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1.
Eur J Neurol ; 20(5): 748-55, 2013 May.
Article in English | MEDLINE | ID: mdl-22891893

ABSTRACT

BACKGROUND AND PURPOSE: In a recent trial in patients with chronic inflammatory demyelinating polyradiculoneuropathy (CIDP), the ICE study, grip strength measurement captured significantly more improvement in patients receiving immune globulin (IGIV-C) intravenously than in those receiving placebo. METHODS: We conducted a systematic analysis to determine the sensitivity of grip strength as an indicator of meaningful clinical changes in CIDP. RESULTS: A randomized double-blind trial was undertaken in 117 CIDP patients who received IGIV-C or placebo every 3 weeks for up to 24 weeks. Grip strength and inflammatory neuropathy cause and treatment (INCAT) disability scores were assessed at each visit, and the responsiveness of each scale was compared. A minimum clinically important difference cut-off value for grip strength (>8 kPa) and INCAT score (>1 point) was applied to assess the proportion of responders to IGIV-C versus placebo. This analysis showed that grip strength demonstrated significant improvement earlier (as early as day 16) than the INCAT disability scale in patients receiving IGIV-C compared with placebo. A significantly higher proportion of improvers were seen in the IGIV-C group (37.5%-50.9%) than in the placebo group (21.1%-25.9%) for grip strength at day 16, week 3, week 6 and the end of the first period. Also, grip strength showed within the first 6 weeks in the placebo group significantly more patients with a clinically meaningful deterioration (>8 kPa), compared with the INCAT (>1-point deterioration) findings. CONCLUSIONS: Grip strength can be considered a sensitive tool for assessing clinically relevant changes in patients with CIDP. Its use in daily practice is suggested.


Subject(s)
Disability Evaluation , Hand Strength/physiology , Immunoglobulins, Intravenous/therapeutic use , Immunologic Factors/therapeutic use , Polyradiculoneuropathy, Chronic Inflammatory Demyelinating/drug therapy , Polyradiculoneuropathy, Chronic Inflammatory Demyelinating/physiopathology , Double-Blind Method , Humans
2.
G Ital Dermatol Venereol ; 147(3): 321-4, 2012 Jun.
Article in English | MEDLINE | ID: mdl-22648333

ABSTRACT

A female infant had been delivered prematurely at 33 weeks to a gravida 1, para 0, 32-year-old mother following normal spontaneous vaginal delivery. Because of persistent patent ductus arteriosus the new born underwent surgery after 30 days. Four months later, when the infant arrived at our observation, approximately 13 red, nodular hemangiomas ranging from 0.5 to 30 mm in diameter were scattered over the scalp, trunk, abdomen, and extremities. Laboratory and instrumental tests investigating visceral involvement were all negative. Our diagnosis was of benign neonatal hemangiomatosis. Benign neonatal hemangiomatosis is a condition with multiple congenital hemangiomas limited to the skin. The incidence in the newborn population is between 1.0% and 4% with females 4 times more affected than males. Solitary hemangiomas occur more frequently in premature neonates with a reported incidence, inversely proportional to birth weight. Although the exact mechanism for hemangioma development remains unknown, vascular growth factors seem to play a role in the pathogenesis. Proliferation most likely results from an imbalance between positive and negative angiogenic factors expressed by the hemangioma and adjacent normal tissue. Patency of the ductus arteriosus is a common complication of preterm birth. During the immediate postpartum period, a loss of vasodilatory stimuli and activation of intrinsic contractile mechanisms facilitates ductus lumen occlusion. The imbalance of these forces, linked to premature birth, interrupts the normal maturation process, leaving the immature ductus patent. Our case is the first one of benign neonatal hemangiomatosis and patency ductus arteriosus described.


Subject(s)
Ductus Arteriosus, Patent/complications , Hemangioma/complications , Infant, Premature, Diseases , Skin Neoplasms/complications , Female , Hemangioma/pathology , Humans , Infant, Newborn , Infant, Premature , Infant, Premature, Diseases/pathology , Skin Neoplasms/pathology
3.
Neurology ; 72(15): 1337-44, 2009 Apr 14.
Article in English | MEDLINE | ID: mdl-19365055

ABSTRACT

BACKGROUND: Chronic inflammatory demyelinating polyradiculoneuropathy trials have demonstrated the efficacy of IV immunoglobulin vs placebo. However, these trails have not addressed the long-term impact on health-related quality of life (HRQoL). METHODS: One hundred seventeen patients in a randomized, double-blind, response-conditional crossover trial received immune globulin IV, 10% caprylate/chromatography purified (IGIV-C [Gamunex(R)]), or placebo every 3 weeks for up to 24 weeks in the first period (FP). Participants whose inflammatory neuropathy cause and treatment disability score did not improve by >/=1 point received alternate treatment in a 24-week crossover period (CP). In either period, participants who improved and completed treatment were eligible to be randomly reassigned to a blinded 24-week extension phase (EP). HRQoL analyses were conducted using the Short Form-36(R) (SF-36) and the Rotterdam Handicap Scale (RHS). RESULTS: In the FP, greater improvements in both SF-36 physical and mental component scores were observed with IGIV-C vs placebo, with a significant improvement in the physical component score (difference 4.4 points; 95% confidence interval [CI] 0.7-8.0). Improvements in all SF-36 domains favored IGIV-C vs placebo, with physical functioning, role-physical, social functioning, and mental health reaching significance. Participants receiving IGIV-C experienced a larger improvement in RHS vs those receiving placebo (difference 3.4 points; 95% CI 1.4-5.5; p = 0.001). In the CP, similar general trends were observed. In the EP, mean SF-36 improvements were generally improved or maintained in participants who continued IGIV-C therapy; however, worsening was observed in participants re-randomized to placebo. CONCLUSIONS: Long-term therapy with immune globulin IV, 10% caprylate/chromatography purified, improves and maintains health-related quality of life in chronic inflammatory demyelinating polyradiculoneuropathy.


Subject(s)
Immunoglobulins, Intravenous/therapeutic use , Polyradiculoneuropathy, Chronic Inflammatory Demyelinating/psychology , Polyradiculoneuropathy, Chronic Inflammatory Demyelinating/therapy , Adolescent , Adult , Cross-Over Studies , Double-Blind Method , Humans , Mental Health , Quality of Life , Social Behavior , Young Adult
4.
Neurology ; 71(23): 1907-13, 2008 Dec 02.
Article in English | MEDLINE | ID: mdl-18971443

ABSTRACT

The US health care crisis is of great concern to American neurologists. The United States has the world's most expensive health care system yet one-sixth of Americans are uninsured. The cost and volume of procedures is expanding, while reimbursement for office visits is declining. Pharmaceutical costs, durable goods, and home health care are growing disproportionately to other services. Carriers spend more for their own administration and profit than on payments to physicians. This first article on the US health care system identifies problems and proposes solutions, many of which are championed by the American Academy of Neurology through its legislative and regulatory committees.


Subject(s)
Delivery of Health Care , Adolescent , Adult , Aged , Aged, 80 and over , Child , Child, Preschool , Cost Sharing , Delivery of Health Care/economics , Delivery of Health Care/methods , Delivery of Health Care/statistics & numerical data , Female , Humans , Infant , Male , Malpractice/statistics & numerical data , Medical Records/statistics & numerical data , Middle Aged , Physicians , Population Dynamics , Reimbursement Mechanisms , United States , Young Adult
5.
Neurology ; 71(23): 1914-20, 2008 Dec 02.
Article in English | MEDLINE | ID: mdl-18971444

ABSTRACT

In the search for a universal, high quality, affordable health care system, Americans seek to identify and correct a series of current problems. In part one of this two-part series, we presented problems along with some suggested actions. This second part presents other health care systems in Europe and Canada. These different systems provide universal care and at a lower cost than in the United States. Further domestic proposals are presented from the Massachusetts plan and positions from US presidential candidates. These systems and proposals raise ideas about possible changes in the US health care system. Knowledge of these issues and other health care systems will help foster a meaningful dialog about changes in the US health care system.


Subject(s)
Delivery of Health Care , Health Care Reform , Health Policy , Models, Organizational , National Health Programs/organization & administration , Community Health Planning , Delivery of Health Care/economics , Delivery of Health Care/methods , Delivery of Health Care/statistics & numerical data , Health Planning Support , Humans , National Health Programs/economics , United States
6.
Am J Transplant ; 7(2): 484-6, 2007 Feb.
Article in English | MEDLINE | ID: mdl-17283492

ABSTRACT

Rabbit antithymocyte globulin (RATG) is indicated for the treatment of acute renal transplant rejection and has also been shown to be effective as an induction immunosuppressive agent after renal transplantation. We report a patient that developed a painful sensory neuropathy within an hour of receiving RATG. The neuropathic symptoms resolved within a month, and a careful review of his medications, exposures and comorbid conditions revealed no other causes of neuropathy. Since the administration of RATG and onset of symptoms were so closely related temporally and the symptoms resolved after the cessation of RATG, we believe it is likely this medication led to the development of neuropathy.


Subject(s)
Antilymphocyte Serum/adverse effects , Immunosuppressive Agents/adverse effects , Nervous System Diseases/chemically induced , Neurons, Afferent/pathology , Adult , Animals , Antilymphocyte Serum/therapeutic use , Graft Rejection/immunology , Graft Rejection/prevention & control , Humans , Immunosuppressive Agents/therapeutic use , Kidney Transplantation/immunology , Male , Nervous System Diseases/physiopathology , Neurons, Afferent/physiology , Rabbits , Transplantation Immunology/immunology
7.
Neurology ; 65(11): 1834-6, 2005 Dec 13.
Article in English | MEDLINE | ID: mdl-16344537
8.
Neurology ; 63(9): 1656-61, 2004 Nov 09.
Article in English | MEDLINE | ID: mdl-15534251

ABSTRACT

BACKGROUND: Mitochondrial dysfunction occurs early in the course of ALS, and the mitochondria may be an important site for therapeutic intervention. Creatine stabilizes the mitochondrial transition pore, and is important in mitochondrial ATP production. In a transgenic mouse model of ALS, administration of creatine prolongs survival and preserves motor function and motor neurons. METHODS: The authors conducted a randomized double-blind, placebo controlled trial on 104 patients with ALS from 14 sites to evaluate the efficacy of creatine supplementation in ALS. The primary outcome measure was maximum voluntary isometric contraction of eight upper extremity muscles, with secondary outcomes including grip strength, ALS Functional Rating Scale-Revised, and motor unit number estimates. Patients were treated for 6 months, and evaluated monthly. RESULTS: Creatine was tolerated well, but no benefit of creatine could be demonstrated in any outcome measure. CI analysis showed that the study, although powered to detect a 50% or greater change in rate of decline of muscle strength, actually made an effect size of greater than 23% unlikely. It was also demonstrated that motor unit number estimation was performed with acceptable reproducibility and tolerability, and may be a useful outcome measure in future clinical trials. CONCLUSION: Any beneficial effect of creatine at 5 g per day in ALS must be small. Other agents should be considered in future studies of therapeutic agents to address mitochondrial dysfunction in ALS. In addition, motor unit number estimation may be a useful outcome measure for future clinical trials in ALS.


Subject(s)
Amyotrophic Lateral Sclerosis/drug therapy , Creatine/therapeutic use , Adolescent , Adult , Aged , Amyotrophic Lateral Sclerosis/diagnosis , Amyotrophic Lateral Sclerosis/urine , Creatine/adverse effects , Creatine/urine , Double-Blind Method , Female , Humans , Isometric Contraction , Male , Middle Aged , Treatment Outcome
9.
Neurology ; 63(5): 865-73, 2004 Sep 14.
Article in English | MEDLINE | ID: mdl-15365138

ABSTRACT

BACKGROUND: Using identical methods, three simultaneous placebo-controlled trials of topiramate for painful diabetic neuropathy (PDN) did not reach significance. This independent yet concurrent placebo-controlled trial used different methods to assess topiramate efficacy and tolerability in PDN. METHODS: This 12-week, multicenter, randomized, double-blind trial included 323 subjects with PDN and pain visual analog (PVA) score of at least 40 on a scale from 0 (no pain) to 100 (worst possible pain). Topiramate (n = 214) or placebo (n = 109) was titrated to 400 mg daily or maximum tolerated dose. Short-acting rescue analgesics were permitted only during the first 6 weeks. RESULTS: Baseline characteristics were comparable between groups except for mean body weight (topiramate, 101.4 kg; placebo, 95.7 kg; p = 0.028). Twelve weeks of topiramate treatment reduced PVA scale score (from 68.0 to 46.2 mm) more effectively than placebo (from 69.1 to 54.0 mm; p = 0.038). Fifty percent of topiramate-treated subjects and 34% of placebo-treated subjects responded to treatment, defined as >30% reduction in PVA scale score (p = 0.004). Topiramate monotherapy also reduced worst pain intensity (p = 0.003 vs placebo) and sleep disruption (p = 0.020 vs placebo). Diarrhea, loss of appetite, and somnolence were the most commonly reported adverse events in the topiramate group. Topiramate reduced body weight (-2.6 vs +0.2 kg for placebo; p < 0.001) without disrupting glycemic control. CONCLUSIONS: Topiramate monotherapy reduced pain and body weight more effectively than placebo in patients with painful diabetic neuropathy.


Subject(s)
Anti-Inflammatory Agents, Non-Steroidal/therapeutic use , Diabetic Neuropathies/drug therapy , Fructose/analogs & derivatives , Fructose/therapeutic use , Neuralgia/drug therapy , Adolescent , Adult , Aged , Anti-Inflammatory Agents, Non-Steroidal/adverse effects , Anti-Inflammatory Agents, Non-Steroidal/pharmacology , Appetite/drug effects , Appetite Depressants/adverse effects , Appetite Depressants/pharmacology , Appetite Depressants/therapeutic use , Body Weight/drug effects , Diabetic Neuropathies/metabolism , Double-Blind Method , Female , Fructose/adverse effects , Fructose/pharmacology , Humans , Leg/innervation , Male , Middle Aged , Neuralgia/etiology , Neuralgia/metabolism , Patient Dropouts , Sleep Disorders, Intrinsic/drug therapy , Sleep Disorders, Intrinsic/etiology , Topiramate , Treatment Outcome
10.
J Eur Acad Dermatol Venereol ; 18(4): 495-8, 2004 Jul.
Article in English | MEDLINE | ID: mdl-15196172

ABSTRACT

Dermatomyositis (DM) is an inflammatory myopathy of skeletal muscle with characteristic cutaneous findings. It is a rare disorder with a bimodal age distribution that affects almost twice as many women as men. One category of DM, normal-enzyme DM, is characterized by cutaneous changes only at baseline, normal serum muscle enzyme levels and myositis demonstrated by electromyography (EMG) and/or muscle biopsy specimens. Typically, patients with normal-enzyme DM progress to severe muscle involvement and require systemic corticosteroid therapy. The patient we report has normal-enzyme DM confirmed by serial serum enzymes, EMG, and skin and muscle biopsies but is unique in that she never experienced progression of muscle weakness although muscle involvement was documented histologically and by EMG. Follow-up examination after 1 year revealed near-complete resolution of cutaneous involvement after topical therapy and no evidence of muscle weakness.


Subject(s)
Dermatomyositis/pathology , Skin/pathology , Aged , Dermatomyositis/diagnosis , Female , Humans , Muscle, Skeletal/pathology , Remission, Spontaneous
11.
Neurology ; 61(4): 456-64, 2003 Aug 26.
Article in English | MEDLINE | ID: mdl-12939417

ABSTRACT

OBJECTIVE: To determine if long-term topiramate therapy is safe and slows disease progression in patients with ALS. METHODS: A double-blind, placebo-controlled, multicenter randomized clinical trial was conducted. Participants with ALS (n = 296) were randomized (2:1) to receive topiramate (maximum tolerated dose up to 800 mg/day) or placebo for 12 months. The primary outcome measure was the rate of change in upper extremity motor function as measured by the maximum voluntary isometric contraction (MVIC) strength of eight arm muscle groups. Secondary endpoints included safety and the rate of decline of forced vital capacity (FVC), grip strength, ALS functional rating scale (ALSFRS), and survival. RESULTS: Patients treated with topiramate showed a faster decrease in arm strength (33.3%) during 12 months (0.0997 vs 0.0748 unit decline/month, p = 0.012). Topiramate did not significantly alter the decline in FVC and ALSFRS or affect survival. Topiramate was associated with an increased frequency of anorexia, depression, diarrhea, ecchymosis, nausea, kidney calculus, paresthesia, taste perversion, thinking abnormalities, weight loss, and abnormal blood clotting (pulmonary embolism and deep venous thrombosis). CONCLUSIONS: At the dose studied, topiramate did not have a beneficial effect for patients with ALS. High-dose topiramate treatment was associated with a faster rate of decline in muscle strength as measured by MVIC and with an increased risk for several adverse events in patients with ALS. Given the lack of efficacy and large number of adverse effects, further studies of topiramate at a dose of 800 mg or maximum tolerated dose up to 800 mg/day are not warranted.


Subject(s)
Amyotrophic Lateral Sclerosis/drug therapy , Fructose/analogs & derivatives , Fructose/therapeutic use , Adult , Aged , Amyotrophic Lateral Sclerosis/mortality , Disease Progression , Double-Blind Method , Female , Fructose/adverse effects , Fructose/pharmacology , Hand Strength , Humans , Life Tables , Male , Middle Aged , Muscle Contraction/drug effects , Proportional Hazards Models , Safety , Survival Analysis , Thromboembolism/chemically induced , Topiramate , Treatment Failure , Vital Capacity/drug effects
12.
Neurology ; 56(4): 445-9, 2001 Feb 27.
Article in English | MEDLINE | ID: mdl-11222785

ABSTRACT

OBJECTIVE: To determine the efficacy of IV immunoglobulin (IVIg) given patients with untreated chronic inflammatory demyelinating polyradiculoneuropathy (CIDP). METHODS: A randomized, double-blind, multicenter, investigator-initiated study compared IVIg (Aventis Behring LLC, King of Prussia, PA) with placebo (5% albumin). On days 1, 2, and 21, IVIg (1 g/kg) or placebo was given. The primary outcome measure was the change in muscle strength from baseline to day 42, using the average muscle score (AMS). Secondary outcome measures included change from baseline AMS at days 10 and 21, the Hughes' functional disability scale, forced vital capacity (FVC), and nerve conduction studies (NCS) of four motor nerves (median, ulnar, peroneal, and tibial). RESULTS: The patients (n = 33) were randomized. Of these, 30 (14 women, 16 men, aged 54 +/- 20 years, range 13 to 82) received IVIg and 23 were given placebo (12 women, 11 men, aged 50 +/- 18 years, range 23 to 73). Baseline AMS values of the groups were similar (IVIg 7.06 +/- 1.31 versus placebo 7.28 +/- 1.18, p = 0.53). There were two dropouts in placebo group and one in the IVIg group. Mean AMS improved at day 42 comparing IVIg with placebo (0.63 versus -0.1, p = 0.006). Improved strength was seen by day 10. The placebo group lost strength over this same interval. In the IVIg, 11 subjects improved by the functional disability scale; none worsened. This differed (p = 0.019) from those in the placebo-treated group (two improved, two got worse, remainder unchanged). Forced vital capacity did not improve with IVIg treatment. IVIg improved ulnar motor distal latency (p = 0.005), tibial distal compound muscle amplitude (p = 0.003), and peroneal nerve conduction velocity (p = 0.03). CONCLUSIONS: IVIg improves strength in patients with untreated CIDP by day 10 with continued benefit through day 42; more than one third improve by at least a functional grade on a disability scale. This study provides data supporting IVIg as the initial treatment for CIDP.


Subject(s)
Immunoglobulins, Intravenous/therapeutic use , Polyradiculoneuropathy, Chronic Inflammatory Demyelinating/drug therapy , Adolescent , Adult , Aged , Aged, 80 and over , Double-Blind Method , Female , Humans , Immunoglobulins, Intravenous/adverse effects , Male , Middle Aged , Neural Conduction/physiology , Polyradiculoneuropathy, Chronic Inflammatory Demyelinating/physiopathology , Time Factors
13.
J Diabetes Complications ; 14(2): 65-70, 2000.
Article in English | MEDLINE | ID: mdl-10959067

ABSTRACT

OBJECTIVE: The objective of this study was to evaluate the efficacy and safety of tramadol in a 6-month open extension following a 6-week double-blind randomized trial. RESEARCH DESIGN AND METHODS: Patients with painful diabetic neuropathy who completed the double-blind study were eligible for enrollment in an open extension of up to 6 months. All patients received tramadol 50-400 mg/day. Self-administered pain intensity scores (scale 0-4; none to extreme pain) and pain relief scores (scale -1-4; worse to complete relief) were recorded the first day of the open extension (last day of the double-blind phase) and at 30, 90, and 180 days. RESULTS: A total of 117 patients (56 former tramadol and 61 former placebo) entered the study. On the first day of the study, patients formerly treated with placebo had a significantly higher mean pain intensity score (2. 2+/-1.02 vs. 1.4+/-0.93, P<0.001) and a lower pain relief score (0. 9+/-1.43 vs. 2.2+/-1.27, P<0.001) than former tramadol patients. By Day 90, both groups had mean pain intensity scores of 1.4, which were maintained throughout the study. Mean pain relief scores (2. 4+/-1.09 vs. 2.2+/-1.14) were similar after 30 days in the former placebo and former tramadol groups, respectively and were maintained for the duration of the study. Four patients discontinued therapy due to ineffective pain relief; 13 patients discontinued due to adverse events. The most common adverse events were constipation, nausea, and headache. CONCLUSIONS: Tramadol provides long-term relief of the pain of diabetic neuropathy.


Subject(s)
Analgesics, Opioid/therapeutic use , Diabetic Neuropathies/physiopathology , Pain/drug therapy , Tramadol/therapeutic use , Adult , Aged , Aged, 80 and over , Analgesics, Opioid/adverse effects , Black People , Double-Blind Method , Female , Glycated Hemoglobin/analysis , Humans , Male , Middle Aged , Pain Measurement , Tramadol/adverse effects , United States , White People
14.
J Orthop Trauma ; 14(4): 245-54, 2000 May.
Article in English | MEDLINE | ID: mdl-10898196

ABSTRACT

OBJECTIVE: To report our experience with the use of continuous electromyography (EMG) for placement of iliosacral screws. DATA SOURCES: Concurrently acquired data as well as patient charts, intraoperative EMG records, x-rays, and pelvic computed tomography (CT) scans. DESIGN: The monitored group of twenty-nine patients was studied prospectively. The control group consisted of twenty-two patients studied retrospectively. SETTING: Level One trauma center. METHODS: Continuous electromyograms were recorded for twenty-nine patients and compared with those from a group of twenty-two antecedent patients who were not monitored. The primary parameter of interest of this study was the presence or absence of neurologic change after iliosacral screw placement. This information was obtained prospectively in the study group and by retrospective review in the historical control. RESULTS: Four patients in the control group had postoperative and/or sensory motor changes prompting a postoperative CT scan; in each of these patients, a misdirected screw was identified and subsequently removed in a second procedure. There were no neurologic changes subsequent to placement in the twenty-nine patients who were monitored (7.5 percent versus 0 percent; p = 0.029, Fisher's exact test). All monitored patients had postoperative CT scans and showed the screw in a safe position with no significant violations of the S1 tunnel. CONCLUSION: Continuous EMG monitoring during iliosacral screw placement may be a useful neuroprotective tool.


Subject(s)
Bone Screws , Electromyography , Fractures, Bone/therapy , Pelvic Bones/injuries , Adolescent , Adult , Female , Humans , Injury Severity Score , Male , Middle Aged , Monitoring, Physiologic , Prospective Studies
15.
Neurol Clin ; 18(3): 601-13, 2000 Aug.
Article in English | MEDLINE | ID: mdl-10873233

ABSTRACT

Electrophysiologic testing in concert with the neurologic history and physical examination can be useful for evaluating the patient with suspected neurotoxicity. Procedures are selected depending on whether the central or peripheral nervous system, or both, are considered to be affected. Extensive data is available on the use of nerve conduction studies to substantiate and serially follow patients with peripheral neuropathy, and the electrophysiologic findings can be used to predict the most likely focus of pathology in the peripheral nervous system. With this information in hand, the electrodiagnostician can guide the clinical neurotoxicologist towards a broad differential diagnosis of the most likely neurotoxins.


Subject(s)
Electrodiagnosis , Neurotoxicity Syndromes/diagnosis , Diagnosis, Differential , Humans , Neurotoxicity Syndromes/physiopathology , Neurotoxins , Synaptic Transmission/drug effects , Synaptic Transmission/physiology
16.
Muscle Nerve ; 21(12): 1794-6, 1998 Dec.
Article in English | MEDLINE | ID: mdl-9843087

ABSTRACT

Injuries to the superior gluteal nerve (SGN) have been reported as a result of trauma, pyriformis muscle entrapment, injections, and lumbar lordosis and inadequate back stabilization. We report 3 patients who developed isolated SGN injuries, 1 after a partial nephrectomy and 2 following revision of a total hip arthroplasty. SGN should be suspected in anyone developing an abnormal gait after hip or pelvic surgery or after prolonged lateral decubitus positioning.


Subject(s)
Buttocks/innervation , Iatrogenic Disease , Adult , Aged , Arthroplasty, Replacement, Hip/adverse effects , Female , Humans , Kidney Calculi/surgery , Male , Middle Aged , Nephrectomy/adverse effects , Nervous System Diseases/etiology , Postoperative Complications , Reoperation
17.
Neurology ; 50(6): 1842-6, 1998 Jun.
Article in English | MEDLINE | ID: mdl-9633738

ABSTRACT

OBJECTIVE: The objective of this study was to evaluate the efficacy and safety of tramadol in treating the pain of diabetic neuropathy. BACKGROUND: The pain of diabetic neuropathy is a major cause of morbidity among these patients and treatment, as with other small-fiber neuropathies, is often unsatisfactory. Tramadol is a centrally acting analgesic for use in treating moderate to moderately severe pain. METHODS: This multicenter, outpatient, randomized, double-blind, placebo-controlled, parallel-group study consisted of a washout/screening phase, during which all analgesics were discontinued, and a 42-day double-blind treatment phase. A total of 131 patients with painful diabetic neuropathy were treated with tramadol (n=65) or placebo (n=66) tramadol, which were administered as identical capsules in divided doses four times daily. The primary efficacy analysis compared the mean pain intensity scores in the tramadol and placebo groups obtained at day 42 of the study or at the time of discontinuation. Secondary efficacy assessments were the pain relief rating scores and a quality of life evaluation based on daily activities and sleep characteristics. RESULTS: Tramadol, at an average dosage of 210 mg/day, was significantly (p < 0.001) more effective than placebo for treating the pain of diabetic neuropathy. Patients in the tramadol group scored significantly better in physical (p=0.02) and social functioning (p=0.04) ratings than patients in the placebo group. No statistically significant treatment effects on sleep were identified. The most frequently occurring adverse events with tramadol were nausea, constipation, headache, and somnolence. CONCLUSIONS: The results of this placebo-controlled trial showed that tramadol was effective and safe in treating the pain of diabetic neuropathy.


Subject(s)
Analgesics, Opioid/therapeutic use , Diabetic Neuropathies/drug therapy , Palliative Care , Tramadol/therapeutic use , Activities of Daily Living , Adult , Aged , Aged, 80 and over , Analgesics, Opioid/adverse effects , Diabetic Neuropathies/physiopathology , Double-Blind Method , Female , Follow-Up Studies , Humans , Male , Middle Aged , Pain/physiopathology , Quality of Life , Sleep/physiology , Tramadol/adverse effects
19.
Dysphagia ; 11(1): 11-3, 1996.
Article in English | MEDLINE | ID: mdl-8556871

ABSTRACT

We reviewed 14 patients with clinically confirmed Guillain-Barré syndrome for swallowing dysfunction. All had swallowing dysfunction varying from mild to severe. Six patients (43%) had equivalent impairment during oral and pharyngeal phases. Seven patients (50%) had more severe functional abnormalities during the pharyngeal phase than during the oral phase. One patient (7%) had moderate disorder during the oral phase and mild disorder during the pharyngeal phase. Thirty-six percent of the patients had moderate-to-severe dysfunction during the oral phase, and 71% had moderate-to-severe dysfunction during the pharyngeal phase. In 5 patients who had multiple sequential examinations, moderate or severe swallowing disorders improved to mild-to-moderate disorders within 4-8 weeks after the onset of the symptoms. Residual swallowing disorders may be seen in those who had severe swallowing dysfunction during the later phases of their disease. Further investigations are needed to determine if swallowing abnormalities persist after complete recovery from Guillain-Barré syndrome.


Subject(s)
Cineradiography , Deglutition Disorders/diagnostic imaging , Fluoroscopy , Polyradiculoneuropathy/diagnostic imaging , Adult , Aged , Barium Sulfate/administration & dosage , Contrast Media/administration & dosage , Deglutition , Deglutition Disorders/physiopathology , Female , Follow-Up Studies , Humans , Male , Middle Aged , Mouth/diagnostic imaging , Mouth/physiopathology , Pharynx/diagnostic imaging , Pharynx/physiopathology , Polyradiculoneuropathy/physiopathology , Polyradiculoneuropathy/therapy , Video Recording
20.
Muscle Nerve ; 17(10): 1129-34, 1994 Oct.
Article in English | MEDLINE | ID: mdl-7935519

ABSTRACT

Monomelic amyotrophy is a rare form of motor neuron disease usually presenting as painless asymmetric weakness and atrophy in the distal upper extremities of young adults. Only rarely are the legs involved and pyramidal findings are uncommon. Monomelic amyotrophy is most often observed in people of Japanese and Indian heritage and affects men almost exclusively. Most cases are sporadic. Laboratory testing is frequently normal or nonspecific except for electrophysiologic studies which typically demonstrate reduced compound muscle action potential amplitudes, fasciculations, and features consistent with acute and chronic denervation in distal upper extremity muscles. Necropsy in 1 patient identified anterior horn cell shrinkage, necrosis, and gliosis in appropriate spinal cord segments. Symptoms and signs often progress for several years before spontaneously arresting. The differential diagnosis for monomelic amyotrophy is broad, including processes which affect the cervical cord, roots, brachial plexus, and individual or multiple nerves in the upper extremity.


Subject(s)
Motor Neuron Disease/diagnosis , Motor Neuron Disease/physiopathology , Motor Neurons/physiology , Neurons, Afferent/physiology , Adolescent , Diagnosis, Differential , Humans , Male , Median Nerve/physiopathology , Motor Neuron Disease/pathology , Muscles/innervation , Muscles/physiopathology , Necrosis , Neural Conduction , Neurologic Examination , Peroneal Nerve/physiopathology , Radial Nerve/physiopathology , Sural Nerve/physiopathology , Ulnar Nerve/physiopathology
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