ABSTRACT
INTRODUCTION: The presence of a Tinel sign in leg nerves has been proposed as a criterion for decompressive surgery in polyneuropathy. We investigated the diagnostic yield of the Tinel sign for nerve entrapment and for distal symmetrical peripheral neuropathy (DSPN). METHODS: We prospectively tested for the Tinel sign at 3 sites of possible nerve entrapment per leg in 91 patients. Entrapment was defined using nerve conduction data. We also investigated whether the number of sites at which the Tinel sign was present identified patients with DSPN. RESULTS: Sensitivity of the Tinel sign for nerve entrapment was low (29%, 44%, and 17%) for the 3 sites, and specificity was moderate (86%, 75%, and 81%). In the subgroup with DSPN, sensitivity was extremely low (0%, 20%, and 8%), and specificity was moderate (91%, 79%, and 73%). The number of sites with a Tinel sign did not identify patients with DSPN. CONCLUSION: The Tinel sign does not reliably indicate nerve entrapment or DSPN. Muscle Nerve 54: 25-30, 2016.
Subject(s)
Leg/physiopathology , Nerve Compression Syndromes/diagnosis , Paresthesia/physiopathology , Polyneuropathies/diagnosis , Adult , Aged , Aged, 80 and over , Female , Humans , Leg/innervation , Male , Middle Aged , Neural Conduction/physiology , ROC Curve , Retrospective Studies , Young AdultABSTRACT
PURPOSE/OBJECTIVES: To investigate the toxicity of temozolomide (TMZ) in patients with brain tumors and appropriate nursing interventions. DESIGN: Explorative analysis of prospective data. SETTING: A TMZ clinic led by a nurse practitioner (NP). SAMPLE: Group A (n = 71) received a standard dose of TMZ daily for five days 200 mg/m2 every four weeks; group B (n = 19) received a dose-intense schedule of TMZ daily for 21 days 75 mg/m2 every four weeks. METHODS: Toxicities were scored according to National Cancer Institute Common Terminology Criteria, and results in the two groups were compared. MAIN RESEARCH VARIABLES: Thrombopenia, neutropenia, and lymphopenia; nausea and vomiting; and NP interventions. FINDINGS: Of observed toxicities during six cycles, grade 3-4 thrombopenia was seen most frequently in group A. Neutropenia and subsequent interventions occurred more frequently in group A than in group B. Subsequent interventions consisted of dose delays and reductions. When patients were treated for a longer duration of time with TMZ, grade 3-4 lymphopenia occurred significantly more often in group B, necessitating Pneumocystis carinii pneumonia prophylaxis. CONCLUSIONS: Degree of toxicity using a 5-day 200 mg/m2 or 21-day 75 mg/m2 schedule every four weeks was similar to that found in other studies. IMPLICATIONS FOR NURSING: Through awareness of toxicity in relation to knowledge of brain tumors, NPs can become more effective in active management of TMZ toxicity.
Subject(s)
Antineoplastic Agents, Alkylating , Dacarbazine/analogs & derivatives , Nurse Practitioners/organization & administration , Nurse's Role , Oncology Nursing/organization & administration , Analysis of Variance , Antineoplastic Agents, Alkylating/administration & dosage , Antineoplastic Agents, Alkylating/adverse effects , Brain Neoplasms/drug therapy , Brain Neoplasms/nursing , Chi-Square Distribution , Dacarbazine/administration & dosage , Dacarbazine/adverse effects , Drug Administration Schedule , Drug Monitoring/nursing , Glioma/drug therapy , Glioma/nursing , Humans , Lymphopenia/chemically induced , Nausea/chemically induced , Netherlands , Neutropenia/chemically induced , Nursing Evaluation Research , Prospective Studies , Statistics, Nonparametric , Temozolomide , Thrombocytopenia/chemically induced , Treatment Outcome , Vomiting/chemically inducedABSTRACT
Trigeminal autonomic cephalgias (TACs) include cluster headache, paroxysmal hemicrania, and short-lasting unilateral neuralgiform headache with conjunctival injection and tearing. Associated structural lesions may be found, but a causal relationship is often difficult to establish. We sought to identify clinical predictors of underlying structural abnormalities by reviewing previously described and new TAC and TAC-like cases associated with a structural lesion. We found that even typical TACs can be caused by an underlying lesion. Clinical warning signs and symptoms are relatively rare. We recommend neuroimaging in all patients with a TAC or TAC-like syndrome.
