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At least 811 records · Page 45Linked to original sources
PubMed1993

Pilot study to determine acceptability and ability of heat-killed Mycobacterium leprae plus BCG (HKML+BCG) vaccine to induce skin test conversion.

Although local reactions, including erythema, induration and ulcers, appeared in every patient after the injection of the combined HKML+BCG vaccine, they were accepted by the patients. There was no tendency for the local reaction to become aggravated after repeated vaccination. However, systemic reactions, mainly iridocyclitis and complaint of numbness of the fingers and toes, became quite common after the 5th vaccination and therefore significantly reduced the acceptability of vaccine by injection. It seems that repeated vaccination might activate the iridocyclitis, but the relationship between the complaint of numbness and vaccination has not been well established. Neither typical ENL nor reversal reaction had been observed throughout the trial. A significant proportion of patients converted to SMLA positivity after repeated vaccination. However, it seems the positive status was not stable as many of them reverted to negative after the following vaccination. After the 7th vaccination, the positive conversion rate to SMLA-I was 45% and to SMLA-II was 35%. After the 8th vaccination, 66.7% of patients converted to Mitsuda reaction positive, which has been confirmed by histopathological examination. Nevertheless, further follow-up is required in order to determine whether or not such conversion will be of a long duration. The reactions to SMLA-I and SMLA-II were associated but only correlated at a moderate level. Overall, the positive conversion rate to SMLA-I was significantly higher than that to SMLA-II after repeated vaccination. Neither the early reaction nor the late (Mitsuda) reaction of the lepromin test were correlated to either SMLA reaction. The repeated vaccination of HKML+BCG vaccine did not affect the weakly-positive anti-PGL-1 Mycobacterium leprae antibody level seen in the skin-smear negative lepromatous patients participating in this study.

Adult↗
PubMed1993

[A case of carcinomatous neuropathy with degeneration of posterior spinal column on MRI].

The patient was a 55-year-old man. He was well until eleven months earlier, when he noticed the onset of numbness in his right fingers. Over the next three months, the numbness spread up the right arm and involved the right leg, left arm and left leg in succession. Six months before admission, sensory impairment of the trunk appeared progressively. Mild diffuse muscle weakness occurred gradually. Swelling of the right lateral cervical lymph node was found just before admission. On neurological examination, sensory disturbance involving all modalities of sensation was recognized in the extremities and trunk. The sensory findings were asymmetric and predominant at the lower extremities and distal parts. A positive Romberg's sign and poor coordination was recognized. All the deep tendon reflexes were absent without pathological reflexes. Motor weakness, which was less severe than sensory findings, was present. There was no sphincter disturbance nor orthostatic hypotension. Routine laboratory findings were within normal limits. The protein level of cerebrospinal fluid was slightly increased. The electrophysiological studies and histological evaluation of the biopsied peroneal muscle and sural nerve showed degeneration and reduction of large myelinated fibers of sensory nerves with minimal motor nerve changes. Histological study also revealed the increase of regenerating fibers. Squamous cell carcinoma of epipharynx with metastasis of neck lymph nodes was found. Radiotherapy without chemotherapy resulted in a complete tumor remission and probably suppressed the progression of neurological disturbances. After two years from the onset, diffuse high intensity area was noted in the posterior spinal column on T2 weighted MRI.(ABSTRACT TRUNCATED AT 250 WORDS)

Carcinoma, Squamous Cell↗
PubMed1995

[A case of subacute sensory neuropathy associated with extraovarian serous papillary adenocarcinoma of the peritoneum].

We reported a case of subacute sensory neuropathy. A 78-year-old woman was admitted to Kenwakai Hospital because of progressive numbness in her hands and feet. Four months before admission, numbness and tingling sensations appeared in her hands and feet, and subsequently she felt difficulty in skilled finger movement. On general examination, she was found to have a mass in the right lower abdomen. Neurological examination revealed marked loss of position sense and vibratory sense in the distal extremities, and mild reduction of sensation to pinprick and light touch in the distal extremities. Stretch reflexs were depressed in the upper limbs and absent in the lower limbs. Her gait was unsteady and Romberg's sign was positive. She showed no cranial nerve dysfunction, cerebellar ataxia, muscle weakness, and autonomic dysfunction. Blood examination revealed high TTT (11.3Kunkel U), high ZTT (16.4Kunkel U) titer. Tumor markers were normal except for CA125 (93 U/ml). The cerebrospinal fluid showed 48 mg/dl of protein, 10.6 mg/dl of IgG. and an almost normal cell count (5.3/mm3). Serum was tested by immunohistochemical staining. Only the cytoplasm of neurons in the dentate nucleus and brain stem was stained on a rat's brain. Sural nerve biopsy showed a severe loss of large myelinated fibers. An exploratory laparotomy revealed a peritoneal tumor, 5 cm in diameter, and it was removed. During the surgery, other than a few rice-sized nodules in the cul-de-sac, there was no evidence of tumor in bilateral ovaries. The tumor was proven to be a serous papillary adenocarcinoma with psammoma bodies resembling ovarian cancer.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1996

Carpal tunnel syndrome.

Patients with carpal tunnel syndrome should be told that it is a progressive condition that, if not treated, probably will worsen as time goes on. When release is performed properly, they have an excellent chance for substantial improvement, although some always may have a degree of residual numbness at the fingertips. Initial relief of pain is rapid, with subsequent improvement in numbness and weakness occurring more slowly. Carpal tunnel syndrome is a very common problem. Although there may be a distinct cause in some patients, the underlying reason for the increased bulk of synovium is not known in most. Conservative treatment gives temporary relief, but surgical release remains the most effective treatment. Complications are not common, and proper attention to details minimizes them. The results generally are excellent.

Carpal Tunnel Syndrome↗
PubMed1996

Carpal tunnel release. Correlations with preoperative symptomatology.

Fifty patients (54 hands) who underwent carpal tunnel release for carpal tunnel syndrome were evaluated to determine the relationship between the prominence of specific clinical symptoms and the early results of carpal tunnel release. Patients were evaluated preoperatively, 3 weeks after surgery, and 3 months after surgery by questionnaire, physical examination, and Semmes-Weinstein monofilament pressure testing. The symptoms evaluated included hand/wrist/forearm pain, night pain/paresthesias, intermittent paresthesias, hand clumsiness, hand weakness, constant numbness, and difficulty with work related tasks. All symptoms showed significant improvements at 3 months after surgery. Overall symptom reduction at 3 months after surgery was 49% +/- 73%. Overall satisfaction at 3 months after surgery was 7.8 +/- 2.8 (0 to 10 scale). the severity of preoperative subjective hand weakness was significantly associated with surgery and with less improvement of function at 3 months after surgery and with less satisfaction with overall symptom relief at 3 months after surgery. Although subjective outcomes in this study were markedly improved after carpal tunnel release regardless of preoperative symptomatology, patients with more preoperative night symptoms and intermittent paresthesias and less preoperative hand/wrist pain, numbness, weakness, clumsiness, and difficulty with work related tasks were the most satisfied with their surgery.

Adult↗
PubMed1995

[Immunoadsorption therapy on Fisher's syndrome--removal ability of anti-ganglioside antibodies by tryptophan-linked immunoadsorbent].

There have been several reports describing that immunoadsorption therapy improves the neurologic involvement in Fisher's syndrome (FS). However, few studies have assessed the usefulness of immunoadsorption therapy in view of the removal ability of anti-GQ(1b) antibody, which may function the development of FS. We examined the ability of immunoadsorbents for the anti-GQ(1b) antibody in a patient with FS. A 28-year-old woman developed diplopia and giddiness following a cough, fever and diarrhea. On admission (day 22), neurologic examination showed bilateral moderate oculomotor paralysis and bilateral complete abducens paralysis. She had areflexia, numbness of middle and ring fingers on the left and mild ataxic gait. Her serum had IgG anti-GQ(1b) and anti-GD(1b) antibodies. We examined the absorption of anti-ganglioside antibodies onto a polyvinyl alcohol gel (PVA), a phenylalanine-linked PVA (PH-350) and a tryptophan-linked PVA (TR-350) by the batchwise adsorption method. TR-350 absorbed the autoantibodies, but the removal ability of autoantibody by PVA and PH-350 was not proved. The FS patient was treated with TR-350 (days 29, 34 and 43) and PH-350 (day 39). Anti-GQ(1b) and anti-GD(1b) antibodies were significantly removed by the TR-350, in accordance with the results of the in vivo study. There was little loss of albumin as compared with the immunoglobulins and complements. The numbness and ataxia disappeared on day 44. The diplopia disappeared on day 106. TR-350 would be better than PH-350 in the treatment of FS by immunoadsorption therapy.

Adult↗
PubMed1995

[Clinical and pathologic analysis of 33 cases of brachial plexus neurinoma].

Clinical and pathological findings in 33 cases of brachial plexus neurinoma are reported. In 30 cases (90.91%) the diagnosis was proved to be correct by postoperative histological sections, and in other 3 cases (9.09%) the diagnosis couldn't be made preoperatively. The 33 cases were subjected to surgical resections and 18 (54.55%) of them still felt numbness and pain within two weeks after surgery. Sixteen cases were followed up for three months and 14 (87.5%) of them felt numbness by percussion over the incision. All the 33 cases had no brachial plexus traumatic complication postoperatively.

Adolescent↗
PubMed1996

Milking is a high-risk job for young females.

The prevalence of and the impact of selected factors on self-reported musculoskeletal complaints in Swedish female milkers with special reference to symptoms in the upper extremities were investigated using data from mail-in surveys. An agricultural study group was formed of three subgroups: 161 active milkers, 108 non-milkers and 62 ex-milkers, women who had been milkers earlier but were no longer doing that kind of work. In the course of the analysis these subgroups were compared with each other and also, separately or in combinations, with a non-agricultural population consisting of 166 nursing assistants. Problems in the upper extremities were significantly more common in the agricultural group than in the non-agricultural group. Milkers ran a higher risk of developing symptoms in the wrists and hands than non-milking women. Symptoms such as numbness, coldness in the wrists and white fingers were more common in all agricultural subgroups than in the non-agricultural group. Numbness and white fingers were related to vibration exposure in the ex-milker and the non-milker groups but not in the milker group. Psychosocial factors such as occupational well-being were not related to the occurrence of symptoms. Milking in a modernized barn gave fewer problems in elbows than milking in a traditional barn. Milkers who had received ergonomic instruction on how to work in order to reduce muscle stress had fewer problems in the elbow region than those who had received no such information.

Adult↗
PubMed1996

[Therapeutic effectiveness of combined microsurgery and radiosurgery in a patient with a huge trigeminal neurinoma].

A case of right trigeminal neurinoma extending from the cavernous sinus to the cerebellopontine angle in a 48-year-old male is reported. The patient first noticed right facial numbness in June 1993. Six months later, he experienced headaches with occasional nausea, diplopia, ataxic gait, tinnitus and dysphagia and was referred to our department on January 21, 1994. Neurological examination on admission showed multiple cranial nerve palsy from the 4th to 11th nerve on the right, and the cerebellar sign on the right. Initial CT and MRI revealed a large mass lesion extending from the right cavernous sinus to the right cerebellopontine angle. On February 16, 1994, radical resection of the tumor, except the lesion invading the cavernous sinus, was performed via a combined retroauricular and preauricular transpetrosal transtentorial approach. The histological diagnosis was neurinoma. The patient's postoperative course was uneventful and there was good clinical improvement, although the right facial numbness and mild diplopia persisted. On April 6, 1994, radiosurgery was performed with a maximum dose of 28 Gy and a marginal dose to 14 Gy to the remaining cavernous sinus lesion. Two weeks after radiosurgery, the patient achieved a complete return to his daily routine. Two-year follow-up CT and MRI showed a small residual les on in the right cavernous sinus alone. There was no evidence of tumor growth. No new neurological deficits had developed, and the patient's the double vision had resolved. Thus, the patient has been able to maintain a satisfactory level of activities of daily living. We wound like to emphasize the clinical value of the strategy used to treat this patient which combined microsurgery with subsequent radiosurgery.

Cranial Nerve Neoplasms↗
PubMed1996

[A case of central pain observed in medical medullary infarction].

A 45-year-old man had typical features of the left medial medullar syndrome which were left tongue paralysis, right hemiparesis, and right disturbance of touch and deep sensation sparing the face. He complained of hyperpathia, numbness and pain of the right body and limb sparing the face. MRI disclosed left upper medial medullary infarction, and cerebral angiography revealed occlusion of the left vertebral artery before the posterior inferior cerebellar artery. In general, the touch and deep sensation are carried through the medial lemniscus located in the medial medulla, therefore central pain is not considered to be induced by the medial medullary lesion. But tingling and numb sensation were sensory symptoms in our patient and the cases previously reported. If spinocervicothalamic tract related to touch and pain sensation has been well developed, it is suspected that central pain is induced by disturbance of the tract.

Cerebral Infarction↗
PubMed1996

The influence of individual factors on the absorption of vibration energy in the hand and arm.

The detrimental effects of vibrating hand-held tools upon humans have been known for a long time, and determination of the absorption of vibration energy into the operator's hand and arm could be an alternative method of risk assessment. The energy absorption in the hand and arm during exposure to random vibration has been measured in 84 subjects, 40 males and 44 females. A special handle was used during the measurements. The influence of various experimental conditions, such as vibration level (3-12m/s2), vibration direction (Xh, Yh, Zh), and grip force (25-75 N) were studied. Furthermore, the influence on the absorption of different individual biological factors, such as age, weight, height, hand and arm dimensions as well as blood pressure were also investigated. The subject also provided demographic data through a questionnaire covering work, symptoms of finger blanching and numbness as well as current use of nicotine (snuff of tobacco). The results show that energy absorption is influenced by exposure directions and levels as well as grip forces. Furthermore, the results show that individual biological differences between subjects, for instance age, hand volume and hand thickness, have a significant influence on the amount of absorbed energy. Blood pressure had no influence on the absorption. The same was also found for the subjective reported symptoms of finger blanching or numbness as well as for use of nicotine.

Adult↗
PubMed1997

[A case of crush syndrome resulting from continuous compression of the upper arm by automatically cycled blood pressure cuff].

We report a case of crush syndrome (rhabdomyolysis) resulting from the prolonged compression of the inadvertently inflated blood pressure cuff around her upper arm. A 61-yr-old woman had undergone total gastrectomy, splenectomy and cholecystectomy for gastric cancer. At the end of the surgery lasting for 5 hrs 40 mins, we found the right upper arm extremely swollen with cyanotic petechiae beyond the inflated cuff. Failure of deflation of the automatically cycled blood pressure cuff was strongly suspected as a cause. She complained numbness and ardor on her hand with motor nerve disturbance and plasma CPK level was elevated. Diuretics were given and fluids were infused vigorously to prevent the renal failure, and continuous cervical epidural block was instituted to increase the blood flow to the injured arm. Prostaglandin E1 and ulinastatin (a protease inhibitor) were also effective for recovery from the crush syndrome. One month later she was discharged home accompanied with a slight numbness on the arm. Attention should be paid to deflation of the automatically cycled blood pressure cuff during anesthesia.

Alprostadil↗
PubMed1996

[Thoracic spondylotic myelopathies. Apropos of 4 new cases].

Four cases of thoracic spondylotic myelopathy are reported, one man and three women, respectively 61, 66, 67 and 76 years old. Clinical presentation was numbness and weakness in the lower limbs in two cases, weakness alone in one and numbness alone in the last one. Diagnosis was settled by both myelography and CT-myelogram in three cases, by both MRI and CT-scan in the other one. The involved thoracic levels were both T9-T10 and T10-T11 for two cases and T11-T12 for the other one. The stenosis was due to hypertrophic ossification of the ligamentum flavum in three cases and to osteophytic changes in one. A laminectomy was performed for each patient and three patients had a significant recovery and the fourth a mild one. Thoracic myelopathy is an uncommon disease which requires a meticulous study of myelogram and now MRI to be recognized and to be cured by laminectomy. As for cervical myelopathy, it results from mechanical and ischemic factors which can lead to a definitive myelomalacia.

Aged↗
PubMed1995

Operating vibrating tools and prevalence of subjective complaints in vibration syndrome.

The aim of this paper is to evaluate the prevalence of subjective symptoms and signs related to vibration syndrome in various groups of subjects exposed to hand-arm vibration (HAV). In 9 groups of subjects occupationally exposed to HAV, one group of subjects previously exposed to HAV, one control group, and 2 groups of general population (males and females), the prevalence of finger blanching, numbness in the hands, stiffness in the hands, and pain in the hands were investigated. The age of subjects ranged from 25 to 59 years. In subjects exposed to HAV, hand-transmitted vibration levels (HTVLs) were measured by means of vibration dosimeters, and the frequency-weighted acceleration levels [(Lh,w)eq,t] were determined as the vibration levels. The prevalence of vibration-induced white finger (VWF) in the exposed subjects was in the range of 0.0-9.6%, and that in subjects who were previously exposed to HAV was 4.1%. The prevalence rates of finger blanching in males and females of the general population were 2.7 and 3.4%, respectively. The highest prevalence rate of VWF was observed among subjects exposed to HTVLs of 2.7-5.1 m/s2. The prevalence of numbness of the hands fluctuated among the groups; i.e., in the exposed groups: in the range of 6.5-30.4%; in those previously exposed to HAV: 16.4%; and was 13.4% in males and 29.5% in females of the general population. The prevalence rates of stiffness in the hands were in the range of 7.6-65.2% in the exposed workers, 13.7% in those previously exposed to HAV, and was 5.5% in males and 20.9% in females of the general population. The prevalence of pain in the hands was between 7.4 and 17.4% in the exposed groups, 1.4% in those who stopped exposure to vibration, and 1.2% in subjects without segmental vibration exposure. Among the subjective symptoms, only VWF showed a significant positive correlation with the measured vibration acceleration; Y = -0.9 + 1.9 X, r = 0.8, P = 0.01. It was concluded that VWF is the most appropriate signs in decisions concerning quantitative recommendations for segmental vibration exposure.

Adult↗
PubMed1997

[A case of foramen magnum meningioma in which case enhanced three-dimensional CT scan was valuable for preoperative evaluation of the surgical approach].

We report a case of foramen magnum meningioma in which case enhanced three-dimensional CT scan was valuable for preoperative evaluation of the surgical approach. A 53-year-old woman had suffered from stiffness and pain in the left occipital region and numbness of the left side of the face for about 2 years before admission. She had also weakness and numbness of the left side of her body for about 2 months before admission, and dysphagia and pain in the occipital region and in the posterior region of the neck produced by straining for about 1 month before admission. Neurological examination revealed left hemiparesis, and hypalgesia and tactile hypesthesia of the left side of the body, including the face. Plain X-P was normal. Enhanced CT scan and gadolinium enhanced MRI revealed a well-enhanced mass attached to the left anterolateral part of the foramen magnum. The left occipital condyle was observed at the lateral side of the attachment part of this mass. Angiography revealed tumor feeders from the meningeal branches of the left vertebral artery and the left ascending pharyngeal artery. Enhanced three-dimensional CT scan clearly showed that the tumor was attached to the left anterolateral part of the foramen magnum, that the left occipital condyle was at the lateral side of the attachment part of this mass and that the jugular foramen and jugular tubercle were situated superolateral to the attachment part of this mass. Considering these factors, we decided that removal of the posterior part of the left occipital condyle was necessary, but removal of the left jugular tubercle was not necessary for a good operative view from the left posterior lateral direction. The tumor was totally removed successfully and good results were obtained by the transcondylar approach without removal of the jugular tubercle. Histology of the tumor revealed meningothelial meningioma. In this case, preoperative evaluation with enhanced three-dimensional CT scan was helpful for deciding the surgical approach. With enhanced three-dimensional CT scan, it is easy to judge whether removal of the posterior part of the occipital condyle and/or the jugular tubercle is necessary for a good operative view, and we can get good images revealing the relationships between the tumor and surrounding structures. Preoperative evaluation with enhanced three-dimensional CT scan is very useful especially in this kind of situation.

Female↗
PubMed1997

[A case of rapidly progressive HTLV-I-associated myelopathy (HAM)].

We report a 65-year-old woman with HAM who showed rapid progression of the clinical symptoms. The initial symptom was lumbago and she became unable to walk within 4 months after the onset of the lumbago. When seen on admission, she had flaccid paraplegia and areflexia was seen in the lower extremities with positive Babinski and Chaddock reflexes. She had numbness below the level of the navel, vibratory sensation was decreased in both lower limbs, and there was a hyperesthesic zone at the tenth thoracic vertebral level. She had a difficulty in urination and defecation. Laboratory examination revealed elevated anti-HTLV-I antibody titers both in serum (4,096x by PA method) and in cerebrospinal fluid (CSF) (4,096x). The levels of IgG and neopterin in CSF were also increased to 16.6 mg/dl (normal: < 5 mg/dl) and 360.3 pmol/ml (normal: < 30 pmol/ml), respectively. HTLV-I messenger RNA positive cells were detected in 0.1% to 0.01% of cells in CSF by in situ hybridization using an oligonucleotide probe labelled with alkaline phosphatase. Spinal cord MRI detected neither spinal cord compression nor vascular diseases. She was treated with 1,000 mg methylprednisolone for 3 days intravenously, followed by 60 mg oral prednisolone therapy. In several days after receiving the treatments, her muscle tonus became spastic and deep tendon reflexes in the legs became brisk. The hyperesthesia at the tenth thoracic vertebral level and numbness below the level of the navel were also gradually improved. Subsequently, her clinical features were consistant with those of the typical HAM. Therefore, the patient was diagnosed as rapidly progressive HAM. The initial phase of rapidly progressive HAM patients had been described only from clinical history. These patients had common characteristic clinical features, such as older age at onset, relatively severe motor dysfunction, high titers of anti-HTLV-I antibody in CSF, and increased levels of neopterin and IgG in CSF, when compared with those of other HAM patients. The clinical course and laboratory findings in the present patient were compatible with those in the previous cases reported as rapidly progressive HAM. This patient showed flaccid paraplegia and areflexia which have rarely been seen in HAM patients. However, these symptoms were changed to spastic and hyperactive after prednisolone therapy. We speculate that inflammation in the spinal cord in this patient was severe enough to spread to the dorsal root, and disturbed the afferent pathway from the peripheral to the central nervous system. This inflammatory reaction might be suppressed by prednisolone to facilitate the recovery of the afferent pathway, which led to the typical clinical symptoms of HAM.

Aged↗
PubMed1997

Dentist and patient evaluation of an electronic dental analgesia system.

Questionnaires were used to evaluate operators' and patients' attitudes to a recently introduced electronic dental analgesia system. Five participating dentists were given 30 minutes' instruction in the use of the system and asked to offer the use of the system to patients who expressed an interest in using the system or anxiety to administration of local anesthesia. The system, used for 113 patients, was considered most useful for placement of Class I and Class V restorations and procedures such as crown or prosthesis insertion. The system was considered most suitable for patients who disliked needles or numbness. Principal difficulties encountered were the time-consuming nature of the system and the differing electrode sites required for different patients. Major benefits identified were the absence of drugs, needles, residual numbness, and invasiveness and a reduction in anxiety in needle phobics. Forty-one percent of patients indicated that the system controlled discomfort more effectively than did local anesthesia. Seventy-two percent of respondent patients stated that they would request its use for future treatment.

Adolescent↗
PubMed1997

[Clinical judgment and decision making in medical practice. A patient with shoulder symptoms].

A 49-year-old man consulted his general practitioner because of left shoulder pain. Analgesics brought no relief. He had a numb feeling in the left axilla. Cervical MRI revealed a herniated disc Cv-Cvi, for which the patient was treated surgically. However, the pain persisted. In retrospect, the axillary numbness could not have been caused by a Cv-Cvi problem, because C6 does not innervate the axilla. Repeated MRI, now of the cervicothoracic region, revealed a tumourous process around TI-TII. Thoracotomy was performed and a mesothelioma was found. The patient died shortly afterwards. It is stressed that the diagnostic satisfaction of a positive MRI finding should not lead to disregarding discrepancies between these radiological results and the clinical findings.

Arthralgia↗