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PubMed2006

Metastatic tumors to the jaws: a report of eight new cases.

PURPOSE: The purpose of the article is to present 8 new cases of metastatic tumors occurring in the jawbones, their clinical features , diagnostic workup and management. PATIENTS AND METHODS: The records of 8 patients with metastatic jaw lesions were reviewed. Demographic data, presenting symptoms, primary tumor site, radiographic findings, bone scintigraphy , histopathology and clinical management were analyzed. RESULTS: The patients , ranged in age from 44 to 80 years, with a mean of 64.5 years. The primary malignant sites were: the lung , the breast , the rectum, the thyroid, the uterus and the parotid gland . The mandible was the site of oral involvement in seven cases and the maxilla in one. There was no gender difference with respect to the oral site affected. The clinical jaw presentations were: exophytic soft tissue mass, paresthesia of the lower lip and a periapical lesion The provided treatment protocols were: chemotherapy , radiotherapy and chemotherapy, surgery and chemotherapy and supportive care only. In one case the jaw lesion was the first indication of an unknown malignancy at a distant primary site. CONCLUSIONS: Metastatic jaw lesions are uncommon. Paresthesia of the lower lip and the chin is a sinister sign for patients with a metastatic jaw lesion. In view of these cases it can be said that meticulous work-up of of jaw lesions suspected of being metastatic, may be life saving or extend the patient s survival period.

Adult↗
PubMed2006

Sinonasal undifferentiated carcinoma of the maxillary sinus.

We describe the case of a 43-year-old man who was referred to our dental school"s acute care clinic with pain and swelling of presumed dental origin in the left maxillary quadrant. Radiographic examination revealed extensive dental decay and periodontal disease. On questioning, the patient admitted to paresthesia of recent onset. Paresthesia associated with pain or swelling of the jaws is an ominous sign that should alert the clinician to the possibility of an underlying aggressive neoplasm. In this case, biopsy of the lesion confirmed that the patient had a rare malignant tumour of maxillary sinus origin, a sinonasal undifferentiated carcinoma.

Adult↗
PubMed2006

[Application of electro-acupuncture-anesthesia device in brachiplex nerve blocking].

OBJECTIVE: To investigate the effect of electro-acupuncture-anesthesia device (EAAD) as an auxiliary localizing method for brachiplex nerve blocking. METHODS: One hundred and twenty patients scheduled for operation in upper limbs were randomly divided into group A and group B, 60 in each group. Bupivacaine 25 ml (0.375% in concentration) was used to block intermuscular plexus brachialis in the operation for anesthesia and EAAD was used for adjunctive localizing in group A, while in group B paresthesia elicitation was used. RESULTS: In group A, the blocking was complete in 56 cases and incomplete in 4, the anesthesia effect was superior to that in group B, complete in 46, incomplete in 9, and of inefficient in 5 (P < 0.01). CONCLUSION: EAAD provides a localizing method for plexus brachialis blocking more precise than paresthesia elicitation.

Acupuncture Analgesia↗
PubMed1991

[A case of adult T cell leukemia/lymphoma with motor and sensory polyneuropathy].

A 62-year-old man was admitted to our hospital because of two months continuing paresthesia and muscle weakness of distal portions of the four limbs. On general physical examination, skin lesions, lymphadenopathy and hepatosplenomegaly were not found. Neurological examination revealed moderate weakness in the bilateral distal muscles of the lower limbs and left distal muscles of the upper limbs, and slight weakness in the right distal muscles of the upper limbs and the bilateral proximal muscles of the four limbs. Hand grasping powers were 24 kg and 2 kg on the right and left, respectively. The biceps, triceps and radial reflexes were decreased on the right, but normal on the left. The Achilles tendon reflex was decreased on the right and absent on the left. Paresthesia and superficial sensory disturbance were observed with glove and stocking distribution, which was more severe on the left side. The vibration and position senses were slightly decreased in the distal part of the lower limbs. On the laboratory examinations, serum anti-HTLV-I antibody was positive and no abnormal lymphocytes were observed in peripheral blood. Cerebrospinal fluid findings were normal, and anti-HTLV-I antibody was negative. Motor and sensory conduction velocities were normal or slightly decreased in all of the limb nerves examined, but the amplitudes of the compound muscle action potentials and the sensory nerve action potentials were asymmetrically decreased. Needle EMG showed fibrillation potentials and giant spikes with a reduction in number of motor unit potentials. The histological examination of the biopsied sural nerve revealed severe axonal degeneration without evidence of vasculitis or infiltration of abnormal lymphocytes.(ABSTRACT TRUNCATED AT 250 WORDS)

CD4-CD8 Ratio↗
PubMed2004

Complications following cervical epidural steroid injections by expert interventionalists in 2003.

BACKGROUND: Two major portals are available for delivery of medication into the cervical epidural space: interlaminar and transforaminal. The choice of which approach to use is commonly made by assessing the patient's structural pathology, one's skill in performing each procedure, and then weighing the advantages versus the risk associated with the particular technique. Over the past several years, a growing number of cases involving serious complications following cervical transforaminal epidural steroid injections have led some to question the safety of the procedure and to preferentially perform interlaminar epidural injections. OBJECTIVE: To explore the prevalence of complications caused by transforaminal versus interlaminar injections. DESIGN: Retrospective survey. METHODS: We selected the list of course instructors of the International Spine Intervention Society (ISIS) as our source for expert spine injection specialists. All data were collected by survey during a period from April 2004 through June 2004. Questions were asked about the type of cervical epidural injections performed and any complications during the preceding 12 months, January through December 2003. RESULTS: All 29 ISIS course instructors were surveyed. Seventeen instructors replied. In 2003, an estimated total of 5968 cervical epidural injections were performed by 17 instructors for neck and/or arm pain. The interlaminar approach was performed in 4389 cases by 14 instructors and the transforaminal approach was used in 1579 cases by 16 of the instructors. Of the 4389 interlaminar injections there were 23 cases (0.52%) of various minor complications including headaches caused by dural puncture, transient vagal episodes, and prolonged complaints of new or increased numbness and paresthesias. In the 1579 transforaminal there were five cases (0.32%) of minor complications including aggravated radicular pain, prolonged paresthesias, and skin rashes. In addition, 2 cases of radicular artery injection were confirmed by digital subtraction angiography during 354 transforaminal approaches performed by one physician. The rates of complication were not different between interlaminar and transforaminal approaches. CONCLUSION: When performed by experienced interventionalists, major complications are probably rare and it could take years for a significant complication to occur. We must however all be aware that these complications can occur.

Journal Article↗
PubMed1991

[Superior vena cava syndrome and compression neuropathy of the right brachial plexus following cardiac pacemaker implantation].

We reported a case with the superior vena cava syndrome and compression neuropathy of the right brachial plexus after pacemaker implantation. A 27-year-old man with the second degree atrio-ventricular block had underwent pacemaker implantation via the right subclavian vein at the age of 19. Since the age of 25, he occasionally experienced paresthesia and swelling in his right arm after excessive work. These symptoms gradually resolved within a few days by rest. On June 2, 1990, he noticed swelling and paresthesia of his right face, arm and upper trunk after excessive labor. A few days later, weakness of right hand developed. On examination on June 8, the right arm was edematous, but not cyanotic. There were weakness and hypoactive muscle stretch responses in the right upper extremity with hypesthesia of all modalities in the neck, arm and upper trunk of the right side. Venous angiography showed total occlusion of the right brachiocephalic vein and superior vena cava and well-developed collateral channels. We speculate that swelling of the right upper extremity, which became overt when arterial blood supply to that limb outbalanced impaired venous drainage, finally compressed the right brachial plexus.

Adult↗
PubMed1991

The failed ulnar nerve transposition. Etiology and treatment.

Various procedures have been recommended for the treatment of cubital tunnel syndrome. Simple decompression in situ, medial epicondylectomy, subcutaneous transposition, intramuscular transposition, and submuscular transposition all have their advocates. The results of the surgical treatment for cubital tunnel syndrome are related to the severity of the compressive neuropathy at the time of diagnosis and to the adequate decompression of the nerve at all sites of potential compression at the time of surgical treatment. Fourteen patients who had previously undergone surgical treatment for cubital tunnel syndrome were evaluated because of persistent pain, paresthesia, numbness, and motor weakness. All patients had documented persistent compression of the ulnar nerve on clinical and electromyographic evaluation. The indication for repeat surgical exploration in all patients was unremitting pain despite nonoperative treatment. All patients had been treated by neurolysis and submuscular transposition of the ulnar nerve as described by Learmonth. The causes of continued pain after initial surgery included retention of the medial intermuscular septum, dense perineural fibrosis of the nerve after intramuscular and subcutaneous transposition, adhesions of the nerve to the medial epicondylectomy site, and recurrent subluxation of the nerve over the medial epicondyle after subcutaneous transposition. Revision surgery was found to be highly successful for relief of pain and paresthesias; however, the recovery of motor function and return of sensibility were variable and unpredictable.

Adolescent↗
PubMed1990

[Peripheral neurologic complications of brachial plexus blocks].

Nerve injury can arise as a complication of peripheral nerve block anesthesia. From the review of the literature remain three factors which alone or in combination, are of special etiologic interest: nerve lesion due to the needle or intraneural injection; toxic effects of the agent injected overall when epinephrine is used; ischemic trauma. The symptoms of such nerve lesions vary from light paresthesia to painful dysesthesia and motor weakness or paralysis. The clinical analysis of these complications does not differ from that in other neurological patients, but must be realized effectively and immediately for avoiding a lawsuit. These postanesthetic neuropathies may benefit from specific treatment or even surgical exploration and external neurolysis. The block should be handled with care: rough paresthesia seeking and intraneural injections should be avoided; short bevel needles and plane solutions should be preferred.

Brachial Plexus↗
PubMed1990

Multiple-dose, double-blind, placebo controlled intravenous tolerance and pharmacokinetic study of trospectomycin sulfate (U-63, 366F) in healthy male volunteers.

Trospectomycin sulfate is a novel aminocyclitol antibiotic. This study evaluated the tolerance and the pharmacokinetics of multiple, intravenous doses of trospectomycin (TRO) in healthy male volunteers. Three groups of 10 volunteers were studied. Eight volunteers in each group were studied in a parallel design to receive trospectomycin (Group 1 = 250 mg, Group 2 = 500 mg, Group 3 = 750 mg) while 2 volunteers received placebo (normal saline). Drug doses were administered in 30 ml volumes over 30 min every 8 h for 7 days (i.e. 21 total doses). Evaluations of vital signs, side effects, and safety laboratory tests were made at regular intervals during the study. The most frequent medical events observed in the volunteers receiving trospectomycin were perioral/facial paresthesias (54%), pain at the i.v. infusion site (46%), dizziness/lightheadedness (58%), and GI symptoms (38%). A statistically significant dose response relationship was observed for the incidence of perioral/facial paresthesias and pain at the i.v. infusion site (i.e., increased incidence with increased dose). All the medical events were mild or moderate in severity and reversible following drug discontinuation. In the 500 and 750 mg trospectomycin groups, standing systolic blood pressure decreased significantly with the first dose of study drug. Elevated levels of SGPT were observed in 9 volunteers (1 in placebo, 3 in 250 mg, 1 in 500 mg, and 4 in 750 mg dose groups). This study demonstrates that multiple intravenous trospectomycin doses up to 750 mg are reasonably well tolerated in healthy male volunteers. The concentration of trospectomycin in serum, measured with a sensitive HPLC assay, was less than 3 mcg/ml at 8 h postinfusion for all dose levels.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

Chronic encephalitis caused by leukoencephalopathy.

As mentioned previously, both MS and PML are demyelinating conditions of the CNS and pose diagnostic difficulties in their differentiation because of similarities in their clinical findings. However, certain features unique to each of these diseases are helpful in clinical diagnosis. MS, unlike PML, is a disease of unknown cause. Polygenetic influences in combination with exposure to an environmental agent and immune-mediated factors may be operative in the pathogenesis of MS. Age of onset peaks in the third to fourth decades with a predominance in women, as contrasted with PML, which peaks in the fifth to sixth decades in most non-AIDS-associated cases with a slight predominance in men. MS is more prevalent in areas farther from the equator: North America, Europe, Australia, and New Zealand. Common initial symptoms seen in MS include bilateral limb weakness (with the legs being affected twice as often as the arms), hyperreflexia, spasticity, optic neuritis, diplopia, incoordination, and paresthesias. (Paresthesias are typically found in the lower limbs in a symmetric pattern, but may follow no obvious anatomic distribution and often do not correspond to the distribution of sensory symptoms. Vibration and position sense are more frequently disturbed than pain and temperature.) Intellectual impairment and mental deterioration are uncommon early in MS, whereas they are a more frequent initial presentation in PML. In addition, the presence of speech impairment and monoparesis or hemiparesis with homonymous hemianopsia is more suggestive of PML. Brain stem involvement is infrequent.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

[Cooperative research of UFT E phase II study. Cooperative Study Group of UFT E in Tohoku Area].

Phase II clinical research of UFT E granules (enteric coated) was carried out in 18 institutes (21 clinical dept.) by Study Group of UFT E in Tohoku Area, to investigate its effect and safety on cancer of the digestive organs. Of all the registered 26 cases, 21 cases were available for evaluation (perfect cases: 17 and imperfect cases: 4). Patients were administered UFT E 600 mg/body/day in principle. The response rate of the overall 26 cases was 14.3% and that of perfect 17 cases was 17.6%. PR was seen in 2 cases with far advanced gastric cancer and in 1 case with sigmoid colon cancer metastasized to lung, NC in 8 cases and PD in 6 cases. Side effects more than Grade II were seen in 4 cases (19%), of which 1 case caused diarrhea with leucopenia, 1 case caused diarrhea with anorexia, fever, pigmentation, stomatitis and general tiredness, 1 case caused anorexia and the other 1 case caused paresthesia on both legs with diarrhea and anorexia. Side effects in upper digestive tract were slight, making it possible to continue administration. But 1 case, which caused simultaneously Grade II anorexia, Grade II diarrhea and Grade III paresthesia on both legs, refused administration and dropped out. He recovered from those symptoms 5 days after discontinuance of administration. UFT E is able to administer for a long term because of its slight side effects on the upper digestive tract.

Adult↗
PubMed1990

Post-traumatic contracture of the elbow. Operative treatment, including distraction arthroplasty.

Twenty-six consecutive patients who had post-traumatic contracture of the elbow were treated by operative release alone or by release and distraction arthroplasty, with or without fascial interposition. The type of operative procedure was determined by whether the factors limiting motion were purely extra-articular (extrinsic) or whether they included intra-articular (intrinsic) elements as well. The mean preoperative arc of total motion was 30 degrees (from 63 to 93 degrees of flexion). At follow-up examination, twenty-two to ninety-four months post-operatively, of twenty-five patients, the mean arc of total motion was 96 degrees (from 30 to 126 degrees). There were eight complications in seven (27 per cent) of the patients. Of these, four (avulsion of the triceps tendon, deep infection, and two ulnar-nerve paresthesias) were managed by subsequent operative treatment. The other four complications included drainage from a pin site, which resolved after removal of the pin: a three by two-centimeter skin slough, which spontaneously epithelialized; aseptic resorption of the distal end of the humerus and proximal end of the ulna, which stopped after immobilization and subsequent bracing of the elbow but resulted in moderate instability; and ulnar-nerve paresthesia, which was not operatively treated and persisted. Twenty-four (96 per cent) of the twenty-five patients who were followed for twenty-two months or more were satisfied with the results of the procedure because of the improved facility in carrying out activities of daily living. No patient had increased pain, but two had moderate instability. It was concluded that the results of distraction arthroplasty can be gratifying, but the technique is demanding and the rate of complications is high.

Adolescent↗
PubMed1990

Restless legs syndrome associated with diminished cardiopulmonary compliance and lumbar spinal stenosis--a motor concomitant of "Vesper's curse".

Lumbosacral and associated leg pain and paresthesias arousing patients from a sound sleep, or Vesper's curse, has been previously reported. An increase in right atrial filling pressure reflected in elevated paraspinal venous volumes within the reduced confines of a stenotic lumbar spine has been cited as the cause of this syndrome. Six cases of concomitant nocturnal calf cramps and fasciculations associated with the night pain and paresthesias are reported. In all cases a reduction in cardiopulmonary compliance was noted, with clinical and electromyographic evidence of paraspinal and lower extremity fasciculations increasing at night. Symptoms were relieved by assuming an erect or semi-reclining sleep position. In five of the six reported cases of lumbar spinal stenosis, spondylolisthesis was also present. The motor equivalent of Vesper's curse was evaluated by electromography, evoked potentials, CAT scan, and myelography. The multiple factors involved in the pathomechanics and pathophysiology of lumbar radiculopathy, and spinal stenosis and the role of the paravertebral plexus of veins are reviewed as they relate to the genesis of the restless legs syndrome.

Aged↗
PubMed1989

The importance of presynaptic beta receptors in Raynaud's disease.

The purpose of the present study was to investigate the effect of atenolol, a beta 1-selective blocker, along with flunarizine, a calcium antagonist, in the management of Raynaud's disease. Forty patients with Raynaud's disease were randomized into a trial in which atenolol (50 mg daily) was given with flunarizine (10 mg daily). During the trial all patients were subjected to finger photoplethysmography and were given a diary to note daily the number and duration of the crises and presence or absence of pain and paresthesia. The association of atenolol with flunarizine caused an 80% reduction in the number of vasospastic crises, a significant increase (p less than 0.001) in the photoplethysmographic wave amplitude, and complete disappearance of pain and paresthesia. These results were not observed in patients treated with a placebo. Flunarizine reinforces the action of atenolol in causing a decrease in vasoconstriction in patients with Raynaud's disease, as observed previously by us, in that it acts directly on the beta-presynaptic receptors or on the calcium slow channels connected to the beta-receptors. The present study confirms that the principal role in the physiopathologic progression of Raynaud's disease seems to be played by a modification of the beta-presynaptic receptors in the nerve endings of the peripheral vessels.

Adolescent↗
PubMed1989

[Antineuronal antibody in carcinomatous neuropathy].

A seventy-year-old woman was admitted to the hospital because of paresthesias and progressive weakness of the extremities. Ten months previously, tightness in the thighs and numbness in the fingers developed, with subsequent tingling sensations of the hands and feet. Three months before entry, she had difficulty in walking because of severe paresthesias in the extremities. She was found to have an abnormal mass in a X-ray film of the chest, and transferred to our hospital. Neurological examination showed generalized hyporeflexia, marked loss of deep and discriminative sensations in the distal portion of the limbs, positive Romberg sign and severely ataxic gait. Cerebellar sign was negative. Cytologic examination of a transbronchial lung biopsy disclosed small cell carcinoma of the lung. A sural nerve biopsy showed severe loss of myelinated fibers accompanied by axonal degeneration of residual fibers. Immunohistochemically antineuronal antibody was found in the serum but not in the CSF, which reacted to nuclei and cytoplasm of the dorsal root ganglion neurons as well as Purkinje cells. Titers of this autoantibody in the serum were markedly reduced after chemotherapy and irradiation. Western blot analysis demonstrated that autoantibody in the serum recognized neuronal antigen with single band at 38 kd. Pathogenesis of carcinomatous neuropathy is still unexplained, but the findings here presented have given rise to the speculation that antineuronal antibody may be a contributory factor in carcinomatous neuropathy.

Aged↗
PubMed1989

[An adult case of congenital Horner's syndrome with heterochromia iridis--with special reference to alteration of Horner's sign associated with development].

It is well known that when the Horner's syndrome is congenital, a defect in pigmentation of the iris is usual; all or part of the iris remains light brown. We reported an adult case of congenital Horner's syndrome with remission and relapse of unilateral ptosis. A 25-year-old man was admitted to our hospital for ophthalmologic surgical treatment of right ptosis. According to the patient's mother, the patient was delivered with the aid of forceps at birth, and the right ptosis was observed during the first few days of his life. At 2 to 3 years of age, his parents noted lighter color of the right eye. The right ptosis was gradually improved as he grew older. However, he developed right ptosis again with left meralgia paresthesia since eighteen age. At age 25 years, he was noted to have right ptosis, right miosis (the left pupil measured 4.5 mm in diameter and the right 3.0 mm), right heterochromia iridis with pigmented iris nevi, and left meralgia paresthesia . Laboratory data of urine, blood and CSF as well as radiological studies of chest X-ray, skull X-ray, spine X-ray, brain MRI and spinal cord MRI showed unremarkable. Sweating test was intact, pharmacologic test to Horner's syndrome with 5% cocaine and 1.25% 1-epinephrine indicated that the damage was pointed to the post ganglionic sympathetic neuron. Ten patients with congenital Horner's syndrome reported in Japan since 1953 were reviewed including our case. Ten of eleven were male and Horner's sign was recorded on the left eye in 8 cases.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1986

Nerve injury complications. Management of neurogenic pain syndromes.

Postural brachial plexus compression neuropathy occurs more frequently than usually realized. The cause is multifactorial with certain predisposing anatomic and congenital factors that are not uncommon. An inciting event is required to cause a clinically significant syndrome. The event can be a specific traumatic episode or cumulative trauma leading to an adoption of a guarding posture, which results in a self-perpetuating cycle and brachial plexus nerve compression. The diagnosis and management may be complicated by concurrent vascular compression, concurrent reflex sympathetic dystrophy, and associated inflammatory musculotendinous conditions. Diagnosis relies on the appreciation of a peculiar symptom complex of pain and paresthesias. The important clinical signs are a supraclavicular Tinel's sign and a positive stress abduction test. Treatment includes exercises, patient education, and behavior modification. However, misdiagnosis can lead to inappropriate treatment, such as unnecessary carpal and cubital tunnel releases. Operative treatment is reserved for those severe cases that are resistant to extended and intense physical therapy. The preferred surgical technique involves an anterior, supraclavicular approach allowing for complete visualization and release of intrinsic and extrinsic nerve compression. Awareness is the key to making the diagnosis, and successful treatment requires a multidisciplinary approach. It is generally accepted that injuries to peripheral nerves result in serious losses of function. Paresthesias and motor weakness cause immediate functional limitation, and place the hand at risk for further injury. The system has little regenerative capacity, and the chance for recovery is poor even under the best circumstances. Therefore the treatment of acute nerve injuries can be difficult and frustrating.(ABSTRACT TRUNCATED AT 250 WORDS)

Brachial Plexus↗
PubMed1988

[Therapeutic use of human leukocyte interferon in dermatologic disorders caused by herpes simplex virus. Multicenter study].

A multi-institutional double blind study was performed in 66 patients in order to evaluate the action of human leukocyte interferon, type alpha (IFN) in lesions produced by herpes simplex virus. Lesions were localized in genital area in 34 cases and in facial area in 32 of them. From the total, 38 patients were treated with 7,000 Ul/gm. of interferon ointment and 28 with carbowax 4,000 as placebo. The symptoms pain, ardor, itching and paresthesia were evaluated asking to patients. Erythema, vesicles, crust, scale adenopathy were objectivated. Signs and symptoms were controlled on days 3 and 7 of treatment. In 42 patients, lesions specimens were taken for virus isolation. In 23 of them, cytopathic effect was detected (54.76%). Results showed a rapid relief from pain (p less than 0.05), ardor (p less than 0.01) and paresthesia (p less than 0.001) and also accelerated healing of vesicles in patients treated with interferon. Tendency to reduce the total time of the disease in those patients treated with IFN was observed.

Administration, Topical↗