Neuromas and gaps of sensory nerves of the hand: management using vein conduits.

This study analyzed the efficacy of an interposed vein conduit graft in eliminating symptoms of painful neuroma of sensory nerves of the hand and preventing recurrence after excising the pathologic tissue and bridging the concomitant gap with the distal nerve segment. Twenty-three patients underwent reconstruction of 25 palmar sensory nerve gaps ranging from 12 mm to 28 mm, as well as 2 dorsal gaps of 32 mm and 35 mm, respectively. Eighteen patients had symptomatic painful neuromas. Subjective and objective evaluation criteria were employed for assessment and were compared with data obtained from primary direct suturing in 25 digital nerves of 21 patients. Electrophysiologic measurements, including sensory nerve action potential and conduction velocity, were similar, with both groups having values significantly lower than normal control values. Two-point discrimination measurements were slightly inferior for the vein conduit-reconstructed nerves compared with results attained after direct suturing. However, neuroma symptoms were eliminated, and in combination with the return of adequate sensibility, all but 1 patient resumed full hand function.

The androgen receptor gene CAG polymorphism is associated with the severity of coronary artery disease in men.

OBJECTIVE: The role of androgens in the pathogenesis of coronary artery disease (CAD) remains controversial. The length of the polyglutamine stretch of the transactivation domain (CAG repeat) of the androgen receptor (AR) inversely affects androgen activity. The aim of this study was to investigate the effect of this polymorphism of the AR gene in the extent of CAD in male patients. DESIGN AND PATIENTS: The relationship of the length of the AR gene CAG repeat on the severity of CAD was examined in 131 men (36-86 years old) undergoing coronary angiography. MEASUREMENTS: The severity of CAD was assessed by the number (0-3) of coronary vessels with > 50% reduction in the luminal diameter. The interaction of the AR gene polymorphism with the intima media thickness (IMT) of peripheral arteries and serum levels of sex steroids, insulin and biochemical parameters were also studied. RESULTS: The upper quartile of CAG length (range 9-30) was > or = 23 repeats (longAR). The mean body mass index (BMI) of patients with shorter repeats (< 23; shortAR) was significantly lower than in men with longAR (26.1 vs. 27.6, respectively; P = 0.043 M-W Rank test). There was no correlation between the AR gene repeat length and serum testosterone. Oestradiol levels were significantly higher in longAR (0.19 +/- 0.08 nmol/l vs. 0.14 +/- 0.07 in shortAR, P = 0.031). This difference was independent of BMI. Men with shortAR had significant CAD (i.e. one to three arteries with stenosis) more frequently (79.5%) than men with longAR (20.5%); of the subjects with stenosis in no arteries, 56.5% had shortAR and 43.5% longAR (chi2 = 4.3, P = 0.038). This association was independent of age and BMI. The IMT of peripheral arteries, lipid parameters, basal insulin resistance, blood pressure and family history for early CAD, did not differ according to AR length. CONCLUSIONS: The shorter CAG repeat of the AR gene is associated with more severe CAD, which suggests a role for the sensitivity to androgens in the increased frequency of CAD in males. In addition, a protective role of endogenous oestrogen, which is higher in the longAR subgroup, can contribute to the observed difference.