1/15. Allergic reaction to spinal cord stimulator.OBJECTIVE: The objective was to report on the possibility of allergic reaction to the components of a spinal cord stimulator. DESIGN: We describe a severe allergic reaction after the insertion of a spinal cord stimulator in a patient with complex regional pain syndrome type 1. SETTING: The patient was being followed in an office-based pain management practice. PATIENT: The patient is a 41-year-old woman with complex regional pain syndrome type 1, posttrauma. Intervention: Insertion of a cervical and lumbar spinal cord stimulator. OUTCOME MEASURES: The outcome measures were a numerical scale of pain intensity and the ability to perform the activities of daily living. RESULTS: Adequate pain control complicated by allergic reaction. CONCLUSIONS: There exists a possibility that a patient may experience an allergic reaction to spinal cord stimulator components. Recognition of such contact sensitivity is important for physicians implanting such devices. patients may be misdiagnosed as having infections, which can delay appropriate management; definitive diagnosis can be confirmed with a patch test. Treatment consists of removal of such devices.- - - - - - - - - - ranking = 1keywords = complex (Clic here for more details about this article) |
2/15. The "Peter Pan" syndrome and allergy practice: facilitating adherence through the use of social support.The complexity of care of some patients in an allergy-immunology practice may be increased by behavioral abnormalities of the patients. Facilitating adherence through the use of social support may be the most effective treatment strategy for some of the most difficult of these patients. We report three patients whose medical management problems were alleviated largely because of the participation of their support system. All three patients were stabilized because of the acceptance of responsibility and support of the physician by the designated member of the patient's support system. The range of social support used to manage nonadherent patients ranged from directly providing instructions to a family member to the consistent presence of a spouse or companion at multiple clinical visits. In all cases, the success in management was attributed largely to the presence of a support system.- - - - - - - - - - ranking = 0.5keywords = complex (Clic here for more details about this article) |
3/15. The safety of low-dose larrea tridentata (DC) Coville (creosote bush or chaparral): a retrospective clinical study.OBJECTIVE: To determine whether internal use of low doses of larrea tridentata tincture or topical applications of this traditional herbal medicine are safe. DESIGN: Retrospective review of all people prescribed larrea for internal or for topical use over a 22-month period. SETTING/LOCATION: A general naturopathic practice in Sedona, arizona. SUBJECTS: Thirteen patients were identified for whom larrea tincture for internal use was prescribed. An additional 20 female and 3 male patients were identified for whom an extract of larrea in ricinus communis (castor) oil for topical use was prescribed. No patient had any history of liver disease. INTERVENTIONS: larrea was prescribed as part of the usual care of each patient. In all cases it was given as either part of a complex herbal formula individualized for each patient containing less than 10% larrea tincture or as an extract in ricinus oil for topical use. OUTCOME MEASURES: serum liver enzyme levels as well as blood urea nitrogen and creatinine levels, glucose levels, electrolytes, bilirubin levels, iron levels, ferritin levels, lipid levels, and complete blood count (CBC) were available for analysis in four patients; general clinical history and physical examination findings were relied on in all other cases. RESULTS: The four patients with complete before and after blood chemistry panels and CBC had no indication of liver damage from use of larrea. This included one patient who was taking medications with significant potential for hepatotoxicity. No patient in the study, whether using larrea for short term or long, internally or externally, showed any sign of organ damage during the period of follow-up. CONCLUSIONS: Relatively small intakes of larrea tincture, or topical application of extracts in ricinus oil, are safe when prescribed by a clinically trained botanical prescriber. larrea should be used with caution in persons with a history of previous, or current, liver disease. It may be preferable to avoid the use of larrea capsules because they have been associated with potentially dangerous overdosing.- - - - - - - - - - ranking = 0.5keywords = complex (Clic here for more details about this article) |
4/15. Acute myopericarditis after diphtheria, tetanus, and polio vaccination.We report the first case of myopericarditis after triple vaccination against diphtheria, tetanus, and poliovirus in a young adult. He presented with fever, acute chest pain, and diffuse ST-segment elevation 2 days after vaccination. Two-dimensional echocardiography findings were normal. Endomyocardial biopsy showed interstitial edema with diapedesis of erythrocytes. Laboratory findings showed inflammatory syndrome and elevated circulating immune complexes. He recovered within a few days with high-dose aspirin treatment and was without complications at 3-month follow-up. We discuss the different hypotheses for infective or hypersensitivity myocarditis.- - - - - - - - - - ranking = 0.5keywords = complex (Clic here for more details about this article) |
5/15. Circulating immune complexes and activation of the complement sequence in acute allergic bronchopulmonary aspergillosis.A 13-yr-old asthmatic girl with allergic bronchopulmonary aspergillosis (ABPA) exhibited eosinophilia, IgE hypergammaglobulinemia, serum precipitins to Aspergillus, a dual skin reaction to aspergillus fumigatus, and positive, lymphocyte transformation in vitro in response to stimulation with aspergillus fumigatus antigen. The acute phase of the disease was characterized by an increase in blood eosinophilia, a rise in serum IgE, circulating immune complexes, and evidence of activation of the complement system through the classical pathway.- - - - - - - - - - ranking = 2.5keywords = complex (Clic here for more details about this article) |
6/15. Autoimmune retinopathy with RPE hypersensitivity and 'negative ERG' in X-linked hyper-IgM syndrome.PURPOSE: To report the clinical, electrophysiological, and immunological features of a patient with X-linked hyper-igm immunodeficiency syndrome type 1 (HIGM1) accompanied by a novel type of autoimmune retinopathy, including retinal pigment epithelium (RPE) hypersensitivity. methods: Comprehensive ophthalmological examinations, electrophysiological function testing, and inquiries into the immunological status of a 13-year-old presenting with subacute loss of vision in association with a molecularly confirmed diagnosis of HIGM1 were performed. The patient was genotyped by a PCR-based sequence tag content mapping strategy to define the genetic defect within the causative X-HIM gene TNFSF5. Since conventional allogenic bone marrow transplantation has been reported to cure HIGM1, a peripheral blood stem-cell transplantation was performed. RESULTS: (1) The patient's reduced visual acuity included prolonged dark adaptation and visual field constriction. electrophysiology revealed a 'negative ERG' indicating post-receptoral dysfunction. (2) Initial immunological examination of the patient's serum identified abnormal antibody activity with components of the photoreceptors and the inner nuclear layer. The patient later developed indications of RPE hypersensitivity. A massively reduced light-peak to dark-trough ratio of the EOG slow oscillations (L/D ratio) corresponded to impaired RPE-photoreceptor complex function. (3) Molecular genetic analyses revealed the patient to be nullizygous for the tumor necrosis factor ligand member 5 gene (TNFSF5; CD40LG). A large chromosomal deletion of approximately 27.6-32.3 kb in size was identified in Xq26. (4) The transplant with its associated immunomodulation appeared to worsen rather than improve the patient's condition. CONCLUSIONS: The fundus appearance and electrophysiological function testing revealed indications of atypical retinal degeneration. However, the clinical course and the serological findings were consistent with those of ocular autoimmunity involving both antiretinal activity and RPE hypersensitivity. In this case, peripheral stem-cell transfusion with its associated chemotherapy failed to benefit the patient's vision; indications of autoimmunity appeared to increase following this treatment.- - - - - - - - - - ranking = 0.5keywords = complex (Clic here for more details about this article) |
7/15. Normocalcemic tetany and candidiasis.We have observed a high frequency of chronic candida albicans infection and of allergic sensitization to candida among patients with normocalcemic latent tetany (LT). Among 50 LT patients, 34% suffered from recurrent or chronic candida infection by history, 24% showed evidence of active infection and 48% demonstrated type I hypersensitivity to C. albicans extract on intradermal testing. Treatment with oral antifungal drugs and allergy desensitization to Candida produced complete relief of symptoms in 44% of the patients, with remission occurring for symptoms of depression, irritable bowel syndrome, fatigue, premenstrual tension, headache, anxiety and back pain. The complex relationship between candidiasis and Mg deficit is discussed. patients with LT, refractory symptoms and a history of prolonged antibiotic exposure or recurrent candida infection should be considered for oral antifungal therapy and candida desensitization.- - - - - - - - - - ranking = 0.5keywords = complex (Clic here for more details about this article) |
8/15. Haemostatic and complement changes in a family with 'allergic' disorders.A family with allergic manifestations, haemostatic disturbances, total absence of haemolytic activity of the complement system and low IgG levels is described. It is suggested that this functional abnormality of the complement system and the decreased level of immunoglobulin g may be due to immune complex reactions.- - - - - - - - - - ranking = 0.5keywords = complex (Clic here for more details about this article) |
9/15. systemic vasculitis with asthma and eosinophilia: a clinical approach to the churg-strauss syndrome.Drawing on our experience of 16 cases and a review of the English literature, we propose that CSS is under-diagnosed because of exclusive emphasis upon pathologic recognition of the disorder. The classical histological picture comprises a necrotizing vasculitis, eosinophilic tissue infiltration and extravascular granulomas, but it is only found in a minority of cases, and is not pathognomonic of the condition (69, 108). On the other hand, the clinical pattern of the disorder is most distinctive, and CSS can be readily identified on clinical grounds. Typically, it begins with allergic rhinitis, which is often complicated by nasal polyposis and sinusitis. asthma and peripheral blood eosinophilia are essential features, often accompanied by pulmonary infiltrates. The systemic vasculitis of CSS resembles that of PAN, but severe renal disease is uncommon (the typical renal lesion is a focal segmental glomerulonephritis), and cardiac involvement accounts for 50% of deaths. Diagnostic difficulties arise from the close relationship of CSS to other granulomatous, vasculitic and eosinophilic disorders. CSS is usefully regarded as a point of overlap between these three disease spectrums (Fig. 5). Individual components of each spectrum can occur in the course of CSS; hence cases may be reported as PAN developing as a complication of Loffler syndrome or eosinophilic gastroenteritis (37, 57, 66). The hypereosinophilia of CSS tends to be less severe and more steroid-responsive than in HES, and evidence of eosinophil degranulation was not found in the patients we studied. Complement abnormalities are not a prominent feature of the disorder, and circulating immune complexes were detected in only two cases; both contained IgM. This may be of pathogenetic significance as IgM deposition was a dominant feature in four of the five cases with positive renal immunofluorescence. IgE levels were elevated in all patients studied during the vasculitic phase, and skin-prick tests were positive in 8 of 10 patients tested. CSS responds well to treatment with steroids, although some patients benefit from the addition of immunosuppressive agents. The vasculitic illness is usually of limited duration, but relapses can occur, and should be detected and treated early. Major problems in the post-vasculitic phase stem from hypertension and persisting peripheral nerve damage. Allergic upper and lower respiratory tract disease is an important cause of morbidity in the pre- and post-vasculitic periods.- - - - - - - - - - ranking = 0.5keywords = complex (Clic here for more details about this article) |
10/15. Distichiasis complicating allergic rhinoconjunctivitis.Three patients had four lid distichiasis and signs and symptoms of allergic rhinoconjunctivitis. The findings consisted of ocular irritation with tearing, photophobia, periodic lid swelling, rhinorrhea, and boggy nasal mucosa. Treatment of the allergic rhinoconjunctivitis was unsuccessful until the distichiasis was relieved. Exacerbations of signs and symptoms recurred when lashes regrew. A neural reflex relationship exists to explain most of the symptom complex resulting from ocular irritation. In the evaluation of patients with rhinoconjunctivitis, trichiasis should be looked for, especially if there is noticeable photophobia present.- - - - - - - - - - ranking = 0.5keywords = complex (Clic here for more details about this article) |
| | Next -> |