1/67. Aggravation of poststroke sensory symptoms after a second stroke on the opposite side.The role of the ipsilateral hemisphere in sensory functions remains unknown. The author describes 5 patients who presented with hemisensory symptoms due to unilateral strokes occurring in the left putamen, left thalamus, right putamen, right lateral medulla and left thalamic-internal capsular area, respectively. Sensory symptoms had gradually improved or remained stable after the initial events. However, when another stroke occurred on the contralateral thalamic-occipital, frontoparietal, lateral medulla, temporoparietal and pontine areas, respectively, previous sensory symptoms significantly worsened and became painful. These observations suggest that ipsilateral sensory pathways play a role in the modulation of sensory functions.- - - - - - - - - - ranking = 1keywords = stable (Clic here for more details about this article) |
2/67. Anginal pain referred to the teeth. Report of a case.A case is reported in which initial anginal pain was localized to the area of the left posterior teeth. Subsequently the patient reported that at certain times he experienced pain in the area of the left posterior teeth with concomitant chest pain while at other times the pain was confined to the teeth.- - - - - - - - - - ranking = 54.770612759049keywords = angina (Clic here for more details about this article) |
3/67. A novel approach to pain relief pre-therapeutic exercise.Musculoskeletal problems are often multifactorial and consequently can be challenging to treat. This paper examines management of chronic musculoskeletal conditions in the light of Panjabi's stabilisation subsystems and Dye's concept of homeostasis and critical symptom threshold. In many circumstances treatment can aggravate symptoms. Tape may be used to unload painful structures to minimise the aggravation of the symptoms so treatment can be directed at improving the patient's 'envelope of function'. This involves specific muscle training of the dynamically unstable segment/s and increasing the mobility of the less flexible surrounding soft tissues. Three case studies of chronic low back and leg pain, patellofemoral pain and shoulder impingement secondary to multidirectional instability, are presented as examples of multifactorial musculoskeletal problems requiring unloading, stabilisation and control.- - - - - - - - - - ranking = 1keywords = stable (Clic here for more details about this article) |
4/67. Changing M3G/M6G ratios and pharmacodynamics in a cancer patient during long-term morphine treatment.A cancer patient receiving long-term oral sustained-release morphine treatment and periodically presenting with unusually high plasma M3G/M6G ratios is described. We found the patient's formation of M6G more unstable and perhaps delayed compared to the formation of M3G. There is no apparent explanation for this phenomenon and the high M3G/M6G ratios had no implications for the patient's pain experience or side effects from the morphine treatment.- - - - - - - - - - ranking = 1keywords = stable (Clic here for more details about this article) |
5/67. Coronary angiographic, echocardiographic, and electrocardiographic studies on a patient with variant angina due to coronary artery spasm.A 45-year-old Caucasian female patient with a clinical rehistory and ECG's conforming to the syndrome of variant angina as characterized by Prinzmetal is presented. ECG's recorded during spontaneous pain demonstrated ST-segment elevation and symmetrical peaking of the T-waves in the lateral precordial leads and short runs of ventricular tachycardia. Similar ECG changes were recorded during treadmill exercise- and hand-grip exercise-induced chest pain. An echocardiogram recorded during angina induced by hand-grip exercise demonstrated progressive flattening of septal motion. Multiple views of the coronary system by selective coronary cineangiography were normal with the patient at rest. Angina was then induced by hand-grip exercise and a repeat right anterior oblique view of the left coronary system revealed marked spasm of the left anterior descending artery proximal to the first septal perforator.- - - - - - - - - - ranking = 328.6236765543keywords = angina (Clic here for more details about this article) |
6/67. bone marrow edema of the forefoot after chevron osteotomy--a rare cause of metatarsalgia: a case report.Treatment options of bone marrow edema syndrome, which is associated with vascular disturbances, are protracted nonoperative treatment or core decompression which still demands several weeks until complete recovery. We obtained excellent results by the use of the vasoactive drug iloprost, a stable prostacyclin analogue, leading to a complete relief of symptoms in cases of bone marrow edema which had initially suggested early avascular necrosis of the second metatarsal head. The bone marrow edema of the second metatarsal bone was thought to be due to altered biomechanics following a distal first metatarsal chevron osteotomy. During the five days of iloprost infusion, the patient reported relief of rest pain. After therapy, the pedobarogram was normalized. The AOFAS forefoot score improved from 44 to 85 points after one month, and to 95 points after three months. At that time, the marrow showed normal signals. Without additional intervention the patient was able to resume normal activities.- - - - - - - - - - ranking = 1keywords = stable (Clic here for more details about this article) |
7/67. Vertebral epidural arteriovenous fistula and radicular pain in neurofibromatosis type I.A minor trauma caused opening of an arteriovenous fistula between the right vertebral artery and cervical spinal epidural venous plexus in a patient with neurofibromatosis Type I. Subsequent dilation of the plexus caused compression of the spinal cord and radicular symptomology of the right upper extremity. The single-hole fistula and its arterial feeder were filled with electrodetachable coils via an intra-arterial approach. This lead into shrinkage of the plexus, reformation of the cord caliber and full and stable clinical recovery. The achieved endovascular occlusion of the fistula proved to be permanent on follow-up.- - - - - - - - - - ranking = 1keywords = stable (Clic here for more details about this article) |
8/67. Palliative treatment of painful bone metastases from non-Hodgkin lymphoma with disodium pamidronate.We report a case of a 72-year-old male, with a known history of non-Hodgkin lymphoma of the left tonsil for two years, histologically proved and successfully treated by radical surgical excision in combination with external radiotherapy. He presented with diffuse bone pain the last month, especially at the lower left ribs, which was found to be due to multiple osseous metastases by bone scintigraphy. The patient was initially treated by common analgesics and when the pain deteriorated he was administered 180 mg i.v. disodium pamidronate (AREDIA, Novartis Inc.). The patient showed excellent pain relief as well as dramatically improvement of WHO status and stopped the analgesics. An interesting point of our case was that the pain deteriorated again after a month and reduced soon after the re-administration of pamidronate, which was continued every month. So far, 10 months after the first pamidronate injection, our patient remains stable with excellent pain relief. Despite the absence of related data in the current literature, we consider the use of high dose pamidronate intravenous therapy safe and an effective method of palliative management of painful osseous metastases from non-Hodgkin lymphoma.- - - - - - - - - - ranking = 1keywords = stable (Clic here for more details about this article) |
9/67. buprenorphine TDS: use in daily practice, benefits for patients.In germany and many other countries, buprenorphine has been used for a long time for the management of pain in both cancer and non-cancer patients. Although a transdermal delivery system for buprenorphine (Transtec) has recently been introduced, the clinical experience in daily practice with this drug, delivered in a matrix patch, is only now being evaluated. In preliminary data from a survey of 3,255 patients with chronic pain, 26% had cancer pain, while the most common diagnoses of the other respondents included back pain (33%), osteoarthritis (22%), osteoporosis (17%), and neuropathic pain (10%, multiple entries). Before being switched to the buprenorphine patch, most patients had been pretreated with world health organization (WHO) Step II opioids (47%) or WHO Step III opioids (18%), including tramadol (in 35% of patients) and a tilidin/naloxone combination (15%); 9% had not been prescribed any opioids in advance of receiving transdermal buprenorphine. Most patients (77%) in the survey had been started on the lowest dose of the buprenorphine patch (35 microg/h), and nearly half (49%) were placed on adjuvant analgesics, including tramadol or tilidin/naloxone. Pain relief was rated as good or very good by 81% of the respondents. Adverse effects were similar to those seen on other opioids, although their intensity was mild in most cases. Local side effects, including erythema (4% of cases) and pruritus (1%), were transitory. Based on the survey results, transdermal buprenorphine is considered an effective opioid treatment for patients with stable cancer and non-cancer pain; it may prove particularly useful in patients who have experienced side effects taking oral analgesic preparations, as well as in those who are taking extensive co-medications.- - - - - - - - - - ranking = 1keywords = stable (Clic here for more details about this article) |
10/67. Transdermal fentanyl: informed prescribing is essential.While morphine is historically the gold standard for the management of severe cancer pain, some patients either do not achieve adequate analgesia, or suffer intolerable side-effects. For these patients an alternative opioid is recommended. One such alternative is the potent mu opioid agonist fentanyl, delivered in a transdermal controlled release formulation. Similar to morphine, transdermal fentanyl is effective for the management of moderate to severe cancer pain. However, inappropriate prescribing of transdermal fentanyl, particularly in the clinical setting of unstable pain, can cause significant opioid toxicity, as highlighted in the case reports described.- - - - - - - - - - ranking = 1keywords = stable (Clic here for more details about this article) |
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