1/187. sympathetic nervous system and pain: a clinical reappraisal.The target article discusses various aspects of the relationship between the sympathetic system and pain. To this end, the patients under study are divided into three groups. In the first group, called "reflex sympathetic dystrophy" (RSD), the syndrome can be characterized by a triad of autonomic, motor, and sensory symptoms, which occur in a distally generalized distribution. The pain is typically felt deeply and diffusely, has an orthostatic component, and is suppressed by the ischemia test. Under those circumstances, the pain is likely to respond to sympatholytic interventions. In a second group, called "sympathetically maintained pain" (SMP) syndrome, the principal symptoms are spontaneous pain, which is felt superficially and has no orthostatic component, and allodynia. These symptoms, typically confined to the zone of a lesioned nerve, may also be relieved by sympathetic blocks. Since the characteristics of the pain differ between RSD and SMP, the underlying kind of sympathetic-sensory coupling may also vary between these cases. A very small third group of patients exhibits symptoms of both RSD and SMP. The dependence or independence of pain on sympathetic function reported in most published studies seems to be questionable because the degree of technical success of the block remains uncertain. Therefore, pain should not be reported as sympathetic function independent until the criteria for a complete sympathetic block have been established and satisfied.- - - - - - - - - - ranking = 1keywords = deep (Clic here for more details about this article) |
2/187. Anterior ischaemic optic neuropathy in a patient with optic disc drusen.BACKGROUND: Although visual field defects are well-known complications of optic disc drusen, reduction in visual acuity with this condition is rare. METHOD/RESULTS: We report on a 68-year-old male with bilateral optic disc drusen who presented with monocular loss of vision in the right eye associated with an inferior altitudinal visual field defect and signs consistent with acute anterior ischaemic optic neuropathy, confirmed on fluorescein angiography. He also had a left inferior nasal step, but no evidence of glaucomatous cupping. The disc drusen were documented clinically and on B scan ultrasound and computed tomography. CONCLUSIONS: The diagnosis of acute anterior ischaemic optic neuropathy should be considered in patients with optic disc drusen who present with reduced visual acuity, particularly when the visual loss has been acute and non-progressive and is associated with altitudinal field loss and characteristic fluorescein angiography signs.- - - - - - - - - - ranking = 22534.789577046keywords = neuropathy (Clic here for more details about this article) |
3/187. prothrombin 20210G/A mutation in two patients with mesenteric ischemia.Primary cases of splanchnic vein thrombosis are now less common since a systematic screening for hypercoagulability is performed. In 1996, a sequence variation in the 3'-untranslated region of the prothrombin gene (F.II 20210G/A mutation) has been linked to a threefold increased risk for venous thrombosis. The role of this thrombophilic disorder is not documented in patients with thrombosis of the splanchnic veins. This report presents two patients with a mesenteric ischemia associated with a heterozygous state for the F.II 20210G/A mutation. The first patient developed an ischemic colitis and the second one an ischemic necrosis of the terminal ileum related to a thrombosis of the superior mesenteric vein. In both cases, another thrombotic risk factor was associated: either a general prothrombic state (primary antiphospholipid syndrome) or a focal factor (abnormal hemodynamic conditions related to a liver cirrhosis). It has recently been proposed that several conditions need to be combined for deep vein thrombosis to develop. Screening for the combination of multiple underlying prothrombotic conditions thus appears justified in patients with splanchnic thrombosis. The role of the F.II 20210G/A mutation as a predisposing factor for thrombosis of the digestive vessels should be considered and needs further investigation.- - - - - - - - - - ranking = 1keywords = deep (Clic here for more details about this article) |
4/187. Natural interferon therapy: optic nerve ischemic damage?The purpose of this study was the evaluation of retinal abnormalities during a treatment with natural interferon (IFN-alpha for chronic hepatitis c. Retinal hemorrhages and optic disk edema were found in a 40-year-old woman during IFN-alpha therapy. The disk edema and retinopathy resolved after the INF was discontinued. Although retinal abnormalities correlated with IFN therapy have been described recently by some authors, the pathogenesis is still unclear. Anterior ischemic optic neuropathy occurring in a patient treated with IFN is a probable complication of the therapy.- - - - - - - - - - ranking = 3755.798262841keywords = neuropathy (Clic here for more details about this article) |
5/187. Transmural necrosis of the esophagus secondary to acute aortic dissection.A case of transmural ischemic necrosis of the esophagus secondary to aortic dissection is presented. A 66-year-old woman with acute type A aortic dissection underwent total arch replacement with a technique of deep hypothermic arrest and retrograde cerebral perfusion. Postoperatively she had hematemesis, and endoscopic examination revealed circumferential mucosal necrosis and desquamation of the lower esophagus. She died of multiple organ failure on postoperative day 74. autopsy demonstrated transmural necrosis of the esophagus secondary to ischemia. ischemia of the esophagus secondary to aortic dissection is extremely rare.- - - - - - - - - - ranking = 1keywords = deep (Clic here for more details about this article) |
6/187. Optic neuropathy in uremia: an interdisciplinary emergency.Optic neuropathy in uremia is rare. Although the consequences of optic neuropathy-blindness or substantial loss of vision-are devastating, only a few cases have been reported by way of single case reports and case series studies. The reported patients are heterogeneous with regard to the cause of neuropathy. We report the case of a patient with uremic optic neuropathy and summarize the other cases reported in the literature so far. Based on the data available from these reports, we propose a classification system, which includes nonischemic neurotoxic uremic optic neuropathy; ischemic optic neuropathy, more specifically anterior ischemic optic neuropathy; and optic neuropathy as a result of drug side effects, benign intracranial hypertension, and optic neuritis. The immediate institution of dialysis and corticosteroid therapy and correction of anemia and relative hypotension can optimize the chances of visual recovery for these patients. Close collaboration among nephrologists, ophthalmologists, and neurologists is important in this interdisciplinary emergency.- - - - - - - - - - ranking = 45069.579154092keywords = neuropathy (Clic here for more details about this article) |
7/187. Interferon-induced retinopathy in asymptomatic cancer patients.OBJECTIVES: Interferon-induced ocular complications, including retinal ischemia and ischemic optic neuropathy, can be associated with significant visual loss. We report three cases of asymptomatic ischemic retinopathy in cancer patients receiving interferon. DESIGN: Retrospective, interventional, noncomparative small case series. methods: Retrospective review of the medical records and fundus photographs. RESULTS: Interferon-induced ischemic retinopathy can occur in asymptomatic cancer patients. The retinal changes are usually reversible with discontinuation of interferon therapy. CONCLUSIONS: These three cases underscore the importance of dilated funduscopic examination at baseline and during follow-up, at least every 3 months, for all cancer patients receiving interferon to identify retinal toxicity at its earliest stages. A prospective study evaluating the incidence and severity of interferon retinopathy in cancer patients would be prudent.- - - - - - - - - - ranking = 3755.798262841keywords = neuropathy (Clic here for more details about this article) |
8/187. "Pseudo-conduction block" in a patient with vasculitic neuropathy.A 63-year-old man presented with progressive asymmetric weakness and numbness in his hands of 2 weeks duration. Nerve conduction studies showed low amplitude motor evoked potentials of both median nerves. The right ulnar, left tibial and peroneal nerves had normal potentials on distal stimulation with markedly decreased amplitudes proximally, suggestive of "conduction block". Three weeks later, amplitudes were decreased throughout. The patient was diagnosed with vasculitis. The acute ischemic injury presumably resulted in axonal damage between the distal and proximal stimulation sites, with subsequent wallerian degeneration.- - - - - - - - - - ranking = 15023.193051364keywords = neuropathy (Clic here for more details about this article) |
9/187. factor v Leiden and prothrombin G20210A in relation to arterial and/or vein rethrombosis: two cases.The factor v Leiden (FV Leiden) and prothrombin G20210A mutations, are the most common established genetic risk factors for deep vein thrombosis (DVT). However, the relationship between these mutations and arterial thrombotic syndromes (coronary heart disease, myocardial infarction, stroke) has not been established. Some studies have suggested a relationship between them, but other authors have considered it unlikely that these anomalies are a major risk factor for arterial thrombosis. From the clinical point of view, a question arises concerning the risk of repeated thrombosis in patients carrying one of these two mutations. The question is whether the recurrence is attributable to the mutations or to the presence of additional circumstantial risk factors. As the risk of repeated thrombosis varies considerably from one patient to another, decisions about long-term treatment require weighing the persistence of risk factors for vascular disease (venous and arterial), especially in selected cases such as young patients or patients with thrombosis of unusual localization.- - - - - - - - - - ranking = 1keywords = deep (Clic here for more details about this article) |
10/187. Staged vascular reconstruction along with repeatedly performed angiography to prevent ischemic limb loss with Buerger's disease: report of a case.An aggressive approach to vascular reconstruction should be adopted in patients with Buerger's disease and peripheral ischemia who are often young and otherwise active. A patient with severe Buerger's disease is reported who was treated successfully by complete vascular reconstruction with staged bypass surgery while also performing repeated angiography to preserve the foot function. A 48-year-old man with Buerger's disease presented with necrosis of the foot. Angiography showed occlusion of the right distal external iliac artery and no runoff below the knee. Repeated angiography after performing a lumbar sympathectomy demonstrated patency of the distal portion of the deep femoral artery. Angiography was again performed after a reconstruction of the deep femoral artery and patency of the anterior tibial artery was observed. A staged bypass operation on the tibial artery was therefore able to achieve a prompt healing of both the toe ulcers and plantar wound.- - - - - - - - - - ranking = 2keywords = deep (Clic here for more details about this article) |
| | Next -> |