1/5. reflex sympathetic dystrophy: electronic thermography as an aid in diagnosis.Reflex sympathetic dystrophies can be distressing conditions for patients as well as physicians. In the full-blown case, the diagnosis is easy to make; however, many more subtle forms of reflex sympathetic dystrophy exist. In the full-blown case, diagnosis may be quite simple when the physical findings are present. In the more subtle forms, however, one must have a high index of suspicion in order to make the diagnosis. Clinical testing, such as stellate ganglion blocks, may or may not be helpful. Electronic infrared thermography emerges as a helpful tool in the aid to diagnosis. We have presented several cases in order to illustrate this.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/5. reflex sympathetic dystrophy in a teenaged girl.A patient had pain, a cold feeling, and absent pulses in the lower part of the right leg. Minimal change was present on Doppler artery examination. She was diagnosed as having reflex sympathetic dystrophy and was treated with nifedipine (Adalat, Procardia). Symptoms gradually diminished, and after three months the results of physical examination were normal, although she still had an occasional cool feeling in the right foot. reflex sympathetic dystrophy seems to be a common condition, but it is not widely understood and is probably underdiagnosed. It may be seen by primary care physicians as well as by specialists. Treatment is fairly simple. When pain with vasospasm is the presenting manifestation, use of a calcium channel blocker or prazosin (Minipress) in addition to physical therapy should be considered.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/5. Musculoskeletal syndromes associated with malignancy.Evidence has been presented supporting a causal relationship between malignancies and musculoskeletal syndromes. This discussion has dealt primarily with lesser known relationships, more common associations such as hypertrophic osteoarthropathy and dermatomyositis being reviewed elsewhere. The ones discussed herein closely mimic primary connective tissue diseases and offer an insight into the study of the pathogenesis of these primary diseases. In view of the natural history of malignant disease, the hope for such patients arises from the physicians early diagnosis and treatment of the underlying malignancy. early diagnosis and treatment may in turn be entirely dependent on the physician's awareness of a musculoskeletal syndrome being the presenting feature of an otherwise occult neoplasm. Several connective tissue syndromes appear to predispose to the development of malignancy, and increasing evidence suggests that this development of malignancy may be further enhanced by immunosuppressive therapy.- - - - - - - - - - ranking = 2keywords = physician (Clic here for more details about this article) |
4/5. reflex sympathetic dystrophy in children: an orthopedic perspective.To design diagnostic criteria for reflex sympathetic dystrophy (RSD) and to initiate a prospective treatment protocol, we reviewed our experience with 49 episodes of RSD in 36 children. There were 24 females and 12 males; mean age at diagnosis was 13.4 years (range: 8 to 19); mean time from pain onset to correct diagnosis was 9.2 months (range: 1 to 53). lower extremity involvement predominated. Pain was "severe" in 61%, and skin color changes, swelling, hyperesthesia, abnormal skin temperatures, muscle weakness, and decreased range of motion were all present in at least 75% of cases. Osteopenia was observed in 15 of 38 radiographs; of 24 bone scans, 7 were normal, 11 showed increased uptake, and 6 demonstrated decreased uptake. Of the 23 children who had psychological evaluations, 83% revealed some type of significant emotional dysfunction. Analgesic and antiinflammatory medications were not helpful, nor were local injections or regional blockades effective. An inpatient diagnostic and rehabilitation program for treating chronic pain, including orthopedics, rheumatology, psychology, and twice-daily physical therapy was most likely to lead to resumption of age-appropriate activities. Despite extensive physiological testing, physician, parent, and/or patient reluctance to accept absence of a primary organic disease was common. We present diagnostic criteria for pediatric RSD.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/5. Upper limb reflex sympathetic dystrophy associated with occult malignancy.reflex sympathetic dystrophy, characterized by pain, swelling, vasomotor instability, and trophic changes in an extremity, has been infrequently described in patients with occult malignancy. Two cases of reflex sympathetic dystrophy associated with local tumor involvement are reported. Both patients had a history of cancer in clinical remission. Despite aggressive physical therapy measures, the patients' symptoms persisted. Workup of the first patient found an apical paravertebral mass in the lung; biopsy revealed recurrent breast carcinoma. In the second case, workup found an axillary mass contiguous with the lower brachial plexus. biopsy revealed lymphoma, a second primary malignancy. In both cases, medical treatment of the tumor was instituted, with consequent improvement of hand and shoulder function. Both patients required prolonged hospitalization and multiple procedures that might have been avoided if malignancy had been suspected. Spontaneous development of reflex sympathetic dystrophy in patients with a history of cancer should alert the physician to the possibility of occult malignancy.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |