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Anesthesia
Published in Peter Houpt, Hand Injuries in the Emergency Department, 2023
Inject one to two centimeters in the carpal tunnel proximal to the wrist fold between the FCR and the PL. A bolus of a few milliliters is sufficient. If no sign of paresthesia occurs after five minutes, the procedure may be repeated.
Adrenoleukodystrophy
Published in William L. Nyhan, Georg F. Hoffmann, Aida I. Al-Aqeel, Bruce A. Barshop, Atlas of Inherited Metabolic Diseases, 2020
William L. Nyhan, Georg F. Hoffmann, Aida I. Al-Aqeel, Bruce A. Barshop
Symptoms in the female heterozygote may resemble those of adrenomyeloneuropathy. In a few, there is severe disability with paraparesis [29, 30]. These women may be thought to have multiple sclerosis, if there is no family history of involved males [31]. One patient had intermittent paresthesia from the age of 40 years [31]. Some asymptomatic patients have had hyperreflexia and impaired vibration sensation in the legs. Some have been diagnosed only after they had an affected son [31]. Adrenal insufficiency is rare in most heterozygotes [32]. Some have had dementia. Others have had an adolescent onset of the kind of progressive cerebral disease seen in the male, even with adrenal insufficiency [30, 33].
Local Anesthetics
Published in Sahab Uddin, Rashid Mamunur, Advances in Neuropharmacology, 2020
Elena González Burgos, Luis Luis García-García, M. Pilar Gómez-Serranillos, Francisca Gómez Oliver
From the structural point of view, this amino amide type local anesthetic differs from those of its category in that it has a thiophene group instead of a benzene ring, which gives it greater lipid solubility and potency. Moreover, articaine has an ester group which gives it a lower plasma half-life (20 min) since this compound is rapidly hydrolyzed by the action of nonspecific plasma esterases to its inactive metabolite articainic acid. This rapid metabolism is associated with a reduced risk of systemic toxicity and overdose compared with other amino amide local anesthetics (Yapp et al., 2011). However, several epidemiological studies suggest that articaine has a higher occurrence of causing paresthesia. Paresthesia is an abnormal sensation, usually pricking, tickling, numbness, burning or itching which occurs in hands, feet, toes, fingers, or another part of the body. Comparing articaine 4% and lidocaine 2% associated both local anesthetic drugs with epinephrine 1:100,000, the ratio of suffering from paresthesias after their administration of in a dental procedure is 1/49 for articaine and 1/63 for lidocaine and the duration of paresthesia varies from a few hours to around 20 days (Haas, 2006; Hopman et al., 2017; Malamed et al., 2001).
Guillain-Barré syndrome after bortezomib therapy in a child with relapsed acute lymphoblastic leukemia
Published in Pediatric Hematology and Oncology, 2022
Valeria Ceolin, Rosita Cenna, Francesca Resente, Manuela Spadea, Franca Fagioli, Nicoletta Bertorello
Peripheral neuropathy (PN) has been described in patients receiving bortezomib, which is predominantly sensory. Symptoms include paresthesia, numbness in distal areas, particularly the lower limbs, burning sensations, dysesthesias, sensory loss, reduced proprioception, vibratory sensation, reduction of deep tendon reflexes and autonomic skin innervation. Neuropathic pain has also been described and happens more frequently than with other neurotoxic drugs.14 PN usually appears after a number of cycles of treatment and is associated with dose accumulation, but symptoms may also appear after the first few doses; recent studies28 did not find a clear linear correlation between the cumulative dose or dose intensity and the severity of polyneuropathy, indicating that certain patients developed a severe polyneuropathy following a relatively low dose of BZM. The pathophysiology of bortezomib induced neuropathy is not completely clear yet. Experimental studies suggest that aggresome formation, endoplasmic reticulum stress, myotoxicity, microtubule stabilization, inflammatory response, and DNA damage could contribute to this neurotoxicity.29
Choice of intrathecal drug in the treatment of neuropathic pain – new research and opinion
Published in Expert Review of Clinical Pharmacology, 2019
Timothy R. Deer, Mark Malinowski, Vishal Varshney, Jason Pope
Interventional management of neuropathic pain involves a variety of procedures depending on the neuropathic pain diagnosis, such as epidural steroid injections and radiofrequency lesioning [5]. These are, however, limited in their long-term efficacy with regards to pain improvement and functionality [1]. Clinical practice guidelines for advanced interventional management of neuropathic pain advocate for the use of spinal cord stimulation (SCS; the treatment of pain by applying electrical currents to the spinal cord delivered by electrodes over the dorsal columns of the spinal cord to modulate pain generation or processing) and intrathecal (IT) therapy (the direct infusion of analgesic medications in the cerebrospinal fluid) to achieve a longer-duration response [5]. However, for patients that fail SCS or do not achieve optimal therapeutic paresthesia coverage, IT therapy remains a viable option [5]. Furthermore, for patients with noncancer pain, the use of IT therapy may show significant economic benefit compared to conventional medical management [6].
Centruroides sculpturatus envenomation in three adult patients requiring treatment with antivenom
Published in Clinical Toxicology, 2018
Nicholas B. Hurst, Demis N. Lipe, Stephen R. Karpen, Asad E. Patanwala, Ann M. Taylor, Keith J. Boesen, F. Mazda Shirazi
The bark scorpion is primarily found in Arizona but has been reported in neighboring states [3]. When contacted about a potential scorpion envenomation, specialists at a regional poison and drug information center provide the following age-specific recommendations: children younger than two years of age should be transported to a health care facility for observation, even in the absence of symptoms for those who live a significant distance from a healthcare facility. This is because they are at greater risk for toxicity and subsequent complications. Children older than two years of age and adults should be carefully monitored at home, and are referred for hospital care if severe muscle twitching, blurry vision, agitation, roving eyes, or excessive drooling occur. Callers are instructed that pain and paresthesias are common and are not a sign of severe envenomation requiring hospitalization. In 2016, data from the poison and drug information centers of Arizona show that 89% of calls received about scorpion envenomations were managed at home.