ABSTRACT
Hiccups are a common phenomenon but little is known about their pathophysiological mechanism or function. The concept of a hiccup reflex lacks a scientific basis. Closure of the glottis may be caused by an active contraction or by a passive, sudden myoclonic contraction of the inspiratory musculature, leading to a rapid reduction in intrathoracic pressure. Hiccups are often benign and of short duration but they can sometimes be a serious medical problem due to their chronicity and underlying causes. Many remedies for hiccups have been reported, such as manoeuvres, medical treatment and invasive procedures. Chlorpromazine is the only drug that is registered for the treatment of persistent hiccups but it has many side effects. Baclofen is often used in practice, and favourable experiences with piracetam are known.
Subject(s)
Hiccup/drug therapy , Hiccup/etiology , Baclofen/therapeutic use , Chlorpromazine/adverse effects , Chlorpromazine/therapeutic use , Humans , Muscle Relaxants, Central/therapeutic use , Piracetam/therapeutic useABSTRACT
Harlequin syndrome is an autonomic syndrome of heat, emotion and exercise induced flushing and sweating limited to one side of the face in combination with impairment of sweating and flushing on the contralateral side, Two women aged 32 and 39 years displayed this syndrome. In one patient no other neurological symptoms were found; MRI of cervicothoracic spine failed to disclose a structural lesion. The second patient had four years before presented with a Horner's syndrome on the contralateral side, where MRI now disclosed a tumour located in the paravertebral thoracic region at the apex of the lung.
Subject(s)
Autonomic Nervous System Diseases/diagnosis , Flushing , Adult , Female , Horner Syndrome/complications , Humans , Magnetic Resonance Imaging , Neuroma/complications , Neuroma/diagnosis , Syndrome , Thoracic Neoplasms/complications , Thoracic Neoplasms/diagnosisABSTRACT
Enlargement of the calf usually is associated with venous thrombosis, haemorrhage, focal myositis or a tumour in bone or muscle. Occasionally a calf enlargement is due to isolated muscle hypertrophy as a sign of radicular or peripheral nerve injury. Most neurogenic muscle hypertrophy is confined to the calf muscle, but the phenomenon has also been seen in other muscles. Three patients with S-I radiculopathy leading to ipsilateral neurogenic calf hypertrophy following hernia nuclei pulposi are described, two men of 79 and 78 years old and a woman of 46 years. The symptoms gradually subsided with time and conservative treatment. The pathogenesis of neurogenic muscle hypertrophy possibly involves partial denervation atrophy and compensatory hypertrophy of remaining muscle fibres.
Subject(s)
Intervertebral Disc Displacement/complications , Muscles/pathology , Nerve Compression Syndromes/complications , Spinal Nerve Roots , Aged , Female , Humans , Hypertrophy , Intervertebral Disc Displacement/diagnosis , Lumbosacral Region , Male , Middle Aged , Nerve Compression Syndromes/diagnosis , Tomography, X-Ray ComputedABSTRACT
In 304 patients the natural history of 339 endarterectomized and 269 nonoperated internal carotid arteries was examined by means of ultrasonic Duplex scanning over a period of 60 months. In 172 cases the operated artery was closed primarily and venous patching was performed in 167 endarterectomies. By life-table analysis the rate of significant recurrent stenosis (more than 50% diameter reduction) during the first year was respectively 3.4% for male and 4.3% for female patched arteries. For primarily closed vessels these numbers were respectively 14.5% for male and 24.4% for female arteries. More than 1 year after surgery, no significant difference between the 4 groups was demonstrated and the mean annual rate of recurrent stenosis amounted to 1.7%. For the nonoperated arteries, no significant difference between the first and the remaining 4 years of follow-up could be demonstrated. For these vessels the mean annual rate of progression to stenosis greater than 50% diameter reduction was 11.2%.
Subject(s)
Arteriosclerosis/surgery , Carotid Artery Diseases/surgery , Endarterectomy , Saphenous Vein/transplantation , Arteriosclerosis/diagnosis , Arteriosclerosis/pathology , Carotid Artery Diseases/diagnosis , Carotid Artery Diseases/pathology , Carotid Artery, Internal/pathology , Carotid Artery, Internal/surgery , Endarterectomy/methods , Female , Follow-Up Studies , Humans , Male , Middle Aged , Prospective Studies , Recurrence , Time Factors , UltrasonographyABSTRACT
Cricoarytenoid arthritis is a frequent complication of rheumatoid arthritis. In most cases it is an insidious, progressive disorder which does not produce early symptoms. A bilateral fixation can lead to a considerable stenosis; exertional dyspnoea, however, may not be noted because mobility of most patients is restricted. We report a case of severely symptomatic cricoarytenoid arthritis in a women known to have myasthenia gravis and rheumatoid arthritis. Initially exacerbation of the myasthenia gravis, leading to severe inspiratory insuffiency was suspected. On indirect laryngoscopy, however, the correct diagnosis was made. Early diagnosis might have prevented an emergency in our patient.