1/293. Stereotactic pallidotomy in a child with Hallervorden-Spatz disease. Case report.The authors present a case of Hallervorden-Spatz disease (HSD) in a 10-year-old boy treated with stereotactic pallidotomy for control of severe dystonia. Hallervorden-Spatz disease is a rare type of neuraxonal dystrophy that can be familial or sporadic. This is the first case of HSD reported in the literature in which a pallidotomy was performed. The patient had progressively worsening dystonias and spasms that prevented useful function of his entire right side and eventually threatened his respiratory ability. Pre- and postoperative magnetic resonance images are presented along with electrophysiological recordings made in the globus pallidus at the time of surgery. Functional improvement in the use of the patient's limbs and relief from the painful dystonia were observed. Stereotactic pallidotomy should be considered as a potential treatment in the management of HSD.- - - - - - - - - - ranking = 1keywords = record (Clic here for more details about this article) |
2/293. sympathetic nervous system and pain: a clinical reappraisal.The target article discusses various aspects of the relationship between the sympathetic system and pain. To this end, the patients under study are divided into three groups. In the first group, called "reflex sympathetic dystrophy" (RSD), the syndrome can be characterized by a triad of autonomic, motor, and sensory symptoms, which occur in a distally generalized distribution. The pain is typically felt deeply and diffusely, has an orthostatic component, and is suppressed by the ischemia test. Under those circumstances, the pain is likely to respond to sympatholytic interventions. In a second group, called "sympathetically maintained pain" (SMP) syndrome, the principal symptoms are spontaneous pain, which is felt superficially and has no orthostatic component, and allodynia. These symptoms, typically confined to the zone of a lesioned nerve, may also be relieved by sympathetic blocks. Since the characteristics of the pain differ between RSD and SMP, the underlying kind of sympathetic-sensory coupling may also vary between these cases. A very small third group of patients exhibits symptoms of both RSD and SMP. The dependence or independence of pain on sympathetic function reported in most published studies seems to be questionable because the degree of technical success of the block remains uncertain. Therefore, pain should not be reported as sympathetic function independent until the criteria for a complete sympathetic block have been established and satisfied.- - - - - - - - - - ranking = 1.2745149497184keywords = relation (Clic here for more details about this article) |
3/293. hyperalgesia with reduced laser evoked potentials in neuropathic pain.Nociceptive evoked potentials to laser stimuli (LEPs) are able to detect lesions of pain and temperature pathways at peripheral, spinal and supraspinal levels. It is commonly accepted that LEP attenuation correlates with the loss of pain and temperature sensations, while pathological heat-pain hypersensitivity has been associated with increased LEP amplitude. Here we present two patients in whom increased pain sensation (hyperalgesia) to laser stimuli was, on the contrary, associated to delayed, desynchronized and attenuated LEPs. Both patients experienced increased unpleasantness and affective reactions to laser, associated to poor ability to localize the stimulus. In both cases the results may be explained by an overactivation of the 'medial pain system', in one patient due to deafferentation of cortical sensory areas by a capsular lesion, and in the other to imbalance between A-delta and C fiber excitation due to peripheral nerve injury. Our results suggest that LEPs, as currently recorded, reflect the activity of a 'lateral' pain system subserved by rapidly conducting fibers. They may therefore, assess the sensory and cognitive dimensions of pain, but may not index adequately the affective-emotional aspects of pain sensation conveyed by the 'medial' pain system. The dissociation between pain sensation and cortical EPs deserve to be added to the current semiology of LEPs, as the presence of abnormal pain to laser on the background of reduced LEPs substantiates the neuropathic nature of the pain.- - - - - - - - - - ranking = 1keywords = record (Clic here for more details about this article) |
4/293. Nivaquine and urethral pain.Two patients, one Jewish and the other Nigerian, were investigated for pain in the urethra. They were both fully treated along the usual lines without any change in the pain. The Jewish patient was later found to be sensitive to chloroquine. When ingestion of this drug was discontinued, his urethral pain disappeared after about four months. The Nigerian patient was advised along the same lines when it was found that he too took chloroquine for malarial attacks regularly. He had total symptomatic relief. The probable relationship between chloroquine and urethral pain is discussed.- - - - - - - - - - ranking = 1.2745149497184keywords = relation (Clic here for more details about this article) |
5/293. Copperhead envenomations: clinical profiles of three different subspecies.Copperhead envenomation cases reported in the literature frequently lack identification of the subspecies of copperhead responsible for the envenomation. Whether subspecific identity would be useful in predicting possible different toxicity profiles may have clinical relevance. We report here the clinical profiles from envenomations involving 3 different subspecies of captive adult copperhead snakes--the southern copperhead (agkistrodon contortrix contortrix), the northern copperhead (agkistrodon contortrix mokasen), and the broad-banded copperhead (agkistrodon contortrix laticinctus). The bites occurred in the north-central region of the US where none of these subspecies are endemic and involved a professional and 2 amateur herpetologists. The victims were adult males with no previous history of venomous snake bite, and all bites were evidenced by fang puncture marks to their index finger or thumb. Envenomations from the broad-banded and northern copperhead subspecies caused localized symptoms of pain, edema and ecchymosis. In addition to these symptoms, southern copperhead envenomation resulted in a more severe clinical toxicity profile as evidenced by propulsive emesis, diarrhea and hematuria. Whether these differences in observed clinical toxicity were the result of unique subspecific venom pharmacological actions is an interesting question. However, independent of the copperhead subspecies involved, conservative medical management was effective in each case.- - - - - - - - - - ranking = 6.6982186226023keywords = bite (Clic here for more details about this article) |
6/293. Primary non-Hodgkin's lymphoma of the liver.The clinicopathological features of a rare case of primary non-Hodgkin's hepatic lymphoma (PHL) are described and compared to those of the other 76 cases reported in the world literature. PHL is mainly a disease of Caucasian, middle-aged males and, in approximately half of the reported cases, was associated with other diseases involving depression or chronic stimulation of the immune system. Right upper abdominal and epigastric pain with loss of weight are the most common presenting symptoms. The tumour is usually a single large mass involving both hepatic lobes and is almost invariably composed of lymphocytes reacting with B-cell markers. Most tumours are of intermediate or high grade according to the classification of the Working Formulation for Clinical Usage. No correlation is apparent between gross appearance of PHL (massive or nodular) and grade of severity. Chemotherapy or radiotherapy alone appears to be ineffective, while relatively good results can be obtained with combination modalities.- - - - - - - - - - ranking = 1.2745149497184keywords = relation (Clic here for more details about this article) |
7/293. Non-steroidal anti-inflammatory drugs with adverse psychiatric reactions: five case reports.Adverse drug reactions of non-steroidal anti-inflammatory drugs (NSAIDs) are quite prevalent, but there are few reports about possible adverse psychiatric reactions, which may be ignored or underestimated. We describe here five psychiatric outpatients, two with major depressive disorders, one bipolar disorder, one schizophrenic disorder and one anxiety disorder, who were treated with NSAIDs for pain due to rheumatoid arthritis, osteoarthritis or other painful neuromuscular conditions. All five patients developed a moderate to severe depressive state, three patients became obviously paranoid, and four had either thoughts of suicide or an attempt while undergoing co-administration of NSAIDs. The psychiatric symptoms remitted when the NSAIDs were stopped. The depressive and paranoid symptoms returned on seven occasions of re-use or re-challenge with the same or a different type of NSAID in all five patients. When the NSAIDs were stopped again, the patients had another remission of the adverse psychiatric reactions, and eventually recovered to their baseline mental states in clear temporal relationships. The cases presented suggest that NSAIDs can induce or exacerbate idiosyncratic reproducible adverse psychiatric symptoms in certain vulnerable patients, including those with a variety of psychotic or neurotic disorders, and also in elderly persons, but these undesirable side-effects were generally transient and disappeared on withdrawal of the NSAIDs.- - - - - - - - - - ranking = 1.2745149497184keywords = relation (Clic here for more details about this article) |
8/293. amputation: two views.It has been over one year now since his surgery, and Allen has returned to school and work, ambulating on his prosthesis most of the time. As his phantom limb pain decreased and his proficiency in walking increased, his acceptance of his amputation has been demonstrated in his comments and references to himself and his relations with others. As he states, the more comfortable he is about his amputation, the easier it is for others to accept and relate to him. This, I think, is the key to approaching that final stage of acceptance mentioned earlier. The more we can help our patients accept their amputation initially by supporting them through this crisis period, the easier it will be for them to relate to others and grow emotionally from these relationships.- - - - - - - - - - ranking = 2.5490298994368keywords = relation (Clic here for more details about this article) |
9/293. Spinal epidural abscess complicating chronic epidural analgesia in 11 cancer patients: clinical findings and magnetic resonance imaging.We reviewed the records of all patients who had received an epidural catheter for management of chronic cancer pain in a 3-year period (1993-1996). Patients with nervous system infections were identified, and pertinent clinical, radiological (magnetic resonance imaging), and bacteriological data were analyzed. We identified 11 patients who developed spinal epidural abscess (SEA). All of these had back pain; radicular signs occurred in seven patients and spinal cord compression in two patients. magnetic resonance imaging revealed SEA in all 11 patients. SEA was iso- to hypointense on T1-weighted images and hyperintense on T2-weighted images relative to spinal cord. After gadolinium administration seven lesions showed characteristic rim enhancement while three showed minimal enhancement. No signs of diskitis or osteomyelitis were present, and the abscess was always localized to the posterior epidural space. Cultures were positive in all cases and revealed staphylococcus epidermidis in eight and S. aureus in three. All patients were treated with intravenous antibiotics, and four had an additional decompressive laminectomy. Two patients died within 1 week of diagnosis from overwhelming septicemia despite apparently adequate antibiotic treatment. Within 4 weeks after diagnosis of SEA two patients died from widely metastatic disease, although infection may have contributed. One patient developed septicemia while receiving appropriate antibiotics and underwent emergency laminectomy. The neurological deficits recovered in all patients who survived the acute infectious episode. We conclude that patients with chronic epidural catheters for cancer pain require prompt neurological evaluation and magnetic resonance imaging when SEA is suspected. Early evaluation and treatment may lead to full recovery.- - - - - - - - - - ranking = 1keywords = record (Clic here for more details about this article) |
10/293. Painful seizures with allodynia in an 11-year-old boy.An 11-year-old boy's epileptic seizures started with a feeling of impending crisis, dizziness, headache, and a bad taste in the mouth. This was followed by swallowing and a burning sensation in the left hand. At the same time, other parts of the body experienced allodynia. MRI and CT scans showed a right anteromesial temporal lesion which proved at neuropathology to be a ganglioglioma. Lesionectomy resulted in complete cessation of seizures. seizures were absent at an 18-month follow-up. Allodynia is discussed in relation to the locality of the lesion.- - - - - - - - - - ranking = 1.2745149497184keywords = relation (Clic here for more details about this article) |
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