The Grueneberg ganglion: signal transduction and coding in an olfactory and thermosensory organ involved in the detection of alarm pheromones and predator-secreted kairomones.

In numerous mammalian species, the nose harbors several compartments populated by chemosensory cells. Among them, the Grueneberg ganglion (GG) located in the anterior nasal region comprises sensory neurons activated by given substances. In rodents, in which the GG has been best studied, these chemical cues mainly include heterocyclic compounds released by predators or by conspecifics. Since some of these substances evoke fear- or stress-associated responses, the GG is considered as a detector for alerting semiochemicals. In fact, certain behavioral and physiological reactions to alarm pheromones and predator-secreted kairomones are attenuated in the absence of a functional GG. Intriguingly, GG neurons are also stimulated by cool temperatures. Moreover, ambient temperatures modulate olfactory responsiveness in the GG, indicating that cross-talks exist between the transduction pathways mediating chemo- and thermosensory signaling in this organ. In this context, exploring the relevant molecular cascades has demonstrated that some chemosensory transduction elements are also crucial for thermosensory signaling in the GG. Finally, for further processing of sensory information, axons of GG neurons project to the olfactory bulb of the brain where they innervate distinct glomerular structures belonging to the enigmatic necklace glomeruli. In this review, the stimuli activating GG neurons as well as the underlying transduction pathways are summarized. Because these stimuli do not exclusively activate GG neurons but also other sensory cells, the biological relevance of the GG is discussed, with a special focus on the role of the GG in detecting alarm signals.

External iliac vein compression and lower-extremity swelling caused by an iliopectineal ganglion: a case report.

BACKGROUND: A hip joint ganglion is a rare cause of lower-extremity swelling. CASE PRESENTATION: We report a case of a Japanese patient with ganglion of the hip with compression of the external iliac/femoral vein that produced signs and symptoms mimicking those of deep vein thrombosis. CONCLUSIONS: Needle aspiration of the ganglion was performed, and swelling of the lower extremity promptly decreased. At 7.5 years after aspiration, there was no recurrence of swelling of the leg. Although the recurrence rate for ganglions after needle aspiration is high, it is worthwhile trying aspiration first.

Variability of PROMIS Scores Across Hand Conditions.

PURPOSE: This study aimed to determine whether Patient-Reported Outcome Measurement Information System (PROMIS) Physical Function and Pain Interference scores varied at presentation for specialty care by nontrauma hand condition. The secondary aim was to compare PROMIS scores with a reference standard, the Quick-Disabilities of the Arm, Shoulder, and Hand (QuickDASH), regarding the magnitude and direction of score differentials among diagnoses. METHODS: PROMIS Physical Function and Pain Interference scores were analyzed from 1,471 consecutive new adult patient clinic visits at a tertiary orthopedic hand clinic presenting with 1 of 5 nontrauma hand conditions. A 5-point difference on PROMIS assessments was presumed to be clinically relevant. A random sample of 30 QuickDASH scores from each diagnostic group was evaluated for score differentials among groups. We also measured the correlation between PROMIS and QuickDASH scores. RESULTS: Patients with carpal tunnel syndrome and thumb basal joint arthritis reported worse physical function and more pain interference, whereas those with Dupuytren contractures and ganglion cysts reported less pain and better function. For both domains, patients with trigger fingers averaged PROMIS scores among the other groups. Similar differences were observed in QuickDASH scores because patients with carpal tunnel syndrome and thumb arthritis reported clinically worse upper-extremity function than did patients with ganglion cysts and Dupuytren contracture. A strong correlation was seen between QuickDASH scores with both PROMIS Physical Function scores and Pain Interference scores. CONCLUSIONS: The PROMIS system is sufficiently able to capture differences in self-reported function and pain interference among patients with different hand conditions. Moreover, PROMIS Physical Function demonstrates construct validity when evaluated against a reference of the QuickDASH across nontrauma hand conditions. CLINICAL RELEVANCE: The use of PROMIS is expanding, but because PROMIS is not disease-specific, assessment of its construct validity is necessary for hand conditions.

Sonography-guided arthroscopic excision is more effective for treating volar wrist ganglion than dorsal wrist ganglion.

The purpose of this study was to compare the treatment results of sonography-guided arthroscopic excision for volar and dorsal wrist ganglions. A total of 42 patients with wrist ganglions underwent sonography-guided arthroscopic resection. Clinical outcome measures included wrist range of motion, grip strength, patient-rated questionnaire Hand20, and numerical pain rating scale. All patients were assessed for recurrence throughout the follow-up period. Ganglions were located at the dorsal wrist in 26 cases and at the volar wrist in 16 cases. The mean Hand20 and pain scores were significantly improved after sonography-guided arthroscopic resection for both volar and dorsal wrist ganglions. Recurrence was seen in six cases (23%) of dorsal wrist ganglion but no cases of volar wrist ganglion (P < .05). The use of sonography-guided arthroscopic ganglion excision is better for treating volar wrist ganglion than dorsal wrist ganglion.

Acute lumbosacral hemorrhagic ganglion cyst after transforaminal epidural steroid injection.

Epidural steroid injection is one of the most commonly used non-surgical treatments for degenerative lumbar vertebral disease. Its use has increased as degenerative lumbar vertebral disease has increased in frequency. Concomitant complications are being reported more often. In this report, we report a rare case of iatrogenic hemorrhagic cyst following epidural steroid injection. The patient underwent operative treatment with complete resolution of his symptoms.

A rapidly progressive foot drop caused by the posttraumatic Intraneural ganglion cyst of the deep peroneal nerve.

BACKGROUND: Intraneural ganglion cysts usually arise from the articular branch of the nerve. The relationship between intraneural ganglion cysts and trauma is not clear. CASE PRESENTATION: We report a case of a 62-year-old female with a rapidly progressive foot drop caused by a posttraumatic intraneural ganglion cyst of the deep peroneal nerve. We excised the ganglion cyst and performed nerve decompression. After the surgery, the patient had a functional recovery. CONCLUSIONS: The concurrence of an intraneural ganglion cyst and trauma may increase damage to the nerve, although it is difficult to diagnosis before an operation. Early diagnosis and early proactive interventions would likely be associated with a good outcome.

Irreversible Footdrop as a Consequence of Neglected Knee Pain in an Adolescent with a Peroneal Intraneural Ganglion Cyst.

BACKGROUND: Peroneal intraneural ganglion cysts (IGCs) are nonneoplastic lesions. They are responsible for a small number of footdrop cases, which occur after additional nerve damage. The earliest patient symptom related to IGCs is knee pain. CASE DESCRIPTION: A 17-year-old boy developed pain in the left knee, which progressively worsened over 14 months. He did not seek any medical assistance during this time. The patient subsequently was involved in a bicycle accident, and 3 months later he was unable to raise his left foot and was referred to our clinic for footdrop. Surgery was performed, but the weakness persisted. We could not detect any functional reinnervation on electromyography 12 months after surgery. CONCLUSIONS: The most important factors in determining the prognosis of IGCs are the extent of the nerve trauma and the early diagnosis and treatment of the IGC. Detection of almost complete functional denervation on electromyography may indicate that it is too late for surgery.

Volar retinacular ganglions (flexor tendon sheath ganglions) The results of surgical treatment.

Volar retinacular ganglions are the third most common group of all ganglions located in the hand and wrist region. The purpose of this work is to present our experience in management and the results of operative treatment of volar retinacular ganglions. One-hundred-and-seven patients were operated-on for volar retinacular ganglions between 2000 and 2014. One-hundred-and-eight ganglions were resected. Complications which were observed in five patients postoperatively (digital nerve irritation, restricted range of motion of digital joints) resolved within several weeks. At final follow-up, no ganglion recurrence, impairment of finger mobility, innervation or blood supply were observed in any of the patients.

Generation of Various Telencephalic Regions from Human Embryonic Stem Cells in Three-Dimensional Culture.

In the developing embryo, telencephalon arises from the rostral portion of the neural tube. The telencephalon further subdivides into distinct brain regions along the dorsal-ventral (DV) axis by exogenous patterning signals. Here, we describe a protocol for in vitro generation of various telencephalic regions from human embryonic stem cells (ESCs). Dissociated human ESCs are reaggregated in a low-cell-adhesion 96-well plate and cultured as floating aggregates. Telencephalic neural progenitors are efficiently generated when ESC aggregates are cultured in serum-free medium containing TGFß inhibitor and Wnt inhibitor. In long-term culture, the telencephalic neural progenitors acquire cortical identities and self-organize a stratified cortical structure as seen in human fetal cortex. By treatment with Shh signal, the telencephalic progenitors acquire ventral (subpallial) identities and generate lateral ganglionic eminence (LGE) and medial ganglionic eminence (MGE). In contrast, by treatment with Wnt and BMP signals, their regional identities shift to more dorsal side that generates choroid plexus and medial palllium (hippocampal primordium).

Ganglion Cyst of the Knee: A Retrospective Review of a Consecutive Case Series.

The aim of this study was to describe relevant medical history, clinical symptoms and outcomes in 12 patients having undergone surgical treatment of intra-articular ganglion cysts of the knee at our Department from January 2010 to June 2016. Patient demographics, medical history, knee manifestations, management and outcome were evaluated. The mean patient age was 26.4 (range, 16-46) years. Th ere were seven female and five male patients. Duration of symptoms prior to the operation varied from 2 months to 3 years (mean, 17.1 months). All patients had preoperative magnetic resonance imaging work-up of the knee. Pain was the most common clinical presentation. All patients were surgically treated arthroscopically, and an additional open approach was used in only one of the patients. There were no complications during surgery and the postoperative period was uneventful in all patients. The mean follow up period was 43.5 (range, 9-83) months and no recurrence was observed. All patients remained symptom-free with full range of motion at final follow up. Despite a wide range of intra-articular ganglion cyst presentations and symptoms, our cohort demonstrated an excellent remission rate and functional prognosis following surgical treatment of the ganglion cysts of the knee.

Permanent Motor Function Loss by Delayed Treatment of Peroneal Intraneural Ganglion.

The low incidence of intraneural ganglion makes it difficult to diagnose and treat before it becomes serious nerve damage. This case describes a 69-year-old female, who suffered from the right drop foot and was diagnosed as a peroneal intraneural ganglion. Resection of the mass relieved the pain; however, motor function was not recovered. Early diagnosis and nerve decompression are essential for the peroneal intraneural ganglion before critical nerve symptoms.

Foot and Ankle Kinematics and Dynamic Electromyography: Quantitative Analysis of Recovery From Peroneal Neuropathy in a Professional Football Player.

The assessment of neuromuscular recovery after peripheral nerve surgery has typically been a subjective physical examination. The purpose of this report was to assess the value of gait analysis in documenting recovery quantitatively. A professional football player underwent gait analysis before and after surgery for a peroneal intraneural ganglion cyst causing a left-sided foot drop. Surface electromyography (SEMG) recording from surface electrodes and motion parameter acquisition from a computerized motion capture system consisting of 10 infrared cameras were performed simultaneously. A comparison between SEMG recordings before and after surgery showed a progression from disorganized activation in the left tibialis anterior and peroneus longus muscles to temporally appropriate activation for the phase of the gait cycle. Kinematic analysis of ankle motion planes showed resolution from a complete foot drop preoperatively to phase-appropriate dorsiflexion postoperatively. Gait analysis with dynamic SEMG and motion capture complements physical examination when assessing postoperative recovery in athletes.

Knee pain · no popping · no previous trauma · Dx?

A 36-year-old man sought care at our family medicine clinic for knee pain that he'd had for the past year. He denied any previous injury or trauma to the knee. The pain affected the posterolateral left knee and was aggravated by squatting and deep flexion. Daily activities did not bother him, but skiing, golfing, mountain biking, and lifting weights worsened the pain. His pain had gradually become more severe and frequent. He denied any mechanical symptoms such as catching, popping, or locking.

A ganglion cyst derived from a synovial cyst: A case report.

The synovial and ganglion cysts originating from the facet joint have been named under the name of the Juxtafacet cyst by the several researchers. They put forward that the synovial cyst originated from the synovial joint. But, they failed to clarify the pathophysiology of the formation of the ganglion cyst. In this case report, we reported a 67-year-old male patient was referred to the emergency from another center with the complaint of a left leg pain and weakness in the left foot and patient was treated with microchirurgical technique. His patological examination was evaluated a ganglion cyst. We have discussed and explained the pathophysiology of the formation of a ganglion cyst derivered from a synovial cyst. And separately, we have presented the spinal cysts by grouping them under a new classification called a cystic formation of the soft tissue attachments of the mobile spine as well as dividing them into sub-groups.

Audit of Clinical and Functional Outcomes of Arthroscopic Resection of Wrist Ganglions.

BACKGROUND: The purpose of this study is to audit the clinical and functional outcomes of arthroscopic ganglionectomy (AG) in our centre. METHODS: A retrospective study was conducted on all 29 patients who underwent AG from 2007 to 2012 with a mean clinic and telephone follow-up duration of 6 months and 32 months respectively. RESULTS: A total of 29 patients (17 women and 12 men) with a mean age of 38 years underwent AG. 15 patients (52%) had associated pain with the lump, 24 out of 29 patients (83%) had preoperative ultrasound to confirm the diagnosis. All patients had preoperative wrist radiographs that showed no chronic carpal instability and bony pathology. 26 out of 29 patients (90%) had dorsal wrist ganglions and 3 patients (10%) had volar wrist ganglions. 15 out of 24 ganglions (62.5%) were multiloculated. Mean ganglion size clinically and through wrist ultrasound was 2.5 cm and 1.8 cm respectively. During arthroscopy, ganglion stalk was identified in 14 patients (48%). Average operating time was 69.5 minutes. Intraoperatively, 24 out of 29 patients (83%) had wrist synovitis and 26 patients (90%) had associated carpal ligament laxity. 97% of cases were successfully resected arthroscopically. Recurrence rate was 10% (3 cases). There was no significant difference between preoperative and postoperative range of motion of wrists - the mean wrist flexion ranged from 63 to 59 degrees pre and postoperatively, and the mean wrist extension ranged from 66 to 64 degrees pre and postoperatively. Overall grip strength improved from 27 kg to 32 kg ([Formula: see text]), and there was also a significant improvement in pain scores pre and post-operatively from visual analogue scale (VAS) score of 0.8 to 0.3 ([Formula: see text]). No major intra or post-operative complications occurred. All patients were satisfied in terms of cosmesis. CONCLUSIONS: AG is a safe and reliable alternative to open resection of wrist ganglions. In addition, it can be used as a diagnostic and therapeutic tool for other wrist conditions.

Plerixafor may treat intractable post-herpetic neuralgia.

Varicella-zoster virus (VZV) causes varicella (chicken pox) and establishes latency in ganglia. A reactivation of latent VZV leads to herpes zoster (shingles). Herpes zoster often causes herpetic pain that can last for months or years after the rash has healed. Prolonged herpetic pain is defined as post-herpetic neuralgia (PHN). There is an unmet need to explore novel therapeutic approaches for intractable PHN. Postmortem studies have shown that VZV induces neuro-inflammation and damage to the ganglia and spinal cord. These pathological changes may be critical factors resulting in PHN. Accumulated evidence suggests that stem cells may alleviate neuropathic pain in animal models through immunomodulatory actions and neuronal repair. Unfortunately, exogenous stem cell transplantation has limited clinical use due to safety concerns, immune rejection, and complications. Pharmacological mobilization of endogenous bone marrow stem cells may overcome these obstacles. Plerixafor is a SDF-1/CXCR4 axis blocker which can stimulate the release of stem cells from the bone marrow into blood circulation. We propose a hypothesis that endogenous stem cells mobilized by plerixafor may relieve the symptoms of PHN. If so, it may represent a novel approach for the treatment of intractable PHN.

Neuregulin 1 as an endogenous regulator of nicotinic acetylcholine receptors in adult major pelvic ganglion neurons.

We investigated whether endogenous neuregulin 1 (NRG1) is released in a soluble form (called sNRG1) and upregulates expression of nicotinic acetylcholine receptor (nAChR) in autonomic major pelvic ganglion (MPG) neurons of adult rats. To elicit the release of sNRG1, either the hypogastric nerve or the pelvic nerve was electrically stimulated. Then, the MPG-conditioned medium (CM) was subjected to western blotting using an antibody directed against the N-terminal ectodomain of NRG1. Both sympathetic and parasympathetic nerve activation elicited the release of sNRG1 from MPG neurons in a frequency-dependent manner. The sNRG1 release was also induced by treatment of MPG neurons with either high KCl or neurotrophic factors. The biological activity of the released sNRG1 was detected by tyrosine phosphorylation (p185) of the ErbB2 receptors in MPG neurons. When MPG neurons were incubated for 6 h in the CM, the protein level of the nAChR α3 subunit and ACh-induced current (IACh) density were significantly increased. The CM-induced changes in IACh was abolished by a selective ErbB2 tyrosine kinase inhibitor. Taken together, these data suggest that NRG1 functions as an endogenous regulator of nAChR expression in adult MPG neurons.

An intra-articular ganglion cyst in a patient with juvenile idiopathic arthritis.

We report an intra-articular ganglion cyst (IAGC) presenting as knee pain and a mass in a patient with longstanding Juvenile Idiopathic Arthritis (JIA). We could not find a similar case of an IAGC occurring in the knee of JIA patients in the literature. IAGC may need to be included as a possibility in patients with inflammatory arthritis with new-onset knee pain, especially in those with a palpable mass. MRI was useful in distinguishing IAGC from more worrisome causes of a knee mass. Orthopedic input was helpful in diagnosis and treatment. In addition, methotrexate therapy was effective in bringing about a long-lasting remission.