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Article
Sciatic nerve injury following gluteal intramuscular injection

Author: Mohammed M. Fathi Alsheikh محمد محمود فتحي الشيخ
Journal: Annals of the College of Medicine Mosul مجلة طب الموصل ISSN: 00271446 23096217 Year: 2011 Volume: 37 Issue: 1&2 Pages: 87-92
Publisher: Mosul University جامعة الموصل

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Abstract

Objective: To study the type of injected agents, clinical features and outcome of conservative treatment of patients with sciatic nerve injury following gluteal intramuscular injection.Methods: A prospective study of patients with sciatic nerve injury following gluteal intramuscular injection from private neurological clinic and neurophysiology unit in Ibn Sena Teaching Hospital in Mosul between January 2008 and July 2010.Results: The total number of the patients was 36. Male patients were 19 and females were 17. There were 28 patients under age of 5 years. Thirty four patients sustained their nerve injury by nurses, and antibiotics were the offending agents in 91.33% of patients. Foot drop is the commonest presenting clinical feature. Complete recovery was reported in 29.6% of the patients, partial recovery in 44.5% and no measurable clinical improvement in 25.5% of them.Conclusion: Children are at higher risk of injury. The injection should be prescribed only when mandatory and administered by a well qualified and competent personnel.Keywords: Intramuscular injection, sciatic nerve, sciatic nerve injury.

الهدف: دراسة أنواع الحقن والعلامات السريرية ونتائج العلاج التحفظي للمرضى الذين يعانون من إصابة العصب الإنسي نتيجة الحقن في عضلة الإلية.طرق الدراسة: دراسة مستقبلية شملت 36 مريضا (19 ذكور و17 إناث) للفترة بين كانون الثاني 2008 وتموز 2010.النتائج: أظهرت الدراسة إن 28 مريضا كانت أعمارهم أقل من خمس سنوات وان 34 مريضا كان تلقوا الحقن من قبل الممرضين وان المضادات الحيوية كانت العامل المسبب عند 91,33% من المرضى كما إن سقوط القدم هو أكثر العلامات السريرية التي راجع من أجلها المرضى وان الشفاء التام قد حصل عند 29,6% من المرضى والشفاء الجزيء عند 44,5% ولم يحصل أي درجة من الشفاء عند 25,5% منهم بعد العلاج التحفظي.الاستنتاجات: الأطفال هم الأكثر عرضة للإصابة. تنصح هذه الدراسة بعدم استخدام الحقن بالعضلة إلا في الحالات الضرورية ومن قبل الشخص الكفوء.


Article
Nerve conduction and electromyography in rheumatoid arthritis patients: a case - control study

Authors: Hakki M. Majdal حقي مجدل --- Shakir M. Sulaiman شاكر محمود سليمان --- Mohammed E. Sulaiman محمد عيسى سليمان
Journal: Annals of the College of Medicine Mosul مجلة طب الموصل ISSN: 00271446 23096217 Year: 2012 Volume: 38 Issue: 2 Pages: 44-51
Publisher: Mosul University جامعة الموصل

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Abstract

ABSTRACTObjectives: This study aims to assess peripheral nerve conduction and electromyographic function abnormalities in patients with rheumatoid arthritis.Subjects and methods: One hundred normal subjects and rheumatoid arthritis patients for each were included in this study, the normal subjects were matched regarding the age and sex with rheumatoid arthritis patients, rheumatoid arthritis patients were diagnosed according to American revised criteria (ARC) 1987; at the Department of Rheumatology in Ibn-Sina Teaching Hospital in Mosul city during the period of 15th of November 2009 - 15th of May 2010. Nerve conduction study for median, ulnar, radial (motor and sensory), posterior tibial and common peroneal nerves were done for all normal subjects and rheumatoid arthritis patients by using system 98-MyoQuik (micromed) EMG. Electromyography for tibialis anterior, gastrocnemius and quadriceps muscles were done for normal subjects and rheumatoid arthritis patients by using Dantec- Neuromatic 2000M-EMG. Results: In this study, peripheral neuropathy was detected in 54 patients (54%); mononeuritis simplex was the commonest lesion and detected in 36 patients (66.6%) out of the 54 patients. The entrapment neuropathy was found in 25 patients (46.74%), affecting the median (24.07%), posterior tibial (14.81%) and ulnar (7.40%) nerves. Mononeuritis multiplex was detected in 11 patients (20.37%), and symmetrical polyneuropathy found in 7 patients (12.90%). In the present study, the axonopathy (due to vasculitis mainly), and local demylination (due to entrapment mainly), were the common types of nerve injury seen in rheumatoid arthritis patients. Muscle involvement could be detected by electromyography in rheumatoid arthritis patients in this study.Conclusion: Neurogenic lesions were present, while no myogenic lesion was detected in patients with rheumatoid arthritis.

الهدف: دراسة توصيل الأعصاب وتخطيط العضلات عند المرضى المصابين بالروماتزم الرثوي.طريقة البحث: شملت الدراسة (100) شخص من الحالات الطبيعية و(100) مريض من المرضى المصابين بالروماتزم الرثوي. أجريت الدراسة في قسم المفاصل وقسم الجملة العصبية في مستشفى ابن سينا التعليمي في الموصل للفترة من 15 تشرين الثاني 2009 ولغاية 15 أيار 2010. تم إملاء الاستمارة الخاصة بالمعلومات للمرضى وأجري الفحص الطبي السريري والمختبري والشعاعي لجميع المرضى المصابين بالتهاب المفاصل الرثوي. تم إجراء فحص توصيل الأعصاب الكهربائي للعصب الوسطي والزندي والكعبري (الحسي والحركي) والشظوي والعصب الضنبوبي لدراسة الكمون العصبي القاص وسعة العصب الحسي والحركي (المدى) وسرعة توصيل العصب الحسي والحركي باستخدام جهاز: System 98-MyoQuick (micro med) EMG. تم إجراء فحص تخطيط العضلات الكهربائي للعضلة الرباعية الفخذية والعضلة الضنبوبية الأمامية وعضلة الساق لدراسة النشاط العضلي التلقائي والوحدات الحركية وخصائصها (مدى الوحدة الحركية، سعة الوحدة الحركية، وعدد الصفحات) والزيادة التدريجية في شدة انقباض العضلة باستخدام جهازDantec - Neuromatic 2000 EMG system.النتائج: لقد أظهرت هذه الدراسة أن عدد المصابين باعتلال الأعصاب المحيطية هو 54 مريض (54%) من بين المرضى المصابين بالروماتزم الرثوي. كما بلغ عدد المرضى المصابين باعتلال الأعصاب المحيطية الأحادي 36 مريض (66.6%) من مجموع المرضى المصابين باعتلال الأعصاب المحيطية. وبلغ عدد المرضى الذين يعانون من الضغط الموضعي على الأعصاب المحيطية 25 مريض (46.72%) وقد شملت العصب الوسطي (24.07%) والعصب الزندي (7.40%) والعصب الضنبوبي (14.81%). كما بلغ عدد المرضى المصابين باعتلال الأعصاب المحيطية المتعدد 11 مريضا (20.27%)، والمرضى المصابين باعتلال الأعصاب المحيطية البعيدة المتشابه 7 مرضى (12.90%). تبين من هذه الدراسة أن من أهم أسباب اعتلال الأعصاب المحيطية هو الضغط الموضعي على الأعصاب المحيطية والتهاب الأوعية الدموية التي تغذي الأعصاب المحيطية، واللذان يؤديان إلى تحلل الغشاء الخارجي المحيط بالألياف العصبية والى اعتلال مركز الألياف العصبية.الاستنتاجات: أظهرت هذه الدراسة وجود اعتلال الأعصاب المحيطية بشكل واسع وعدم وجود الاعتلال العضلي عند المرضى المصابين بالروماتزم الرثوي.


Article
Nerve conductive study in women with carpel tunnel syndrome in Tikrit city

Author: Umer T. Ismael
Journal: Tikret Journal of Pharmaceutical Sciences مجلة تكريت للعلوم الصيدلانية ISSN: 18172716 Year: 2012 Volume: 8 Issue: 2 Pages: 172-178
Publisher: Tikrit University جامعة تكريت

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Abstract

Carpal tunnel syndrome (CTS) is one of the most common upper limb compression neuropathies. CTS account for approximately 90% of all entrapment neuropathies. An estimated one million adults from the United States (annually) have CTS requiring medical treatment. The aim of the study is to investigate to compare the normal values of median nerve of normal healthy women (distal latency, amplitude & conduction velocity) with the same values of median nerve in women with carpel tunnel syndrome. The study was conducted as a case series study for Iraqi volunteers and patients attended to rheumatology department - neurophysiology unit at Tikrit teaching hospital (TTH) at the period from the 1st of December 2010 to the 1st of August 2011. Forty healthy female subjects with a mean age of (40.315 ± 10.324 years) to compare with the CTS female patients. Thirty eight female patients with mean age group of (40.55 ± 10.230 years) with CTS affect them in right hand diagnosed by rheumatologist and neurologist then referred to nerve conductive study (NCS) and EMG unit at TTH. The NCS was done by using NIHON KOHDEN / Neuropack S1 EMG / EP Measuring System MEB-9400 MODEL 2009. There are no significance differences between control subjects & CTS patients regarding age, body mass index. Also, there are no significance difference between normal control subjects & CTS patients in regard to upper limb length, arm circumference, index finger length (IFL), index finger circumference and wrist circumference. In regard to motor activity of median nerve, there is significance increase in distal latency time of median nerve of CTS patients (5.632 ± 1.791 msec) on compare to normal control subjects (3.540 ± 0.622 msec). Also, the amplitude of action potential of motor activity of median nerve is higher in control subjects (9.217 ± 0.509 mv) in compare to CTS patients motor activity of amplitude of (6.530 ± 1.937 mv). The difference between median nerve motor amplitude is significance at ( p<0.01) between patients and controls. Moreover the conduction velocity in CTS patients of median motor (58.354 ± 1.789 m/sec) is significance lower (p<0.01) in compare to motor conduction values of median nerve in normal control subjects (53.744 ± 4.232 m/sec). However, in regard to sensory activity of median nerve in right hand of both normal control subjects and CTS patients. The latency period in CTS patients is delayed (3.414 ± 1.606 msec) in compare to normal subjects (2.761 ± 0.344 msec). While, the amplitude of action potential of the sensory activity of median nerve is significantly lower (p< 0.01) in compare to normal subjects. Also, the conduction velocity of sensory activity of median nerve of CTS patients is significantly lower (38.357 ± 4.357 m/sec) on compare to conduction velocity of sensory activity of median nerve of normal subjects (48.236 ± 2.545 m/sec). The present study concludes that: The present study showed abnormal values NCS of median nerve at CTS patients as compare to normal healthy women of same age. The present study recommend that;- Using median nerve ultrasonography as diagnostic tools to confirm or exclude CTS & minimize false positive results.


Article
A study of 62 cases of sciatic nerve injury

Author: Ali K. AL-Shalchy علي كامل الشالجي
Journal: Journal of the Faculty of Medicine مجلة كلية الطب ISSN: 00419419 Year: 2009 Volume: 51 Issue: 1 Pages: 6-7
Publisher: Baghdad University جامعة بغداد

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Abstract

Objectives: a study of surgical procedures used in the management of sciatic n injury & acomparism between them including comparism with other universal studies.Patients and methods: 62 patients collected from the neuro-surgical unit in the specialized surgical hospital from Jan-2004 till October 2007, all patients studied thoroughly regarding age, Gender, type of injury, time of injury & outcome.Results: 85% of our patients were پ‰, 45% were in the age of 21-30 years, most injured by bullet or shells, the delay in surgery was mostly 1-3m, the repair is by direct suture 45%, 29% release of adhesions 16%, excision of neuroma & suturing, 9.6% by nerve graft, the direct suturing carried the best results, & grafting the worse type, comparism done with universal studies.Conclusion: Direct suturing of neural sheath (Epineurium) caries the best results if done at proper time.

Keywords

Sciatic nerve --- suturing --- grafting


Article
Modalities of Management of Radial Nerve Injury presented with Fracture in different Sites of Humerus

Author: Hamza N. Aboud
Journal: Mustansiriya Medical Journal مجلة المستنصرية الطبية ISSN: 20701128 22274081 Year: 2010 Volume: 9 Issue: 1 Pages: 63-66
Publisher: Al-Mustansyriah University الجامعة المستنصرية

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Abstract

Background This topic has been the subject of interest for many authors for many years, because still there is a recurrent theme …should the nerve be explored routinely along with internal fixation of fracture or should exploration be limited to those cases in which spontaneous recovery has not occurred within expected time ? or when justify? Objectives This study is designed is to shed a light on the dilemma of management radial nerve injury, in surgically treated patients versus conservatively treated others. Methods A series of 25 patients presented with any degree of radial nerve palsy complicating140 case of closed fracture shaft humerus , were treated by surgical & conservative method , according to certain indicators and evaluated during three years period, in two teaching hospital in Baghdad, from 2006 to 2008. Most of patients were males 19 case & the remaining patients were females 6 cases ,their age ranging from 3 days old baby to 45 years old & the mean age was 25 years .Ten (10) patients treated conservatively , Fifteen (15 ) patient treated surgically by either early exploration ( too early & late early ) or delayed exploration. Results The radial nerve was explore in seventeen patients from total number of study 25 patients. Eight treated by early exploration .. ( five by too early exp. within few days & three by late early exp. within next two weeks).Nine patients treated by delayed exploration after ( 3.5~ 4 ) months post traumatic period .In the last eight patients , the radial nerve was not explored & treated conservatively? The overall useful recovery rate from applying our policy was (84 % ). Conclusion Treatment of radial nerve palsy complicated closed fracture shaft humerus should be programmed well, depending on many factors , such as severity & onset of nerve lesion and type & site of associated fractures.

Keywords

Radial --- Nerve --- Fracture --- Management.


Article
17- EVALUATION OF PERIPHERAL NERVE INJURIES AROUND ELBOW IN ASSOCIATION WITH FRACTURES

Authors: Ali Hamzaa --- Alaa A Dawood
Journal: Basrah Journal of Surgery مجلة البصرة الجراحية ISSN: 16833589 / ONLINE 2409501X Year: 2011 Volume: 17 Issue: 1 Pages: 119
Publisher: Basrah University جامعة البصرة

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Abstract

Alaa A Dawood# & Ali Hamzaa*#MB,ChB, FICMS, Orthopaedic Surgeon, Lecturer, Dept. Of Surgery, College of Medicine, University ofBasrah. *MB,ChB, Orthopaedic Surgeon, Basrah General Hospital, Basrah, IRAQ.AbstractIn this prospective study, 147 cases of trauma around elbow were examined and evaluated. Allwere unilateral. Only 22 were associated with peripheral nerve injuries (14.9%). Males were 19(86%) and females were 3 (14%). Their ages were between 5 and 54 years (mean 24 years).The radial nerve was found to be most vulnerable to injury (40.9%) followed by ulnar nerve(31.8%) and lastly the median nerve (9.1%).The injurious agents in 2 patients were bullet and missile while in 20 were civilian causes.In thirteen cases (59.1%) there were primary nerve palsy and in 9 (40.9%) there weresecondary nerve palsies.The degree of nerve injury in 13 patients were neuropraxia (59.1%) with complete recovery, in6 were neurotmesis (27.3%) and in 3 were axonotmesis (13.6%).The full recovery of the nerve was in 13 patients (59.1%), 12 of them by spontaneous recovery(54.5%) and one of them by surgical exploration and neurolysis (4.5%).Timing of nerve recoverywere variable, range from 1.5 to 8 months. There was no recovery in 9 patients (40.9%).We concluded that when closed fractures are complicated by primary nerve deficits, waiting forspontaneous re-innervation seems reasonable up to eight months and early surgical explorationis better to be avoided, conversely if closed fracture complicated by secondary nerve palsy earlyexploration of nerve is favored except in Tourniquet palsies.

Keywords

PERIPHERAL NERVE --- ELBOW --- FRACTURES


Article
THE FACTORS THAT INFLUENCE ON NERVE CONDUCTION IN DIABETIC PATIENTS

Authors: Abdul Al-Razzaq N Khudair --- Thamer A Hamdan --- Oras Kadhim Baqer,
Journal: Basrah Journal of Surgery مجلة البصرة الجراحية ISSN: 16833589 / ONLINE 2409501X Year: 2015 Volume: 21 Issue: 2 Pages: 7-13
Publisher: Basrah University جامعة البصرة

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Abstract

Abstract The alteration in nerve conduction is considered one of the important complaints of patients who are suffering from diabetes mellitus nowadays. Therefore, we conduct this study which aimed to evaluate the nerve conduction velocity and amplitude in diabetic patients and assess the effects of the patients’ age, severity and duration of diabetes on nerve conduction impairment. A case control study, the studied sample were 200 persons, 150 diabetic patients (93 males and 57 females) and the control group consisted of 50 participants (32 males and 38 females). All the patients attended the neurophysiology outpatient department of Al-Sader Teaching Hospital in Basrah city. The diabetic participants were selected at random from age, diabetes duration, and sex. Regarding the ages and exclusion criteria of the controls were ranged same as the diabetic. All participants were interviewed and a questionnaire form was filled prior to examination. Both the diabetic patients and the controls were subjected to the same electrophysiological and laboratory investigations. The results of the study showed a significant decrease in nerve conduction velocity and amplitude in diabetic patients comparing to controls in all the examined nerves. Furthermore, there was a significant association between advancing age and longer-duration of diabetes with the reduction of conduction velocity and amplitude. Also, a significant inverse correlation between increased severity of diabetes disease (HbA1c level) and decreasing of both conduction velocity and amplitude. However, the study demonstrated no statistical significant difference between patients and controls regarding the gender. In conclusion, the age of the patients, duration of the disease and the severity of diabetes (hyperglycemia control) are playing a crucial role as risk factors in developing of peripheral neuropathy in diabetic patients.


Article
Non – Exploration of the Recurrent Laryngeal Nerve in Thyroid Surgery

Author: Hussain AlwanAl-Obaidy
Journal: Diyala Journal of Medicine مجلة ديالى الطبية ISSN: 97642219 Year: 2014 Volume: 6 Issue: 1 Pages: 77-80
Publisher: Diyala University جامعة ديالى

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Abstract

Background: Goiter is a common disease in Iraq and it is more common in the North .The disease is more common in females than in males.For this reason thyroid surgery is a common procedure.Many complications occur during and after surgery such as; bleeding, hypothyroidism, and recurrent laryngeal nerve injury.The later complication, although infrequently encountered can cause a lot of suffering to the patient.Objective: The objective of our study is assessing injury to the recurrent laryngeal nerve without exploration of the nerve routinely during thyroid surgery. exploration of the nerve done for selected cases where there is increase risk to injury.Patients and method: Prospective study of 400 patients whom underwent different thyroid surgery for different thyroid diseases done by one surgeon from July 1992 to July 2012 in Baquba teaching hospital were analyzed for permanent injury to RLN , when non-exploration of the RLN is the rule.Result: from the 400 cases included in the study only 4 cases (1%) had permanent injury to the RLN, 6 cases (1.5%) had transient injury and no injury in 390 cases (97.5%).Conclusion: Exploration of the RLN is not necessarily to be done routinely during thyroid surgery. We recommend exploration of the nerve in selected thyroid diseases.


Article
Facial Nerve Palsy as Frequent Presentation in Patient with Rhinocerebral Mucormycosis

Author: Suha N. Aloosi
Journal: Journal of Oral and Dental Research مجلة طب الفم والاسنان ISSN: 23106417 Year: 2018 Volume: 5 Issue: 1 Pages: 55-69
Publisher: Iraqi Association for Oral Research الجمعية العراقية لبحوث طب الفم

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Abstract

Background Early recognition of rhinocerebral mucormycosis is critical for initiation of treatment. The clinical presentation of the disease shares the same clinical picture with many other diseases, which might lead to misdiagnosis. Features of neural involvement, such as facial nerve palsy, headache and mental state alteration, are important in presentation of mucormycosis; however, they are commonly overlooked.Objectives This study was done to highlight facial nerve palsy as an early feature of Rhinocerebral mucormycosis, which may improve the quality of the clinical recognition and encourage further related investigation and managements steps.Materials and Methods Thirteen patients with variable signs and symptoms of Rhinocerebral Mucormycosis were diagnosed and treated in The Maxillofacial Unit in Sulaimani Teaching Hospital, Kurdistan / Iraq. Their clinical and laboratory data were retrospectively analyzed. Results Neurological features of facial nerve palsy were reported in a signifcant percent of the included patients (61.5%) p=0.001. It was signifcantly associated with misdiagnosis as Cerebro-Vascular Accident (CVA) (P=0.047) and with bad prognosis of the disease (p=0.042). Conclusion Facial nerve weakness is a signifcant sign in presentation of mucormycosis. A signifcant proportion of such patients could be misdiagnosed as CVA patients, with subsequent delay in treatment. Increasing the suspicion index for mucormycosis in diabetic patients presenting withfacial palsy helps in reaching an accurate and early diagnosis.


Article
Preventing nerve damage during total thyroidectomy or total lobectomy surgeries
منع تلف الأعصاب أثناء استئصال الدرقية الكلي أو جراحات استئصال الفص الكلي

Authors: Masrur Sleman Aziz --- Karzan Mohammed Salih --- Mohammed I. Gubari --- Diary A. smael --- et al.
Journal: Zanco Journal of Medical Sciences مجلة زانكو للعلوم الطبية ISSN: 19955588/19955596 Year: 2016 Volume: 20 Issue: 2 Pages: 1390-1395
Publisher: Hawler Medical Univeristy جامعة هولير الطبية

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Abstract

Background and objective: Thyroidectomy is an operation that involves surgical removal of all or part of the thyroid gland. The main postoperative complications of thyroidectomy are hypoparathyroidism and recurrent laryngeal nerve injury. This study aimed to find out the main postoperative complications particularly nerve damage during total thyroidectomy or total lobectomy.Methods: The medical records of patients who were diagnosed with thyroid disease and underwent surgery between January 2nd, 2013 and December 30th, 2014 in Teaching, Shar, Soma and Zhian hospitals in Sulaimaniyah were retrospectively reviewed. Results: All patients who underwent total thyroidectomy or total lobectomy surgeries were discharged within 24 hours of the operation. During the average follow-up of 24 months, no case of permanent recurrent laryngeal nerve injury was registered. Vocal cord paralysis was considered to be present, when there was absent or markedly reduced movement of the affected vocal cord. Conclusions: Meticulous hemostasis and a delicate technique are required to prevent nerve injury. We recommend dissection and division of all the vessels flush with the thyroid capsule at the anterior and peripheral aspect of the gland. Separate ligation of anterior and posterior branched of the superior thyroid artery will preserve the external branch of the superior laryngeal nerves.

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