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  • 1. Abul-Kasim, Kasim
    et al.
    Backman, Clas
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Handkirurgi.
    Björkman, Anders
    Dahlin, Lars B
    Advanced radiological work-up as an adjunct to decision in early reconstructive surgery in brachial plexus injuries2010Ingår i: Journal of Brachial Plexus and Peripheral Nerve Injury, E-ISSN 1749-7221, Vol. 5, s. 14-Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background

    As neurophysiologic tests may not reveal the extent of brachial plexus injury at the early stage, the role of early radiological work-up has become increasingly important. The aim of the study was to evaluate the concordance between the radiological and clinical findings with the intraoperative findings in adult patients with brachial plexus injuries.

    Methods

    Seven consecutive male patients (median age 33; range 15-61) with brachial plexus injuries, caused by motor cycle accidents in 5/7 patients, who underwent extensive radiological work-up with magnetic resonance imaging (MRI), computed tomography myelography (CT-M) or both were included in this retrospective study. A total of 34 spinal nerve roots were evaluated by neuroradiologists at two different occasions. The degree of agreement between the radiological findings of every individual nerve root and the intraoperative findings was estimated by calculation of kappa coefficient (К-value). Using the operative findings as a gold standard, the accuracy, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of the clinical findings and the radiological findings were estimated.

    Results

    The diagnostic accuracy of radiological findings was 88% compared with 65% for the clinical findings. The concordance between the radiological findings and the intraoperative findings was substantial (К = 0.76) compared with only fair (К = 0.34) for the clinical findings. There were two false positive and two false negative radiological findings (sensitivity and PPV of 0.90; specificity and NPV of 0.87).

    Conclusions

    The advanced optimized radiological work-up used showed high reliability and substantial agreement with the intraoperative findings in adult patients with brachial plexus injury.

  • 2.
    Backman, Clas
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Klinisk fysiologi. Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Handkirurgi.
    Cold finger1993Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [en]

    Post Traumatic Cold Intolerance is the most common, and often the most prominent disabilityfrom hand trauma. The discomfort caused by cold is believed to be linked to a dysfunction o f thedigital vasoregulation, but its pathophysiology is poorly understood. Cold induced vasospasm, i.e.the pathologically increased reactivity o f the digital vessels to cold, is commonly found in handsthat have sustained trauma, especially with damage to vascular and neural structures.

    This thesis is based upon a series o f clinical and laboratory studies on cold induced vasospasm andcold intolerance in 35 patients treated for digital amputation. The replanted digit was used as astudy model, since it represents a body part which at the moment o f reconstruction is devoid o f allinnervation. Replantations were performed according to two different principles o f vascularreconstruction; using long or short vessel grafts. Finger Systolic Pressure (FSP) was used as aparameter o f digital vasoregulation at different temperatures, and cold intolerance was assessedusing a logarithmic rating scale (Borg). Non-injured fingers and amputation stumps were used ascontrols. Clinical and laboratory investigations were performed at different intervals from oneweek to three years after the reconstruction.

    During the first two weeks following replantation, whole body cold exposure, or cooling o f thereplanted part to 10°C, did not cause serious spasm in the replanted vessels. Follow upinvestigations demonstrated that a cold related vasospastic tendency is established inapproximately 60% o f the replanted parts within one year after trauma. The once establishedpathologic vasoregulation, is unlikely to normalize spontaneously. Whether a cold related arterialspasticity will develop in the replanted digit or not, is not related to the surgeon's choice o ftechnique for vascular reconstruction. Cold related arterial spasticity was more common inamputation stumps than in replanted digits, Our findings suggest that there is a pathologicalreaction to cold in the distal palm vessels but the nature o f this disturbance is not clear.

    All patients developed some degree o f Post Traumatic Cold Intolerance. Approximately 60% o fthe patients stated that some improvement took place, but none o f the patients was free o f coldintolerance 1-7 years after the injury. Patients with a pathological cold induced vasospasm is likelyto present with severe cold intolerance, which indicates that the vasospasm is involved as one o fthe causes o f Post Traumatic Cold Intolerance.

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  • 3. Dahlin, Lars B.
    et al.
    Andersson, Gert
    Backman, Clas
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Handkirurgi. Department of Hand Surgery, University Hospital of Northern Sweden, Umeå University, Umeå, Sweden.
    Svensson, Hampus
    Bjorkman, Anders
    Rehabilitation, Using Guided Cerebral plasticity, of a Brachial plexus Injury treated with Intercostal and phrenic Nerve transfers2017Ingår i: Frontiers in Neurology, E-ISSN 1664-2295, Vol. 8, artikel-id 72Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Recovery after surgical reconstruction of a brachial plexus injury using nerve grafting and nerve transfer procedures is a function of peripheral nerve regeneration and cerebral reorganization. A 15-year-old boy, with traumatic avulsion of nerve roots C5-C7 and a non-rupture of C8-T1, was operated 3 weeks after the injury with nerve transfers: ( a) terminal part of the accessory nerve to the suprascapular nerve, (b) the second and third intercostal nerves to the axillary nerve, and (c) the fourth to sixth intercostal nerves to the musculocutaneous nerve. A second operation-free contralateral gracilis muscle transfer directly innervated by the phrenic nerve-was done after 2 years due to insufficient recovery of the biceps muscle function. One year later, electromyography showed activation of the biceps muscle essentially with coughing through the intercostal nerves, and of the transferred gracilis muscle by deep breathing through the phrenic nerve. Voluntary flexion of the elbow elicited clear activity in the biceps/gracilis muscles with decreasing activity in intercostal muscles distal to the transferred intercostal nerves (i.e., corresponding to eighth intercostal), indicating cerebral plasticity, where neural control of elbow flexion is gradually separated from control of breathing. To restore voluntary elbow function after nerve transfers, the rehabilitation of patients operated with intercostal nerve transfers should concentrate on transferring coughing function, while patients with phrenic nerve transfers should focus on transferring deep breathing function.

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  • 4. Dahlin, Lars B.
    et al.
    Coster, Marcus
    Björkman, Anders
    Backman, Clas
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap.
    Axillary nerve injury in young adults-An overlooked diagnosis?: early results of nerve reconstruction and nerve transfers2012Ingår i: Journal of Plastic Surgery and Hand Surgery, ISSN 2000-656X, E-ISSN 2000-6764, Vol. 46, nr 3-4, s. 257-261Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    An injury to the axillary nerve from a shoulder trauma can easily be overlooked. Spontaneous functional recovery may occur, but occasionally reconstructive surgery is required. The time frame for nerve reconstruction procedures is from a neurobiological view crucial for a good functional outcome. This study presents a group of operatively and non-operatively treated young adults with axillary nerve injuries caused by motorcycle accidents, where the diagnosis was set late. Ten young men (median age at trauma 13 years, range 9-24) with an axillary nerve injury were diagnosed by examination of shoulder function and electromyography (EMG). The patients had either a nerve reconstruction procedure or were treated conservatively and their recovery was monitored. The axillary nerve was explored and reconstructed at a median of 8 months (range 1-22 months) after trauma in 8/10 patients. Two patients were treated non-operatively. In 4/8 cases, a reconstruction with sural nerve graft was performed and in 1/8 case only exploration of the nerve was made (minor neuroma). In 3/8 cases a radial nerve branch transfer to the axillary nerve was chosen as the procedure. The shoulder was mobilised after 3 weeks with physiotherapy and the patients were monitored regularly. Functional recovery was observed in 9/10 cases (median follow up 11 months, range 7-64) with EMG signs of reinnervation in seven patients. Axillary nerve function should not be overlooked in young patients with a minor shoulder trauma. Nerve reconstruction can successfully recreate function.

  • 5. Dahlin, Lars B.
    et al.
    Nennesmo, Inger
    Besjakov, Jack
    Ferencz, Istvan
    Andersson, Gert S.
    Backman, Clas
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap.
    Case report: Intraneural perineurioma of the sciatic nerve in an adolescent - strategies for revealing the diagnosis2016Ingår i: Clinical Case Reports, E-ISSN 2050-0904, Vol. 4, nr 8, s. 777-781Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Diagnosis of intraneural conditions can be revealed by a combination of clinical examination, electrophysiology, magnetic resonance imaging (MRI), and targeted fascicular biopsy with subsequent microscopic analyses.

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  • 6.
    Song, Yafeng
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för integrativ medicinsk biologi (IMB), Anatomi.
    Stål, Per S
    Umeå universitet, Medicinska fakulteten, Institutionen för integrativ medicinsk biologi (IMB), Anatomi.
    Yu, Ji-Guo
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Idrottsmedicin.
    Lorentzon, Ronny
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Idrottsmedicin.
    Backman, Clas
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Handkirurgi.
    Forsgren, Sture
    Umeå universitet, Medicinska fakulteten, Institutionen för integrativ medicinsk biologi (IMB), Anatomi.
    Inhibitors of endopeptidase and angiotensin-converting enzyme lead to an amplification of the morphological changes and an upregulation of the substance P system in a muscle overuse model2014Ingår i: BMC Musculoskeletal Disorders, E-ISSN 1471-2474, Vol. 15, s. 126-Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: We have previously observed, in studies on an experimental overuse model, that the tachykinin system may be involved in the processes of muscle inflammation (myositis) and other muscle tissue alterations. To further evaluate the significance of tachykinins in these processes, we have used inhibitors of neutral endopeptidase (NEP) and angiotensin-converting enzyme (ACE), substances which are known to terminate the activity of various endogenously produced substances, including tachykinins.

    METHODS: Injections of inhibitors of NEP and ACE, as well as the tachykinin substance P (SP), were given locally outside the tendon of the triceps surae muscle of rabbits subjected to marked overuse of this muscle. A control group was given NaCl injections. Evaluations were made at 1 week, a timepoint of overuse when only mild inflammation and limited changes in the muscle structure are noted in animals not treated with inhibitors. Both the soleus and gastrocnemius muscles were examined morphologically and with immunohistochemistry and enzyme immunoassay (EIA).

    RESULTS: A pronounced inflammation (myositis) and changes in the muscle fiber morphology, including muscle fiber necrosis, occurred in the overused muscles of animals given NEP and ACE inhibitors. The morphological changes were clearly more prominent than for animals subjected to overuse and NaCl injections (NaCl group). A marked SP-like expression, as well as a marked expression of the neurokinin-1 receptor (NK-1R) was found in the affected muscle tissue in response to injections of NEP and ACE inhibitors. The concentration of SP in the muscles was also higher than that for the NaCl group.

    CONCLUSIONS: The observations show that the local injections of NEP and ACE inhibitors led to marked SP-like and NK-1R immunoreactions, increased SP concentrations, and an amplification of the morphological changes in the tissue. The injections of the inhibitors thus led to a more marked myositis process and an upregulation of the SP system. Endogenously produced substances, out of which the tachykinins conform to one substance family, may play a role in mediating effects in the tissue in a muscle that is subjected to pronounced overuse.

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  • 7.
    Suhr, Ole B
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Anan, Intissar
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Backman, Clas
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Handkirurgi.
    Karlsson, A
    Department of Clinical Chemistry, Karolinska Hospital, Stockholm, Sweden.
    Lindqvist, Per
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Mörner, Stellan
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Waldenström, Anders
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Do troponin and B-natriuretic peptide detect cardiomyopathy in transthyretin amyloidosis?2008Ingår i: Journal of Internal Medicine, ISSN 0954-6820, E-ISSN 1365-2796, Vol. 263, nr 3, s. 294-301Artikel i tidskrift (Refereegranskat)
  • 8.
    Wiberg, Mikael
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Handkirurgi. Umeå universitet, Medicinska fakulteten, Institutionen för integrativ medicinsk biologi (IMB), Anatomi.
    Backman, Clas
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Handkirurgi.
    Wahlström, Per
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Handkirurgi.
    Dahlin, Lars B
    Plexus brachialis-skador hos vuxna: Tidig nervreparation ger bättre kliniskt slutresultat2009Ingår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 106, nr 9, s. 586-590Artikel i tidskrift (Refereegranskat)
    Abstract [sv]

    Unga personer kan drabbas av skador på plexus brachialis – armens nervfläta – vid högenergitrauma.

    Medicinsk prioritering av patientens samtliga skador för adekvata åtgärder ska alltid göras vid stort trauma.

    Noggrann och tidig, eventuellt upprepad, klinisk neurologisk diagnostik kompletterad med tex MRI, DT-myelografi och neurofysiologiska undersökningar ska göras för att kartlägga plexusskadan.

    Neurobiologisk forskning visar att celldöd kan minskas och nervutväxt förbättras vid tidig nervreparation.

    Olika reparations- och rekonstruktionstekniker används beroende på plexusskadans omfattning och lokalisation.

    Tidig kirurgi och rekonstruktion vid plexusskador förbättrar det kliniska slutresultatet.

    Rehabiliteringen är omfattande och inkluderar ett adekvat omhändertagande av smärtproblematik.

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