1/3. Can vitamin d deficiency produce an unusual pain syndrome?An unusual pain occurred in five patients in the presence of compromised vitamin D status and resolved 5 to 7 days after supplementation with vitamin D in the form of ergocalciferol. The pain had a hyperesthetic quality and did not respond to the use of analgesics, including opiate derivatives. Treatment with therapeutic levels of a tricyclic antidepressant did not bring relief of symptoms. In one case, months after treatment and subsequent improvement of vitamin D status and pain, the vitamin D status again declined and the pain recurred. The pain again resolved with vitamin D replacement and improvement of levels. There may be a pain syndrome associated with vitamin D depletion that appears as hyperesthesia worsened by light, superficial pressure or even small increments of movement. This pain restricts mobility and function and may lead to further complications, such as pressure sores.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
2/3. Impaired blood pressure response to norepinephrine in a case of insulin-dependent diabetes mellitus--improvement with a beta-adrenergic antagonist.A case of juvenile-onset insulin-dependent diabetes mellitus in a 30-year-old male patient is reported. He was admitted to the hospital because of severe diabetic neuropathy, predominantly in the lower extremities. Signs of autonomic neuropathy were not evident but the patient had severe orthostatic hypotension. Circulating catecholamine concentrations were normal; however, the blood pressure response to infused norepinephrine was reduced ten-fold compared to a group of normals. An improvement of the blood pressure response to sympathomimetic drugs was accomplished during the simultaneous administration of propranolol, a beta-receptor blocking agent. The present data suggest a possible defect of the adrenergic receptor system in response to sympathomimetic drugs while the release of catecholamines and the function of the parasympathetic nervous system appears to be intact. Treatment with beta-blocking agents such as propranolol as an adjunct to sympathomimetics seems to be a promising approach which might deserve further consideration in similar cases.- - - - - - - - - - ranking = 3keywords = pressure (Clic here for more details about this article) |
3/3. Posterior compartment syndrome resulting from a dissecting popliteal cyst. Case report.Calf swelling, associated with an intra-articular effusion of the knee, should be considered a dissecting popliteal cyst until proven otherwise. The posterior compartment syndrome caused by an increase in pressure within the deep posterior compartment of the leg is usually secondary to trauma. This case history of a dissecting popliteal cyst reports another unusual cause of the posterior compartment syndrome. Popliteal cysts, especially dissecting ones, are typical of connective tissue diseases, and are not limited to rheumatoid arthritis.- - - - - - - - - - ranking = 0.5keywords = pressure (Clic here for more details about this article) |