ABSTRACT
Mujer de 42 años, que presentó durante 6 años clínica insidiosa de dolor e impotencia funcional de miembro inferior izquierdo con pruebas diagnósticas normales llegando a un diagnóstico de exclusión de origen funcional. Fue sometida a tratamientos y técnicas conservadores sin mejoría por lo que se decidió realizar cirugía exploratoria donde se observó una compresión del nervio ciático por una variación anatómica del músculo piriforme. Tras resecar parte del músculo piramidal y liberarse la rama del nervio ciático afectada, se constató mejoría del cuadro clínico quedando la paciente asintomática (AU)
The case is presented of a 42 year old woman who had been suffering a loss of strength in her left leg for six years. After an extensive diagnostic study, the pain was classified as of functional origin by a diagnosis of exclusion. Since then, the patient has tried all kind of drug treatments and conservative techniques without improvement. After an exhaustive study with inconclusive results, the case was discussed with the Orthopaedics Department, who performed an exploratory surgery, in which compression of the sciatic nerve due to an anatomical variation of the piriformis muscle was observed. Part of the muscle was resected during surgery and the sciatic nerve was freed, after which the patient experienced a great improvement (AU)
Subject(s)
Humans , Female , Adult , Sciatic Nerve , Sciatic Neuropathy/complications , Sciatic Neuropathy/diagnosis , Sciatic Neuropathy/drug therapy , Nerve Compression Syndromes/complications , Nerve Compression Syndromes/diagnosis , Nerve Compression Syndromes/drug therapy , Muscles , Anesthesiology/methods , Diplopia/complications , Evoked Potentials, Somatosensory , Somatosensory Disorders/drug therapyABSTRACT
The case is presented of a 42 year old woman who had been suffering a loss of strength in her left leg for six years. After an extensive diagnostic study, the pain was classified as of functional origin by a diagnosis of exclusion. Since then, the patient has tried all kind of drug treatments and conservative techniques without improvement. After an exhaustive study with inconclusive results, the case was discussed with the Orthopaedics Department, who performed an exploratory surgery, in which compression of the sciatic nerve due to an anatomical variation of the piriformis muscle was observed. Part of the muscle was resected during surgery and the sciatic nerve was freed, after which the patient experienced a great improvement.
Subject(s)
Muscle, Skeletal/abnormalities , Piriformis Muscle Syndrome/etiology , Sciatica/etiology , Adrenal Cortex Hormones/therapeutic use , Adult , Anesthetics, Local/therapeutic use , Decompression, Surgical , Diagnostic Techniques, Neurological , Female , Humans , Injections, Intramuscular , Mobility Limitation , Paresthesia/etiology , Piriformis Muscle Syndrome/diagnosis , Piriformis Muscle Syndrome/pathology , Piriformis Muscle Syndrome/surgery , Sciatica/pathologyABSTRACT
Patients with the acquired immunodeficiency syndrome (AIDS) are characteristically hypouricemic. Therefore, the occurrence of gouty arthritis in association with AIDS would be expected to be a rare phenomenon. We describe a patient with AIDS in whom gouty arthritis developed. Features of both diseases in relation to their coexistence in this patient are discussed.
Subject(s)
Acquired Immunodeficiency Syndrome/complications , Arthritis, Gouty/complications , Arthritis, Gouty/diagnostic imaging , Arthritis, Gouty/drug therapy , Biopsy, Needle , Colchicine/therapeutic use , Humans , Indomethacin/therapeutic use , Joints/pathology , Male , Middle Aged , RadiographyABSTRACT
BACKGROUND: Costochondritis (CC) is a common, but poorly understood condition among patients with chest wall pain. We have prospectively analyzed distinctive features of patients presenting to the emergency department with chest pain and CC. METHODS: Patients with a chief complaint of chest pain, not due to trauma, fever, or malignancy, were prospectively evaluated for the presence of CC and compared with another chest pain group without CC. RESULTS: Of 122 consecutive patients studied, 36 had CC (30%) and in 17 the pain induced reproduced the original one (15%). Women made up 69% of the patients with CC (vs 31% of control subjects) and Hispanics 47% (vs 24% of control subjects). Only three patients (8%) with CC met the American College of Rheumatology criteria for fibromyalgia, while none of the control subjects did. Widespread pain was more common in the CC group (42% vs 5%). The mean sedimentation rate in the CC group was 44 +/- 31 mm/h vs 41 +/- 31 mm/h in the control group. The acute myocardial infarction rate was 6% in the CC group vs 28% in the control group. Rheumatoid arthritis and osteoarthritis were diagnosed in three and two patients, respectively, of 32 patients with CC cases. One year later, 11 (55%) of 21 patients with CC were still suffering from chest pain, but only one third still had definite CC. CONCLUSIONS: Costochondritis is common among patients with chest pain in an emergency department setting, with a higher frequency among women and Hispanics. It is associated with fibromyalgia in only a minority of cases. Patients with CC appear to have a lower frequency of acute myocardial infarction. Spontaneous resolution is seen in most cases at 1 year.
Subject(s)
Tietze's Syndrome/diagnosis , Aged , Chest Pain/etiology , Chronic Disease , Diagnosis, Differential , Female , Humans , Male , Middle Aged , Prospective Studies , Tietze's Syndrome/complicationsABSTRACT
OBJECTIVE: To describe an observed improvement in CD4 lymphocytes in patients with Reiter's syndrome (RS) and human immunodeficiency virus (HIV) infection, after treatment with sulfasalazine (SFSZ). METHODS . Care series. We analyzed CD4 lymphocyte counts in 4 consecutive patients with RS and HIV disease before and after treatment with SFSZ. RESULTS: CD4+ lymphocyte counts increased from a mean of 315 +/- 179 before treatment to 542 +/- 231 x 10(6)/l on followup (p < 0.03), in the absence of antiretroviral therapy. The significance of these observations is discussed. CONCLUSION: Treatment of RS with SFSZ in HIV disease appears to be associated with an improvement in CD4 count.
