Carpal impaction with the ulnar styloid process: treatment with partial styloid resection.

Carpal impaction with the ulnar styloid process (stylocarpal impaction) occurs less frequently than with the ulnar head (ulnocarpal impaction), and more commonly develops in wrists with negative ulnar variance. Physical examination, radiographic evaluation, and wrist arthroscopy are all helpful in excluding alternative causes of ulnar wrist pain. When an ulnocarpal stress test elicits pain, and radiographs suggest that this is due to carpal impaction with the ulnar styloid, partial resection of the styloid process provides successful treatment, so long as the insertion of the triangular fibrocartilage at the base of the styloid is not disrupted.

Somatization of dissociated traumatic memories in a case of reflex sympathetic dystrophy.

In this single case report, I examine the treatment of reflex sympathetic dystrophy (RSD) with hypnosis and ego-state therapy in a subject with a dissociative disorder. RSD is an unusual, debilitating, chronic pain syndrome with a usually poor outcome. The subject achieved temporary symptomatic relief using hypnosis and auto-hypnotic pain-management techniques. Eventually, she achieved permanent relief of RSD symptoms that continued over a two-year follow-up period. She achieved this permanent relief through a process of psychologically integrating physical functions that she experienced as specific to several dissociated ego states. This case illustrates the role of metaphor and imaginative symbolism in constituting a physical condition. It also illustrates how imaginative transformation of the symbolic imagery can induce psychological and physical change.

Ego-state therapy for self-injurious behavior.

The authors describe the use of ego-state therapy for the treatment of self-injurious behavior (SIB). We propose that for some patients, SIB results from conflict among dissociated ego states. We review the historical and theoretical basis for this position and delineate a specific treatment technique. Our strategy consists of identifying an ego state in which SIB occurs, activating the patient's ego strengths using inner-adviser techniques and facilitating the integration of these resources within the ego state responsible for the behavior. We have used this strategy with favorable results for patients with dissociative symptoms, primarily those suffering from borderline personality disorder, posttraumatic stress disorder, or dissociative disorders.

Hypnotherapy for reflex sympathetic dystrophy.

Reflex sympathetic dystrophy (RSD) is an unusual, debilitating, chronic pain syndrome thought to be the result of a continuous excessive discharge of regional sympathetic nerves. Supportive and stress-reduction psychotherapies are commonly recommended as adjunctive treatments. Biofeedback is a more direct symptomatic treatment. Although hypnotherapy is effective in altering sympathetic reflex and pain responses, there are no reports of its use for the treatment of RSD. This article reviews some promising results of hypnotherapy with three RSD sufferers. I discuss the role of hypnotherapy as a supportive adjunct to medical treatment. I also explore the possible role of hypnotherapy as a complementary treatment.

Interaction of brevetoxin A with a new receptor site on the sodium channel.

Measurements of neurotoxin-activated 22Na influx in neuroblastoma cells and neurotoxin binding in synaptosomes were used to define the site and mechanism of action of brevetoxins on sodium channels. Brevetoxin A alone did not enhance the sodium permeability of neuroblastoma cells, but markedly enhanced persistent activation of sodium channels by veratridine, aconitine and batrachotoxin, which act at neurotoxin receptor site 2. Enhancement of batrachotoxin action was accompanied by a 4.3-fold increase in the binding of [3H]batrachotoxinin A 20-alpha-benzoate to receptor site 2 on sodium channels in synaptosomes. These results point to an allosteric mechanism of brevetoxin action involving preferential binding to active states of sodium channels which have high affinity for neurotoxins, causing persistent activation of sodium channels at receptor site 2. Brevetoxin A does not block [3H]saxitoxin binding at neurotoxin receptor site 1 or 125I-labeled scorpion toxin binding at neurotoxin receptor site 3. The brevetoxins appear to act at a new neurotoxin receptor site on the sodium channel.

In vivo regulation of muscarinic cholinergic receptors in embryonic chick brain.

Prolonged treatment of chick embryos in vivo with the muscarinic agonists oxotremorine or carbachol leads to dose- and time-dependent decreases in the number of brain muscarinic acetylcholine receptors (mAChR) as measured by the specific binding of the potent muscarinic ligand L-[3H]quinuclidinyl benzilate to brain membranes. Maximal doses of agonists reduced the number of mAChR as much as 44%. Maximal loss of mAChR occurs 4 hr after treatment, but can be prevented or totally reversed within 24 hr by blockade of agonist-receptor interactions with muscarinic antagonists. After sustained in vivo oxotremorine treatment, brain mAChR show a decreased apparent affinity for agonists owing to a decrease in the affinities of both the high- and low-affinity agonist binding sites.