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At least 775 records · Page 43Linked to original sources
PubMed1991

Bicycling induced pudendal nerve pressure neuropathy.

Pudendal neuropathies are well recognised as part of more generalised peripheral neuropathies; however, focal abnormalities of the pudendal nerve due to cycling-related injuries have been infrequently reported. We describe two patients who developed pudendal neuropathies secondary to pressure effects on the perineum from racing-bicycle saddles. Both were male competitive athletes, one of whom developed recurrent numbness of the penis and scrotum after prolonged cycling; the other developed numbness of the penis, an altered sensation of ejaculation, with disturbance of micturition and reduced awareness of defecation. Both patients improved with alterations in saddle position and riding techniques. We conclude that pudendal nerve pressure neuropathy can result from prolonged cycling, particularly when using a poor riding technique.

Adult↗
PubMedDate not supplied

[The results of internal saphenous vein stripping under local anesthesia in outpatient care (700 cases)].

700 operations involving complete removal of varicose veins in a single stage by invaginated long stripping and phlebectomies under local anesthesia on an out-patient basis were reviewed. Anesthesia consisted of local injections and a femoral block using Mepivacaine or Lidocaine. The out-patient approach adopted did not cause any complications. 95% of patients were satisfied with the method of anesthesia. Three types of neurological sequelae were studied: local numbness due to tearing of a strip of nerve by Muller's hook (7%) was transitory: sub-malleolar numbness was avoided when the lower incision for the stripping was low and sub-malleolar; damage to the saphenous nerve occurs in 1.2 per cent of cases following general anesthesia because of recognition of the particular pain associated with stretching of the nerve during stripping and passage through this junctional area by the Müller technique.

Adolescent↗
PubMed1990

[Maintaining epidural anesthesia by the midwife].

Epidural anaesthesia as a method of pain relief during labour has lately become very popular. Statistics show that in some labour units up to 70 per cent of all patients undergo epidural anaesthesia. The popularity of this method can be attributed to its effectiveness in relieving pain during labour. The anaesthetist commences an epidural block by introducing an epidural catheter into the epidural space. The anaesthetist administers the test dose and the first therapeutic dose. Within a short duration of time (10 to 20 minutes) the patient can already experience the numbing effect of the anaesthetic. This anaesthetic loses its numbing effect within two to three hours and effective pain relief can only be achieved by administering a further dose of local anaesthetic via the epidural catheter. This procedure can be repeated between three to six times during the average duration of labour. Alternatively, a continuous epidural infusion procedure can be used. The last method, however, sometimes requires the administration of additional epidural "top-ups". There are some risks in administering additional "top-up" dosages. The possibility exists of the anaesthetic causing a spinal block as a result of being administered into the spinal fluid. The "top-up" can also cause convulsions if administered intravenously. In some units it is expected of the midwife to maintain epidural anaesthesia on prescription by the doctor. These side-effects can, however, also occur when the patient is being treated by medical personnel with ample experience and knowledge. It is expected of some midwives to maintain an epidural block on prescription by the anaesthetist. If the midwife lacks the necessary knowledge of epidural anaesthetic and its maintenance, she might unintentionally administer the local anaesthetic into the spinal fluid or intravascularly. This might cause a threat to the mother's and baby's lives. This research covers the maintenance of epidural anaesthesia as carried out by the midwife. The level of involvement of the midwife in the maintenance of epidural anaesthesia has been investigated. The midwife's knowledge about the maintenance of epidural anaesthesia, her legal rights, obligations and emergency treatment of patients have been investigated. It has also been considered whether protocols in the maintenance of epidural anaesthesia exist. All the abovementioned information was acquired by submitting a questionnaire for completion by midwives practising in labour wards in the Johannesburg area. The results of this research show that the midwife's knowledge as regards to epidural anaesthesia and its maintenance is inadequate.(ABSTRACT TRUNCATED AT 400 WORDS)

Anesthesia, Epidural↗
PubMed1990

[A case of achondroplasia showing diffuse spinal canal stenosis].

A rare case of achondroplasia showing diffuse spinal canal stenosis is presented. A 39-year-old woman was admitted to our hospital because of numbness of lower extremities and intermittent claudication. The patient's height was 121cm and she had the typical clinical features of an achondroplastic dwarf. Neurological examination revealed spastic paraparesis, and sensory impairment below the level of T11 in the left side and L1 in the right. A plain X-ray feature of the spine showed spinal canal stenosis. The interpedicular distances were short in all vertebrae, and especially more prominent in the caudal lumbar region. The sacrum laid horizontally and the sacral angle was narrower than normal case. Myelography and computed tomographic myelography demonstrated severe stenosis of the subarachnoid space at the level of T9-11. Laminectomy was performed from the inferior half of T9 to T11. The yellow ligaments were prominently hypertrophic and these were removed as far as possible. Postoperatively, the weakness of the lower extremities was improved immediately, but numbness remained. Five months after the operation, she suffered from urinary dysfunction, so further laminectomy from T12 to L5 was performed. Also in this operation, hypertrophic yellow ligament was pathognomonic. Following this operation the patient had a good recovery course and returned to work.

Achondroplasia↗
PubMed1990

A new approach to sinus relief.

You suffer from "sinus". Medical treatment isn't getting you better, and now you need surgery. It is better that you be treated surgically today rather than as in the past. Five years ago, surgery meant an incision through the eyebrow, with probable numbing of the forehead, in order to relieve the pain of acute frontal sinusitis; or a long eyebrow incision, or shaving the front part of the scalp and pulling down the forehead skin from the skull was the procedure of choice for chronic disease in these sinuses. If the cheek sinuses were chronically diseased, an incision was made through the gums above the upper teeth, often resulting in numbing of the teeth and marked swelling of the cheek.

Adult↗
PubMed1989

[Two cases of scleroderma associated with vibration syndrome].

Case 1, a 49-year-old male who had been engaged in repair and reclamation of automobile tires, developed symptoms of vibration syndrome (Raynaud's phenomenon, numbness of both hands, tinnitus and impaired hearing) after some 30 years' use of a grinder and impact wrench. Two years thereafter, multiple sclerodermic lesions appeared over the trunk, upper extremities, and thighs; these disappeared about 2 years later. Histologically, hyperplasia and nodular swelling of collagen bundles were present in the dermis. An immunological study showed the serum to be positive for anti-centromere antibody, but no visceral lesions were demonstrable. This case corresponded to generalized morphea. Case 2, a 53-year-old male, developed symptoms of vibration syndrome (Raynaud's phenomenon, numbness of both hands, impaired hearing and arthralgia) after 25 years' use of a jack hammer in a quarry. Thereafter, sclerodermic changes of the forearms, lower legs, face and abdomen occurred with an associated sclerodactyly. Histological examination of involved skin revealed diffuse hyperplasia and homogenization of collagen bundles throughout the entire thickness of the dermis. These findings, together with serum positivity for anti-RNP antibody and dilation of the lower portion of the esophagus, led us to a diagnosis of progressive systemic sclerosis. We inferred that the vibration syndrome in the present cases might be related etiologically to these forms of scleroderma.

Autoantibodies↗
PubMed1989

[Migrating multiple mononeuritis and nonsystemic angitis].

Multiple mononeuritis of migrating nature at onset occurs in a variety of disease conditions. "Migrant sensory neuritis" without a systemic underlying disorder described by Wartenberg (1958) is the most distinctive form of this type of neuropathy. Its pathomechanism is not uniform, but angiopathy has been suggested by Matthews et al. (1981). In this report, we describe five cases of sensory-dominant multiple mononeuritis with migrating nature and without systemic visceral involvement. The patients consisted of four females and one male between 26 and 71 years of age. All showed recurrent episodes of sensory involvement along the distal branches of the cutaneous nerve. The patients presented with sudden onset of numbness or pain radiating along the cutaneous branches of the involved nerves often followed by persistent sensory deficit. In mild episodes, the sensory symptom with numbness almost completely subsided. The frequency of these episodes ranged from 7 times in 6 months to 6 times in 9 years. The clinical manifestations were similar or identical to those of migrant sensory neuritis reported by Watenberg and Matthews et al. Cranial nerve involvement and less frequent episodes in the present series differed from those in the previous reports. Laboratory examinations did not disclose any underlying disorder, suggesting systemic collagen vascular disease. Sural nerve biopsy study in two patients revealed vasculitis in small or medium-sized arteries in the epineurium as well as reduced population of large myelinated fibers. Small myelinated fibers were slightly increased in number, probably to regenerating fibers. Sensory action potentials were low or not evoked in the nerves examined.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

[Carpal tunnel syndrome associated with long-term hemodialysis: case report].

Since Warren and Otieno reported carpal tunnel syndrome in patients on intermittent hemodialysis in 1975, a number of related reports have been published. However, there are few reports associated with neurosurgery about carpal tunnel syndrome in patients on long term hemodialysis. We reviewed this disease and reported our case. We treated a patient who complained of bilateral hand numbness and atrophy of the right thenar muscle. He had been suffering from chronic renal failure and had been treated with hemodialysis for ten years. We diagnosed carpal tunnel syndrome based on the findings concerning Tinel's sign, Phalen test, and the conduction velocity of the median nerve. We performed decompression surgery of the median nerve. However, although there was no recovery from thenar muscle atrophy, there was improvement of hand numbness. Histologically, amyloid deposits within the hypertrophic transverse carpal ligament on the right side, could be found but on the left side where the internal shunt had been made amyloid deposits were absent. The reason why patients receiving long term hemodialysis develop carpal tunnel syndrome is controversial, but it seems that beta 2 microglobulin may play an important role in developing carpal tunnel syndrome in hemodialysis patients. This was reported by Gejyo in 1985. There may be uremic and/or diabetic neuropathy in these patients, and these neuropathies may be responsible for the more rapid deterioration and poorer surgical results in carpal tunnel syndrome associated with hemodialysis than in idiopathic cases. It is most important that carpal tunnel syndrome has to be diagnosed early and that surgical decompression is performed while the disease is in its early stage.

Carpal Tunnel Syndrome↗
PubMed1989

[A case report of quadriparesis due to compression of the medulla oblongata by the elongated left vertebral artery].

A patient, 30-year-old man, was admitted to Shinshu University Hospital with gait disturbance and numbness of both arms and legs in June 1985. General physical findings were normal except for facial asymmetry, i.e. mild right facial hemiatrophy. Blood pressure was normal and there were no signs of arteriosclerosis. Neurological examination revealed marked bilateral pyramidal tract signs, muscular weakness of all extremities predominant of the right side, spastic gait and sensory disturbance with impairment of pin prick and light touch sensation in the second and third trigeminal nerve regions and extremities of the left side, and mild loss of vibratory sense and numbness in all extremities. X-ray examination of the cervical spine and the myelogram of the spinal canal were normal. CT scan of the brain performed 3 hours after the myelography showed that the left vertebral artery extended from the left side of the medulla oblongata to the midline and distorted it by compression. MRI confirmed the findings of the CT scan. Vertebral angiography disclosed that the elongated left vertebral artery crossed the ventral aspect of the medulla oblongata. Compression of the medulla oblongata by the vertebral artery was diagnosed and neurovascular decompression was performed. About one month after the operation his spastic gait and muscular weakness were slightly improved, but these symptoms progressed thereafter. One year after operation his spastic gait was more marked than preoperatively. In many cases with dolichoectatic intracranial arteries, hypertension and arteriosclerosis have been reported to be usually associated with this condition. In other opinions dolichoectasia has been suggested to be a congenital disease, because such vessels are occasionally present in children.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

[Trigeminal nerve dysfunction as a false localizing sign: a case of the choroid plexus papilloma in the IVth ventricle].

Trigeminal nerve dysfunction as a false localizing sign, although rate, is known to occur. A case of choroid plexus papilloma in the 4th ventricle with hemifacial numbness is presented. A 24-year-old woman had been suffering from intermittent facial numbness on the left side for 3 months prior to admission. She noted no other symptoms. Neurological examination disclosed marked papilledema, horizontal nystagmus on both lateral gazes and mild truncal ataxia. CT scans showed a calcified mass lesion in the 4th ventricle on the midline extending into the left lateral recess. It was enhanced homogeneously with contrast material. The pathogenesis of such a false localizing sign and its clinical implications were discussed from the anatomical point of view.

Adult↗
PubMed1989

Dermatitis-sympathetic dysfunction in carpal tunnel syndrome. A case report.

A 52-year-old woman complained of numbness affecting the thumb, index, and middle fingers of both hands. The patient was managed with night splints with partial relief of symptoms. As a house cleaner, the patient was routinely exposed to water and detergents. About a year later, the patient developed contact dermatitis in the fingertips innervated by the median nerves. Electromyographic studies confirmed the presence of bilateral carpal tunnel syndrome. The temperature of all the fingertips was measured. The median innervated fingertips were warmer than those innervated by the ulnar nerves. The median sympathetic fibers may be compromized by compression in the carpal tunnel. This caused vasodilation, increased finger temperature, and lack of sweating in the median innervated fingers. Due to regular exposure to water and detergents, the susceptible dry fingertips developed contact dermatitis. The patient was managed conservatively, and the rash and numbness disappeared.

Carpal Tunnel Syndrome↗
PubMed1977

Communicating with the rheumatic patient.

To explore the meanings attached to words by patients and doctors, a multiple-choice questionnaire was given to 214 rheumatic patients, 110 non-rheumatic patients, 227 rheumatologists and 36 general practitioners. Words and phrases dealt with symptoms in descriptive terms, common disorders and parts of the body relevant to rheumatology. Poor agreement was obtained for 'back' among rheumatologists and hospital doctors, and for 'arthritis' among general practitioners. The word 'sciatica' means very different things to different doctors. Among rheumatic sufferers good agreement was only reached for 'rheumatism' and 'hereditary'. Non-rheumatic sufferers obtained better agreement than the rheumatic patients. This may have been due to more in the professional classes among the former group. The poorest agreement among rheumatic patients was for 'numbness', 'sciatica', 'slipped disc', 'vertebra', 'cervical', 'spinal cord', 'arthritis', 'deformity', 'anaemia', 'ligaments', 'osteoarthritis', 'lumbar', 'sacrum' and 'back'. Poor doctor-patient correlation between patients and rheumatologists occurred for 'numbness', 'spinal cord', 'cervical', 'sacrum', 'loin', 'slipped disc', 'arthritis', 'osteoarthritis' and 'steroids'.

Adult↗
PubMedDate not supplied

The effectiveness of ketanserin in patients with primary Raynaud's phenomenon. A randomized, double blind, placebo controlled study.

In 41 patients with Primary Raynaud's Phenomenon (PRP) the effectiveness of the serotonin receptor blocker ketanserin has been studied in a double blind cross-over study. Subjective assessments included: frequency and duration of the attacks (both per se and combined to a severity score), cold sensation, numbness, paresthesia, pain, cold water and cold weather provocation and the appearance of spontaneous attacks. The objective measurements comprised Digital Skin Temperature (DST), Digital systolic Blood Pressure (DBP) and Doppler Spectral Analysis (DOSA) of the radial and ulnar arteries. All measurements were performed both at room temperature and after instant cold provocation. The severity score, the occurrence of numbness and paresthesia and cold weather provocation improved significantly on ketanserin treatment. All objective measurements with the exception of the end-diastolic blood flow velocity of DOSA did not show significant improvements. Neither blood chemistry nor systemic blood pressure showed any significant change during ketanserin treatment. However, in the 6 (15%) patients with hypertension both systolic and diastolic blood pressure normalized. Although in objective measurements hardly any significant effects of ketanserin could be demonstrated, the results of the study suggest that orally administered ketanserin is effective for minimizing subjective complaints in patients with PRP. Ketanserin did not show any side effects.

Adolescent↗
PubMed1988

The elbow flexion test. A clinical test for the cubital tunnel syndrome.

The elbow flexion test is a little known, inadequately standardized, and poorly understood clinical test for the cubital tunnel syndrome. To evaluate and define this test, 13 patients with clinical and electrophysiologic evidence of cubital tunnel syndrome were tested with elbow flexion in a standardized manner. This consisted of full elbow flexion with full extension of the wrists for three minutes. All patients noted the onset of or the increase in one or more of the symptoms of pain, numbness, or tingling with this test. Numbness and tingling followed the sensory distribution of the ulnar nerve, but pain was not limited to the ulnar nerve distribution. The symptom complex, rapid onset, and rapid resolution of symptoms support a locally induced segmental ulnar nerve ischemia as the cause of symptoms. This study demonstrates the elbow flexion test to be a useful, reliable, and provocative test for the cubital tunnel syndrome.

Adult↗
PubMed1987

[Trigeminal somatosensory evoked potentials: II. Some clinical experiences].

Compared to other somatosensory evoked potentials (SEP), little information has been published so far on trigeminal somatosensory evoked potentials (TSEP) in the various kind of disorders. This may be due to few recording technique suitable for clinical practice. We previously reported a new recording method and showed the normal pattern of TSEP. The purpose of this report is to examine its reliability for clinical use. Sixty patients, with either a complaint of facial numbness or an organic lesion supposed to involve facial sensory pathway, were investigated. Their age ranged from 13 to 74 years old (mean 47.0). They consisted of 34 organic lesions (30 brain tumors and 4 cerebrovascular diseases) and 26 non-organic lesions (16 hemifacial spasms, 6 trigeminal neuralgias and other miscellaneous disorders). TSEP was recorded by the stimulation of the half of the contralateral upper or lower lip with the clip-shaped electrode. C'5 or C'6 (midpoint between Cz and the external auditory porus) was used as an active electrode and Fz as a reference. Two hundred or four hundred responses were averaged by a Nicolet Pathfinder II. All recordings were repeated at least twice to confirm the reproducibility. (1) Among 21 patients with a complaint of facial numbness except for neuralgia, the abnormality rate of TSEP was significantly different (p less than 0.02) between organic and non-organic lesions. The former was 87.5% (14 out of 16 cases) and the latter was 20% (1 out of 5 cases).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1986

Assessment of vibration white finger syndrome.

The degree of Raynaud's phenomenon due to the use of vibrating tools is difficult to assess because of the episodic nature of the attacks and the paucity of vascular and neurologic signs between attacks. Ninety-two loggers, miners and other workers using vibrating tools and experiencing Raynaud's phenomenon were examined at the Vancouver General Hospital between 1982 and 1985. Details of history, symptoms and occupation were obtained. The majority of workers had loss of sensation in their hands to pinprick, and the extent of this correlated closely with the severity of symptoms, a correlation not previously described. In 16 subjects the loss of sensation was proximal to the level of symptoms, in 50 at the same level and in 23 distal. In three the correlation was unknown. The severity of the vibration white finger syndrome was assessed using the classification of Taylor. Four workers were placed in stage 1 (occasional blanching of fingertips, with or without tingling or numbness), 30 in stage 2 (blanching of one or more fingers with numbness in cold weather), 36 in stage 3 (frequent finger blanching affecting most digits) and 22 in stage 4 (as stage 3 but symptoms so severe that manual work is difficult and vibrating tools cannot be used). The correlation of symptoms with loss of sensation to pinprick was useful in assessing the severity of the syndrome and in the classifying of claimants for Workers' Compensation Boards.

Adult↗
PubMedDate not supplied

Long-acting local anesthetics in oral surgery: an experimental evaluation of bupivacaine and etidocaine for oral infiltration anesthesia.

The effect of bupivacaine 7.5 mg/ml with epinephrine 5μg/ml, etidocaine 15 mg/ml with epinephrine 5 μg/ml, and lidocaine 20 mg/ml with epinephrine 12.5 μg/ml was studied when used for oral infiltration anesthesia. Twenty healthy volunteers took part in the experimental and double-blind study. One ml of the respective anesthetic solution was deposited supraperiosteally in the apical area of the maxillary right lateral incisor. Onset time, frequency of analgesia, gingival spread, and duration of tooth analgesia were studied and duration of soft-tissue numbness registered. The present investigation showed that lidocaine had a shorter onset time compared with bupivacaine. No difference with regard to frequency was found. Bupivacaine and etidocaine had a longer period of soft-tissue numbness, but a significantly shorter duration of tooth analgesia than lidocaine.

Acetanilides↗
PubMed1985

Maxillary sinus barotrauma--case report and review.

A case is presented in which a mucous retention cyst that obliterated the right maxillary sinus caused symptoms due to pressure on two separate branches of the second branch of the fifth cranial nerve during a chamber dive to 112 feet. The symptoms of pain and numbness occurred at different times during and after the dive. Referred pain to the maxillary teeth was due to pressure on the posterior superior alveolar branch and paresthesia with numbness and tingling of the lip and cheek was caused from pressure on the infraorbital nerve prior to its emergence through the infraorbital foramen. The symptoms resolved promptly on recompression treatment. The underlying mechanisms for the production of sinus barotrauma and the causes of tooth and sinus pain are differentiated, and a differential diagnosis of maxillary sinus opacities is schematized.

Adult↗