Cases reported "Pain"

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1/34. Tibialis posterior myofascial tightness as a source of heel pain: diagnosis and treatment.

    STUDY DESIGN: We report 2 cases in which a novel tibialis posterior muscle stretch is used to treat heel pain and lower extremity impairment. OBJECTIVES: To explore dysfunction of the tibialis posterior as a source of heel pain. BACKGROUND: heel pain is a common symptom of orthopaedic dysfunction of the lower extremity. Tibialis posterior tendon dysfunction is well documented in the medical and surgical literature, but its identification in its early or precursive stages has received little attention. methods AND MEASURES: An examination and treatment outline, incorporating a novel assessment and stretching technique, is presented. RESULTS: We identified a stage of dysfunction of the tibialis posterior ("Pre-Stage 1") without clinically identifiable tendon pathology. We refer to this as tibialis posterior myofascial tightness (TPMT). CONCLUSION: Tibialis posterior myofascial tightness is a clinical entity that may be differentially diagnosed in cases of heel pain and specifically treated.
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2/34. Primary hemangiopericytoma of lung: radiography and pathology.

    Two cases of primary hemangiopericytoma of the lung are reported. The massive tumors had radiographic features of round or oval contour, homogeneous opacity, well circumscribed smooth outline without calcification, and no compression of the surrounding lung tissue. They were rather homogeneous histologically, well encapsulated, and centrally located, but extended peripherally by replacement, instead of compression, of the pulmonary parenchyma. review of the literature about 34 other cases suggests these are the usual characteristics of primary hemangiopericytomas of the lungs.
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3/34. Treatment of proctalgia fugax with botulinum A toxin.

    Two recent studies described a temporal association between a high-amplitude and high-frequency myoelectrical activity of the anal sphincter and the occurrence of proctalgia, which suggest that paroxysmal hyperkinesis of the anus may cause proctalgia fugax. We describe a single case of proctalgia fugax responding to anal sphincter injection of clostridium botulinum type a toxin. The presumed aetiology of proctalgia fugax is discussed and the possible mechanism of action of botulinum toxin (BTX) in this condition is outlined. Botulinum A toxin seems to be a promising treatment for patients with proctalgia fugax, and further trials appear to be worthwhile for this condition, which has been described as incurable.
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4/34. Juvenile fibromyalgia syndrome: proposed management using a cognitive-behavioral approach.

    In recent years, fibromyalgia has become an increasingly recognized chronic syndrome. Although it occurs more frequently in adults, it is also seen among school-age children and adolescents. In such cases, it is known as juvenile fibromyalgia syndrome (JFS). The widespread pain and other possible symptoms associated with JFS can have a negative impact on the occupational performance and developmental tasks of children and adolescents. As experts in the areas of occupational performance, daily functional skills, and child development, occupational therapists have a potential role to play in the assessment and management of children and adolescents with JFS. To date, however, no occupational therapy management approach for clients with JFS has been documented in the professional literature. In this paper, we outline the clinical features of JFS, pertinent assessment areas, and potential management strategies using a cognitive-behavioral approach.
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5/34. Case study to illustrate a multidisciplinary approach to a case of critical limb ischaemia and the role of chemical lumbar sympathectomy.

    This case study illustrates the role of the Podiatrist in the primary health care team and how a multidisciplinary approach to treatment promotes successful diagnosis and treatment regimes. It also outlines the role for chemical lumbar sympathectomies in treating critical lower limb ischaemia, a procedure regarded as having been superseded by more effective treatments but which proved to be the treatment of choice in this case. The subject of this case study presented at a community podiatry clinic exhibiting the signs of acute ischaemia, together with two recently developed ulcers on her right foot. After further vascular investigations, including angiograms and doppler studies, a blockage in the popliteal artery was revealed. Due to anatomically slender arteries, angioplasty and by-pass surgery were contra indicated. A chemical lumbar sympathectomy was performed in an attempt to increase blood flow to the tissues and to reduce the extreme pain being experienced by the patient. This proved successful, allowing the lesions to heal and also the collateral circulation to develop, resulting in a re-vascularized, viable foot.
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6/34. EMDR in the treatment of chronic pain.

    chronic pain presents a persistent and significant clinical challenge. research examining commonly used psychotherapeutic treatments suggests that the results are not always well maintained, and that pain often is unrelieved. Continued exploration of new and more effective approaches is necessary. This article outlines an application of eye movement Desensitization and Reprocessing (EMDR), developed to improve coping and reduce chronic pain and suffering. The effectiveness of the EMDR chronic pain Protocol was investigated with three adult chronic pain sufferers. Intervention effectiveness was measured at baseline, during, and postintervention, with a two-month follow-up. All clients reported substantially decreased pain levels, decreased negative affect, and increased ability to control their pain following treatment. These results indicate that EMDR may be efficacious in the treatment of chronic pain and that further research is warranted.
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7/34. Sickle cell disease -- when opioids and physicians fail.

    An interview with a 32-year-old male with sickle cell anemia and multiple sequential admissions for vaso-occlusive crises, receiving high dose narcotic analgesics, is presented. The subsequent clinical discussion outlines psychiatric, psychosocial and treatment issues. Management of acute vaso-occlusive crisis is summarized along with a discussion of the value of comprehensive care for sickle cell disease patients. This article will be useful to physicians and consultation-liaison psychiatrists treating patients with sickle cell disease as well as policy makers developing service delivery models for this population.
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8/34. Natural killer cell lymphoma in the duodenum.

    We present a case of duodenal non-Hodgkin lymphoma in a 71-year-old woman. immunohistochemistry characterized the lymphoma cells as CD2( ); surface CD3(-) but cytoplasmic CD3( ); CD7( ); and CD56( ) without a rearrangement of the T-cell receptor gene. cells had a high N/C ratio and irregular nuclear outlines and lacked azurophilic granules and these features indicated that the lymphoma cells arose from natural killer (NK) cells. She was treated with intensive chemotherapy including pirarubicin, cyclophosphamide, vincristine, and prednisolone, but died three weeks after diagnosis. CD56( ) lymphomas originate from NK or cytotoxic T cells and are designated "extranodal NK/T-cell lymphoma, nasal type" in the WHO classification. Nasal NK cell lymphoma is most common in East Asians and CD56( ) lymphomas usually occur in the nasal area. Extranasal forms such as gastrointestinal lymphomas are very rare and usually carry a poor prognosis. Extranodal NK/T-cell lymphoma, nasal type, is characterized by a broad morphologic spectrum and have variable prognosis. These lymphomas constitute an heterogeneous group, and their subclassification has not yet been established.
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9/34. Painful neuropathy vasculitis in 2 patients with long-standing human immunodeficiency virus-1 infection.

    We describe 2 most unusual cases of distal symmetrical painful polyneuropathy in patients with long-standing hiv-1 infection well controlled by HAART. sural nerve biopsies revealed vasculitis in both cases and steroid therapy led to resolution of symptoms not influenced by analgesics and anti-inflammatory drugs. These unusual cases outline the importance of nerve biopsies in order to reach a diagnosis.
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10/34. Bilateral spontaneous vertebral artery dissection: management during labor and vaginal delivery.

    We report the successful management of labor and delivery of a parturient with a history of spontaneous bilateral vertebral artery dissection. We also outline the reasons why the obstetric anesthetist should be aware of this condition as well as other cranio-cervical dissections.
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