Does skin temperature difference as measured by infrared thermography within 6 months of acute herpes zoster infection correlate with pain level?

BACKGROUND: Changes in the temperature distribution of the skin follows herpes zoster (HZ). Infrared thermography is a non-invasive, non-ionizing diagnostic tool that provides information about normal and abnormal functioning of the sensory and sympathetic nervous systems. This study examined the usefulness of infrared thermography as a predictor of post-herpetic neuralgia (PHN). METHODS: Infrared thermography was performed on the affected body regions of 110 patients who had been diagnosed with acute HZ. Demographic data collected included age, gender, time of skin lesions onset, development of PHN, and comorbidities. The temperature differences between the unaffected and affected dermatome were calculated. Differences >0.6 degrees C for the mean temperature across the face and trunk were considered abnormal. RESULTS: The affected side was warmer in 35 patients and cooler in 33 patients than the contralateral side. A patient's age and disease duration affected treatment outcomes. However, the temperature differences were not correlated with pain severity, disease duration, allodynia, development of PHN, and use of antiviral agents (P>0.05). CONCLUSION: A patient's age and disease duration are the most important factors predicting PHN progression, irrespective of thermal findings, and PHN cannot be predicted by infrared thermal imaging.

Wolff-Parkinson-White syndrome in young people, from childhood to young adulthood: relationships between age and clinical and electrophysiological findings.

PURPOSE: The aim of the present study was to evaluate the characteristics of electrophysiologic studies (EPS) and radiofrequency ablation (RFA) performed in subjects aged less than 30 years with Wolff-Parkinson-White (WPW) syndrome, particularly pediatric patients under 18 years of age, based on our experience. METHODS: Two hundred and one consecutive patients with WPW syndrome were recruited and divided to 3 groups according to age: group 1, 6 to 17 years; group 2, 18 to 29 years; and group 3, 30 to 60 years. The clinical, electrophysiological, and therapeutic data for these patients were evaluated by a retrospective medical record review. RESULTS: A total of 73 (36%) of these patients were <30 years of age. Although there were more males than females in group 2 (male:female, 31:11), there was no sex difference in group 1 (male:female, 16:15). Left accessory pathway was detected less frequently in group 1 (32%, 10/31) than in group 2 (57%, 24/42) and group 3 (63%, 81/128) (P=0.023 and P=0.002, respectively). CONCLUSION: The present study describes several different electrophysiological characteristics in children and adolescents with WPW syndrome. Therefore, when EPS and RFA are performed in children and adolescence with WPW syndrome, we recommend that these characteristics be considered.

Unpredicted tachycardia and hypotension in a patient with medullary thyroid cancer and undiagnosed pheochromocytoma: A case report.

A 35 year old woman with hypercalcitoninemia was scheduled for an operation to treat her medullary thyroid cancer (MTC). TIVA with propofol and remifentanil was planned, and about 3 minutes after the infusion of anesthetics, her heart rate was suddenly elevated to 180/min and the systolic blood pressure was lowered to nearly 50 mmHg. The blood pressure returned to normal after the injection of phenylephrine 100 microgram and a rapid infusion of 700 ml crystalloid solution. After the operation, bilateral pheochromocytoma and a RET proto-oncogene mutation related with multiple endocrine neoplasia 2A (MEN-2A) were found. Patients with MTC can present with peripheral vasodilation and relative hypovolemia that are related with hypercalcitoninemia. Patients with MEN-2A can be anesthetized for a MTC operation without the appropriate preparation for their pheochromocytoma. Therefore, we suggest that patients with MTC and hypercalcitoninemia should be cautiously anesthetized with TIVA. They also should be screened for pheochromocytoma and the RET proto-oncogene mutation to prevent deleterious hemodynamic events during anesthesia.