MRI and ultrasonography in Morton's neuroma: Diagnostic accuracy and correlation

Background:

The diagnosis of Morton''s neuroma is based primarily on clinical findings. Ultrasonography (US) and magnetic resonance image (MRI) studies are considered complementary diagnostic techniques. The aim of this study was to establish the correlation and sensitivity of both techniques used to diagnose Morton''s neuroma.

Materials and Methods:

Thirty seven patients (43 intermetatarsal spaces) with Morton''s neuroma operated were retrospectively reviewed. In all cases MRI or ultrasound was performed to complement clinical diagnosis of Morton''s neuroma. In all cases, a histopathological examination confirmed the diagnosis. Estimates of sensitivity were made and correlation (kappa statistics) was assessed for both techniques.

Results:

Twenty seven women and 10 men participated with a mean age of 60 years. Double lesions presented in six patients. The second intermetatarsal space was affected in 10 patients and the third in 33 patients. An MRI was performed in 41 cases and a US in 23 cases. In 21 patients, both an MRI and a US were performed. With regard to the 41 MRIs performed, 34 were positive for Morton''s neuroma and 7 were negative. MRI sensitivity was 82.9% [95% confidence interval (CI): 0.679–0.929]. Thirteen out of 23 US performed were positive and 10 US were negative. US sensitivity was 56.5% (95% CI: 0.345–0.768). Relative to the 21 patients on whom both techniques were carried out, the agreement between both techniques was poor (kappa statistics 0.31).

Conclusion:

Although ancillary studies may be required to confirm the clinical diagnosis in some cases, they are probably not necessary for the diagnosis of Morton''s neuroma. MRI had a higher sensitivity than US and should be considered the technique of choice in those cases. However, a negative result does not exclude the diagnosis (false negative 17%).     

La disfunción eréctil y su severidad están en relación con el número de factores de riesgo cardiovascular

AimErectile dysfunction (ED) is a very common condition in the general population. ED is closely related to Hypertension (HT), Diabetes Mellitus (DM), Dyslipidemia (DLP) and Metabolic Syndrome (MS). This study has aimed to clarify whether the presence and severity of ED are related to the presence and number of cardiovascular risk factors (CVRF).Material and methodsWe retrospectively analyzed the characteristics of 242 males referred to our center for a prostate biopsy from September 2007 to December 2009. The following variables were collected prospectively: age, height, weight, body mass index (BMI), AHT, DM, DLP and obesity (BMI < 30 kg/m²). The Erection Hardness Score Questionnaire was used to assess erectile function. We analyzed the relation between the presence and severity of ED and the presence of HT, DM, DLP and obesity. We analyzed the clinical variables based on the presence or absence of ED and in relationship to its severity.ResultsThe presence of ED was related to HT (OR: 1.805 [1.128-2.887]; p = 0.013), DM (OR 3.585 [1.613-7.966]; p = 0.001) and Dyslipidemia (OR: 1.928 [1.062-3.500]; p = 0.029). Erectile function was not related to Obesity (OR: 0.929 [0.522-1.632]; p = 0.795). Patients with ED were more likely to have more CVRF (p = 0.009) and the severity of ED was related to the presence of HT (p < 0.001), DM (p < 0.001), DLP (p = 0.001) and the number of CVRF (p < 0.001).ConclusionsThe presence and severity of ED correlate with the presence of HT, DM, Dyslipidemia and the number of DVRF.     

Correlation of axon frojections anct peptide immunoreactivity in mesocerebral neurons of the snail helix aspersa

The purpose of this investigation was to elucidate the organization of efferent neurons in the mesocerebrum of a terrestrial snail. The mesocerebrum is one of three regions, or lobes, that can be identified by gross inspection. Previous studies have indicated a possible function for the mesocerebrum in the control of mating behavior. We used both anterograde and retrograde tracing methods to determine the axon projections of mesocerebral neurons. Virtually all the neurons (96%) send an axon into the cerebropedal connective nerve, and about 25% of these fibers continue into the nervus cutaneus pedalis primus dexter, which innervates the dart sac. Many neurons have additional axon branches in other perves, especially the penial nerve, which receives projections from about 25% of mesocerebral cells. Neurons that are backfilled from the nervus cutaneus pedalis primus dexter are predominately immunoreactive for FMRFamide, whereas neurons that are backfilled from the penial nerve are predominately immunoreactive for APGWamide. These results suggest a functional association between FMRFamide and dart shooting on the one hand, and between APGWamide and penial eversion on the other. Some cells contain both APGWamide and FMRFamide; these cells, may have dual projections in both the penial nerve and the nervus cutaneus pedalis primus dexter. © 1995 Wiley-Liss, Inc.     

改良腰硬联合麻醉在产科与妇科手术中的对比研究

目的探讨改良腰硬联合麻醉技术(CSEA)的安全性、有效性和可行性,并比较在产科与妇科手术中麻醉的特点。方法选择ASAⅠ~Ⅱ级剖宫产和子宫全切手术各40例。以一次性硬膜外麻醉包和20-22G直接静脉留置针芯为材料,行两点法穿刺,在蛛网膜下腔注入1%丁卡因1m l 3%麻黄碱1m l 10%葡萄糖1m l混合液2 m l。观察起效时间、最高阻滞平面、血流动力学的变化和不良反应。结果所有患者穿刺均一次成功,效果满意,无麻醉并发症。其中剖宫产组恶心呕吐发生率、腰麻注药后平面上升的速度和最高阻滞平面均大于子宫全切组,两组患者在注药后10~30m in血压和心率下降,剖宫产组30m in后血压下降最明显。结论以该法行CSEA,简便易行,价格低廉,麻醉效果满意。可安全用于产科和妇科等手术的麻醉,但在剖宫产手术中宜尽早将阻滞平面控制在较低范围。     

Osteodystrophy of diabetics in chronic dialysis: A histomorphometric study

Summary A decreased incidence of hyperparathyroidism in diabetic uremic patients has been reported, but comprehensive bone histomorphometric studies on uremic diabetic osteodistrophy are scarce. We present here the results of static and dynamic bone morphometry in 13 diabetic patients on dialysis (DCD) and their comparison with a pairmatched group of nondiabetic uremics with similar age, sex, and time on dialysis (NCDC), and with a group of 17 normals (N). Diabetic bone showed: (1) Low trabecular volume (Vt 9.9% in DCD and 22.8% in N), (2) Moderately increased remodeling values of intermediate intensity between N and NDCD values (Sf=19.3% in DCD, 37.4% in NDCD, and 8.8±6% in N, Sr=4.3% in DCD, 7.3% in NDCD and 2.04±0.9% in N), and (3) Moderate fibrosis (Sfib 1.2% in DCD, 12.9% in NDCD). Besides these confirmatory results, two suggestions emerged from the study: (1) The relative number of cells: osteoclast density (OI) and osteoblasts (Ob/OID) appears to be lower not only than NDCD values but also lower than N values (OI=0.04 c/mm. in DCD, 0.31 in NDCD, and 0.14 in N; Ob/OID=5.58% in DCD, 14.6 in NDCD and 22.12±9% m N). (2) Dynamic behavior in tetracycline based studies disclosed the appearance of two populations of DCD: a subgroup of preserved calcification dynamics with values not quite different than the NDCD group and a subgroup with a significant derangement of mineralization with no measurable bone trabecular dynamics. This late subgroup also showed significantly lower number of Ob/OID values compared with the former with preserved calcification. Both findings may agree with other reported experimental evidences on diabetes.     

大肠癌组织中RB基因的点突变现象

为了进一步了解大肠癌中ＲＢ基因呈过度表达状态的机制，本文作者研究了ＲＢ基因存在点突变的可能性。利用ＲＮａｓｅ保护试验，在一例结肠癌中首次证实了其ＲＢ基因存在着点突变现象，同时也针对同大肠癌中ＲＢ基因过度表达相关的机制进行了讨论。