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Biomedical subjects

N Hendler

Publications and source records attributed to N Hendler.

At least 19 recordsLinked to original sources
PubMed2001

Painless electrodiagnostic current perception threshold and pain tolerance threshold values in CRPS subjects and healthy controls: a multicenter study.

The purpose of this study is to evaluate both painless and painful sensory transmission in patients with Complex Regional Pain Syndrome (CRPS) using the automated electrodiagnostic sensory Nerve Conduction Threshold (sNCT) test. This test generates reliable, painless Current Perception Threshold (CPT) and atraumatic Pain Tolerance Threshold (PTT) measures. Standardized CPT and PTT measures using constant alternating current sinusoid waveform stimulus at 3 different frequencies 5 Hz, 250 Hz, and 2 kHz (Neurometer CPT/C Neurotron, Inc. Baltimore, MD) were obtained from CRPS subjects at a distal phalange of the affected extremity and at an ipsilateral asymptomatic control site. Matched sites were tested on healthy subjects. Detection sensitivities for an abnormal PTT and CPT test were calculated based on specificity of 90% as determined from data obtained from healthy controls. A Spearman rank correlation was used to test for a significant association between presence of allodynia and an abnormal PTT or CPT at any frequency tested. Thirty-six CRPS subjects and 57 healthy controls were tested. The highest detection sensitivity of the PTT test from symptomatic test sites was 63% for the finger and 71% for the toe. PTT abnormalities were also detected, to a lesser degree, at the asymptomatic control site (41% finger control site, 16% toe control site). The highest CPT detection sensitivity at the symptomatic site was 37% for the finger site and 53% for the toe site. CPT abnormalities were also detected at the asymptomatic control site (29% finger control site, 37% toe control site). Eighty-six percent of the CRPS subjects had either a PTT or CPT abnormality at any frequency at the symptomatic site. There was a significant correlation between presence of allodynia and presence of an abnormal CPT and PTT, respectively (P < .01). The correlation coefficient was lower for CPT than for PTT, ie, 0.34 versus 0.6 for the finger and 0.48 versus 0.67 for the toe, respectively. In studied CRPS patients an abnormal PTT was detected with higher sensitivity than an abnormal CPT. Assessing PTT may become a useful electrodiagnostic quantitative sensory test for diagnosing and following the course of neuropathic pain conditions.

Journal Article↗
PubMed1998

Complex Regional Pain Syndromes: guidelines for therapy.

This report aims to present an orderly approach to the treatment of Chronic Regional Pain Syndrome (CRPS) types I and II through an algorithm. The central theme is functional restoration: a coordinated but progressive approach that introduces each of the treatment modalities needed to achieve both remission and rehabilitation. Reaching objective and measurable rehabilitation goals is an essential element. Specific exercise therapy to reestablish function after musculoskeletal injury is central to this functional restoration. Its application to CRPS is more contingent on varying rates of progress that characterize the restoration of function in patients with CRPS. Also, the various modalities that may be used, including analgesia by pharmacologic means or regional anesthesia or the use of neuromodulation, behavioral management, and the qualitatively different approaches that are unique to the management of children with CRPS, are provided only to facilitate functional improvement in a stepwise but methodical manner. Patients with CRPS need an individual approach that requires extreme flexibility. This distinguishes the management of these conditions from other well-described medical conditions having a known pathophysiology. In particular, the special biopsychosocial factors that are critical to achieving a successful outcome are emphasized. This algorithm is a departure from the contemporary heterogeneous approach to treatment of patients with CRPS. The underlying principles are motivation, mobilization, and desensitization facilitated by the relief of pain and the use of pharmacologic and interventional procedures to treat specific signs and symptoms. Self-management techniques are emphasized, and functional rehabilitation is the key to the success of this algorithm.

Algorithms↗
PubMed1995

Divalproex sodium and other medications for headache following craniotomy for acoustic neuroma.

Multiple pharmacologic agents were used in attempt to relieve a constant and severe headache in a 47-year-old patient following craniotomy for removal of an acoustic neuroma. Possible etiologies for the unremitting headache are presented. Response to various pharmacologic agents are listed and discussed. During the postoperative course of two surgeries on this patient, it was possible to propose an etiology for the headache by analyzing the mechanisms of each therapeutic agent, along with the patient's response. Divalproex sodium provided complete relief, suggesting the headache is attributable to cell membrane instability.

Anticonvulsants↗
PubMed1994

Perceptions of asthma severity: the role of negative affectivity.

The role of negative affectivity on patients' perceptions of and behavior during asthma attacks was explored among 47 asthmatic subjects. Patients completed 17 to 30 daily questionnaires assessing negative affect, asthma perception, additional drug intake, search for medical assistance, and peak-flow measures of respiratory distress. Asthma perceptions were correlated with negative affect and educational level; the perception of the asthma severity, but not negative affect, did predict behavior during an attack. The importance of symptom perceptions for the clinical management of chronic asthma is underscored.

Adult↗
PubMed1992

Shift from left to right axis deviation during ischemia.

A case report of a patient with persistent left anterior hemiblock admitted with acute ischemic heart disease is described. At effort during follow-up evaluation, the patient complained of retrosternal pain when the heart rate was 124 beats/min. No pathological ST-T changes were demonstrated at this time. At 133 beats/min, the precordial pain increased, the QRS axis displayed a marked shift to the right, and ischemic ST-T depression was recorded. In discussing this unreported phenomenon, it is pointed out that left anterior hemiblock does not necessarily represent an anatomical block of the atrioventricular bundle but may simply reflect a relative delay in conduction. In addition, acute ischemia may change the physiological behavior of the system resulting in slower conduction through the posterior rather than through the anterior atrioventricular bundle. The influence of left anterior and left posterior hemiblock on ischemic ST-T changes and on the coronary flow distribution is discussed.

Aged↗
PubMed1992

Testicular carcinoma with inferior vena cava thrombosis extending into the right atrium treated with chemotherapy and anticoagulation.

A 34-year-old male with pulmonary emboli and thrombosis of the inferior vena cava extending into the right atrium was found at presentation to have a mixed seminoma and embryonal cell testicular carcinoma with high-volume retroperitoneal disease and visceral metastases. The patient was free of disease 19 months after treatment with combination chemotherapy and anticoagulation followed by resection of the residual mass. We could not find any previous report of a patient with bulky retroperitoneal disease and vena cava thrombosis successfully treated with chemotherapy without vena cava resection.

Adult↗
PubMed1991

Jaccoud's-type arthropathy: an association with sarcoidosis.

We describe a patient with sarcoidosis involving the lungs, muscles and tendons of the forearms who developed Jaccoud's-type arthropathy of the hands. This is the first reported case to the best of our knowledge of sarcoidosis associated with this type of arthropathy.

Female↗
PubMed1991

An outbreak of penicillin-resistant Neisseria gonorrhoea in southern Israel.

Since the early 1980s the incidence of gonorrhea has been declining worldwide, as well as in Israel. This decline has been attributed to the fear of AIDS. We report an outbreak of penicillin-resistant Neisseria gonorrhoea that occurred in the last quarter of 1988 and throughout 1989 in southern Israel. During 1987 and the first three-quarters of 1988 only 13 new cases were diagnosed, all penicillin sensitive. During the epidemic, 94 new cases were diagnosed, 41% of them penicillin resistant. In March 1989, ceftriaxone was substituted for penicillin for the treatment of gonococcal urethritis. The number of cases of penicillin-resistant gonorrhea dropped dramatically. It is concluded that despite the AIDS panic, outbreaks of gonorrhea can still be encountered, as demonstrated in this study.

Adolescent↗
PubMed1989

Effects of active and completed litigation on treatment results: workers' compensation patients compared with other litigation patients.

Outcomes of multidisciplinary pain treatment in workers' compensation claimants and in the claimants of other insurance companies were studied. Patients were also segregated as to state of completion of the litigation process. No differences were found between the groups in organic and psychologic pathology. Significant improvement in outcome measures was found for the total group, but the workers' compensation claimants with completed litigation failed to show any significant improvement in these measures. The system itself and legal factors can be obstacles to rehabilitation of the patient with chronic pain. Early intervention is recommended to improve treatment outcome.

Activities of Daily Living↗
PubMed1988

A comparison between the Minnesota Multiphasic Personality Inventory and the 'Mensana Clinic Back Pain Test' for validating the complaint of chronic back pain.

Reports on the efficacy of the Minnesota Multiphasic Personality Inventory (MMPI) for selecting patients with valid complaints of pain have been equivocal. The Mensana Clinic Back Pain Test (MPT) was able to predict, with some degree of success, patients who had a definite organic pathologic condition. However, the MMPI measures personality traits, whereas the MPT measures the impact of pain on a patient's life. To determine which of the two tests would be a better predictor of actual physical abnormalities, and hence valid pain complaints, a comparison was undertaken between the two tests. The charts of 83 patients admitted to the Neurosurgery Service of Johns Hopkins Hospital with complaints of back pain were assessed. MMPI test results, as well as test results for the MPT, were compared to the presence or absence of pathologic conditions on electromyography, nerve conduction velocity studies, thermography, myelogram, or computerized axial tomography scan. The MPT had a correlation factor of -.59700, that was significant as P = .000005. Of the 52 patients scoring 17 points or less on the MPT, 85% had objective physical abnormalities, considered moderate or severe by blind review. Of the 31 patients scoring 18 points or greater on the MPT, only 26% had objective physical findings that were considered moderate or severe. Only the F scale (faking badly) of the MMPI correlated with objective physical abnormalities (r = .21340, P less than .033). However, 60% of the patients with T scores of less than 70 on the F scale had objective findings, whereas 75% of patients with T scores greater than 70 had objective physical findings.(ABSTRACT TRUNCATED AT 250 WORDS)

Back Pain↗
PubMed1984

Depression caused by chronic pain.

The chronic pain patient presents a difficult diagnostic and management challenge. The relationships between depression and chronic pain, and the stages of chronic pain with their associated psychiatric symptoms, are reviewed. The methods of validating pain and the most commonly missed causes of chronic pain are described. It is clear that depression associated with chronic pain is a complex problem necessitating a careful multidisciplinary approach if misdiagnosis and inappropriate or insufficient treatment are to be avoided.

Antidepressive Agents, Tricyclic↗