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At least 811 records · Page 45Linked to original sources
PubMed2004

Medial antebrachial cutaneous nerve conduction study, a new tool to demonstrate mild lower brachial plexus lesions. A report of 16 cases.

OBJECTIVE: This was to demonstrate the ability to electrodiagnosed mild lower brachial plexus lesion only through abnormal medial antebrachial cutaneous nerve (MABCN) conduction study. METHODS: We report 16 cases of unilateral, atypical pains and paresthesias of the upper limbs without motor deficit or atrophy. Patients were referred as carpal tunnel syndrome in 12 cases. All patients had needle examination of the impaired upper limb from C5 to T1. Motor and sensory conductions of median and ulnar nerves were bilaterally studied. MABCN was antidromically (16 cases) and orthodromically (9 cases) studied at the elbow in the both sides. MABCN abnormality was defined by an interside amplitude ratio of the sensory nerve action potential equal or greater than 2 (mean + 3 SD). RESULTS: No patient had a definitive and accurate diagnosis, before MABCN abnormality determination. MABCN testing was abnormal in all the 16 cases with a mean interside amplitude ratio of 7.2 (mean + 25 SD), when all other motor and sensory nerve conductions were normal. All except four patients showed normal needle examination from C5 to T1. In 5 cases, an obvious cause (traumatic and neoplastic) explained the mild lower brachial plexus lesion. In 2 cases, a mild neurogenic thoracic outlet syndrome (NTOS) was confirmed by surgical findings. In the 9 other cases, the mild lower brachial plexus lesion defined by MABCN findings, was without cause and was considered as a mild NTOS. CONCLUSIONS AND SIGNIFICANCE: These 16 cases, support a new electrodiagnostic pattern to define a mild lower brachial plexus lesion: comparatively low or low MABCN SNAP amplitude, normal median and ulnar SNAP/Compound motor action potential amplitudes and normal or slightly reduced interference pattern in some C8-T1 innervated muscles. This pattern can be found in patients with 'carpal tunnel syndrome like' symptoms who have normal electro-diagnostic examination, or in patients with clinical features suggesting a lower brachial plexus lesion.

Action Potentials↗
PubMed2006

The use of gabapentin for post-operative and post-traumatic pain in thoracic surgery patients.

OBJECTIVE: The pain following thoracic surgery and trauma is often refractory to conventional analgesic strategies. However, it shares key characteristics with neuropathic pain which gabapentin, an anticonvulsant, has been proven to effectively treat. To our knowledge, this is the first prospective study assessing the use of gabapentin in cardiothoracic surgery patients. METHODS: Gabapentin was prescribed to 60 consecutive out-patients with refractory pain persisting at four weeks or more after thoracic surgery or trauma. Follow-up of 45 patients (75%) was performed for a median of 21 months (range: 12-28), and clinical data collected prospectively. The mean age of these patients was 51.6 years (range 22-83). Of these 45 patients, 22 had received video-assisted thoracic surgery (VATS), 8 had received thoracotomy, 3 had received median sternotomy, and 12 were treated for blunt chest trauma. RESULTS: The mean duration of pre-treatment refractory pain was 5.76 months (range 1-62). The mean duration of gabapentin use was 21.9 weeks (range 1-68). No deaths or major complications were encountered. Minor side effects-mostly somnolence and dizziness-occurred in 18 patients (40.0%), causing 3 patients (6.7%) to discontinue gabapentin. Overall, 33 patients (73.3%) noted reduction of pain. Chest wall paresthesia distinguishable from wound pain was relieved in 24 (75.0%) of 32 affected patients. Severe initial pain was significantly correlated with pain relief using gabapentin (p=0.009). No other demographical or clinical variable correlated with benefit or side effects. Satisfaction with gabapentin use was expressed by 40 patients (88.9%). Side effects were not a source of dissatisfaction in any patient. CONCLUSIONS: Gabapentin appears safe and well tolerated when used for persistent post-operative and post-traumatic pain in thoracic surgery patients, although minor side effects do occur. Gabapentin may relieve refractory chest wall pain in some of these patients, particularly those with more severe pain. Further studies are warranted to define the role of gabapentin in cardiothoracic surgical practice.

Adult↗
PubMed2006

Pre-emptive local anesthesia for needlescopic video-assisted thoracic surgery: a randomized controlled trial.

OBJECTIVE: Studies in other surgical specialties have suggested that pre-emptive wound infiltration using a local anesthetic may reduce post-operative pain. We report the first randomized trial to assess the use of pre-emptive local anesthesia in video-assisted thoracic surgery (VATS). METHOD: Thirty-one consecutive patients undergoing bilateral needlescopic VATS sympathectomy for palmar hyperhidrosis were studied prospectively. Each patient acted as their own control. For each patient, one side was randomized to receive 10ml 0.5% bupivicaine injected to the port sites before incision, and the contralateral control side to receive 10ml saline. Pain severity on a visual analog scale (VAS) was recorded for each chest side at 4h, 1 day and 7 days following surgery. All patients were blinded to the results of randomization throughout the study. RESULTS: Follow up was complete for all patients. At 7 days after surgery, wound pain was significantly reduced by pre-emptive local anesthesia, with 10 (62.5%) of the 16 patients having residual pain reporting less pain on the pre-treated side (p=0.039). There was a trend for reduced pain on the pre-treated side at the other time points. Pain reduction by pre-emptive local anesthesia was not correlated with any demographic or clinical variable. Chest wall paresthesia distinct from localized wound pain was noted by six patients (19.4%), but was not reduced by pre-emptive local anesthesia. Overall, the post-operative discomforts felt by the patients after needlescopic VATS were mild, and did not cause significant functional disturbances. CONCLUSION: Pre-emptive wound infiltration with a local anesthetic may reduce post-operative wound pain in needlescopic VATS procedures.

Adolescent↗
PubMed2006

Acute sensory neuronopathy as the presenting symptom of Sjögren's syndrome.

Sensory neuronopathy associated with Sjögren's syndrome (SS) usually has a subacute or chronic onset. We report the case of a 37-year-old woman who presented with an unusual hyperacute form of SS ganglionopathy. She initially developed paresthesias of her fingertips and rapidly became severely ataxic. Nerve conduction studies revealed abnormal sensory but normal motor functions. Lip biopsy showed findings consistent with SS. Sural nerve biopsy showed severe axonal loss. The patient showed modest improvement with immunosuppressive therapies.

Adult↗
PubMed2004

Inferior meatal antrostomy: is it necessary after radical sinus surgery through the Caldwell-Luc approach?

PURPOSE: In the Caldwell-Luc (CWL) operation, an antrostomy at the inferior meatus is created surgically to promote sinus drainage. This inferior meatal antrostomy (IMA) has been criticized because of the need for an additional time, early loss of the sinusotomy, injury to the nasolacrimal duct, epistaxis from the sphenopalatine artery, and deviation from the normal sinus physiology. This trial was undertaken with specific attention to the question: Is it necessary to perform antrostomy at the inferior meatus after radical sinus surgery through the CWL approach? MATERIALS AND METHODS: Thirty-three patients with a dental origin of sinus disease indicating the CWL operation were entered into this trial. They were treated in blocks of 3, in which IMA was not performed in the first and second patients of each successive block. Only the third patient of each block had IMA performed. Cheek swelling, infection, and failure to relieve the patient's symptoms were the criteria for comparison between patient groups. Cheek swelling was measured by the eye-mouth line and the ear-nose line on the second and fourth day after surgery. RESULTS: At no time was there a statistically significant difference in cheek swelling between the treated groups (P >.05). No infection or failure of treatment was encountered. However, some patients in both groups had numbness or paresthesias of the cheek, upper lip, upper front gingiva, and teeth. These complaints were transient and lasted for several weeks. CONCLUSION: Based on our findings, it does not seem necessary to perform antrostomy at the inferior meatus, provided the patient has a patent osteomeatal complex and no anatomic abnormalities.

Adult↗
PubMed2004

Refeeding syndrome in patients with gastrointestinal fistula.

OBJECTIVE: Although refeeding syndrome has been well documented in starved patients, obese patients, those with anorexia nervosa, malnourished elderly individuals, and certain postoperative patients, little is known about the presence and the importance of refeeding syndrome in patients with gastrointestinal fistula and insufficient nutrition support over the long term. The objective of this study was to estimate the morbidity of this syndrome in these patients, to assess the safety and efficacy of our graduated refeeding regimen, and to emphasize the importance of this syndrome. METHODS: One hundred fifty-eight patients with gastrointestinal fistula during the past 2 y were reviewed. RESULTS: Fifteen of these patients were diagnosed as having refeeding syndrome. They were started on the refeeding procedure according to our regimen, and changes in their serum levels of electrolytes were recorded. The symptoms and signs they presented were noted. All patients were successfully advanced to full nutrition support. During the refeeding procedure, patients presented with weakness, paralysis of limbs, slight dyspnea, paresthesia, tachycardia, edema, and diarrhea. Serum phosphorus concentration decreased in all patients within 24 h of refeeding, reaching a mean nadir after 3.3 +/- 1.5 d and another 6.1 +/- 2.1 d to return to above 0.70 mM/L upon phosphorus supplementation. Three patients treated with growth hormone presented more severe hypophosphatemia (<0.20 mM/L) than the others. CONCLUSIONS: 1) Refeeding syndrome occurs commonly in patients with malnutrition secondary to gastrointestinal fistula. 2) Alterations in phosphate metabolism are central to the refeeding syndrome. 3) Supplementation with electrolytes (including especially phosphate) and vitamins is the focal point of the treatment of this syndrome. 4) Growth hormone treatment may aggravate hypophosphatemia.

Adult↗
PubMed2005

Spinal epidural abscess: an analysis of 24 cases.

BACKGROUND: Despite advances in neuroimaging and neurosurgical care, spinal abscess remains a challenging problem with mortality rates ranging from 4.6% to 31% in recent series. METHODS: Between January 1986 and December 2003, 24 patients with spinal epidural abscess were treated. Seventeen were men and 7 were women at the average age of 47.5 years. Concurrent illnesses that result in immunodepression such as diabetes and infections occurred in 62% of the case patients. All patients had back pain, 16 had muscle weakness, 9 had paresthesias, and 8 had sphincteral changes. Twenty-one patients underwent surgical procedures. In 11 case patients, the abscess had a frankly purulent material, and, in 5, the epidural lesion consisted of granulation tissue; the other 5 case patients had a combination of the 2. Three patients were treated conservatively. Staphylococcus aureus was isolated in 57% of the case patients. The lumbar spine was affected in 11 patients; the cervical spine, in 3. RESULTS: Fifteen patients recovered their normal neurological functions but 4 remained with some neurological disability. No deaths occurred in this series. CONCLUSIONS: Immediate surgical drainage of the abscess, before the development of severe neurological deficit, combined with specific antibiotics remains the treatment of choice.

Adolescent↗
PubMed1998

[Interbody arthrodesis of the lumbar vertebrae using retroperitoneal videoendoscopy. A preliminary study of 38 cases].

AIM OF THE STUDY: To report a series of 38 patients presenting retroperitoneoscopic inter-body fusion of the lumbar spine from L2 to L5, performed between 1995 and 1998. PATIENTS AND METHODS: This series included 25 women and 13 men aged from 16 to 74 years (mean age: 48.5 years). Surgery was performed in 32 patients for primary degenerative or post-operative instability of the lumbar spine, in five patients for painful sequels of burst fracture, and in one patient for sequels of disc infection. The main complaint was lumbar pain but a real sciatic pain was present in nine patients and was not a contraindication for this surgery. Standard X-rays were performed for each patient, and MRI performed in 30 patients confirmed the diagnosis and was also useful in determining vascular abnormalities. A cast immobilisation of the lumbar spine was done as a preoperative test in every patient. RESULTS: Forty-two levels were fused: 31 with a cage filled with cancellus bone and screwed between the end plates, and 11 with cancellus bone alone or in association with bone substitute, such as beta TCP. Post-operative complications included only a transient paresthesia of the thigh in two cases and a chyloretroperitoneum spontaneously resolutive. After 2.3 months of plaster immobilisation with a follow-up of 11.4 months, patient satisfaction rate was 84.5%, with 68.5% reporting no further back pain. The improvement was estimated by Prolo score. Fusion was considered effective by X-ray examination in all patients with an increase in the intervertebral space of 35% and a recovery of the local lordosis of 15%. CONCLUSION: Retroperitoneoscopic surgery is an elegant and secure method for lumbar interbody fusion of L2 to L5 with very few postoperative complications.

Adult↗
PubMed2003

Surgical treatment of thoracic outlet syndrome: effect and results of surgery.

BACKGROUND: Because of the difficulty in diagnosis and different treatment options, debate on thoracic outlet syndrome (TOS) has continued. Our aim is to report our surgical experience. METHODS: Forty-seven patients with thoracic outlet syndrome were operated on between 1985 and 2000. Mean age was 37.9 years (range, 17 to 58 years); female/male ratio was 41/6. The most frequent symptom was paresthesia (72.3%). Seventeen patients (36%) had bilateral symptoms. Of all, 89.3% (42 cases) were neurologic thoracic outlet syndrome, and 10.7% (five cases) were vascular. Lower plexus (C8-T1/ulnar nerve) compression was present in 36 patients and upper plexus (C5-C7/median nerve) compression in 6 patients. Doppler ultrasonography in 11 patients, angiography in 8, and lymph node scintigraphy in 1 patient were also performed. Main operative indications were persistence of symptoms after conservative therapy and reduced (< 60 m/s) ulnar nerve conduction velocity. RESULTS: Fifty-five operations were performed on the 47 patients. First (59.6%) and cervical costae (21.3%) resections were the most frequent operations. Mean ulnar nerve conduction velocity was 54.8 m/s (range, 43 to 68 m/s) preoperatively and 69.4 m/s (range, 47 to 70 m/s) postoperatively (p < 0.05). The morbidity rate was 17% (8 of 47). No difference was observed between transaxillary and supraclavicular incisions. No brachial plexus injuries occurred. The most frequent cause of morbidity was incisional pain. Two reoperations were performed for recurrences. Follow-up was 4.6 years, and 75% of lower plexus and 50% of upper plexus compressions remained asymptomatic. Severe and long-term pain occurred in 1 patient. CONCLUSIONS: Surgical decompression for thoracic outlet syndrome is efficient and dependable, but results deteriorate over time.

Adolescent↗
PubMed1998

Intracranial tumor masquerading as cervical radiculopathy: a case study.

Physicians who treat musculoskeletal and neurologic disorders often treat patients who have paresthesias or weakness of a single extremity. Although the diagnosis is often straightforward, cases that are atypical in nature may pose a diagnostic dilemma. This report describes the case of a middle-aged man with symptoms indicative of, though not classic for, a cervical radiculopathy. An extensive investigation was unremarkable and only the eventual rapid progression of symptoms led to the diagnosis of a glioblastoma multiforme. Although this is a deadly form of brain cancer, early recognition provides the best chance for a prolonged and greater quality of life.

Biopsy↗
PubMed1992

Cyclosporine treatment of inflammatory bowel disease.

Numerous uncontrolled studies and one controlled trial of cyclosporine therapy suggest that this selective inhibitor of cell-mediated immunity may be of benefit in patients with chronically active Crohn's disease. In addition, uncontrolled studies indicate that cyclosporine may be useful in the following settings: fistulous Crohn's disease; corticosteroid sparing in Crohn's disease; severe ulcerative colitis; and refractory proctosigmoiditis. The major advantages of cyclosporine therapy are apparent efficacy in patients with refractory disease and a rapid onset of response. Nevertheless, the incidence of relapse is high after cyclosporine therapy is discontinued, and this outcome is not prevented by low-dose maintenance therapy. Furthermore, the frequency of occurrence of cyclosporine-related side effects during treatment of patients with inflammatory bowel disease is high; paresthesias and hypertrichosis are the two most common adverse effects reported in the literature. Although the potential for permanent renal damage is of concern, serious, irreversible toxicity seldom occurs. Ongoing clinical trials will provide additional information about the efficacy and safety of cyclosporine for the aforementioned indications.

Cholangitis, Sclerosing↗
PubMed2005

[Transsacral approach to lumbosacral extraforaminal disc herniations].

INTRODUCTION: The lateral approach is classically used for surgical treatment of extraforminal disc herniations (EDH). However, its use at the level of the L5-S1 space can require more or less extensive resection of the facet joint. This study reports our experience in the treatment of L5-S1 EDH using the transsacral approach described by Muller and Reulen in 1998. MATERIAL AND METHODS: From February 2002 to October 2004, 12 patients presenting EDH at the L5-S1 level underwent treatment using the transsacral approach. There were 8 men and 4 women. Mean age was 55 years (range: 36 to 75 years). All patients presented lumbalgia and L5radiculalgia. Only one patient had dysesthesia. Five patients presented motor deficits and 3 presented sensory deficits. Surgical treatment was proposed after failure of medical treatment and two L5 corticoids infiltrations. RESULTS: All patients were re-examined two months after the procedure. Mean follow-up was 15 months. Complete resolution of radiculalgia with no paresthesia was achieved in all patients. Patients presenting preoperative motor deficit recovered fully after treatment. All patients resumed normal activity. CONCLUSION: The transsacral approach is a valid alternative to the lateral approach for treatment of L5-S1 EDH. The amount of operative exposure achieved using this technique is sufficient to avoid joint injury that can result in chronic postoperative lumbalgia. Another advantage is that excision of the protruding disc fragment can be achieved without mobilization of the nerve root or dorsal root ganglion, thus avoiding postoperative dysesthesia.

Adult↗
PubMed1997

Lumbar disk disease in pregnancy.

BACKGROUND: Lumbar disk herniation is rare in pregnancy. We report on three pregnant women with this disorder seen over 2 years. CASES: Three women were seen with progressive back pain, paresthesias, and urinary retention. In all three cases, magnetic resonance imaging confirmed the diagnosis. All failed conservative treatment and required surgery. All did well postoperatively, with improvement of symptoms and delivery at or near term. CONCLUSION: Lumbar disk herniation should be considered in pregnant women presenting with considerable back or leg pain. Magnetic resonance imaging is a useful diagnostic tool. Most patients can be treated conservatively, but those with incapacitating pain, progressive neurologic deficits, or bowel or bladder dysfunction may require surgical treatment.

Adult↗
PubMed2004

[Neuropathic pain: experimental advances and clinical applications].

Neuropathic pain is a clinical entity designating the different types of pain associated with a lesion of the nervous system including a wide range of pathological conditions from painful peripheral lesions (for example diabetic neuropathy, post-zoster pain, trauma-induced nerve injury) and central pain (particularly stroke-induced pain, spinal lesions, and multiple sclerosis). Despite this wide range of etiologies, neuropathic pain has well characterized clinical features which generally allow distinction from other types of pain: continuous often burn-like pain, paroxysmal pain (electrical discharge, knife stab), evoked pain, highly invalidating pain (allodynia, hyperalgesia), and associated dysethesia and/or paresthesia. Over the last ten Years, very little work has been published on neuropathic pain, which is now becoming a very active domain of research in neurobiology. Advances to date have not been spectacular although better tolerated agents have been recently marketed. Future progress should enable an appropriate response to the therapeutic challenge of neuropathic pain.

Animals↗
PubMed2005

[Transient trochlear nerve palsy as the presenting neurological sign of panarteritis nodosa].

INTRODUCTION: Panarteritis nodosa (PAN) is a systemic vasculitis affecting small and medium-sized arteries. Neuro-ophthalmological complications of PAN are rare but numerous, and may affect the eye, the visual and the oculomotor pathways. Such complications occur mainly in patients previously diagnosed with PAN. OBSERVATION: A 51-year-old woman presented with an isolated right trochlear (IV) palsy, in the setting of headaches and fluctuating fever of unknown etiology. Erythrocyte sedimentation rate was 13 mm and full blood cell count was normal. Previous chest X-ray and blood studies were negative for an infection or inflammation. Orbital and cerebral CT scan was normal. Spontaneous recovery of diplopia ensued over four days. Two days later, paresthesia and sensory paresis of the dorsal portion of the left foot were present. Lumbar puncture revealed 14 leucocytes (76 percent lymphocytes) with elevated proteins, but blood studies and serologies were negative. A diagnosis of undetermined meningo-myelo-radiculoneuritis was made. Because of a possible tick bite six weeks previously the patient was empirically treated with 2 g intravenous ceftriaxone for 3 weeks. Fever rapidly dropped. Six weeks after the onset of diplopia, acute onset of blindness in her right eye, diffuse arthralgias and fever motivated a new hospitalization. There was a central retinal artery occlusion of the right eye. Blood studies now revealed signs of systemic inflammation (ESR 30 mm, CRP 12 mg/L, ANA 1/80, pANCA 1/40, leucocytosis 12.4 G/L, Hb 111 g/L, Ht 33 percent). Biopsy of the left sural nerve revealed arterial fibrinoid necrosis. A diagnosis of PAN was made. CONCLUSIONS: Transient diplopia can be the heralding symptom of a systemic vasculitis such as PAN, giant cell arteritis and Wegener granulomatosis. In this patient the presence of accompanying systemic symptoms raised a suspicion of systemic inflammation, but the absence of serologic and imaging abnormalities precluded a specific diagnosis initially. A few weeks later, the presence of a second ischemic event (retinal) and positive blood studies led to a further diagnostic procedure. Oculomotor and abducens palsies have rarely been reported in association with PAN. We report the first case of trochlear nerve paresis as the inaugural neurological sign of PAN. This case highlights the importance of considering inflammatory systemic disorders in patients with acute diplopia particularly when they are young, lack vascular risk factors or cause, and complain of associated systemic symptoms.

Diplopia↗
PubMed2000

Lumbar disc herniation mimicking meralgia paresthetica: case report.

BACKGROUND: Meralgia paresthetica, a syndrome of pain and/or dysesthesia in the anterolateral thigh, is normally caused by an entrapment of the lateral femoral cutaneous nerve (LFCN) at the anterior superior iliac spine. In a few cases compression of the nerve in the retroperitoneum has been reported to mimic meralgia paresthetica. CASE DESCRIPTION: A 67-year-old woman presented with a 5-year history of permanent paresthesia in the anterolateral thigh. Motor weakness was not detected. Electromyography showed a neurogenic lesion at the level of L3. Lumbar spine MRI detected a foraminal-extraforaminal disc herniation at L2/L3, which was extirpated via a lateral transmuscular approach. The patient was free of symptoms on the first postoperative day. CONCLUSION: In patients with meralgia paresthetica we emphasize a complete radiological investigation of the lumbar spine, including MRI, to exclude radicular compression by a disc herniation or a tumour at the level of L2 or L3.

Aged↗
PubMed2000

Safety profile and tolerability of amprenavir in the treatment of adult and pediatric patients with HIV infection.

BACKGROUND: Amprenavir (APV) is a new HIV-I protease inhibitor used in combination with other antiretroviral agents for the treatment of HIV-1 infection. OBJECTIVE: The aim of this study was to assess the safety profile and tolerability of APV. METHODS: A review of data from 358 adults enrolled in 2 phase III, randomized, 48-week, controlled studies and from 268 children enrolled in 1 phase II and 1 phase III study was conducted. The adult data were collected between February 25, 1997, and April 1, 1999. Data were collected in children from September 10, 1997, to January 15, 1999; these data were collected before completion of either study. Adults and children who had and had not been treated previously with antiretroviral agents were enrolled. In these studies, APV was used in combination with 2 nucleoside reverse transcriptase inhibitors. RESULTS: The most common drug-related adverse events in patients receiving APV were gastrointestinal events and oral/perioral paresthesia. The majority of adverse events were mild or moderate in intensity, early in onset, and transient. Nausea (27/358 patients, 8%), vomiting (15/358, 4%), rash (11/358, 3%), and diarrhea/loose stools (9/358, 3%) were the most common adverse events associated with treatment discontinuation. Severe laboratory abnormalities possibly related to APV were rare. In children, the nature and frequency of adverse events were similar to those in adults. Metabolic complications were infrequent in APV studies to date; symptoms related to fat redistribution were reported in <3% of patients treated with APV. Lipid or glucose laboratory abnormalities were reported with similar frequency in the APV and control groups in both studies in adults. CONCLUSIONS: In the clinical trials reviewed, APV was generally well tolerated when administered with other antiretroviral agents in adult and pediatric patients with HIV infection.

Adolescent↗