1/19. Patient-controlled epidural analgesia for postherpetic neuralgia in an hiv-infected patient as a therapeutic ambulatory modality.A 43-year-old hiv-positive male was referred to our pain clinic one month after his fourth attack of herpes zoster infection. He complained of intermittent intolerable sharp and lancinating pain accompanied by numbness over the inner aspect of the left upper extremity, left anterior chest wall and the back. physical examination revealed allodynia over the left T1 and T2 dermatomes without any obvious skin lesion. The pain was treated with epidural block made possible by a retention epidural catheter placed via the T2-3 interspace. After the administration of 8 ml of 1% lidocaine in divided doses, the pain was completely relieved for 4 h without significant change of blood pressure or heart rate. A pump (Baxter API) for patient-controlled analgesia (PCA) filled with 0.08% bupivacaine was connected to the epidural catheter on the next day and programmed at a basal rate of 2 ml/h, PCA dose 2 ml, lockout interval 15 min, with an one-hour dose limit of 8 ml. He was instructed to report his condition by telephone every weekday. The pump was refilled with drug and the wound of catheter entry was checked and managed every 3 or 4 days. The epidural catheter was replaced every week. During treatment, the pain intensity was controlled in the range from 10 to 0-2 on the visual analogue scale. He was very satisfied with the treatment and reported only slight hypoesthesia over the left upper extremity in the early treatment period. Epidural PCA was discontinued after 28 days. He did not complain of pain thereafter but reported a slight numb sensation still over the lesion site for a period of time. In conclusion, postherpetic neuralgia in an hiv-infected man was successfully treated with ambulatory therapeutic modality of epidural PCA for 28 days.- - - - - - - - - - ranking = 1keywords = chest (Clic here for more details about this article) |
2/19. The value of MR neurography for evaluating extraspinal neuropathic leg pain: a pictorial essay.SUMMARY: Fifteen patients with neuropathic leg pain referable to the lumbosacral plexus or sciatic nerve underwent high-resolution MR neurography. Thirteen of the patients also underwent routine MR imaging of the lumbar segments of the spinal cord before undergoing MR neurography. Using phased-array surface coils, we performed MR neurography with T1-weighted spin-echo and fat-saturated T2-weighted fast spin-echo or fast spin-echo inversion recovery sequences, which included coronal, oblique sagittal, and/or axial views. The lumbosacral plexus and/or sciatic nerve were identified using anatomic location, fascicular morphology, and signal intensity as discriminatory criteria. None of the routine MR imaging studies of the lumbar segments of the spinal cord established the cause of the reported symptoms. Conversely, MR neurography showed a causal abnormality accounting for the clinical findings in all 15 cases. Detected anatomic abnormalities included fibrous entrapment, muscular entrapment, vascular compression, posttraumatic injury, ischemic neuropathy, neoplastic infiltration, granulomatous infiltration, neural sheath tumor, postradiation scar tissue, and hypertrophic neuropathy.- - - - - - - - - - ranking = 388.96589387755keywords = plexus (Clic here for more details about this article) |
3/19. Use of endoscopic transthoracic sympathicotomy in intractable postherpetic neuralgia of the chest.Although there are various treatments for postherpetic neuralgia (PHN), none produces definitive effects. We report a case of 72-year-old woman who developed intractable PHN of the chest in which treatment with endoscopic transthoracic sympathicotomy (ETS) produced long-term effective results. When hyperesthesia of the sympathetic nerve participates in PHN, the blocking of sympathetic excitation seems to be effective for PHN suppression. The method using a single resectoscope is safe, accurate, yields excellent results cosmetically, and generates minimal invasion and very little postoperative pain. Although ETS is not always effective for all cases of PHN, it could be a useful method of treating patients with PHN that is resistant to conventional therapies.- - - - - - - - - - ranking = 5keywords = chest (Clic here for more details about this article) |
4/19. Perineal-onset Fournier's gangrene in a patient undergoing hemodialysis--importance of perineal-onset manifestation.We present a rare case of perineal-onset Fournier's gangrene in a patient undergoing hemodialysis. A 51-year-old Japanese man manifested an acute-onset perineal pain with perirectal abscess; subsequently, the pain extended to the abdomen, chest, and loin despite quick treatment. His consciousness deteriorated to delirium and he died of septic shock on the third day of admission. Computed tomography (CT) revealed soft-tissue air along the right rectal wall, moreover, the infection extended to the anterior wall of the bladder and the right peripsoas muscle. On the basis of the clinical course and CT findings, the patient was diagnosed as having the complications of Fournier's gangrene, however, no scrotal lesions were detected. Fournier's gangrene is considered to be easily diagnosed on the basis of skin lesions, such as scrotal erythema and swelling. However, in the early stage, the diagnosis of Fournier's gangrene is difficult in a patient with perineal pain before the detection of skin lesions. In conclusion, definitely the key to improving the prognosis of this fulminant infection is the prompt recognition of the pathological process. Therefore, Fournier's gangrene should always be considered when patients undergoing hemodialysis manifest perirectal disorders, even when no scrotal lesions are detected, because there is the possibility of intra-abdominal and intra-retroperitoneal infections resulting in septic shock.- - - - - - - - - - ranking = 1keywords = chest (Clic here for more details about this article) |
5/19. The natural history and long-term outcome of 57 limb sarcoidosis neuropathy cases.Fifty-seven patients with biopsy-proven sarcoidosis causing limb neuropathy were reviewed in order to delineate the characteristic symptoms, impairments, disability, course, outcome and response to corticosteroid treatment of limb sarcoid neuropathy. Typically the neuropathy had a definite date of symptomatic onset. Prominent were positive neuropathic sensory symptoms (P-NSS), especially pain, overshadowing weakness and sensory loss. P-NSS were the main cause of disability. Almost always the pattern was asymmetric and not length-dependent (unlike distal polyneuropathy). We inferred (from kind and distribution of symptoms, signs and electrophysiologic and other test results) that the pathologic process was focal or multifocal, involving most classes of nerve fibers and variable levels of proximal to distal levels of roots and peripheral nerves. Additional features aiding in diagnosis were: systemic symptoms such as fatigue, malaise, arthralgia, fever and weight loss; involvement of multiple tissues (i.e. skin, lymph nodes and eye); the patterns of neuropathy; MRI features; and ultimately tissue diagnosis. Axonal degeneration predominated, although an acquired demyelinating process was observed in 3 patients. For most cases, the disease had a chronic, monophasic course. MRI studies done in later years of affected neural structures were helpful in identifying leptomeningeal thickening, hilar adenopathy; and enlargement and T2 enhancement of nerve roots, plexuses, and limb nerves. Corticosteroid treatment appeared to ameliorate symptoms more than impairments. Several variables were associated with neuropathic improvement: CSF pleocytosis, short duration between symptom onset and treatment, and a higher grade of disability at first evaluation-a possible rationale for future earlier diagnosis and treatment.- - - - - - - - - - ranking = 194.48294693878keywords = plexus (Clic here for more details about this article) |
6/19. Extended neuralgic amyotrophy syndrome.Neuralgic amyotrophy refers to an idiopathic syndrome where weakness and wasting occur in one limb, usually in the muscles innervated by the upper brachial plexus. Seven patients are presented who developed cranial nerve involvement (facial, spinal accessory) in the midst of a typical attack of neuralgic amyotrophy or who developed either recurrent brachial or brachial and lumbosacral plexopathies. An underlying demyelinating neuropathy was identified in one patient and two patients were herion addicts. These reports confirm that neuralgic amyotrophy may occasionally form part of a more extensive disorder of the peripheral nervous system, thereby providing indirect support for the role of a systemic immunological factor in pathoetiology.- - - - - - - - - - ranking = 194.48294693878keywords = plexus (Clic here for more details about this article) |
7/19. Intercostal neuralgia following stellate ganglion block. An infrequent complication.The case is described of a 78-year-old female patient who experienced temporary but severe chest wall pain following stellate ganglion block. The possible mechanisms and treatment of this complication are discussed.- - - - - - - - - - ranking = 1keywords = chest (Clic here for more details about this article) |
8/19. Combined trigeminal and glossopharyngeal neuralgia.A case of combined trigeminal and glossopharyngeal neuralgia is described. The superior cerebellar artery and normal choroid plexus compressed and indented the root entry zones of the trigeminal and glossopharyngeal nerves, respectively. Complete relief was obtained after microvascular decompression and resection of the choroid plexus.- - - - - - - - - - ranking = 388.96589387755keywords = plexus (Clic here for more details about this article) |
9/19. brachial plexus injuries with causalgia resulting from transaxillary rib resection.In each of four patients with suspected thoracic outlet syndromes, the transaxillary approach to resection of the first thoracic and cervical ribs resulted in severe and permanent damage to the brachial plexus. The most severe sequela was causalgia. Weakness of the hand muscles, sensory deficits, and autonomic dysfunction also occurred. Abuse of narcotic analgesics was common. Two patients suffered severe psychological depressions, with one committing suicide. Current enthusiasm with transaxillary rib resections in cases of thoracic outlet syndrome should be tempered by the possibility of severe and permanent injury to the brachial plexus and intractable causalgia.- - - - - - - - - - ranking = 1166.8976816327keywords = plexus (Clic here for more details about this article) |
10/19. The flexion-adduction sign in neuralgic amyotrophy.In the "flexion-adduction" sign, the arm is maintained in a posture of flexion at the elbow and adduction at the shoulder. Abduction and lateral rotation of the arm, with the elbow in extension, may result in radicular pain. These signs may be useful in the evaluation of patients with cervical root or brachial plexus lesions.- - - - - - - - - - ranking = 194.48294693878keywords = plexus (Clic here for more details about this article) |
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