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At least 793 records · Page 44Linked to original sources
PubMed1999

Evaluation of neurotoxicity induced by paclitaxel second-line chemotherapy.

The most important cytotoxic drugs for the treatment of ovarian cancer, platinum compounds and paclitaxel, are known to induce neurotoxicity, which is dose limiting when higher paclitaxel doses are used or platinum-pretreated patients are treated. The absolute dose of paclitaxel per course has been demonstrated to be an important risk factor for the development of neurotoxicity. The role of cumulative dose, treatment duration and infusion schedule as additional risk factors are still in debate, and are therefore evaluated in this study. This study evaluates paclitaxel induced neurotoxicity in 38 patients, most of whom had already received platinum treatment, receiving either 135 or 175 mg/m2 as 3-h or 24-h infusion. Patients were compared with an age-matched control group. A detailed questionnaire and neurophysiological measurements including vibration perception threshold were used. Overall, the majority of patients (76%) developed some degree of neurotoxicity, but symptoms were usually mild or moderate with no grade 3/4 neurotoxicity observed. Age has been demonstrated to be an important risk factor for the development of neurotoxicity. Furthermore, the higher dose per course showed a significant impact on neurotoxicity, while the different infusion schedules were of minor importance. Vibration threshold perception, 2-point discrimination, a walking-the-line test, and reports of paresthesias were shown to be the most sensitive and useful parameters for neurotoxicity evaluation. Neurotoxicity is a common adverse event during paclitaxel chemotherapy in platinum-pretreated patients. A clinically useful test panel composed of a detailed history and the above three easily performed neurophysiological evaluations should be incorporated into future studies evaluating new drugs, treatment modifications, new combinations, and potential modulators of chemotherapy-induced neurotoxicity.

Adult↗
PubMed2003

Clinical and neurological abnormalities in adult celiac disease.

We assessed the occurrence of neurological signs and symptoms in adult patients with celiac disease and evaluated the correlation between neurological features and diet. A total of 176 patients and 52 age-matched controls underwent a semistructural interview and a neurologic examination. The effect of gluten-free diet was evaluated by comparing the prevalence of signs and symptoms among patients adhering to a gluten-free diet and patients on an unrestricted diet. The occurrence of headache, dysthymia and signs of peripheral neuropathy was significantly higher in patients with celiac disease than in control subjects. Adherence to a strict gluten-free diet was associated with a significant reduction of headache, dysthymia, cramps and weakness, but did not modify the occurrence of paresthesia or hyporeflexia. Neurological signs and symptoms are associated with celiac disease and can be ameliorated by a gluten-free diet.

Adolescent↗
PubMed1980

Arthralgia associated with acute urinary retention. A syndrome of probable viral etiology.

Four patients are described in whom paresthesia and arthralgia developed in association with acute urinary retention. Neurologic and musculoskeletal complaints persisted for varying periods, up to five year, after cessation of urinary symptoms. Significantly elevated titers to Herpes simplex and Herpes zoster viruses were observed in three and four subjects, respectively, although none exhibited cutaneous lesions of herpetic infection. The symptom complex, presumably the result of viral radiculitis, may present in varying patterns that can be confused with lumbar disc protrusion, obstructive uropathy or primary rheumatic disorder. Diagnostic studies requisite for documentation of a viral etiology of the syndrome are discussed.

Adult↗
PubMed1986

Personality characteristics as predictors and sequelae of surgical and conventional orthodontics.

The aims of this study were to determine the effects of surgical and conventional orthodontics on patients' body image and self-esteem and the association between personality characteristics and postoperative reports of pain, paresthesia, swelling, and satisfaction among 90 patients who underwent surgical orthodontics. Patients who underwent surgery completed questionnaires before their operations and up to 6 months after surgery. Self-esteem and body image were compared longitudinally between these patients and 33 persons who were undergoing orthodontic treatment only and 33 persons who had decided against treatment. Results suggest that patients' self-esteem, body image, and degree of extroversion are unrelated to postsurgical satisfaction and discomfort. Neuroticism was correlated with satisfaction, so that patients who scored in the higher range on a scale of neuroticism were less satisfied immediately after surgery and at removal of fixation wires. Neurotic patients also were more likely to complain of pain and swelling 6 months after surgery. Surgical patients held a more negative facial image and were more introverted than those in the other two groups but were similar in other personality traits before surgery. Both surgical and orthodontic patients improved significantly in body image over time, with the greatest increase among the former. Similar shifts in self-esteem occurred for the three groups, suggesting that surgery per se may not be the major determinant of longitudinal changes in self-esteem. Notably, the positive effect of surgery and orthodontic treatment on body image is an important motive for many persons seeking treatment. Results of this study provide important insights into how to prepare and counsel patients undergoing orthodontic treatment with and without surgery.

Body Image↗
PubMed1976

Probability of conduction deficit as related to fiber length in random-distribution models of peripheral neuropathies.

This paper presents a set of probabilistic models which reproduce the proximodistal gradient of sensory deficit in peripheral neuropathies, on the basis of the occurrence of axonal dysfunction as a result of randomly distributed abnormalities. The models, which are based on conduction block, loss of temporal coherence, and weak interactions between nerve fibers, demonstrate that randomly distributed axonal dysfunction provides a sufficient condition for distal sensory deficit. The models predict a marked reduction in the length for normal sensory conduction with small increases in the probability of axomal dysfunction, providing a possible correlate for the rapid clinical progression of some neuropathies. The hypothesis that weak interactions between fibers result in paresthesiae in peripheral neuropathies is also discussed.

Humans↗
PubMed1979

Transketolase inhibition and uremic peripheral sensory neuropathy.

The relationships between predialysis and postdialysis erythrocyte transketolase activities and symptoms of uremic peripheral neuropathy were studied prospectively for 21 months in 19 chronic hemodialysis patients. In all patients the predialysis activity was observed to be sometimes greater and sometimes less than the postdialysis activity. These observations were interpreted as indicating the coexistence in uremic blood of stimulatory and inhibitory substances which influence the enzyme independently. After enzyme stimulation was assumed to be a constant feature of uremia, the expected stimulated activity in erythrocytes of predialysis blood was found to be variably inhibited up to about 55% in these patients. The occurrence of paresthesiae was closely correlated with prolonged erythrocytes transketolase inhibition which in most cases reached a level of about 40%. Our conclusion is that the magnitude of erythroycte transketolase inhibition above a certain minimum level, together with its duration, is associated with symptoms of sensory peripheral neuropathy in the uremic patient. It is therefore predicted that such measurements may be usefully applied in ascertaining the extent of hemodialysis needed to prevent the development of this pathological state.

Adult↗
PubMed1990

Carcinoma of the lower lip with perineural extension to the middle cranial fossa.

An 81-year-old man had left labial paresthesia and a palpable mass adjacent to the left mental foramen 6 months after apparent adequate excision of a small (1.5 cm) primary squamous cell carcinoma of the left portion of the lower lip. Biopsy and clinical evaluation revealed recurrent squamous cell carcinoma. Subsequent left hemimandibulectomy confirmed perineural extension of tumor along the mandibular branch of the trigeminal nerve to the foramen ovale. Seven months later, the patient died of complications resulting from intracranial extension of tumor to the left cerebellopontine angle. This case illustrates the lethal potential of carcinoma of the lip due to contiguous perineural extension, even with a small primary tumor and absence of regional lymph node metastases.

Aged↗
PubMed1992

The morbidity associated with fifty maxillary fractures treated by closed reduction.

Fifty patients with maxillary fractures treated by closed reduction over an 85 month period at a Level I trauma center were reviewed. Thirty patients (60%) experienced forty-one midfacial complications. The most frequent problems were infraorbital nerve paresthesia (12), enophthalmus (5), septal deviation (3), and altered vision (3). No relationship could be established between complications and age, sex, cause of injury, or the method of suspension used. Most complications were related to concomitant injury or the concurrent management of fractures of other facial bones. Only eight problems (16%) were directly attributed to the closed reduction of maxillary fractures. Patients treated by closed reduction and maxillomandibular fixation without suspension experienced no surgical complications.

Adolescent↗
PubMed1985

Maxillary nerve involvement in bacterial endocarditis.

A case of right maxillary nerve paresthesia during an active phase of bacterial endocarditis probably due to embolic occlusion of the nerve's vascular supply is reported. The authors suggest that infective endocarditis be considered as a rare but potential cause of unexplained trigeminal nerve branch lesions, and that such lesions be sought in cases of established endocarditis.

Embolism↗
PubMed1995

Neurosensory disturbances of the trigeminal nerve: a long-term follow-up of traumatic injuries.

PURPOSE: This study assesses the physical and psychosocial consequences of trigeminal nerve damage. MATERIAL AND METHODS: A questionnaire consisting of 33 questions, 30 of which had fixed alternatives, was mailed to 300 persons who had received compensation from a syndicate of several insurance companies (Konsortiet för Patientförsäkring) because of trigeminal nerve damage. One question with no alternative reply gave the respondents an opportunity to comment on their problems and to rate them on a visual analogue scale. The questionnaire was answered by 226 recipients, 72 men and 153 women. RESULTS: Most of the patients had sensory disturbances resulting from damage to the inferior alveolar nerve, the mental nerve, or the lingual nerve. More than 70% of the respondents complained about paresthesia. No fewer than one of five patients suffered from pain in the affected area. The altered sensation caused functional disturbances in speech and eating which, in turn, had social and psychological consequences. CONCLUSIONS: This study shows that mainly women and older persons have the most severe discomfort after oral nerve damage.

Adolescent↗
PubMed1995

Implant survival rates in partially edentulous patients: a 3-year prospective multicenter study.

PURPOSE: This multicenter investigation is an interim 3-year survival report of a 5-year prospective study using Brånemark osseointegrated implants in partially edentulous patients. MATERIALS AND METHODS: Previously defined patient characteristics and clinical parameters were related to implant survival using lifetable analysis. RESULTS: Three years after prosthesis insertion, 460 implants placed in 139 patients remained in the study. Cumulative success rates for maxillary implants (92.5%) were less than for mandibular implants (94.8%), with an overall cumulative success rate of 93.9%. CONCLUSION: Failures were associated with poor bone quality, smaller implant sizes, and a higher plaque index, and were more likely to occur before loading. A 4% incidence of residual long-term inferior alveolar nerve paresthesia was higher than previously reported.

Adolescent↗
PubMed1995

Germectomy or delayed removal of mandibular impacted third molars: the relationship between age and incidence of complications.

PURPOSE: To analyze and compare complications and side effects after removal of 1,500 mandibular impacted third molar teeth in three age groups. MATERIALS AND METHODS: The sample comprised 868 patients, 462 women and girls and 406 men and boys aged 9 to 67 years. The patients were divided according to age into the following three groups: group A, aged 9 to 16 years; group B, aged 17 to 24 years; group C, older than 24 years of age. RESULTS: The incidence of complications and side effects was 2.6% in group A, 2.8% in group B, and 7.4% in group C. All complications were temporary except in one instance of mandibular nerve paresthesia that occurred in a group C patient, in whom symptoms were still present 25 months after surgery. CONCLUSION: This study showed no significant difference in the complication rate between groups A and B, but complications significantly increased in group C.

Adolescent↗
PubMed1996

Prevalence and characteristics of chronic sensory problems in burn patients.

Problems of pain and paresthesia in the healed wounds of burn patients are an understudied and poorly documented phenomenon. This descriptive study was designed to examine the prevalence and characteristics of these chronic sensory problems 1 year or more postburn. Four hundred and thirty patients were sent questionnaires which assessed the frequency and intensity of the problems, influencing factors and impact on patients' lives. These problems were assessed by rating scales (visual analogue and categorical scales) and the McGill Pain Questionnaire (MPQ). The response rate was 67%. Over one-third of the participants (36.4%) complained of pain while the prevalence of paresthetic sensations was 71.2%. More than half of the symptomatic patients experienced sensory problems every week sufficient to interfere with daily living. No relationships were found between these sensory problems and the patients' age or sex, burn etiology, or length of time elapsed since injury. Burn severity was related to the frequency of the problems. Discussion emphasizes the need for adequate treatment of these problems and suggests further research issues.

Adolescent↗
PubMed1992

Injection injuries to the median and ulnar nerves at the wrist.

Carpal tunnel syndrome is often treated nonoperatively with temporary wrist immobilization and local steroid injections. A direct injection into a peripheral nerve can result in permanent damage. Two cases of median nerve injection injury and one involving the ulnar nerve are presented; all were treated with neurolysis and debridement of the injected material. At follow-up ranging from 1 to 11 years, all patients showed significant improvement, but with some functional loss. The literature is confusing because of the variety of injection techniques used for the treatment of carpal tunnel syndrome, some of which put the median nerve at risk. We recommend that the injection be made midway between the palmaris longus tendon and the flexor carpi ulnaris tendon just proximal to the proximal edge of the transverse carpal ligament in a line with the superficialis tendon of the ring finger. The injection should be stopped and redirected if the patient experiences paresthesia of any kind.

Adult↗
PubMed1993

Upper extremity tourniquet tolerance.

Twenty unsedated volunteers were tested to compare the relative tolerance of an arm tourniquet on one side and of a forearm tourniquet on the other. The forearm tourniquet was tolerated an average of 13 minutes (45%) longer and was consistently rated as less painful during and immediately after the test. No subject tolerated the arm tourniquet longer than the forearm tourniquet. Two peaks of discomfort were found, one just before deflation beneath the tourniquet and one in the hand 2 minutes later. Ulnar nerve distribution paresthesias were the earliest changes experienced; however, complete numbness occurred first in the median nerve distribution. Complete paralysis occurred 7 minutes later (24%) with the forearm tourniquet. Pulse rate did not correlate with tourniquet pain, but blood pressure did. No measurable tourniquet-induced edema occurred on either side.

Adult↗
PubMed1993

Preliminary experience with Ilizarov method in late reconstruction of radial hemimelia.

We report the outcome of ulnar lengthening with the Ilizarov technique in five adults with radial hemimelia and previous wrist centralization. The indications for ulnar lengthening in these patients were either a functional deficit due to the short ulna or poor appearance that caused the patient significant unhappiness. All patients had a successful lengthening of the ulna, with a gain in length from 4 to 13 cm; however, the procedures were prolonged (7 to 25 months), and all patients experienced complications. At the time of follow-up examination no patient had residual pain or paresthesias. In four of five patients, although ulnar lengthening resulted in somewhat stiffer digits, it improved function of the extremity as a whole. When asked if they would repeat the lengthening, knowing what they know now, all five replied that they would. The technical difficulties encountered in these cases suggest a cautious approach to ulnar lengthening. This is a long, arduous, painful process that requires a psychologically robust patient. If the ulna is very short preoperatively, lengthening can enhance the volume of space accessible to the hand and in that way improve function.

Adult↗
PubMed1988

Pyrethrin poisoning from commercial-strength flea and tick spray.

A case of acute poisoning followed inhalation and cutaneous exposure to an over-the-counter flea and tick insecticide containing 0.15% pyrethrins. A self-limited syndrome of cutaneous paresthesias, upper respiratory tract irritation, dyspnea with productive cough, and repetitive vomiting and diarrhea occurred. The patient recovered uneventfully with conservative therapy. A review of the pharmacology and toxicity of pyrethrins and related products is discussed, as well as management of pyrethrin poisoning.

Acute Disease↗
PubMed2005

Randomized study on oral administration of calcitriol to prevent symptomatic hypocalcemia after total thyroidectomy.

BACKGROUND: Symptomatic hypocalcemia remains the main postoperative complication after total thyroidectomy. The aim of the present study was to evaluate the role of oral supplementation of calcitriol and calcium salts in preventing severe postoperative hypocalcemia after total thyroidectomy. METHODS: A consecutive series of patients undergoing total thyroidectomy followed by administration of 500 mg of calcium salts 3 times per day were randomized to 3 different postoperative medical treatments: in group A, .5 microg of calcitriol twice per day was administered to 104 patients; in group B, 1 mmicrog of calcitriol twice per day was administered to 111 patients; and in group C, 202 patients did not receive calcitriol. RESULTS: The rate of postoperative tetany in group A was 2.9%, in group B was 0%, and in group C was 7.4% (P=.03) and the rate of paresthesias was 28.8%, 17.1%, and 22.3%, respectively (P=.19). At discontinuation of calcitriol/calcium salts treatment, intact parathyroid hormone levels did not significantly differ from the preoperative levels. Receiver operating characteristic (ROC) curve analysis showed that the area under the curve for serum concentration of calcium in predicting postoperative tetany was .749, .858 and .862 on the first, second, and third postoperative day, respectively. The best cut-off value of calcemia for prediction tetany was 7.5 mg/dL, and the rate of severe hypocalcemia on the third postoperative day was 23.1% in group A, 9.9% in group B, and 27.2% in group C (P=.001). CONCLUSIONS: Oral administration of 1 microg of calcitriol twice per day and 500 mg of calcium salts 3 times per day after total thyroidectomy significantly decreases the risk of severe postoperative hypocalcemia.

Administration, Oral↗