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At least 1,063 records · Page 59Linked to original sources
PubMed1980

Lumbosacral stenosis in dogs.

Fifteen dogs with stenosis of the lumbosacral portion of the spinal canal were treated by laminectomy, bilateral facetectomy, and foraminotomy. Concomitant disk extrusion, spondylosis, fracture, infection, neoplasia, hemivertebrae, and spinal bifida were not associated with the stenosis and attendant cauda equina compression. The predominant neurologic signs were intermittent hindlimb lameness and motor weakness; hindlimb muscle atrophy; presumed paresthesia with resultant dermatologic manifestations from self mutilation of the hindlimbs, tail, perineum, anal area, and genitalia; urinaryu or fecal incontinence, or both; and consistently elicitable pain on manipulation of the lumbosacral spine. Surgical decompression of the stenotic canal alleviated the clinical signs in all cases.

Animals↗
PubMed1995

Meralgia paresthetica: a report on two cases treated surgically.

Meralgia paresthetica (Bernhart-Roth Syndrome) is characterised by pain, burning, or tingling paresthesias, and decreased touch and pain sensation on the anterolateral aspect of the thigh. It is due to neuropathy of the lateral femoral cutaneous nerve (LFCN). Conservative treatment is usually successful in relieving the symptoms in most of the patients. We describe two patients who required surgical treatment for intractable symptoms. Although neurolysis with transposition is the most common procedure, we preferred neurectomy with excision of a portion of the LFCN for its very low recurrence rate as opposed to neurolysis. The area of anesthesia generated by this procedure in the distribution of the LFCN tends to shrink with time. Moreover, this pathology, to our knowledge, has not been reported much in the African literature.

Diagnosis, Differential↗
PubMedDate not supplied

Fish-oil fatty acid supplementation in mixed cryoglobulinemia: a preliminary report.

OBJECTIVE: Since fish oils seem to play a potential role in the treatment of inflammatory disorders by inhibiting arachidonic acid metabolism, the purpose of this study was to determine their therapeutic efficacy in mixed cryoglobulinemia (MC), an inflammatory condition caused by the deposition of immune complexes in vessel walls. METHODS: In an 8-week double-blind randomized trial, ten MC patients received a daily dietary supplement of 3 gm of eicosapentaenoic acid (EPA) and 2 gm of docosahexenoic acid (DHA), while 10 other MC patients received placebo (olive oil). The severity of purpura, arthralgias, paresthesias, asthenia and Raynaud's phenomenon were monitored daily, and serological assays were performed at the beginning of the study, at the end of the treatment period, and after 4 weeks of wash-out. RESULTS: No significant differences were found between the two groups with regard to the clinical symptoms, although the percentage of patients who reported a clinical improvement was higher in the group treated with fish oils. As for the serological parameters, no variation was found in the placebo group, while in the group receiving fish oils a significant decrease in cryocrit and rheumatoid factor levels was observed, which in the case of rheumatoid factor persisted at the end of the wash-out period. CONCLUSIONS: Under the experimental conditions employed in this study, we could not demonstrate a significant improvement in clinical symptoms in patients with mixed cryoglobulinemia treated with fish oils. However, since our results indicated some improvement in the serological parameters potentially involved in the pathogenesis of the disorder, further studies are warranted to establish the optimal dose and duration of fish oil supplementation in the treatment of MC.

Adult↗
PubMedDate not supplied

Radial or brachial artery injections for intraarterial regional anesthesia for hand surgery?

BACKGROUND AND OBJECTIVES: The aim of this study was to determine the optimal injection site for the intraarterial regional anesthesia for hand surgery. METHODS: Forty-two adult patients undergoing elective hand surgery were studied. 0.5% lidocaine plain 1.5 mg/kg was injected over 3 minutes into the radial artery (group 1), or the brachial artery (group 2) through a 22 or 20 gauge Teflon catheter. RESULTS: Two patients (one in each group) were excluded due to technical problems. Onset of analgesia in the hand was faster after radial artery injection (P < .05). Onset of analgesia in the forearm was similar in both groups. Catheterization time, operating conditions, motor block, offset of analgesia, injection, surgical and tourniquet pain scores, and patient's acceptance were similar. Ten patients in group 1 and nine patients in group 2 needed supplemental analgesia at the start of surgery. Median nerve paresthesias were unintentionally elicited during catheterization in three patients in group 2. Six patients (two in group 1 and four in group 2) had minor systemic adverse effects after tourniquet release. Seven patients in group 1 and five in group 2 developed minor bruises after catheterization. No permanent sequelae of injections were observed. CONCLUSIONS: Radial artery is preferred for intraarterial regional anesthesia. Compared with the brachial artery, injection in the radial artery produces faster analgesia in the hand and reduces the risk of damage to the median nerve.

Adolescent↗
PubMed1994

[Multiple myeloma with numb chin syndrome as the initial manifestation].

The numb chin syndrome (NCS) is characterized by chin or lower lip numbness restricted to the distribution of the mental nerve (the distal trigeminal nerve). A case of multiple myeloma with polycythemia vera was diagnosed with NCS as the initial manifestation. A 73-year-old Japanese male was admitted to our hospital in April, 1993, because of paresthesia around the chin and lower lip. X-ray film showed multiple osteolytic lesions. According to serum and urine immunoelectrophoresis, lambda type Bence Jones protein was demonstrated. The bone marrow aspiration showed the normocellular marrow with 14.1% myeloma cells. He was diagnosed a suffering from multiple myeloma and was treated with melphalan and prednisolone. He is alive at present with resolution of NCS. We discussed pathogenesis, diagnosis, and treatment of NCS.

Aged↗
PubMed1993

[Carpal tunnel syndrome II. Clinico-electroneurological correlation].

In patients with carpal tunnel syndrome (CTS), it has frequently been observed a disparity between the clinical manifestations, especially pain, and the electroneurological (ENG) tests, the reason for which we have conducted this study, in order to assess to what extent the symptoms and signs of CTS are correlated with the ENG findings. The study included 288 hands, 190 patients with ENG diagnosis of CTS, 127 of which were women and 63 men. With respect to the sensitive manifestations observed, pain was present in 146 hands (50.87%), paresthesia in 142 hands (49.47%) and objective hypoesthesia in 43 hands (14.98). All these manifestations were significantly correlated with sustained sensitive distal latency (SDL). In addition, hypoesthesia was correlated with reduced sensitive conduction rate (SCR). Among the motor manifestations, the subjective loss of strength was referred in 102 hands (35.54%), the objective loss of strength we observed in 49 hands (17.07%) and atrophy in 22 hands (7.66%). We observed a significant correlation between objective motor signs, mainly atrophy, and altered electroneurological motor parameters; there was also a significant correlation between the time of evolution of the process and the presence of thenar atrophy. As well as with the sensitive clinical manifestations, the objective physical findings correlated more significantly with the electroneurological findings than with the subjective manifestations.

Atrophy↗
PubMed1993

[Notalgia paresthetica, "posterior pigmented pruritic patch" and macular amyloidosis. Three stages of a disease].

We report on nine cases of notalgia paresthetica, a cutaneous condition that has rarely been described in the dermatological literature and is characterized by localized pruritus, burning and hyperesthesia and/or paresthesia on the back. Histological and immunohistochemical studies have not clarified the pathogenesis of this disease. Several factors might be involved in various cases, including increased cutaneous innervation and neuropathy. The so-called posterior pigmented pruritic patch and macular amyloidosis may be considered as progressive evolutional stages of notalgia paresthetica.

Adult↗
PubMed1994

[Pseudotumoral medullary syndrome manifesting a probably beginning multiple sclerosis. Clinical, radiological and neuropathological correlations].

A 19-y old sportsman was admitted because he complained of ascending paresthesia since two weeks, muscular strength diminution in both arms, then respiratory difficulties without fever. Clinical examination confirmed an asymmetric bilateral pyramidal syndrome affecting the four limbs, a hyposensitive level up to C5, without meningeal symptoms. MRI detected a widening of the cervical (C2-C5) spinal cord, with gadolinium enhancement. CSF demonstrated lymphocytic pleocytosis and total protein of 530 mg/l with an oligoclonal IgG pattern. With a diagnosis of multiple sclerosis, a corticoid therapy was started but without clinical improvement. Six weeks later, a new MRI revealed an increased enlargement of the cervical spinal cord suggesting a tumoral process. No tumor could be detected at neurosurgery. Biopsy specimen (from C3-C4) demonstrated an inflammatory demyelinating disease with astrocytic hypertrophy. Electron microscopy confirmed the active demyelinating disorder with persistently denuded axons. Several macrophages were observed, but no lymphocytic invasion. Astrocytes were prominent in some areas with "en plaque" gliosis. MRI failed to discover any other demyelinating lesions. Further clinical evaluation was inconspicuous, the patient regaining full activities after 6 months. MRI after 9 months demonstrated no spinal cord lesion. This observation contributes to suggest the influence of the blood-brain barrier breakdown on the occurrence of clinical and radiological signs of new lesions in suspected multiple sclerosis.

Adult↗
PubMedDate not supplied

Reproduction of radicular symptoms by paraspinal muscle EMG needling.

With a frequency of 0.3-0.5%, patients who had cervical and lumbosacral radiculopathies had their symptoms of radicular pain or paresthesia reproduced during needling of the paraspinal muscles at the level of the lesion. The occurrence of the patient's symptoms during paraspinal EMG needling is an insensitive but specific diagnostic sign which helps establish the level of a root lesion.

Action Potentials↗
PubMed1993

[Guillain-Barré syndrome and pregnancy].

Guillain-Barré syndrome is a rare occurrence in pregnant women. We describe the case of a 21-year old woman, seen at "Nuevo Hospital Civil de Guadalajara" with a term pregnancy, who presented with limbs weakness and paresthesias, drowsiness and malaise. Her vital signs were normal but she was quadriparetic, there was muscular atrophy in the extremities and deep tendon reflexes were decreased. Spinal fluid analysis revealed a protein of 71.2 mg/dl, glucosa 48 mg/dl and no white cells and both Gram stain and routine cultures were negative. EMG studies reported poliradiculoneuritis; a C-section was done, and both the mother and a newborn girl did very well. Guillain-Barré syndrome should be suspected in similar cases in order to offer prompt intervention.

Adult↗
PubMed1977

["Paralytic shellfish poisoning" (author's transl)].

In October 1976 an epidemic of 120 cases of paralytic shellfish poisoning was recorded in western Europe. Analysis of the 23 cases seen in Swizterland shows the following data; paresthesia of mouth and lips (100%); cerebellar syndrome (86%) with giddiness, ataxia, dysmetry and floating sensation; paresia or paralysis (62%); digestive symptoms (14%); no death. The mean incubation time is 3 hs 30 min; mean duration of the symptoms is 2 days. Half of the patients complain of asthenia and moderate memory disturbance lasting up to 3 weeks. The severity of the illness is in relation to the amount of ingested neurotoxin. The epidemiologic study shows that all European cases were due to consumption of mussels from the Atlantic coast of Spain.

Adult↗
PubMed1993

Effective response evoked by microstimulation of thalamus nuclei in patients with tremor.

459 microstimulations were done in 10 patients with tremor. The motor evoked response with reduction tremor drive was observed at 38 sites, of which 30 (79%) were noted in ventrointermedialis (vim) nuclei, and 5 (13.2%) in ventrocaudalis (vc) nuclei, 2 in ventroralis posterior (vop) nuclei, 1 in dorsal thalamus (dth). No increased tremor drive response was noted in all the sites. Paresthesia was the most common response (47.1%). Except pain at 1 site in vc nuclei, warm/cold and vertigo were noted in vop, vim, vc nuclei. No responses accounted for 43.8%.

Electric Stimulation↗
PubMed1993

Prospective evaluation of the course of disc herniations in patients with proven radiculopathy.

Although surgery is often recommended as the definitive treatment for radiculopathy when definite disc herniation is demonstrated with imaging techniques, complete improvement can occur with nonoperative treatment. However, what happens to the disc in the latter circumstance is not well defined. We report the first prospective study in subjects with proven radiculopathy and definite disc herniation who improve with nonoperative management to determine what occurs to the herniated disc material. Eighteen subjects with lower extremity pain or paresthesia, positive straight leg raising, weakness in a myotomal distribution, reflex asymmetry, or electromyogram evidence of radiculopathy were studied. Subjects were admitted to the study if computed tomography (CT) scanning demonstrated definite disc herniation corresponding to the side and level of the radiculopathy. After complete clinical improvement, repeat CT scan was performed at six to 18 months after the initial study. The CT scans were interpreted separately by two neuroradiologists. Disc herniations were characterized by size (large, moderate, or minimal); the presence of absence of free fragments; and location. Follow-up scans were compared with the original study and characterized as resolved, improved, or unchanged. Fourteen subjects completed the study, an additional three had operative treatment, and one refused repeat scanning. Subjects were followed an average of 30.4 months with no recurrence of radicular symptoms during this follow-up period in 13 patients. One had recurrence of symptoms at 21 months and surgery at 26 months. Six follow-up scans (43%) were interpreted as completely resolved, five (36%) as improved, and three (21%) as unchanged.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

Extensive application of epidural anesthesia and analgesia in a university hospital: incidence of complications related to technique.

BACKGROUND AND OBJECTIVES: The authors report the role of epidural anesthesia and analgesia (EAA) and the incidence of epidural puncture-related complications in a university hospital in Japan. METHODS: Epidural anesthesia and analgesia was the major (39.7%) technique when administering 40,010 anesthetics. For the upper and the lower abdominal procedures, EAA was the major anesthetic technique in 79.5%, and 71.1% of these were carried out without potent inhaled anesthetics or long-acting muscle relaxants, and without endotracheal intubation. RESULTS: Epidural anesthesia and analgesia-related complications included failure to produce anesthesia on the first attempt (4.1%), bleeding/intravascular cannulation (0.67%), unintentional dural puncture (0.61%), paresthesia (0.16%), and local anesthetic toxicity (0.12%). CONCLUSIONS: The incidence of EAA-related complications was greater with lumbar than with thoracic puncture. Four patients had transient neuropathy related to epidural puncture, but no serious neurologic complications occurred.

Analgesia, Epidural↗
PubMed1995

Osseointegration and nerve transposition after mandibular resection to treat an ameloblastoma: a case report.

This case report demonstrates the use of osseointegrated implants to replace the mandibular left second premolar and first and second molars removed during a surgical resection of a walnut-sized ameloblastoma. The first-stage surgery was performed 2 years after the oncologic surgery, and it was necessary to laterally reposition the inferior alveolar nerve prior to placement of implants. The patient has been restored to full dental function. There was no occurrence of paresthesia at any time. The treatment plan and the treatment were a collaboration of an oral surgeon, a periodontist, and a restorative dentist, located in Sweden, the United States, and Italy, respectively, and is an indication of what can be accomplished to the benefit of the patient when teamwork is exercised.

Adolescent↗
PubMedDate not supplied

The incidence of neurovascular complications following axillary brachial plexus block using a transarterial approach. A prospective study of 1,000 consecutive patients.

BACKGROUND AND OBJECTIVES: The present study was performed at the Crystal Clinic Surgery Center, an outpatient free-standing surgicenter specializing in orthopedic surgery, to determine the incidence of both neurologic and vascular sequelae associated with exclusive use of a transarterial approach to axillary brachial plexus block in order to assess the technique's safety and efficacy. METHODS: The prospective consecutive study involved 1,000 adult patients scheduled for surgery using axillary brachial plexus block. The transarterial approach was performed on all patients using a medium-bevel 24-gauge Jelco 1-5-inch needle. Data tabulated included the incidence of neurovascular complications and the outcome of successful axillary brachial plexus anesthesia. RESULTS: Two patients presented with a sensory paresthesia (0.2%) in the distribution of the ulnar nerve and the musculocutaneous nerve that most likely occurred during supplementation of an incomplete block. Three patients presented with upper-arm myalgias (0.3%) related to tourniquet injury. After the operation, two patients developed reflex sympathetic dystrophy, which responded to stellate ganglion blocks. Vascular complications, including transient arterial spasm in 10 of 996 (1%), unintentional intravascular injection in 2 of 996 (0.2%), and small (0-2 cm) hematoma formation in 2 of 996 (0.2%), were recognized but did not require any intervention other than close observation. The study revealed a complete block in 88.8% of cases, an incomplete block requiring supplemental local anesthesia in 10% of cases, and a complete block failure in 1.2%. CONCLUSIONS: This study demonstrated the safety and efficacy of the transarterial technique in achieving brachial plexus block.

Adult↗
PubMed1995

An epidemic of tetrodotoxin poisoning following ingestion of the horseshoe crab Carcinoscorpius rotundicauda.

At certain seasons of the year in Thailand, the horseshoe crab Carcinoscorpius rotundicauda may be toxic to human and fatal poisoning occasionally occur. Tetrodotoxin (TTX) and its derivatives were major toxins in the toxic eggs of the horseshoe crab. An epidemic of poisoning by eating toxic eggs of the horseshoe crab affected 71 persons in Chon Buri which located in the eastern coast of Thailand. Patients generally presented with neurologic symptoms such as paresthesia, vertigo, weakness, respiratory paralysis, altered consciousness with unreactive dilated pupils in addition to gastrointestinal symptoms such as nausea and vomiting. Nineteen patients required artificial ventilation and there were two deaths. This is the first large outbreak of tetrodotoxin poisoning recognized in Thailand.

Animals↗
PubMed1995

A phase I/II study of paclitaxel plus cisplatin as first-line therapy for head and neck cancers: preliminary results.

Improved outcomes among patients with head and neck carcinomas require investigations of new drugs for induction therapy. Preliminary results of an Eastern Cooperative Oncology Group study of single-agent paclitaxel (Taxol; Bristol-Myers Squibb Company, Princeton, NJ) reported a 37% response rate in patients with head and neck cancer, and the paclitaxel/cisplatin combination has been used successfully and has significantly improved median response duration in ovarian cancer patients. We initiated a phase I/II trial to determine the response and toxicity of escalating paclitaxel doses combined with fixed-dose cisplatin with granulocyte colony-stimulating factor support in patients with untreated locally advanced inoperable head and neck carcinoma. To date, 23 men with a median age of 50 years and good performance status have entered the trial. Primary tumor sites were oropharynx, 10 patients; hypopharynx, four; larynx, two; oral cavity, three; unknown primary, two; and nasal cavity and parotid gland, one each. Of 20 patients evaluable for toxicity, four had stage III and 16 had stage IV disease. Treatment, given every 21 days for a maximum of three cycles, consisted of paclitaxel by 3-hour infusion followed the next day by a fixed dose of cisplatin (75 mg/m2). The dose levels incorporate escalating paclitaxel doses, and intrapatient escalations within a given dose level are permitted if toxicity permits. At the time of this writing, dose level 4 (260, 270, and 280 mg/m2) is being evaluated; three patients from this level are evaluable. With paclitaxel doses of 200 mg/m2 and higher, granulocyte colony-stimulating factor 5 micrograms/kg/d is given (days 4 through 12). Of 18 patients evaluable for response, seven (39%) achieved a complete response and six (33%) achieved a partial response. Three patients had no change and disease progressed in two. The overall response rate is 72%. Eleven responding patients had subsequent surgery/radiotherapy or radical radiotherapy. Two pathologic complete responses were observed in patients who had achieved clinical complete responses. Alopecia, paresthesias, and arthralgias/myalgias have occurred frequently, but with one exception (a grade 3 myalgia) they have been grade 1 or 2. No dose-limiting hematologic toxicity has been seen. Paclitaxel/cisplatin is an effective first-line regimen for locoregionally advanced head and neck cancer and continued study is warranted. Results thus far suggest no dose-response effect for paclitaxel doses above 200 mg/m2.

Adult↗