Histopathologic findings in autogenous saphenous vein graft wrapping for recurrent tarsal tunnel syndrome: a case report

Autogenous saphenous vein graft wrapping of the tibial nerve has been described as an effective treatment option for failed tarsal tunnel decompression. Various theories have been proposed to explain how this method works, with little histologic evidence to date. A pathologic investigation of a sectioned nerve that had been previously wrapped provides some insight into these proposals.     

Space-occupying lesions as a cause of tarsal tunnel syndrome

In diagnosing the etiology of tarsal tunnel syndrome, the practitioner must be aware of space-occupying lesions as a possibility. These masses, rarely found beneath the laciniate ligament, can occur. Satisfying results have occurred after removal of these lesions. Careful dissection will assure preservation of the nerve and prevent sensory or motor loss.     

The electrophysiological diagnosis of carpal tunnel syndrome

Electrophysiological investigations were carried out both in patients with carpal tunnel syndrome (CTS) and in healthy individuals. The evoked potentials were examined during stimulation of sensitive branches of n. medianus and of other nerves. The most sensitive and important for diagnosis appeared to be the electrophysiological test of alteration of responsive reaction to the stimulation of the sensitive branch of n. medianus for 4 finger and the considerable difference of evoked reactions on stimulation of skin palm branch and branch of the 1-st finger of n. medianus. The diagnostic importance of these indices corresponds well to anatomical and pathophysiological characteristics of CTS.     

Clinical findings in Brown-McLean syndrome

The Brown-McLean syndrome is a clinical condition with corneal edema involving the peripheral 2 to 3 mm of the cornea. The edema typically starts inferiorly and progresses circumferentially, but spares the central portion of the cornea. Additionally, the edema is associated with a punctate orange-brown pigmentation on the endothelium underlying the edematous areas. Central cornea guttata is frequently seen. This condition occurs most frequently after intracapsular cataract extraction, but may also occur after extracapsular cataract extraction and phacoemulsification, or pars plana lensectomy and vitrectomy. Surgical complications and multiple intraocular procedures are frequently observed in these patients. Less frequently, the Brown-McLean syndrome can occur in eyes that have not had surgery. We studied the clinical characteristics of 43 affected eyes of 32 patients. New findings included Brown-McLean syndrome occurring in two eyes of a phakic patient with intermittent angle-closure glaucoma. Two eyes developed Brown-McLean syndrome after phacoemulsification and one eye developed peripheral edema after pars plana vitrectomy and lensectomy. Additionally, severe, infectious keratitis occurred after rupture of peripheral bullae in two eyes. Patients with this condition should be examined periodically and educated regarding the early clinical signs of corneal ulceration.     

Flexor digitorum accessorius longus muscle: an etiology of tarsal tunnel syndrome?

Body image, as measured by the Appearance Evaluation and Body Areas Satisfaction scales of the Multidimensional Body-Self Relations Questionnaire (T.F. Cash, 1994b), was assessed in 59 obese women before, during, and after 48 weeks of weight loss treatment. Before treatment, positive ratings of body image were associated with higher levels of self-esteem, lower levels of dysphoria, and fewer previous diets. After 24 weeks and a mean weight loss of 19.4 kg (SD = 6.5), participants showed significant (p < .0001) improvements in body image. A small weight gain from Week 24 to Week 48 was associated with a slight but significant worsening in both measures of body image. Nevertheless, after 48 weeks and a mean weight loss of 16.3 kg (SD = 7.1), body image was significantly improved from baseline (p < .0001). Changes in body image were not related to changes in weight. Future studies are needed to separate the effects of treatment and weight loss on body image in obese persons.     

Clinical and electrophysiological observations in a case of Romano-Ward syndrome

Syncope associated with atypical ventricular tachycardia of the "torsades de pointes" type was observed in a 16 year-old girl with hereditary QT prolongation. The arrhythmia occurred only during maximal prolongation of the QTc to 0.77 sec, which had possibly been aggravated by exercise and hypokalaemia. Electrophysiological studies were performed when the QTc was 0.59 sec. Incremental as well as premature ventricular pacing with single or double premature ventricular beats did not initiate ventricular arrhythmias, but revealed AV nodal and bundle branch reentry. It is postulated that these types of macroreentry are involved in the twisting of the QRS complexes in the surface ECG in torsades de pointes.     

Kindler syndrome. Clinical and ultrastructural findings

BACKGROUND: Kindler syndrome is a genodermatosis that combines clinical features of hereditary epidermolysis bullosa and poikiloderma congenitale. The ultrastructural level of blister formation has not been well characterized. OBSERVATIONS: Two brothers with Kindler syndrome had a history of primarily acral blistering since infancy as well as photosensitivity. Blister formation was found through the basal layer. Marked tonofilament clumping was found in intact keratinocytes adjacent to the blisters. The younger brother (aged 21 years) had actinic keratoses, which have not been previously described in Kindler syndrome. CONCLUSIONS: The findings of basal layer separation in both spontaneous and induced blisters in Kindler syndrome suggest this is the true level of blister formation. The finding of actinic keratoses in a young patient with Kindler syndrome suggests that some patients may be at increased risk for early solar-induced skin disease. The presence of clumped tonofilaments in keratinocytes adjacent to blistered areas suggests an abnormality of keratin 5 or 14 could be present and may play a role in blister formation in patients with Kindler syndrome.     

Carpal tunnel syndrome

Patients with carpal tunnel syndrome should be told that it is a progressive condition that, if not treated, probably will worsen as time goes on. When release is performed properly, they have an excellent chance for substantial improvement, although some always may have a degree of residual numbness at the fingertips. Initial relief of pain is rapid, with subsequent improvement in numbness and weakness occurring more slowly. Carpal tunnel syndrome is a very common problem. Although there may be a distinct cause in some patients, the underlying reason for the increased bulk of synovium is not known in most. Conservative treatment gives temporary relief, but surgical release remains the most effective treatment. Complications are not common, and proper attention to details minimizes them. The results generally are excellent.     

耳压结合睑板腺按摩治疗干眼症80例临床观察

目的:观察和评价耳压结合睑板腺按摩治疗干眼症的临床疗效.方法:干眼症80例随机分为治疗组40例,对照组40例.1个月为一疗程,对照组行玻璃酸钠眼液点眼,治疗组在对照组治疗基础上用耳压结合睑板腺按摩治疗.治疗结束后总结实验结果.结果:治疗组总有效率为87.5%,对照组总有效率为57.5%,二者相比具有显著统计学差异(P<0.05).结论:耳压结合睑板腺按摩可有效治疗干眼症.     

Solvent-induced toxic encephalopathy: electrophysiological data in relation to neuropsychological findings

Male subjects with type 2A (n = 12) and 2B (n = 12) solvent-induced toxic encephalopathy and a reference group of healthy men (n = 12) without previous solvent exposure were studied using quantitative EEG and event-related potentials from an odd-ball and a dual-task paradigm. Subjects with toxic encephalopathy of types 2A and 2B showed markedly lower P300 amplitudes than did controls in both paradigms. In the relatively complex dual-task setting, subjects with 2A and 2B showed lower signal detection than did controls.     

Clinical features, image analysis, and laparoscopic and histological liver findings in Budd-Chiari syndrome

BACKGROUND/AIMS: Clinical manifestations and histological features of the liver in Budd-Chiari syndrome (BCS), with or without idiopathic membranous obstruction of the inferior vena cava (MOVC), vary according to whether BCS is acute, subacute or chronic. We clarified the diagnostic features in 6 patients with MOVC and in 1 without MOVC. METHODOLOGY: Five patients with subacute or chronic type BCS with MOVC complaining of epigastric pain, hematemesis and encephalopathy, and signs of portal hypertension or collateral circulation were seen. There was 1 asymptomatic patient with MOVC. One patient with acute type BCS without MOVC revealed hepatic and multi-organ failure. Liver function tests in BCS with MOVC were similar to those in liver cirrhosis, and laboratory data in acute type without MOVC were quite the same as those seen in fulminant hepatitis. Non-invasive image analysis by US, CT and MRI showed thrombi and obstruction of the IVC, and extrahepatic vasculature or communication between hepatic veins and IVC. Vena cavography showed the length of obstruction in IVC and collateral circulation in the extrahepatic or intrahepatic veins. Liver biopsy demonstrated massive hemorrhagic necrosis in acute type without MOVC, and laparoscopy with liver biopsy in asymptomatic, subacute and chronic type with MOVC showed subcapsular hemorrhage, congestion, fibrosis, and cirrhotic features. CONCLUSIONS: The non-invasive image analysis was complementary to vena cavography, and liver biopsy with or without laparoscopy was essential not only for diagnosis of acute, subacute, and chronic BCS, but also for therapeutic decision-making.     

Clinical and electrophysiological evaluation of dysphagia in myasthenia gravis

OBJECTIVE: To evaluate dysphagia at the oropharyngeal stage of swallowing and to determine the pathophysiological mechanisms of dysphagia in patients with myasthenia gravis. METHODS: Fifteen patients with myasthenia gravis with dysphagia and 10 patients without dysphagia were investigated by a combined electrophysiological and mechanical method described previously. Laryngeal movements were detected by a piezoelectric transducer and the related submental EMG (SM-EMG) and sometimes the EMG of cricopharyngeal muscle of the upper esophageal sphincter (CP-EMG) were recorded during dry or wet swallowing. The results of these electrophysiological variables were compared with those of normal age matched control subjects. RESULTS: In patients with myasthenia gravis with dysphagia, it was found that the time necessary for the larynx to remain in its superior position during swallowing and swallowing variability in successive swallows increased significantly compared with normal subjects and with patients with myasthenia gravis without dysphagia. The total duration of SM-EMG activity was also prolonged in both groups but more severely in the dysphagic patients. Electromyographic activity of the CP sphincter was found to be normal in the dysphagic patients investigated. All the patients with myasthenia gravis with dysphagia had pathological dysphagia limits (<20 ml water) whereas other patients except two, were within normal limits. CONCLUSIONS: Because the electrophysiological variables related to oropharyngeal swallowing were prolonged even in patients with myasthenia gravis without dysphagia, it is concluded that the submental and laryngeal elevators are involved subclinically in myasthenia gravis and, because of compensating mechanisms, the patient may not be dysphagic. As the CP-EMG behaviour was found to be normal, a coordination disorder between normal CP sphincter muscle and the affected striated muscles of the laryngeal elevators may be one of the reasons for dysphagia in myasthenia gravis. This method also made it possible to investigate the myasthenic involvement in the laryngeal elevators that cannot be evaluated by other electrophysiological methods in myasthenia gravis.     

Cubital tunnel syndrome pathophysiology

Cubital tunnel syndrome is the second most common peripheral compression neuropathy. The unique anatomic relationships of the ulnar nerve at the elbow place it at risk for injury. Normally with elbow range of motion, the ulnar nerve is subjected to compression, traction, and frictional forces. As the elbow is flexed the arcuate ligament elongates producing a decrease in canal volume of 55%. Intraneural and extraneural pressures increase and have been shown to exceed 200 mm Hg with elbow flexion and flexor carpi ulnaris contraction. Because the ulnar nerve courses behind the elbow axis of rotation, elbow flexion produces excursion of the nerve proximal and distal to the medial epicondyle. The ulnar nerve also elongates 4.7 to 8 mm with elbow flexion. Cubital tunnel syndrome may develop because of various factors including repetitive elbow motion, prolonged elbow flexion, or direct compression. An understanding of the anatomy and pathophysiology associated with cubital tunnel syndrome will aid in patient evaluation and determination of the appropriate treatment.     

Acute carpal tunnel syndrome

Although the carpal tunnel is open at both ends, it has the physiologic properties of a closed compartment bounded by synovium proximally and distally. When the intracarpal canal interstitial pressure rises above a critical threshold pressure, capillary blood flow is reduced below the level required for median nerve viability. Acute carpal tunnel syndrome is recognized frequently as occurring secondary to wrist trauma and infrequently due to a variety of infectious, rheumatologic, and hematologic disorders. This condition warrants prompt recognition and the treatment is early carpal tunnel release.     

MR findings in oculocerebrorenal syndrome

Oculocerebrorenal syndrome is an X-linked recessive disorder characterized by congenital ocular abnormalities, mental retardation, renal disease, and metabolic bone disease. We report a case of oculocerebrorenal syndrome and, using T1-, proton density-, and T2-weighted imaging sequences, are able to characterize two distinct white matter abnormalities: one lesion is punctate and has signal characteristics that parallel that of cerebrospinal fluid; a second lesion, found in association with the first, consists of patchy white matter abnormalities that are hypointense on T1-weighted images but hyperintense on proton density- and T2-weighted images.