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PubMed2003

Impaired sensory-emotional integration in a violent adolescent sex offender.

Social risk factors, executive neuropsychological functioning, and emotional numbing were examined as potential risk factors for violent sexual assaults by an adolescent male. The subject had been exposed to at least four previously identified social risk factors, including neglect, early separation from both parents, sexual abuse, and low socioeconomic status. At the time of assessment, executive neuropsychological functioning was intact. At the time of assessment, executive neuropsychological functioning was intact. While impaired emotional responsiveness was an important factor in the assaults, the construct of emotional numbing is too broad to identify the specific neuropsychological impairment involved in the subject's assault behavior. The authors suggest that failures in sensory-emotional integration contributed to the likelihood of violent behavior. Implications for further research and clinical practice are discussed.

Adolescent↗

PubMed1997

Tourniquets in forefoot surgery: less pain when placed at the ankle.

We studied perioperative pain and postoperative neurological changes after surgery for hallux valgus in 50 patients operated on under local ankle block. Patients were randomised to have the pneumatic tourniquet either at calf level or just above the ankle. The cuffs were inflated to 100 mmHg above systolic blood pressure. One patient was withdrawn from the study after randomisation. Areas of pain, paraesthesia and numbness were marked by patients on a diagram of the foot before operation and at six and ten weeks after operation. Both positions of the tourniquet gave an excellent bloodless field. The proximal tourniquet gave significantly greater discomfort (p < 0.01) during the operation, after 10, 20 and 30 minutes. Application of the cuff at the ankle gave no relative increase in areas of numbness and paraesthesia at six and ten weeks. An ankle tourniquet gives less discomfort with no increase in the incidence of nerve injury.

Adolescent↗

PubMed1999

Dropped hallux after the intramedullary nailing of tibial fractures.

We made a prospective study of 208 patients with tibial fractures treated by reamed intramedullary nailing. Of these, 11 (5.3%) developed dysfunction of the peroneal nerve with no evidence of a compartment syndrome. The patients with this complication were significantly younger (mean age 25.6 years) and most had closed fractures of the forced-varus type with relatively minor soft-tissue damage. The fibula was intact in three, fractured in the distal or middle third in seven, with only one fracture in the proximal third. Eight of the 11 patients showed a 'dropped hallux' syndrome, with weakness of extensor hallucis longus and numbness in the first web space, but no clinical involvement of extensor digitorum longus or tibialis anterior. This was confirmed by nerve-conduction studies in three of the eight patients. There was good recovery of muscle function within three to four months in all cases, but after one year three patients still had some residual tightness of extensor hallucis longus, and two some numbness in the first web space. No patient required further treatment.

Adolescent↗

PubMed2005

Gender difference in prevalence of upper extremity musculoskeletal symptoms among Swedish pig farmers.

There have been very few epidemiological studies dealing with pig farmers' musculoskeletal health. The aim of this study was to carry out a cross-section postal questionnaire survey dealing with musculoskeletal symptoms among female and male pig farmers in large-scale production. The participation rate overall was 70% (288/410). Over 10% of the questionnaires had missing gender data. Three different questionnaires were used: the general standardized Nordic questionnaire for the analysis of musculoskeletal symptoms; a questionnaire dealing with occurrence of numbness, reduced muscle strength, etc., in the wrists and hands; and occupational factors were screened by a special questionnaire. The results showed that musculoskeletal morbidity is high among pig farmers. The women had significantly more problems than the men with respect to the upper extremities. Symptoms in the wrists and hands such as numbness, reduced muscle strength, aching fingers and wrists, and tendency to drop things were significantly more common among the women than the men. Occupational factors dealing with, for example, the size of the pig farm, were not related to the occurrence of symptoms. Occupational factors of importance for the development of disorders, particularly among women pig farmers, should be given priority in ergonomic interventions.

Adult↗

PubMed2002

Idiopathic paresthesia reaction associated with rofecoxib.

OBJECTIVE: To report a case of a paresthesia-type reaction due to the use of rofecoxib in standard doses for the treatment of osteoarthritis. CASE SUMMARY: A 55-year-old white woman was receiving rofecoxib for treatment of osteoarthritis. The patient began to have tongue numbness and hand tingling and numbness shortly after starting therapy with rofecoxib. The occurrence and resolution of her symptoms correlated with the start and end of the therapy. DISCUSSION: An adverse reaction with rofecoxib is a likely explanation for the patient's symptoms. Paresthesias have been reported in 0.1-1.9% of patients who took rofecoxib during premarketing studies, but no causality has been established. One case report of paresthesias occurring in a 59-year-old white man who took one 20-mg dose of piroxicam is available. Information on when the reaction occurred in relation to the dose and resolution of the reaction was not recorded in this study. Our patient's reaction is best classified as idiopathic. CONCLUSIONS: We report the first case of a paresthesia-type reaction to rofecoxib in a patient receiving the drug in standard doses for treatment of osteoarthritis. Although the reaction is rare, clinicians should be aware of its potential.

Anti-Inflammatory Agents, Non-Steroidal↗

PubMed2002

Lower extremity compartment syndrome following a laparoscopic Roux-en-Y gastric bypass.

BACKGROUND: Bariatric surgery has the potential for serious complications. A case is presented of unilateral lower extremity compartment syndrome after a laparoscopic Roux-en-Y gastric bypass performed in the modified lithotomy position. CASE REPORT: A 38-year-old female (weight 134.5 kg, BMI 49.6) underwent a laparoscopic Roux-en-Y gastric bypass (operating time 375 min). Postoperatively, she complained of bilateral lower extremity pain that gradually subsided over the course of the day. However, on the 1st postoperative day she developed numbness on the dorsum of the foot and compartment syndrome was diagnosed (anterior compartment pressure 71 mmHg). She underwent emergency fasciotomy, which resulted in a reduction of the pain and numbness on the dorsum of the foot. The next day she ambulated without difficulty and was discharged home on the 5th postoperative day. 12 days after her operation, delayed primary closure of the fasciotomy wound was done with the assistance of a novel device (Proxiderm) that applies constant tension to the wound edges. Subsequent recovery was uneventful, and at 4-month follow-up the patient had a weight loss of 28 kg without any right leg motor or sensory deficits. CONCLUSION: Bariatric surgeons should be aware of compartment syndrome as a rare but serious complication. Prevention, early recognition, and prompt fasciotomy are crucial for a favorable outcome.

Adult↗

PubMed1983

The effectiveness of 1.5% etidocaine HCl with epinephrine 1:200,000 and 2% lidocaine HCl with epinephrine 1:100,000 in oral surgery: a clinical comparison.

A clinical comparison of 28 patients was done in a double-blind fashion to evaluate the effectiveness of 1.5 etidocaine with epinephrine 1:200,000 and 2% lidocaine with epinephrine 1:100,000 in oral surgery. The patients selected had no medical problems, but required the extraction of bilaterally impacted third molars. Each subject served as his or her own control with etidocaine being used to produce local anesthesia on one side of the face, and lidocaine on the opposite side. The results were evaluated to allow a comparison of the onset and quality of anesthesia; the duration of lip numbness and the onset of postoperative pain; and the incidence, type, and severity of adverse reactions. Both lidocaine and etidocaine were similar in onset and quality of anesthesia. No adverse reactions were observed with either agent. The two anesthetics differed mainly in their durations of action. Etidocaine proved 2.16 times longer acting than lidocaine with respect to recovery from lower lip numbness and 1.75 times longer acting than lidocaine with respect to the onset of postoperative pain. Therefore, the conclusion was reached that 1.5% etidocaine with epinephrine 1:200,000 is an effective local anesthetic for use in oral surgery because it has a rapid onset, provides profound anesthesia, and possesses a longer duration of action than 2% lidocaine with epinephrine 1:100,000. The final characteristic is of particular value as the onset of postoperative pain is significantly delayed.

Acetanilides↗

PubMed1992

[A case of Hashimoto's thyroiditis associated with renal tubular acidosis, Sjögren syndrome and empty sella syndrome].

This report describes a 48-year old female patient with Hashimoto's thyroiditis, distal-type renal tubular acidosis (d-RTA), Sjögren syndrome (SjS), and empty sella syndrome (ESS). She has been receiving replacement of thyroxine for Hashimoto's thyroiditis since 1967. She felt muscle weakness and numbness in the extremities and was found to have low serum potassium (2.9 mEq/l) in 1987. Since then she has been administrated potassium chloride orally. She was admitted to our hospital because of recurrence of muscle weakness and numbness of the extremities in November 1990. Laboratory examination revealed that her serum levels of antimicrosomal antibody and anti-thyroglobulin antibody were highly positive (MCHA: x 2(10) x 100, and TGHA: x 100). Furthermore, she was revealed to have 1) d-RTA by oral tolerance tests with the administration of NH4Cl and NaHCO3, 2) SjS by Schirmer test and sialography, and 3) ESS by computed tomography and magnetic resonance imaging examinations of the pituitary. Association of Hashimoto's thyroiditis, d-RTA, SjS and ESS in this case may possibly be caused by common autoimmune mechanism.

Acidosis, Renal Tubular↗

PubMed2004

Stroke transiently increases subventricular zone cell division from asymmetric to symmetric and increases neuronal differentiation in the adult rat.

The orientation of mitotic cleavage regulates neurogenesis during neural development. We examined the orientation of mitotic cleavage of dividing progenitor cells in the subventricular zone (SVZ) of adult rats subjected to stroke. In nonstroke rats, 55% of dividing cells were oriented horizontally, whereas 40% were oriented vertically. Horizontal and vertical cleavage orientations produce asymmetric and symmetric divisions, respectively. Four days after stroke, the number of dividing cells increased twofold, whereas the proportion of symmetric dividing cells significantly (p < 0.01) increased from 40% before stroke to 60%. Fourteen days after stroke, the percentage of symmetric dividing cells was 47%. Stroke-increased numbers of dividing cells in M-phase were confirmed by immuostaining. In nonstroke rats, 37 and 33% of symmetric and asymmetric dividing cells, respectively, exhibited a neuronal marker (TuJ1). Four days after stroke, rats exhibited a significant (p < 0.05) augmentation of the frequency (47%) of neuronal distribution showing TuJ1 immunoreactivity in cells with symmetric division but not cells with asymmetric division (33%). Numb immunoreactivity was detected in SVZ cells of nonstroke rats. Stroke did not change Numb distribution. Our data suggest that neurons are produced by both asymmetric and symmetric cell divisions in the adult SVZ, and the transient increases in symmetric division and neuronal differentiation may result in stroke-induced neurogenesis.

Animals↗

PubMed2004

Long-term arm morbidity after radial artery harvesting for coronary bypass operation.

BACKGROUND: The use of the radial artery (RA) in coronary bypass operations has become increasingly popular in recent years, but there is almost no documentation regarding the midterm and long-term arm complications. METHODS: Between January 1 and December 31, 1998, 109 patients underwent operations for myocardial revascularization employing a pedicled RA as 1 of the coronary grafts. The patients were surveyed for subjective arm morbidities at 2 times during their follow-up: short term (mean, 7 months postoperatively; range, 0.3-14 months) and long term (mean, 49 months postoperatively; range, 46-57 months). RESULTS: At the short-term follow-up, 33 (33.3%) of the patients had some complaints regarding the arm that was operated on, with 4 (4%) of the patients reporting arm disability with complaints that focused on pain (11, 11%), numbness (15, 15%), and parasthesias (12, 12%). At the longterm follow-up, only 9 patients (10.5%) still experienced some sort of inconvenience with the arm that was operated on, with 1 case of functional disability, 4 complaints (4.6%) of residual parasthesias, and 1 report (2.3%) each of pain or numbness. All but 2 of the patients with complaints at the short-term follow-up reported amelioration of symptoms at the long-term follow-up. CONCLUSION: It appears that severe arm disability early after RA harvesting is likely to dissolve with time. Our favorable late follow-up results support the continuation of the employment of the RA as a conduit for coronary artery bypass grafting operations.

Aged↗

PubMed1979

[An objective technique to examine sensory disturbance in patients with occupational vibration disease. By means of somatosensory evoked response to mechanical stimulation (author's transl)].

Somatosensory evoked responses (SERs) to mechanical (tapping) stimulation were recorded in 24 patients with occupational vibration disease, and they were compared with those recorded in 48 normal subjects. Tapping stimuli were applied on the finger, the palm and the forearm of the bilateral sides. On the other hand, SERs to electrical stimulation were recorded in 5 of the patients, and these were compared with SERs to mechanical stimulation. 1. Some peaks in 32 out of 48 SERs to mechanical stimulation on the finger were absent, and peak latencies in 10 out of the remaining 16 SERs were abnormally prolonged. On the other hand, only 2 out of 27 SERs to mechanical stimulation on the forearm were abnormal. 2. Some peaks in 27 out of 35 SERs recorded in patients with numb sensation in the fingers were absent and peak latencies in the remaining 8 SERs were abnormally prolonged. 3. With respect to the absence of peaks in SERs, P2 and N2 peaks were more frequently absent than N3 and P4 peaks. 4. Peak latencies of the SERs in the patients with occupational vibration disease were abnormally prolonged. The difference of the peak latency between the patients and the controls was statistically significant. 5. Ten SERs to mechanical stimulation and 10 SERs to electrical stimulation were recorded in 5 patients. Nine out of the 10 SERs to mechanical stimulation were abnormal, while only 2 out of the 10 SERs to electrical stimulation were observed. 6. Based on a close relationship between abnormal SERs to mechanical stimulation and the numb sensation in the finger of the patients, it was concluded that sensory disturbances in the occupational vibration disease was due to the lesion in the peripheral nerve. Therefore, SERs to mechanical stimulation can be used for detecting some localized sensory abnormality due to the lesion in the peripheral nerve.

Adult↗

PubMed1987

[Prevalence of Raynaud's phenomenon in individuals not using vibrating tools].

Vibration syndrome, especially Raynaud's phenomenon, has generally been observed in vibrating tool operators, but the frequency of Raynaud's phenomenon in individuals not using vibrating tools is unknown. The authors therefore conducted a survey on the prevalence of stiffness of hands, numbness of fingers, and Raynaud's phenomenon among the examinees of Gifu Prefectural Health Care Center and among the female students of Gifu Prefectural Nursing and Paradental School. The following results were obtained by this survey. 1. Prevalences of stiffness of hands, numbness of fingers and Raynaud's phenomenon in female students were 20.9%, 29.5% and 4.6%, respectively, which are 2-3 times higher than those in male adults. 2. The prevalence of Raynaud's phenomenon in female students aged 20-24 yr was equal to that of female adults aged 30-39. It was higher than that of those aged 18-19, 40-49 and 50-59. The prevalence of Raynaud's phenomenon in males did not show any difference by age group. 3. There was no occupational specificity in the prevalence of Raynaud's phenomenon, but the prevalences in male sales workers and in female professional and technical workers were higher than in other groups.

Adult↗

PubMed2000

Care to underserved children: Residents' attitudes and experiences.

OBJECTIVES: To examine: 1) the relationship between residents' responses toward caring for underserved children and families during residency and their perceptions of their continuity clinic experience; and 2) which characteristics are related to continuing to care for the underserved after completion of training. DESIGN: Cross-sectional descriptive study. METHODS: A 49-item questionnaire was mailed to 210 third-year pediatric residents at 12 urban training programs in the Northeast in May 1995. Information was collected about residents' emotional responses toward caring for underserved families, their assessments of clinic operations, their sense of effectiveness in caring for underserved patients in continuity clinic, preresidency experiences with the underserved, and their intent to care for the underserved after training. RESULTS: Of 210 surveys mailed, 71% were returned. Thirty-six percent of residents planned to pursue a career in primary care, 53% did not, and 11% did not answer or were planning a year as chief resident. Fifty-seven percent of all residents planned to devote a portion of their practice toward caring for the underserved after training. Residents whose emotional responses toward caring for the underserved included: 1) not worrying that they had become numb to children's psychosocial difficulties, 2) not feeling angry with how families cared for their children, and 3) feeling more empathy with the underserved had significantly higher mean scores on both their assessment of clinic operations and their sense of effectiveness. The only demographic characteristic associated with a greater sense of effectiveness was being black. To better characterize which residents planned to care for the underserved after training, we examined a subsample of 46 residents who recalled an interest in caring for the underserved during residency training and who were pursuing a career in primary care. Residents that did not recall an interest in caring for the underserved at the onset of residency training were unlikely to have plans to care for the underserved after the completion of training. Within this group residents who planned to care for the underserved after training differed significantly from residents who did not plan to continue this work by feeling a greater sense of effectiveness in clinic, feeling less worried about becoming numb, and having greater empathy for underserved families. CONCLUSIONS: There are a number of identifiable emotional responses residents develop toward caring for the underserved that relate to their perceptions of continuity clinic and whether a resident chooses to continue to care for the underserved after training.

Adult↗

PubMed2003

Therapeutic effects of two antidepressant agents in the treatment of posttraumatic stress disorder (PTSD).

Posttraumatic stress disorder (PTSD) is a psychiatric disorder characterised by an acute emotional response to a traumatic event or situation involving severe environmental stress (natural disasters, wars, epidemics, rape, assaults, physical torture, catastrophic illness or accident), which may be identified in cognitive, affective or sensory motor activities. The objective was to perform a pilot clinical trial designed to compare the effects of older (tricyclic) and newer "second-generation" (selective inhibitors of serotonin uptake) antidepressants in the treatment of PTSD. A total of 20 hospitalised chronic military combat Bosnian veterans with PTSD symptoms were randomly assigned into two groups of 10 patients each. One group was treated with amitriptyline hydrochloride (AMYZOL) 75 mg/day as a representative of older antidepressants and the other with fluoxetine hydrochloride 60 mg/day (OXETIN) as a representative of newer antidepressants. Those drugs were administered by mouth two or three times-a-day in equally divided doses for at least 8 weeks. Favourable response was achieved in 70% of patients treated with amitriptyline hydrochloride and 60% of patients treated with fluoxetine hydrochloride. Amitriptyline hydrochloride was more effective in the treatment of acute PTSD symptoms (emotional numbing, startle reaction, nightmares, flashbacks, intrusive thoughts, vulnerability, poor impulse control or irritability and explosiveness). Fluoxetine hydrochloride showed a greater efficacy in the treatment of chronic PTSD symptoms (avoidance and numbing symptoms, hyperarousal, nightmares and a feeling of guilt).

Journal Article↗

PubMed1990

A case of bulbospinal muscular atrophy with chief complaint of sensory disorder in the lower extremities.

A 56-year-old man was admitted to our department with a chief complaint of lower extremity dysesthesia. He described a dull numbness below the ankle and a dull pain in the nates for the past two years. Although the numbness extended to the thigh, he did not notice any muscular weakness or atrophy. Neurological examination revealed weakness and atrophy in the face, tongue and the proximal portions of all four extremities. Deep tendon reflexes were decreased. A moderate loss of vibratory sensation was noted below the knees. Electromyography showed neurogenic changes. Muscle biopsy revealed both myogenic and neurogenic changes. Sural nerve biopsy revealed a mild reduction of myelinated fibers, particularly the large-diameter fibers. Based on these findings, a diagnosis of bulbospinal muscular atrophy (BSMA) was made. In recent years, there have been some case reports of BSMA with sensory disturbances, or merely with subclinical manifestations of a sensory disturbance. This case is included in the same category as those reports, but it is interesting to note that the sensory disturbance in the lower extremities occurred as the chief complaint of the disease.

Humans↗

PubMed1986

An unusual cause of bilateral mental neuropathy in an AIDS patient. Report of a case.

A case is reported of a patient with sudden onset, generalized toothache accompanied with a numb chin and lower lip. A thorough oral examination was negative. A complete medical evaluation revealed a positive HTLV-III antibody titer and acute lymphoblastic leukemia (Burkitt's-type). An unexplained trigeminal neuropathy should prompt the dentist to refer the patient for complete medical evaluation. A high index of suspicion of a malignant process should be maintained in all cases of unexplained numb lower lip and/or chin.

Acquired Immunodeficiency Syndrome↗

PubMed2004

Patient evaluation of a novel non-injectable anesthetic gel: a multicenter crossover study comparing the gel to infiltration anesthesia during scaling and root planing.

BACKGROUND: Periodontal scaling procedures commonly require some kind of anesthesia. From the patient's perspective, the choice of anesthetic method is a trade-off between the degree of anesthesia and accepting the side effects. The present study evaluates the preferences for a novel non-injection anesthetic product (a gel, containing lidocaine 25 mg/g plus prilocaine 25 mg/g and thermosetting agents) versus injection anesthesia (lidocaine 2% adrenaline) in conjunction with scaling and/or root planing (SRP). METHODS: In a multicenter, crossover, randomized, open study patients were asked, after they had experienced both products, if they preferred anesthetic gel or injection anesthesia. In addition, the adequacy of anesthesia and occurrence of post-procedure problems were assessed. The patients were also asked about their willingness to return if they were offered anesthetic gel at their next visit and their maximum willingness to pay (WTP) for this option. RESULTS: One-hundred seventy (170) patients at eight centers in Belgium were included in the study. There were 157 per protocol (PP) patients. A vast majority of the PP patients (70%) preferred the anesthetic gel to injection anesthesia (22%). The most common reason was less post-procedure numbness. Eighty percent (80%) of the patients expressed satisfactory anesthesia with the gel and 96% with injection anesthesia (P <0.001). Post-procedure problems were significantly less with the gel than with injection (P <0.001): numbness 15% versus 66%, unpleasant sensations such as soreness and pain 44% versus 63%, and problems connected with daily activities 19% versus 69%. The majority of patients (60%) who preferred gel were also willing to pay for it. A conservative estimate of the median WTP was $10.00. Furthermore, anesthetic gel would make almost every second patient (45%) more or much more willing to return for the next treatment. CONCLUSIONS: The data suggest that a somewhat less profound anesthesia with gel is clearly preferred by the patients because of the low incidence of post-procedure problems as compared to conventional injection anesthesia. The median WTP is likely in excess of the acquisition cost of the product, which indicates a favorable cost-benefit ratio for the individual patient.

Administration, Topical↗

PubMed2001

The dorsiflexion-eversion test for diagnosis of tarsal tunnel syndrome.

BACKGROUND: The clinical diagnosis of tarsal tunnel syndrome lacks objectivity and consistency. We have devised a new diagnostic physical examination test in which the tibial nerve is compressed as it runs beneath the flexor retinaculum behind the medial malleolus. In this test, the ankle is passively maximally everted and dorsiflexed while all of the metatarsophalangeal joints are maximally dorsiflexed and held in this position for five to ten seconds. METHODS: We performed this test on fifty normal volunteers (100 feet) and on thirty-seven patients (forty-four feet) treated operatively for tarsal tunnel syndrome between 1987 and 1997. We performed the maneuver both preoperatively and postoperatively and recorded any consequent changes in the signs and symptoms; during the operation we observed the altered anatomical relationships in the tarsal tunnel that were produced by the maneuver. The average duration of follow-up was three years and eleven months. RESULTS: Before the operation, the signs and symptoms of tarsal tunnel syndrome were intensified or induced by the maneuver in fifteen of the twenty feet of the patients who reported numbness, in fifteen of the seventeen feet of those who reported pain alone, and in six of the seven feet of those who had combined numbness and pain. Local tenderness was intensified in forty-two of forty-three feet, and it was induced in one foot in which it had been previously absent. A Tinel sign became more pronounced in forty-one feet, and the sign was induced in three feet in which it had been absent previously. During the operation, the tibial nerve was stretched and compressed beneath the laciniate ligament when the ankle was dorsiflexed, the heel was everted, and the toes were dorsiflexed. Preoperative signs and symptoms disappeared on an average of 2.9 months after the operation, and they could not be induced by repeating the test except in three patients, all of whom had tarsal tunnel syndrome subsequent to a fracture of the calcaneus. In the normal volunteers, no symptoms or signs could be induced by the test. CONCLUSION: This new physical examination test is effective in facilitating the diagnosis of tarsal tunnel syndrome.

Adolescent↗