Painful nodules and cords in Dupuytren disease.

PURPOSE: The etiology of Dupuytren disease is unclear. Pain is seldom described in the literature. Patients are more often disturbed by impaired extension of the fingers. We recently treated a series of patients who had had painful nodules for more than 1 year, and we therefore decided to investigate them for a possible anatomical correlate. METHODS: Biopsies were taken during surgery from patients with Dupuytren disease and stained to enable detection of neuronal tissue. RESULTS: We treated 17 fingers in 10 patients. Intraoperatively, 10 showed tiny nerve branches passing into or crossing the fibrous bands or nodules. Of 13 biopsies, 6 showed nerve fibers embedded in fibrous tissue, 3 showed perineural or intraneural fibrosis or both, and 3 showed true neuromas. Enlarged Pacinian corpuscles were isolated from 1 sample. All patients were pain free after surgery. CONCLUSIONS: Although Dupuytren disease is generally considered painless, we treated a series of early stage patients with painful disease. Intraoperative inspection and histological examination of tissue samples showed that nerve tissue was involved in all cases. The pain might have been due to local nerve compression by the fibromatosis or the Dupuytren disease itself. We, therefore, suggest that the indication for surgery in Dupuytren disease be extended to painful nodules for more than 1 year, even in the early stages of the disease in the absence of functional deficits, with assessment of tissue samples for histological changes in nerves.

Mechanoreceptors and length of the patellar ligament after Ho-YAG laser treatment: a long-term follow-up in rabbits.

We studied the shortening and the number of mechanoreceptors in the patellar ligament up to 18 months after Ho-YAG irradiation of the ligament's surface in 35 rabbits. The ligaments shortened an average 13% immediately after irradiation. After treatment, we divided the rabbits into a mobilized or immobilized group. At 2 weeks and 12 months after treatment both groups showed no shortening of the ligament, as compared to the intact ligament while that in the mobilized group had elongated at 12 months. Fewer Pacinian and Ruffini corpuscles were found in the irradiated ligaments than in the intact ones at 2 weeks after treatment, but we found no difference between irradiated and intact ligaments at 18 months after treatment.

Denervation of Pacinian corpuscles: electron microscopic observations in the rat following nerve transection.

Nerve transection using rat sciatic nerves was employed to observe morphologic changes in the periodic denervation of Pacinian corpuscles. During periods of from 1 to 20 weeks after surgery, a total of 15 corpuscles were obtained under the operating microscope and processed for morphologic analysis using light and electron microscopes. Based on the morphologic findings, normal corpuscles were composed of an axon terminal and inner and outer core cells. Following nerve transection, the axon terminal immediately disappeared at 1 week, but the original inner and outer core cells were preserved, with macrophage migration occurring in the outer core. After 8 weeks, the circular regularity of the inner and outer core lamellae was occasionally broken. The lamellae had wavy courses and there were many empty spaces in the inner core. Even at 20 weeks after denervation, there was interruption in the continuity of the outer core cells; the membranous structure of the outer core and the lamellar structure of the inner core were well-preserved; the outer and inner core cells were still present. Simultaneously, a small number of collagen fibrils were observed between the inner and outer core cells from the earliest postoperative stage. These fibrils increased in number in later stages. The results suggest that, immediately after destruction of axon terminals, macrophages migrate into the interlamellar spaces where they engulf the debris of the degenerated axon terminals. The degeneration of the corpuscles seems to be similar to that of denervated nerve axons; therefore, the inner core cells, which are continuous with the Schwann cells, maintain their original condition for at least 20 weeks after corpuscle denervation. The outer core cells, which are continuous with the perineurial nerve cells, are assumed to be the main cells producing the collagen fibrils in the denervated Pacinian corpuscles.

Exposure-response relationship between hand-arm vibration and vibrotactile perception sensitivity.

BACKGROUND: The objectives of the study were to examine whether occupational use of vibrating hand-held tools was associated with an impaired vibrotactile perception, whether any exposure-response relationship exists, and whether the different populations of mechano-receptive afferent units are equally affected. METHODS: Vibrotactile perception thresholds have been measured at seven frequencies (8-500 Hz) and evaluated among 125 vibration-exposed and 45 non-exposed male employees in a heavy engineering production workshop. Vibration exposure measurements were assessed on tools in accordance with ISO 5349. Vibrotactile perception thresholds have been individually graded in stages and placed in relation to individual vibration exposure. RESULTS: The outcome did not reveal a clear relationship between vibration exposure and reduced vibrotactile sensitivity on an individual basis. There was a clear tendency on a group basis towards elevated thresholds when the study population was divided into three exposure categories. A fourfold increase in relative risk of reduced vibrotactile sensitivity for test frequencies above 40 Hz was observed between the highest exposure category compared to the non-exposed. CONCLUSIONS: It was concluded that reduced tactile sensitivity is related to the degree of vibration exposure but it is not at present possible to delineate an exposure-response relationship.

[Covering the foot sole and heel with pedicled and free transplants]. / Deckung der Fusssohle und Ferse mit gestielten und freien Transplantaten.

Thirty patients suffering from defects of the weight-bearing areas of the sole and heel were analyzed employing various methods. Sensibility was analyzed quantitatively. The level of sensibility of the flaps was found to be variable, but it had no effect on soft-tissue stability. Sensory recovery in the flaps was slow and unpredictable. Gait analysis showed that patients supplied with footwear walked relatively symmetrically even though there was a tendency to protect the flap by decreased weight-bearing. Postural control as analyzed by a sway plate was impaired only in patients with flaps having very poor sensibility. Thin skin flaps were found to be most suitable for degloving defects and muscle flaps with split-skin coverage for deep defects. The scapular flap was often too thick and was prone to develop superficial ulcerations on the weight-bearing areas.

[Lamelate corpuscles in lymph nodes and their significance for metastasizing melanoma (author's transl)]. / Lamellenkörperchen im Lymphknotenhilus und ihre Bedeutung für die Melanommetastasierung

For the first time the occurrence of corpuscles of Vater-Pacini lacated in the hili of lymph nodes in patients with melanoma is described. As these corpuscles are pressure sensitive they participate in the regulation of blood and lymph flow inside the lymph node. By these means they may influence secondary deposition of melanoma cells.