1/6. Functional improvement after physiotherapy with a continuous infusion of local anaesthetics in patients with complex regional pain syndrome.Three patients were referred to our pain clinic with evidence of complex regional pain syndrome in their extremities. Two presented at the atrophic stage with joint contractures. Multiple analgesics had been prescribed without long-lasting relief. Physiotherapy was required to improve physical activity but was severely limited by pain. We instituted local anaesthetic infusion with the possibility of self-supplementation to facilitate physiotherapy; two via brachial plexus catheters for hand pain and one via epidural catheter for knee pain. Although their resultant pain scores were variable after cessation of local anaesthetic infusion, all the affected joints exhibited marked improvement in range of movement. We propose that this technique is a useful option for patients in all stages of complex regional pain syndrome where the emphasis is now directed toward functional improvement.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/6. Fulminant dermatomyositis after removal of a cancer.dermatomyositis developed suddenly in a diabetic patient with crest syndrome after the removal of a malignant tumor. Scrupulous physical examination excluded further systemic or cutaneous involvement. We raise certain still unsolved aspects regarding the association between dermatomyositis and neoplastic disorders.- - - - - - - - - - ranking = 12.316926393556keywords = physical examination, physical (Clic here for more details about this article) |
3/6. anorexia nervosa associated with acromegaloid features, onset of acrocyanosis and Raynaud's phenomenon and worsening of chilblains.patients with anorexia nervosa may develop many physical and endocrinological complications. We wish to report two patients who developed soft tissue swelling of their hands and worsening of their peripheral vascular disease, evidenced by the appearance of acrocyanosis and Raynaud's phenomenon and more severe perniosis, following the onset of their anorexia nervosa.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
4/6. Thermal feedback in Raynaud's phenomenon secondary to systemic lupus erythematosus: long-term remission of target symptoms.Thermal feedback shows promise when applied to Raynaud's phenomenon secondary to systematic lupus erythematosus (SLE). A female subject was followed over an 8-year period that included initial training, 1-year follow-up, and 8-year follow-up. Peripheral circulation was initially very poor, as evidenced by low basal fingertip temperatures and trophic lesions at the fingernails. An intensive 5-week training regimen in thermal self-regulation yielded evidence of hand warming, followed by an increase in basal finger temperature. Reported vasospasms were markedly reduced and the lesions healed in the ensuing weeks. As of the 1-year follow-up, the skill was intact. Symptoms remained in substantial remission throughout the 8-year period during which the subject practiced somatic relaxation and hand warming without electronic feedback. Objective temperature measurement at the 8-year juncture yielded results similar to the initial acquisition, gradual manifestation of control over the first 4 days. The subject also reported diminution of vascular headache, another symptom of SLE. While much of the biofeedback literature is focused on stress-related disease, research of this kind affirms the value of self-regulatory technique in illnesses whose causes are primarily physical.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
5/6. Large vessel occlusive disease associated with crest syndrome and scleroderma.OBJECTIVES--To report the cases of three patients with crest syndrome and one patient with diffuse scleroderma who had severe macrovascular disease and only minimal vascular risk factors. methods--The medical histories, physical examinations, and results of clinical investigations were reviewed in four patients. RESULTS--These four patients had severe morbidity from macrovascular disease of the arms and legs in the presence of minimal underlying vascular risk factors. These patients represent 11% of the women with scleroderma seen at our hospital since 1974. This is a greater than threefold increase above the expected proportion of symptomatic vascular disease seen in population studies. In the patients with crest syndrome, large vessel disease was first seen more than 10 years after the onset of Raynaud's phenomenon, which was the first manifestation of the disease. A pathological specimen of the ulnar artery from one patient showed severe luminal narrowing by an acellular material with no evidence of atheroma. CONCLUSIONS--These cases suggest an association of both the crest syndrome and scleroderma with macrovascular disease.- - - - - - - - - - ranking = 12.316926393556keywords = physical examination, physical (Clic here for more details about this article) |
6/6. Silicone granuloma in acral skin in a patient with silicone-gel breast implants and systemic sclerosis.A 68-year-old white woman was referred to us by her rheumatologist for possible participation in a clinical study of photopheresis for scleroderma. In February 1993, she noticed edema of her distal phalanges, Raynaud's phenomenon in both hands, flu-like symptoms, fatigue, intermittent diarrhea, abdominal pain, tearing in both eyes, dyspnea on exertion, dysphagia, and odynophagia. Bilateral silicone-gel breast implants had been placed 12 years before; 2 months before her present evaluation, they were removed and found to be ruptured. physical examination revealed edema, limited to the fingers and hands bilaterally, and slight induration of the skin on the dorsum of both hands and distal forearms. The remainder of the physical examination was normal. According to our study protocol, a skin biopsy specimen from the dorsum of the right hand was taken, but all other laboratory investigations were refused. Histopathologic examination revealed multiple clear spaces of varying sizes in the dermis and multinucleated macrophages containing small refractile particles, characteristic of silicone granuloma (Figs. 1 and 2); however, the specimen showed no evidence of scleroderma. X-ray energy dispersive analysis by scanning electron-microscopy confirmed the presence of elemental silicon in the small refractile particles. The patient did not receive any treatment after her diagnosis and shortly thereafter, she was lost to follow-up.- - - - - - - - - - ranking = 12.316926393556keywords = physical examination, physical (Clic here for more details about this article) |