Neurology (56)

Complex regional pain syndrome (type I, RSD; type II, causalgia): controversies. (The Cleveland Clinic Foundation, Cleveland, OH) Clin J Pain 2000;16:S33–S40.
In this review, the relationship of sympathetically maintained pain and sympatholysis is examined, particularly as a neuropathic process that is found in many conditions including complex regional pain syndromes. This review also focused on recent observations proposing a pathologic basis in support of diagnosis and treatment of these disorders.     

Neurology (64)

Treatment of postherpetic neuralgia: an update. (University of Rochester School of Medicine and Dentistry, Rochester, NY) Drugs 2000;59:1113–1126.
This article provided an update on recent developments in the treatment of postherpetic neuralgia (PHN). In clinical trials, the topical lidocaine patch, gabapentin, and controlled release oxycodone have been shown to provide superior pain relief in patients with PHN when compared with placebo. It has also been demonstrated that the tricyclic antidepressant nortriptyline provides equivalent analgesic benefit when compared with amitriptyline, but is better tolerated. Based on these results, nortriptyline can now be considered the preferred antidepressant for treatment of PHN. The topical lidocaine patch, gabapentin, and controlled release oxycodone all appear to be as effective as tricycline antidepressants in the treatment of patients with PHN, and the results of these recent studies suggest that each of these treatments should be considered early in the course of treatment. Additional controlled trials are needed to compare the efficacy and tolerability of these 4 treatments for patients with PHN.     

Neurology (60)

Reflex sympathetic dystropy syndrome of the lower limbs in a renal transplant patient treated with tacrolimus. (Hospital de Mar, Barcelona, Spain) Transplantation 2000;70:210–211.
This study describes the treatment of a 49-year-old woman who received a kidney transplant from a cadaver donor and was treated with tacrolimus. Three months later, the patient complained of severe pain in her lower limbs that affected both knees and ankles. Bone scintigraphy and magnetic resonance were consistent with reflex sympathetic dystrophy syndrome. Laboratory tests that included creatinine, glomerular filtration rate, calcium, phosphate, urate, alkaline phosphatase, and parathormone were normal or near normal. Tacrolimus levels were around 13 μg/mL. Clinical improvement appeared slowly and spontaneously during the following 3 months, without appreciable changes in the tacrolimus level. Conclude that in kidney transplant patients, tacrolimus could be a risk factor for the development of a reflex sympathetic dystrophy syndrome.     

Neurology (52)

Phantom limb pain as a manifestation of paclitaxel neurotoxicity. (Providence Hospital, Southfield, MI) Mayo Clin Proc 2000;75:740–742.
This case report described 2 patients with prior amputation who experienced phantom limb pain (PLP) after receiving paclitaxel therapy. A third patient experienced disabling neurotoxicity in the extremity of a prior ulnar nerve and tendon transposition after receiving paclitaxel. This unique syndrome should be identified as a direct causal effect of paclitaxel. The pathophysiology of PLP and the treatment options are reviewed. Conclude that physicians should be aware that PLP can occur after initiation of paclitaxel.     

Neurology (65)

Herpes zoster and postherpetic neuralgia in the elderly. (University of Virginia, Charlottesville, VA) Geriatr Nurs 2000;21:132–136.
This article described herpes zoster (HZ), its causes, diagnosis, treatment, and associated complications. Postherpetic neuralgia (PHN), the most common complication of HZ, is the primary focus of the discussion. PHN is defined broadly as chronic pain that persists after the characteristic vesicular rash of HZ has resolved.     

Neurology (57)

New analgesics for neuropathic pain: the lidocaine patch. (North Shore University Hospital, Syosset, NY) Clin J Pain 2000;16:S62–266.
This article reviewed the basis for the development of the lidocaine patch and reviewed the reports of the clinical studies published. Potential uses of the lidocaine patch for other conditions in addition to postherpetic neuralgia (PHN) were also discussed. Conclude that it has been clearly established that the lidocaine patch is a safe and effective treatment for PHN and it is recommended as a first-line treatment based on demonstrated efficacy, quick onset of action, lack of systemic effects, and ease of use with other treatments.
Comment by Enrique Reig, MD.
Intravenous lidocaine is used in pain units for the transient relief of chronic neuropathic pain. If the analgesic result is satisfactory, some physicians start treatment with a lidocaine analogue, oral mexylithene. However, the latter drug is not always well tolerated and its efficacy (in my opinion) is far lower than that of intravenous lidocaine. The recently marketed lidocaine patch is a highly recommended therapeutic alternative if we are considering long-term treatment with lidocaine. Topical agents act locally (skin, soft tissues, peripheral nerves) and do not cause high blood levels (no higher than 0.6 micgr/mL). Topical 5% lidocaine decreases the ectopic discharges from peripheral afferents, reducing nociceptive input to the CNS. There are few side effects and the main indication is postherpetic neuralgia and all those syndromes with peripheral neuropathic pain. The relief that can be expected after using topical 5% lidocaine is not complete, and it can be associated with other types of drugs (anticonvulsants, antidepressants, analgesics, etc.) to obtain a synergistic effect.     

Neurology (59)

Reflex sympathetic dystrophy. (Mount Sinai School of Medicine, New York, NY) Int J Dermatol 2000;39:481–486.
This review aimed to familiarize the dermatologist with the essential features of reflex sympathetic dystrophy. It highlights areas that are most likely to be of interest to the dermatologist. Information regarding diagnosis, pathogenesis theories, and treatment are included.
Comment by Enrique Reig, MD.
This paper analyses RSD from the point of view of a specialist in dermatology. It addresses in depth the definition of RSD (or the new name, CRPS type I), the symptoms required for adequate diagnosis, some theories to explain this syndrome, and some of the treatments available. It highlights the clinical pictures, which can cause RSD (trauma, ischemia, tumors, infection, neurological and iatrogenic causes), and particularly dermatological syndromes (minor surgery, postherpetic neuralgia, Dupuytren, vasculitis …).
The treatment has a bipolar objective: to relieve pain in order to be able to apply appropriate physical therapy, which will allow recovery of the involved limb. There are more than 60 treatments reported in the literature, suggesting that there is no universal protocol. However, prevention of RSD, and particularly the early onset of treatment are essential for achieving functional and pain relief. To suppress sympathetic hyperactivity, nerve blocks (somatic and sympathetic), intravenous regional blockade with guanethidine or reserpine, alpha blockers (phentolamine), beta blockers (propranolol), and calcitonine can be used.
No reference is made to anticonvulsants (gabapentine, topiramate), antidepressants (ie, amitriptyline), intravenous lidocaine, or spinal cord stimulation.     

Neurology (53)

Sympathetic innervation and function in reflex sympathetic dystrophy. (National Institutes of Health, Bethesda, MD) Ann Neurol 2000;48:49–59. This study examined sympathetic neurocirculatory function and the role of sympathetic postganglionic nerve traffic in maintaining the pain in 30 patients with reflex sympathetic dystrophy. Most had had the condition for more then 1 year, and 14 had undergone sympathectomy for the pain. Positron emission tomographic scanning after administration of ¹³N‐ammonia was used to assess local perfusion, and 6‐[¹⁸F]fluorodopamine was used to assess sympathetic innervation. Rates of entry of norepinephrine in the regional venous drainage (spillovers) and regional plasma levels of L‐dihydroxyphenylalanine (the immediate product of the rate‐limiting enzymatic step in norepinephrine biosynthesis) and dihydroxyphenylglycol (the main neuronal metabolite of norepinephrine) were measured with and without intravenous trimethaphan for ganglion blockade. ¹³N‐ammonia‐derived radioactivity was less on the affected side than on the unaffected side, whereas 6‐[¹⁸F]fluorodopamine‐derived radioactivity was symmetrical. Thus, perfusion‐adjusted 6‐[¹⁸F]fluorodopamine‐derived radioactivity was higher on the affected side. Norepinephrine spillover and smaller arteriovenous increments in plasma levels of L‐dihydroxyphenylalanine and dihydroxyphenylglycol did not differ significantly between affected and unaffected limbs, although 4 patients had noticeably less norepinephrine spillover and smaller arteriovenous increments in plasma dihydroxyphenylglycol on the affected side. Trimethaphan decreased the pain in only 2 of 12 nonsympathectomized patients. The results indicate that patients with chronic unilateral reflex sympathetic dystrophy have decreased perfusion of the affected limb, symmetrical sympathetic innervation and norepinephrine synthesis, variably decreased release and turnover of norepinephrine in the affected limb, and failure of ganglion blockade to improve the pain in most cases. These findings suggest augmented vasoconstriction, intact sympathetic terminal innervation, possibly impaired sympathetic neurotransmission, and pain usually independent of sympathetic neurocirculatory outflows.     

鼻内窥镜下鼻咽部活检术(附48例)

目的：探讨鼻内窥镜下鼻咽部活检术在诊断鼻咽癌中的作用。方法：48例常规鼻咽 活检阴性的可疑鼻咽癌患者行鼻内窥镜下鼻咽活检术。结果：所有患者经1次鼻内窥镜下鼻咽活检术45例病检为鼻咽癌，2例为黏膜慢性炎症，1例鼻咽结核，阴性2例随访再次活检仍为慢性炎症。结论：鼻内窥镜下鼻咽活检术可充分观察鼻咽部各个部位，视野清楚，直视下操作，取材准确，诊断准确率高，在鼻咽癌诊断中值得提倡。     

睾丸扭转(附48例报告)

目的：探讨睾丸扭转的病因及诊治。方法：回顾分析48例睾丸扭转的临床资料。结果：48例患者中32例（66．67％）被误诊为睾丸炎，3例（6．23％）被误诊为肠炎，仅11例（22．9％）首诊得以确诊。33例（68．75％）睾丸缺血性坏死被切除。12月－2月发病者占43．75％（21／48）。结论：睾丸扭转的病因除本身解剖异常外，受凉、冷刺激可能是诱发因素。提高首诊诊断正确率将有助于扭转睾丸的获效。     

胸腹联合伤48例临床分析

目的探讨胸腹联合伤的特点和诊治方法。方法回顾分析经手术证实的48例胸腹联合伤临床资料。结果开放性损伤21例（占43．8％）,以锐器穿刺伤为主;闭合性损伤27例（占56．2％）,以交通车祸伤为主;受损器官3个以上23例（占47．9％）,术前休克29例（占60．4％）;术前确诊22例（占45．8％）,9例漏诊或延误诊断（占18．8％）;治愈40例,死亡8例（占16．7％）。结论胸腹联合伤伤情复杂、严重,休克发生率及死亡率高;膈肌损伤容易漏诊及延误诊断,重视院内急救、及时纠正休克及尽早手术治疗是抢救成功的关键。     

JAL (RH48) blood group antigen: serologic observations

BACKGROUND: JAL (RH48) is a low-prevalence antigen in the Rh blood group system and anti-JAL has caused hemolytic disease of the newborn. JAL is associated with either a haplotype carrying depressed C and e antigens or one carrying depressed c and e antigens. Blood samples from JAL+ people were tested, published serologic findings were confirmed, serologic studies were extended to include expression of other Rh antigens, and the antibody specificities produced by three sensitized JAL+ probands are reported.
STUDY DESIGN AND METHODS: Red blood cell (RBC) samples from 17 (12 probands) JAL+ persons were tested by hemagglutination using standard methods.
RESULTS: RBCs from both the Caucasian JAL+ probands had the (C)(e) haplotype and weakened C, e, hr^B, and hr^S antigens. JAL+ samples from black persons had the (c)(e) haplotype and expressed weakened c, e, f, V, VS, hr^B, and hr^S antigens. Plasma from three sensitized c+e+ JAL+ probands contained alloanti-c, alloanti-e, or alloantibody of apparent anti-Rh17 specificity. This study shows that this alloanti-Rh17−like antibody recognizes the high-prevalence antigen antithetical to JAL that has been named CEST.
CONCLUSIONS: The presence of the JAL antigen has a quantitative (weakening) effect on the expression of C, e, hr^B, and hr^S antigens in Caucasian persons and of c, e, f, V, VS, hr^B, and hr^S antigens in people of black African ancestry. A qualitative effect also was demonstrated by the presence of alloanti-c or alloanti-e in the plasma of two transfused c+e+ patients and by an antibody (anti-CEST) that recognizes the high-prevalence antigen antithetical to JAL.     

Comparative evaluation of a novel chromogenic medium (chromID OXA-48) for detection of OXA-48 producing Enterobacteriaceae

Comparative evaluation of the recently developed chromogenic culture medium chromID OXA-48 (bioMérieux) with chromID CARBA (bioMérieux) and SUPERCARBA showed that chromID OXA-48 and SUPERCARBA media have the highest sensitivity for detection of OXA-48 producing Enterobacteriaceae (91% and 93%) comparatively to chromID CARBA (21 %). The chromID OXA-48 has the highest specificity, with 100%, as compared to 53% and 68% for the SUPERCARBA and chromID CARBA media for detecting those OXA-48 producers.