11/84. The efficacy of hypnosis in the treatment of pruritus in people with HIV/AIDS: a time-series analysis.pruritus, or generalized itch, is a source of serious discomfort and distress in a significant minority of people living with AIDS. Anecdotal reports suggest hypnosis might be a useful treatment, leading to reductions in distress and improvements in the condition. But empirical examination of the question is notably lacking. This time-series study reports results of a 6-session self-hypnosis treatment (relaxation, deepening, imagery, and home practice) for 3 HIV-positive men suffering from pruritus, related to disease progression and/or HIV medications. Posttreatment, all 3 patients reported significant reductions in daily itch severity and extent of sleep disturbance due to itch. One patient also evidenced significantly less itch distress. Another also experienced significantly less time bothered by itch. For the 2 patients on which 4-month follow-up data were available, treatment benefit across variables was stable or further improved.- - - - - - - - - - ranking = 1keywords = discomfort (Clic here for more details about this article) |
12/84. Primary sclerosing cholangitis and ulcerative colitis.This is a report on a 36-year-old male patient presenting with a rare combination of ulcerative colitis and primary sclerosing cholangitis. The disease of the biliary tract was suspected on the basis of the endoscopic retrograde representation of the common bile duct, and serologically differentiated from a chronic destructive, non-supperative cholangitis on the basis of a lack of antimitochondrial antibodies. Subsequently, a hepaticojejunostomy was carried out to normalize the bile flow.- - - - - - - - - - ranking = 0.0045388219068163keywords = upper (Clic here for more details about this article) |
13/84. Invisible mycosis fungoides: a diagnostic challenge.We describe a 76-year-old woman who had persistent generalized pruritus as the only cutaneous manifestation of a cutaneous T-cell lymphoma (mycosis fungoides). No cutaneous lesions were observed throughout the patient's course. skin biopsy specimens obtained from normal-looking pruritic skin revealed a discrete perivascular lymphocytic infiltrate in the upper dermis and focal intraepidermal clusters of atypical lymphoid cells (Pautrier's microabscesses). PCR analysis of TCR-gamma gene disclosed a monoclonal T-cell rearrangement. Sequencing of the PCR monoclonal product identified the J(8)V(2)C(2) TCR gene rearrangement. This observation illustrates the existence of a peculiar and exceedingly rare form of mycosis fungoides characterized only by persistent pruritus unresponsive to several therapeutic approaches. The diagnostic difficulties of this rare variant are stressed.- - - - - - - - - - ranking = 0.0045388219068163keywords = upper (Clic here for more details about this article) |
14/84. hypothermia and excessive sweating following intrathecal morphine in a parturient undergoing cesarean delivery.OBJECTIVE: Intrathecal morphine has been used for the relief of postoperative pain following cesarean delivery. We report a case of postoperative hypothermia down to 33.6 degrees C associated with excessive sweating in patient undergoing elective cesarean delivery under spinal bupivacaine anesthesia who received intrathecal morphine for postoperative pain management. Case Report: A healthy 31-year-old multigravida presented for elective cesarean delivery. Following prehydration with 500 mL hemaccel, she had a subarachnoid block, using hyperbaric bupivacaine 12 mg and morphine 200 microgram, via a 25-gauge Whitacre needle. In the recovery room, 3 hours after induction of spinal anesthesia, the patient's sublingual temperature was 33.6 degrees C and she was noted to be sedated and sweating excessively. During the next 2 hours, the patient was still hypothermic despite active warming. She also complained of severe nausea, vomiting, and moderate pruritis. Following administration of naloxone 400 microgram sedation, vomiting, and pruritis were relieved. Also, the patient experienced excessive shivering, and her body temperature started to increase in association with a concurrent decrease of sweating. The postoperative hypothermia and excessive sweating in our patient may be related to the cephalad spread of the intrathecal morphine within the cerebrospinal fluid (CSF) to reach the level of opioid receptors in the hypothalamus, causing a perturbation of the thermoregulatory center. This effect could be counteracted by administration of naloxone. CONCLUSIONS: Intrathecal morphine may cause disruption of thermoregulation resulting in hypothermia associated with excessive sweating.- - - - - - - - - - ranking = 0.097395183165296keywords = pain (Clic here for more details about this article) |
15/84. pruritus in pediatric non-Hodgkin's lymphoma.A two-year-old girl presented with a 3-month history of generalized pruritus. One week before hospitalization she developed a superior vena cava syndrome and obstruction of the upper airways. Clinical and laboratory findings included generalized lymphadenopathy, a mediastinal mass compressing the tracheal lumen to the point of near closure, hepatomegaly and moderate eosinophilia. The diagnosis of an anaplastic large cell lymphoma (ALCL) was made by the histologic examination of a mediastinal lymph node. The history of generalized pruritus without diagnostic skin lesions was as uncommon as age at presentation. In conclusion, this case illustrates that generalized pruritus in a toddler can be an early sign of ALCL.- - - - - - - - - - ranking = 0.0045388219068163keywords = upper (Clic here for more details about this article) |
16/84. Normolipemic plane xanthoma associated with adenocarcinoma and severe itch.Normolipemic plane xanthomas are yellow-red-colored flat patches or plaques with barely palpable borders, under normolipemic conditions usually involving the eyelids, the lateral sides of the neck, the upper aspect of the trunk, or the flexural folds. Histologically the lesions are characterized by an infiltrate consisting of foamy macrophages in the papillary and middermis with a distinct perivascular localization. Plane xanthoma has been associated with monoclonal gammopathy, cryoglobulinemia, and myeloproliferative disorders. We present a patient in whom plane xanthoma developed on the upper aspect of the back, which was accompanied by severe itch in the affected area. These symptoms started 1 month after resection of an adenocarcinoma of the rectum that was complicated by recurrent abdominal abscesses and, currently, by ongoing inflammatory bowel disease. A hypothetic pathophysiologic scheme of events leading to xanthoma formation in this patient is presented.- - - - - - - - - - ranking = 0.028475341424732keywords = back, upper (Clic here for more details about this article) |
17/84. Pain as a complication of use of opiate antagonists for symptom control in cholestasis.Controlled trials have suggested that opiate antagonist therapy may be effective for the treatment of the symptoms of cholestasis. The oral opiate antagonist naltrexone in particular has started to enter into routine clinical use for amelioration of cholestatic itch. attention regarding the side effects of opiate antagonist therapy has, to date, largely focused on an opiate withdrawal-type reaction (which can be controlled effectively by titrated therapy introduction regimens). Here we describe 3 cases of a further clinically important side effect, loss of control of pain resulting from other pathologies, which in each case necessitated the withdrawal of hitherto clinically effective opiate antagonist therapy. Of the 14 patients treated by our unit with opiate antagonist agents for the control of cholestatic symptoms, 13 (93%) showed resolution of, or significant improvement in, symptoms. Of the 13 patients showing a clinical response, 7 (54%) subsequently had to discontinue therapy because of side effects (including the 3 patients with uncontrolled pain). It is our experience that in the routine clinical setting, opiate antagonists are highly effective for the treatment of cholestatic symptoms. In practice, however, their usefulness is limited by their side-effect profile.- - - - - - - - - - ranking = 0.097395183165296keywords = pain (Clic here for more details about this article) |
18/84. Itching attacks with generalized hyperhydrosis as initial symptoms of Hodgkin's disease.BACKGROUND: Clinical signs of Hodgkin's disease are unexplained weight loss, nocturnal sweating, fever and more or less permanent itching or pain around the affected lymphnodes, especially after alcohol consumption. Paraneoplastic symptoms are major challenges to the dermatologist, particularly if these seem harmless, though somewhat strange, as in the following case. observation: A 35-year-old patient had suffered for about 6 months from paroxysmal severe itching. A transient, generalized hyperhydrosis followed these attacks closely. The itching attacks usually began between the fingers and on the palms of the hands, and then spread to become generalized over the entire integument. The itching attacks commonly occurred three times daily for only a few minutes, while the subsequent severe hyperhydrosis, with cold sweat, lasted up to an hour. CONCLUSIONS: This case illustrates the necessity of considering a malignant underlying disease like Hodgkin's disease, not only in the presence of the well-known B-symptoms, but also when peculiar symptom combinations, like itching attacks and immediately subsequent transient generalized hyperhydrosis are present.- - - - - - - - - - ranking = 0.048697591582648keywords = pain (Clic here for more details about this article) |
19/84. Epidural clonidine relieves intractable neuropathic itch associated with herpes zoster-related pain.OBJECTIVE: We present a case of intense herpes zoster-related pain and itching in the ophthalmic division of the trigeminal nerve (V1). Successful pain and itch management was achieved after insertion of a high thoracic epidural catheter with a continuous infusion of bupivacaine and clonidine. CASE REPORT: A 73-year-old woman with metastatic malignant melanoma developed acute herpes zoster-related pain and itching unresponsive to conventional oral medications. The patient described severe and frequent attacks of lancinating pain occurring in the dermatomal distribution of the left ophthalmic division of the trigeminal nerve. She also had a disturbing itch in the same distribution as her pain. The patient had significant reduction in the frequency and intensity of the lancinating attacks after placement of a thoracic epidural catheter with continuous infusion of 1 microg/mL clonidine and 0.05% bupivacaine. The itching resolved completely as well. CONCLUSION: High thoracic epidural infusion of bupivacaine and clonidine was beneficial in relieving neuropathic itch in a patient with acute herpes zoster-related pain in the distribution of the trigeminal nerve.- - - - - - - - - - ranking = 0.48697591582648keywords = pain (Clic here for more details about this article) |
20/84. Chigger mite infestation.This article reports on a 45-year-old woman who presented with pruritus and was diagnosed as having chigger mite infestation, a rare condition. The chigger mite larvae were encountered while the patient was traveling in south america. A small erythematous area with a well-circumscribed papule in the sulcus of the second digit of the right foot was incised and drained. Follow-up examination showed relief of all symptoms, including pain and pruritus. This unusual case presentation underscores the need for all podiatric physicians to obtain a comprehensive history, including history of travel, along with performing a thorough physical examination.- - - - - - - - - - ranking = 0.048697591582648keywords = pain (Clic here for more details about this article) |
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