M. Naito

Blood flow of peripheral nerve effects of dissection stretching and compression

Blood flow rate of the peripheral nerve was measured using the hydrogen washout technique and the effects of dissection, stretching and compression were studied on blood flow of the rabbit sciatic nerve. Regional surgical dissections revealed that a proximal portion of the sciatic nerve receives its blood supply from gluteal vessels whereas a distal portion receives from popliteal vessels. Blood flow direction in the proximal half of the sciatic nerve in the thigh was found to be distal whereas in the distal half to be proximal. The longitudinal pathway appeared to be capable of compensating for local diminution of blood flow. The average stretching of more than 15.7% caused complete arrest of blood flow in the stretched nerve. The average stretching force at this point was 74 grams. Complete standstill of intraneural circulation was observed under compression of 50 to 70 mm Hg, or 60 to 80% of mean arterial pressure. These values of critical stretching and compression on the intraneural blood flow corresponds well with those previously reported by Lundborg, 1973; Rydevik, 1981).

Destructive spondylo-arthropathy during long-term haemodialysis

We reviewed 29 patients who had developed destructive arthropathy of the spine during long-term haemodialysis. Their mean age when haemodialysis began was 43.8 years; at diagnosis they had been dialysed for an average of 8.6 years. In 26 patients, the lesions were between C4 and C7; in six they were between L4 and S1, three having lesions in both regions. Sixteen patients had had previous surgery for carpal tunnel syndrome. Spinal surgery was performed in nine patients with satisfactory results in only five. We demonstrated beta-2 microglobulin amyloid deposits in the discs and surrounding ligaments in all biopsied cases. The natural history and management of this condition are not yet clear.

Blood flow direction in the lumbar nerve root.

The effect of clipping on lumbar nerve root blood flow rates in the region of the nerve root canal was studied experimentally in the hog. Blood flow rate was measured using the hydrogen washout technique. When the entrance zone was clipped with a microvascular clip, blood flow rate of the nerve root was decreased by 37% in comparison with the initial control rate; clipping at the exit zone reduced blood flow rate by 69%. Blood flow direction in the lumbar nerve root within the nerve root canal was found to be predominantly proximal. The current data indicate that the more lateral the impingement of the nerve root occurs, the more ischemic changes are induced.

Effect of surgery for dialysis carpal tunnel syndrome

長期透析患者の合併症として手根管症侯群が注目を集めている. 最近20ヵ月間に本症で済生会八幡病院を受診した患者は男20女22計42名で平均年齢54.6歳 (35-77歳), 原疾患は原発性腎症40, 糖尿病性腎症1, 多発性のう胞腎1であった. 両側発症が42名中22名と多く, また17例40%には弾発指の合併がみられた. 本症は内シャント作成手の発症が多く, 内シャント作成から発症までの期間は2-138月平均83.4±37.0月であったが, 両側発症22名中7名では内シャント作成のない手の発症であった. 透析導入から発症までの期間は3-180月平均113.8±36.6月で, 5年未満での発症は3例のみで本症は明らかに長期透析患者の合併症である. 診断は臨床症状に正中神経のdistal motor latencyの遅延を参考にするが, 全例手術所見で確認できた. 42名59手の正中神経除圧術はクーレンカンプ伝達麻酔でtourniquetを使用し無血下に手掌面を広くS字状に切開し, 横手根靱帯の切離, 神経剥離術を行った. 術後6-20月目に経過を観察できた31例43手の術前術後を比較すると手の疼痛夜間痛は100%, 正中神経領域のしびれは86%, 母指球筋の萎縮は77%の手に改善され, 正中神経のdistal motor latencyはabsentが9例から2例に減, 残り34手の平均値は8.71±3.33msecから3.25±0.97msecに改善され, 示指末節手掌面での2点識別覚も識別不能が3例から2例に減, 平均値は15.3±14.4mmから3.6±1.7mmに著明に改善された. 血腫, 感染, 神経損傷, 運動障害, シャントトラブル等の合併症は皆無で手術成績は十分満足できるものであった. 回復の不完全な症例では発症から手術までの期間が長い傾向にあり, 早期の正中神経除圧術が推奨される.

Tuberculous Tenosynovitis of the Hand Report of Two Cases and Review of the Literature

The tuberculous tenosynovitis of the hand is an uncommon condition.Early diagnosis is important because this condition has a slow and progressively destructive process.In this report we describe two cases and review the available literature.