Shunsuke Konno

Recurrence of fibrous hamartoma of infancy excised 14 years after the primary surgery

Fibrous hamartoma of infancy is a rare, benign, superficial soft-tissue mass. It usually occurs within the first 2 years of life at the axial regions, upper arms, and external genital areas. There have been some recurrences within the 1st year of the surgery, although no cases have been reported to recur after 1 year. The authors present a recurrent case of fibrous hamartoma of infancy 14 years after the primary surgery, and they show the clinical and histopathological findings.

Clinical usefulness of assessing lumbar somatosensory evoked potentials in lumbar spinal stenosis. Clinical article.

OBJECT The aim of this retrospective study was to evaluate the clinical usefulness of assessing lumbar somatosensory evoked potentials (SSEPs) in central lumbar spinal stenosis (LSS). METHODS The latencies of lumbar SSEPs were recorded in 40 patients with central LSS, including 16 men and 24 women. The mean age of the patients was 67.3 +/- 7.4 years. The diagnosis was LSS in 23 cases and LSS associated with degenerative spondylolisthesis in 17 cases. The average duration of symptoms was 43.8 +/- 51.2 months. Twenty-two cases had bilateral and 18 cases had unilateral leg symptoms. Thirty-seven cases were associated with neurogenic intermittent claudication and the mean walking distance of patients with this condition was 246.8 +/- 232.7 m. The mean Japanese Orthopedic Association scale score, as well as the visual analog scale (VAS) scores of low-back pain, leg pain, and numbness, were 16.5 +/- 3.5, 6.0 +/- 2.5, 6.9 +/- 2.1, and 7.8 +/- 2.2, respectively. The minimal cross-sectional area of the dural sac on MR imaging was 0.44 +/- 0.21 cm(2). Thirty-nine cases of cervical spondylotic myelopathy without lumbar and peripheral neuropathy were chosen as the control group. RESULTS The latencies of lumbar SSEPs in patients with LSS and in the control group were 23.0 +/- 2.0 ms and 21.6 +/- 1.9 ms, respectively. There was a statistically significant difference between the LSS and control groups (p < 0.05). The latency of lumbar SSEPs was significant correlated with the VAS score of leg numbness (p < 0.05). The latency of lumbar SSEPs in LSS was clearly delayed when the VAS score of leg numbness was > or = 8 (p < 0.05). CONCLUSIONS Lumbar SSEPs are able to detect neurological deficit in the lumbar area effectively, and they can reflect part of the subjective severity of sensory disturbance (numbness) in LSS. Both lumbar SSEPs and VAS scores of leg numbness may be useful for clinical evaluation in patients with LSS.

P3-17 The effects on the reliability of reading parameters of F-waves by flattening the baselines of the waveforms using a mathematical approximation

Objective: We reported previously that motor imagery executed with cutaneous input by cutaneous input tape (CIT) facilitated corticospinal tract excitability. However, the amount of influence induced by the cutaneous input has not been clarified. The purpose of the present study was to clarify the influence of the CIT on motor neuron pool excitability. Methods: Healthy subjects participated in this experiment. There were four test conditions, the rest condition: Rest, the cutaneous input-rest condition: CI-Rest, the motor imagery condition: MI, and the cutaneous input-motor imagery condition: CI-MI. H-reflex was recorded from the right soleus muscle for each condition. CIT was applied from the right sole to the gastrocnemius muscle. The motor imagery was executed, so that the ankle plantar flexion was imaged in the brain. H-reflex test stimulus intensity was defined as the level at which half amplitude of the maximum H-reflex amplitude could be evoked. Results: The mean value of H-reflex amplitude increased in the order of Rest, MI, CI-Rest, and CI-MI, and there was a significant main effect on the condition. A post hoc test revealed that the H-reflex amplitude increased more significantly in CI-MI than in Rest or MI. The increasing ratio of H-reflex amplitude during motor imagery was significantly larger than that recorded without CIT. Conclusions: The results of this study suggested that CIT affects the motor neuron pool excitability at the spinal level during motor imagery. One possible explanation is that two independent facilitatory effects of CIT and the motor imagery were finally detected after those independent interventions were combined. Another possible explanation is purposive utilization. A facilitatory effect of gain modification induced by taping was shown during motor imagery, but this effect did not occur during the rest condition, when no motor imagery was invoked.

P15.7 Sensory conduction study of carpal tunnel syndrome with inching technique

and 93 limbs. All patients were referred to the EMG laboratory with a preliminary diagnosis of ulnar nerve entrapment at the elbow. The study group consisted of 55 females (64%) and 31 males (36%). The most common clinical complaint was numbness in the ulnar lateral of the ring and little fingers (72%). Slowing of the CV (<50 m/sn) across the elbow was recorded in 45 (48.4%) limbs with a long segment (6–12 cm) study and in 68 limbs (73%) with a short segment (3 cm) study. The most common localization of slowing was the ‘‘elbow-3 cm below elbow’’ segment which was recorded in 45 limbs (66.1%) and at the ‘‘elbow-3 cm proximal the elbow’’ segment which was recorded in 41 limbs (60.2%). In 82% of these cases an amplitude drop of the compound muscle action potential (CMAP) was also recorded. A CMAP amplitude drop of 10–30% between the wrist and elbow was recorded in 35 limbs (51.4%) an amplitude drop of 30–50% was recorded in 12 limbs (17.6%) while a drop of more than 50% was only recorded in 5 limbs (7.3%). Conclusion: Short segment studies are more sensitive for the electrodiagnosis of ulnar nerve entrapment at the elbow and even though a CMAP amplitude drop is recorded in most patients an amplitude drop consistent with a conduction block (>50%) is rare.