1/18. colchicine neuromyopathy: a report of six cases.colchicine has been in use for therapeutic purposes for many years. It can, however, cause subacute onset muscle and peripheral nerve toxicity in patients with chronic renal failure. In this report we describe 6 patients who developed neuromyopathy after the administration of colchicine. All patients presented with proximal muscle weakness, elevated serum creatine kinase (CK) levels, and neuropathy and/or myopathy on electromyography (EMG). The diagnosis of colchicine toxicity was confirmed in all cases by the normalization of CK levels and EMG after discontinuation of the drug. Toxicity developed in 4 renal failure patients on therapeutic doses of the drug, while one patient took a massive dose for suicidal reasons, and the other was on high-dose therapy. patients using colchicine--especially those with renal failure--should be warned about the side effects of the drug and physicians should be careful in the administration of the drug.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/18. Chemotherapy-induced radiation recall myositis.Myofasciitis syndrome encompasses a group of disorders characterized by chronic inflammation and/or fibrosis of the subcutaneous septa and muscular fascia. We report on a patient in whom myositis was diagnosed in the areas previously irradiated for papillary thyroid carcinoma and anal canal carcinoma respectively 21 and 3 years after radiotherapy. We are not able to explain why myopathy developed at the same time in two different sites at a different interval from the two radiotherapic schemes. We can suppose that the patient developed a subclinical regional myopathy after the first radiotherapic scheme. radiation induced heritable mutations within surviving cells that were unable to tolerate the second damage by systemic chemotherapy. It is unclear how radiosensitization correlates with an ability to reactivate latent effects in normal tissue. physicians using chemotherapic radiosensitizers should be aware of their potential to induce a delayed form of radiosensitization. We report this case to encourage physicians to be alert to the knowledge of the clinical, histologic and morphologic characteristics of radiation myositis in order to distinguish it from an infectious or immune fasciitis or myositis.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/18. Anaphylactic reactions to tolperisone (Mydocalm).Four patients with anaphylaxis attributed to the intake of the centrally acting muscle relaxant tolperisone hydrochloride (Mydocalm) were observed at the Emergency Department of the Geneva University Hospital between November 2001 and March 2003. All patients were middle-aged women who took tolperisone for chronic muscular pain. All reactions occurred within an hour after oral intake of this drug frequently prescribed in switzerland. The severity of anaphylaxis ranged from urticarial reactions to shock with arterial hypotension. Prick-to-prick skin testing performed in one patient with a tablet of tolperisone diluted in water was negative. Its globally restricted commercialisation may explain the lack of reports on such adverse effects in the medline database. Anaphylactic reactions to this drug, however, are mentioned in other sources such as the Swiss Drug Compendium and the WHO drug reaction database. Together, these findings suggest that anaphylaxis to tolperisone is not uncommon and should be known to physicians in countries where this drug is available.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/18. Manipulation with the patient under anesthesia.Manipulation while the patient is under anesthesia is an old, widely recognized procedure in musculoskeletal medicine. It is used for treating acute and chronic musculoskeletal conditions with significant biomechanical dysfunction unresponsive to conservative therapy. The procedure is helpful when muscle spasm and irritability preclude success without anesthetization of the patient. safety and effectiveness are favored by appropriate selection of patients, knowledge of indications and contraindications, suitable anesthetic, and services of a qualified physician trained in structural diagnosis and manipulative technique. A team approach is recommended. To illustrate effective use of the procedure, a classic case is described.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/18. Longitudinal tears of both peroneal tendons associated with tophaceous gouty infiltration. A case report.The authors report a case of longitudinal tendon tears of the peroneus longus and brevis in the presence of tophaceous gouty infiltration. There are a limited number of reports discussing similar processes affecting various tendons throughout the body. There has been 1 prior case of peroneal tendon involvement affecting only the peroneus brevis. A 35-year-old man presented with a 4-year history of left-sided lateral ankle pain, redness, and swelling. The patient described the "attacks" as occurring off and on, with a recent increase in frequency. The symptoms were relieved with indomethacin, colchicine, and narcotic analgesics. Upon clinical evaluation, there was a cavus foot type with moderate calcaneal varus. Peroneal subluxation was elicited with resisted eversion. An MRI evaluation revealed longitudinal tears of both peroneal tendons. During surgical repair, a chalky-white substance resembling gouty tophi was present within both tendon tears. The tendons were remodeled and repaired. The patient had an uneventful postoperative course with nearly completed resolution of his symptoms at 1-year follow-up. The patient was referred to his primary care physician for further evaluation and long-term control of elevated uric acid levels.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/18. Side-locked headache as the chief complaint of inflammatory orbital pseudotumor (myositic form): a case report.The case of a 38-year-old woman with continuous unilateral side-locked headache is reported. She had continuous right-sided periorbital pain of mild to moderate intensity for the past 5 months. She also reported a few episodes of pain exacerbations every day. She had no autonomic features. Based on a normal CT scan ordered by her general physician, we started indomethacin (150 mg/day) as well as celecoxib (400 mg/day) for 2 weeks, without relief. Oral prednisone for 6 days provided important relief, and she stayed on daily use of steroids, refusing other forms of therapy. After 5 months she developed orbital and eyelid edema, with painful restrictions to eye movement. Orbital MRI and pathological exam demonstrated inflammatory orbital pseudotumor (myositic form).- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
7/18. Spontaneous iliopsoas haemorrhage--an unusual complication of streptokinase therapy.We report a case of spontaneous iliopsoas haemorrhage following intravenous streptokinase which serves to remind physicians of the potential dangers of this form of therapy.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
8/18. Myositis in Kawasaki disease.Myositis is recognized as one of several neurologic complications encountered in Kawasaki disease. We report an unusual patient with Kawasaki disease which was complicated by severe myositis and respiratory failure secondary to weakness. Comparison of our patient with previously reported cases leads us to conclude that myositis in Kawasaki disease usually is present within 1-3 weeks of illness; the symptoms usually are mild and probably remain unnoticed by most physicians, but weakness can be severe and respiratory failure may occur. The degree of creatine kinase elevation may be useful in predicting the severity of myopathy and in alerting the physician to the need for close respiratory monitoring. Therapy is supportive and complete recovery is to be expected.- - - - - - - - - - ranking = 2keywords = physician (Clic here for more details about this article) |
9/18. Concurrent musculoskeletal pain in a patient with symptomatic lower extremity arterial insufficiency.The etiology of back and lower extremity pain can, at times, be difficult to differentiate. This is especially true in cases where two pain-producing conditions coexist. Such difficulties have been reported in cases of coexisting vascular and neurogenic claudication. We report the case of a 66-year-old woman with concurrent musculoskeletal pain and hip claudication. Her arterial insufficiency was initially masked by her diffuse pain complaints and only became apparent to us after successful treatment of her soft tissue problems. We caution physicians to be aware of coexisting musculoskeletal pain that may mask significant underlying pathology.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
10/18. pyomyositis in spinal cord injury patients.bacterial infections remain a major cause of morbidity and mortality among patients with longstanding spinal cord injury. Infection may occur in a number of different foci, often taxing the skill of the most accomplished diagnostician. Herein are described three patients with fever of unknown origin wherein extensive diagnostic workups ultimately led to the diagnosis of primary pyomyositis. These patients demonstrate the importance of repeated careful physician examination in determining the site of infection in patients with established sensorimotor deficits. Although primary pyomyositis is not a common occurrence in those with spinal cord injuries, it should be included as a potential cause of fever in this patient population.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
| | Next -> |