Inferior alveolar nerve paresthesia relieved by microscopic endodontic treatment.
(33/209)
We experienced two cases of inferior alveolar nerve paresthesia caused by root canal medicaments, which were successfully relieved by microscopic endodontic treatment. In the first case, the paresthesia might have been attributable to infiltration of calcium hydroxide into the mandibular canal through the root canals of the mandibular left second molar tooth. In the second case, the paresthesia might have been attributable to infiltration of paraformaldehyde through the root canals of the mandibular right second molar tooth. The paresthesia was relieved in both cases by repetitive microscopic endodontic irrigation using physiological saline solution in combination with oral vitamin B12 and adenosine triphosphate. (+info)
Indolent herpetic whitlow of the toe in an elderly patient with diabetic neuropathy.
(34/209)
We report a case of indolent herpetic whitlow of the toe occurring in an elderly male patient with poorly controlled diabetes mellitus. In this case, the mechanism of transmission was not clear, although he was in a habit of taking a hot spring bath. This patient's symptoms were unusual for herpes simplex; he had no pain in the presence of diabetic neuropathy. The standard therapeutic dose of acyclovir was not effective in suppressing the lesions, and a higher dose was required to induce complete healing. (+info)
Serotonin reuptake inhibitor induced sensory disturbances are reported rarely in the literature. This case report describes numbness and dysmorphic symptoms in the upper facial area associated with fluoxetine. There is no previous report of such an adverse reaction with any serotonin reuptake inhibitor in the literature and this report is intended to draw attention towards these unusual adverse effects. (+info)
Severe interscapular pain and increased creatine kinase activity: the answer was in the ankles.
(36/209)
Severe thoracic back pain with increased creatine kinase activity is a clinical presentation that suggests a variety of life threatening conditions. If initial examination is unrevealing, multiple diagnostic tests are usually performed attempting to identify the origin of the problem, sometimes neglecting apparently unrelated subtle physical findings. A patient is described in whom this was the initial presentation of a sensory demyelinating neuropathy, resulting in a diagnostic challenge. This case expands the differential diagnosis of severe thoracic back pain and increased creatine kinase activity, and illustrates the importance of physical examination in reaching a final diagnosis. (+info)
Bell's palsy with ipsilateral numbness.
(37/209)
Bell's palsy is an idiopathic facial palsy of the peripheral type. A herpes virus is the most likely mechanism. We report a patient with the often encountered combination of a facial palsy with ipsilateral sensory changes. Magnetic resonance imaging showed had contrast enhancement in the greater petrosal nerve. Viral spread through anatomical connections could be an explanation for the association of facial palsy with numbness. (+info)
Decreased corneal sensitivity in patients with dry eye.
(38/209)
PURPOSE: To explore changes in corneal sensitivity that develop in patients with dry eye and the relationship between sensibility and severity of the dry eye disease. METHODS: Experiments were performed in 44 patients with dry eye and 42 healthy individuals. Corneal sensitivity was measured with the Belmonte noncontact gas esthesiometer. Mechanical (air jets at flow rates from 0 to 200 mL/min, reaching the corneal surface at 34 degrees C), thermal (cold or warm air at subthreshold flow rates changing corneal basal temperature +/-1 degrees C), and chemical stimuli (air containing 0% to 50% CO2 at subthreshold flow rate and temperature at the cornea of 34 degrees C) were applied to the center of the cornea to determine the sensitivity threshold for each stimulus modality. The clinical state of the ocular surface was also explored, measuring the fluorescein tear break-up time, the degree of corneal staining with fluorescein and Lissamine green, and tear production with the Schirmer test. RESULTS: Both in control subjects and patients with dry eye, the corneal thresholds for mechanical, chemical, and thermal stimulation increased with age. Moreover, the thresholds for the three modalities of stimuli were significantly higher in patients with dry eye than in control subjects. In both groups, individual mechanical, chemical, and thermal thresholds correlated significantly. Also, high thresholds in patients with dry eye correlated with the intensity of fluorescein and Lissamine green corneal staining but not with the results of the Schirmer test. CONCLUSIONS: Patients with dry eye exhibit corneal hypoesthesia after mechanical, thermal, and chemical stimulation that appears to be related to damage to the corneal sensory innervation. (+info)
Morbidity after sentinel lymph node biopsy in primary breast cancer: results from a randomized controlled trial.
(39/209)
PURPOSE: Axillary lymph node dissection (ALND) as part of surgical treatment for patients with breast cancer is associated with significant morbidity. Sentinel lymph node biopsy (SLNB) is a newly developed method of staging the axilla and has the potential to avoid an ALND in lymph node-negative patients, thereby minimizing morbidity. The aim of this study was to investigate physical and psychological morbidity after SLNB in the treatment of early breast cancer in a randomized controlled trial. PATIENTS AND METHODS: Between November 1999 and February 2003, 298 patients with early breast cancer (tumors 3 cm or less on ultrasound examination) who were clinically node negative were randomly allocated to undergo ALND (control group) or SLNB followed by ALND if subsequently found to be lymph node positive (study group). A detailed assessment of physical and psychological morbidity was performed during a 1-year period postoperatively. RESULTS: A significant reduction in postoperative arm swelling, rate of seroma formation, numbness, loss of sensitivity to light touch and pinprick was observed in the study group. Although shoulder mobility was less impaired on average in the study group, this was significant only for abduction at 1 month and flexion at 3 months. Scores reflecting quality of life and psychological morbidity were significantly better in the study group in the immediate postoperative period, with fewer long-term differences. CONCLUSION: SLNB in patients undergoing surgery for breast cancer results in a significant reduction in physical and psychological morbidity. (+info)
A prospective study of cutaneous nerve injury following long saphenous vein surgery.
(40/209)
OBJECTIVES: The aim of this study was to identify the incidence and distribution of nerve damage in patients undergoing primary venous surgery. METHODS: Patients undergoing primary great saphenous vein surgery between February and November 2003 were enrolled. In all cases the great saphenous vein was 'flush' ligated at the sapheno-femoral junction and stripped to the knee by inversion without using a stripper head; multiple phlebectomies were performed using an Oesch hook. A vascular nurse followed up patients 6 weeks post-operatively. Those reporting altered sensation and/or pain were examined by a doctor to provide an objective assessment of any neurological damage. These patients were again followed up by telephone at 6 and 12 months. RESULTS: Sixty-three limbs from 54 patients were enrolled. Numbness or paraesthesia was identified in 17 (27%) limbs at 6 week follow-up. 11 (17%) limbs were affected below the knee and 7 (11%) limbs were affected at the thigh or groin. One of the limbs was affected above and below the knee. Of these 17 limbs there was resolution in six limbs at 6 months and nine limbs at 12 months. Two patients with persistent nerve lesions regretted undergoing surgery. Patients undergoing bilateral surgery were more likely to report abnormal sensation (chi(2) test, p=0.006). There was no significant difference between the incidence of nerve injury for consultant, SpR or SHO as first operator (chi(2) test, p=0.9). CONCLUSION: This study demonstrates the frequency of nerve injury during primary great saphenous vein surgery. It will be useful for clinicians providing informed consent and may provide a benchmark for comparison with newer techniques. (+info)