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At least 1,405 records · Page 78Linked to original sources
PubMed2004

A new clinical test for radial tunnel syndrome--the Rule-of-Nine test: a cadaveric study.

PURPOSE: Radial tunnel syndrome refers to pain on the lateral aspect of the forearm as a result of compression of the posterior interosseous nerve within a tunnel with specific anatomical boundaries. Diagnosis of the condition is difficult because of its close association with lateral epicondylitis, which warrants different methods of treatment. Based on a cadaveric study, a new clinical test, the Rule-of-Nine test, is proposed to improve the diagnostic accuracy in radial tunnel syndrome. The test involves constructing 9 equal squares on the anterior aspect of the forearm and noting those squares where tenderness can be elicited. METHODS: 19 upper limbs were dissected to delineate the path of the posterior interosseous nerve through the radial tunnel, and the relationship of the path of the nerve with the 9 squares. RESULTS: A consistent mapping of the posterior interosseous nerve to the lateral column of 3 squares was observed. CONCLUSION: The Rule-of-Nine test is proposed as a reliable method of diagnosing radial tunnel syndrome.

Aged↗
PubMed2005

Reappraisal of Lhermitte's sign in multiple sclerosis.

Lhermitte's sign (LS) is strongly linked to multiple sclerosis (MS). Our aim is to reassess its frequency, natural history, various characteristics and neuroradiological correlation in a cohort of MS patients attending our specialized MS clinic and to propose a working definition. Consecutive patients with CDMS and normal controls were interviewed using a structured questionnaire. Cervical MRIs were reviewed when available. There were 300 MS patients and 100 normal controls. Forty-one per cent of the patients and none of the controls reported having LS during the course of their illness. In 53% of those who reported LS, it started in the first three years of the illness and began as an isolated symptom in 64% and was polysymptomatic in 36%. In all patients LS was a short-lasting sensation in all patient who experienced it and was mostly stereotyped in individual patients. Characteristics varied widely between patients. Forty-three patients had cervical MRIs; 17 out of 18 patients who reported LS had abnormalities, whereas only 13 out of the 25 with no LS had abnormalities. The results indicate that LS is highly prevalent in MS, is commonly stereotyped in individual patients, has a variable natural course and correlates significantly with cervical MRI abnormalities. A working definition is proposed.

Adult↗
PubMed1999

The developmental character of cardiac autonomic responses to an acute noxious event in 4- and 8-month-old healthy infants.

Heart rate (HR) has been widely studied as a measure of an individual's response to painful stimuli. It remains unclear whether changes in mean HR or the variability of HR are specifically related to the noxious stimulus (i.e. pain). Neither is it well understood how such changes reflect underlying neurologic control mechanisms that produce these responses, or how these mechanisms change during the first year of life. To study the changes in cardiac autonomic modulation that occur with acute pain and with age during early infancy, the relationship between respiratory activity and short-term variations of HR (i.e. respiratory sinus arrhythmia) was quantified in a longitudinal study of term born healthy infants who underwent a finger lance blood collection at 4 months of age (n = 24) and again at 8 months of age (n = 20). Quantitative respiratory activity and HR were obtained during baseline, lance, and recovery periods. Time and frequency domain analyses from 2.2-min epochs of data yielded mean values, spectral measures of low (0.04-0.15 Hz) and high (0.15-0.80 Hz) frequency power (LF and HF), and the LF/HF ratio. To determine sympathetic and parasympathetic cardiac activity, the transfer relation between respiration and HR was used. At both 4 and 8 months, mean HR increased significantly with the noxious event (p > 0.01). There were age-related differences in the pattern of LF, HF, and LF/HF ratio changes. Although these parameters all decreased (p > 0.01) at 4 months, LF and LF/HF increased at 8 months and at 8 months HF remained stable in response to the noxious stimulus. Transfer gain changes with the lance demonstrated a change from predominant vagal baseline to a sympathetic condition at both ages. The primary finding of this study is that a response to an acute noxious stimulus appears to produce an increase in respiratory-related sympathetic HR control and a significant decrease in respiratory-related parasympathetic control at both 4 and 8 months. Furthermore, with increasing age, the sympathetic and parasympathetic changes appear to be less intense, but more sustained.

Aging↗
PubMed2004

Gilliatt-Sumner hand revisited: a 25-year experience.

OBJECTIVE: Thirty-three patients with true neurogenic thoracic outlet syndrome, or Gilliatt-Sumner hand, underwent surgical treatment at Louisiana State University during a 25-year period. This study retrospectively evaluated the outcome referable to pain and motor function in these patients. METHODS: All patients had the typical Gilliatt-Sumner hand, secondary to compression of C8, T1, and/or lower trunk. Nineteen patients underwent an anterior supraclavicular approach, and 15 patients underwent a posterior subscapular approach to the brachial plexus. Nerve action potential recordings showed plexus involvement close to the spine, at the level of the junction of the spinal nerves to the lower trunk. RESULTS: Pain, present in 22 patients, improved in 21. Mild motor deficit improved in 12 of 14 patients. Severe motor deficit improved partially in 14 of 20 patients. CONCLUSION: The diagnosis of true neurogenic thoracic outlet syndrome provides a clear operative indication. Surgical decompression needs to involve the medial portion of the plexus, and especially the spinal nerves. An anterior supraclavicular approach is preferred in most cases. If there is a large cervical rib or there has been a prior anterior operation, then a posterior subscapular approach is indicated.

Action Potentials↗
PubMed2002

Viral skin infections in the elderly: diagnosis and management.

Over the past several years, there have been advances in the diagnosis and treatment of cutaneous viral diseases in elderly patients. Herpes zoster is caused by reactivation in adults of the varicella-zoster virus (VZV) that causes chickenpox in children. For many years, aciclovir was the gold standard of antiviral therapy for the treatment of herpes zoster. Famciclovir and valaciclovir are newer antivirals, which offer less frequent administration. Postherpetic neuralgia (PHN) refers to pain lasting 2 months or more after an acute attack of herpes zoster. The pain may be constant or intermittent. The treatment of established PHN may include topical anaesthetics, analgesics, tricyclic antidepressants and anticonvulsants, and nonpharmacological therapy may be used to complement such treatment. Therapeutic strategies to prevent PHN include the use of oral corticosteroids, nerve blocks, and treatment with standard antiviral therapy. The three most recently discovered human herpes viruses (HHV-6, HHV-7 and HHV-8), in common with the other members of the family, may cause a primary infection, establish latent infection in a specific set of cells in their host, and then reactivate if conditions of altered immunity develop. These viruses have been associated with an array of disorders, which are important for the clinician to recognise. Cytomegalovirus (CMV) is a member of the herpesvirus family that is very prevalent worldwide. More than 80% of primary infections and 20% of reactivation-producing symptoms occur in transplant populations. Treatment options include intravenous administration of ganciclovir, foscarnet or cidofovir. Herpes simplex virus (HSV) most commonly affects the genital and perioral regions. In the elderly, HSV infection is typically manifest at the vermilion border of the lip. The main concern of recurrent herpes labialis in the elderly is related to potential autoinoculation of the eye or genital area. Treatment with aciclovir, famciclovir or valaciclovir is indicated for these infections. Molluscum contagiosum is caused by a poxvirus, which produces cutaneous lesions that appear as small, firm, umbilicated papules. Immunocompromised patients often do not respond to the usual destructive therapies, and intravenous or topical cidofovir may be useful in these patients.

Aged↗
PubMed2004

Myofascial pain disorders: theory to therapy.

Voluntary muscle is the largest human organ system. The musculotendinous contractual unit sustains posture against gravity and actuates movement against inertia. Muscular injury can occur when soft tissues are exposed to single or recurrent episodes of biomechanical overloading. Muscular pain is often attributed to a myofascial pain disorder, a condition originally described by Drs Janet Travell and David Simons. Among patients seeking treatment from a variety of medical specialists, myofascial pain has been reported to vary from 30% to 93% depending on the subspecialty practice and setting. Forty-four million Americans are estimated to have myofascial pain; however, controversy exists between medical specialists regarding the diagnostic criteria for myofascial pain disorders and their existence as a pathological entity. Muscles with activity or injury-related pain are usually abnormally shortened with increased tone and tension. In addition, myofascial pain disorders are characterised by the presence of tender, firm nodules called trigger points. Within each trigger point is a hyperirritable spot, the 'taut-band', which is composed of hypercontracted extrafusal muscle fibres. Palpation of this spot within the trigger point provokes radiating, aching-type pain into localised reference zones. Research suggests that myofascial pain and dysfunction with characteristic trigger points and taut-bands are a spinal reflex disorder caused by a reverberating circuit of sustained neural activity in a specific spinal cord segment. The treatment of myofascial pain disorders requires that symptomatic trigger points and muscles are identified as primary or ancillary pain generators. Mechanical, thermal and chemical treatments, which neurophysiologically or physically denervate the neural loop of the trigger point, can result in reduced pain and temporary resolution of muscular overcontraction. Most experts believe that appropriate treatment should be directed at the trigger point to restore normal muscle length and proper biomechanical orientation of myofascial elements, followed by treatment that includes strengthening and stretching of the affected muscle. Chronic myofascial pain is usually a product of both physical and psychosocial influences that complicate convalescence.

Analgesics, Opioid↗
PubMed1991

[Ossifying fibroma in the cranial vault. Case report].

Ossifying fibroma is relatively common in the maxilla, but rare in the cranial vault. A 10-year-old girl was referred for painful swelling of the left temporal region. On admission, she presented no abnormal physical and neurological findings except for the painful swelling. Plain skull X-ray films showed a radiolucent lesion of the left temporal bone about 4 cm in diameter, with a hyperostotic area of the parietal side. Computed tomography scan using bone window level also showed an abnormal density lesion in the same site. Curettage of this tumor was performed from a cosmetic point of view and at the family's petition. Histological examination showed vascular fibrous tissue in which lamellar bone was surrounded by osteoblasts.

Child↗
PubMed2002

Local sympathetic denervation in painful diabetic neuropathy.

This study assessed whether painful diabetic neuropathy is associated with abnormal sympathetic nervous function in the affected limbs. Nine patients with diabetes (four men, five women; age 61 +/- 7 years) and painful peripheral neuropathy of the feet, but without evidence of generalized autonomic neuropathy, underwent intravenous infusion of tritiated norepinephrine (NE) and sampling of arterial and venous blood in both feet and in one arm to quantify the rate of entry of NE into the local venous plasma (NE spillover). In the same patients, positron emission tomography (PET) scanning after intravenous injection of the sympathoneural imaging agent 6-[(18)F]fluorodopamine was used to visualize sympathetic innervation and after intravenous [(13)N]ammonia to visualize local perfusion. The results were compared with those in the feet of normal volunteers and in an unaffected foot of patients with unilateral complex regional pain syndrome (CRPS). In addition, neurochemical results obtained in painful diabetic neuropathy were compared with those obtained in diabetic control patients with painless neuropathy and diabetic control patients without neuropathy. Local arteriovenous difference in plasma NE levels (DeltaNE(AV)) and NE spillover in the arms did not differ across the groups. However, DeltaNE(AV) in the feet was significantly less in the group with painful diabetic neuropathy than in the control groups. Also NE spillover in the feet tended to be lower in painful neuropathy. DeltaNE(AV) of diabetic control patients without neuropathy (n = 6) resembled values in the control groups without diabetes, whereas patients with painless diabetic neuropathy (n = 6) had evidence suggesting partial loss of sympathetic innervation. PET scanning revealed decreased flow-corrected 6-[(18)F]fluorodopamine-derived radioactivity in patients with painful diabetic neuropathy, compared with values in normal volunteers and patients with CRPS. The results provide neurochemical and neuroimaging evidence for regionally selective sympathetic denervation in the painful feet of patients with diabetic neuropathy.

Aged↗
PubMed1989

Mapping diabetic sensory neuropathy by current perception threshold testing.

Detailed clinical neurological examinations were conducted on 44 nondiabetic volunteers and 59 diabetic subjects. The examinations focused particularly on sensory symptomatic and physical evaluation. Standardized assessment of symptoms and physical testing of light touch, pain, vibratory, and thermal sensation was performed at the hand, wrist, elbow, foot, ankle, and knee. A total symptom score and physical score were defined by summing test scores at each site. Current perception threshold (CPT) testing that used constant sine-wave-alternating current was conducted at the same anatomic sites. CPT correlations with the physical score gave r values of .55 for 5 Hz, .60 for 250 Hz, and .62 for 2000 Hz (n = 618). Correlations with the symptom score were not as strong: r = .45 for 5 Hz, .46 for 250 Hz, and .51 for 2000 Hz. The correlation with symptom score was due primarily to a strong relationship for the symptom of numbness (r = .53 for all 3 frequencies). Correlations with pain and paresthesia were much lower. CPTs for diabetic subjects at the three frequencies were higher at most locations than for the nondiabetic volunteers. However, CPTs were no different from normal values in diabetic subjects without evidence of neuropathy. CPT testing appears to be a useful technique for assessment of diabetic sensory neuropathy.

Adult↗
PubMed2002

Crying of a newborn child: alarm signal or protocommunication?

The purpose of the study was to explore whether the new-born cry is a simple alarm signal or differentiated cries with different meanings. 12 digital audio taped recordings of 6 full-term healthy babies were analysed. Cries of 6 newborns in this preliminary study were recorded in a pain condition after a prick for the hematic check-up the third day after delivery and then while crying spontaneously in the cradle. The sounds were sampled at 44100 Hz with a 16-bit resolution and converted to the .wav format. All the analyses were performed with a software written in the MAT-LAB environment. The most important result was that these new-born children modulated the supralaryngeal tract considerably more in cries following the painful stimulus than in "spontaneous" ones, as would be expected by the hypothesis of crying as "protolanguage."

Arousal↗
PubMed1994

An electromyographic analysis of the hip abductors during load carriage: implications for hip joint protection.

Decreasing the relative force demands on the hip abductor muscles may reduce hip joint forces. The purpose of this study was to use surface electromyography (EMG) to determine the relative demand on the hip abductor muscles as subjects walked and carried single hand-held loads of multiple weights. Thirty healthy, college-aged subjects carried single hand-held loads by their side. The loads weighed between 3 and 30% of body weight. Loads were carried in a position either ipsilateral or contralateral to a given hip side. Normalized EMG (%EMG) was collected during the middle stance phase of walking. The amount of %EMG remained statistically equal to or less than the no-load EMG baseline for all ipsilateral-held loads and greater than the no-load EMG for all contralateral-held loads above 3% body weight. Load positions and weights that generated %EMG levels less than or equal to the no-load baseline most likely offer a degree of hip joint protection for persons with hip disability.

Adult↗
PubMed1997

Blood pressure and metabolic factors in relation to chronic pain.

Physical pain is a major trigger for changes in many homeostatic systems of the body physiology. Our aim was to study the relationship between blood pressure, metabolism and pain perception in subjects with chronic pain symptoms. This was undertaken in a population-based study in primary health care, including subjects with widespread pain (n = 16), or localized pain (n = 15), and pain-free controls (n = 14). The main outcome measures were office and ambulatory blood pressure, glucose, insulin, lipids, and beta-endorphin. Subjects with widespread pain were more obese and showed higher levels than controls (p < 0.05) of fasting glucose (4.9 vs 4.5 mmol/l), cholesterol (6.9 vs 5.8 mmol/l) and office systolic blood pressure (133 vs 120 mmHg), while the subjects reporting localized pain had values in-between. Ambulatory blood pressure, insulin and beta-endorphin levels did not differ between the groups. In conclusion, subjects with widespread and/or intense chronic pain have higher BMI, more pronounced metabolic disturbances and higher (office) systolic blood pressure, but not ambulatory blood pressure, than subjects without chronic pain. Future epidemiological studies are needed to test whether this is compatible with increased cardiovascular risk.

Adult↗
PubMedDate not supplied

Effects of topical ketorolac and diclofenac on normal corneal sensation.

BACKGROUND: A randomized, double-masked study was conducted to investigate the effects of 0.5% ketorolac tromethamine (Acular) and 0.1% diclofenac sodium (Voltaren) on normal human corneal sensation. METHODS: Thirty normal volunteers were divided into two groups, (1) two-drop group, and (2) multiple-drop group. In the two-drop group, 15 volunteers randomly received two drops of 0.5% ketorolac tromethamine on one eye and two drops of 0.1% diclofenac sodium on the fellow eye. A masked investigator measured corneal sensation with the Cochet-Bonnet esthesiometer before applying the drops, and at 15, 30, and 60 minutes after using the eye drops. In the multiple-drop group, another 15 volunteers were randomly administered one drop of 0.5% ketorolac tromethamine or 0.1% diclofenac sodium in each eye, and the procedure was repeated every 5 minutes for 20 minutes. Corneal sensation was measured before, and 0, 15, 30 and 60 minutes after applying the drops. RESULTS: In the two-drop group, neither of the eye drops had any effect on corneal sensation when only two drops were applied. In the multiple-drop group, corneal sensation was significantly reduced after multiple drops (p < 0.05) and was subsequently effective for at least 1 hour. CONCLUSION: Both 0.5% ketorolac and 0.1% diclofenac can significantly decrease corneal sensation in normal eyes when multiple drops are used.

Administration, Topical↗
PubMed2004

[Amaurosis after lachrymo-nasal stent surgery].

CLINICAL CASE: A 74 year old woman with lachrymo nasal stent introduced three days before referring periocular pain and loss of visual acuity in left eye. With aggressive treatment the inflammatory illness improved but not the visual acuity (no light perception). The lachrymal stent was removed and, later, the lachrymal sack. DISCUSSION: Orbital cellulitis is an inflammation of fat and intraorbital structures that needs aggressive treatment in order to prevent serious complications.

Aged↗
PubMed1998

[Retroperitoneal Castleman's disease occurred around the bilateral upper ureters. A case report].

A 45-year-old woman with a history of right regional dull pain was referred to our hospital for evaluation of right hydronephrosis. CT and MRI showed a solitary mass (1 x 1 cm, L1-L2 level) at the right upper ureter. Laboratory data were within the normal range. A right nephrectomy was carried out under a clinical diagnosis of primary right ureteral tumor. The pathohistological diagnosis of surgical specimen was plasma cell type of Castleman's disease. One year after surgery, the patient was rehospitalized for azotemia and left hydronephrosis. Abdominal CT revealed a solitary mass (1.5 x 1.5 cm) located at left upper ureter similar to that on her right side. We diagnosed that the mass lesion was due to asynchronous Castleman's disease, so we performed steroid therapy. After the treatment, mass had disappeared. The patient is uneventful for two years. This is the first case reported in the Japanese literature describing Castleman's disease occurred around the bilateral upper ureters.

Castleman Disease↗
PubMed1999

[PET-FDG in thyroid cancer with high thyroglobulin levels and negative 131-I scan. A case report].

The value of whole body PET-FDG in the evaluation of metastases has been demonstrated in a wide variety of tumors. In this report, we present the case of a patient with antecedent of papillary thyroid carcinoma, who was operated twelve years ago, and submitted to an ablative dose of residual thyroid tissue through 131I, being the levels of thyroglobulin normals. After twelve years of evolution, the patient refers bag pain and respiratory trouble, appearing in the CT image suspicious of metastases in right pulmonary base. The levels of thyroglobulin were shown increased, being the 131I scan negative. A whole body PET-FDG study was performed in order to exclude metastases of his malignant process, showed multiple high FDG uptake focus in brain, cerebellum, neck, chest, lymphatic nodes and bone, suggestive of dedifferentiated disease These findings were confirmed subsequently in the clinic evolution. Therefore, whole-body PET-FDG is a complementary diagnostic technique for study patients with CDT (Thyroid Differentiated Carcinoma) with 131I scan negative and rising thyroglobulin levels.

Aged↗