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At least 343 records · Page 19Linked to original sources
PubMed1992

Different options for treatment of inverting papilloma of the nose and paranasal sinuses: a report of 41 cases.

Forty-two cases of inverting papilloma of the nose and paranasal sinuses were reviewed from 1972 to 1989. Forty-one patients underwent surgical excision. Of those patients followed up for at least 6 months, lateral rhinotomy was performed in 14 patients and midfacial degloving in 9 patients. The recurrence rates were 29% and 22%, respectively. The other 10 patients underwent excision through an external ethmoidectomy, Caldwell-Luc operation, or intranasal approach. There were five patients (12%) diagnosed with squamous cell carcinoma associated with inverting papilloma. The correlation of malignancy with proptosis, visual changes, infraorbital hypesthesia, and skull base involvement on presenting symptomatology is noted. Inverting papilloma is a benign neoplastic lesion that shows variable aggressiveness. A computed tomography (CT) scan evaluation is very important for the work-up. An aggressive wide surgical excision is best performed through an open approach. The approach for surgical removal should be based on the location and extension of the lesion. A graduating approach from a lesser to a more major excision is advocated even though a risk exists of having to reoperate in about one fifth of the patients who experience a recurrence. A secondary surgical excision, even with craniofacial resection, is essential to eradicate disease in cases of recurrence. Close follow-up is necessary. Further surgery may be indicated. Post-operative radiation therapy is recommended if malignancy is indeed present.

Adult↗
PubMed2001

Articaine hydrochloride: a study of the safety of a new amide local anesthetic.

BACKGROUND: Articaine is an amide local anesthetic introduced clinically in Germany in 1976 and subsequently throughout Europe, Canada and, in 2000, the United States. METHODS: The authors report on three identical single-dose, randomized, double-blind, parallel-group, active-controlled multicenter studies that were conducted to compare the safety and efficacy of articaine (4 percent with epinephrine 1:100,000) with that of lidocaine (2 percent with epinephrine 1:100,000). RESULTS: A total of 1,325 subjects participated in these studies, 882 of whom received articaine 4 percent with epinephrine 1:100,000 and 443 of whom received lidocaine 2 percent with epinephrine 1:100,000. The overall incidence of adverse events in the combined studies was 22 percent for the articaine group and 20 percent for the lidocaine group. The most frequently reported adverse events in the articaine group, excluding postprocedural dental pain, were headache (4 percent), facial edema, infection, gingivitis and paresthesia (1 percent each). The incidence of these events was similar to that reported for subjects who received lidocaine. The adverse events most frequently reported as related to articaine use were paresthesia (0.9 percent), hypesthesia (0.7 percent), headache (0.55 percent), infection (0.45 percent), and rash and pain (0.3 percent each). CONCLUSIONS: Articaine is a well-tolerated, safe and effective local anesthetic for use in clinical dentistry.

Adolescent↗
PubMed1982

[Studies of peripheral nerve conduction velocities in vibrating tool operators].

Vibrating tools such as chain-saws, rock-drills, grinders and tie-tampers have been widely used in many kinds of industries in Japan, causing vibration syndrome among the operators. As is well-known, the syndrome includes disorders of the peripheral circulation in the hands, e.g. Raynaud's phenomenon, and of the peripheral and central nervous systems. As the result of preventive countermeasures to the syndrome during the last decade, the picture of the syndrome has been partly changing especially for the patients among the state forestry workers; for example, the prevalence of the peripheral nerve disorders has been relatively increasing compared with that of Raynaud's phenomenon. Peripheral nerve disorders such as numbness, paresthesia and hypesthesia in the upper limbs tend to be usually cumulative and irreversible. The disorders are very important problem of vibration syndrome from the standpoint of treatment and prevention, though there are only a few reports of the study on the disorders using electrophysiological methods. In order to make objectively clear the peripheral nerve disorders, 236 male vibrating tool operators (= Group V) were examined. The following nerve conduction velocities were measured: (1) Maximal motor nerve conduction velocities (MCV) of the median and ulnar nerves in the forearm. (2) Sensory nerve conduction velocities (SCV) of the median and ulnar nerves in the forearm and palm. (3) Residual latency (RL) of the median and ulnar nerves. Besides, working conditions and complaints relevant to vibration syndrome were examined by using questionnaires. MCVs, SCVs and RLs that were outside of mean +/- 2 S.D. of the control group (= Group C), consisting of 30 healthy men, were evaluated as abnormal. The obtained results led to the following conclusions: (1) All MCVs, SCVs and RLs of Group V were significantly less than those of the control group. In Group V, prevalence of the abnormality in each of forearm SCVs was higher than that in each of MCVs of the corresponding nerves. (2) The difference between the median and ulnar SCV in the palm and the respective SCV in the forearm of each subject was significantly greater for Group V than Group C. (Palm-forearm difference) (3) The difference between the forearm and palmar SCV of the ulnar nerve and the respective velocities of the median nerve was statistically greater for Group V than for Group C. (Ulnar-median difference) (4) Ulnar SCV in the palm of Group V was significantly related to the total operating hours of vibrating tools. (5) There was no significant relation between all the nerve conduction velocities and the white finger attack. But a significant relation was noticed between the prevalence of the abnormal values of ulnar SCV in the palm and the peripheral circulatory function score computed from the data of nail press test and cold immersion test.

Adult↗
PubMed1996

Intramedullary spinal cord paracoccidioidomycosis. Report of two cases.

Two cases of intramedullary paracoccidioidomycosis are reported. Paracoccidioidomycosis is a systemic disease that involves the buccopharyngeal mucosa, lungs lymph nodes and viscera and infrequently the central nervous system. Localization in the spinal cord is rare. Case 1: a 55-year old male admitted with crural pararesis, tactile/painful hypesthesia and sphincter disturbances of 15 days duration. Cutaneous-pulmonary blastomycosis was diagnosed 17 years ago. Myelotomography showed a blockade of T3-T4 (intramedullary lesion). The lesion surgically removed was a Paracoccidioides brasiliensis granuloma. Treatment with sulfadiazine was started after the surgery. Follow-up of 15 month showed an improvement of the clinical signs. Case 2: a 57-year old male was admitted elsewhere 6 months ago and, with a radiologic diagnosis of pulmonary paracoccidioidomycosis, was treated with amphotericin B. He progressively developer paresthesia and tactile/pain anaesthesia on the left side, sphincter disturbances and tetraparesis with bilateral extensor plantar response and clonus of the feet. Myelotomography showed a blockade of C4-C6 (intramedullary lesion). The lesion was not found during surgical exploration and the patient deteriorated and died. Post-mortem examination revealed an intramedullary tumor above the site of the mielotomy (Paracoccidioides brasiliensis granuloma). The preoperative diagnosis of intramedullary paracoccidioidomycotic granulomas is difficult because the clinical and radiologic manifestations are uncharacteristic. Clinical suspicion was possible in our cases based on the history of previous systemic disease. Contrary to intracranial localizations, paracoccidioidomycotic granulomas causing progressive spinal cord compression may require early surgery because response to clinical treatment is slow and the reversibility of neurological deficits depends on the promptness of the decompression.

Granuloma↗
PubMed1997

Churg-Strauss syndrome associated with necrotizing crescentic glomerulonephritis in a diabetic patient.

We report a patient with Churg-Strauss syndrome-associated rapidly progressive glomerulonephritis concurrent with diabetes mellitus. The patient was a 64-year-old woman who was admitted to our hospital because of a glove and stocking type hypesthesia and numbness, multiple purpurae on both legs, and renal insufficiency with hematuria and proteinuria. Renal biopsy revealed necrotizing crescentic glomerulonephritis accompanied by necrotizing arteritis, marked eosinophilic infiltration of the interstitium, and diffuse and nodular diabetic glomerulosclerosis. Cyclophosphamide and steroid therapy succeeded in improving her neurologic symptoms as well as retarding the deterioration in renal function. No clinical manifestations suggestive of a recurrence of Churg-Strauss syndrome have been observed during the one-year follow-up period.

Anti-Inflammatory Agents↗
PubMed2000

Diabetic ketoacidosis associated with Guillain-Barré syndrome with autonomic dysfunction.

A 37-year-old woman was admitted in a comatose state, after exhibiting fever and diarrhea. Diabetic ketoacidosis was diagnosed due to an increased blood glucose level (672 mg/dl), metabolic acidosis, and positive urinary ketone bodies. On the fifth hospital day, despite recovery from the critical state of ketoacidosis, the patient suffered from dysphagia, hypesthesia and motor weakness, followed by respiratory failure. Cerebrospinal fluid analysis was suggestive of Guillain-Barre syndrome (GBS). Autonomic dysfunction was manifested as tachycardia and mild hypertension in the acute stage. Marked orthostatic hypotension persisted long after paresis was improved, indicating an atypical clinical course of GBS.

Adult↗
PubMed1998

Secondary glioblastoma remarkably reduced by steroid administration after anaplastic transformation from gliomatosis cerebri--case report.

A 45-year-old female presented with gliomatosis cerebri manifesting as hemiballismus-like involuntary movement in the arm, motor weakness in the leg, and hypesthesia in her left side. Computed tomography showed only diffuse swelling of the right cerebral hemisphere, but T2-weighted magnetic resonance imaging revealed a diffuse lesion spreading from the right thalamus to the temporal, parietal, and occipital lobes on the same side. No abnormal enhancement was recognized. Cerebral angiography showed no specific finding. A right occipital lobectomy was performed to confirm the diagnosis of gliomatosis cerebri. Anaplastic transformation was recognized 5 months later. The disease did not resolve with radiation or interferon administration, but steroid therapy achieved remarkably effective tumor regression. The patient died due to pneumonia. Autopsy showed the features of diffuse glioblastoma. Steroid therapy may be an effective treatment for gliomatosis cerebri before the terminal stage.

Astrocytoma↗
PubMed1999

Transorbital-transpetrosal penetrating cerebellar injury--case report.

A 4-year-old boy presented with a transorbital-transpetrosal penetrating head injury after a butter knife had penetrated the left orbit. The knife tip reached the posterior fossa after penetrating the petrous bone. Wide craniotomy and the pterional, subtemporal, and lateral suboccipital approaches were performed for safe removal of the object. The patient was discharged with left-sided blindness, complete left ophthalmoplegia, and hypesthesia of the left face. Early angiography is recommended to identify vascular injury which could result in fatal intracranial hemorrhage.

Cerebellum↗
PubMed2000

Calcification of the cervical ligamentum flavum--case report.

A 52-year-old male presented with calcification of the cervical ligamentum flavum manifesting as hypesthesia of the bilateral middle, ring, and little fingers and ulnar halves of both forearms, as well as motor weakness in the bilateral upper extremities and gait disturbance. Cervical x-ray tomography detected a round calcified mass on the posterior wall of the cervical canal at the C-5 level. Computed tomography showed the round, nodular calcified mass more clearly. Magnetic resonance imaging showed an epidural low intensity mass compressing and distorting the cervical cord at the C-5 level on both T1- and T2-weighted images. Administration of gadolinium-diethylenetriaminepenta-acetic acid caused marginal enhancement of the mass. The lesion was eventually removed by posterior laminectomy. The mass was composed of a very hard crystal-like calcified deposition in the ligamentum flavum. X-ray diffraction analysis of the histological specimen showed calcium pyrophosphate dihydrate (CPPD) and hydroxyapatite in the crystal-like substance, confirming that CPPD is responsible for calcification of the cervical ligamentum flavum.

Calcinosis↗
PubMed2000

Superior sagittal sinus and cerebral cortical venous thrombosis caused by congenital protein C deficiency--case report.

A 47-year-old male receiving anticoagulant therapy for thrombophlebitis in the left leg for several years presented with mild left hemiparesis and ipsilateral hypesthesia. The cause of the thrombophlebitis was still unknown. Magnetic resonance (MR) imaging showed subacute thrombosis of both the superior sagittal sinus (SSS) and a cortical vein in the right cerebral hemisphere. Fluid attenuation inversion recovery axial MR imaging demonstrated these lesions more obviously than conventional T2-weighted axial MR imaging. Right carotid angiography showed a partial SSS filling defect and occlusion of the cortical vein with collateral circulation. Coagulation studies revealed decreases in both protein C activity and antigen levels with normal levels of blood coagulation factors II, VII, IX, and X and protein S activity and antigen. The patient's mother had normal levels of both protein C activity and antigen, but his father had decreased levels. The diagnosis was SSS and cerebral cortical venous thrombosis caused by congenital protein C deficiency. The patient was treated conservatively, and his clinical course was uneventful. His neurological dysfunctions recovered within approximately 3 weeks after the onset. Ten months later, right carotid angiography showed recanalization of the SSS and partial filling of the cortical vein. Anticoagulant therapy has been continued, and no cerebral venous thrombosis has recurred during the 1.5 years after the onset.

Cerebral Angiography↗
PubMed2002

Chordoma of the thoracic spine--case report.

A 44-year-old woman presented with a thoracic chordoma with intrathoracic extension manifesting as complaints of lower extremity weakness, hypesthesia below the levels of T5-6, and sphincter incontinence. Almost total resection combined with anterior interbody fusion and stabilization was possible through a left transpleural transthoracic approach. She suffered recurrence after 2 years and was considered inoperable. Biopsy revealed a malignant chordoma with no sarcomatous differentiation. Chordoma is an uncommon malignant bone tumor originating from remnants of the embryonal notochord, occurring mostly along the axial skeleton, at the extremity of the vertebral spine, and is least common in the thoracic region. Differential diagnosis is problematic and biopsy is helpful particularly if considered inoperable. Thoracic chordomas of the malignant type manifest as cord or root compression. Classical malignant chordomas must be distinguished from chondroid, benign, or other types of chordomas, since the biological behavior and clinical features are distinct. However, the differential diagnosis cannot be based on histological examination, but long-term follow up is required. Most patients have extradural and intraspinal tissue extension at the time of diagnosis, which makes complete resection impossible. Aggressive surgery without violation of surgical borders is the best choice in the treatment of thoracic chordoma. Thoracic chordoma is a recurring neoplasm and is prone to dissemination and sarcomatous differentiation despite its slow-growing nature.

Adult↗
PubMed2002

Upper plexus thoracic outlet syndrome--case report.

A 47-year-old right-handed female became aware of proximal ache and muscle weakness in the right shoulder and elbow in 1997. Atrophy of the right biceps muscle was recognized and the right deltoid, triceps, supraspinatus, and infraspinatus muscles were weak. The Morley test and elevated arm stress test were positive. Neurolysis of the brachial plexus and anterior scalenectomy were performed via a right supraclavicular approach. An abnormal fibromuscular band was identified passing between the upper and middle trunks and constricting the middle trunk. Another scalene muscle anomaly was found passing between the C-5 and C-6 nerve roots and connecting the anterior and middle scalene muscles. These muscles were resected, and thorough neurolysis was performed around all nerves and the trunks. Postoperatively, all symptoms completely resolved and the patient was discharged 5 days after surgery. Thoracic outlet syndrome (TOS) manifests as symptoms of lower cervical nerve involvements with hypesthesia and paresthesia. However, upper plexus TOS manifests as symptoms due to the involvement of the C-5 to C-7 nerve roots, and is relatively rare. Transaxillary first rib resection is performed as the primary operation for TOS, but supraclavicular scalenectomy is effective for upper plexus TOS.

Brachial Plexus↗
PubMed2004

[Successful treatment of intravenous cyclophosphamide pulse therapy for lupus myelitis with urinary disturbance and acute confusional state].

A 18-year-old female had low grade fever, butterfly rush, proteinuria, leukocytopenia and hypocomplimentemia in 1988, and she was diagnosed as systemic lupus erythematosus (SLE) with lupus nephritis (WHOIIb). Treatments with prednisolone and mizoribine resulted in the remission for three years. In May 2001, she presented neurosis and polakisuria despite of the increase of prednisolone to 20 mg/day. Finally, she admitted in our hospital because of manic and repressive state and disorientaion. A brain MRI revealed high intensity lesions in bilateral basal ganglia in T2 weighted images, and cerebrospinal fluid showed elevated protein and IFN-alpha (421 IU/ml). In addition, she manifested neurogenic bladder, muscle weakness and hyperactive deep tendon reflex of bilateral lower limbs due to both supranuclear disorder and hypesthesia under the Th 10 level. Spinal MRI revealed marked atrophy and high intensity signals at the middle to lower thoracic spinal cord in T2 weighted images, indicating complication of lupus myelitis as well as cerebral involvement. Although the symptoms of CNS lupus did not respond to prednisolone, twelve monthly cyclophosphamide pulse therapy (IV-CY) has resolved urinary disturbance, muscle weakness and sensory loss, along with the improvement of both cerebral and spinal MRI images. Lupus myelitis and neurogenic bladder are the rare, but very refractory manifestation among CNS involvement of SLE. We here propose IV-CY as an invaluable choice for the treatment of not only active lupus myelitis but also neurogenic bladder resisted for steroid.

Adolescent↗
PubMed1987

The effect of restricting the indications for lumbosacral spine radiography in patients with acute back symptoms.

A prospective study was performed to evaluate the effect of using a special requisition form on the utilization of lumbosacral spine radiography for patients presenting in the emergency room with acute lower back complaints. Over a 1-year period, emergency room house officers were encouraged to complete a special form that listed only three acceptable indications for lumbosacral spine radiographs: history of trauma, evidence of focal neurologic abnormality, and "other." Neurologic abnormalities included hypesthesia, hyperesthesia or anesthesia of lumbar or sacral dermatomes, weakness or hyporeflexia of the lower extremities, and bladder or bowel incontinence. If the indication "other" was chosen, radiographs were done only if the form contained both a one- to two-sentence history and the signed approval of a supervising attending physician. The number and results of lumbosacral spine examinations were compared with those from the previous year, which served as a control. In the control year 1443 examinations were performed, and in the experimental year only 759 were done (a decrease of 47%). The percentage of patients with vertebral fractures increased from 5.1% to 5.8% in the experimental year if only the detection of new fractures was considered positive, and from 9.1% to 13.4% if the detection of fractures of all ages was regarded as significant. The use of the special requisition form appears to be a simple and effective means of reducing unnecessary lumbosacral radiography in the emergency room setting.

Acute Disease↗
PubMedDate not supplied

[Acute sciatic neuropathy--"post-Saturday palsy"].

This is a case report of 25-year old, unemployed male, admitted to hospital due to acute onset of the left foot drop, subsequent walking difficulty and numbness of the left calf and foot. Symptoms began after prolonged sleep with previous heroin abuse by sniffing. During neurological examination, mild weakness of knee flexors, moderate weakness of plantar flexors and paralysis of foot dorsiflexors, together with hypesthesia of the left calf, foot and fingers, predominantly in the innervation area of common peroneal nerve on the same side, were observed. The electrophysiologic examination revealed predominant involvement of peroneal division within the sciatic nerve, together with recorded conduction block indicating the compression as possible mechanism of nerve injury. The patient was administered corticosteroid therapy during two months, what resulted in almost complete recovery. The peculiarity of this case report is in the presence of the sciatic nerve "Saturday night palsy" with possible effect of former heroin abuse.

Acute Disease↗
PubMed1984

Long term results of superselective sacral nerve resection for motor urge incontinence.

Eight female patients suffering from severe urge incontinence not manageable by conservative treatment were subjected to superselective sacral nerve resection in the period 1974-1977. The aim of the resection was a complete parasympathetic decentralization of the bladder. The resection was carried out according to the results of pre-operative sacral nerve blockade and per-operative electrical nerve stimulation. Post-operatively all cystometrograms were shifted to the right and four patients had bladder areflexia. At six months follow-up, three patients were continent, four were improved and one patient had an indwelling catheter for persistent retention. However, incontinence and detrusor instability returned in all the patients within one year. After seven to eight years follow-up one patient had died, two patients had had a urinary diversion operation and three had an indwelling urethral catheter. Only two patients were permanently improved. The surgical procedure was complicated by wound necrosis in one patient, by persistent dysesthesia in two and hypesthesia in three.

Adult↗
PubMed1997

Radiotherapy of vertebral hemangiomas.

Between 1975 and 1996, 14 patients (11 females, 3 males) with vertebral hemangioma received treatment with radiotherapy. Thirteen patients had a history of back pain or lumbago and 2 patients had neurological symptoms such as sensory impairment or paraplegia. The standard dose administered was 36 Gy in 18 fractions (five treatments per week). In the 13 patients with pain, this was completely or partially relieved. The condition of a man with hypesthesia of the legs deteriorated and a woman with paraplegia who was treated with decompressive laminectomy followed by radiotherapy recovered completely after irradiation. CT scan before irradiation showed thickened trabeculae as small punctate areas of sclerosis in all patients. At MR imaging before irradiation, T2-weighted MR images showed areas of high intensity in all patients and MR images demonstrated lesion enhancement. However, none of the patients who were treated successfully with radiation demonstrated any changes of the affected vertebra in the conventional radiographic films. CT scan or MR imaging, even 5 years after irradiation. Radiological imaging is indispensable for the diagnosis of vertebral hemangiomas but does not appear to be useful for evaluating the effects of radiotherapy.

Adult↗
PubMed1985

Unilateral orbital floor fractures.

Ninety patients operated on, on suspicion of unilateral orbital floor fractures are described. Age, sex, and etiology are given. Operative indication is examined and related to the operative findings. Fifty-six of the patients had fractures requiring transplantation, 24 had fractures which did not. Ten patients had no fractures. Only autogenous bone graft was used. The patients were examined three months and one to 11 years postoperatively (questionnaire). Of 82 operated patients who answered the questionnaire diplopia was found in eight, enophthalmos in two, hypesthesia in 18, reduced mobility in four and sinuitis in four. Preoperative X-ray: Three patients showed false positive X-ray findings. In 19 patients with false negative X-ray findings 12 required transplantation. Twenty-five tomographed patients showed fractures, two of which proved to be false positives. In eight patients with negative tomographical findings, fractures were found, seven of which required transplantation. The frequency of complications assessed in relation to the time of operation shows no significant difference, if surgery takes place within seven days of injury. Surgery performed later than this seems to produce more cases of chronic sinuitis.

Adolescent↗