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At least 631 records · Page 35Linked to original sources
PubMed2000

Stereotactic radiosurgery for tumor-related trigeminal pain.

OBJECTIVE: Between 1 and 6% of patients who are diagnosed with facial pain syndromes have tumors that involve the trigeminal nerve. We report the effects of stereotactic radiosurgery on tumor-related trigeminal pain. METHODS: We reviewed results, from a prospective database, for 24 consecutive patients with cranial base tumors and either trigeminal neuralgia (n = 9) or painful trigeminal neuropathy (n = 15) who underwent stereotactic radiosurgery during an 8-year period. The tumor was the radiosurgical target for these patients (not the trigeminal nerve or ganglion). The median clinical follow-up period after radiosurgery was 45 months (range, 12-90 mo); the median neuroimaging follow-up period was 36 months (range, 5-86 mo). RESULTS: There were 20 women and 3 men, with an average age of 57 years (range, 33-79 yr). One patient had bilateral facial pain and underwent staged radiosurgery. Pathological classification indicated 16 meningiomas and 8 malignant cranial base tumors (adenoid cystic carcinoma, n = 6; squamous cell carcinoma, n = 2). Twelve of 24 patients (50%) were initially free of pain, and another 11 patients (46%) reported that they experienced significant improvements in their trigeminal pain syndromes after radiosurgery. The tumor histological type, quality of facial pain, preexisting facial numbness, and marginal and maximal radiation doses were not related to postradiosurgical facial pain outcomes. Three patients with malignant cranial base carcinomas developed recurrent facial pain, 1 to 9 months after radiosurgery, which was related to tumor progression outside the irradiated volume. One patient (4%) developed new partial V2 numbness after radiosurgery. CONCLUSION: Radiosurgery proved to be effective in improving tumor-related trigeminal pain for the majority of patients with either benign or malignant cranial base tumors. Recurrence of trigeminal pain is frequent for patients with malignant cranial base carcinomas and is related to tumor progression.

Adult↗
PubMed2001

High-dose trigeminal neuralgia radiosurgery associated with increased risk of trigeminal nerve dysfunction.

OBJECTIVE: Stereotactic radiosurgery is being used with more frequency in the management of patients with trigeminal neuralgia. To improve facial pain outcomes, many centers have increased the prescribed radiation dose to the trigeminal nerve. METHODS: Between April 1997 and December 1999, 68 patients underwent radiosurgery for trigeminal neuralgia with use of the Leksell gamma knife (Elekta Instruments, Norcross, GA) and a single 4-mm isocenter of radiation. Twenty-seven patients (40%) received 70 Gy (low dose) of irradiation and 41 patients (60%) received 90 Gy (high dose). The groups were similar with regard to age, sex, duration of pain, number of prior surgeries, and preexisting trigeminal deficits. The primary facial pain outcomes for analysis were excellent (pain-free, no medications) and good (pain-free, reduced medications). The mean length of follow-up after radiosurgery was 14.4 months (range, 2-36 mo). RESULTS: At last follow-up examination, 11 (41%) of the 27 patients with low-dose radiosurgery remained pain-free compared with 25 (61%) of the 41 patients with high-dose radiosurgery (P = 0.17). Additional surgery was performed in 12 low-dose patients (44%) and 8 high-dose patients (20%) (P = 0.05). High-dose radiosurgery was associated with an increased rate of permanent trigeminal nerve dysfunction (54% versus 15%, P = 0.003). Bothersome dysesthesias occurred in 13 high-dose patients (32%), whereas only 1 low-dose patient had this complication (P = 0.01). Three high-dose patients (8%) developed corneal numbness after radiosurgery. Pain recurred with more frequency in patients not developing trigeminal nerve dysfunction after radiosurgery (9 of 22 patients, 41 %) compared with those who sustained facial numbness, paresthesias, or dysesthesias (4 of 27 patients, 15%); however, the difference was not statistically significant (P = 0.08). CONCLUSION: Higher doses of radiation may correlate with better facial pain outcomes after radiosurgery for trigeminal neuralgia. However, the incidence of significant trigeminal nerve dysfunction is markedly increased after radiosurgery for patients receiving high-dose radiosurgery. Because of the nonselective nature of this ablative technique, dose prescription should be limited to less than 90 Gy.

Aged↗
PubMedDate not supplied

Predicting breast cancer-related lymphedema using self-reported symptoms.

OBJECTIVES: This study aimed to determine the accuracy of using self-reported signs and symptoms to identify the presence of lymphedema as well as the usefulness of identifying clinically measurable lymphedema on the basis of certain symptoms elicited by the Lymphedema Breast Cancer Questionnaire (LBCQ). METHODS: This analysis used logistic regression to identify symptoms predictive of differences between symptom experiences of participants belonging to two distinct groups (study A): those with known post-breast cancer lymphedema (n = 40) and those in a control group of women with no history of breast cancer or lymphedema (n = 40). Symptoms in this model of best fit were used to examine their relation to limb circumferences of breast cancer survivors in a second independent data set (study B; n = 103) in which a diagnosis of known lymphedema was not previously determined using symptom experiences. RESULTS: The presence of lymphedema was predicted by three symptoms comprising a model of best fit for study A (c =.952): "heaviness in past year," "swelling now," and "numbness in past year." Using this model, prediction of absolute maximal circumferential limb difference (i.e., >or=2 cm) in study B showed that "heaviness in the past year" (p =.0279) and "swelling now" (p =.0007) were predictive. "Numbness in the past year" was not predictive. However, those with lesser limb differences reported this symptom more often. CONCLUSIONS: The findings suggest that changes in sensations may be indicators of early lymphedema or other treatment-related sequelae that must be assessed carefully at each follow-up visit and over time. A combination of symptom assessment and limb volume measurement may provide the best clinical assessment data for identifying changes associated with post-breast cancer lymphedema.

Adult↗
PubMed1977

Vertical ramisection for prognathism.

Forty-four patients with Class III malocclusion, who were operated on for prognathism, have been reviewed. In spite of the associated problems of pain, nausea, fear, relapse, additional orthodontia, lip numbness, lip weakness, and 8 weeks with their teeth wired together, only one patient of the 44 said he (or she) would decline this surgery if it were to be considered anew. The surgeon must make a strong effort to keep the vertical cut in the bony ramus posterior to the lingula, to avoid postoperative lip numbness. He should also keep traction on the soft tissues minimal, to avoid postoperative weakness of the lower lip. A significant relapse was uncommon in this series, and the facial symmetry was greatly enhanced. Most of these 44 patients (66 percent) said the improvement in their self-image and personal appearance was far more important to them than the improvement in their bite.

Adolescent↗
PubMed1990

Retro-orbicularis oculus fat (ROOF) resection in aesthetic blepharoplasty: a 6-year study in 63 patients.

Sixty-three nonconsecutive patients have undergone resection of the retro-orbicularis oculus fat (ROOF) in conjunction with aesthetic blepharoplasty. In these patients, a consistent and useful ability to soften and flatten heaviness and bulkiness in the lateral upper orbital region was seen. Two patients developed postoperative hematoma, and two different patients had transient dry-eye symptoms following blepharoplasty. Twenty percent of patients had a transient degree of numbness in the lateral supraorbital nerve region, and all patients noted some transient numbness over the lateral upper brow region. No patient demonstrated significant paralysis of the orbicularis oculus or corrugator muscle. From this experience, retro-orbicularis oculus fat resection would appear to be a useful adjunct to standard blepharoplasty techniques in selected patients.

Adipose Tissue↗
PubMed1993

Acrodysostosis associated with spinal canal stenosis.

An adult case of acrodysostosis with striking lumbar spinal canal stenosis is reported. She complained of numbness on the right arm, intermittent claudication with numbness on both legs and pain and weakness on the left leg. Although the reduced lumbar interpedicular distance has been reported, no adult case with neurologic symptoms has been reported.

Adult↗
PubMed2003

Spinal arachnoid cysts associated with syringomyelia: report of two cases and a review of the literature.

We describe two cases of spinal arachnoid cyst associated with syringomyelia and report the clinical results after surgical treatment using excision of the cyst without a shunt operation for the syringomyelia. Case 1 is a 73-year-old woman who presented with a spastic gait and numbness of her bilateral lower extremities. Magnetic resonance imaging (MRI) showed the presence of a spinal arachnoid cyst extending from T3 to T8 and syringomyelia from T8 to T10. The cyst had compressed the spinal cord anteriorly. We excised the cyst without applying a shunt tube for the syringomyelia. Case 2 is a 68-year-old woman who presented with gait disturbance and numbness of her left lower extremity. MRI indicated that the spinal cord had been compressed anteriorly by a spinal arachnoid cyst extending from T10 to T11. Syringomyelia existed just caudal to the cyst at T11. In our surgical treatment, we excised only the cyst. In both cases, neurologic examination after the operation showed amelioration of the condition. Postoperative MRI indicated that the spinal cord had moved to the center, its original position, and the syringomyelia had decreased in size. Conclusively, spinal arachnoid cyst associated with syringomyelia can be treated by simple excision of the cyst without shunting the syrinx if the decompression effect resulting from removal of the cyst is sufficient.

Aged↗
PubMed1995

Musculocutaneous nerve entrapment: a case report.

Atraumatic isolated musculocutaneous nerve problems are uncommon but have been cited in the literature with increasing frequency since the initial cases discussed in 1978. There appear to be two clinically distinct syndromes involving this nerve--a lesion of the musculocutaneous before its division into the lateral cutaneous nerve, causing a mixed motor and sensory syndrome, and a lesion of the sensory portion, which causes pure sensory findings of the lower radial aspect of the volar forearm. The diagnosis of the more proximal lesion is made by the findings of biceps weakness with no deltoid or other muscle involvement, with the possible exception of the coracobrachialis. There may also be a small area of numbness on the radial aspect of the distal volar forearm, which can be missed unless careful examination is carried out. The lateral cutaneous nerve syndrome is characterized by numbness in the radial half of the volar forearm with some diffuse tenderness over the elbow crease just lateral to the insertion of the biceps tendon. Treatment of the mixed lesion is based on absolute rest for a period of 8-12 weeks. Treatment of the lateral cutaneous nerve syndrome is based on small studies but has included splinting, cortisone injections, and decompression of the nerve.

Action Potentials↗
PubMed2001

Update on conservative management of acoustic neuroma.

OBJECTIVE: To update the authors' experience with conservative management of acoustic neuromas. STUDY DESIGN: Retrospective chart review. SETTING: Private practice and tertiary care referral setting. INTERVENTION: Of 600 patients with acoustic neuroma, 102 were treated with the "wait and scan" treatment option. At least two magnetic resonance imaging scans were required of all patients. MAIN OUTCOME MEASURES: Change in tumor size over time was evaluated, as were clinical symptoms: hearing status, tinnitus, balance disturbance, aural fullness, vertigo, headache, and facial pain, numbness, or weakness. RESULTS: Of 102 patients, the average follow-up time interval was 28.5 months. Forty-five (44%) of 102 patients demonstrated a change in tumor size: an average total growth of 2.17 mm per year. In the remaining 54 patients (53%), no growth was demonstrated during a mean follow-up of 28.5 months. Three patients demonstrated actual tumor shrinkage. Of the 102 patients receiving conservative treatment, 85 (84%) reported hearing loss, 67 (66%) tinnitus, 37 (36%) balance disturbance, 29 (28%) aural fullness, 28 (27%) vertigo, 7 (7%) headache, 4 (4%) facial numbness, 2 (2%) facial weakness, and 0 (0%) facial pain. CONCLUSION: Conservative management-"wait and scan"-for selected patients with acoustic neuroma is a reasonable choice of management instead of radiation or microsurgery. In some situations the individual morbidities associated with surgery or radiation make those treatments not in the patient's best interests. A third option is necessary in patients who cannot or do not wish to undergo those other treatments.

Adult↗
PubMed2006

Dynamic degenerative lumbar spondylolisthesis: diagnosis with axial loaded magnetic resonance imaging.

STUDY DESIGN: Retrospective review of case notes and imaging. OBJECTIVE: To show the advantage of axial loaded magnetic resonance imaging (MRI) for identification of dynamic degenerative spondylolisthesis as a suspected cause of spinal claudication. SUMMARY OF BACKGROUND DATA: Degenerative spondylolisthesis typically occurs at L4/L5 and is usually evident on plain radiography. However, dynamic degenerative spondylolisthesis may become evident on erect radiographs when not shown on supine radiographs or MRI. METHODS: The case notes and imaging (radiography, conventional MRI, and axial loaded MRI) in 2 patients with symptoms of spinal claudication were reviewed. RESULTS: A 44-year-old female presented with a 3-year history of intermittent low back pain and right leg numbness after a fall. A 52-year-old female presented with a 4-year history of low back pain, bilateral leg weakness, and right leg numbness. In both cases, conventional MRI studies showed mild-to-moderate degenerative disc disease only with no evidence of abnormal spinal alignment or nerve root compression. Axial loaded MRI clearly showed the development of a degenerative spondylolisthesis with central canal stenosis and facet ganglion formation in 1 case. CONCLUSIONS: Axial loaded MRI identified occult dynamic degenerative spondylolisthesis, which correlated with the clinical picture but was not shown on initial conventional MRI or plain radiography.

Adult↗
PubMed2003

Apicoectomy of an endosseous implant to relieve paresthesia: a case report.

Various radiographic and surgical techniques have been recommended to avoid paresthesia following mandibular implant placement. However, nerve impingement is sometimes inevitable, and when lingering numbness is reported, clinicians have a limited number of corrective options. This report describes a technique for cutting-back the apex of the implant, a technique that may be useful when lingering numbness persists after osseointegration has occurred.

Aged↗
PubMed2006

Prophylactic ilioinguinal neurectomy in open inguinal hernia repair: a double-blind randomized controlled trial.

OBJECTIVE: We conducted a double-blinded randomized controlled trial to investigate the short- to mid-term neurosensory effect of prophylactic ilioinguinal neurectomy during Lichtenstein repair of inguinal hernia. METHOD: One hundred male patients between the age of 18 and 80 years with unilateral inguinal hernia undergoing Lichtenstein hernia repair were randomized to receive either prophylactic ilioinguinal neurectomy (group A) or ilioinguinal nerve preservation (group B) during operation. All operations were performed by surgeons specialized in hernia repair under local anesthesia or general anesthesia. The primary outcome was the incidence of chronic groin pain at 6 months. Secondary outcomes included incidence of groin numbness, postoperative sensory loss or change at the groin region, and quality of life measurement assessed by SF-36 questionnaire at 6 months. All follow-up and outcome measures were carried out by a designated occupational therapist at 1 and 6 months following surgery in a double-blinded manner. RESULTS: The incidence of chronic groin pain at 6 months was significantly lower in group A than group B (8% vs. 28.6%; P = 0.008). No significant intergroup differences were found regarding the incidence of groin numbness, postoperative sensory loss or changes at the groin region, and quality of life measurement at 6 months after the operation. CONCLUSIONS: Prophylactic ilioinguinal neurectomy significantly decreases the incidence of chronic groin pain after Lichtenstein hernia repair without added morbidities. It should be considered as a routine surgical step during the operation.

Adolescent↗
PubMed1997

Binding specificity and in vivo targets of the EH domain, a novel protein-protein interaction module.

EH is a recently identified protein-protein interaction domain found in the signal transducers Eps15 and Eps15R and several other proteins of yeast nematode. We show that EH domains from Eps15 and Eps15R bind in vitro to peptides containing an asparagine-proline-phenylalanine (NPF) motif. Direct screening of expression libraries with EH domains yielded a number of putative EH interactors, all of which possessed NPF motifs that were shown to be responsible for the interaction. Among these interactors were the human homolog of NUMB, a developmentally reguated gene of Drosophila, and RAB, the cellular cofactor of the HIV REV protein. We demonstrated coimmunoprecipitation of Eps15 with NUMB and RAB. Finally, in vitro binding of NPF-containing peptides to cellular proteins and EST database screening established the existence of a family of EH-containing proteins in mammals. Based on the characteristics of EH-containing and EH-binding proteins, we propose that EH domains are involved in processes connected with the transport and sorting of molecules within the cell.

Adaptor Proteins, Signal Transducing↗
PubMed1998

Miranda as a multidomain adapter linking apically localized Inscuteable and basally localized Staufen and Prospero during asymmetric cell division in Drosophila.

Neuroblasts in the developing Drosophila CNS asymmetrically localize the cell fate determinants Numb and Prospero as well as prospero RNA to the basal cortex during mitosis. The localization of Prospero requires the function of inscuteable and miranda, whereas prospero RNA localization requires inscuteable and staufen function. We demonstrate that Miranda contains multiple functional domains: an amino-terminal asymmetric localization domain, which interacts with Inscuteable, a central Numb interaction domain, and a more carboxy-terminal Prospero interaction domain. We also show that Miranda and Staufen have similar subcellular localization patterns and interact in vitro. Furthermore, miranda function is required for the asymmetric localization of Staufen. Miranda localization is disrupted by the microfilament disrupting agent latrunculin A. Our results suggest that Miranda directs the basal cortical localization of multiple molecules, including Staufen and prospero RNA, in mitotic neuroblasts in an actin-dependent manner.

Actins↗
PubMed2004

The effects of cryoanalgesia combined with thoracic epidural analgesia in patients undergoing thoracotomy.

This study was performed to evaluate the effects of cryoanalgesia combined with thoracic epidural analgesia on pain and respiratory complications in patients undergoing thoracotomy. Ninety patients were prospectively randomised to epidural analgesia alone (n = 45) or epidural analgesia and cryoanalgesia combined (n = 45). We monitored the use of rescue pain medication and changes in forced vital capacity and forced expired volume in 1 s, and recorded pain and opioid-related side-effects during the immediate postoperative period. The incidence of post-thoracotomy pain and numbness were also assessed up to the sixth month after surgery. Cryoanalgesia combined with thoracic epidural analgesia was associated with earlier recovery in pulmonary function, less pain during movement and a lower daily requirement for rescue analgesia one week after surgery. However, the combination of cryoanalgesia and epidural analgesia failed to decrease the incidence of long-term pain and numbness. In view of its associated long-term morbidity, cryoanalgesia combined with thoracic epidural analgesia is not recommended for patients undergoing thoracotomy.

Adult↗
PubMed2004

Bilateral occipital neuropathy as a rare complication of positioning for thyroid surgery in a morbidly obese patient.

BACKGROUND: Peripheral neuropathies in various locations are described as complications after anesthesia and surgery. This is the first case report of temporary bilateral occipital neuropathy from positioning for thyroid surgery in a morbidly obese patient. METHODS: A 48-year-old women with a history of depression, fibro-myalgia, asthma, sleep apnea, diabetes mellitus and morbid obesity (127 kg, 165 cm) underwent 4 hours anesthesia with propofol/remifentanil without muscle relaxation for thyroid surgery. The neck with a very low range of motion secondary to fat tissue needed to be extended to facilitate surgery as much as possible. The head was carefully padded and there were no episodes of hypotension or hypoxemia throughout the case or in the PACU. At post op day 1 she complained of bilateral numbness in the distribution area of both greater occipital nerves. On post op day 2 tingling sensations and improvement of numbness was noticed. The patient recovered without residual symptoms after 6 weeks. CONCLUSION: Pressure or shear stress to the nerve, hypoperfusion or metabolic disturbances are discussed as the leading etiology of nerve damage during surgery in the literature. Pressure from fat tissue during prolonged head extension for surgery seems to be the cause in this case and should therefore be avoided whenever possible in morbidly obese patients, especially when other risk factors for neuropathy like diabetes are present.

Cranial Nerve Injuries↗
PubMed1993

Discogenic compression of the cauda equina: a surgical emergency.

The syndrome of cauda equina compression due to central disc rupture is uncommon but its importance greatly transcends its rarity. Key symptoms and signs are bilateral leg pain, weakness or numbness (although unilateral symptoms or even absence of leg pain do not exclude the diagnosis), perineal numbness and, in 60% of patients, bladder and bowel incompetence ranging from dysuria to vesical and anal sphincter paralysis. Diagnosis and treatment are often delayed due to lack of recognition of the condition and failure to appreciate the surgical imperative for its treatment. At the present time myelography is the one essential investigation, although this may become supplanted in time by magnetic resonance imaging. Arrangements for myelography should be planned so that immediate operation can be commenced following the procedure. The onset of disc rupture may be acute and massive and result in intradural sequestration of disc fragments in 7.5% of cases. Intradural exploration and/or transdural sequestrectomy avoids traction on already compromised nerve roots and is often safer than extradural sequestrectomy. The onset of bladder paralysis is a most important indication for immediate surgery. The cases presented show that there is a highly significant difference in the outcome of those cases operated on within 24h of bladder paralysis compared to those operated on after this period.

Adult↗
PubMed1995

Complications of the Caldwell-Luc operation and how to avoid them.

The complications of the Caldwell-Luc operation were retrospectively studied in 1990. The case records were analysed and updated information from telephone interviews and posted questionnaires were available for most patients. One hundred and eighty-five patients with 216 procedures with a mean postoperative follow-up period of 33.5 months were studied. The commonest indication for the operation was for chronic sinusitis. There were three common complications found: facial swelling (61.9%), pain and/or numbness of the face (46.0%) and pain and/or numbness of the teeth/gums (30.9%). Rare complications are postoperative epistaxis (0.4%), oroantral fistulae (0.4%), epiphora (0.4%) and dental discoloration (0.4%). This paper discusses the pathophysiology of these complications and surgical techniques on how to avoid them. Although the use of the Caldwell-Luc operation has declined in recent years with the development of endoscopic sinus surgery, it still has occasional indications and a set of practical guidelines on how to prevent complications would be useful. The basis for treating chronic sinusitis with functional endoscopic sinus surgery at the expense of the more traditional form of treatment is also discussed.

Chronic Disease↗