Efficacy of gabapentin in the improvement of pruritus and quality of life of patients with notalgia paresthetica

BACKGROUND: notalgia paresthetica is a subdiagnosed sensory neuropathy presenting as a condition of intense itching and hyperchromic macule on the back that interferes with daily habits. OBJECTIVES: To determine the efficacy of treatment of notalgia paresthetica using oral gabapentin, assessing the degree of improvement in itching and influence on quality of life. Moreover, to evaluate the signs and symptoms associated with notalgia paresthetica. METHODS: We conducted an experimental, non-randomized, parallel, non-blinded study including 20 patients with clinical and histopathological diagnosis of notalgia paresthetica. After application of the visual analogue scale of pain adapted for pruritus and of the questionnaire of dermatology life quality index (DLQI), ten patients with visual analogue scale > 5 were given treatment with gabapentin at the dose of 300 mg/day for four weeks. The other ten were treated with topical capsaicin 0.025% daily for four weeks. After the treatment period, patients answered again the scale of itching. RESULTS: The use of gabapentin was responsible for a significant improvement in pruritus (p=0.0020). Besides itching and hyperchromic stain on the back, patients reported paresthesia and back pain. It was observed that the main factor in the worsening of the rash is heat. CONCLUSION: Gabapentin is a good option for the treatment of severe itching caused by nostalgia paresthetica. .

Blefaroplastia: elevação transpalpebral das sobrancelhas / Blepharoplasty: transpalpebral brow elevation

Introdução: A descida das sobrancelhas faz parte do processo natural de envelhecimento do terço superior da face. A ação da musculatura glabelar é uma das causas desta ptose e de outros sinais de envelhecimento. Estes sinais devem ser diagnosticados e tratados de maneira adequada durante os procedimentos de blefaroplastia sob pena de piora da ptose e de resultado não satisfatório. Métodos: Ao longo dos últimos 17 anos, um total de 246 pacientes, portadores de alterações do terço superior da face e com indicação de blefaroplastia, foram submetidos à elevação transpalpebral das sobrancelhas pela técnica de McCord modificada, mediante ampla dissecção, maior número de pontos de fixação e miomectomias dos músculos corrugadores e prócerus. Os pacientes foram acompanhados com avaliações ambulatoriais e com registros fotográficos nos 6 e 12 meses de pós-operatório. Resultados: A intercorrência mais comum foi a parestesia temporária da região frontal e do couro cabeludo. Não ocorreram casos de hematomas pós-operatórios. Ao longo do tempo foram observados resultados consistentes, com manutenção da elevação das sobrancelhas e diminuição efetiva da ação da musculatura glabelar, sem cicatrizes no couro cabeludo. Conclusões: A elevação transpalpebral de sobrancelhas, associada à miomectomia glabelar, mostra-se uma alternativa adequada, segura e efetiva para tratamento dos sinais de envelhecimento do terço superior da face.

Introduction: The brows lowdown naturally occur as an aspect of the aging upper face process. The glabelar muscular action is one cause of this ptosis and also of others aging signs. These signs must be adequately treated during the blepharoplasty, to avoid the penalty of a limited final result. Methods: Along of the last 17 years, a total of 246 patients with aesthetic problems of the upper face and with blepharoplasty indication, were submitted to a transpalpebral browlift by modified McCord technique, based in a extended dissection, more fixation stitches and prócerus and corrugators muscles miomectomy. Out patients follow-up were in ambulatory conditions with photographic records after 6 and 12 months. Results: The most common intercurrence was a transient parestesia of the frontal region and of the scalp. No postoperative hematomas were registered. The results were consistent with maintenance of the eyebrows elevation and the effective reduction of the glabelar muscles action, without the necessity of any type of coronal incision. Conclusions: The transpalpebral brow elevation associated with glabellar myomectomy shows to be an adequate option, by its safe and effective procedures for the treatment of the upper face aging signs.

El síndrome del cerebro descalificado: redivivo / The disquality brain syndrome: revivified

Se describe una nueva patología nostra-de nosotros los médicos-un nuevo síndrome que afecta al médico moderno en su relación con sus pacientes y enfermedades. Se postula que el ente mórbido toma su origen en la servil sumisión del facultativo ante la ¨Deidad Máquina¨ a quien concede, entre otros atributos, omnisciencia y omnipotencia. Como resultado de su fantasía, con mucha frecuencia ¨descalifica su cerebro¨ y abdica su juicio clínico a favor de los dictados erróneos de aquella, con el consiguiente perjuicio para el paciente. Como ilustración de la condición se narran las vicisitudes de algunos enfermos y el tortuoso camino del diagnóstico de sus condiciones patológicas

The ¨dysqualified¨ brain syndrome. The author describes a hitherto undescribed syndrome which affects the modern physician and his/her relationship with patients and their diseases. He postulates that the morbid entity takes its origin from the doctor’s submission to the ¨Machine Deity¨ to whom he concedes, among other attributes, those of omnipotence and omniscience. As a result of this fantasy, physicians frequently ¨disqualify¨ his/her brain,and abdicate their clinical judgment in its favor with the ensuing disservice to their patients. As an illustration of such condition, the difficulties of several patients are presented, whose diagnostics were abusive, erroneous or delayed due to deficient clinical histories

Síndrome del túnel carpiano: libaración endoscópica versus cirugía a cielo abierto / Carpal tunnel syndrome: endoscopic release versus open surgery

El síndrome del túnel carpiano, se produce por la compresión del nervio medio dentro del túnel carpiano por cualquier afección que rellene o reduzca la capacidad del mismo, ocurriendo con mayor frecuencia en pacientes entre los 30 y 60 años, y es cinco veces más común en la mujer que en el hombre. Los síntomas se carcaterizan por parestesia en el primero, segundo y tercer dedo y la mitad radial del cuarto, inicialmente de predominio nocturno; mediante estudios eléctricos, pueden determinarse la latencia distal sensitiva y motora y la velocidad de conducción sensitiva y motora. Los estudios imagenológicos (radiografía) antero posterior, perfil y túnel carpiano pueden comprobarse si existe un conflicto de espacio de origen óseo. La sección del ligamento anular del carpo, ha sido largamente probada como un procedimiento quirúrgico eficaz y las complicaciones de la cirugía clásica a cielo abierto varia entre el 10 al 25 por ciento e incluyen: la división incompleta del ligamento anular del carpo, lesión de rama motora (tenar) del nervio mediano, lesión de la rama cutáneo-palmar del nervio medio, cuerda de arco de los tendones flexores en la muñeca, hiperestesia cicatrizal post-quirúrgica, lesión del arco palmar superficial, adherencias tendinosas, disminución de la fuerza del puño, rigidez, y la cicatrización fascicular intra neural. Con el propósito de minimizar la morbilidad post-operatoria y algunas de estas complicaciones, se abrió una nueva perspectiva con el uso de las nuevas técnicas de la cirugía endoscópicas, el análisis comparativo de los resultados muestra una clara diferencia de los beneficios de la técnica endoscópica. El propósito de este trabajo es presentar nuestra experiencia en el tratamiento quirúrgico del síndrome del túnel carpiano, utilizando la técnica endoscópica de dos portales (técnica de J. Chow) y la técnica a cielo abierto, realizándose un estudio comparativo entre ambos procedimiento quirúrgicos, morbilidad postoperatoria...

Carpal tunnel syndrome is a compression neuropathy of the median nerve as it passes through the fibro-osseous caspal tunnel at the level of the wrist. The etiology is likely multifactorial, and diagnosis is made primarily on the basis of a thorough patient history and physical examination that commonly involve pain, weakness, paresthesias, and/or numbness, happening most frequently in patients between the 30 and 60 years, and is five times commonest in the woman than in the man. The open surgical release of the carpal tunnel produced consistently excellent clinical results and the complications varies between the 10 to 25 percent, they include: Incomplete division of the annular ligament of the carpus, injury of the motor branch (to tenar) of the medium nerve, injury of the cutaneous-palmar branch of the medium nerve, cicatrizal hyperesthesia, adhesions, rigidity; in order to diminish the morbidity post operating and some of these complications. a new perspective was opened with the use of the new techniques such of the endoscopic carpal tunnel release surgery; the comparative analysis of the results shows a clear difference of the benefits of the endoscopic technique witch is a reliable procedure with a hign success rate but requieres experience and a meticulous surgical technique for avoid neurological complications. Our experience in the surgical treatment of the carpal tunnel syndrome, using the endoscopic technique of the vestibules (technical of J. Chow) and the open technique, being made a comparative study between both surgical procedures, postoperating morbity, complications and result in the "Hospital Sor Juana Ines de la Cruz" from october 2006 to january of the 2009. They were valued 92 patients with diagnose of carpal tunnel syndrome, with a follow-up of 20 months. The right side was but affected in (55 59,78 percent cases) and the left side in 40,21 percent (37 cases). 36 wrists were performed with endoscopic carpal tunnel release...

Síndrome trófico trigeminal: una causa infrecuente de úlceras faciales / Trigeminal trophic syndrome: a rare cause of facial ulceration

El síndrome trófico trigeminal (SST) es una rara causa de úlceras crónicas en cara. Se presenta con una tríada característica de úlceras faciales, parestesias y anestesia del área inervada por el nervio trigémino. Representa un doble desafío: diagnóstico, por la cantidad de diagnósticos diferenciales, y terapéuticos, por ser de muy difícil resolución. Se presenta un paciente de sexo masculino, con antecedentes de accidentes cerebrovascular con secula facial y ulceras correspondientes a este síndrome.

Notalgia parestésica / Notalgia paresthetica

La notalgia parestésica es una neuropatía sensorial caracterizada clínicamente por una mancha hiperpigmentada bien circunscrita localizada en la espalda, que afecta las áreas correspondientes a los dermatomos D2 a D6. El prurito es el síntoma más común, aunque algunos pacientes describen otras sensaciones, incluyendo ardor, parestesia, hiperestesia o dolor. Los hallazgos histopatológicos son inespecíficos. Su etiología no ha sido claramente demostrada, pero en algunos casos existe una llamativa correlación con patología de la columna vertebral, incluyendo cambios degenerativos y/o hernias del núcleo pulposo. El diagnóstico diferencial incluye la neurodermitis y la amiloidosis macular. No existe un tratamiento definitivo para la enfermedad. Se han empleado diversas terapias incluyendo capsaicina tópica, bloqueo anestésico para vertebral, oxcarbazepina, gabapentina y toxina botulínica.

Notalgia paresthetica is a sensory neuropathy characterizd clinically by a well-circumscribed hyperpigmented patch located on the back, affecting the areas corresponding to dermatomes D2-D6. Pruritus is its most common symptom, but some patients describe other sensations including burning, paresthesia, hypeesthesia or pain. Histopathological findings are not specific. The etiology of this condition has not be en clearly demonstrated but in some cases there exists a striking correlation with spinal pathology, including degenerative changes or a herniated nucleous pulposus. Differential diagnoses include neurodermitis and maclular amyloidosis There is no definitive treatment for the disease diverse therapies have been employed including topical capsaicin paravertebral local anesthetic block, oxcarbazepine, gabapentir and botulinum toxin type A.