A histological and anatomical profile of pacinian corpuscles from Dupuytren's contracture and the expression of nerve growth factor receptor

The etiology of Dupuytren's disease is unknown. The causes of the fibroplastic response of nodules, fibrosis of cords, and prominence of pacinian corpuscles are not evident. Histological and immunohistology differences in pacinian corpuscles from the hands of five patients with Dupuytren's disease compared with 17 Dupuytren's-free patients are presented. Histological sections of pacinian corpuscle specimens were stained with hematoxylin and eosin and immunostained for nerve growth factor receptor. The length and width of intact pacinian corpuscles were measured, and the number of layers within each corpuscle was counted and recorded. Grossly, the pacinian corpuscles from Dupuytren's patients were larger and more numerous compared with those from unaffected patients. When measured microscopically, the pacinian corpuscles from Dupuytren's diseased fascia were significantly larger (2.0 x 1.1 mm) compared with controls (1.5 x 0.78 mm). The pacinian corpuscles from Dupuytren's-affected patients had significantly more layers (64 +/- 14) compared with those from control patients (40 +/- 9). Nerve growth factor receptor staining of pacinian corpuscles from patients affected with Dupuytren's disease showed greater intensity and more area stained compared with unaffected controls. It is suggested that nerve growth factor may be involved in the increased size of pacinian corpuscles in Dupuytren's-affected fascia. It is proposed that the cellular outgrowth from pacinian corpuscles may generate the cells that develop into Dupuytren's nodules.     

Role of the Sympathetic Innervation of the Pacinian Corpuscle

An investigation was made into the nature of the role played by the noradrenergic innervation of the pacinian corpuscle. Corpuscles of the cat mesentery and mesocolon were used in all experiments. Blockade of noradrenergic beta receptors by dichloroisoproterenol and interference with norepinephrine release by reserpine are each capable of reversibly blocking mechanoelectric transduction by the pacinian corpuscle. The monoamine oxidase inhibitors iproniazid and phenelzine are capable of protecting the transducer from the blocking effects of reserpine. It is concluded that the presence of norepinephrine, as maintained by sympathetic tonus, is required for the afferent nerve terminal of the pacinian corpuscle to be mechanosensitive.     

The effect of cholinergic substances on individual mechanoreceptors--Pacinian corpuscles]

Acetylcholine and nicotine application to the intact pacinian corpuscle failed to stimulate the spike activity, but changed the sensitivity to the mechanical stimulation: low concentration (1.10(-6) g/ml) increased the sensitivity and high concentration (1.10(-4) g/ml) decreased it. This influence can be attributed to the action of these substances on the structures which generate the action potentials. Acetylcholine application to decapsulated pacinian corpuscles stimulated the appearance of the spike activity. This reaction was possibly connected with the acetylcholine influence on the mechanoreceptive zones proper. Tubocurarine or hexonium application of decapsulated pacinian corpuscles led to depression of the sensitivity of the receptor to the mechanical stimulation that can also be explained by the participation of acetylcholine in the process of adequate receptor stimulation.     

Intestinal Volvulus in Idiopathic Steatorrhea

Volvulus of the intestine has recently been observed in three patients with idiopathic steatorrhea in relapse. Two patients gave a history of intermittent abdominal pain, distension and obstipation. Radiographic studies during these attacks revealed obstruction at the level of the sigmoid colon. Reduction under proctoscopic control was achieved in one instance, spontaneous resolution occurring in the other. The third patient presented as a surgical emergency and underwent operative reduction of a small intestinal volvulus. Persistence of diarrhea and weight loss postoperatively led to further investigation and a diagnosis of idiopathic steatorrhea. In all cases, treatment resulted in clinical remission with a coincident disappearance of obstructive intestinal symptoms. The pathogenesis of volvulus in sprue is poorly understood. Atonicity and dilatation of the bowel and stretching of the mesentery likely represent important factors. The symptoms of recurrent abdominal pain and distension in idiopathic steatorrhea necessitate an increased awareness of intestinal volvulus as a complication of this disease.     

THE FINE STRUCTURE OF MEISSNER's TOUCH CORPUSCLES OF HUMAN FINGERS

Thin slices of the finger pads of six individuals were fixed in buffered 1 per cent osmic acid, embedded in deaerated, nitrogenated methacrylate, and cut into thin sections for electron microscopic study. Before embedding, the slices were trimmed so as to include several digital tactile corpuscles. Some thin sections were stained in 10 per cent aqueous phosphotungstic acid solution. The principal part of Meissner's corpuscle is made up of flattened laminar cells stretching across the corpuscle in irregular layers. The perinuclear cytoplasm of these cells contains numerous small mitochondria, a sparse granular endoplasmic reticulum, and a large number of small vesicles. Nerve fibers enter the side or base of the corpuscle, lose their myelin sheaths, and follow a meandering course between the laminar cell plates. The nerve endings enter into a close appositional relationship with the flattened portions of the laminar cells. In some areas the apposed axolemma and cell membranes are slightly thickened with small vesicles located along the cell membrane or on both surfaces. These regions are interpreted as synapses. The most prominent feature of the nerve endings is an extraordinary accumulation of small mitochondria which vary in size and internal density. The nerve endings also contain vacuoles, groups of dense concentric membranes, and small dense vesicles of irregular distribution. The laminar cells are separated from one another by a dense intercellular substance of uniform thickness which also envelops the entire corpuscle. This material contains randomly oriented collagen fibers and fine fibrils bound together by a dense material at nodal points recurring at regular intervals of approximately 120 mµ. These findings are discussed in relation to the problems of the function of Meissner's corpuscle, neural material loss and replacement, and the presence of synapses.     

家鸽Herbst小体对振动的反应特征

鸟类的Herbst小体是一种形态特殊的感觉性神经末梢器官.本文利用电生理学方法,研究了家鸽腿部胫骨-腓骨之间的Herbst小体对振动刺激的反应特征.这种小体对振动刺激非常敏感,当振动频率在600—800赫时,它们有反应的最低阈值约为0.3微米.不同的Herbst小体的反应阈值与频率的关系曲线表明:这种小体具有明显的带通滤波的特征,对振动反应的最佳频率范围为400—1000赫.在适宜频率、超阈值强度的振动刺激下,Herbst小体能以1:1的方式作出反应,即相对于每次正弦波振动刺激都有一个锁相的神经脉冲产生.在背根脊神经节内的细胞外记录表明:对振动敏感的神经节细胞具有和Herbst小体完全相似的反应特征.     

江豚背部小齿的超微结构与功能

长江江豚背部皮肤表面有一长条小齿,由1—3排组成。它是由表皮向体表突起而成。小齿区皮肤中的乳头深深伸入表皮,几达表面,它的高度在成体约占整个表皮厚度的70—80%,新生幼儿为84.6%。经研究,我们发现在小齿区皮肤中存在着大量类似于人类皮肤中的环层小体那样的被囊神经末梢和几种有鞘神经纤维束。根据这些结构,我们认为小齿是一种感觉器官,它并不能起到防止幼儿从母体背部滑落的作用。       

Exertional gastro-oesophageal reflux: a mechanism for symptoms in patients with angina pectoris and normal coronary angiograms.

During 24 hour oesophageal pH monitoring 52 patients who had angina pectoris and normal coronary angiograms underwent exercise testing, as far as their symptoms allowed, on a treadmill to determine whether gastro-oesophageal reflux occurred during exertion. In 11 patients the 24 hour oesophageal pH score was abnormally high; 10 of these showed exertional gastro-oesophageal reflux, and in nine this was associated with their usual chest pain. A further 13 patients had a normal 24 hour pH score but had exertional reflux coincident with chest pain during exercise testing. The mean lower oesophageal sphincter pressure in both of these groups of patients was appreciably lower than that in 28 patients who had a normal 24 hour pH score and no exertional reflux. These findings suggest that exertional gastro-oesophageal reflux accounts for the symptoms of a large proportion of patients who have angina pectoris and normal coronary angiograms and that oesophageal pH monitoring during exercise testing on a treadmill enables this group of patients to be identified.     

Tonsillolithiasis and orofacial pain

Tonsilloliths are rare calcified structures that usually result from chronic inflammation of the tonsils. Concretions show differences in size, shape and colour. They are usually asymptomatic but can be associated with halitosis, foreign body sensation, dysphagia and odynophagia, otalgia, and neck pain. A patient was referred because panoramic radiography performed by a general dentist revealed radiopaque shadows over the ascending rami of the mandible, located bilaterally: a solitary structure on the higher portion of the right side and two small structures on the left side. Paroxysmal attacks of orofacial pain and symptoms such as dysphagia and swallowing pain on the left side distributed within the tonsillar fossa and pharynx and the angle of the lower jaw were present. The computed tomography images revealed bilateral tonsilloliths. Clinically, there was no sign of inflammation, and the patient's past history revealed an approximately 2-year history of dysphagia, swallowing pain and left-sided neck pain. At the request of the patient, no surgical intervention was carried out. Glossopharyngeal neuralgia is a rare entity, and the aim of this report was to indicate the importance of tonsilloliths as a cause of orofacial pain.     

Retrocardiac mass causing collapse

A 78-year-old man with a history of hypertension presented to the emergency room after the sudden onset of near-collapse, dyspnoea, dizziness, and nausea. Symptoms had started while the patient was stooped over in an attempt to reach for an item underneath his bed. The patient reported upper abdominal pain, radiating to his back. Prior to his presenting symptoms he had no complaints, nor had he suffered from trauma.     

Traumatic Pseudoaneurysm of Axillary Artery Combined with Brachial Plexus Injury

Traumatic pseudoaneurysm of the axillary artery combined with brachial plexus injury is extremely rare. The factors that influence the symptoms and functional recovery related to this condition are unclear. Nine patients who had sustained this trauma were surgically treated at our unit between June 1999 and November 2010. The cause of trauma, symptoms, signs and examinations of neurological and vascular deficits, and the surgical findings of the involved nerves and vessels were recorded in detail. The functional recovery of vessels and nerves, as well as the extent of pain, were evaluated, respectively. The average length of patient follow-up was 4.5 years (range, 24 months to 11.3 years). After vessel repair, whether by endovascular or operative treatment, the distending, constant, and pulsating pain was relieved in all patients. Furthermore, examination of the radial artery pulse on the repaired side appeared normal at last follow-up. All patients showed satisfactory sensory recovery, with motor recovery rated as good in five patients and fair in four patients. The symptom characteristics varied with the location of the damage to the axillary artery. Ultrasound examination and computed tomography angiography are useful to evaluate vascular injury and provide valuable information for operative planning. Surgical exploration is an effective therapy with results related to the nerve injury condition of the brachial plexus.     

Diagnosis and management of 528 abdominal aortic aneurysms.

Between 1960 and 1979 528 patients with abdominal aortic aneurysms presented to the university department of surgery. Of these, 222 (42%) were elective cases, 72 acute (14%), 174 had ruptured (33%), and four had had a spontaneous aortoduodenal fistula (1%). In all these patients resections were undertaken, but in another 56 patients (11%) the aneurysm was not resected. A review of these cases showed that 91% had symptoms at their first presentation; abdominal pain and backache being most common. The diagnosis could be established in 91% by the presence of pulsatile abdominal mass on clinical examination. The operative mortality for elective resection was 8%, for acute 19%, for ruptured cases 42%, and for spontaneous aortoduodenal fistula 50%. After successful resection the overall five-year survival was 65% by the life table method, and there was no significant difference between elective, acute, and ruptured cases. This five-year survival after resection compares favourably with the expected 76% survival of a similar normal population, and was considerably better than that for conservatively treated patients. As most cases have symptoms, and diagnosis may be established easily by routine physical examination in 91%, the prognosis for this condition could be considerably improved by increased awareness of its existence and early referral for treatment as an elective surgical procedure.     

肺隐球菌病12例临床分析

目的 提高对隐球菌病的认识.方法 对确诊为肺隐球菌病的12例病例的临床资料进行回顾性分析.结果 12例病例中,男性8例,女性4例,年龄31～68岁,平均年龄(51.8±12.6)岁,6例伴有基础疾病,但无1例有鸟类接触史;有临床症状者10例,其中咳嗽8例,咯痰3例,胸痛4例,发热2例,有体征者仅2例;胸部影像表现为:1...     

Reaction to stainless steel wire following orthognathic surgery.

A patient is reported in whom, following orthognathic surgery, developed a bilateral burning sensation and pain along the masseteric muscles and preauricular region in the sight of the mandibular osteotomy where the lateral segment was tied to the medial segment using a single wire loop. This patient also had previous Kirschner wires used for a metatarsal osteotomy that needed to be removed because of similar symptoms. Removal of the mandibular wires resulted in elimination of the symptoms from the mandibular region as well. The patient's subsequent skin test proved a nickel allergy.     

Mediastinal pancreatic pseudocyst--a case report and review of the literature

Pancreatic pseudocyst, a common complication of acute or chronic pancreatitis, in rare instances may also extend to the mediastinum. A case of 67-year-old woman presenting with a triad of chest pain, dysphagia, and dyspnea is presented. The patient had an episode of acute alcoholic pancreatitis 1 year before presentation. Chest radiography on admission showed a retrocardiac opacity. Two-dimensional echocardiography revealed an echolucent mass compressing the left atrium. A subsequent upper gastrointestinal series for her dysphagia showed extrinsic compression of the distal esophagus. Finally a definitive diagnosis was made with computed tomography (scan), which revealed a 19 x 12 cm pseudocyst extending from the body of pancreas into the thorax and compressing the esophagus and the cardiac chambers. A mediastinal pseudocyst can cause symptoms due to compression or invasion of surrounding structures. The fluid collection may enlarge slowly and hence the symptoms can be delayed as in our patient. The pseudocyst was successfully treated using endoscopic ultrasound-guided transesophageal drainage. Approximately 50 cases of mediastinal extension of the pancreatic pseudocyst in the world literature are reported. At this time, this is only the second time that successful drainage of a mediastinal pseudocyst using a transesophageal approach under endoscopic ultrasound guidance has been reported. The literature was reviewed for clinical presentation, complications, and available treatment options for mediastinal pancreatic pseudocysts.     

Managing gynaecological emergencies with laparoscopy.

A consecutive series of 49 women (50 procedures), whose conditions were haemodynamically stable, presenting with acute lower abdominal pain, pelvic tenderness, and either a urine concentration of greater than 50 U/l beta human chorionic gonadotrophin or a pelvic mass shown by ultrasonography were treated with operative laparoscopy under video monitoring (videopelviscopy) as an alternative to laparotomy. Ectopic pregnancy, ovarian and non-ovarian cysts, pelvic adhesions, endometriosis, and fibroids were found, for which salpingotomy, salpingectomy and salpingo-oophorectomy, cystectomy, adhesiolysis, thermocoagulation, and myomectomy were carried out by laparoscopy. In one patient pelviscopy was repeated because of persistent tubal pregnancy after the fimbria was expressed. Laparotomies were carried out on three patients because treatment was not possible by laparoscopy and on a further patient two days after adhesiolysis had been attempted. These were the only serious complications. For the 46 cases (45 patients) in which operative laparoscopy was successful the mean stay in hospital was 1.9 days after operation, and this group of patients returned to normal activities and to work after an average of 2.3 and 2.6 weeks respectively. Most gynaecological emergencies that are managed by laparotomy can be treated by laparoscopy and benefit both patients and the health service.     

Opitz-C syndrome: on the nosology of mental retardation and trigonocephaly.

We report on two patients with a complicated form of trigonocephaly. The first patient has the Opitz-"C"-trigonocephaly syndrome. The second patient had initially a delayed motor development, but finally attained normal intelligence. A review of 22 patients with Opitz-C syndrome from the literature is presented. Most of the typical facial dysmorphism can be regarded as part of a trigonocephaly "sequence" rather than presenting characteristic features of a syndrome. More specific are the intra-oral anomalies, abnormally modelled ears, cardiac anomalies and neonatal hypotonia. All surviving patients are severely retarded. Since almost all patients are sporadic cases we suggest that the "C"-syndrome is a cytogenetically yet undetectable microdeletion syndrome.     

The effectiveness of surgical and nonsurgical interventions in relieving the symptoms of macromastia

In this report, the authors evaluate the effectiveness of breast reduction in alleviating the symptoms of macromastia by comparing baseline and postoperative health status using a series of well-validated self-report instruments. The study had a prospective design with a surgical intervention group and two control groups: a hypertrophy control group with bra cup sizes D or larger and a normal control group with bra cup sizes less than D. The effectiveness of nonsurgical interventions in relieving the symptoms of macromastia was also evaluated, both in the operative subjects and in the control groups.Surgical candidates and controls completed a self-administered baseline survey that consisted of the following validated and standardized instruments commonly used to evaluate outcomes: SF-36, EuroQol, Multidimensional Body-Self Relations Questionnaire (MBSRQ), and the McGill Pain Questionnaire (MPQ). A specially designed and validated instrument, the Breast-Related Symptoms (BRS), was also used. There were also questions about prior nonsurgical treatments, comorbid conditions, bra size, and a physical assessment. Additional information obtained on the operative subjects included surgical procedure data, resection weight, and complications. Approximately 6 to 9 months postoperatively, surgical subjects completed the same questionnaire as described above, and a final physical assessment was performed.The cohort included 179 operative subjects with matched preoperative and postoperative data sets, 96 normal controls and 88 hypertrophy controls. The women were predominantly Caucasian, middle-aged, well educated, and employed. Fifty percent of the operative subjects reported breast-related pain all or most of the time in the upper back, shoulders, neck, and lower back preoperatively compared with less than 10 percent postoperatively. Operative subjects and hypertrophy controls tried a number of conservative treatments, including weight loss, but none provided adequate permanent relief. Compared with population norms, the preoperative subjects had significantly lower scores (p < 0.05) in all eight health domains of the SF-36, and in the mental and physical component summary scores. After surgery, the operative subjects had higher means (better health) than national norms in seven of the eight domains and improved significantly from presurgical means in all eight domains (p < 0.05). Before surgery, the operative subjects reported high levels of pain with a Pain Rating Index (PRI) score from the MPQ of 26.6. After surgery, pain was significantly lower with a mean PRI score of 11.7, similar to that of our controls (mean PRI score, 11.2). Regression analysis was used to control for covariate effects on the main study outcomes. Among the operative subjects, benefits from breast reduction were not associated with body weight, bra cup size, or weight of resection, with essentially all patients benefiting from surgery.Breast hypertrophy has a significant impact on women's health status and quality of life as measured by validated and widely used self-report instruments including the SF-36, MPQ, and EuroQol. Pain is a significant symptom in this disease, and both pain and overall health status are markedly improved by breast reduction. In this population, conservative measures such as weight loss, physical therapy, special brassieres, and medications did not provide effective permanent relief of symptoms.     

Patellofemoral knee pain treatment using neuromuscular retraining of the hip musculature in an adolescent female: a case report

The purpose of this case study is to demonstrate the treatment of patella-femoral knee pain in an adolescent female athlete with emphasis on neuromuscular training of the knee and hip in synergy movement strategies. A 1.67-m, 61.5-kg, 15-year-old woman athlete reported to rehabilitation with the complaint of a 1-year history of bilateral knee pain. The patient noted that the symptoms were exacerbated with any sports-specific training. The patient played softball as an infielder. The athlete was referred by her family practice physician. After the patient was assessed, a clinical hypothesis was generated. It was thought that neuromuscular dysfunction of the hips and knees was causing faulty knee mechanics. These abnormal mechanics were presenting as patella-femoral knee pain. Initially, the athlete was assigned a home exercise program of side-lying hip abduction and lateral step-downs. At her first follow-up appointment, she noted increased symptoms that were aggravated with her home program. Upon inspecting her exercise technique, faulty step-down mechanics were contributing to her symptoms. Step-downs were discontinued, and the patient was instructed in and performed a chair squatting exercise, which was added to her home program. At her next follow-up, the patient noted being asymptomatic for 2 days. Her exercises were increased in intensity to include a Stairmaster and hip abduction and adduction on a 4-way hip machine. Eventually, over her treatment course, perturbation and proprioceptive training were initiated. By the sixth visit, the patient reported no symptoms and felt comfortable with self-management. A phone interview 3 months later indicated that the patient had no recurrent symptoms and was participating in sports without difficulty. This case demonstrates effectiveness of using hip and knee joint synergy to treat patella-femoral pain (PFP). The use of this synergy promotes proper patella–femoral alignment and improved knee mechanics. This case also is unique in the lack of physical agents and taping used to improve the patient's condition. It reinforces how exercise technique can carry over to functional athletic activities. This study provides a case for the use of hip and knee mechanical retraining in the treatment of PFP in adolescent female athletes who do not exhibit abnormal foot mechanics in weight bearing. It is important that sports medicine professionals be aware of these treatment options and are able to use them to correct these deficits in order to facilitate return to training and competition as quickly and safely as possible.     

Effect of herbal therapy on herpes labialis and herpes genitalis

Administration of hot water extracts of six herbs to four patients with recurrent herpes labialis led to prompt crusting over and complete recovery within a few days. Similar treatment for one female patient who had been suffering from recurrent genital herpes resolved the associated pain dramatically. In all cases mentioned, symptoms disappeared much more quickly than with previous outbreaks when herb extracts were not administered.