1/11. Understanding peripheral neuropathy in patients with cancer: background and patient assessment.PN is a troublesome symptom that frequently occurs in patients with cancer and is associated with certain neurotoxic chemotherapeutic agents. By understanding the basic principles of PN and recognizing the potential toxicities of specific chemotherapy drugs, nurses can take an active role in minimizing their occurrence. nursing assessment is critical to early identification of toxicities and successful intervention. nurses need to educate their patients regarding potential drug side effects and review safety issues that may put them at risk for injury. patients need to be instructed to report symptoms of PN to their nurses and physicians. Healthcare professionals, in turn, need to assess neurologic function on a routine basis, monitor those at risk, and intervene when appropriate. Ultimately, PN can be recognized as a significant symptom, such as pain or fatigue. Current treatment options include both pharmacologic and nonpharmacologic therapies, and the success of the treatment often depends on the cause. research is needed to find better and more effective therapies for PN. The Neuropathy association is a national organization that offers patients with PN the chance to contact others to share experiences and information to help them to cope with symptoms, increase public awareness of the problem, and promote the development of better therapies. This organization provides a newsletter, information booklets, and activities for members and can be contacted at 800-247-6968 or www.neuropathy.org.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/11. Pharmacologic management part 1: better-studied neuropathic pain diseases.Neuropathic pain impacts millions of people in the united states and around the world. patients experience one of many symptoms, such as pain, paresthesia, dysesthesia, hyperalgesia, and allodynia, for many years because of unavailable or inadequate treatment. One of the major challenges in treating patients with neuropathic pain syndromes is a lack of consensus concerning the appropriate first-line treatment options for conditions associated with neuropathic pain, including postherpetic neuralgia, diabetic peripheral neuropathy, and trigeminal neuralgia. This review summarizes the published results of randomized trials involving treatment for neuropathic pain conditions. anticonvulsants, such as gabapentin, carbamazepine, and lamotrigine, and tricyclic antidepressants, including amitriptyline and desipramine, have demonstrated efficacy in relieving pain associated with postherpetic neuralgia, diabetic peripheral neuropathy, and trigeminal neuralgia, in several studies. However, the lack of head-to-head comparison studies of these agents limits the conclusions that can be reached. Clinicians who must make decisions regarding the care of individual patients may find some guidance from the number of randomized trials with a positive outcome for each agent. Using quality-of-life study outcomes, treatment strategies must encompass the impact of therapeutic agents on the comorbid conditions of sleep disturbance and mood and anxiety disorders associated with neuropathic pain. Looking to the future, emerging therapies, such as pregabalin and newer N-methyl-D-aspartate-receptor blockers, may provide physicians and patients with new treatment options for more effective relief of pain.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/11. Case report: painful peripheral neuropathy following treatment with docetaxel for breast cancer.Peripheral neuropathy is a common side effect of many chemotherapy agents. As many as 60% of patients receiving taxane therapy report symptoms such as numbness, tingling, burning, pain, and, in severe cases, weakness in a stocking and glove pattern. These symptoms are associated with problems in physical mobility and decreased quality of life, yet few articles in the literature discuss collaborative interdisciplinary assessment and treatment of this population. This article describes the care of a patient with diabetes and docetaxel-induced, painful peripheral neuropathy by a multidisciplinary team of nurses, physicians, and physical therapists. Because nurses are often the first clinicians to recognize symptoms of chemotherapy-induced peripheral neuropathy, they provide the essential coordination of care by appropriate medical and rehabilitative services. This case also raises important questions about the relationship between diabetes mellitus and persistent, painful peripheral neuropathy.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/11. Mononeuropathy due to vincristine toxicity.vincristine sulfate is a known neurotoxin. Peripheral neuropathy is the most common toxic manifestation and is usually of the symmetrical, mixed, sensory-motor type. With this report we alert other physicians to another feature of vincristine neurotoxicity, namely, mononeuropathy.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/11. Asymptomatic pontine myelinolysis.A 43-year-old lady presented with bilateral foot drop due to alcohol-related peripheral neuropathy. There was no history of electrolyte disturbance or altered consciousness. Cranial nerve, bulbar and pyramidal symptoms and signs were absent. Nerve conduction studies confirmed the neuropathy. Inadvertently requested neuroimaging of brain demonstrated signal change typical of central pontine myelinolysis. Asymptomatic pontine myelinolysis occurs rarely in alcoholics in the absence of bulbar dysfunction. It is important for physicians to be aware of the clinical entity of asymptomatic pontine myelinolysis to avoid misinterpretation of abnormalities detected on cerebral imaging in alcoholic individuals.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/11. thiamine deficiency neuropathy. It's still common today.Despite the fact that thiamine deficiency neuropathy is increasing in incidence in our society, it remains an underdiagnosed disorder. The typical complaints of weakness and burning feet are often regarded as trivial by the attending physician. Electrophysiologic studies are sensitive and often provide supportive evidence to aid in the diagnosis. Since chronic pain therapy is often ineffective, a high index of suspicion should be maintained to help ensure early diagnosis and successful intervention.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
7/11. football head and neck injuries--an update.In the last 5 years there has been a dramatic decrease in the deaths directly related to football participation. The incidence of serious spinal cord injuries, however, appears to be increasing. The number of quadriplegic athletes varies from an estimated 1 per 7,000 to 1 per 58,000 participants per year in different areas of the country. The majority of catastrophic head and neck injuries occurs while tackling or blocking, and defensive players are much more liable to sustain these injuries than offensive players. In addition to permanent and irreversible spinal cord damage, football players may suffer spinal concussions as well as spinal contusions. The latter may be manifested by severe burning paresthesias and dysesthesias in the extremities as the only symptoms. Furthermore, fracture-dislocations with ligamentous tears may be present in this syndrome, with no complaint of cervical pain. Adequate preconditioning and strengthening of the head and neck musculature prior to football participation are essential for the prevention of catastrophic head and neck injury. Furthermore, proper blocking and tackling techniques must be taught, and such punishing maneuvers as spearing, goring, and butt-blocking and tackling must be eliminated. Arbitrarily, most physicians discourage further football participation if an athlete has suffered three cerebral concussions. Strong consideration must be given, however, not only to the number and severity of the concussion, but also to any CAT scan evidence of cerebral edema, contusion, or hemorrhage. With this incredibly sensitive diagnostic tool, one concussion, which is associated with radiographic evidence of structural brain damage, may be enough to strongly discourage or forbid further football participation.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
8/11. Postpartum femoral neuropathy.Two cases of postpartum femoral neuropathy occurred. The literature on this subject is reviewed, and possible etiologic mechanisms are discussed. Complete functional recovery is typical of the excellent prognosis of puerperal femoral neuropathy. The importance of recognizing this complication is to predict a favorable prognosis and thus eliminate anxiety for both patient and physician.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
9/11. Peripheral neuropathy after concomitant dimethyl sulfoxide use and sulindac therapy.The case is presented of a 63-year-old man with a long history of degenerative arthritis who took sulindac (Clinoril) 200 mg BID for 6 months with no untoward effects. Then, without physician knowledge, he began using 90% dimethyl sulfoxide (DMSO) topically to his upper and lower extremities. Shortly thereafter, he developed a profound mixed sensorimotor peripheral neuropathy. Serial electromyographic and nerve conducion studies performed at intervals of several months for 1 year suggested both segmental demyelination and axonal neuropathy. The patient experienced initial deterioration followed by gradual but incomplete recovery.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
10/11. leprosy in teenage immigrants. case reports and clinical review.Two cases of newly diagnosed leprosy (Hansen's disease) are presented to remind physicians of the nature of this disorder and its increasing prevalence due to migration to the united states from endemic areas. In both cases, leprosy was not initially considered by the American physicians. Important clinical clues to diagnosis are reviewed.- - - - - - - - - - ranking = 2keywords = physician (Clic here for more details about this article) |
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