There are differences in the number of ganglion cells among different parts of the human digestive tract. The differences range from a few to several tens of thousands of neuron/cm2. The myenteric nervous plexus of the esophagus was characterized by a significantly smaller number of neurons but their bodies and nuclei are significantly larger compared to other parts of the digestive tract.
The study shows the relevance of sciatic nerve stiffness assessed by strain elastography using ARFI (Acoustic Radiation Force Impulse) for surgical decision making and the follow up of patients with deep gluteal syndrome (DGS). The research focuses on nerve stiffness associated with knee movements in order to determine the degree of nerve entrapment. Neurological examination, MRI of pelvis and electromyography (EMG) were performed as well. The sciatic nerve was scanned by ARFI (strain) elastography during knee movements in patients with DGS (143). In 54 patients surgical treatment was indicated, while 24 of them underwent surgery. The results were based on tissue response to ARFI by color elastogram and stiffness ratio. Diameters of the sciatic nerve in patients with DGS during knee flexion were statistically significantly lower than during extension movement (p<0.01).In patients with DGS (in ones without indication and the ones scheduled for surgery) sciatic nerve stiffness ratio was significantly increased (p<0.01) during knee flexion. Patients scheduled for surgery confirmed increased sciatic nerve stiffness during knee movements, compared with those without indications for surgery (p<0.05). Sciatic nerve recovery after surgery by diameter and stiffness ratio was marked (r=0.881). The correlation between MRI and EMG findings and ARFI nerve stiffness values in patients scheduled for surgery was high (r=0.963). The overall specificity of method was 93.5%, sensitivity was 88.9% with accuracy of 90.6%. ARFI elastography (by strain) is a diagnostic procedure based on nerve stiffness assessment and a useful tool in decision making for surgery and the follow up.
Uvod: Prisustvo maligno izmenjenih aksilarnih limfnih nodusa, i njihovo pravovremeno detektovanje je od ključnog značaja za određivanje stadijuma i prognoze karcinoma dojke. Ehotomografija je široko korišćena tehnika, i predstavlja jedan od prvih dijagnostičkih modaliteta ispitivanja. Klasični B mod, Dopler sonografija, kao i MicroPure tehnika ispitivanja, omogućavaju sveobuhvatnu detaljnu procenu morfologije i unutrašnje strukture čvorova (broj, lokalizacija, veličina, oblik, granice, ehogenost, edem okolnog mekog tkiva, prisustvo mikrokalcifikacija) i određivanje njihove prirode. Cilj rada: Odrediti ulogu ehotomografskog pregleda u ispitivanju morfologije, određivanju prirode kao i postavljanje smernica za dijagnostički algoritam ispitivanja maligno izmenjenih aksilarnih limfnih nodusa. Materijal i metode: Studijom preseka obuhvaćeno je 212 ehotomografski testiranih aksilarnih limfnih nodusa u Službi za radiološku dijagnostiku KBC ''Dr Dragiša Mišović-Dedinje'' u Beogradu, u periodu od februara 2016.do marta 2017.godine. Sve pacijente smo ispitivali u ležećem položaju sa rukama u abdukciji, i spoljašnjoj rotaciji. Ispitivani su sledeći parametri: oblik, veličina, homogenost i ehostruktura, ivice, pomoćne strukture poput intranodalne nekroze, periferni edem i vaskularizacija, kao i prisustvo mikrokalcifikacija, koristeći klasično snimanje u B modu, Dopler sonografiju i MicroPure tehniku. Sva snimanja smo obavljali na aparatu marke Toshiba, Aplio XG, linearnom sondom od 10MHz. Rezultati: Od ukupno 212 testiranih nodusa, patohistološki je verifikovano 44 maligno izmenjenih (21%), od kojih 4 primarno (9%) kod pacijenta sa Hodžkinovim limfomom, a 40 sekundarno (91%), kod pacijenata sa karcinomom dojke. Ostala 168 nodusa (79%) su bili normalni-reaktivni. Najbolje performanse u ehosonografskom ispitivanju jesu kriterijumi: oblika (uzdužno poprečni odnos <2) sa senzitivnošću od 86,9%, prisustva mikrokalcifikacija sa senzitivnošću od 83,7%, hilusa (nejasno definisan i hipoehogen) sa senzitivnošću od 81,8%, veličine (poprečni dijametar veći od 8mm) sa senzitivnošću od 79,2%, kao i ehogensoti (hipo do anehogen) sa senzitivnošću od 73,1%. Zaključak: Ehotomografski pregled je koristan modalitet snimanja u proceni morfologije i prirode aksilarnih limfnih nodusa, međutim nijedan ehotomografski kriterijum sam za sebe nije dovoljno pouzdan u proceni malignosti. Minucioznost prilikom pregleda, kao i ispitivanje svih kriterijuma kao i modaliteta (B mod, Dopler, MicroPure) ostaju imperativ u dijagnostičkom algoritmu ispitivanja aksilarnih limfnih nodusa. Ključne reči: ehotomografija, aksilarni limfni nodusi, MicroPure tehnika
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