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Bilateral phrenic nerve injury

Oren Lev-Ran, Dan Abrahamov, Nina Baram, Menachem Matsa, Yaron Ishai, Ohad Gabai, Yael Refaely, Mahmud Abu Salah, Gideon Sahar
Background Procurement of the internal thoracic artery risks ipsilateral phrenic nerve injury and elevated hemidiaphragm. Anatomical variations increase the risk on the right side. Patients receiving left-sided in-situ right internal thoracic artery configurations appear to be at greatest risk. Methods From 2014 to 2016, 432 patients undergoing left-sided in-situ bilateral internal thoracic artery grafting were grouped according to right internal thoracic artery configuration: retroaortic via transverse sinus (77%) or ante-aortic (23%); targets were the circumflex and left anterior descending artery territories, respectively...
February 2018: Asian Cardiovascular & Thoracic Annals
Virginia Fancello, S A Reza Nouraei, Kate J Heathcote
PURPOSE OF REVIEW: To present the current state of knowledge concerning different laryngeal reinnervation procedures for unilateral and bilateral vocal palsy. RECENT FINDINGS: Recent reports show positive outcomes on both unilateral and bilateral reinnervations. The phrenic nerve is the most commonly used donor for bilateral vocal palsy, but use of the superior laryngeal nerve has also been suggested. SUMMARY: Reinnervation of the larynx is a complex undertaking that can be performed by ENT surgeons with skills in microsurgery...
December 2017: Current Opinion in Otolaryngology & Head and Neck Surgery
Andrew C Vivas, Steven W Hwang, Joshua M Pahys
Phrenic stimulators offer an alternative to standard mechanical ventilation as well as the potential for ventilator independence in select patients with chronic respiratory failure. Young patients (< 10 years old) with high cervical spinal cord injuries often develop paralytic scoliosis due to loss of muscle tone caudal to their spinal cord lesion. Growing rod systems allow for stabilization of spinal deformity while permitting continued growth of the spine and thoracic cavity. Magnetically controlled growing rods (MCGRs) offer the advantage of noninvasive expansion, as opposed to the operative expansion required in traditional growing rod systems...
October 2017: Neurosurgical Focus
Jeroen J J van Eijk, Harry R Dalton, Paolo Ripellino, Richard G Madden, Catherine Jones, Miriam Fritz, Claudio Gobbi, Giorgia Melli, Emanuela Pasi, Jenny Herrod, Rebecca F Lissmann, Hamad H Ashraf, Mohamed Abdelrahim, Omar A B A L Masri, Montserrat Fraga, David Benninger, Thierry Kuntzer, Vincent Aubert, Roland Sahli, Darius Moradpour, Hélène Blasco-Perrin, Shahram Attarian, Rene Gérolami, Philippe Colson, Maria T Giordani, Johannes Hartl, Sven Pischke, Nan X Lin, Brendan N Mclean, Richard P Bendall, Marcus Panning, Jean-Marie Peron, Nassim Kamar, Jacques Izopet, Bart C Jacobs, Nens van Alfen, Baziel G M van Engelen
OBJECTIVE: To determine the clinical phenotype and outcome in hepatitis E virus-associated neuralgic amyotrophy (HEV-NA). METHODS: Cases of NA were identified in 11 centers from 7 European countries, with retrospective analysis of demographics, clinical/laboratory findings, and treatment and outcome. Cases of HEV-NA were compared with NA cases without evidence of HEV infection. RESULTS: Fifty-seven cases of HEV-NA and 61 NA cases without HEV were studied...
August 29, 2017: Neurology
Elisa J Gonzalez-Rothi, Kristi A Streeter, Marie H Hanna, Anna C Stamas, Paul J Reier, David M Baekey, David D Fuller
C2 spinal hemilesion (C2Hx) paralyzes the ipsilateral diaphragm, but recovery is possible through activation of "crossed spinal" synaptic inputs to ipsilateral phrenic motoneurons. We tested the hypothesis that high-frequency epidural stimulation (HF-ES) would potentiate ipsilateral phrenic output after subacute and chronic C2Hx. HF-ES (300 Hz) was applied to the ventrolateral C4 or T2 spinal cord ipsilateral to C2Hx in anesthetized and mechanically ventilated adult rats. Stimulus duration was 60 s, and currents ranged from 100 to 1,000 µA...
October 1, 2017: Journal of Neurophysiology
Kun-Ze Lee, Shih-Hui Hsu
Unilateral high cervical spinal hemisection (i.e., C2Hx) interrupts the respiratory bulbospinal pathway and results in paralysis of the hemidiaphragm. The ipsilateral diaphragmatic activity can partially recover over weeks to months; however, its contribution to the tidal volume generation is less than 20%. Accordingly, we hypothesized that the contralateral diaphragm exerts a compensatory function to maintain the essential ventilation following C2Hx. The cardiorespiratory pattern and bilateral diaphragm electromyogram (EMG) signals were measured in urethane-anesthetized and spontaneously breathing adult rats at 1 day, and 2 or 8 weeks post-C2Hx or C2 laminectomy...
September 15, 2017: Journal of Neurotrauma
Mathieu Raillard, Pamela J Murison, Ivan P Doran
The anesthetic management of a pediatric pug for removal of a mediastinal mass is described. During recovery from anesthesia, the dog's respiratory pattern was compatible with bilateral diaphragmatic paralysis. Incidence, complications, possible treatments of phrenic nerve injury, problems of long-term mechanical ventilation, and alternative case management are discussed.
March 2017: Canadian Veterinary Journal. la Revue Vétérinaire Canadienne
Henning Gaissert, Susan R Wilcox
The perioperative management of diaphragmatic weakness and phrenic nerve dysfunction is complex, due to varied etiologies and clinical presentations. The factors leading to diaphragmatic weakness may culminate after the operation with transient or persistent respiratory failure. This review discusses diaphragmatic disorders and postoperative respiratory failure caused by unilateral or bilateral diaphragmatic impairment. The origins of neuromuscular weakness involving the diaphragm are diverse, and often lie within the domains of different medical specialties, with only a portion of the condition related to surgical intervention...
December 2016: Thoracic and Cardiovascular Surgeon
Rachel A McBain, Janet L Taylor, Robert B Gorman, Simon C Gandevia, Jane E Butler
What is the central question of this study? The aim was to determine whether specific reflex connections operate between intercostal afferents and the scalene muscles in humans, and whether these connections operate after a clinically complete cervical spinal cord injury. What is the main finding and its importance? This is the first description of a short-latency inhibitory reflex connection between intercostal afferents from intercostal spaces to the scalene muscles in able-bodied participants. We suggest that this reflex is mediated by large-diameter afferents...
October 1, 2016: Experimental Physiology
Kaoru Okishige, Hideshi Aoyagi, Naohiko Kawaguchi, Nobutaka Katoh, Mitsumi Yamashita, Tomofumi Nakamura, Manabu Kurabayashi, Hidetoshi Suzuki, Mitsutoshi Asano, Kentarou Gotoh, Tsukasa Shimura, Yasuteru Yamauchi, Toshirou Kanazawa, Tetsuo Sasano, Kenzo Hirao
BACKGROUND: Diaphragmatic electrogram recording during cryoballoon ablation (CB-A) of atrial fibrillation is commonly used to predict phrenic nerve palsy (PNP). OBJECTIVE: The purpose of this study was to investigate a novel method for predicting PNP at an earlier stage to prevent sustained PNP. METHODS: A total of 197 patients undergoing CB-A were enrolled. We attempted to detect PNP using fluoroscopic images of diaphragmatic contractions and by monitoring diaphragmatic compound motor action potentials (CMAPs) provoked by superior vena cava (SVC) and left subclavian vein (LCV) pacing during CB-A for bilateral pulmonary veins (PVs)...
September 2016: Heart Rhythm: the Official Journal of the Heart Rhythm Society
Miao Zhang, Heng Wang, Xuefeng Pan, Wenbin Wu, Hui Zhang
The aim of the present study was to examine the feasibility and efficacy of thoracoscopic radical resection of large retrosternal thymoma using artificial pneumothorax. A retrospective analysis was performed on 19 patients with bulky thymoma who underwent thoracoscopic resection using artificial pneumothorax by CO2 insufflation. The operations were performed with unilateral or bilateral thoracic incisions via single lumen endotracheal intubation and two-lung ventilation. This approach provided excellent exposure of the thoracic cavity and reliable control of the neuro-vascular structures in the anterior mediastinum, which was of vital importance for the extended resection of malignant thymoma...
May 2016: Oncology Letters
Kun-Ze Lee
KEY POINTS: Activation of bronchopulmonary C-fibres, the main chemosensitive afferents in the lung, can induce pulmonary chemoreflexes to modulate respiratory activity. Following chronic cervical spinal cord injury, bronchopulmonary C-fibre activation-induced inhibition of phrenic activity was exaggerated. Supersensitivity of phrenic motor outputs to the inhibitory effect of bronchopulmonary C-fibre activation is due to a shift of phrenic motoneuron types and slow recovery of phrenic motoneuron discharge in cervical spinal cord-injured animals...
October 15, 2016: Journal of Physiology
Nicole L Nichols, Gordon S Mitchell
Integrated electrical activity in the phrenic nerve is commonly used to assess within-animal changes in phrenic motor output. Because of concerns regarding the consistency of nerve recordings, activity is most often expressed as a percent change from baseline values. However, absolute values of nerve activity are necessary to assess the impact of neural injury or disease on phrenic motor output. To date, no systematic evaluations of the repeatability/reliability have been made among animals when phrenic recordings are performed by an experienced investigator using standardized methods...
June 2016: Respiratory Physiology & Neurobiology
Shane V Abdunnur, Daniel H Kim
Phrenic nerve stimulation is a technique used to reanimate the diaphragm of patients with central nervous system etiologies of respiratory insufficiency. Current clinical indications include congenital central hypoventilation syndrome, spinal cord injury above C4, brain stem injury, and idiopathic severe sleep apnea. Presurgical evaluation ensures proper patient selection by validating the intact circuit from the phrenic nerve through alveolar oxygenation. The procedure involves placing leads around the phrenic nerves bilaterally and attaching these leads to radio receivers in a subcutaneous pocket...
2015: Progress in Neurological Surgery
Pradeep Bhaskar, Reyaz A Lone, Ahmad Sallehuddin, Jiju John, Akhlaque N Bhat, Muhammed R K Rahmath
Diaphragmatic paralysis following phrenic nerve injury is a major complication following congenital cardiac surgery. In contrast to unilateral paralysis, patients with bilateral diaphragmatic paralysis present a higher risk group, require different management methods, and have poorer prognosis. We retrospectively analysed seven patients who had bilateral diaphragmatic paralysis following congenital heart surgery during the period from July, 2006 to July, 2014. Considerations were given to the time to diagnosis of diaphragm paralysis, total ventilator days, interval after plication, and lengths of ICU and hospital stays...
June 2016: Cardiology in the Young
Shinsuke Miyazaki, Hitoshi Hachiya, Hiroshi Taniguchi, Hiroaki Nakamura, Noboru Ichihara, Eisuke Usui, Akio Kuroi, Takamitsu Takagi, Jin Iwasawa, Kenzo Hirao, Yoshito Iesaka
BACKGROUND: Left phrenic nerve injury (PNI) can occur during cryoballoon ablation of the left pulmonary veins (PVs). This study aimed to evaluate the feasibility of monitoring the bilateral phrenic nerve function during cryoballoon ablation of atrial fibrillation (AF). METHODS: Fifty consecutive paroxysmal AF patients undergoing cryoballoon ablation using one 28-mm second-generation balloon were prospectively enrolled. Bilateral diaphragmatic compound motor action potentials (CMAPs) were obtained from modified surface electrodes by pacing from the bilateral subclavian veins, and monitored during 3-minute cryoballoon applications at the ipsilateral PVs...
June 2015: Journal of Cardiovascular Electrophysiology
Toshihiro Kitajima, Kota Momose, Seigi Lee, Shusuke Haruta, Masaki Ueno, Hisashi Shinohara, Sakashi Fujimori, Takeshi Fujii, Ryoji Takei, Tadasu Kohno, Harushi Udagawa
We herein report a case of bronchial bleeding after radical esophagectomy that was treated with lobectomy. A 65-year-old male who underwent subtotal esophagectomy with three-field lymph node dissection for esophageal carcinoma was referred to our hospital because of sudden hemoptysis. After the esophagectomy, bilateral vocal cord paralysis was observed, and the patient suffered from repeated episodes of aspiration pneumonia. Bronchoscopy revealed hemosputum in the right middle lobe bronchus, and contrast-enhanced computed tomography showed tortuous arteries arising from the right inferior phrenic artery and left subclavian artery toward the right middle lobe bronchus...
March 21, 2015: World Journal of Gastroenterology: WJG
Seby John, Jinny Tavee
Neck pain from cervical spinal disease is a common problem with significant disability, and chiropractic manipulation has emerged as one of the leading forms of alternative treatment for such spinal symptoms. However, more experience with these forms of treatment has revealed associated complications that are far from benign. Complications range from mild symptoms, such as local neck tenderness or stiffness, to more severe injuries involving the spinal cord, peripheral nerve roots, and arteries within the neck...
February 2015: Neurologist
G Setty, R Saleem, P Harijan, A Khan, N Hussain
Nerve injuries after thoracic and cardiovascular surgery have been reported but generally concern the brachial plexus, phrenic nerve, recurrent laryngeal, and facial nerve. Common peroneal nerve injury (CPNI) following cardiopulmonary bypass has been reported in adults (4); however bilateral injury is extremely uncommon. Age, low body weight, co-morbidities such as peripheral arteriosclerotic disease, diabetes mellitus, and arrhythmias were associated with CPNI following cardiothoracic surgery in adults. Common peroneal nerve injury (CPNI) following cardiopulmonary by-pass has been reported in adults; however, bilateral injury is extremely uncommon...
September 2014: Journal of Pediatric Neurosciences
Yaoki Nakao, Hiroshi Terai
OBJECTIVE: The purpose of this case report is to describe a patient with brain infarction due to recanalization of an occluded vertebral artery (VA) following closed reduction and open fixation of cervical spinal dislocation and to discuss the management of asymptomatic VA injuries associated with spine trauma. CLINICAL FEATURES: A 41-year-old Asian man experienced a C4-5 distractive-flexion injury manifesting with quadriplegia and anesthesia below the C3 cord level (including phrenic nerve paralysis), and bowel and bladder dysfunction...
December 2014: Journal of Chiropractic Medicine
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