A rare case of anti-Hu paraneoplastic neurologic syndrome in association with cervical cancer.

Anti-Hu antibodies, also known as ANNA-1, are well characterized in paraneoplastic neuropathies. We present here the first known case of anti-Hu seropositivity, cerebellar ataxia, and sensory neuropathy in association with cervical cancer.

Cinchonism in a patient taking Quinine for leg cramps.

Quinine is often used as a treatment for benign nocturnal cramps. The use of Quinine remains controversial with conflicting studies regarding its efficacy. Quinine has a side effect profile that cannot be ignored. Cinchonism, or quinine toxicity, includes nausea, vomiting, and tinnitus. Many other side effects have been reported in the literature. A case report demonstrating the side effects of quinine is presented. We briefly review the literature on quinine and alternative medications.

Planning for the HPV vaccine and its impact on cervical cancer prevention.

Genital human papilloma virus (HPV), the most common sexually transmitted disease in the United States, is associated with cervical cancer in women, and penile cancers in men. The infection is asymptomatic until a malignancy develops. Of the more than 90 subtypes, only a small number are associated with malignancies. Vaccines made with recombinant HPV proteins have been shown effective in preventing infection with the more virulent strains of the virus.

As if the cancer wasn't enough! Understanding and treating the pain that comes with cancer.

In people with cancer, pain often occurs from the malignancy, from procedures done to diagnose, stage, and treat the malignancy, and from the toxicities of therapy used in treating the cancer. Of people with cancer, 75% complain of some sort of pain. Determining whether the pain is from tissue damage or nerve structures will guide therapy. Assessment of the severity of the pain by location, oncological type, as well as psychosocial and environmental factors are necessary to understand and treat the pain that accompanies cancer. Medical interventions include non-opioid analgesics, opioids, and multiple different combinations of medications. Adjuvant medication like anticonvulsants and steroids are being used frequently to help people feel more comfortable.

Shin splints: painful to have and to treat.

When people overuse their legs they develop an uncomfortable awareness of these limbs manifested as a dull burning or aching. The cause is often clear to the person with the problem as a result of the often obvious relationship to overdoing an exercise or activity and the pain. "Shin splints" is the lay term; physicians use the term medial tibial stress syndrome. The pathophysiology that leads to this pain is unclear, although there are a number of competing theories. Differential diagnosis includes stress fractures and compartment syndromes. Bone tumors or lipomas can also cause similar pain to shin splints. Diagnosis can be made by history alone in a majority of cases, but if the diagnosis is unclear, an X-ray and magnetic resonance imaging should be considered. Treatment is still mostly supportive and symptom related. Rest is the most important aspect of treatment. Locally applied cold and anti-inflammatory medication have also been felt to be beneficial.

Probiotics: the benefits of bacterial cultures.

Probiotics are bacterial cultures widely used in the treatment of disease. They are available without a prescription. Bacterial interference between types of bacteria and immunomodulation are the most common explanations as to why people may benefit from these treatments. The data on the use of probiotics in pediatric and adult diarrhea, inflammatory bowel disease, ileal pouchitis, urogenital infections, allergy, skin infections, and cancers are reviewed. Although generally safe, cases of complications from probiotic therapy are discussed, as well as potential problems that may develop.

A practical approach to fibromyalgia.

Fibromyalgia is the name given to a collection of symptoms with no clear physiologic cause, The constellation of symptoms are clearly recognizable as a distinct pathologic entity. The diagnosis is made through clinical observations made by the examiner. Differential diagnosis must include other somatic syndromes as well as disease entities like hepatitis, hypothyroidism, diabetes mellitus, electrolyte imbalance, multiple sclerosis, and cancer. Diagnostic criteria are given as guidelines for the diagnosis, not as absolute requirements. Treatment of this condition remains individualized and relies heavily on having a therapeutic relationship with a provider. Treatment of this syndrome needs to be looked at as an ongoing process. Goal oriented treatment aimed at maintaining specific functions can be directed at helping a patient get restorative sleep, alleviating the somatic pains that ail the patient, keeping a person productive, regulating schedules or through goal oriented agreements made with the patient. Since this syndrome is chronic and may effect all areas of a persons functioning the family and social support system of the person being treated need to be evaluated. Patients often seek alternative medical treatments for this problem including diet therapy, acupuncture, and herbal therapy. Treatment must involve more than just the symptoms presented and the patient can only be treated successfully if they are willing to work at changing their own perceptions, and ways of relating to stressors in their world.

Retrospective analysis of hiccups in patients at a community hospital from 1995-2000.

Hiccups are a physiologic phenomenon noted in animals and humans. There is little understanding of what makes hiccups occur and whether or not they have any productive purpose. A retrospective analysis of all patients seen in a community hospital over a 5 year period was conducted to see who is affected by hiccups, evaluate laboratory findings in people with hiccups, and to see what the currently accepted treatment is for hiccups. The vast majority of patients were male, older than 50 years of age, and with co-morbid conditions. Laboratory values appeared to be of little value in determining whether treatment interventions would be effective. Gastroenterology was the service most consulted and EGD the most common procedural intervention conducted, but with little success. No treatments showed a statistically significant effect.

Joint cracking and popping: understanding noises that accompany articular release.

Articular release is a physiologic event that may or may not be audible. It is seen in patients with healthy joints as well as those with somatic dysfunction. After an articular release, there is a difference in joint spacing-with the release increasing the distance between articular surfaces. Not all noise that emanates from a joint signifies an articular release. A hypothesis about the noise that frequently accompanies this release is offered and includes anatomic, physiologic, and functional models of articular release. Repeated performance of articular release may decrease the occurrence of arthritis. Potential problems from repeated articular release (eg, hypermobility) are also examined.