Case of Raynaud Syndrome after the Use of Methimazole

Raynaud syndrome is a medical condition that causes pain, numbness, and changes in skin color at the distal extremities. Raynaud syndrome can be subdivided into primary Raynaud's and secondary Raynaud's. The former is diagnosed when the cause is unknown and the latter is caused by an underlying condition, such as connective tissue diseases, injury, smoking, or certain medications. Both cancer chemotherapy and β-blockers are relatively common causes of Raynaud syndrome but there are no reports of its association with methimazole administration. The authors encountered a 43-year old woman with hyperthyroidism who developed digital ulcers associated with Raynaud syndrome after a methimazole treatment. Her digital ulcers and Raynaud syndrome were improved after methimazole was replaced with propylthiouracil and conventional therapy. This paper reports this case along with a review of the relevant literature.

Ulnar Artery Obstruction in Guyon Canal Compression Syndrome

PURPOSE: There are many articles describing about Guyon canal compression syndrome. Until recently, most of these articles have been presented about the symptoms of ulnar nerve compression, but there have been no reports about ulnar artery compression. In this article, besides the nerve compression symptoms in the Guyon's canal, we represented the symptoms and treatments based on the ulnar artery obstruction. METHODS: Guyon canal is composed of the hamate and pisiform, and the ligaments which connect them. The course of the ulnar nerve and artery, which passes through this narrow canal, is affected by the anatomical structure of the base of the canal. Out of 14 patients (21 cases) were retrospectively reviewed in this study from 2006 to 2009. Of 14 patients, there were 5 men and 9 women with ages between 21 to 61 years old. The symptoms had volar sensory loss of ulnar sided digits, with muscular atrophy of hypothenar muscles. Prior to surgery, most of these patients had vascular disorders which was diagnosed definitively by angiography and electromyogram. RESULTS: The release of Guyon canal and interposition graft of the obstructed arteries was carried out to 11 patients (15 cases) who had artery (vascular) occlusive disorder, and. 12 cases had sympathectomy and interposition graft after resection of obstructed ulnar artery. Six cases had release of carpal tunnel performed simultaneously. There were no major complications after surgery. The circulation of the ulnar artery was improved along with the patients' symptoms. CONCLUSION: The pre-existing articles about Guyon canal compression syndrome were mainly focused on ulnar nerve compression. This study, which was carried out by our department, showed that most of these patients had ulnar artery obstruction or stenosis simultaneously with ulnar nerve compression. The vascular disorder was corrected by interposition graft after the resection of the site of ulnar artery occlusion. And to conclude, When we resolve the ulnar nerve compression, the proper diagnosis & treatment of impaired ulnar artery circulation should be carried out concomitantly.

Effective treatment of a digital ulcer and pain in a Raynaud's syndrome patient with using a spinal cord stimulator : A case report

Raynaud's phenomenon associated with connective tissue disease (Raynaud`s syndrome) may be difficult to manage with conservative therapy, and no gold standard therapy currently exists. Raynaud's syndrome can cause digital ulcer and necrosis, digital amputation is inevitable in some patients. Spinal cord stimulation seems to be an effective treatment for ischemic vascular disease, although little is known about the mechanisms of this effect. We present here a case for which cervical spinal cord stimulation was used to treat a digital ulcer and the intractable digital pain in a 60-year-old male patient who had severe Raynaud's syndrome. The patient had Raynaud's phenomenon associated with mixed connective tissue disease for 10 years. Three years before visiting our clinic, he underwent amputation at the second and third distal phalanges of his right hand because of digital necrosis. Two months after spinal cord stimulator implantation, his pain significantly improved from 100/100 mm VAS to 0/100 mm and the function of his hands noticeably improved.

Fenómeno de Raynaud con lesiones isquémicas digitales: tratamiento con bloqueo de ganglio estrellado: presentación de un caso / Digital ischemic lesions associated to Raynaud's phenomenon treated with stellate ganglion block: case report

El fenómeno de Raynaud consiste en la aparición paroxística de espasmo vascular, que afecta a pequeñas arterias y arteriolas cutáneas, de las extremidades. Se manifiesta con palidez extrema, que puede ir seguida de cianosis y posterior rubicundez durante la fase hiperémica. Se acompaña generalmente de disestesias y, en forma ocasional, también de dolor. Generalmente, presentan escasa repercusión sistémica asociada. Los principales desencadenantes son el frío y el estrés emocional. El bloqueo del ganglio estrellado es utilizado frecuentemente para el diagnóstico y tratamiento de múltiples sindromes dolorosos crónicos. Con el bloqueo de la actividad simpática, se produce una vasodilatación de los vasos de la extremidad superior, cabeza y cuello, siendo éste el sustrato para su utilización en cuadros de insuficiencias vasculares de las zonas inervadas. Presentamos el caso de un bloqueo de ganglio estrellado en una paciente con lesiones isquémicas digitales secundarias a un fenómeno de Raynaud primario.

The sudden onset of vascular spasm, affecting small arteries and skin arterioles of limbs is known as Raynaud's phenomenon. it includes severe paleness sometimes followed by cyanosis and redness during the hyperemic phase. Usual findings are dysestesias and ocassionally pain. Normally it causes a small systemic impact. The most relevant triggering factors are cold and emotional stress. Stellate Ganglion Block is frequently used to diagnose and treat several chronic pain syndromes. The sympathetic activity block causes the vasodilation of the arms, head and neck, and this is the substratum for using it in vascular impairment syndrome. We present a stellate ganglion block in a patient with isquemic digital lesions secondary to Raynaud phenomenon.

Digital Sympathectomy for Treatment of Raynaud's Syndrome

Raynaud's syndrome causes discolorization, ischemic claudication(pain) and necrosis of the digits through insufficiency in the circulation which is induced by intermittent spasms of the digital arteries. From January, 2002 to December, 2004, 10 patients were surgically treated for Raynaud's syndrome. 9 patients were female and 1 patient was male. 2 patients showed unilateral involvement, 8 patients were operated on both hands. 6 patients had necrotic changes on the finger tips due to the disease. Ages ranged from 21 to 60 with an average of 39.1. Ischemic pain, discolorization, and cold intolerance of the digits were the common symptoms. All patients were evaluated with color doppler before the surgery. Two different procedures were applied according to the severity of the disease: Patients with decreased circulation received, what we call a limited digital sympathectomy, i.e. stripping of the adventitia of the ulnar, radial and common digital arteries. An extended procedure, radical digital sympathectomy, was performed on patients with a complete block of circulation. Stripping of the adventitia in these patients also involved the proper digital arteries. Symptoms like discolorization, ischemic pain, and cold intolerance improved immediately after the surgery. The patients did not suffer from pain even with exposure to cold weather. We conclude that digital sympathectomy could improve the symptoms in Raynaud's patients who do not respond to conservative treatment such as calcium channel blocker and other vasodilators.

Effect of Hot Bag Application on the Extremities in Angiography of Patients with Raynaud's Syndrome

PURPOSE: It is sometimes difficult to evaluate the angiographic findings pertaining to spasm of the arteries in the hands and feet in patients with Raynaud's syndrome. The purpose of this study is to investigate the effectiveness of applying a hot bag to the hands and/or feet for the control of vasospasm in patients with Raynaud's syndrome during angiography. MATERIALS AND METHODS: Forty five cases (hands: feet=15:30) in forty patients (M:F=9:31, mean age; 39 years) with Raynaud's syndrome whose conventional angiography demonstrated the presence of vasospasm were included. First, digital subtraction angiography of the extremities was performed at room temperature (20 to 21 degrees Celsius). Then a hot bag was applied for 5 minutes on the hand or foot, and a post-hot bag angiography of the extremity was performed. The angiographic findings were classified into 6 grades in the case of the feet (0; anterior/posterior tibial artery, 1; dorsalis pedis /lateral plantar artery, 2; arcuate artery/plantar arch, 3; metatarsal artery, 4; digital artery, 5; blushing of toe tip) and 5 grades in the case of the hands (0; ulnar/radial artery, 1; palmar arch, 2; common palmar artery, 3; proper palmar artery, 4; blushing of finger tip) according to the level of the visualized vessels on the angiography. The time and the time difference to maximal visualization of the vessels between the measurements taken at room temperature and those taken after the hot bag application were calculated. RESULTS: In all cases, more vessels were visualized after the hot bag application than at room temperature. After the application of the hot bag, the grade of vessel visualization was increased in both the feet (range; 1-4, mean; 2.3) and hands (range; 1-2, mean; 1.4). The time to the maximal visualization of the vessels was faster after the hot bag application than at room temperature. The time difference between the two groups ranged from 1 to 33 seconds (mean; 12.3 seconds) in the feet and 2 to 26 seconds (mean; 11.8 seconds) in the hands. CONCLUSION: Angiography of patients with Raynaud's syndrome showed that the application of a hot bag provides a convenient and effective method of relieving the vasospasm of the vessels of the hands or feet.