Dynamic sonography of the forefoot in Morton's syndrome: correlation with magnetic resonance and surgery.

PURPOSE: The aim of this paper is to demonstrate the efficacy of the dynamic study of the forefoot during lateral compression of the metatarsal heads (Mulder's manoeuvre) in the visualisation of Morton's neuroma. The data were compared with clinical signs, conventional ultrasound (US), magnetic resonance (MR) and surgical findings. MATERIALS AND METHODS: Forty forefeet in 38 patients were investigated with conventional and dynamic US using a 10-MHz linear probe (Esaote Technos). MR was performed in 26 forefeet with a 0.2-T scanner (Esaote Artoscan). Twenty intermetatarsal spaces in 18 forefeet were explored surgically. RESULTS: Thirty-seven intermetatarsal masses were identified through dynamic US in the 40 forefeet investigated (two double localisations). This method was clearly more effective than conventional US, which could only locate 25. In those forefeet investigated with MR, it was possible to confirm dynamic US findings in 16 out of 22. In one of the six cases unconfirmed by MR, a neuroma was removed following surgery. Twenty masses (19 neuromas and one synovial ganglion) were found in the 18 forefeet treated by surgery. CONCLUSIONS: Clinical evaluation, which is fundamental for accurate diagnosis, can make use of dynamic US in the first instance in order to confirm clinical signs and identify the correct site and number of masses. In our opinion, MR maintains a primary role in differential diagnosis with other diseases (mainly stress fractures, bursitis, ganglion cysts or tendon tumour sheaths).

"Light" versus "classic" laser treatment for clinically significant diabetic macular oedema.

AIM: To compare the effectiveness of "light" versus "classic" laser photocoagulation in diabetic patients with clinically significant macular oedema (CSMO). METHODS: A prospective randomised pilot clinical trial in which 29 eyes of 24 diabetic patients with mild to moderate non-proliferative diabetic retinopathy (NPDR) and CSMO were randomised to either "classic" or "light" Nd:YAG 532 nm (frequency doubled) green laser. "Light" laser treatment differed from conventional ("classic") photocoagulation in that the energy employed was the lowest capable to produce barely visible burns at the level of the retinal pigment epithelium. Primary outcome measure was the change in foveal retinal thickness as measured by optical coherence tomography (OCT); secondary outcomes were the reduction/elimination of macular oedema on contact lens biomicroscopy and fluorescein angiography, change in visual acuity, contrast sensitivity, and mean deviation in the central 10 degrees visual field. Examiners were masked to patients' treatment. RESULTS: 14 eyes were assigned to "classic" and 15 were assigned to "light" laser treatment. At 12 months, seven (50%) of 14 eyes treated with "classic" and six (43%) of 14 eyes treated with "light" laser had a decrease of foveal retinal thickness on OCT (p = 0.79). A comparison of reduction/elimination of oedema, visual improvement, visual loss, change in contrast sensitivity, and mean deviation in the central 10 degrees showed no statistical difference between the groups at 12 months (p>0.05 for all groups). CONCLUSIONS: This study suggests that "light" photocoagulation for CSMO may be as effective as "classic" laser treatment, thus supporting the rationale for a larger equivalence trial.

[Evaluation of left ventricular enlargement in isolated aortic insufficiency. Importance of the total cardiac volume calculated on the standard chest film]. / Valutazione dell'ingrandimento ventricolare sinistro nell'insufficienza aortica isolata. Importanza del volume totale del cuore calcolato sulla radiografia standard del torace.

A radiographic and hemodynamic investigation has been performed in 53 patients with pure isolated aortic regurgitation, in order to evaluate the most reliable method to detect left ventricular enlargement in this condition. Twelve plain chest film measurements have been compared to the end diastolic volume of the left ventricle calculated by left ventricular angiography. The most sensitive detector of left ventricular enlargement was the plain film total heart volume ( r = 0.754); the cardiothoracic ratio, the cardiac perimeter and the frontal area were less sensitive measurements, but still statistically significant (p less than 0.001). The results of our investigation support the conclusion that plain film total heart volume is the most reliable single measurement for evaluating the left ventricular enlargement in patients with isolated pure aortic incompetence.