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Acta Dermatovenerologica Alpina,... Jun 2011Reflex sympathetic dystrophy syndrome (RSDS) is a painful condition that usually follows regional trauma. We report the case of a 13-year-old girl that was seen for a...
Reflex sympathetic dystrophy syndrome (RSDS) is a painful condition that usually follows regional trauma. We report the case of a 13-year-old girl that was seen for a painful swelling of the right hand associated with palmar hyperhidrosis, which occurred after a trauma to the hand. Bone scan images showed early tissue abnormality, which was more significant on the right hand and wrist, as well as moderate bone uptake on the right side. Nonsteroidal anti-inflammatory drugs and alternating hot and cold baths led to a marked improvement. RSDS occurs following trauma or subsequent to various diseases or drug intake. This syndrome is related to impaired tissue microvasculature under the influence of abnormal sympathetic reflex hyperactivity. Bone scan is the diagnostic procedure of choice in RSDS, but it may be normal. Physiotherapy should be preferred in pediatric cases.
Topics: Adolescent; Female; Humans; Reflex Sympathetic Dystrophy
PubMed: 21993705
DOI: No ID Found -
Revista de Neurologia Oct 2011Carpal tunnel syndrome (CTS) is the most common of all focal neuropathies. Its diagnosis is based on a neurophysiological study of the thick motor and sensory fibres in...
INTRODUCTION
Carpal tunnel syndrome (CTS) is the most common of all focal neuropathies. Its diagnosis is based on a neurophysiological study of the thick motor and sensory fibres in patients with a characteristic clinical picture, although sometimes, in mild cases, this study does not detect the abnormalities. The decision was made to evaluate the small-calibre sympathetic fibres by means of cutaneous-plantar reflex (CPR) in patients with different degrees of idiopathic CTS.
SUBJECTS AND METHODS
The study involved 54 cases -15 males and 39 females with CTS- and 15 healthy volunteer controls. The cases were divided into three groups: those with only positive clinical features; those with clinical features and alteration of sensory conduction; and those with clinical features, alteration of sensory and motor conduction, and axonal loss. The CPR was obtained by means of the usual technique (which we modified), involving stimulation of the median nerve in the wrist and recording the response in the contralateral hand. Two successive responses were processed with an interval of more than one minute between them. Special attention was paid to controlling the baseline and sweating. A descriptive statistical inference and correlation analysis was performed.
RESULTS
A decrease in amplitude of the response was observed in patients with CTS, with shorter latencies in women and a good correlation between the latencies of the first and the second response. No significant differences were observed in the other parameters that were studied.
CONCLUSION
Studying the CPR can provide complementary data in the evaluation of CTS.
Topics: Adult; Carpal Tunnel Syndrome; Female; Humans; Male; Median Nerve; Middle Aged; Neural Conduction; Reflex; Reflex, Abnormal; Young Adult
PubMed: 21960386
DOI: No ID Found -
Physiological Measurement Oct 2011Measurements of blood volume pulse (BVP) and skin conductance are commonly used as indications of psychological arousal in affective computing and human-machine... (Clinical Trial)
Clinical Trial Comparative Study
Measurements of blood volume pulse (BVP) and skin conductance are commonly used as indications of psychological arousal in affective computing and human-machine interfaces. To date, palmar surfaces remain the primary site for these measurements. Placement of sensors on palmar surfaces, however, is undesirable when recordings are fraught with motion and pressure artifacts. These artifacts are frequent when the human participant has involuntary movements as in hyperkinetic cerebral palsy. This motivates the use of alternative measurement sites. The present study examined the correlation between measurements of blood volume pulse and skin conductance obtained from three different sites on the body (fingers, toes and ear for BVP; fingers, toes and arch of the foot for skin conductance) in response to cognitive and affective stimuli. The results of this pilot study indicated significant inter-site correlation among signal features derived from different sites, with the exception of BVP amplitude, the number of electrodermal reactions and the slope of the electrodermal activity response. We attribute these differences in part to inter-site discrepancies in local skin conditions, such as skin temperature. Despite these differences, significant changes from baseline were present in the responses to the cognitive and affective stimuli at non-palmar sites, suggesting that these sites may provide viable signal measurements for use in affective computing and human-machine interface applications.
Topics: Blood Volume; Cognition; Female; Galvanic Skin Response; Humans; Male; Music; Organ Specificity; Physical Stimulation; Pulse; Regression Analysis; Signal Processing, Computer-Assisted; Time Factors; Young Adult
PubMed: 21849720
DOI: 10.1088/0967-3334/32/10/002 -
Mayo Clinic Proceedings Aug 2011To review surgical results of endoscopic transthoracic limited sympathotomy for palmar-plantar hyperhidrosis during the past decade.
OBJECTIVE
To review surgical results of endoscopic transthoracic limited sympathotomy for palmar-plantar hyperhidrosis during the past decade.
PATIENTS AND METHODS
We retrospectively reviewed 155 consecutive patients who underwent surgery from June 30, 2000, through December 31, 2009, for medically refractory palmar-plantar hyperhidrosis using a technique of T1-T2 sympathotomy disconnection, designed for successful palmar response and minimization of complications.
RESULTS
Of the 155 patients, 44 (28.4%) were male, and 111 (71.6%) were female; operative times averaged 38 minutes. No patient experienced Horner syndrome, intercostal neuralgia, or pneumothorax. The only surgical complication was hemothorax in 2 patients (1.3%); in 1 patient, it occurred immediately postoperatively and in the other patient, 10 days postoperatively; treatment in both patients was successful. All 155 patients had successful (warm and dry) palmar responses at discharge. Long-term follow-up (>3 months; mean, 40.2 months) was obtained for 148 patients (95.5%) with the following responses to surgery: 96.6% of patients experienced successful control of palmar sweating; 69.2% of patients experienced decreased axillary sweating; and 39.8% of patients experienced decreased plantar sweating. At follow-up, 5 patients had palmar sweating (3 patients, <3 months; 1 patient, 10-12 months; 1 patient, 16-18 months). Compensatory hyperhidrosis did not occur in 47 patients (31.7%); it was mild in 92 patients (62.2%), moderate in 7 patients (4.7%), and severe in 2 patients (1.3%).
CONCLUSION
In this series, a small-diameter uniportal approach has eliminated intercostal neuralgia. Selecting a T1-T2 sympathotomy yields an excellent palmar response, with a very low severe compensatory hyperhidrosis complication rate. The low failure rate was noted during 18 months of follow-up and suggests that longer follow-up is necessary in these patients.
Topics: Adult; Aged; Ambulatory Surgical Procedures; Causality; Comorbidity; Female; Follow-Up Studies; Foot Dermatoses; Galvanic Skin Response; Ganglia, Sympathetic; Hand Dermatoses; Hemothorax; Humans; Hyperhidrosis; Male; Middle Aged; Retrospective Studies; Skin Temperature; Sweating; Sympathectomy; Thoracoscopy; Treatment Outcome
PubMed: 21803954
DOI: 10.4065/mcp.2011.0199 -
Orthopaedics & Traumatology, Surgery &... Sep 2011Malunion following open reduction and internal fixation of distal radius fracture threatens wrist function. Fixed-angle palmar plates provide rigid fixation that is...
INTRODUCTION
Malunion following open reduction and internal fixation of distal radius fracture threatens wrist function. Fixed-angle palmar plates provide rigid fixation that is stable over time; however, the pronator quadratus sectioning required by the anterior approach entails a risk of pronation strength loss and of distal radioulnar joint destabilization. The present study assessed recovery of grip, pronation and supination strength following such internal fixation.
PATIENTS AND METHOD
A prospective study included 26 distal radial fractures with dorsal displacement, osteosynthesized using a fixed-angle palmar plate, in 25 patients (mean age: 47.5 years; range: 17-72 years). Assessment concerned the classical parameters, plus grip and pronosupination strength recovery.
RESULTS
At a mean 14 months follow-up (range: 6-30 months), patients had recovered 91% grip strength, 88% pronation strength and 85% supination strength with respect to the healthy side. Complications comprised three cases of malunion, two of reflex sympathetic dystrophy syndrome, and four of post-traumatic carpal tunnel syndrome.
DISCUSSION
A study of the literature found 75-95% grip strength recovery following osteosynthesis using fixed-angle plates. Few studies, however, have focused on pronosupination strength, and none reported its evolution following osteosynthesis.
CONCLUSION
The present study found no drawbacks associated with a technique which usually involves sectioning the pronator quadratus. Except in case of malunion or joint stiffness, fixed-angle palmar plate osteosynthesis was followed by recovery of grip and pronosupination strength.
LEVEL OF EVIDENCE
Level IV: prospective non-randomized, non-comparative observational study.
Topics: Adolescent; Adult; Aged; Bone Plates; Fracture Fixation, Internal; Humans; Middle Aged; Muscle Strength; Palmar Plate; Pronation; Prospective Studies; Radius Fractures; Recovery of Function; Supination; Wrist Joint; Young Adult
PubMed: 21640686
DOI: 10.1016/j.otsr.2011.01.016 -
Journal of Neurophysiology Jul 2011Presynaptic modulation of Ia afferents converging onto the motor neuron pool of the extensor carpi radialis (ECR) was compared during contractions (20% of maximal force)... (Clinical Trial)
Clinical Trial
Presynaptic modulation of Ia afferents converging onto the motor neuron pool of the extensor carpi radialis (ECR) was compared during contractions (20% of maximal force) sustained to failure as subjects controlled either the angular position of the wrist while supporting an inertial load (position task) or exerted an equivalent force against a rigid restraint (force task). Test Hoffmann (H) reflexes were evoked in the ECR by stimulating the radial nerve above the elbow. Conditioned H reflexes were obtained by stimulating either the median nerve above the elbow or at the wrist (palmar branch) to assess presynaptic inhibition of homonymous (D1 inhibition) and heteronymous Ia afferents (heteronymous Ia facilitation), respectively. The position task was briefer than the force task (P = 0.001), although the maximal voluntary force and electromyograph for ECR declined similarly at failure for both tasks. Changes in the amplitude of the conditioned H reflex were positively correlated between the two conditioning methods (P = 0.02) and differed between the two tasks (P < 0.05). The amplitude of the conditioned H reflex during the position task first increased (129 ± 20.5% of the initial value, P < 0.001) before returning to its initial value (P = 0.22), whereas it increased progressively during the force task to reach 122 ± 17.4% of the initial value at failure (P < 0.001). Moreover, changes in conditioned H reflexes were associated with the time to task failure and force fluctuations. The results suggest a task- and time-dependent modulation of presynaptic inhibition of Ia afferents during fatiguing contractions.
Topics: Adult; Afferent Pathways; Electric Stimulation; Electromyography; Female; H-Reflex; Humans; Male; Median Nerve; Muscle Contraction; Muscle Fatigue; Muscle, Skeletal; Neural Inhibition; Weight-Bearing; Wrist; Young Adult
PubMed: 21543747
DOI: 10.1152/jn.00954.2010 -
Clinical Autonomic Research : Official... Feb 2011We studied patients with palmar hyperhidrosis before and after endoscopic thoracic sympathotomy (ETS) to determine the effect of chronic sympathetic denervation on (1)...
PURPOSE
We studied patients with palmar hyperhidrosis before and after endoscopic thoracic sympathotomy (ETS) to determine the effect of chronic sympathetic denervation on (1) forearm blood flow (FBF) response to mental stress and (2) exercise tolerance.
METHODS AND RESULTS
Twenty-two healthy patients were evaluated before ETS, and 17 returned after surgery (11 F; 19-32 years). We measured heart rate (HR; 12 lead), blood pressure, and FBF (plethysmography, ml dl(-1) min(-1)). Supine HR tended to decrease after ETS (69 ± 10 vs. 66 ± 6, p = 0.2). Mental stress FBF was recorded during baseline, 3-min Stroop color word test, and 2-min recovery. Mental stress responses were unaffected by ETS. However, during post-mental stress recovery period, ETS resulted in a significant elevation in FBF (2 ± 1 vs. 3 ± 1), FVC (3 ± 1 vs. 4 ± 2), and a decrease in FVR (52 ± 22 vs. 32 ± 16, p < 0.01 for all). ETS resulted in a reduction in pre-exercise seated baseline HR (94 ± 2.5 beats/min preoperatively vs. 84 ± 4.3 beats/min postoperatively, p < 0.05), maximal HR response to cycle exercise, and exercise systolic blood pressure (172 ± 5.2 mmHg pre-op vs. 158 ± 5.9 mmHg post-op, p < 0.05) but not mean or diastolic pressure. VO(2)max and exercise duration determined by cycle ergometry was unchanged.
CONCLUSIONS
Functional evidence of upper limb denervation is observed during the FBF recovery period from mental stress and hemodynamic alterations associated with upright cycle exercise. However, the sustained exercise capacity suggests modest clinical consequences.
Topics: Adolescent; Adult; Baroreflex; Endoscopy; Exercise Test; Female; Forearm; Hand; Heart Rate; Hemodynamics; Humans; Hyperhidrosis; Male; Middle Aged; Oxygen Consumption; Postoperative Period; Prospective Studies; Regional Blood Flow; Stress, Psychological; Stroop Test; Sympathectomy; Vasodilation; Young Adult
PubMed: 20700642
DOI: 10.1007/s10286-010-0078-2 -
Journal of Neurophysiology Feb 2010The present work investigated presynaptic modulation of Ia afferents in the extensor carpi radialis (ECR) when young and old adults exerted a wrist extension force...
The present work investigated presynaptic modulation of Ia afferents in the extensor carpi radialis (ECR) when young and old adults exerted a wrist extension force either to support an inertial load (position control) or to achieve an equivalent constant torque against a rigid restraint (force control) at 5, 10, and 15% of the maximal force. H reflexes were evoked in the ECR by stimulating the radial nerve above the elbow. A conditioning stimulus was applied to the median nerve above the elbow to assess presynaptic inhibition of homonymous Ia afferents (D1 inhibition) or at the wrist (palmar branch) to assess the ongoing presynaptic inhibition of heteronymous Ia afferents that converge onto the ECR motor neuron pool (heteronymous Ia facilitation). The young adults had less D1 inhibition and greater heteronymous Ia facilitation during the position task (79 and 132.1%, respectively) compared with the force task (69.1 and 115.1%, respectively, P < 0.05). In contrast, the old adults exhibited no difference between the two tasks for either D1 inhibition ( approximately 72%) or heteronymous Ia facilitation ( approximately 114%). Contraction intensity did not influence the amount of D1 inhibition or heteronymous Ia facilitation for either group of subjects. The amount of antagonist coactivation was similar between tasks for young adults, whereas it was greater in the position task for old adults (P = 0.02). These data indicate that in contrast to young adults, old adults did not modulate presynaptic inhibition of Ia afferents when controlling the position of a compliant load but rather increased coactivation of the antagonist muscle.
Topics: Adult; Afferent Pathways; Aged; Aging; Feedback, Sensory; Female; H-Reflex; Humans; Male; Movement; Muscle Contraction; Muscle, Skeletal; Postural Balance; Posture; Presynaptic Terminals; Stress, Mechanical; Task Performance and Analysis; Wrist Joint
PubMed: 19939955
DOI: 10.1152/jn.00839.2009 -
Neurology India 2007
Topics: Action Potentials; Carpal Tunnel Syndrome; Electric Stimulation; Hand; Humans; Median Nerve; Reflex; Sensory Receptor Cells; Skin
PubMed: 18040129
DOI: 10.4103/0028-3886.37106 -
Jornal Brasileiro de Pneumologia :... 2007To compare different levels of ablation in terms of the degree of patient satisfaction and extent of postoperative reflex sweating in sympathectomized patients.
OBJECTIVE
To compare different levels of ablation in terms of the degree of patient satisfaction and extent of postoperative reflex sweating in sympathectomized patients.
METHODS
A retrospective study involving 521 patients with primary hyperhidrosis, submitted to thoracic sympathectomy at the Monte Sinai Hospital and University Hospital of the Federal University of Juiz de Fora, from January of 2001 to December 2005. All patients were submitted to thermal ablation of the sympathetic stem and were divided into three groups: up to T2 (group I, n = 162); up to T3 (group II, n = 65); and up to T4 (group III, n = 294).
RESULTS
Optimal postoperative control of palmar/axillary hyperhidrosis was achieved in, respectively, 94/82% of the patients of group I, 89/89% of those in group II and 80/80% of those in group III. Postoperative reflex sweating was observed in 67% of the patients in groups I and II, compared with 61.29% of those in group III. Severe reflex sweating occurred in 32% of the group I patients, 9% of the group II patients and 4% of the group III patients.
CONCLUSION
Sympathectomy provided excellent patient satisfaction and a low incidence of complications. There was no significant difference between the levels of ablation in terms of reflex sweating, although the intensity of this complication decreased when lower levels of blockage, principally at the T4 level, were employed.
Topics: Adolescent; Adult; Aged; Axilla; Chi-Square Distribution; Child; Female; Follow-Up Studies; Hand; Humans; Hyperhidrosis; Male; Middle Aged; Patient Satisfaction; Reflex; Retrospective Studies; Sweating; Sympathectomy; Thoracic Nerves; Thoracic Surgery, Video-Assisted; Treatment Outcome
PubMed: 17906784
DOI: 10.1590/s1806-37132007000300004