The SLAP lesion as a reason for glenolabral cysts: a report of five cases and review of the literature

Introduction: Cysts in the spinoglenoidal or supraglenoidal incisura can be a cause of compression of the suprascapular nerve. There is agglomerated appearance of these cysts in combination with SLAP lesions. Hypothesis is SLAP lesions can lead to cysts in this region and should be repaired. Material and methods: MRI of five patients (all male, four 30–40 years, one 75 years) showed cysts in the supralabral region. All were in combination with lesions of the superior glenoidal labrum (Type II or more). Results: In two cases, in addition to cyst resection, the SLAP lesion was also repaired and symptoms disappeared completely and no recurrent cyst was detected in postoperative MRI. Two patients without SLAP repair showed recurrent cystic formation in MRI with similar complaints compared to their preoperative status. One patient (75 years) was treated primarily by puncture and afterwards with open resection of the cyst. His outcome was good in terms of activities of daily living without major pain. Conclusions: Our results are based on the assumption that cysts in the region of the spinoglenoidal/supraglenoidal incisura can originate from SLAP lesions. If a patient is suspected of having cysts in this region, the question of a SLAP lesion should be clarified. SLAP lesions should be repaired to avoid relapse. Arthroscopic repair of SLAP lesion can lead to the disappearance of symptoms in younger patients. In older patients puncture or resection of the ganglion alone may be an adequate therapeutic strategy.     

Feasibility and technical problems of sentinel node analysis in melanoma

BACKGROUND: Development of the sentinel lymph node (SLN) biopsy the last 10 years has changed surgical approach of solid tumor treatment and particularly of melanoma. The aim of our study was to analyze in our hospital, the feasibility of the SLN biopsy technique in order to define a better prognostic classification of melanomas. PATIENTS AND METHODS: Between July 1999 and October 2003, 97 patients were included in this study in our center. Criteria for inclusion were cutaneo-mucosal melanoma of Breslow >or=1,5 mm, and/or Clarck >or=IV, and/or ulceration, and/or signs of regression, before any surgical margins. RESULTS: Lymphoscintigraphy (LS) identified at least 1 SLN in 94 cases/97 (97%), thus permitting intraoperative SLN mapping and sentinel node biopsy of at least 1 lymph node in 88 cases/94 (94%). Failure of the SLN procedure was noted in 9 cases: in 3 cases, no lymph node was individualized by LS, in 1 patient, intraoperative SLN mapping failed to find the previously identified SLN and in 5 cases, a SLN was identified by LS and intraoperative mapping but could not be removed because of its deep location and difficulty of dissection. In 17 patients, removal of one or two "non sentinel lymph node(s)" was (were) made by the surgeon because of its (their) suspected aspect (black or large). Among the 88 patients who had dissection of at least 1 SLN, a micrometastasis was detected by standard histological evaluation and/or immunohistochemical stains in 14 cases (16%) and into a "non SLN" in 2 cases (2,3%). The median follow up of patients was 16 months (1- 48 months). Among the 14 patients with positive SLN, 6 (43%) relapsed. The other eight were in complete remission of their melanoma with a mean follow up of 11,44 months . Among the 74 patients with negative SLN, 7 (9,5%) developed a recurrence. Among the 9 patients in whom any sentinel lymph node have been removed, 3 had a relapse (one in transit than on lymph nodes, and two on lymph nodes). CONCLUSION: Our results are in accordance with the literature, and confirm the feasibility of SLN mapping and of SLN histological analysis in our center. We described in this study technical problems we encountered. Our study also show the prognostic value of this technique. However, advantage in global survey of sentinel node dissection and regional lymph node dissection in cases of micrometastases has still to be demonstrated.     

星状神经节阻滞对心率变异性影响的实验研究

目的：探讨在家兔清醒状态下,以第7颈椎横突为标志,经皮行星状神经节阻滞的可行性和有效性．及其对心率变异性的影响。方法：健康新西兰大耳白兔16只被随机均分为左侧星状神经节阻滞组（LSGB组）、右侧星状神经节阻滞组（RSGB组）。白兔均在清醒状态下四肢固定,仰卧于动物手术台,胸前及四肢连接十二导动态心电图分析系统,稳定30min后,以第七颈椎横突为骨性标志,垂直进针,给予0．5％布比卡因1ml,行星状神经节阻滞。观察眼睑下垂程度、耳廓温度、心率变异性指标[24h正常RR间期标准差（SDNN）、低频功能（LF）、高频功能（HF）、LF／HF]。另取9只家兔同法向星状神经节处推注亚甲蓝溶液后暴露星状神经节,以其是否蓝染判断注射阻滞部位的精确程度。结果：两组动物均完成星状神经节阻滞操作,术后即刻及饲养1周均未发现并发症。阻滞10min后两组动物阻滞侧均出现上睑下垂和眼裂变小。与对侧及阻滞前相比．阻滞侧耳廓温度明显升高（P〈0．05）。两组动物阻滞前后心率无明显差异,LSGB组,阻滞前、后SDNN、LF、HF、LF/HF无显著差异。RSGB组．LF和HF值在阻滞后较阻滞前显著减小（P〈0．05）．但LF／HF、SDNN无明显改变。9只家兔行亚甲蓝注射后．解剖发现8只星状神经节被染色,精确程度为88．9％（8／9）。结论：以第7颈椎横突为标志,经皮行星状神经节阻滞建立动物模型的方法切实可行,眼睑、眼裂及耳廓温度是较好的阻滞成功判断指标。星状神经节阻滞对自主神经功能有调节作用,可能就是其阻滞治疗各种疾病的作用机制之一。     

频域-OCT在观察高眼压症视网膜神经纤维层及神经节细胞复合体中的应用

使用频域相干光断层扫描（ SD-OCT）观察高眼压症患者视盘形态学参数、视网膜神经纤维层（RNFL）及黄斑区神经节细胞复合体（GCC）的表现。方法选取52例（96只眼）高眼压患者,按照眼压高低分为两组,与20例（40只眼）正常人进行SD-OCT检查,测量视盘形态学参数、整体平均RNFL厚度（RNFL-Avg）、上方平均RNFL厚度（RNFL-Sup）、下方平均RNFL厚度（RNFL-Inf）、整体平均GCC的厚度（GCC-Avg）、上方平均GCC厚度（ GCC-Sup）、下方平均GCC厚度（ GCC-Inf）,比较两组高眼压症患者与正常对照组之间的差异,并分析高眼压症组RNFL与GCC的相关性。结果两组高眼压症患者与正常对照组比较,视盘各形态学参数（ P ＞0．05）、RNFL-Avg（ P ＝0．9017）、RNFL-Sup（ P ＝0．9659）、 RNFL-Inf（ P ＝0．7465）、 GCC-Avg（ P ＝0．3498）、GCC-Sup（ P ＝0.4203）、GCC-Inf（ P ＝0．3071）均无显著的统计学差异。而RNFL与GCC在整体、上方及下方的厚度均呈明显的正相关（ r ＝0．5631 P ＝0．001;r ＝0．5122 P ＝0．005;r ＝0．5459 P ＝0．002）。结论 SD-OCT是一种比较敏感的能够观察到视网膜结构改变的检查方法,对青光眼的早期诊断具有重要的作用。高眼压症患者在眼压明显高于正常的情况下,并无RNFL及GCC的改变,对于高眼压症应该强调严格随诊。     

Effects of early postnatal exposure to ethanol on retinal ganglion cell morphology and numbers of neurons in the dorsolateral geniculate in mice

Background: The adverse effects of fetal and early postnatal ethanol intoxication on peripheral organs and the central nervous system are well documented. Ocular defects have also been reported in about 90% of children with fetal alcohol syndrome, including microphthalmia, loss of neurons in the retinal ganglion cell (RGC) layer, optic nerve hypoplasia, and dysmyelination. However, little is known about perinatal ethanol effects on retinal cell morphology. Examination of the potential toxic effects of alcohol on the neuron architecture is important because the changes in dendritic geometry and synapse distribution directly affect the organization and functions of neural circuits. Thus, in the present study, estimations of the numbers of neurons in the ganglion cell layer and dorsolateral geniculate nucleus (dLGN), and a detailed analysis of RGC morphology were carried out in transgenic mice exposed to ethanol during the early postnatal period. Methods: The study was carried out in male and female transgenic mice expressing yellow fluorescent protein (YFP) controlled by a Thy‐1 (thymus cell antigen 1) regulator on a C57 background. Ethanol (3 g/kg/d) was administered to mouse pups by intragastric intubation throughout postnatal days (PDs) 3 to 20. Intubation control (IC) and untreated control (C) groups were included. Blood alcohol concentration was measured in separate groups of pups on PDs 3, 10, and 20 at 4 different time points, 1, 1.5, 2, and 3 hours after the second intubation. Numbers of neurons in the ganglion cell layer and in the dLGN were quantified on PD20 using unbiased stereological procedures. RGC morphology was imaged by confocal microscopy and analyzed using Neurolucida software. Results: Binge‐like ethanol exposure in mice during the early postnatal period from PDs 3 to 20 altered RGC morphology and resulted in a significant decrease in the numbers of neurons in the ganglion cell layer and in the dLGN. In the alcohol exposure group, out of 13 morphological parameters examined in RGCs, soma area was significantly reduced and dendritic tortuosity significantly increased. After neonatal exposure to ethanol, a decrease in total dendritic field area and an increase in the mean branch angle were also observed. Interestingly, RGC dendrite elongation and a decrease in the spine density were observed in the IC group, as compared to both ethanol‐exposed and pure control subjects. There were no significant effects of alcohol exposure on total retinal area. Conclusions: Early postnatal ethanol exposure affects development of the visual system, reducing the numbers of neurons in the ganglion cell layer and in the dLGN, and altering RGCs’ morphology.     

CT引导下奇神经节脉冲射频热凝术治疗肛门会阴部疼痛的临床观察

目的 评估在CT定位下奇神经节脉冲模式射频热凝术治疗肛门会阴部疼痛的疗效.方法 肛门会阴部疼痛的患者26例,在CT引导下行奇神经节穿刺,采用射频疼痛治疗系统行脉冲模式射频热凝治疗,射频温度定位42℃,持续120 s,连续3次.观察并记录术前、术后VAS评分.结果 与射频热凝术前VAS评分（5.92±1.38）相比,患者于治疗后1 h VAS评分（2.86±1.75）明显降低（P〈0.05）,术后第1日VAS评分（3.58.±1.63）和第3日VAS评分（3.21±1.28）均明显降低（P〈0.05）.结论 奇神经节脉冲射频热凝术治疗肛门会阴部疼痛安全有效.     

超声引导下置管持续阻滞星状神经节治疗周围性面神经麻痹的体会

目的评估超声引导下置管持续星状神经节阻滞术治疗周围性面神经麻痹的临床价值。方法周围性面神经麻痹患者12例在超声显像确认颈6横突后,置管于颈6～7横突之间,行持续星状神经节阻滞15d。结果全组均穿刺置管成功,出现霍纳综合征且未见相关并发症,痊愈9例,好转3例。结论在超声引导下置管持续星状神经节阻滞术是一种安全、有效治疗面神经麻痹的方法。     

Intraosseous ganglion cysts of the carpus: current practice

Intraosseous cysts of the carpal bones are an infrequent cause of chronic wrist pain. The main body of work has investigated their occurrence in the proximal carpus, with limited incidence in the distal row. We review the current literature on the treatment of symptomatic carpal cysts following the report of a 17-year-old male with a 12-month history of progressive right wrist pain due to an intraosseous ganglion of the trapezoid. This review explores the pathology of carpal cysts, their varying presentation and current treatments.     

Ultrasound of wrist and hand masses

Ultrasound is a useful tool to investigate soft tissue masses in the wrist and hand. In most situations ultrasound helps distinguish between a cyst and a tissue mass. This article provides a simple clinical approach to the use of ultrasound imaging for the diagnosis and preoperative assessment of wrist and hand masses.