Neuromas as the cause of pain in the residual limbs of amputees. An ultrasound study.

AIM: To explore the morphology of neuromas and to determine the differences, if any, between asymptomatic and symptomatic neuromas using ultrasound. MATERIALS AND METHODS: Eighty patients with symptomatic neuromas were included in this retrospective review. High-resolution ultrasound examination was performed. Transducer pressure allowed real-time analysis of both symptomatic and asymptomatic neuromas. Quantifiable assessment of pain by the patient assigned a pain score of 0, 1, 2, or 3, to each neuroma. RESULTS: One hundred and fifty-nine neuromas were identified in total. Fifty-three neuromas were asymptomatic (pain score=0), very severe pain was recorded in 54 (pain score=3), 16 neuromas were mildly painful (pain score=1) and 36 were moderately painful (pain score=2). The average number of neuromas per patient was 1.98, and the average number of symptomatic neuromas per patient was 1.3. There was no correlation between pain score and patient age, neuroma volume, amputation type, and time since amputation. CONCLUSIONS: High-resolution ultrasound can distinguish between asymptomatic and symptomatic neuromas. Patient age, time since amputation, the type of amputation, and the neuroma volume were not related to the presence of pain.

Small intestinal lactase status, frequency distribution of enzyme activity and milk intake in a multi-ethnic population.

The aims of the study were to investigate the prevalence of primary lactase deficiency, frequency distribution of lactase activity and the relationship between lactose intake and lactase activity in three ethnic groups resident in Birmingham. Seventy-two white, 103 Indian and 58 Afro-Caribbean adult dyspeptic patients had distal duodenal biopsies taken for disaccharidase assay at endoscopy. Ten percent of whites, 51% Indians and 81% Afro-Caribbeans had primary lactase deficiency (sucrase/lactase ratio > 4). There was a generalized unexplained depression of disaccharidase activities in the Indians. Frequency distribution of lactase activity for the whole population showed a negative skew without evidence of trimodality. Lactose intake and symptoms attributed to lactose were assessed in a subgroup of 20 whites, 20 Indians and 18 Afro-Caribbeans by questionnaire. Lactose intake did not differ between lactase persistent and deficient subjects both within each racial group and between the groups. Diarrhoea, bloating and cramps were not significantly more common in lactase deficient than lactase persistent individuals.

Nutritional screening--evaluation and implementation of a simple Nutrition Risk Score.

Development of a simple, validated Nutrition Risk Score for identification of patients at risk of undernutrition is described. The score is easy to use, applicable to all patient categories and ages, and correlated well with a validated Nutrition Risk Index (r = 0.68, p < 0.001) and clinical impression (r = 0.83, p < 0.001). Reproducible scores were obtained between dietitians (r = 0.91, p < 0.001) and between dietitians and nursing staff (r = 0.80, p < 0.001). The score was used to assess risk of undernutrition in 153 consecutive admissions to medical and surgical specialties. Patients were categorised as low (50%), moderate (24%) or high risk (26%). Evaluation of measures to prevent nutritional depletion revealed that no action was taken in 64% (23/36) of moderate risk and 30% (12/40) of high risk patients. Implementation of routine, hospital-wide nutritional screening, to identify patients in need of nutritional support, has been achieved by inclusion of the score in the standard nursing assessment process.

Food-deprivation-induced phase shifts in Sminthopsis macroura froggatti.

Past research has shown that there is a circadian oscillator in laboratory rats that is entrained by restricted feeding schedules. However, in laboratory rats at least, the light-dark (LD) cycle is the dominant zeitgeber in the entrainment of wheel-running activity rhythms. Given that dasyurid marsupials are predominantly carnivorous, the episodic intake of food in the wild and the high nutritive content of that food suggest that food may be an important zeitgeber in these species. Twelve Sminthopsis macroura froggatti were presented with a daily meal at 0900 hr under an LD 12:12 cycle with lights-on at 0600 hr for 37 days. Activity in anticipation of the meal was observed in most animals. Following this, all animals were exposed to periods of 12-18 days ad lib. food interspersed with 3-day periods of deprivation--a technique used previously to demonstrate persistent meal-associated rhythms. The meal-associated activity rhythms previously observed in rats during the 3-day deprivation period were not seen, but the 3-day deprivation period produced large phase-shifts in the activity rhythms of several S.m. froggatti. It is concluded that meal feeding does not dominate the LD cycle in entraining dasyurid marsupials, but that the frequent observation of phase shifts suggests a different and, perhaps, stronger role for food intake in biological rhythmicity than has been observed previously in laboratory rats.

The role of adrenocorticotropin and norepinephrine in appetitive learning in the rat.

This study examines the involvement of ACTH/4-10 and norepinephrine during training and testing of a complex maze task. Hormones were administered post-trial to eliminate effects on processes other than learning and memory during training and testing sessions. ACTH/4-10, but not NE, facilitates acquisition of an appetitive maze task, but neither affect test performance. Facilitation of acquisition by ACTH/4-10 is discussed within two frameworks. ACTH/4-10 may enhance memory, presumably via a direct action on certain brain cells, resulting in stimulated protein synthesis and modified synaptic transmission. An interaction with serotonin synthesis and metabolism may be involved. Alternatively, during training and testing of a complex maze task, an ACTH-opiate receptor interaction may modify reinforcing properties, thus facilitating acquisition.