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[KINESITHERAPY OF REFLEX DYSTROPHIC RHEUMATISM OF THE SHOULDER IN SUBJECTS WITH HEART DISEASE. (CLINICAL CONTRIBUTION)].
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TENNIS ELBOW AND FROZEN SHOULDER.
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[UNUSUAL SYMPTOMS IN SPACE-OCCUPYING SPINAL PROCESSES].
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[FURTHER EXPERIENCES WITH VERTEBRAN IN ORTHOPEDIC PRACTICE].
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[PAIN IN THE UPPER FOURTH OF THE BODY AND ITS TREATMENT].
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[ON THE TREATMENT OF PERIPHERAL CIRCULATION DISORDERS].
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Cardioneuropathy and extracardiac neural disease.
The pathology of cardiac innervation, both intrinsic and external to the heart (aortopulmonary glomera included), is scarcely known, yet it can be critical to life-threatening disorders in cardiac performance, or to reflexes discharging outside the heart, or both. Evidence has been supplied in cardiac neuroanatomy relevant to cardioneuropathy. The arrhythmogenic potential of imbalanced autonomic input in the heart has been corroborated by histopathologic findings in intrinsic plexuses. In turn, significant neurogenic substrates for cardiomyopathy have not been confirmed. Changes in the extrinsic sympathetic chain (left stellate ganglion) and in the prevailing vagal cardiac plexus were found in subjects with arrhythmias (with long QT interval and ventricular tachycardia/fibrillation, respectively). In myocardial infarction with sudden cardiac death, a complicating mediastinitis often presented and was seen to produce focal inflammation of mediastinal nerve plexus and paraganglia. This can worsen the imbalance in autonomic control of the performance of the heart and interfere with barochemoreflex regulation of the systemic or coronary circulation, or both. Such ill-understood sequelae of infarction as the shoulder-hand, chest pain and Dressler syndromes might also correlate with the newly described neuromediastinitis.
Three-phase bone studies in hemiplegia with reflex sympathetic dystrophy and the effect of disuse.
Eighty-five patients with cerebral vascular accidents were assessed with three-phase bone scintigraphy of the hands and with whole-body delayed bone imaging. Nine patients (10%) had normal three-phase bone images. Fifty-five patients (65%) showed decreased blood flow and blood-pool images of the hands and wrists with normal delayed bone scintigrams, indicating the effect of paralysis or disuse. Twenty-one patients (25%) had diffuse increased uptake with periarticular accentuation, felt to be bone-scintigraphic evidence of reflex sympathetic dystrophy of the hands and wrists; in two patients this occurred before its clinical appearance. Thirteen of the 21 reflex sympathetic dystrophy syndromes (RDS)-involved limbs (62%) had increased blood flow, whereas 8 (38%) had decreased flow. Gross limb blood flow appears to be related to the degree of muscle activity, but flow may be altered by the presence of sympathetic changes. A possible dissociation between whole-limb flow and bone blood flow in paralyzed limbs involved with RDS is discussed. The elbow was involved in only one case, and a true "shoulder-hand" distribution was seen in only 11 of 21 cases (52%). Five patients (6%) had leg involvement on whole-body imaging. Traumatic synovitis of the wrist, and trauma to subluxed shoulders, could be recognized on the delayed study.