Cisto perineural cervical sintomático: um achado incomum / Cervical symptomatic perineural cyst: an unusual finding

Os cistos perineurais (Tarlov) referem-se a uma dilatação cística entre o perineuro e o endoneuro das raízes nervosas dorsais, preenchidos com líquido cefalorraquidiano. Foram inicialmente descritos em 1938. Eles são mais frequentemente encontrados na coluna sacral, especialmente nas raízes nervosas de S2- S3, com a prevalência de 4,6% com base em uma revisão retrospectiva das imagens de ressonância magnética (RM) da coluna lombo-sacral. Em ocasiões muito raras, foram observadas acima da coluna lombossacra. Os cistos perineurais são geralmente achados incidentais sem significância clínica. Poucos relatos estão disponíveis sobre cistos sintomáticos na coluna cervical - os casos sintomáticos são raros, constituindo menos de 1% do total

Perineural (Tarlov) cysts refer to a cystic dilatation between the perineurium and endoneurium of the dorsal nerve roots, filled with cerebrospinal fluid, and were the first described in 1938. They are most often found in the sacral spine, especially S2-S3 nerve roots, with a prevalence of 4.6% based on a retrospective review of magnetic resonance images (MRI) of the lumbosacral spine. On very rare occasions, they were observed above the lumbosacral spine. Perineural cysts are usually incidental findings with no clinical significance. Few reports are available on symptomatic cysts in the cervical spine - symptomatic cases are rare, constituting less than 1% of the total

Adenomegalia dolorosa: doença de Kikuchi entre os diagnósticos diferenciais / Painful adenomegaly: Kikuchi disease among differential diagnoses

RESUMO: A doença de Kikuchi-Fujimoto ou linfadenite histiocítica necrosante, de curso benigno, é prevalente em mulheres jovens, e associada à febre e leucopenia. Estudos recentes têm demostrado que sua etiologia ainda é incerta, sendo uma doença rara, com incidência de 0,5 a 5% de todas as adenopatias analisadas histologicamente. O diag-nóstico diferencial por imunohistoquímica foi decisivo, descartando outras hipóteses diagnósticas como: linfoma, tuberculose ganglionar e lúpus eritematoso sistêmico. Este relato de caso mostra as características da apresentação da doença em uma mulher, caucasiana e todas as etapas da investigação, destacando a importância dos diagnósticos diferenciais em adenopatias dolorosas e as dificuldades quando avaliamos portadores de doenças raras. (AU)

ABSTRACT: Kikuchi-Fujimoto disease or benign necrotizing histiocytic lymphadenitis is prevalent in young women and associated with fever and leukopenia. Recent studies have shown that its etiology is still uncertain, being a rare disease, with an incidence of 0.5 to 5% of all histologically analyzed adenopathies. Differential diagnosis by immunohistochemistry was decisive, ruling out other diagnostic hypotheses such as lymphoma, ganglion tuberculosis, and systemic lupus erythematosus. This case report shows the characteristics of the presentation of the disease in a Caucasian woman and all stages of the investigation, highlighting the importance of differential diagnoses in painful adenopathies and the difficulties when evaluating rare-disease patients. (AU)

Changes in the Ganglion Cell-inner Plexiform Layer after Consecutive Intravitreal Injections of Anti-vascular Endothelial Growth Factor in Age-related Macular Degeneration Patients

Hierarchical Cluster Analysis of Peripapillary Retinal Nerve Fiber Layer Damage and Macular Ganglion Cell Loss in Open Angle Glaucoma

Artrhoscopic Resection of Volar Wrist Ganglion: Surgical Technique and Case Series / Ressecção artroscópica do cisto sinovial volar do punho: Técnica cirúrgica e série de casos

Abstract Objectives To describe the technique and results of the arthroscopic surgical treatment of volar ganglion cyst of the wrist. Materials and Methods The present study comprised 21 patients submitted to the arthroscopic treatment of volar ganglion cysts of the wrist from January 2015 to May 2017, with a full evaluation for at least 6 months. The technique was indicated for patients presenting pain and functional impairment for more than four months, with no improvement with the conservative treatment, or for those with cosmetic complaints and cyst present for more than three months. Results The mean age of the patients was 43.6 years; 16 (76%) patients were female, and 5 (24%) were male. The mean follow-up time from surgery to the final assessment was of 10.9 months. A total of 2 (9.6%) patients complained of mild pain after the procedure, and another patient presented slight motion restrictions. The 18 (90.4%) remaining patients reported cosmetic improvement, complete functional recovery, and pain improvement. There were no recurrences or infections. No patient required further surgery. Conclusions The arthroscopic resection of volar ganglion cysts is a useful and safe technique. It is a minimally-invasive procedure, with low morbidity and very few complications, representing a good alternative to the open technique.

Resumo Objetivo Descrever a técnica e os resultados da artroscopia no tratamento cirúrgico dos cistos sinoviais volares no punho. Materiais e Métodos Foram incluídos e analisados neste trabalho 21 pacientes submetidos a artroscopia para o tratamento de cisto sinovial volar no punho, no período entre janeiro de 2015 e maio de 2017, com avaliação completa e mínima de 6 meses. A técnica descrita foi indicada para os pacientes com dor e incapacidade funcional com duração de mais de quatro meses, sem melhora com o tratamento conservador, ou para aqueles com queixas estéticas e que apresentavam o cisto havia mais de três meses. Resultados A média de idade dos pacientes foi de 43,6 anos, sendo 16 (76%) do sexo feminino, e 5 (24%) do masculino. O tempo de seguimento médio entre a cirurgia e a avaliação final foi de 10,9 meses. Um total de 2 (9,6%) pacientes apresentaram dor leve e uma restrição da mobilidade no pós-operatório. Nos 18 (90,4%) pacientes restantes, houve melhora das queixas estéticas, recuperação funcional completa, e melhora completa da dor. Não houve recidivas ou infecções. Nenhum paciente necessitou ser submetido a nova cirurgia. Conclusões A ressecção artroscópica do cisto sinovial volar mostrou-se uma técnica útil e segura. É um procedimento minimamente invasivo, com baixa morbidade e poucas complicações, sendo uma boa alternativa à técnica aberta.

Colonic Pseudo-obstruction With Transition Zone: A Peculiar Eastern Severe Dysmotility

BACKGROUND/AIMS: Previous studies from Korea have described chronic intestinal pseudo-obstruction (CIPO) patients with transition zone (TZ) in the colon. In this study, we evaluated the pathological characteristics and their association with long-term outcomes in Korean colonic pseudo-obstruction (CPO) patients with TZ. METHODS: We enrolled 39 CPO patients who were refractory to medical treatment and underwent colectomy between November 1989 and April 2016 (median age at symptoms onset: 45 [interquartile range, 29–57] years, males 46.2%). The TZ was defined as a colonic segment connecting a proximally dilated and distally non-dilated segment. Detailed pathologic analysis was performed. RESULTS: Among the 39 patients, 37 (94.9%) presented with TZ and 2 (5.1%) showed no definitive TZ. Median ganglion cell density in the TZ adjusted for the colonic circumference was significantly decreased compared to that in proximal dilated and distal non-dilated segments in TZ (+) patients (9.2 vs 254.3 and 150.5, P < 0.001). Among the TZ (+) patients, 6 showed additional pathologic findings including eosinophilic ganglionitis (n = 2), ulcers with combined cytomegalovirus infection (n = 2), diffuse ischemic changes (n = 1), and heterotropic myenteric plexus (n = 1). During follow-up (median, 61 months), 32 (82.1%) TZ (+) patients recovered without symptom recurrence after surgery. The presence of pathological features other than hypoganglionosis was an independent predictor of symptom recurrence after surgery (P = 0.046). CONCLUSIONS: Hypoganglionosis can be identified in the TZ of most Korean CPO patients. Detection of other pathological features in addition to TZ-associated hypoganglionosis was associated with poor post-operative outcomes.

The feasibility of shear wave elastography for diagnosing superficial benign soft tissue masses

PURPOSE: The purpose of this study was to investigate the feasibility of shear wave ultrasound elastography for differentiating superficial benign soft tissue masses through a comparison of their shear moduli. METHODS: We retrospectively analyzed 48 masses from 46 patients from February 2014 to May 2016. Surgical excision, fine-needle aspiration, and clinical findings were used for the differential diagnosis. The ultrasonographic examinations were conducted by a single musculoskeletal radiologist, and the ultrasonographic findings were reviewed by two other radiologists who were blinded to the final diagnosis. Conventional ultrasonographic features and the median shear modulus were evaluated. We compared the median shear moduli of epidermoid cysts, ganglion cysts, and lipomatous tumors using the Kruskal-Wallis test. Additionally, the Mann-Whitney U test was used to compare two distinct groups. RESULTS: Significant differences were found in the median shear moduli of epidermoid cysts, ganglion cysts, and lipomatous tumors (23.7, 5.8, and 9.2 kPa, respectively; P=0.019). Epidermoid cysts showed a greater median shear modulus than ganglion cysts (P=0.014) and lipomatous tumors (P=0.049). CONCLUSION: Shear wave elastography may contribute to the differential diagnosis of superficial benign soft tissue masses through a direct quantitative analysis.

Compresión del nervio mediano en el túnel del carpo en una paciente de 16 años. Reporte de caso / Compression of the median nerve in the carpal tunnel in a 16 year-old: A case report

Introducción El síndrome del túnel del carpo es la patología nerviosa compresiva mas frecuente del miembro superior. En niños es una entidad infrecuente, en la mayoría de las ocasiones esta asociado principalmente a una alteración de origen genético como la mucopolisacaridosis, puede ser de origen idiopático, traumático, infeccioso asociado patologías sistémicas y ocupación del túnel del carpo. Reporte del caso Se trata de una paciente femenina de 16 años de edad con dolor en la mano izquierda de un año de evolución, presenta hipoestesia y parestesia de la punta de los dedos sin evento traumatico previo. El examen físico no es conclusivo, aunque altamente sospecho de patología neurológica compresiva. Mediante electrodiagnóstico e imagenología se realiza el diagnóstico de síndrome del túnel del carpo por secundario a ganglión en el piso del túnel. El tratamiento mas recomendado en este tipo fue la liberación quirúrgica y resección del ganglión. Discusión El diagnóstico del síndrome del túnel del carpo en niños y adolescentes es de difícil diagnóstico dado por la amplia sintomatología, una vez diagnósticado el síndrome del túnel del carpo, el tratamiento más recomendado según esta causa es la liberación quirúrgica del túnel del carpo y resección del ganglión. El síndrome del túnel del carpo es una patología infrecuente en los niños, se debe realizar estudios complementarios para realizar un diagnóstico adecuado y un tratamiento efectivo. Es infrecuente que después de la liberación del túnel del carpo exista persistencia de la sintomatología neurológica distal.

Background Carpal tunnel syndrome is the most frequent nerve compression disorder of the upper limb. It is uncommon in children and in the majority of cases it is mainly associated with an alteration of genetic origin such as mucopolysaccharidosis. It can be of an idiopathic, traumatic, infectious origin, associated with systemic infectious diseases and occupation of the carpal tunnel. Case report The case is presented on a 16 year-old female patient with pain in the left hand for a year, with hypoesthesia and paraesthesia of the fingertips, with no previous traumatic event. The physical examination was not conclusive, although a nerve compression disorder was highly suspected. Using electrodiagnosis and imaging, the diagnosis of carpal tunnel syndrome was made that was secondary to a ganglion identified on the floor of the tunnel. The most recommended treatment in this type of condition is surgical release and resection of the ganglion. Discussion Carpal tunnel syndrome in children and adolescents is difficult to diagnose due to the wide range of symptoms. Once the carpal tunnel syndrome has been diagnosed, the most recommended treatment according to this cause is the surgical release of the carpal tunnel and resection of the ganglion. Carpal tunnel syndrome is an infrequent condition in children. Complementary studies should be performed to make an adequate diagnosis and an effective treatment. After the release of the carpal tunnel it rare for the neurological symptomatology to persist.

Cubital Tunnel Syndrome by a Ganglion Cyst in an Amateur Tennis Player / 대한스포츠의학회지

Ganglion cyst is considered to be a usual cause of peripheral nerve compression. In this report, we present a rare case of ulnar nerve compression by a multi-septated ganglion cyst in the cubital tunnel. A 33-year-old left-handed male amateur tennis player developed progressive numbness and weakness in his right elbow, forearm, and hand for 1 year. Decrease of grip power was apparent in left hand. Clinical examination revealed a cystic mass at the posterior side of the elbow. Magnetic resonance imaging identified a ganglion cyst at the elbow. During surgery about 3 cm diameter epineural ganglion was observed compressing the ulnar nerve and was excised using microsurgery techniques. Three months postoperatively, the clinical recovery of the patient was very satisfactory and he restored his original performance in tennis match.

Ganglion Cell Analysis in an Optic Tract Syndrome Patient Previously Diagnosed with Glaucoma

PURPOSE: To report the results of ganglion cell analysis in a patient with optic tract syndrome who was previously diagnosed with glaucoma. CASE SUMMARY: A 32-year-old male, who had been diagnosed with glaucoma 12 years ago, but had not visited an ophthalmology clinic since then, came to our clinic for evaluation of his glaucoma. Both eyes showed an increased cup-to-disc ratio and temporal pallor of the disc. Retinal nerve fiber layer (RNFL) optical coherence tomography showed thinning of the superior, inferior, and temporal peripapillary RNFL in both eyes. On ganglion cell analysis (GCA), ganglion cell layer thinning in the nasal region of the right eye and in the temporal region of the left eye was observed. The visual field test showed right incongruous homonymous hemianopsia. After the atrophic change of the left optic tract was confirmed by orbit magnetic resonance imaging, he was diagnosed with left optic tract syndrome. CONCLUSIONS: We report the results of GCA in a case of optic tract syndrome, previously diagnosed as glaucoma. GCA can be useful when diagnosing optic tract syndrome.

Retinal Nerve Fiber Layer and Macular Retinal Ganglion Cell Layer Thicknesses in Healthy Korean Children

PURPOSE: To measure the thicknesses of the circumpapillary retinal nerve fiber layer (RNFL) and macular retinal ganglion cell-inner plexiform layer (GCIPL) by optical coherence tomography (OCT) in healthy Korean children and adolescents. METHODS: Circumpapillary RNFL and macular GCIPL thicknesses were measured by OCT in 352 healthy eyes of 352 children and adolescents (child-adolescent group) aged 5–17 years and in 159 healthy eyes of 159 adults (adult group) aged 18-75 years. The difference in RNFL and GCIPL thicknesses between the groups and the effects of age and refractive errors on the measurements were evaluated. RESULTS: The mean age of the children and adults were 9.7 ± 3.6 and 44.7 ± 15.7 years, respectively. The mean of the average RNFL and GCIPL thicknesses were 103.1 ± 9.2 and 85.7 ± 4.6 µm, respectively, in the children group and 97.8 ± 8.2 and 82.9 ± 4.4 µm, respectively, in the adult group. The child-adolescent group had greater RNFL and GCIPL thicknesses compared to the adult group in all areas (p < 0.05) with the exception of the RNFL thickness in the temporal quadrant (p = 0.555). A thinner RNFL and thinner GCIPL were significantly associated with older age and greater myopia (p < 0.001). CONCLUSIONS: The mean RNFL and GCIPL thicknesses measured by OCT in the healthy eyes of children and adolescents were 103.1 and 85.7 µm, respectively. Children and adolescents had a thicker RNFL and GCIPL compared to adults.

Visual Field Changes after Internal Limiting Membrane Peeling in Glaucoma Patients with Epiretinal Membrane

PURPOSE: To report visual field changes after internal limiting membrane (ILM) peeling for macular epiretinal membrane (ERM) according to the severity of glaucoma. METHODS: A retrospective review of 37 eyes from 37 patients who underwent ILM peeling to treat ERM. Standard automated perimetry (Humphrey visual field 24-2 program) was performed preoperatively and postoperatively. Based on the Advanced Glaucoma Intervention Study (AGIS) scoring system of preoperative visual field, patients were classified into the early glaucoma (AGIS ≤ 1) group or the advanced glaucoma (AGIS ≥ 2) group. Postoperative visual field sensitivity at each point was compared with the preoperative value. RESULTS: Out of 37 eyes, 15 eyes had early glaucoma and 22 had advanced glaucoma. Eyes from both groups had poor postoperative visual field parameters. For eyes with advanced glaucoma, the visual field index was significantly reduced and the visual field damage was larger and wider compared to those with early glaucoma. In both groups, visual field impairment was greater on the nasal side than on the temporal side, and visual acuity was not significantly different. Postoperatively, the macular ganglion cell-inner plexiform layer thickness was decreased, especially on the temporal side of advanced glaucoma. CONCLUSIONS: Visual field impairment was greater and wider in eyes with advanced glaucoma than in those with early glaucoma after ILM peeling in patients with ERM.

Thrombosed Fusiform Dilatation of Persistent Median Artery with Normal Median Nerve

Carpal tunnel syndrome can be produced by abnormal mass effect due to trauma, ganglion cysts, various soft tissue tumors, musculotendinous variants, and aberrant vascular structures. Persistent median artery is one of the causes of the carpal tunnel syndrome. Thrombosed persistent median artery usually accompanies the anomaly of the median nerve and causes a sudden onset of severe pain and paresthesia. In contrast to previous literature, we report the rare case of gradual onset and mild symptom of a 53-year-old man with a thrombosed persistent median artery but without anomaly of the median nerve and abnormal finding of electrophysiologic study.

An ANKRD11 exonic deletion accompanied by a congenital megacolon in an infant with KBG syndrome

KBG syndrome is an autosomal dominant syndrome presenting with macrodontia, distinctive facial features, skeletal anomalies, and neurological problems caused by mutations in the ankyrin repeat domain 11 (ANKRD11) gene. The diagnosis of KBG is difficult in very young infants as the characteristic macrodontia and typical facial features are not obvious. The youngest patient diagnosed to date was almost one year of age. We here describe a 2-month-old Korean boy with distinctive craniofacial features but without any evidence of macrodontia due to his very early age. He also had a congenital megacolon without ganglion cells in the rectum. A de novo deletion of exons 5–9 of the ANKRD11 gene was identified in this patient by exome sequencing and real-time genomic polymerase chain reaction. As ANKRD11 is involved in the development of myenteric plexus, a bowel movement disorder including a congenital megacolon is not surprising in a patient with KBG syndrome and has possibly been overlooked in past cases.

A Case of Concurrent Ampullary Adenoma and Gangliocytic Paraganglioma at the Minor Papilla Treated with Endoscopic Resection

A gangliocytic paraganglioma is a benign tumor of the digestive system with a very low incidence. The tumor is histopathologically characterized by a triphasic pattern consisting of epithelioid, ganglion, and spindle-shaped Schwann cells. In most cases, it occurs in the second portion of the duodenum near the ampulla of Vater. We report a case of a gangliocytic paraganglioma occurring at the minor duodenal papilla (a rare location) with a concurrent adenoma of the ampulla of Vater. Both lesions were treated simultaneously using endoscopic resection. Additionally, we have presented a literature review.

Nervus terminalis and nerves to the vomeronasal organ: a study using human fetal specimens / 대한해부학회지

The human nervus terminalis (terminal nerve) and the nerves to the vomeronasal organ (VNON) are both associated with the olfactory nerves and are of major interest to embryologists. However, there is still limited knowledge on their topographical anatomy in the nasal septum and on the number and distribution of ganglion cells along and near the cribriform plate of the ethmoid bone. We observed serial or semiserial sections of 30 fetuses at 7–18 weeks (crown rump length [CRL], 25–160 mm). Calretinin and S100 protein staining demonstrated not only the terminal nerve along the anterior edge of the perpendicular lamina of the ethmoid, but also the VNON along the posterior edge of the lamina. The terminal nerve was composed of 1–2 nerve bundles that passed through the anterior end of the cribriform plate, whereas the VNON consisted of 2–3 bundles behind the olfactory nerves. The terminal nerve ran along and crossed the posterior side of the nasal branch of the anterior ethmoidal nerve. Multiple clusters of small ganglion cells were found on the lateral surfaces of the ethmoid's crista galli, which are likely the origin of both the terminal nerve and VNON. The ganglions along the crista galli were ball-like and 15–20 µm in diameter and, ranged from 40–153 in unilateral number according to our counting at 21-µm-interval except for one specimen (480 neurons; CRL, 137 mm). An effect of nerve degeneration with increasing age seemed to be masked by a remarkable individual difference.

Achalasia Cardia Resulting in Bronchial Obstruction: A Case Series and Literature Review / 대한소화기학회지

Achalasia is a motility disorder of the esophagus that is characterized by loss of ganglionic neurons within the myenteric plexus of the lower esophageal sphincter (LES) resulting in failure of the LES to relax. Clinically this disorder presents with simultaneous dysphagia to solids and liquids, and if left untreated, leads to esophageal dilation, which can give rise to many adverse consequences. Extrinsic compression of respiratory structures is one such consequence, and rarely, cases of tracheal compression secondary to achalasia have been reported. However, cases of extrinsic bronchial compression are yet rarer. Here, we present a case series comprised of two patients with achalasia who presented with extrinsic bronchial compression by a dilated esophagus secondary to achalasia.

The Connection between Charles Darwin's Evolutionary Theory of ‘Heredity of Behaviors’ and the 19th Century Neuroscience: The Influence of Neuroscience on Darwin's Overcoming of Lamarck's Theory of Evolution / 의사학

The nineteenth century neuroscience studied the instinct of animal to understand the human mind. In particular, it has been found that the inheritance of unconscious behavior like instinct is mediated through ganglion chains, such as the spinal cord or sympathetic nervous system, which control unconscious reflexes. At the same time, the theory of Inheritance of Acquired Characteristics (hereafter ‘IAC’) widely known as Lamarck's evolutionary theory provided the theoretical frame on the origin of instinct and the heredity of action that the parental generation's habits were converted into the nature of the offspring generation. Contrary to conventional knowledge, this theory was not originally invented by Lamarck, and Darwin also did not discard this theory even after discovering the theory of natural selection in 1838 and maintained it throughout his intellectual life. Above all, in the field of epigenetics, the theory of ‘IAC’ has gained attention as a reliable scientific theory today. Darwin discovered crucial errors in the late 1830s that the Lamarck version's theory of ‘IAC’ did not adequately account for the principle of the inheritance of unconscious behavior like instinct. Lamarck's theory regarded habits as conscious and willful acts and saw that those habits are transmitted through the brain to control conscious actions. Lamarck's theory could not account for the complex and elaborate instincts of invertebrate animals, such as brainless ants. Contrary to Lamarck's view, Darwin established the new theory of ‘IAC’ that could be combined with contemporary neurological theory, which explains the heredity of unconscious behavior. Based on the knowledge of neurology, Darwin was able to translate the ‘principle of habit’ into a neurological term called ‘principle of reflex’. This article focuses on how Darwin join the theory of ‘IAC’ with nineteenth century neuroscience and how the neurological knowledge from the nineteenth century contributed to Darwin's overcoming of Lamarck's ‘IAC’. The significance of this study is to elucidate Darwin's notion of ‘IAC’ theory rather than natural selection theory as a principle of heredity of behavior. The theory of ‘IAC’ was able to account for the rapid variation of instincts in a relatively short period of time, unlike natural selection, which operates slowly in geological time spans of tens of millions of years. The nineteenth century neurological theory also provided neurological principles for ‘plasticity of instinct,’ empirically supporting the fact that all nervous systems responsible for reflexes respond sensitively to very fine stimuli. However, researchers of neo-Darwinian tendencies, such as Richard Dawkins and evolutionary psychologists advocating the ‘selfish gene’ hypothesis, which today claim to be Darwin's descendants, are characterized by human nature embedded in biological information, such as the brain and genes, so that it cannot change at all. This study aims to contribute to reconstructing the evolutionary discourse by illuminating Darwin's insights into the “plasticity of nature” that instincts can change relatively easily even at the level of invertebrates such as earthworms.

Are steroids required in the treatment of ganglion impar blockade in chronic coccydynia? a prospective double-blinded clinical trial / 대한통증학회지

BACKGROUND: Ganglion impar blockade is a reliable and effective treatment option used in patients with coccydynia. Our primary objective was to specify the role of corticosteroids in impar blockade. We compared applications of local anesthetic with the local anesthetic + corticosteroid combination in terms of treatment efficiency in patients with chronic coccydynia. METHODS: Our study was a prospective randomize double-blind study. The patients were divided into 2 groups after randomization. The first group (group SL) was made up of patients where a corticosteroid + local anesthetic were used during ganglion impar blockade. In the second group (group L) we used only local anesthetic. We evaluated numeric rating scale (NRS) and Beck depression scale, which were employed before the procedure and in 1st and 3rd months after the procedure. RESULTS: Seventy-three patients were included in the final analysis. We detected a significantly greater decrease in NRS values in the 1st month in group SL than in group L (P = 0.001). In the same way, NRS values in the 3rd month were significantly lower in the group with steroids (P = 0.0001). During the evaluation of the Beck test, we detected significantly greater decreases in the 1st month (P = 0.017) and 3rd month (P = 0.021) in the SL group than in the L group. CONCLUSIONS: Ganglion impar blockade decreases pain in the treatment of chronic coccydynia and improve depression. Addition of steroids in a ganglion impar blockade is required for treatment response that should accumulate over a long period of time.

Resonancia magnética en el atrapamiento del nervio supraescapular por quiste supraglenoideo / Magnetic resonance in nerve entrapment suprascapular supraglenoid cyst

El síndrome de atrapamiento del nervio supraescapular es una causa infrecuente de dolor en el hombro y de difícil diagnóstico clínico. Puede ser consecuencia de traumatismo, infección, compresión extrínseca o estiramiento secundario a movimientos repetitivos. Los quistes supraglenoideos deben considerarse en el diagnóstico diferencial pues son una causa frecuente de compresión del nervio supraescapular que ocurre casi exclusivamente en hombres. Se evaluaron con resonancia magnética (RM) y en forma retrospectiva siete pacientes con diagnóstico de atrapamiento del nervio supraescapular por quiste supraglenoideo. La RM mostró la causa y localización de la compresión nerviosa así como la distribución del edema muscular en todos los casos. Puede evaluar el grado de severidad de la enfermedad y realizar el diagnóstico diferencial con otras causas que provocarían atrapamiento del nervio supraescapular. (AU)

Suprascapular nerve entrapment has been regarded as a relatively uncommon condition that is easily overlooked in the differential diagnosis of shoulder discomfort. The common feature is nerve damage, caused either by trauma, extrinsic compression or by stretching secondary to repeated movements. Ganglion cysts account for the majority of the masses causing entrapment and seem to occur exclusively in men. Seven cases of suprascapular nerve entrapment caused by supraglenoid cyst compression were reviewed with MRI. MRI showed the cause and location of nerve compression as well as the distribution of muscular edema in all cases. MR imaging also allows an evaluation of the severity of the disease. It is also very efficient in excluding several differential diagnoses. (AU)