11/1691. Disseminated nocardiosis in a bone marrow transplant recipient with chronic GVHD.We describe a case of disseminated nocardiosis in a 53-year-old male allogeneic marrow recipient with chronic GVHD, 15 years post BMT. Six months prior to admission he was treated for recurrent chronic GVHD with corticosteroids with a good response. He deteriorated subsequently while still on steroids requiring admission for fever, anorexia, weight loss, productive cough and progressive dyspnoea. On admission he had multiple nodular lesions on chest roentgenogram and subsequently grew nocardia farcinica in blood culture. N. farcinica is rare post BMT, has a high mortality, is resistant to various antibiotics and needs prolonged antimicrobial therapy. We report the successful management of our patient with single agent trimethoprim-sulphamethoxazole.- - - - - - - - - - ranking = 1keywords = chest (Clic here for more details about this article) |
12/1691. Incomplete nondisplaced tibial osteotomy for treatment of osteoarthritic knee pain.Intraosseous venous hypertension is considered a significant factor in the production of knee pain secondary to degenerative arthrosis, thus vascular decompression by means of tibial osteotomy is a rational option for treatment of selected patients. A preliminary report is presented of six patients with symptoms of primary or secondary degenerative arthrosis who were treated by incomplete nondisplaced proximal tibial osteotomy with good or excellent results. These patients were refractory to nonoperative treatment and were not deemed suitable candidates for angulated osteotomy, arthroscopic surgery alone, or total knee arthroplasty. patients ranged in age from 36 to 61 years (mean age: 47 years). Follow-up ranged from .8 to 6.7 years (mean: 3.1 years). The subjects were studied postoperatively by interview, physical examination, radiographs, and bone scans. Results were assessed using the knee rating system of The Hospital for Special Surgery.- - - - - - - - - - ranking = 433.48170155955keywords = pain (Clic here for more details about this article) |
13/1691. Autoimmune atrophic gastritis with hypergastrinemia.Elevation in fasting serum gastrin levels was found in three patients being evaluated for persistent upper abdominal pain without radiographic evidence of peptic ulcer disease. Fiberoptic endoscopy of the upper gastrointestinal tract in each patient revealed characteristic changes of chronic atrophic gastritis. Gastric biopsies showed diffuse chronic inflammation in the lamina propria, a decrease in the number of parietal cells, and "intestinalization" of gastric mucosa. Total achlorhydria was demonstrated after a maximal histalog stimulus; however, serum levels of vitamin B12 and schilling test values were normal in all three patients. Parietal cell antibodies were found in the serum in all patients in a dilution of 1:20 to 1:80. These cases represent autoimmune (type A) chronic atrophic gastritis and should be distinguished from chronic simple (type B) gastritis, in which serum gastrin levels are normal and no parietal cell antibodies are found in the serum. patients with autoimmune gastritis should be observed at frequent intervals for the occurrence of pernicious anemia or gastric carcinoma.- - - - - - - - - - ranking = 114.26171819471keywords = pain, abdominal pain, upper (Clic here for more details about this article) |
14/1691. Sporadic amyotrophic lateral sclerosis of long duration mimicking spinal progressive muscular atrophy: a clinicopathological study.We report an autopsy case of amyotrophic lateral sclerosis (ALS) clinically diagnosed as spinal progressive muscular atrophy (SPMA). The patient was a Japanese woman without hereditary burden. She developed muscle weakness of the distal part of the left lower extremity at age 42, followed by muscle weakness and atrophy of the right lower extremity and upper extremities. At age 57, she needed transient ventilatory support. Slight weakness in the facial muscles and fasciculation of the tongue appeared at age 60. At age 61, she died of sudden respiratory arrest. During the clinical course, neurological examination revealed neither Babinski signs nor hyperreflexia. The neuropathological examination revealed not only neuronal loss with gliosis in the facial nucleus, hypoglossal nucleus, and anterior horns of the spinal cord, but also loss of Betz cells and degeneration of the pyramidal tracts. Based on these clinicopathological findings and review of literature, we conclude that sporadic ALS mimicking SPMA is present.- - - - - - - - - - ranking = 0.69106691871456keywords = upper (Clic here for more details about this article) |
15/1691. Low power laser therapy and analgesic action.OBJECTIVE: The semiconductor or laser diode (GaAs, 904 nm) is the most appropriate choice in pain reduction therapy. SUMMARY BACKGROUND DATA: Low-power density laser acts on the prostaglandin (PG) synthesis, increasing the change of PGG2 and PGH2 into PG12 (also called prostacyclin, or epoprostenol). The last is the main product of the arachidonic acid into the endothelial cells and into the smooth muscular cells of vessel walls, that have a vasodilating and anti-inflammatory action. methods: Treatment was performed on 372 patients (206 women and 166 men) during the period between May 1987 and January 1997. The patients, whose ages ranged from 25 to 70 years, with a mean age of 45 years, suffered from rheumatic, degenerative, and traumatic pathologies as well as cutaneous ulcers. The majority of patients had been seen by orthopedists and rheumatologists and had undergone x-ray examination. All patients had received drug-based treatment and/or physiotherapy with poor results; 5 patients had also been irradiated with He:Ne and CO2 lasers. Two-thirds were experiencing acute symptomatic pain, while the others suffered long-term pathology with recurrent crises. We used a pulsed diode laser, GaAs 904 nm wavelength once per day for 5 consecutive days, followed by a 2-day interval. The average number of applications was 12. We irradiated the trigger points, access points to the joint, and striated muscles adjacent to relevant nerve roots. RESULTS: We achieved very good results, especially in cases of symptomatic osteoarthritis of the cervical vertebrae, sport-related injuries, epicondylitis, and cutaneous ulcers, and with cases of osteoarthritis of the coxa. CONCLUSIONS: Treatment with 904-nm diode laser has substantially reduced the symptoms as well as improved the quality of life of these patient, ultimately postponing the need for surgery.- - - - - - - - - - ranking = 173.39268062382keywords = pain (Clic here for more details about this article) |
16/1691. Successful treatment of whiplash-type injury induced severe pain syndrome with epidural stimulation: a case report.Chronic severe cervico-facial pain syndrome associated with a whiplash-type injury was successfully treated with epidural spinal cord stimulation. The patient had been in pain for 9 years, responding temporarily only to stellate ganglion blocks. The patient has now been painless for 18 months. We have been unable to find a similar case reported in the literature to date.- - - - - - - - - - ranking = 606.87438218336keywords = pain (Clic here for more details about this article) |
17/1691. Chronic toxic encephalopathy in a painter exposed to mixed solvents.This paper describes symptoms and findings in a 57-year-old painter who had been exposed to various organic solvents for over 30 years. He began to work as a painter at 16 years of age, frequently working in poorly ventilated areas; he used solvents to remove paint from the skin of his arms and hands at the end of each work shift. The patient and his family noticed impaired short-term memory function and changes in affect in his early forties, which progressed until after he stopped working and was thus no longer exposed to paints and solvents. After the patient's exposures had ended, serial neuropsychological testing revealed persistent cognitive deficits without evidence of further progression, and improvement in some domains. magnetic resonance imaging revealed global and symmetrical volume loss, involving more white than gray matter. The findings in this patient are consistent with chronic toxic encephalopathy and are differentiated from other dementing processes such as Alzheimer's disease, multi-infarct (vascular) dementia, and alcoholic dementia. Previous descriptions in the literature of persistent neurobehavioral effects associated with chronic exposure to organic solvents corroborate the findings in this case.- - - - - - - - - - ranking = 693.57072249527keywords = pain (Clic here for more details about this article) |
18/1691. Misdiagnosis of specific cytomegalovirus infection of the ileoanal pouch as refractory idiopathic chronic pouchitis: report of two cases.PURPOSE: Chronic nonspecific reservoir ileitis (pouchitis) occurs in 5 to 10 percent of patients who undergo ileal pouch-anal anastomosis for ulcerative colitis. Specific infection of the ileal pouch-anal anastomosis with cytomegalovirus has not been reported. AIM: We report two patients with specific cytomegalovirus infection of the ileal pouch-anal anastomosis, initially misdiagnosed as idiopathic chronic pouchitis. CASE SERIES: Patient 1 had ileal pouch-anal anastomosis for ulcerative colitis. Three years later she had diarrhea, fever, pelvic pain, and pouch inflammation at endoscopy consistent with pouchitis. She had no response to medical therapy. Repeat endoscopy showed persistent inflammation and biopsies showed cytomegalovirus. She had symptomatic improvement after treatment with intravenous ganciclovir, 10 mg/kg/day for ten days (stopped for rash). Repeat pouch biopsies were negative for cytomegalovirus. Patient 2 had ileal pouch-anal anastomosis for ulcerative colitis. Nine years later she had resection of obstructing stricture at previous loop ileostomy site. She underwent reoperation with ileostomy and pouch defunctionalization for peritonitis. Four weeks later she had fever and bloody discharge from the diverted pouch. Pouch endoscopy with biopsy showed inflammation consistent with pouchitis. She had no response to medical therapy. Re-examination of pouch biopsies with a specific monoclonal immunofluorescent stain showed cytomegalovirus. She had symptomatic improvement after treatment with intravenous ganciclovir, 10 mg/kg/day for 21 days. Repeat pouch biopsies were negative for cytomegalovirus. CONCLUSIONS: Specific cytomegalovirus infection of the ileal pouch-anal anastomosis may be misdiagnosed as idiopathic refractory chronic pouchitis. cytomegalovirus must be excluded before immune modifier therapy or pouch excision in these patients.- - - - - - - - - - ranking = 86.696340311909keywords = pain (Clic here for more details about this article) |
19/1691. The development of a pancreatic abscess, suppurative pylethrombosis, and multiple hepatic abscesses after a pancreatojejunostomy for chronic pancreatitis: report of a case.We present herein an autopsy case of 63-year-old Japanese man who died as a result of pancreatic abscess, suppurative pylethrombosis, and multiple liver abscesses that had developed 10 years after a pancreato- and cystojejunostomy with side-to-side anastomosis for chronic pancreatitis. Even after this operation, the patient had continued to consume excessive amounts of alcohol. He had first experienced back pain with leukocytosis 9 years after the operation, which relapsed the following year. Despite percutaneous transhepatic gallbladder drainage, his icterus had deteriorated into hepatic insufficiency. Computed tomographic scans of the abdomen had disclosed multiple liver abscesses. At autopsy, a pancreatic abscess and suppurative pylethrombosis as well as multiple liver abscesses were found. There have been few reported cases of such lethal complications developing after a pancreato- and cystojejunostomy for chronic pancreatitis. As the consumption of alcohol would have exacerbated the chronic pancreatitis, such patients should be strongly advised to abstain from drinking alcohol.- - - - - - - - - - ranking = 136.21147816635keywords = pain, back pain, back (Clic here for more details about this article) |
20/1691. Chronic subdural haematoma following caesarean section under spinal anaesthesia.Intracranial subdural haematoma is a rare complication of spinal anaesthesia. This report describes the case of a 31-year-old woman who presented with post partum headache following spinal anaesthesia for caesarean section. Bilateral haematomata were evacuated via burr-holes performed under total intravenous anaesthesia and the patient made a complete and uneventful recovery. The recognized causes of subdural haematoma are discussed.- - - - - - - - - - ranking = 28.5620536862keywords = headache (Clic here for more details about this article) |
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