HBO facilitated the success of a penile replantation complicated by postoperative Pseudomonas wound infection. In addition, a literature review supports the microsurgical repair of at least a single isolated dorsal penile artery, but not a single or multiple profundi arteries.
A case is reported of a 43 year old who performed a self amputation of his penis. Reimplantation was successfully performed.
Despite the introduction of microsurgical techniques into clinical practice, the results of surgical procedures involving the brachial plexus and peripheral nerves are still far from spectacular. We therefore studied the rat brachial plexus and its terminal branches in 203 rats. Detailed anatomic and morphologic analyses of the biceps brachii and musculocutaneous nerve, finger flexors, flexor carpi radialis, and the median nerve were performed. Various sources of conventional and vascularized nerve grafts were explored. After musculocutaneous nerve section or median nerve section, there were no articular contractures or automutilations, which constitutes an advantage for these experimental models over the sciatic nerve model. The brachial plexus and its terminal branches provide a good experimental model which can be used to assess the development and normal control of muscle function, examine the mechanisms underlying functional recovery, and test the effects of treatments to enhance recovery.
In recent years, injection of pure glycerol into the trigeminal cistern has been used for the treatment of trigeminal neuralgia. The mechanism of action of this therapy remains unclear. Using both light and electron microscopy, we investigated the effects of microinjections of sterile, pure glycerol into the endoneurium of the sciatic nerve of the rat. We observed total destruction of both myelinated and unmyelinated fibers. In nearly all animals, signs of automutilation were observed in the paralyzed limb. Histological evidence of nerve degeneration appeared soon after injection, with intense proliferation of perineurial cells that eventually divided the endoneurium into numerous microcompartments.
The cutaneous nociceptive response threshold to mechanical and thermal stimulation, the development of hyperalgesia and plasma extravasation after subcutaneous injection of carrageenan and the development of autotomy behaviour after nerve section were assessed in interleukin-6-deficient (IL-6-/-) and age-matched wild-type (IL-6+/+) mice. IL-6-/- mice had significantly lower response threshold to both mechanical and thermal stimulation in comparison to IL-6+/+ controls. Both IL-6-/- and IL-6+/+ mice developed hyperalgesia to mechanical and thermal stimulation after localized carrageenan injection, but the magnitude of the hyperalgesia was less in the IL-6-/- than in the IL-6+/+ controls. IL-6-/- mice also exhibited less plasma extravasation after carrageenan injection. No difference was noted between males and females in basal nociception and inflammatory hyperalgesia. However, female IL-6-/- mice exhibited autotomy behaviour, a sign of neuropathic pain, significantly more frequently and after a shorter interval following peripheral nerve injury than male IL-6-/- or male and female IL-6+/+ mice. It is suggested that IL-6-/- mice exhibited numerous changes in nociceptive responses compared to controls, some of which are sex related. The mechanisms of these changes in relation to null-mutation of the IL-6 gene and the influence of genetic background are discussed. 1997 Academic Press Limited.
Sciatic cryoneurolysis (SCN) is an experimental rat mononeuropathy model that produces neuropathic behavioral sequelae distinct from other neuropathy models. Following SCN, there is limited autotomy peaking in severity and incidence at 7-14 days and delayed but sustained allodynia appearing at about 21 days, with no evidence of thermal hyperalgesia. This study quantified peripheral nerve pathology at weekly intervals following SCN to determine the relationship of nerve degeneration and regeneration to the resulting abnormal behaviors. Fiber histograms based on axon diameter and grid morphometry were used to quantify the pathologic state of nerve fibers, activated phagocytic cells, vessels, and edema at the lesion site. Approximately 90% of the axons demonstrated Wallerian-like degeneration by 3 days post-SCN. At 14 days, small diameter axons significantly increased in number from earlier times following SCN (P < 0.05) but were not significantly different from normal values. At 21 days, the number of small diameter axons was significantly increased over both 14 days (P < 0.05) and normal values (P < 0.05). At 28 days, intermediate diameter axons significantly increased in number with respect to all earlier time periods (P < 0.05). These increases in regenerating fibers overlapped with the development of peak autotomy at 7-14 days and the onset of allodynia after 21 days. Autotomy scores at 7 days positively correlated with grid morphometry data of regenerating axons (rho = 0.7) and activated macrophages and Schwann cells (rho = 0.8) and inversely correlated with edema (rho = -0.8) using Spearman's rank correlation analysis.(ABSTRACT TRUNCATED AT 250 WORDS)
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We used probes from the juxta-centromeric region of the chromosome 17 short arm to map three microdeletions in patients with Smith-Magenis syndrome. The common clinical findings were: speech delay with behavioural problems associated with broad flat midface, brachycephaly, broad nasal bridge and brachydactyly. We demonstrated, using Southern blot analysis (loss of heterozygosity and gene dosage), that all patients were deleted for two p11.2 markers: pYNM 67-R5 (D17S29) and pA10-41 (D17S71). We determined that one breakpoint was located between D17S58 and D17S29 and the other breakpoint distal to D17S71. The possibility that an unstable region, located between the Smith-Magenis syndrome locus and CMT1A a closely located locus, could be involved in the rearrangements associated with these two inherited diseases is discussed.
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Long-term results of stereotaxic operations in 23 patients with severe erethitic (aggressive-destructive) imbecility were evaluated. Target areas in the thalamus, electrocoagulated in separate bilateral operations, were the dorsomedial nucleus and the internal medullary lamina. Definite tranquilization was achieved in 50% and acquiescence in 27% of patients, resulting in a positive effect on more than 75% of patients. The postoperative course showed a constant level of quiet behavior in only 25% of patients ("static course"), whereas 50% of patients showed an oscillating course leading to subsequent improvement and later stabilization ("undulant course"). The final outcome was improvement and later stabilization ("undulant course"). The final outcome was not improved in 25% of patients. Additional therapeutic measures involving adaptation of psychopharmacotherapy improvements in surroundings, and play and working therapy were occasionally effective (Fig 3). In the pneumoencephalograms of these patients a new distinctive variant was encountered that awaits confirmation: typically, a definite increase in thalamic height, a decrease in ventricular width, and a relative diminution of base line length was found. Stereotaxic thalamotomy in erethitic imbeciles is a therapeutic method with a 75% long-term effectiveness and should be considered a proven therapeutic alternative.
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Newborn mice were injected with monosodium glutamate (MSG), and behavioral testing and physical development in neonatal, juvenile, adult, and aged mice were observed by means of a battery of appropriate tests. Early exposure to MSG resulted in altered behavioral performances postnatally, which were transitory and reflected the neurotoxicity of the chemical. Although behavioral deficits were not observed in mice neonatally treated with MSG at 1 month of age, a definite decline was manifested at 12 months and 34 months of age.
A total of 71 patients (12 males and 59 females) who attended the University Skin Clinic of Basle in the years 1956-1982, have been investigated by a dermatologist, a psychiatrist and a psychologist. Among 55 female patients (group I and II) 14 had a suicide attempt in their history. Of the 39 female patients of group I 25 (64%) had suffered from a stressful childhood event. Of group I (39 female patients) 19 (48.7%) had had psychiatric therapy in the past or at the time of investigation; 23 patients (59%) had suffered from depressions either in the past or at the time of investigation. Among group II (16 patients) 11 (68.7%) had had psychiatric therapy in the past or at the time of investigation. The psychological test investigation (Colour Pyramid Test and Rosenzweig Picture-Frustration Test) revealed artefact patients to be in a state of considerable depressive-aggressive tension without being able to handle their emotions and impulses in an adequate manner.
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Bilateral section of dorsal roots was performed in 9 adult rats in order to ascertain whether the tendency to extension, the appearance of spontaneous electromyographic (EMG) activity in extensor muscles and other symptoms of postdenervation hypersensitivity after unilateral deafferentation are not due to the sensory inflow from the contralateral limb. EMG activity from the soleus (SOL) and tibialis anterior (TA) muscles was bilaterally recorded before and at various periods after deafferentation by a previously implanted electrode array. The postural activity in both SOL muscles disappeared after the operation. One to two days later, however, spontaneous tonic EMG activity, similar to that found in the SOL after unilateral deafferentation, appeared in these bilaterally deafferented muscles. The tonic spontaneous EMG activity in hind limb extensor muscles after deafferentation is apparently due to hypersensitivity of spinal neurones to supraspinal influences, since this activity completely disappears after myelotomy. The paradoxical inhibitory EMG response to stretch of the deafferented SOL frequently appeared 1-2 weeks after bilateral dorsal rhizotomy. The performance of movement was highly atactic after bilateral deafferentation. However, the basic locomotor EMG pattern persisted, although simultaneous activation of homonymous muscles was also occasionally recorded.