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The diagnosis of pure neural leprosy is more challenging because patients share characteristics with other common pathologies, such as ulnar compression, which should be taken into consideration for differential diagnosis. In this study, we identify ulnar nerve conduction characteristics to aid in the differential diagnosis of ulnar neuropathy (UN) in leprosy and that of non-leprosy etiology. In addition, we include putative markers to better understand the inflammatory process that may occur in the nerve. Data were extracted from a database of people affected by leprosy (leprosy group) diagnosed with UN at leprosy diagnosis. A non-leprosy group of patients diagnosed with mechanical neuropathy (compressive, traumatic) was also included. Both groups were submitted to clinical, neurological, neurophysiological and immunological studies. Nerve enlargement and sensory impairment were significantly higher in leprosy patients than in patients with compressive UN. Bilateral impairment was significantly higher in the leprosy group than in the non-leprosy group. Leprosy reactions were associated to focal demyelinating lesions at the elbow and to temporal dispersion (TD). Clinical signs such as sensory impairment, nerve enlargement and bilateral ulnar nerve injury associated with eletrodiagnostic criteria such as demyelinating finds, specifically temporal dispersion, could be tools to help us decided on the best conduct in patients with elbow ulnar neuropathy and specifically decide if we should perform a nerve biopsy for diagnosis of pure neural leprosy., Competing Interests: No authors have competing interests.

Upper limb nerve injuries are common, and their treatment poses a challenge for physicians and surgeons. Experimental models help in minimum exploration of the functional characteristics of peripheral nerve injuries of forelimbs. This study was conducted to characterize the functional recovery (1, 3, 7, 10, 14, and 21 days) after median and ulnar nerve crush in mice and analyze the histological and biochemical markers of nerve regeneration (after 21 days). Sensory-functional impairments appeared after 1 day. The peripheral nerve morphology, the nerve structure, and the density of myelin proteins [myelin protein zero (P0) and peripheral myelin protein 22 (PMP22)] were analyzed after 21 days. Cold allodynia and fine motor coordination recovery occurred on the 10th day, and grip strength recovery was observed on the 14th day after injury. After 21 days, there was partial myelin sheath recovery. PMP22 recovery was complete, whereas P0 recovery was not. Results suggest that there is complete functional recovery even with partial remyelination of median and ulnar nerves in mice.

We investigate the usefulness of quantitative ultrasound and B-mode texture features for characterization of ulnar nerve fascicles. Ultrasound data were acquired from cadaveric specimens using a nominal 30-MHz probe. Next, the nerves were extracted to prepare histology sections. Eighty-five fascicles were matched between the B-mode images and the histology sections. For each fascicle image, we selected an intra-fascicular region of interest. We used histology sections to determine features related to the concentration of collagen and myelin and ultrasound data to calculate the backscatter coefficient (-24.89 ± 8.31 dB), attenuation coefficient (0.92 ± 0.04 db/cm-MHz), Nakagami parameter (1.01 ± 0.18) and entropy (6.92 ± 0.83), as well as B-mode texture features obtained via the gray-level co-occurrence matrix algorithm. Significant Spearman rank correlations between the combined collagen and myelin concentrations were obtained for the backscatter coefficient (R = -0.68), entropy (R = -0.51) and several texture features. Our study indicates that quantitative ultrasound may potentially provide information on structural components of nerve fascicles., (Copyright © 2019 World Federation for Ultrasound in Medicine & Biology. Published by Elsevier Inc. All rights reserved.)

Objective: To estimate the application of prognosis evaluation of ulnar nerve injury by 1H-magnetic resonance spectroscopy (1H-MRS)., Methods: The metabolites of first dorsal interossei (FDI) of two hands from 12 healthy volunteers and 1 volunteer with complete ulnar nerve injury were detected by 1H-MRS and the data were statistically analyzed., Results: For the FDI of healthy adults, the female peaks area of extra-myocellular lipids (EMCL) was higher than the male (P < 0.05); There was no significant difference in Cho, Cr and intra-myocellular lipids (IMCL) between male and female (P > 0.05); There was no significant difference in all the peaks area between the left and right hand (P > 0.05). The EMCL peak of the injury side was higher than that of the healthy side, and the area of FDI was reduced in the volunteer with ulnar nerve injury., Conclusion: Noninvasive and quantitative detection of 1H-MRS may be valuable for prognosis evaluation of peripheral nerve injury.

Using ulnar nerve as donor and musculocutaneous nerve as recipient we found earlier that end-to-side neurorrhaphy resulted in weak functional reinnervation after lengthy survival. End-to-side neurorrhaphy however is the sole choice of nerve repair at times and has the advantage of conserving donor nerve function. Here, we investigated whether myelination-enhancing agent methylcobalamin and motoneuron trophic factor pleiotrophin enhances the recovery after end-to-side neurorrhaphy. Methylcobalamin significantly increased the expression of growth associated protein 43 and S100 protein and βIII tubulin in musculocutaneous nerve 1 month after neurorrhaphy suggesting the ingrowth of ulnar axonal sprouts in reactive Schwann cell environment. Upper limb functional test, compound muscle action potential measurements, motor end plate counts, and axon and myelin analyses showed that methylcobalamin treatment alone or with pleiotrophin improved the recovery significantly, 3 and 6 months post-surgery. There were fewer axons, closer in number to that of the intact recipient nerve, found in the distal repaired nerve of the methylcobalamin-treated than that of the vehicle control, suggesting that methylcobalamin facilitates axonal maturation and eliminates supernumerary sprouts. In conclusion, our results showed that methylcobalamin does indeed enhance the recovery of peripheral nerve repaired in end-to-side configuration.

Background and Objective: The aim of this study was to determine which of two clinically applied methods, electromyography or acceleromyography, was less affected by external disturbances, had a higher sensitivity and which would provide the better input signal for closed loop control of muscle relaxation., Methods: In 14 adult patients, anaesthesia was induced with intravenous opioids and propofol. The response of the thumb to ulnar nerve stimulation was recorded on the same arm. Mivacurium was used for neuromuscular blockade. Under stable conditions of relaxation, the infusion-rate was decreased and the effects of turning the hand were investigated., Results: Electromyography and acceleromyography both reflected the change of the infusion rate (P = 0.015 and P < 0.001, respectively). Electromyography was significantly less affected by the hand-turn (P = 0.008) than acceleromyography. While zero counts were detected with acceleromyography, electromyography could still detect at least one count in 51.1%., Conclusions: Electromyography is more reliable for use in daily practice as it is less influenced by external disturbances than acceleromyography.

Background: Nerve conduction study is essential in the diagnosis of focal neuropathies and diffuse polyneuropathies. There are many factors that can affect nerve conduction velocity, and age is one of them. Most of the many studies of this effect, and the values from them, were on Caucasian subjects. Therefore, this study was designed to investigate the effect of age on conduction velocity among healthy Asian Malay subjects by analyzing its influence on the median, ulnar, and sural nerves., Material/methods: A total of 250 healthy subjects were recruited. The subjects were divided into four age groups. The nerves tested were the median, ulnar, and sural nerves. Surface electrodes were used and the temperature was kept constant. The nerves were stimulated and recorded at specific sites both for motor and sensory conduction velocities., Results: The mean velocities for the median and ulnar nerves, both motor and sensory, were 54.71+/-5.69 m/s (motor) and 54.04+/-7.02 m/s for the median nerve and 60.57+/-5.00 m/s (motor) and 52.92+/-5.89 m/s for the ulnar nerve. The mean velocity for the sural nerve was 47.97+/-4.48 m/s. Only median motor conduction velocity showed a significant reduction with increasing age (p=0.000)., Conclusions: This study did not show any significant effect of age on nerve conduction velocities except for median motor conduction velocity. For future research it is planned to extend the recruitment to subjects who are much older (over 60 years of age) and study the effect of other personal factors such as height and body mass index on NCV.

Intraneural perineurioma is a rare peripheral nerve sheath tumor consisting of intraneural proliferation of neoplastic perineurial cells. Clinical and pathological findings of a perineurioma involving the ulnar nerve is presented. A 7-year-old girl presented with a 2 year history of weakness and atrophy of the right hand muscles. Physical examination and imaging study revealed a pea-sized tumor in the ulnar side of the right forearm. At surgery, a fusiform swelling of the ulnar nerve was found and an excisional biopsy of the lesion was performed. Light microscopy revealed numerous whorls consisting of concentric layers of spindle cells encircling the nerve fibers. The proliferating cells were immunoreactive for vimentin, epithelial membrane antigen and glucose transporter protein 1 (Glut1), but negative for S-100 protein and CD34. Ultrastructural examination revealed features of perineurial cell differentiation. The current study suggests that Glut1 is a useful marker of intraneural perineurioma.

A tumor involving cubital nerve was resected and studied; it was classified as an angiolymphoid hyperplasia with eosinophilia (ALHE). Immunohistochemical and molecular study was done both to confirm the reactive nature of the process and rule out the presence of clonal T or B cell rearrangement. This lesion has been designated as epitheloid hemangioma [Coindre (1994) Ann Pathol 14:426]. Typically, ALHE occurs in the skin and the subcutaneous tissue, and extracutaneous involvement is rare. No cases of ALHE affecting a nerve have been described, but a case of Kimura's disease, the lesions of which have repeatedly been confused with ALHE, has been reported involving median nerve.

The spinal cord projections of the 3 main forelimb nerves-median, radial and ulnar, were studied in the rat dorsal horn with transganglionic transport of wheat germ agglutinin-horseradish peroxidase (WGA-HRP), or using the disappearance of fluoride resistant acid phosphatase (FRAP) after nerve section. The projection patterns in lamina II were similar following the two procedures. The median and the radial nerve fibers projected to the medial and the intermediate thirds, respectively, of the dorsal horn lamina II in spinal cord segments C4-C8. The ulnar nerve projected to segments C6-C8 between the areas occupied by the other two nerves. The FRAP method also showed that the lateral part of lamina II, which was not filled by radial nerve fibers, received the projections from the dorsal cutaneous branches of cervical spinal nerves. In addition, FRAP disappeared from the medial end of segment T1 after skin incisions extending from the medial brachium to the axilla, which seemed due to severance of the cutaneous branchlets of the lateral anterior thoracic nerve. The FRAP procedure is thus sensitive enough to detect fibers in lamina II arising from small peripheral nerves, and may be used as an alternative to the anterograde tracing methods whenever there are no overlapping projections.

The ulnar nerve taken at autopsy from 30 subjects aged 24-98 who died without features of clinical involvement of peripheral nerves was examined morphologically. Density of myelinated fibers (m.f) per 0.1 mm2, frequency distribution of the external diameter of m.f., and teased fiber were estimated. Besides, in 8 nerves some lipids were assessed biochemically. The study showed that the percentage of fibers with morphological changes increases with aging (7-10% in adults and even up to 35% in aged subjects). In older subjects loss of m.f. may be marked. Morphological changes in the nerves of subjects in all groups of age are unspecific (axonal degeneration, and segmental demyelination). Striking feature for the nerve is the preserved ability to repair damage of the fiber independently of the subjects' age. Accidental factors play some role as a cause of morphological changes in the nerve in all groups of age but in the elderly, aging of the neuron seems to be an important factor. Biochemical changes in the nerves with age are not prominent, and much less expressed than morphological changes.

A case of localized hypertrophic mononeuropathy was studied by electron microscopy and immunohistochemistry for S100 protein, epitopes recognized by the Leu-7 monoclonal antibody, 200 kD neurofilament polypeptide, and the epithelial membrane antigen (EMA). The primary role of perineurial cell proliferation without the participation of Schwann cells in this process was directly demonstrated by EMA immunohistochemistry. Focal delamination of the EMA-positive perineurium, increased fibrosis between its layers, and compartmentalization of the fascicles by EMA-positive septae were the first recognizable changes. In practice, recognition of these early changes by EMA immunocytochemistry may be important for the clear definition of functionally unimpaired segmental margins for excision and graft implantation, and also for the future study of the process responsible for aberrant perineurial proliferation.

The axonal transport of vasoactive intestinal polypeptide (VIP) was examined in anesthetized cats. The distally directed (anterograde) flux of peptide was found to be about 35 fmol/h in the sciatic nerve. A smaller retrograde flux (8.5 fmol/h) weas also detected. In ulnar, radial and sciatic nerves, the average velocity of transport was calculated to be 2.5 mm/h in the anterograde and 0.6 mm/h in the retrograde direction. Clearance experiments indicated that the amounts of peptide available for transport in these two phases were 28% and 15% of the total, respectively. Estimates of true velocity based on these figures are 9 mm/h for anterograde transport and 4 mm/h for retrograde transport. Local injections of vinblastine were found to induce marked local increases in VIP-immunoreactivity, indicating that microtubules play a role in peptide transport. Subcellular distribution experiments showed that most of the transported VIP was associated with a particulate fraction, possibly corresponding to large vesicles. Only one molecular form of VIP-immuno-reactivity was detected by gel permeation chromatography and no evidence was obtained for cleavage of VIP precursors in the axon. Comparison of axonal flux of peptide with the apparent content of VIP in terminal regions indicated that the turnover time for this peptide is 5 days or longer in the periphery. The results are consistent with the view that peripheral neurons are dependent upon rapid axonal transport for the supply of vip to their terminals.