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PubMed2004

Spinal epidural hematoma associated with oral anticoagulation therapy.

Spontaneous spinal epidural hematoma is an uncommon cause of spinal cord compression. It may be associated with various causative factors, but in many patients, anticoagulation can be implicated. It is noteworthy that many of the reported cases were anticoagulated in the therapeutic range. Spontaneous spinal epidural hematoma should be suspected in any patient receiving anticoagulant agents who complains of local or referred spinal pain associated with limb weakness, sensory deficits, or urinary retention. Early diagnosis and treatment are very important for the functional recovery of the patient. Spinal magnetic resonance imaging is the most suitable neuroradiological method for early diagnosis. Although primary management is the surgical evacuation of the spinal epidural hematoma via laminectomy, rare cases in which the patient is improving rapidly and progressively could be treated conservatively. A 22-yr-old man with a spontaneous spinal epidural hematoma who was receiving warfarin treatment for a mechanical aortic valve is presented in this article.

Adult↗
PubMed2005

MMPI-2 subgroups in a sample of chronic pain patients.

MMPI-2 scores of 307 female and 161 male chronic pain patients were analyzed by gender using a multivariate clustering method. Two subgroups were found for both sexes replicating previous results. The major subgroup corresponded to the classical "Conversion V" and the minor corresponded to the "Generally elevated" profile. The results also indicated a satisfactory internal consistency and a high discriminant validity of the Swedish version of the MMPI-2.

Case-Control Studies↗
PubMed1994

Pain of injection and duration of anesthesia for intradermal infiltration of lidocaine, bupivacaine, and etidocaine.

BACKGROUND: Bupivacaine and etidocaine are local anesthetics said to be long acting based on nerve block data. There are insufficient data on pain of infiltration and duration of anesthesia when either is used for dermal infiltration to assess suitability for skin surgery. OBJECTIVE: We conducted a randomized, placebo-controlled, double-blinded comparison of intradermal 1% etidocaine, 0.5% bupivacaine, and 2% lidocaine for pain of injection and duration of anesthesia. METHODS: Twenty subjects received the above three agents plus normal saline, each with and without epinephrine 1:200,000, with all solutions adjusted to pH 5.95 +/- 0.15. RESULTS: Lidocaine hurt least and etidocaine hurt most. Adrenalized solutions were more painful than plain. For plain solutions bupivacaine lasted longest and lidocaine lasted shortest by far. For adrenalized solutions bupivacaine lasted 27% longer than lidocaine and 45% longer than etidocaine. CONCLUSION: Where epinephrine is contraindicated and long anesthesia matters, use plain bupivacaine. When epinephrine can be used, lidocaine lasts almost as long as bupivacaine and hurts less.

Adult↗
PubMed1989

Walk headache: an unusual manifestation of ischemic heart disease.

A 71 year old man sought neurological advice because for two years he had suffered from headache every time he made an effort. A treadmill stress test showed a relation between effort, headache and depression of ST segments on E.C.G. With isosorbide dinitrate and diltiazem, the manifestations improved. This suggests a referred head pain due to myocardial ischemia.

Aged↗
PubMed1981

Reproducibility along a 10 cm vertical visual analogue scale.

Reproducibility along a vertical 10 cm visual analogue scale (VAS) was investigated. Eight normal volunteers attempted to duplicate a set of marked VAS. There was a tendency to estimate too high on the scale, and reproducibility was found to be variable along its length. This indicates that the error involved in the use of VASs is even more complex than previously thought.

Adolescent↗
PubMed1999

How should Helicobacter pylori positive dyspeptic patients be managed?

Dyspepsia, according to the internationally accepted Rome criteria, refers to pain or discomfort centred in the upper abdomen; patients with predominant heartburn are excluded from this group, although minor or infrequent heartburn is commonly associated with dyspepsia. It is an important condition not only because it is common and costly, but because it may indicate the presence of serious disease such as peptic ulcer or gastric cancer. However, the most frequent causes of dyspepsia are functional dyspepsia and gastro-oesophageal reflux disease. The discovery of Helicobacter pylori has resulted in important advances in the management of dyspepsia. The clinician faced with a patient who has persistent or recurrent dyspepsia needs to differentiate clearly those patients who have not been previously investigated from patients documented to have functional dyspepsia after investigation (fig 1). Here, the management of H pylori positive dyspeptic patients who have and have not been fully investigated will be reviewed.

Dyspepsia↗
PubMed1988

Sensory and pain threshold characteristics to laser stimuli.

The clinical applications of thermal sensory and pain thresholds have been very limited due to large intra-individual variations. In the present paper CO2 and argon lasers were used as thermal stimulators, and the different factors (stimulus parameters and skin conditions) affecting the thresholds are described. The intra-individual variations obtained in sensory (9.3%) and pain (4.3%) thresholds were very low, which suggests that the method can be applied for clinical purposes.

Adult↗
PubMed2001

Adaptation to eccentric exercise: neutrophils and E-selectin during early recovery.

The purpose was to determine the responses of blood neutrophils and E-selectin concentrations during early recovery (<24hr) from 2 bouts of eccentric exercise. Subjects (N=9) completed 2 bouts of eccentric arm exercise using their non-dominant arm (Bout 1 and Bout 2) and 1 non-exercise control condition. The exercise bouts were separated by 4 weeks, and the control condition preceded bout 1. Neutrophil concentrations were significantly higher at 3, 6, and 9-hr post-exercise for Bout 1 relative to Bout 2 and control. No significant changes in blood E-selectin concentrations were observed. Isometric strength deficit was similar for Bout 1 and Bout 2 at 5 min and 3 hr post exercise and was significantly great for Bout 1 relative to Bout 2 at 6, 9, and 24-hr post-exercise. The adaptation to eccentric exercise is associated with a lower concentration of blood neutrophils during early recovery. The neutrophilia associated with novel eccentric arm exercise precedes secondary changes in isometric strength and is not associated with changes in the concentration of blood E-selectin.

Adaptation, Physiological↗
PubMed1984

A CT-clinical approach to patients with symptoms related to the V, VII, IX-XII cranial nerves and cervical sympathetics.

Forty-three patients who had signs and symptoms possibly related to the extracranial course of cranial nerves V, VII, IX, X-XII, and the cervical sympathetics were examined prospectively using high resolution CT to obtain images of thin sections during rapid drip infusion of contrast material. Anatomic areas in the scan protocols included the posterior fossa, cavernous and paranasal sinuses, skull base, temporal bone, nasopharynx, parotid gland, tongue base, and neck. Nine of the 23 patients with possible fifth nerve deficits had extracranial structural lesions that explained the symptoms; none of these nine, however, had typical trigeminal neuralgia. Of eight patients with peripheral seventh nerve abnormalities, two had positive findings on scans. No patient with classic Bell palsy had a positive finding on CT. Two of five patients presenting with the Horner syndrome had positive findings on CT. Of five patients presenting with referred ear pain, three had carcinoma of the upper aerodigestive tract. Our experience suggests that patients at high risk for structural lesions responsible for cranial nerve deficits can be selected by clinical criteria. Moreover, it is essential to extend the CT examination of such patients beyond the skull base when clinically indicated. Protocols for each clinical setting are presented.

Accessory Nerve↗
PubMed2000

In vitro responses of gallbladder muscle from patients with acalculous biliary pain.

BACKGROUND: Diagnosis and identification of patients with acalculous biliary pain, who would benefit from surgery, remains a significant clinical problem. The cholecystokinin (CCK) provocation test helps diagnosis, but lack of consistency limits its usefulness. AIM: To characterize the response of gallbladder muscle strips, from patients with acalculous biliary pain, to hormonal and muscarinic stimulation and to compare these with strips from gallstone patients and normal controls. PATIENTS: Eleven patients with acalculous biliary pain were studied, 5 had a positive CCK test. Eight gallbladders from gallstone patients and 6 from partial hepatectomies were used for comparison. METHODS: Muscle strips from the body and neck of the gallbladder were suspended in organ baths and dose-response curves were constructed for CCK-8 and carbachol. RESULTS: In the acalculous group the strips from the body were less sensitive to carbachol than those of the neck. CONCLUSION: Since we found no differences in the CCK responses for the groups, it casts doubt over the effectiveness of the CCK test to diagnose acalculous biliary pain. Since carbachol sensitivity was different, it might be that a similar test using muscarinic stimulation would help in the diagnosis of this difficult group of patients.

Adult↗
PubMed2002

Difficult decisions: social and ethical implications of changing medical technology.

OBJECTIVES: A primary objective of this paper is to present data on subjective perceptions of health and quality of life in individuals living with early- or late-onset genetic conditions (cystic fibrosis, CF, and Huntington's disease, HD, respectively). The paper will also discuss the social and ethical dilemmas raised by advances in reproductive and testing technology, consider the different emphases in definitions in quality of life, and speculate on criteria used to make reproductive decisions following prenatal testing. METHODS: Adults suffering from CF and HD attending two regional centres in the UK took part in semi-structured interviews between late 1999 and summer 2001. Self-report data on how a specific body image is constructed were also collected. Interviews were analysed using thematic qualitative analysis, and the body data were analysed using SPSS. RESULTS: Qualitative analysis uncovered themes relating to the question of how we value life, and exposed broad ethical dilemmas arising from advances in testing and treatment technology. These data are supported by findings from a body chart analysis that highlight a discrepancy between the quality of life experienced by this group of respondents and the way they believe the wider public perceives them, particularly in reference to pain. CONCLUSIONS: Although some of the data support previous findings, such as the disability paradox, other voices contradict this view. Due to their unique experiences, the accounts of individuals currently living with genetic conditions should be considered in the wider bio-ethical debates.

Abortion, Eugenic↗
PubMed1987

Assay of the cell-mediated immunity in patients with malignant and non-malignant diseases.

The depression of cell-mediated immunity (CMI) was determined in patients with ovarian and breast carcinomas by lymphokine production under Con-A-stimulation (migration inhibitory factor), T-lymphocyte-transformation test under PHA-stimulation and with a skin reactivity test with a viscum album extract (Plenosol, Dr. Madaus, Cologne, FRG). The results show a good correlation between the different types of CMI function tests. The cytostatics have a depressive effect on CMI more through a cumulative effect than through the actual concentration. Some of the patients with chronic rheumatism who were not treated were anergic, and that also had an influence on the therapy.

Arthritis↗
PubMed1994

Coronary vasodilator reserve, pain perception, and sex in patients with syndrome X.

BACKGROUND: It remains unclear whether myocardial ischemia due to coronary microvascular dysfunction is the cause of chest pain in syndrome X (chest pain, ischemic-like stress ECG despite angiographically normal coronary arteries). To assess the function of the coronary microcirculation and its relation to pain perception, we measured myocardial blood flow (MBF) and coronary vasodilator reserve (CVR) in 29 patients with syndrome X and 20 matched normal control subjects. METHODS AND RESULTS: MBF at rest and after intravenous dipyridamole (0.56 mg.kg-1 over 4 minutes) was measured using positron emission tomography with H2(15)O. CVR was calculated as MBFdipyridamole/MBFrest. ECG changes and chest pain after dipyridamole in syndrome X were compared with those in 35 patients with coronary artery disease (CAD). Resting and postdipyridamole MBFs were homogeneous throughout the left ventricle in syndrome X patients and control subjects. MBF was 1.05 (0.25), mean (SD) versus 1.00 (0.22) mL.min-1.g-1 (P = NS) at rest and 2.73 (0.81) versus 3.00 (1.00) mL.min-1.g-1 (P = NS) after dipyridamole in patients and control subjects, respectively. CVRs were 2.66 (0.76) and 3.06 (1.08) (P = NS) and after correction of resting MBF for rate-pressure product were 2.35 (0.83) and 2.34 (0.90) (P = NS) in patients and control subjects, respectively. Female syndrome X patients had higher resting MBF than males, at 1.18 (0.20) versus 0.88 (0.19) mL.min-1.g-1 (P < .001). Chest pain after dipyridamole occurred in syndrome X as frequently as in CAD (21/29 versus 22/35, P = NS). CONCLUSIONS: When patients with syndrome X are compared with control subjects, no differences are found in MBF either at rest or after dipyridamole, despite syndrome X patients experiencing chest pain after dipyridamole to the same extent as patients with CAD. These findings, together with the absence of any relation among MBF, chest pain, and ECG changes under stress, cast further doubt on ischemia as the basis of the chest pain, at least in the majority of syndrome X patients.

Adult↗
PubMed1996

Discriminative sensory dysfunction after unilateral stroke.

BACKGROUND AND PURPOSE: Although sensory deficits caused by stroke have been reported occasionally, dysfunction of discriminative sensation has seldom been studied in patients with unilateral stroke. The frequency and modality of bilaterally impaired discriminative sensation also remain to be clarified. METHODS: With the use of specifically designed methods, we tested discriminative sensations including texture discrimination, two-point discrimination, stereognosis, point localization, and position sense in 67 patients with acute unilateral stroke. The locations of the lesions were identified with the use of CT and/or MRI. Thirty-two age- and sex-matched healthy subjects were used as a control. RESULTS: Impaired discriminative sensation was common in patients with unilateral stroke (detected in 57 of the 67 patients) regardless of lesion location except for patients with lateral medullary infarction. Discriminative sensation remained intact in only 3 of 25 patients who were initially diagnosed as having pure motor stroke on the basis of conventional sensory tests. Point localization and stereognosis were bilaterally impaired in 17 of 39 patients and 7 of 38 patients, respectively, regardless of the laterality of the lesion. Dysfunction of other sensory modalities was observed exclusively on the side contralateral to the lesion. CONCLUSIONS: Discriminative sensory disturbances, which often occur bilaterally in some modalities, are common in patients with unilateral stroke even in those with intact sensory function on routine examination. The subtle disturbances of this sensation may explain, at least in part, the clumsiness of the patients that is not readily explained by conventional neurological tests.

Adult↗
PubMed2005

Canine coronavirus-associated puppy mortality without evidence of concurrent canine parvovirus infection.

This report presents 2 cases in which puppy fatalities were associated with canine coronavirus (CCV), but no evidence of concurrent canine parvovirus (CPV-2) disease was observed. Case 1 involved a 7-week-old, male short-haired Chihuahua, which had become lethargic 24 hours after purchase from a pet store. Within 72 hours, the puppy began to vomit, had diarrhea, and was admitted to the veterinary clinic, where it was placed on IV fluids. The parvovirus Cite test was negative. The puppy died within 12 hours of admission and was submitted for diagnostic workup. Gross pathology revealed an enteritis suggestive of CPV-2. Histopathology on intestines showed scattered dilated crypts with necrotic cellular debris and neutrophils. There was moderate depletion and necrosis of lymphoid follicles. Electron microscopy (EM) on intestinal contents was positive for coronavirus and negative for parvovirus. Immunohistochemistry (IHC) on gut sections was positive for CCV and negative for CPV-2. Case 2 was an 8-week-old, male Shih Tzu, which was admitted to the veterinary clinic exhibiting symptoms of severe gastroenteritis with abdominal pain. The referring veterinarian euthanized the puppy, and the entire body was submitted for diagnostic evaluation. Necropsy revealed a severe ileo-cecal intussusception and segmental necrotic enteritis of the small intestine. Electron microscopy of the intestinal contents was positive for coronavirus and negative for parvovirus. Immunohistochemistry on sections of affected gut were positive for CCV and negative for CPV-2. These cases emphasize the importance of pursuing a diagnosis of CCV in young puppies when CPV-2 disease has been ruled out by IHC.

Animals↗
PubMed1998

Ankle osteoarthritis scale.

Although there is a wide array of outcome tools for assessing patients with symptomatic ankle arthritis, no disease-specific instrument for ankle arthritis has been shown to be reliable and valid. The purpose of this study was to develop a simple, reliable, and validated outcome measure for the clinical assessment of ankle osteoarthritis. We modified the Foot Function Index, a visual analog-based scale used to assess rheumatoid foot problems, to measure patient symptoms and functional limitations stemming from osteoarthritis of the ankle joint. Test-retest reliability and criterion and construct validity were determined for the overall Ankle Osteoarthritis Scale and its two subscales (pain and disability). Overall reliability (r=0.97; 95% confidence interval [CI], 0.94-0.99), pain subscale reliability (r=0.95; 95% CI, 0.90-0.98), and disability subscale reliability (r=0.94; 95% CI, 0.88-0.97) were excellent. Criterion validity testing of the instrument with the WOMAC (a disease-specific scale for osteoarthritis) and the SF-36 (a general health survey) showed a high degree of concordance for related subscales. Construct validity using a physical measure of ankle function demonstrated sensitivity of the instrument to the degree of joint dysfunction. Normative data were obtained from 562 individuals who were not patients (264 men and 298 women). The responses were analyzed for trends in gender, body mass index, presence of arthritis, history of fracture in relation to the response levels, and age. A small but statistically significant main effect for gender was found, with women consistently reporting higher pain, disability, and total index scores. Body mass index and arthritis were also found to correlate with response answers across the subscale and total index scores; however, these factors only accounted for 12% of the variation. The Ankle Osteoarthritis Scale is a reliable and valid self-assessment instrument that specifically measures patient symptoms and disabilities related to ankle arthritis.

Adult↗