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In most cases, the cause of an earache is obvious. If the cause is not apparent after careful inspection, a systematic approach to the associated causes and sites of referred pain is necessary. Glue ear is the most frequent cause of hearing loss in children. The diagnosis, investigation and management have been described. Recurrent earache from pressure change or from recurrent middle ear infection is an important clue to the presence of a glue ear.
Headaches are a frequent symptom in ENT-patients. The complex sensory innervation of the ear, nose and paranasal sinuses is demonstrated. Heterotopic or referred pain must be differentiated from homotopic pain that is experienced at the point of injury. The nervous pathways of heterotopic otalgia are shown. The quality of pain of the most common rhinological and otological diseases is reported.
Conditions that occur in the dancer's hip fall into the following categories: poor training; conditions that occur as the result of normal use; overuse syndromes, including tendinitis and myositis; and conditions referring pain to the hip. Dancers are highly motivated and goal oriented and often suppress symptoms for long periods, making diagnosis and treatment difficult. Observing the dancer at work and understanding his art are emphasized, and a practical guide to therapy is presented. Development of proper dance technique and a proper flexibility program can decrease the incidence of injuries.
Angina-like phenomena of CNS etiology were studied. Data were collected and analyzed from clinical cases of cerebral hematoma, concussion, and tumors in which cardiological disturbances were observed consequent to compressive brain lesions or surgical brain manipulations. The cases in which the disturbances were largely angina-like and without ectopic beats or arrhythmias were chosen for study. The brain region most significantly related to this phenomenon seemed to be the hypothalamus. Experiments conducted in cats and monkeys showed that stimulation of specific sites in the hypothalamus resulted in angina-like manifestations with no other cardiac changes. These data support our working hypothesis that a cerebrally induced syndrome that is conspicuously angina-like must be related to hypothalamic involvement. In the awake monkey hypothalamic stimulation caused angina-like ECG changes and behavior suggestive of referred pain. In some cases, repetitions of the stimulations or irritations in all of the species resulted in permanent pathological myocardial changes, mostly bleeding into the myocardium. In some animals there were minute hemorrhagic necroses that were subepicardial in distribution. It is significant that the most severe or permanent pathological changes were found in cases in which the angina-like ECG alterations were persistent. There were also cases, however, with persistent angina-like ECG changes that showed no such pathology.
The nature, frequency and cause of clinical features suggesting muscle involvement in systemic lupus erythematosus were studied in 20 patients during "active" disease. Half of these patients experienced varying combinations of myalgia, proximal muscle weakness and muscle tenderness. This group "with muscle features" had a higher incidence of arthralgia and much of their myalgia may simply have been due to pain referred from adjacent joints. However, a greater number of abnormalities were also found in the muscle biopsies of this group and it is likely that polymyositis and steroid myopathy were important contributory factors.
Four joggers had early confirmation of clinically suspected stress fractures by radionuclide bone scans. The radioactive bone scan was abnormal as early as six weeks prior to the appearance of conventional roentgenographic changes. The stress fractures involved the bones of the lower extremities and included the femur, tibia, and calcaneus. Radioactive bone scanning also correctly identified stress fractures with bilateral involvement and referred pain. In joggers, when a stress fracture is clinically suspected and the conventional radiographs are negative, a radioactive bone scan is indicated for early confirmation and institution of appropriate treatment.
The Brown-Séquard syndrome is infrequently reported. Though widely considered indicative of intramedullary spinal cord disease, in the absence of penetrating spinal cord trauma, the syndrome is frequently an early stage of extramedullary spinal cord compression, as an extensive analysis of diverse literatures reveals. We describe two cases resulting from compression of the spinal cord by a meningioma. While previous reviews emphasize that radicular or vertebral pain is a prominent feature of spinal cord compression by intradural tumors, our patients had no pain referable to tumor. Awareness that painless extramedullary spinal cord compression can produce the Brown-Séquard syndrome, early myelography, and surgical intervention are necessary to prevent progressive deficit. Even when encountered in a patient who has previously well-documented demyelinating disease, the syndrome should not be written off as a relatively untreatable intramedullary process.
Osteoid osteoma occurring in the thoracic spine, manifest as purely referred pain, is extremely uncommon. In the case of a 24-year-old man, the treatment for painful osteoid osteoma of the spine was excision. Since excision of a thoracic spinal osteoid osteoma compromised stability, a posterior fusion was performed at the time of excision, and the results were excellent.
The term endometriosis means the presence in an ectopic site of normal functioning endometrial tissue, the ectopic endometrial tissue, as the normal uterine mucosa, undergo hormonal stimulation and follow the proliferative and functional changes along the menstrual course; this evolution, characterize the clinical story of patients affected by endometriosis. Endometriosis is considered to be one of the most common gynecologic disorders, occurring in about 10% of women in fertile age. An involvement of adjacent organs such as the pelvic colon and rectum by endometriosis is not uncommon and may cause symptoms difficult to distinguish from malignant or inflammatory disease located in the pelvic region. The purpose of the following case report is to elucidate certain diagnostic and therapeutic problems of a disease concerning both the surgeon and gynecologists. Our case concerns a 44 year old patient with two children and a negative previous clinical gynecological history; the patients reports the occurrence in the last two years of alterations of colic evacuation consisting in a period of constipation lasting 5-7 days. The patient reached us in emergency with a sub-occlusive state that has lasted for 5 days, in the last 12 hours the appearance of a violent trafictive pain referred to the lower abdomen configure the clinical picture of a acute abdomen. The patient underwent surgery and the laparotomy demonstrated the presence of a perforated tumours located at the recto-sigmoid junction. We proceed to perform an Hartman's resection and a right ovariectomy.(ABSTRACT TRUNCATED AT 250 WORDS)
An attempt has been made to relate clinical thinking to available experimental evidence of the physiological background to temporomandibular joint dysfunction. There is little or no evidence that the condition results from displacement of the mandibular condyles. The contention that muscle hyperactivity is a primary cause receives some experimental support, but there is no clear evidence that malocclusion of the teeth leads, through reflex mechanisms, to maintained hyperactivity. Instead there is an increasing weight of evidence that hyperactivity of jaw closing muscles may originate in the central nervous system. It is concluded that such centrally induced activity may be sufficient to cause muscle damage, which leads to disturbed function, local pain and tenderness and to pain referred to adjacent structures.
1. The HRP labeled method was used to study the segmental distribution of sympathetic afferent neurons of the heart. 10%-20% HRP 150 microliters solution was injected around the left coronary artery of 18 cats. The HRP labeled cells were observed in the C8-T10 spinal ganglions, therefore the segmental distribution of sympathetic afferent neurons of the heart were in C8-T10 spinal cord. 2. The segmental distribution of cardiac nerve's afferent neurons was studied, 30% HRP 15 microliters was injected into the cardiac nerve of 18 cats. The HRP labeled cells were observed in the C8-T9 spinal ganglions. 3. CB-HRP 10 microliters was injected into the medium and inferior cardiac nerves. The cardiac nerve's fibers project into T1-5 spinal cord, the HRP labeled fibers were observed in III-VII lamina of spinal cord, and there were connections with III, IV, V, VI, VII laminas. 4. The segmental distribution of sympathetic afferent neurons of heart and cardiac nerve, projection of the cardiac nerve the III-VII laminae of spinal cord and the connection of fibers in the III-VII laminae were the morphologic foundations of referred pain and the heart disease. (tachycordia, angina etc.) treated with acupuncture.
In order to evaluate the clinical and sonographic findings in 60 patients with ectopic pregnancy confirmed at laparotomy, we carried out a prospective study at the Hospital de Gineco-Obstetricia del Centro Médico León, Instituto Mexicano del Seguro Social. The patients were 28.17 years old, average. The ectopic pregnancy was more common in multiparous women (80%) than in nuliparous ones. The obstetric risk factors more frequent were abortion (26.6%) and use of intrauterine device (23.3%). The clinical sign reported most common was pelvic pain, referred in 48 patients (80%). Hemodynamic changes were detected in 21.6% of the cases. The ultrasound findings were seen in most of the patients and heterogeneous adnexal mass was observed in 91.6% of them, moreover intraperitoneal fluid was reported in 61.6% of the patients with ectopic pregnancy. The heterogeneous adnexal mass had a direct relationship with the diagnosis of ectopic pregnancy and had a correlation coefficient value R = 0.99 (P < 0.01). The ultrasonographic findings seen with transvaginal technique were similar than those obtained through transabdominal procedure. We conclude that ultrasonography has a definite role in improving the diagnosis of ectopic pregnancy.
Reflex sympathetic dystrophy, a well-described clinical entity that is frequently encountered in adults, is uncommonly reported in children. We report a case of reflex sympathetic dystrophy in a little girl aging 8 years. The main symptom was the acute pain referred to the right lower extremity. We underline once more the difficult of diagnosis and the contribution of 3-phase bone scan.
Diffuse sclerosing chronic osteomyelitis is a lasting pathological entity characterized for recurrent outbreaks of intensive pain referred to the mandible, escorted with inflammatory phenomena, trismus, paresthesia of the nervus alveolaris inferior and progressive deformity of the lower jaw. The differential diagnosis with other facial neuralgies of the face must be very carefully get up and its treatment is disappointing. The etio-pathology of the illness remains uncertain. The AA. report one clinic case with typical course, which offer them the opportunity to review and discuss the literature of the subject.
Muscle contraction headache (tension-type headache; MCH) usually begins when a patient is looking down or bending their neck. In the case of MCH patients, EMG activity of the posterior neck muscles at a sitting posture is significantly higher than the controls when the orbito-meatal line is horizontal or bending downward. Comparing with the controls, blood flow of the posterior neck muscle decreases sharply when the head is bent downward. Decrease of the muscle blood flow continues if the muscle is passively contracted. However, in the case of active contraction, blood flow recovers reflexly in 30 seconds. This explains why postural muscle contraction is important. When a patient is ordered to bend her neck down at the orbitomeatal line 30 degrees from horizontal, patient complains of a dull feeling at her posterior neck muscles in 30 seconds. In two minutes dull headache appears at the occipital area, soon becoming more intense and spreading to the forehead and temporal area. Once she looks up, muscle contraction of the neck disappears though she still feels headache. After the local anesthesia is applied to the occipital tender point, her headache disappears completely. From this experiment, MCH is a referred pain from occipital tender point which is the insertion point of occipital neck muscles. Patients with poor stability of cervical bone, and relatively heavy head weight compared with their neck are susceptible to MCH. Psychological stress decreases blood flow of the muscle and aggravates ischemic muscle contraction. Other risk factors include hypotension, anemia, and weak muscle power.
The etiological role of Chlamydia trachomatis in chronic nonbacterial prostatitis is controversial. To assess whether C. trachomatis relates to chronic nonbacterial prostatitis, we investigated the serum levels of immunoglobulin G (IgG) and IgA antibodies specific for C. trachomatis in 41 patients with chronic nonbacterial prostatitis and 47 patients with prostatodynia. The positive rates of the IgG antibody were 29% and 28% in patients with chronic nonbacterial prostatitis and prostatodynia, respectively. There was little difference in the positive rates of the IgG and IgA antibodies for C. trachomatis, between patients with chronic nonbacterial prostatitis and prostatodynia. Also, there was no significant difference in the positive rate of the IgG antibody between 51 patients complaining of urinary symptoms and 25 complaining of referred pain. However, a high positive rate of the IgG antibody (80%) was observed in patients with hematospermia. Our findings suggest that C. trachomatis could not be etiologically responsible for chronic nonbacterial prostatitis, but that it may be related to hematospermia.
In a prospective study of 163 consecutive patients operated on because they were thought to have lumbar disc hernia, the authors investigated whether physical signs could predict the degree of hernia (complete hernia, incomplete hernia, protruded disc, and normal disc) found at surgery. Stepwise discriminant analysis showed that there were only 2 physical signs of diagnostic value: lumbar range of motion and crossed Lasegue sign. By these signs, 74% of the uncontained hernias and 68% of the contained hernias could be correctly classified. Discrimination also was made between intact annuli (negative exploration and protruded disc) versus ruptured annuli (incomplete hernias and complete hernias). Again, lumbar range of motion and crossed Lasègue sign were the only significant parameters, predicting 71% of the ruptured annuli and 80% of the intact annuli. These 2 physical signs are important because the degree of the hernia is the most important prognostic factor for the outcome of lumbar disc surgery. The degree of the hernia also has an impact on the choice of invasive therapy: open surgery, percutaneous surgery, or enzymatic nucleolysis. Neurologic signs often were absent, showed low correlation to the degree of the hernia, and had a limited value for predicting the level of the hernia. However, they are important for the differential diagnosis in distinguishing between radicular and referred pain.
The differential diagnostic classification of the "shoulder-hand-syndrome" according to etiology and pathophysiological principles is of major importance. The radicular syndrome, subsumed as the shoulder-hand syndrome following a local lesion, must be exactly defined. The pseudoradicular syndrome, which frequently appears clinically in the cervical region under the guise of middle and lower cervical syndrome, has its cause in disturbed function of the vertebral joints. But it can also arise as a mixed syndrome, radicular and pseudoradicular, through a substantial root lesion. The diagnosis of a referred pain in a "shoulder-hand syndrome" can lead to the discovery of internal organic lesions or lesions of the locomotor apparatus of the extremities.