Infraorbital nerve injury triggers sex-specific neuroimmune responses in the peripheral trigeminal pathway and common pain behaviours

Trigeminal neuropathic pain is emotionally distressing and disabling. It presents with allodynia, hyperalgesia and dysaesthesia. In preclinical models it has been assumed that cephalic nerve constriction injury shows identical molecular, cellular, and sex dependent neuroimmune changes as observed in extra-cephalic injury models. This study sought empirical evidence for such assumptions using the infraorbital nerve chronic constriction model (ION-CCI). We compared the behavioural consequences of nerve constriction with: (i) the temporal patterns of recruitment of macrophages and T-lymphocytes at the site of nerve injury and in the trigeminal ganglion; and (ii) the degree of demyelination and axonal reorganisation in the injured nerve. Our data demonstrated that simply testing for allodynia and hyperalgesia as is done in extra-cephalic neuropathic pain models does not provide access to the range of injury-specific nociceptive responses and behaviours reflective of the experience of trigeminal neuropathic pain. Similarly, trigeminal neuroimmune changes evoked by nerve injury are not the same as those identified in models of extra-cephalic neuropathy. Specifically, the timing, magnitude, and pattern of ION-CCI evoked macrophage and T-lymphocyte activity differs between the sexes.

The differences in the anatomy of the thoracolumbar and sacral autonomic outflow are quantitative

PURPOSE

We have re-evaluated the anatomical arguments that underlie the division of the spinal visceral outflow into sympathetic and parasympathetic divisions.

METHODOLOGY

Using a systematic literature search, we mapped the location of catecholaminergic neurons throughout the mammalian peripheral nervous system. Subsequently, a narrative method was employed to characterize segment-dependent differences in the location of preganglionic cell bodies and the composition of white and gray rami communicantes.

RESULTS AND CONCLUSION

One hundred seventy studies were included in the systematic review, providing information on 389 anatomical structures. Catecholaminergic nerve fibers are present in most spinal and all cranial nerves and ganglia, including those that are known for their parasympathetic function. Along the entire spinal autonomic outflow pathways, proximal and distal catecholaminergic cell bodies are common in the head, thoracic, and abdominal and pelvic region, which invalidates the "short-versus-long preganglionic neuron" argument. Contrary to the classically confined outflow levels T1-L2 and S2-S4, preganglionic neurons have been found in the resulting lumbar gap. Preganglionic cell bodies that are located in the intermediolateral zone of the thoracolumbar spinal cord gradually nest more ventrally within the ventral motor nuclei at the lumbar and sacral levels, and their fibers bypass the white ramus communicans and sympathetic trunk to emerge directly from the spinal roots. Bypassing the sympathetic trunk, therefore, is not exclusive for the sacral outflow. We conclude that the autonomic outflow displays a conserved architecture along the entire spinal axis, and that the perceived differences in the anatomy of the autonomic thoracolumbar and sacral outflow are quantitative.

Natural History of Pediatric Hand and Wrist Ganglion Cysts: Longitudinal Follow-Up of a Prospective, Dual-Center Cohort

PURPOSE

This investigation describes the outcomes of pediatric ganglion cysts in a prospective cohort that elected not to undergo cyst aspiration or surgical treatment. Our primary aim was to investigate the rate of spontaneous resolution over time among the subset of patients who did not undergo specific treatments.

METHODS

Children (aged ≤18 years) who presented to the clinic with ganglion cysts of the hand or wrist were enrolled in a prospective two-center registry between 2017 and 2021. Enrolled subjects who never elected to undergo cyst aspiration or surgical treatment were analyzed. The data collected included age, sex, cyst location and laterality, hand dominance, Wong-Baker pain scale scores, and Patient-Reported Outcome Measurement Information System upper-extremity scores. Follow-up surveys were completed for up to 5 years.

RESULTS

A total of 157 cysts in 154 children, with an average age of 9.4 years and a female-to-male ratio of 1.4:1, were eligible. The most common ganglion location was dorsal wrist (67/157, 42.7%), followed by volar wrist (49/157, 31.2%), the flexor tendon sheath (29/157, 18.5%), and the extensor tendon synovial lining (8/157, 5.1%). The average follow-up duration was 2.5 years after initial presentation to the clinic, and 63.1% (99/157) of the patients responded to follow-up surveys. Among them, 62.6% (62/99) of cysts spontaneously resolved; the resolution rates ranged from 51.9% of volar wrist ganglions to 81% of flexor tendon sheath cysts, with an average time to resolution of 14.1 months after cyst presentation. Cysts were more likely to resolve in the hand than in the wrist (84.0% vs 55.4%, respectively). Cysts present for >12 months at initial evaluation were less likely to resolve spontaneously (41.2% vs 67.1%).

CONCLUSIONS

Of children who elected not to undergo aspiration or surgical treatment, approximately two-thirds of families reported that their child's ganglion cyst resolved spontaneously. Cysts that resolve spontaneously usually do so within 2 years of presentation.

TYPE OF STUDY/LEVEL OF EVIDENCE

Therapeutic IV.

'Arm brains' (axial nerves) of Jurassic coleoids and the evolution of coleoid neuroanatomy

Although patchy, the fossil record of coleoids bears a wealth of information on their soft part anatomy. Here, we describe remains of the axial nerve cord from both decabrachian (Acanthoteuthis, Belemnotheutis, Chondroteuthis) and octobrachian (Plesioteuthis, Proteroctopus, Vampyronassa) coleoids from the Jurassic. We discuss some hypotheses reflecting on possible evolutionary drivers behind the neuroanatomical differentiation of the coleoid arm crown. We also propose some hypotheses on potential links between habitat depth, mode of life and the evolution of the Coleoidea.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13358-023-00285-3.

A Pilot Study: Transcriptional Profiling, Functional Analysis, and Organoid Modeling of Intestinal Mucosa in Hirschsprung Disease

BACKGROUND

Hirschsprung disease (HSCR) is a congenital colonic aganglionosis. Many HSCR patients develop enterocolitis despite surgical resection. The pathophysiology of this inflammatory process is poorly understood. We compared transcriptional profiles and function of ganglionic and aganglionic tissue in HSCR patients.

METHODS

RNA sequencing was performed on mucosal tissues from HSCR patients (n = 6) and controls (n = 3). Function of matched ganglionic and aganglionic regions were investigated utilizing organoids generated from these tissues.

RESULTS

Transcriptional differences observed in ganglionic and aganglionic regions of HSCR patients included upregulation of genes involving inflammation, cell differentiation and proliferation as well as decreased expression of genes encoding mucins compared to controls. Organoids derived from ganglionic and aganglionic regions of HSCR patients were similar in epithelial cell differentiation, epithelial barrier formation and response to stimulation with bacterial metabolites and pro-inflammatory cytokines.

CONCLUSIONS

Despite normal ganglionic structure, the section of colon adjacent to the aganglionic region in HSCR patients has perturbed gene expression which resembles the aganglionic segment. Transcriptional and functional changes in colonic epithelium are persevered in the ganglionic colon used for pull-through surgery. This may explain persistence of enterocolitis despite surgical excision of aganglionic colon and subsequent endorectal pull-through performed with ganglionic colon during correction of HSCR.

LEVEL OF EVIDENCE

N/A.

Effects of intra-nasal melanocortin-4 receptor antagonist on trigeminal neuropathic pain in male and female rats

Treatment of chronic orofacial pain remains a major therapeutic challenge despite available medications. Melanocortins have been implicated in pathologic pain. Intrathecal administration of MC4R antagonists has been shown to alleviate neuropathic pain (NP) in male rats. However, intrathecal delivery is very invasive and requires surgeon's intervention. Intra-nasal rout offers a non-invasive drug delivery method that can be self-administered making it very attractive clinically. In this study, we investigated the effects of intra-nasally delivered MC4R antagonist (HS014) on trigeminal neuropathic pain (TNP) in male and female rats. We also measured the MC4R protein levels in the trigeminal ganglia (TG) and infraorbital nerve (ION) of rats. We used ION chronic constriction injury (ION-CCI) to induce TNP in rats. We used von Frey and pinprick assays to measure the development of hypersensitivity in the face following ION-CCI. At 22 days post-ION-CCI, we delivered HS014 intra-nasally to measure its effects on TNP in rats. We used enzyme linked immunosorbent assay to measure MC4R protein levels in the TG and ION. ION-CCI resulted in a significant increase of MC4R protein levels in the ipsilateral TG and ION of male and female rats. Intra-nasal delivered HS014 resulted in a significant reduction of ION-CCI induced hypersensitivity in male and female rats. These results demonstrate that intranasal delivery of MC4R antagonist alleviated TNP in male and female rats and suggest that such treatment could be beneficial therapeutically for individuals with chronic NP.

The Key to a Successful PBC in Treatment of Trigeminal Neuralgia

As a minimally invasive treatment of trigeminal neuralgia, percutaneous balloon compression (PBC) has become increasingly popular worldwide. Because it is simple and straightforward, it does not need a complicated apparatus only a fluoroscope plus an operator's experience. Therefore, the surgical technique seems to be essential and worth further addressing. The paper stresses that the target of PBC should be the semilunar ganglion (the soma of neurons) rather than the rootlets (axons) because the latter is renewable. To obtain a sufficient pressure against the ganglion, Meckel's cave should be covered utterly by an inflating balloon, which fluoroscopically appears in a pear shape. To attain a proper balloon position, it is suggested to make a tunnel with a blunt stylet in a proper penetrative angle before inserting a soft catheter. Too large a pear is unnecessary, hence injecting should be stopped when growth becomes apparently slow. To avoid an unacceptable postoperative paresthesia, a prolonged compression is not encouraged.

History and Recent Progress in Carotid Body Studies

This chapter describes the history of the carotid body (CB) and the subsequent research on its structure and function. The chronological development of ideas about its anatomical structure as a ganglion, the first descriptions of its glandular nature as a ball of highly vascular tissue (glomus), the discovery of its neural crest origin and relevant embryological views as a true paraganglion toward a more conclusive understanding of its sensory nature as a chemoreceptor for chemical changes in blood have been consistently demonstrated. The knowledge of the CB neurochemistry, physiology and pathophysiology has progressed immensely in the past century and a large and compelling body of evidence for the presence of a neurogenic niche in the CB has accumulated over the last two decades, thus underlying its function and possibility for the development of cell replacement therapies.

Visualization of the location and level of pain in common wrist pathologies using color-coded heatmaps

BACKGROUND

Pain of the hand and wrist affects a large patient population. If the onset is unrelated to recent trauma, the first medical contact is rarely established with a specialized hand surgeon.

OBJECTIVE

The objective of this investigation was to (1) visualize the localization of hand pain using pain-related heatmaps in common wrist pathologies, (2) to test whether differences between these pathologies exist with regard to sociodemographic and pain-related aspects, and (3) to evaluate the major patient-reported complaints associated with the pathologies.

METHODS

This observational cross-sectional study included patients suffering from: thumb basal joint arthritis (CMC-1-OA), dorsal wrist ganglions, and TFCC tears. Patients marked the location of maximum pain projection on hand graphics depicting the outline of the palmar and dorsal hand. Color-graded frequency heat maps were generated for the wrist pathologies investigated. Daily life impairments were assessed and clustered into groups of functions/activities.

RESULTS

120 patients with a mean age of 44.3 years were investigated. The diagnostic groups showed significant differences regarding the level and location of pain, as well as daily life impairments. Patients with CMC-1-OA presented with increased pain levels compared to patients with dorsal wrist ganglions and TFCC tears. Daily life impairment was rated highest when household chores were adversely affected, and sport activities were symptomatic/painful. All groups showed significant skin surface pain projection, which was visualized in heatmaps. While general trends in pain localization were visible, pain levels were also reported distal/proximal and palmar/dorsal to the pathology.

CONCLUSIONS

Knowledge of main demographic parameters, pain projection, and degree of impairment in daily activities can help physicians to narrow differential diagnosis of wrist pain during first patient contact. Patients should then be referred to hand surgeons for specialist examination, to further differentiate the origin of the pain.

Snapping Sartorius tendon due to a medial knee ganglion: an unusual cause of medial knee pain

Snapping of knee could be due to plethora of causes. We describe a case of snapping of Sartorius over a medial knee ganglion that was treated successfully by ultrasound guided aspiration with complete resolution of symptoms.

The management of foot and ankle ganglia: A scoping review

PURPOSE

A ganglion cyst is a benign soft tissue swelling filled with hyaluronic acid and other mucopolysaccharides. Whilst they most commonly present in the wrist region, their occurrence in the foot and ankle is not rare. This scoping review aims to systematically map and summarise current evidence regarding the management of ganglia of the foot and ankle, whilst identifying areas for further research.

METHODS

This scoping review follows the frameworks of Arksey and O'Malley, Levac and Peters. A comprehensive search strategy was used to identify relevant articles, before a two-stage screening process was performed independently by two reviewers.

RESULTS

A total of 2286 unique articles were identified, of which 12 were included in the review. A variety of conservative and surgical treatment strategies are reported, showing good outcomes. An overall pooled recurrence rate of 29.5% was seen across 8 studies. Aspiration alone showed the highest recurrence rate (78.1%), followed by aspiration and steroid injection (62%), steroid injection alone (37.5%) and surgical excision (17.6%). The pooled complication rate across six studies was 21/261 (8.0%), with the most common complication being paraesthesia, reported in 14/261 (5.4%) patients.

CONCLUSIONS

There is a lack of high-quality research currently regarding the treatment of foot and ankle ganglia. Limited evidence suggests that there could potentially be associations between time to treatment, ganglion location and extent of surgical resection and recurrence rate. However, further research is required before any definitive conclusions can be drawn.

Penlight versus Smartphone: Diagnostic Efficacy of Transillumination

Background: The purpose of this study was to compare the diagnostic accuracy of a smartphone flashlight to a conventional penlight with regards to transillumination of simulated soft tissue masses of the hand and wrist. Methods: Eight participants performed transillumination assessments in a fresh frozen cadaver upper extremity model. Spheres measuring 9.5 mm were used to simulate fluid-filled or solid soft tissue masses. Two spheres were placed on the volar aspect and two on the dorsal aspect of the wrist. These were then evaluated with either a smartphone flashlight or penlight. Participants noted whether each sphere did or did not transilluminate. Each participant performed two evaluations at an interval of 3 weeks. Results: The overall sensitivity, specificity and accuracy of the smartphone were 100%, 44% and 72%, respectively. The overall sensitivity, specificity and accuracy of the penlight were 100%, 75% and 88%, respectively. The difference in accuracy between the smartphone group and penlight group was statistically significant (p = 0.029). The kappa value, indicating intra-observer agreement, for the smartphone group and penlight group was 0.76 and 0.76, respectively. Conclusion: In conclusion, transillumination with a penlight is a viable adjunct to the examination of soft tissue masses of the hand and wrist. The use of a smartphone flashlight, while convenient, is less accurate than a penlight and can lead the examiners to misinterpret the composition of soft tissue masses. Level of Evidence: Level IV (Diagnostic).

Volar Ganglion Cyst and Echo-Guided Assistance for the Arthroscopic Removal

The ganglion of the wrist is very common but with uncertain prognosis. The arthroscopic resection seems to improve the result compared with open procedure, in decreasing recurrence and morbidity. Volar ganglions are close to the radial artery, the flexor pollicis longus tendon, and even the median nerve. Ultrasonography combined with arthroscopy offers incomparable safety for the resection of volar ganglions. The technical steps of this combined procedure are described, and the first published series are discussed.

Bilateral ganglion cysts at L4/5 causing central canal stenosis and producing sciatica and neurogenic claudication: a case report

Symptomatic bilateral juxtafacet ganglion cysts are relatively uncommon in the degenerated spine. The literature describes 16 cases of bilateral ganglion or synovial cysts, none reported sciatica and neurogenic claudication simultaneously. We present a case of a 60-year-old woman who presented with symptoms of bilateral sciatica and neurogenic claudication. Magnetic resonance imaging of the lumbar spine revealed bilateral lesions related to the facet joints at the L4/5 level, causing bilateral lateral recess stenosis and narrowing of the central canal due to encroachment of these bilateral lesions at the same level. She underwent an elective central canal decompression of the L4/5 level and excision of the facet cysts bilaterally with lateral recess decompression, which resulted in good relief of both the radicular and claudication symptoms.

Intraarticular injection of the interphalangeal joint for therapy of digital mucoid cysts

Mucoid cysts are associated with osteoarthritis (OA) of the digital joints and frequently recur after needle drainage, injection, or surgical ablation. This study determined whether intraarticular injection of the adjacent interphalangeal joint rather than the cyst itself might be effective in resolving digital mucoid cysts. Using paired case series design and sterile technique, 25 consecutive OA digital joints with an adjacent mucoid cyst underwent dorsal non-transtendinous intraarticular injection with a 25-gauge needle and 20-mg triamcinolone acetonide, followed by puncture and manual expression of cyst fluid. Patient pain was measured with the 10-cm Visual Analogue Pain Scale prior to the procedure and at 6 months. Cyst resolution was determined at 6 months and 3 years. The subjects were 61.0 ± 7.7 years old and 60% (15/25) female. Mucoid cysts were adjacent to 19 distal interphalangeal, 3 metacarpophalangeal, and 3 interphalangeal joints. Pre-procedural pain was 4.7 ± 1.0; procedural pain was 6.2 ± 0.6 cm, and post-procedural pain at 6 months was 1.2 ± 0.8 cm (74.5% reduction, 95% CI of difference: 3.0 < 3.5 < 4.0 (p < 0.0001)). 84% (21/25) of the cysts resolved at 6 months; however, 60% (15/25) of the mucoid cysts recurred within 3 years and required retreatment (14 adjacent joints re-injected and 1 ablative cyst surgery). No complications were noted. Intraarticular corticosteroid injection using a dorsal non-transtendinous approach of the joint adjacent to a mucoid cyst is effective resolving cysts and reducing pain at 6 months; however, 60% of mucoid cysts reoccur within 3 years and may require reinjection or surgery.Trial registration: This was not a clinical trial.

The triple technique: A simple and effective outpatient procedure for the dorsal wrist ganglion

BACKGROUND

Dorsal ganglia are the most common types of wrist ganglia. Though largely asymptomatic, they can cause pain, stiffness and require treatment. The different methods described for the management have high recurrence rates even up to 70%. We describe a new method which combines 3 of these methods thus aiming to achieve the best from each of the techniques.

METHODS

A prospective observational study was undertaken to include patients requiring surgery for dorsal ganglion. The method involved a combination of aspiration, steroid instillation and tranfixation with silk suture for 3 weeks. Various demographic parameters, operative variables and functional criteria like QuickDASH Score and Numerical Pain Rating scale (NPRS) were used. The patients were followed up for atleast 24 months. Overall satisfaction rate was also recorded.

RESULTS

83 patients were included with a mean age of 31.7 ± 12.4 years. The mean duration of surgery was 12.0 ± 4.9 min and follow up was 29.8 ± 7.1 months. 15 patients had complex multilobulated ganglia. The most common indication for surgery was cosmesis. 4 complications were encountered of which 2 were superficial infections, 1 whitish discoloration locally and 1 case of persistent pain. We achieved a success rate of 95.2% with only 4 recurrences with a mean reduction in size to be 82.2 ± 5.8%. NPRS and QuickDASH scores improved significantly. Mean satisfaction rate was 89% and 84.3% wished to have the surgery again for a similar complaint. The loss of work was 2.5 ± 1.4 days.

CONCLUSIONS

Triple Technique is an effective and safe technique with <5% recurrence at 2 years.

Evaluation of occupational therapy-led advanced practice hand therapy clinics for patients on surgical outpatient waiting lists at eight Australian public hospitals

STUDY DESIGN

This is a prospective cohort study.

INTRODUCTION

Evidence is emerging that advanced practice hand therapy clinics improve patient outcomes.

PURPOSE OF THE STUDY

The aim of this study was to evaluate an advanced practice hand therapy model of care for patients with chronic hand conditions on surgical outpatient waiting lists at eight Australian public hospitals.

METHODS

Nonurgent and semiurgent patients were screened and treated, as required, by an advanced practice hand therapist and then discharged from the surgical outpatient waiting list as appropriate. Outcomes included patient safety, impact on the waiting list, patient satisfaction, and patients' perception of change as measured by Global Rating of Change (GROC). The GROC score was also compared across diagnoses. The relationship between the waiting time and need for surgical review during hand therapy treatment was also assessed. As appropriate, T-tests and analysis of variance were used for statistical analyses.

RESULTS

A total of 37.2% of patients who commenced hand therapy were removed or discharged from the surgical outpatient waiting lists. Of the subset of patients who completed hand therapy (n = 1116), 28.4% were discharged without requiring surgical follow-up. A further 7.53% requested return to the waiting list despite discharge being recommended. The model of care was safe, and patient satisfaction was above 90%. The mean GROC score was +2.09 (±3.58) but varied across diagnoses with trigger finger or trigger thumb showing the greatest improvement (+4.21 ± 2.92, P < .01). Patients who did not require surgical consultation during hand therapy had a shorter wait time for their initial hand therapy appointment (P < .001).

CONCLUSIONS

The advanced practice hand therapy model of care was safe and effective in reducing hospital surgical outpatient waiting lists. Patients reported high satisfaction.

Bilateral ganglion cysts at L4/5 causing central canal stenosis and producing sciatica and neurogenic claudication: a case report

Symptomatic bilateral juxtafacet ganglion cysts are relatively uncommon in the degenerated spine. The literature describes 16 cases of bilateral ganglion or synovial cysts, none reported sciatica and neurogenic claudication simultaneously. We present a case of a 60-year-old woman who presented with symptoms of bilateral sciatica and neurogenic claudication. Magnetic resonance imaging of the lumbar spine revealed bilateral lesions related to the facet joints at the L4/5 level, causing bilateral lateral recess stenosis and narrowing of the central canal due to encroachment of these bilateral lesions at the same level. She underwent an elective central canal decompression of the L4/5 level and excision of the facet cysts bilaterally with lateral recess decompression, which resulted in good relief of both the radicular and claudication symptoms.

Percutaneous ultrasound-guided ganglion fenestration in children: initial results

OBJECTIVE

To evaluate our pediatric experience with percutaneous ultrasound-guided fenestration of ganglia (PUGG).

MATERIALS AND METHODS

Retrospective study of pediatric patients who underwent PUGG from June 2016 to October 2018 at a free-standing tertiary referral academic children's hospital with a minimum of 6 months follow-up. Electronic medical records, picture archiving system, and post-procedural calls were utilized for patient demographics, lesion characteristics, procedure details, and recurrence. The procedure itself consisted of assessment by Child Life, application of topical anesthetic cream, sterile preparation and draping, and intra-procedural ultrasound guidance for local anesthetic instillation, ganglion aspiration, fenestration, and intra-remnant steroid instillation. Post-procedure care included an ice pack, compression dressing for 48 h, and 4 weeks of brace wear and activity restriction.

RESULTS

Forty-five patients met the inclusion criteria, ages 3-18 years, mean 13.5 years, and female to male ratio of 2:1. Ganglion locations consisted of 80% (36/45) in the wrist and 20% (9/45) in other locations (elbow, ankle, and foot). Ninety-eight percent (44/45) of procedures were performed non-sedated, including 20% (9/44) between ages 7 and 11 years. 28.9% (13/45) of ganglia recurred, the earliest at 3 weeks, the latest at 10 months, and an average of 3 months' time. No complication occurred and no patients required post-procedural narcotics or Emergency Department visitation for pain control.

CONCLUSION

Percutaneous ultrasound-guided fenestration of ganglia (PUGG) is a safe, minimally invasive alternative to surgical excision in the pediatric population, which can be performed without sedation and does not leave a scar.

[CME Sonography 97: Ultrasound Pathologies of the Hip]

CME Sonography 97: Ultrasound Pathologies of the Hip Abstract. Hip pain has a broad differential diagnosis. A clinical examination is not enough to determine the underlying cause. In most cases, sonography helps to narrow the differential diagnosis or to make a specific diagnosis. Furthermore, ultrasound allows a targeted and anatomically precise diagnostic aspiration or therapeutic infiltration. Examples are used to illustrate different pathologies by region.

[CME Sonography 97/Answers: Ultrasound Pathologies of the Hip]

CME Sonography 97/Answers: Ultrasound Pathologies of the Hip Abstract. Abstract: Hip pain has a broad differential diagnosis. A clinical examination is not enough to determine the underlying cause. In most cases, sonography helps to narrow the differential diagnosis or to make a specific diagnosis. Furthermore, ultrasound allows a targeted and anatomically precise diagnostic aspiration or therapeutic infiltration. Examples are used to illustrate different pathologies by region.

The Neurobiology of Ocean Change - insights from decapod crustaceans

The unprecedented rate of carbon dioxide accumulation in the atmosphere has led to increased warming, acidification and oxygen depletion in the world's oceans, with projected impacts also on ocean salinity. In this perspective article, we highlight potential impacts of these factors on neuronal responses in decapod crustaceans. Decapod crustaceans comprise more than 8,800 marine species which have colonized a wide range of habitats that are particularly affected by global ocean change, including estuarine, intertidal, and coastal areas. Many decapod species have large economic value and high ecological importance because of their global invasive potential and impact on local ecosystems. Global warming has already led to considerable changes in decapod species' behavior and habitat range. Relatively little is known about how the decapod nervous system, which is the ultimate driver of all behaviors, copes with environmental stressors. We use select examples to summarize current findings and evaluate the impact of current and expected environmental changes. While data indicate a surprising robustness against stressors like temperature and pH, we find that only a handful of species have been studied and long-term effects on neuronal activity remain mostly unknown. A further conclusion is that the combined effects of multiple stressors are understudied. We call for greater research efforts towards long-term effects on neuronal physiology and expansion of cross-species comparisons to address these issues.

Giant intraosseous ganglion of the fibula: multimodality imaging

Intraosseous ganglia around the knee are most commonly located in the proximal tibia and limited to the epiphyseal-metaphyseal region. We report the case of a giant intraosseous ganglion of the fibula. MRI demonstrated the fluid avascular content of the lesion. CT arthrography of the knee demonstrated partial opacification of the lesion through a cortical bone defect. The lesion was treated with curettage and bone grafting. Anatomopathological examination confirmed the medical imaging diagnosis of intraosseous ganglion. This case highlights the value of joint opacification with CT arthrography to demonstrate the communication between the articular cavity and the ganglion.

Intratendinous ganglion in the extensor digitorum communis

We encountered a patient with intratendinous ganglion which developed in the extensor digitorum communis tendon. Although its developmental mechanism is unclear, synovitis is considered the cause. For treatment, it may be necessary to prepare for tendon transfer and tendon grafting in consideration of the risk of tendon injury.

Results of modified thread technique for the treatment of wrist ganglion

BACKGROUND

Ganglion cyst is the commonest swelling around the wrist. It usually presents as a painless swelling. There is no consensus as to the exact cause and the ideal modality of its treatment. Surgical excision has the best cure rates but has its share of complications. The aim of this study was to evaluate whether a modified thread technique can give reasonably good results with a low complication rate in patients with wrist ganglion.

MATERIAL AND METHODS

One hundred and sixteen patients with wrist ganglion underwent a modified thread technique in which a sterile silk suture was passed through the ganglion, the contents of the ganglion were expressed out completely by firm pressure and the thread was tied over a sterile gauze piece forming a single loop. The thread was removed once serosanginous discharge was seen at entry point of the thread into the cyst.

RESULTS

One hundred and eight patients were available for final analysis with minimum six months follow up. There was no recurrence in ninety eight patients giving success rate of ninety one percent. Recurrence was only seen in patients where complete evacuation of the contents of ganglion could not be achieved. Nine patients had minor complications in the form of superficial infection in two patients and mild pain around thread entry point in seven patients.

CONCLUSION

Modified thread technique for the treatment of wrist ganglion is a minimally invasive, low cost, day care procedure which can give reasonably good results with a very low complication rate.

A cost and efficacy analysis of performing arthroscopic excision of wrist ganglions under wide-awake anaesthesia versus general anaesthesia

Background

Arthroscopic excision has currently become popular for the treatment of wrist ganglions. The objective of this study was to evaluate the clinical outcomes and cost effectiveness of arthroscopic wrist ganglion excisions under Wide-Awake Local Anaesthesia No Tourniquet versus general anaesthesia.

Methods

We retrospectively reviewed patients who underwent arthroscopic ganglionectomy from April 2009 to October 2016 at our institute. They were separated into two groups according to anaesthesia techniques: general anaesthesia and Wide-Awake Local Anaesthesia No Tourniquet. We compared the clinical outcomes and cost-effectiveness of the two groups.

Results

Seventy-four patients were included. Both groups were matched with regard to the demographics and preoperative clinical assessments. We found no significant differences between groups in postoperative visual analog scale, modified Mayo wrist score, Disabilities of Arm, Shoulder and Hand score, recurrence, residual pain, or complications. Recurrence was found in five of 74 patients, one (4.3%) in the Wide-Awake Local Anaesthesia No Tourniquet group and four (7.8%) in the general anaesthesia group. One extensor tendon injury and four extensor tenosynovitis cases occurred in the general anaesthesia group. Regarding cost effectiveness, the mean operating time in the Wide-Awake Local Anaesthesia No Tourniquet and general anaesthesia groups were 88.7 ± 24.51 and 121.5 ± 25.75 min, respectively (p < 0.001). The average total costs of the Wide-Awake Local Anaesthesia No Tourniquet and general anaesthesia groups were €487.4 ± 89.15 and €878.7 ± 182.13, respectively (p < 0.001).

Conclusions

For arthroscopic wrist ganglion resections, both anaesthesia techniques were effective and safe regarding recurrence rates, complications, and residual pain. The most important finding of this study was that arthroscopic ganglionectomy under Wide-Awake Local Anaesthesia No Tourniquet was superior to that under general anaesthesia for cost-effectiveness.

Level of evidence

Level III, Retrospective comparative study.

[Retroperitoneal lymph node assessment in pediatric paratesticular rhabdomyosarcoma]

Paratesticular Rhabdomyosarcoma accounts for 7 to 11% of pediatric rhabdomyosarcomas. Children older than 10 years have a worse event-free survival (69 to 80% vs. 87 to 92%) than children younger than 10 years. In this location, the relapses are essentially in the retroperitoneal lymph nodes and are often fatal. In European protocols, the assessment of the retroperitoneal lymph nodes at diagnosis is made by imaging whereas it is performed by retroperitoneal lymph node dissection in the American protocols. This method has been proved to improve event-free survival in the group of patient older than 10 years with a tumour bigger than 5cm. In the next European protocol, when nodes will be enlarged a surgical biopsy will be performed, this will be irrespective of age or size, and when no nodes will be enlarged in patients older than 10 years, retroperitoneal lymph node assessment will be performed. Other techniques of lymph nodes assessment will be tested like sentinel node biopsies or PET-scan.

The role of additional late PSMA-ligand PET/CT in the differentiation between lymph node metastases and ganglia

PURPOSE

Differentiating between prostate cancer (PC) lesions and benign structures which exhibit radiotracer uptake in PSMA-ligand PET/CT can be challenging. Additional late imaging has been shown to be a powerful method for the discrimination between PC and non-PC lesions, owing to the increasing tracer uptake of the former. Nevertheless, there are no pre-existing studies which describe the dynamic tracer uptake for ganglia, which this present study aims to address.

METHODS

Fifty consecutive patients with PC who received standard and late ⁶⁸Ga-PSMA-11-PET/CT (by local protocol at 1.5 h "standard" and 2.5 h p.i. "late") underwent retrospective evaluation. All lesions with a tracer uptake above local background indicative for ganglia as well as PC lesions were analysed with regard to their maximum standardised uptake values (SUVmax) and localisation.

RESULTS

Overall, 86 PSMA-positive ganglia were identified in 70% (n = 35) of the patients. Five ganglia exhibited PSMA avidity at late imaging only, and three at standard imaging only. A total of 66 lesions suggestive for PC were detected in 44 patients (88%), of which 45% (n = 30) were morphologically identified as lymph nodes (LN), the remainder being locally recurrent lesions or bone metastases. No solid organ metastases were present in our cohort. At late scanning, 73% of the LN exhibited an increase in SUVmax, whereas 65% of the ganglia exhibited a decreasing or stable SUVmax.

CONCLUSION

Whereas the presence of increasing tracer uptake in potential PC lesions can provide additional data about the likelihood of malignancy, increasing SUVmax alone does not reliably differentiate between ganglia and PC lesions and is a potential diagnostic pitfall. We therefore recommend high-resolution CT to enable morphological characterisation of ganglia.

The effect of oral contraceptive pills on the macula, the retinal nerve fiber layer, the ganglion cell layer and the choroidal thickness

Backgroun

To evaluate the effect of oral contraceptive pills (OCP) on the macula, the retinal nerve fiber layer (RNFL), the ganglion cell layer (GCL), and the choroidal thickness (CT).

Methods

In this prospective observational cross-sectional study, 60 eyes of 30 healthy women taking monophasic OCP (0.03 mg ethinylestradiol and 0.15 mg levonorgestrel) for contraception for at least 1 year were compared with 60 eyes of a control group of 30 healthy women who were not taking any OCP. Spectral-Domain Optical Coherence Tomography (SD-OCT) was used to evaluate the macula, the RNFL, the GCL, and the CT. Measurements were taken in the follicular phase (day 3) of the last menstrual cycle in all women. The body mass index (BMI) scores of all participants were also recorded.

Results

No disparity in terms of age and BMI between both groups was observed (p = 0.444, p = 0.074, respectively). All the macular parameters measurements were considerably lower in the OCP group compared to the control group (p < 0.001). Also, the RNFL thickness, the GCL thickness, and the CT were all significantly thinner in the OCP group (p < 0.001).

Conclusions

The use of OCP can cause significant changes in the retina and choroid thickness over 1 year period. The women who are using OCP for a longer duration could have some eye problems. OCT should be routinely done for follow up. Further long term studies are required, using different preparations of OCP. It is important to find out when this thickness alterations can be clinically significant or symptomatic and if these changes are reversible or not.

Dynamic patterns of [68Ga]Ga-PSMA-11 uptake in recurrent prostate cancer lesions

PURPOSE

Dual-time point PET/CT scanning with [⁶⁸Ga]Ga-PSMA-11 in the diagnosis of prostate cancer (PC) has been advanced as a method to increase detection of PC lesions, particularly at early stages of biochemical recurrence and as a potential means to aid the discrimination between benign and pathological prostate-specific membrane antigen (PSMA) uptake. However, the assumption that all PC lesions uniformly exhibit increasing tracer uptake at delayed imaging has not yet been investigated, which this present study aims to address.

METHODS

One hundred consecutive patients with biochemically recurrent PC who received standard and late [⁶⁸Ga]Ga-PSMA-11 PET/CT (by local protocol at 1.5 h "standard" and 2.5 h p.i. "late") underwent retrospective evaluation. All lesions with a tracer uptake above local background were analysed with regard to their maximum standardised uptake values at standard and late images (SUVmax) and characterised according to their morphological characteristics.

RESULTS

Seventy-nine of 100 patients had PSMA-positive scans, in whom a total of 185 individual PSMA-positive lesions were identified. These were morphologically characterised as bone lesions (n = 48), solid organ lesions (n = 3), lymph node (LN) lesions (n = 78) and locally recurrent lesions in the prostatic fossa or seminal vesicles (n = 56). The relative uptake between standard and late imaging was considered; all lesions classified as local recurrence presented with increasing (86%) or stable patterns of tracer uptake (14%). In contrast, only 58% of bone lesions exhibited increasing tracer uptake, with 21% exhibiting a stable pattern and 21% exhibiting a decreasing tracer uptake at late imaging.

CONCLUSION

A heterogeneous pattern of dynamic tracer uptake was observed, with a largely increasing pattern observed for locally recurrent lesions and lymph nodes and a significant proportion of bone lesions exhibiting decreasing tracer uptake. The results are of significance not only in the imaging and identification of PC lesions, but they also have implications for PSMA-directed ligand therapy.

Aspiration and steroid injection in ganglion cysts: An ultrasound guided evaluation of the response

PURPOSE

The Response of ganglion cysts to Intralesional steroids is variable. They may disappear completely to never recur again. Others may disappear for some period or show no response to the treatment. We wanted to analyse the response with the help of ultrasound. We also tried to search for the factors responsible for the unpredictable outcome.

METHODS

A single centre prospective cohort study was conducted. Ganglion cysts located near the wrist and the ankle region of the limbs were included in the study. Overall 40 patients were followed for 6 months. The ultrasound was used to measure the volume which was measured at zero & sixth month.

RESULTS

Volume of the cysts reduced to more than half in 45% of the participants. Complete disappearance was seen in only 10%.

CONCLUSION

Aspiration and steroid injection reduces the volume of the cyst. The effect wanes off progressively over a period of time. Majority will have a smaller cyst at sixth month at the same site. It may work better in the smaller cysts.

TYPE OF STUDY AND LEVEL OF EVIDENCE

Therapeutic, Level IV.

The medial safe zone for treating intraneural ganglion cysts in the tarsal tunnel: a technical note

INTRODUCTION

Intraneural ganglion cysts in the tarsal tunnel are rare but are being increasingly reported. The cysts involve the tibial or plantar nerves and are most commonly derived from a neighboring (degenerative) joint, (i.e., the tibiotalar or subtalar) via an articular branch arising from the medial aspect of the nerve. We describe a safe zone for approaching these cysts in the tarsal tunnel that allows for identification of the joint connection without injury to important distal branches.

METHODS

We present a case of an intraneural ganglion cyst within the tarsal tunnel in a patient with symptoms consistent with tarsal tunnel syndrome. Using intraoperative photographs and artist rendering, we describe a technique to safely disconnect the abnormal joint connection while preserving the important distal branches of the tibial nerve.

CONCLUSION

The safe zone for the tibial nerve in the tarsal tunnel can be exposed by mobilization and gentle retraction of the vascular bundle. In cases of intraneural ganglion cysts, all apparent connections between the nerve and degenerative joints within this safe zone can be resected without injury to important distal nerve branches.

Intra-neural ganglion cyst of the lateral dorsal cutaneous nerve: an uncommon cause of lateral ankle pain

INTRODUCTION

An intra-neural ganglion cyst of the lateral dorsal cutaneous branch of the sural nerve is rare, with only a few cases reported in the literature.

MATERIALS AND METHODS

We carried out a retrospective investigation of patients with an intraneural ganglion cyst of the lateral dorsal cutaneous nerve.

RESULTS

We present a case series of four patients with intra-neural ganglion cysts of the lateral dorsal cutaneous nerve, the distal continuation of the sural nerve at the lateral aspect of the foot.

CONCLUSION

Intra-neural ganglion cysts of the lateral dorsal cutaneous nerve are rare. They represent a relatively uncommon source of lateral ankle pain, which can easily be diagnosed with ultrasound (US) and magnetic resonance imaging and managed effectively with US-guided aspiration or surgical excision.

Molecular characterization, expression analysis, and functional properties of multiple 5-hydroxytryptamine receptors in Pacific abalone (Haliotis discus hannai)

Neurotransmitters such as serotonin (5-hydroxytryptamine; 5-HT) in the central nervous system regulate diverse physiological functions, including reproduction, feeding, learning, and memory, in diverse animal phyla. 5-HT and the 5-HT1 subtype receptor play important roles in sexual maturation and in the initiation of gamete release in mollusks. However, little is known about the involvement of other 5-HT receptor subfamilies in the reproduction process. In the present study, we identified the cDNAs encoding eight subtypes of 5-HT receptors from the ganglia tissues of the Pacific abalone Haliotis discus hannai (Mollusca; Gastropoda; Haliotidae), and examined the gonadal expression of the transcripts of 5-HT receptors. A phylogenetic analysis indicated that the molluskan 5-HT receptors are largely classified into four major clades: 5-HT1/5/7, 5-HT2, 5-HT4, and 5-HT6. Among the H. discus hannai (Hdh) 5-HT1-7 transcripts, Hdh5-HT1B, 4A, 4B, and 6 were the major subtypes detected in the mature ovary. Estradiol-17β injection into the pedal sinus induced the downregulation of 5-HT4B and upregulation of 5-HT6 transcripts in the ovary of mature abalone within 72 h. In HEK293 cells overexpressing Hdh5-HT1B, forskolin-stimulated cAMP response element luciferase (CRE-Luc) reporter activity was inhibited by 5-HT in a dose-dependent manner, whereas serum response element luciferase (SRE-Luc) activity was not affected. In Hdh5-HT4A-expressing HEK293 cells, forskolin-stimulated CRE-Luc and SRE-Luc reporter activities were both marginally increased by treatment with a high dose of 5-HT. Our results provide new insights into the roles of 5-HT through diverse G protein-coupled 5-HT receptors in the reproductive process of mollusks.

The neuroanatomy of Barentsia discreta (Entoprocta, Coloniales) reveals significant differences between bryozoan and entoproct nervous systems

BACKGROUND

Entoprocta affinities within Lophotrochozoa remain unclear. In different studies, entoprocts are considered to be related to different groups, including Cycliophora, Bryozoa, Annelida, and Mollusca. The use of modern methods to study the neuroanatomy of Entoprocta should provide new information that may be useful for phylogenetic analysis.

RESULTS

The anatomy of the nervous system in the colonial Barentsia discreta was studied using immunocytochemistry and transmission electron microscopy. The ganglion gives rise to several main nerves: paired lateral, aboral, and arcuate nerves, and three pairs of tentacular cords that branch out into tentacular nerves. The serotonergic nervous system includes paired esophageal perikarya and two large peripheral perikarya, each with a complex net of neurites. Each tentacle is innervated by one abfrontal and two laterofrontal neurite bundles. Sensory cells occur regularly along the abfrontal side of each tentacle. Star-like nerve cells are scattered in the epidermis of the calyx. The stalk is innervated by paired stalk nerves.

CONCLUSIONS

The neuroanatomy of the colonial Barentsia discreta is generally similar to that of solitary entoprocts but differs in the anatomy and ultrastructure of the ganglion, the number of neurite bundles in the calyx, and the distribution of serotonin in the nerve elements. A comparison of the organization of the nervous system in the Entoprocta and Bryozoa reveals many differences in tentacle innervations, which may indicate that these groups may not be closely related. Our results can not support with any certainty the homology of nervous system elements in adult entoprocts and adult "basal mollusks".

Arthroscopic resection of wrist ganglia: About 30 cases

Introduction

The synovial wrist ganglion is a particularly common pathology of which the first "complication" is recidivism. The main objective of our study was to determine the rate of recurrence of this pathology in a series of arthroscopic patients. The secondary objective was to assess patient satisfaction well after the operation.

Material and methods

Our study was observational and retrospective and involved 30 patients (17 dorsal and 13 palmar cases) aged 41 years on average. The patients underwent an arthroscopic procedure for a palmar or dorsal ganglion of the wrist between March 2007 and April 2013. The data were collected by re-reading the files and conducting telephone interviews. Each patient answered a questionnaire about the operation, after-treatment, and their satisfaction well after the surgery. At the end of the interview, we calculated the Patient Rated Wrist Evaluation (PRWE) score.

Results

The mean follow-up was 4.6 years. A recurrence was noted in 4 (13%) cases, at an average delay of 9 months (6 months-1 year). There were only 2 patients (6.7%) that experienced the complication of complex regional pain syndrome type 1. Twenty-eight (93%) patients experienced improvement in postoperative pain. For 27 (90%) patients, firm-handed activities could be practised without limitation. The average time to resumption of activities of daily living was 27.1 days (1-240 days), resumption of firm-handed activities was 56 days (15-360 days), and return to work was 47.5 days (1-360 days). The mean PRWE score was 6.9/50 (0-34) for pain and 1.38/50 (0-8) for function.

Conclusion

The 13% recurrence rate is on the average of what is observed in the literature. Later satisfaction with the intervention is very good, and complications remain rare.Studies tend to show a lower rate of complications and recurrence following arthroscopic treatment, but to date, no randomized comparative series between the two methods has yet revealed any significant difference in these two points. A study of this type on a large scale could make it possible to highlight one of these treatment approaches.

Intraosseous "Lipoma" of the Calcaneus Developing in an Intraosseous Ganglion Cyst

Intraosseous lipomas are rare primary bone tumors, most common to the calcaneus. There are several proposed theories of the natural etiology of intraosseous lipomas; however, all lack definitive support. In this report, an 18-year-old man presented with radiologic evidence of a simple bone cyst of the calcaneus. Over a 4-year period, the patient was followed with interval magnetic resonance imaging. The cyst demonstrated progressive development of peripheral intralesional fat with final magnetic resonance imaging features characteristic of an intraosseous lipoma. To our knowledge, this is the first longitudinal study that shows gradual peripheral fat deposition within an intraosseous ganglion cyst, illustrating a potential cause of intraosseous lipomas of the calcaneus.

Endoscopic Excision of Ganglion at Anterolateral Elbow: A Case Report

Ganglion of the anterolateral elbow is rare and may be associated with compression neuropathy of the radial nerve or its branches. Open ganglionectomy implies extensive soft tissue dissection. We present a case of anterolateral elbow ganglion without any compression neuropathy. This was successfully treated with endoscopic ganglionectomy.

Recurrent Cubital Tunnel Syndrome Caused by Ganglion: A Report of Nine Cases

BACKGROUND

Cubital tunnel syndrome (CuTS) is generally treated successfully by surgery and recurrent cases are rare. This study retrospectively investigated the clinical characteristics of recurrent CuTS caused by ganglion.

METHODS

We evaluated nine patients who were surgically treated for recurrent CuTS caused by ganglion. Age distribution at recurrence ranged from 43 to 79 years. The initial surgery for CuTS had been performed using various methods. The asymptomatic period from initial surgery to recurrence ranged from 22 to 252 months. Clinical, diagnostic imaging, and operative findings during the second surgery were analyzed. All patients were treated by anterior subcutaneous ulnar nerve transposition with ganglion resection and later examined directly within a mean of 71 months after the second surgery.

RESULTS

The interval from recurrence to consultation was shorter than two months for eight cases. Chief complaints included numbness with or without pain in the ring and little fingers in all patients and resting pain in the medial elbow in five patients. Elbow osteoarthritis was present in all cases. Although four of 10 ganglia were palpable, ultrasonography and magnetic resonance imaging could identify all ganglia preoperatively. The ulnar nerve typically had become entrapped by the ganglion posteriorly and by fascia, scar tissue, and/or muscle anteriorly. Chief complaints and ulnar nerve function were improved in all patients following revision surgery.

CONCLUSIONS

The acute onset of numbness with or without intolerable pain in the ring and little fingers after a long-term remission period following initial surgery for CuTS in patients with elbow osteoarthritis appears to be the characteristic clinical profile of recurrent CuTS caused by ganglion. As ganglia are often not palpable, ultrasonography and magnetic resonance imaging are recommended for accurate diagnosis.

Ultrasound facilitates the diagnosis of tarsal tunnel syndrome: intraneural ganglion cyst of the tibial nerve

The tibial nerve intraneural ganglion cyst-which presents with fluid accumulated inside the nerve epineurium-is a rare etiology of tarsal tunnel syndrome. We report a case with insidious onset of numbness over his left medial ankle. Ultrasound imaging revealed that the tibial nerve was encircled by crescent-shaped anechoic substances, spanning from the distal leg to the sole. Magnetic resonance imaging disclosed a thickened tibial nerve wrapped by hyperintense materials in the tarsal tunnel. Some effusion was observed besides the tibialis posterior and flexor digitorum tendons as well. The patient underwent a surgical treatment and an intraneural ganglion cyst was confirmed. This report elaborated the clinical and imaging presentations of a tibial nerve intraneural ganglion cyst and highlighted the usefulness of ultrasound in exploring the cause of compressive neuropathy at the ankle region.

Expression profile and reproductive regulation of APGWamide in Pacific abalone (Haliotis discus hannai)

Neuropeptides in the central nervous system regulate reproductive activities in vertebrates. Ala-Pro-Gly-Trp-NH₂ (APGWamide), a neuromediator expressed in the neural ganglia of mollusks, controls sexual maturation and reproduction. To clarify the role of APGWamide in sexual behavior regulation and gamete cell maturation in mollusks, we cloned the cDNA of APGWamide precursor (Hdh-APGWamide) and examined the spatiotemporal expression of the transcript in the Pacific abalone Haliotis discus hannai. The 222-amino acid sequence of the precursor deduced from the cDNA sequence showed typical features of gastropod APGWamide precursors. Phylogenetic analysis revealed that Hdh-APGWamide is classified with other gastropod APGWamide precursors, which form a separate branch from those of the bivalves. Hdh-APGWamide mRNA was highly expressed in the neural ganglia in both sexes. In females, the three ganglia (pleuro-pedal ganglion, PPG; branchial ganglion, and cerebral ganglion) showed similar expression in immature and mature animals, whereas in males, the level in the PPG only was higher at maturity (P < 0.05). In vivo injection of APGWamide or 5-hydroxytryptamine (10^-3 M) increased the frequency of spawning and the number of released sperm cells by mature males (P < 0.05), while concentrations above 10^-7 M enhanced germinal vesicle breakdown in fully developed cultured oocytes (P < 0.05). Thus, the phylogenetic branch of the APGWamide precursor gene in Haliotidae was separate from the other branches under the phylum Mollusca, and this gene exhibited ganglion-specific expression, indicating that it may induce final maturation and spawning in both sexes of Haliotis spp.

The Grueneberg olfactory organ neuroepithelium recovers after injury

The Grueneberg organ (also termed Grueneberg ganglion) is an olfactory subsystem at the rostral nasal septum of rodents, and has been suggested to exist also in humans. Grueneberg organ neurons respond to coldness and alarm pheromones, but the anatomical arrangement and regenerative capacity are not fully characterised. We examined the relationship between the glia and the neurons using crosses of two transgenic mouse lines, S100ß-DsRed and OMP-ZsGreen, to visualise olfactory ensheathing cells (OECs) and Grueneberg olfactory neurons, respectively. Within the epithelium, Grueneberg organ OECs were in direct contact with Grueneberg organ neuron cell bodies. Individual axons from the neurons initially grew over the surface of the OECs before forming larger fascicles consisting of numerous axons and OECs. Considering the location of the Grueneberg organ so close to the external environment, it may be that the Grueneberg neurons are likely to be subject to damage suggesting that as in other olfactory regions there is a capacity for recovery after injury. Here, we used a well characterised model of olfactory nervous system injury, unilateral bulbectomy, to determine whether Grueneberg organ neurons degenerate after injury. We found that Grueneberg organ neurons degenerated in response to the axotomy, yet by 11 days post injury neurons and/or axons were detected again within the epithelium. Our results demonstrate that while Grueneberg organ neurons and glia have a distinct relationship in the epithelium, they have largely similar characteristics to that of the main olfactory neurons and glia.

A Case of Infrapatellar Fat Pad Ganglion of the Knee

Introduction:

A ganglion cyst can induce symptoms around the knee and should be considered as an intra-articular mass in differential diagnosis.

Case Presentation:

A 22-year-old female presented with a persistent medial knee joint pain in her left knee for 2 years. There was soft tissue swelling on the anteromedial aspect of the infrapatellar region on her left knee. Lachman and McMurray tests were negative. MRI showed a multilobular cyst in the infrapatellar fat pad with T1 low intensity and T2 STIR high intensity. The cyst was not attached to either meniscus. ACL and PCL looked normal.

During surgery, the cyst was found to arise from the intra-patellar fat pad and was not attached to the menisci or synovium. The cyst was completely resected.

Histological findings showed a multilobular cyst with a glassy fibrous tissue wall and clear jelly-like consistency, confirming the diagnosis of a ganglion. The patient recovered asymptomatically and has been without recurrence 7 years postoperatively.

Conclusion:

Differential diagnoses of an infrapatellar swelling are a meniscal cyst, synovial cyst, or ganglion. Most cases of cysts around the knee generate from fluid collection through meniscal tears. A ganglion cyst is a synovium-lined structure and is common around the wrist joint, but rare in the knee joint. A ganglion cyst in the knee joint often arises from ACL or PCL, but rarely arises from the infrapatellar fat pad. A ganglion cyst is one of the differential diagnoses of parameniscal cysts around the knee. We recommended an open resection with arthroscopic examination.

Persistent Symptoms of Ganglion Cysts in the Dorsal Foot

Background

A ganglion is a common benign cystic lesion, containing gelatinous material. Ganglia are most commonly asymptomatic, except for a lump, but symptoms depend on the location. A dorsal foot ganglion is typically painful. On the dorsal foot, the dorsalis pedis artery and the medial branch of the deep peroneal nerve are located under the fascia.

Objective

Five female patients of average age 45.8 ± 20 years (range, 12 to 60 years) with a painful ganglion in the dorsal foot were analyzed.

Results

Average lesion size was 2.94 ± 1.1 cm (range, 1.5 to 4.0 cm) and patients had experienced pain for a median of 2-3 years (range, 6 months to 3 years). Four patients had a single cystic lesion and 1 patient had developed multiple cystic lesions over the time that were associated with hypoesthesia. In 3 cases, symptomatic lesions were located deep beneath the fascia and were resected. In 2 cases, the depth of the non-resected lesions was shallow.

Conclusion

The cause of a painful dorsal foot ganglion can be attributed to its location in the thin subcutaneous tissue over the foot bone, in addition to its proximity to a nearby artery and nerve. Mild symptoms caused by a dorsal foot ganglion seem to be persistent, and the deeper the location, the more likely is the need for resection. To avoid nerve injury, anatomical knowledge is prerequisite to any puncturing procedure or operation performed.

Morphological Survey from Neurons to Circuits of the Mouse Retina

The mouse retina has a layered structure that is composed of five classes of neurons supported by Müller glial and pigment epithelial cells. Recent studies have made progress in the classification of bipolar and ganglion cells, and also in the wiring of rod-driven signaling, color coding, and directional selectivity. Molecular biological techniques, such as genetic manipulation, transcriptomics, and fluorescence imaging, have contributed a lot to these advancements. The mouse retina has consistently been an important experimental system for both basic and clinical neurosciences.

Pancreatic neuro-insular network in young mice revealed by 3D panoramic histology

AIMS/HYPOTHESIS

It has been proposed that the neuro-insular network enables rapid, synchronised insulin secretion. However, to date, acquiring the pancreatic tissue map to study the neural network remains a challenging task as there is a lack of feasible approaches for large-scale tissue analysis at the organ level. Here, we have developed 3-dimensional (3D) panoramic histology to characterise the pancreatic neuro-insular network in young mice.

METHODS

Pancreases harvested from young wild-type B6 mice (3 and 8 weeks old) and db/db mice (3 weeks old; db/db vs db/+) were used to develop 3D panoramic histology. Transparent pancreases were prepared by optical clearing to enable deep-tissue, tile-scanning microscopy for qualitative and quantitative analyses of islets and the pancreatic tissue network in space.

RESULTS

3D panoramic histology reveals the pancreatic neurovascular network and the coupling of ganglionic and islet populations via the network. This integration is identified in both 3- and 8-week-old mice, featuring the peri-arteriolar neuro-insular network and islet-ganglionic aggregation. In weaning hyperphagic db/db mice, the 3D image data identifies the associated increases in weight, adipose tissue attached to the pancreas, density of large islets (major axis > 150 μm) and pancreatic sympathetic innervation compared with db/+ mice.

CONCLUSIONS/INTERPRETATION

Our work provides insight into the neuro-insular integration at the organ level and demonstrates a new approach for investigating previously unknown details of the pancreatic tissue network in health and disease.

Iatrogenic intratendinous ganglion cyst of the extensor digitorum tendon following intravenous cannulation

Peripheral venous cannulation is one of the most commonly performed medical procedures in hospital medicine. The dorsal metacarpal veins are typically used for cannulation as they are easily accessible. We present the first case of an iatrogenic intratendinous ganglion cyst of the extensor digitorum tendon of the middle finger following intravenous cannulation.

Lumbar ganglion cyst: Nosology, surgical management and proposal of a new classification based on 34 personal cases and literature review

AIM

To analyze different terms used in literature to identify lumbar extradural cysts and propose a common scientific terminology; to elaborate a new morphological classification of this pathology, useful for clinical and surgical purposes; and to describe the best surgical approach to remove these cysts, in order to avoid iatrogenic instability or treat the pre-existing one.

METHODS

We retrospectively reviewed 34 patients with symptomatic lumbar ganglion cysts treated with spinal canal decompression with or without spinal fixation. Microsurgical approach was the main procedure and spinal instrumentation was required only in case of evident pre-operative segmental instability.

RESULTS

The complete cystectomy with histological examination was performed in all cases. All patients presented an improvement of clinical conditions, evaluated by Visual Analogic Scale and Japanese Orthopaedic Association scoring.

CONCLUSION

Spinal ganglion cysts are generally found in the lumbar spine. The treatment of choice is the microsurgical cystectomy, which generally does not require stabilization. The need for fusion must be carefully evaluated: Pre-operative spondylolisthesis or a wide joint resection, during the operation, are the main indications for spinal instrumentation. We propose the terms “ganglion cyst” to finally identify this spinal pathology and for the first time its morphological classification, clinically useful for all specialists.

Dorsal Wrist Ganglion Associated with Extensor Digitorum Brevis Manus: Case Report and Review of the Literature

Aberrant accessory muscles are rare entities in the hand. The extensor digitorum brevis manus (EDBM) muscle is amongst them and may be seen in association with dorsal ganglion cysts. Distinguishing an EDBM muscle is relevant in the diagnostic consideration of a dorsal ganglion in order to facilitate and guide its proper treatment. To date, there have been only few reports of an EDBM in association with a dorsal ganglion cyst. We report our experience with an incidental intraoperative finding of an intramuscular EDBM dorsal ganglion cyst and follow with a literature review and guide to management.