[Eosinophilic fasciitis associated with Parkinson's syndrome - a case report]. / Eozinofilni fasciitis udruzen s Parkinsonovim sindromom - prikaz bolesnika.

We present a 67 year old patient with erythema and swelling of the right arm. Suspected erysipelas and lymphedema are diagnosed at infectious department in the second month of the disease. He was treated with parenteral antibiotics (clindamycin + quinolon). After that, he was hospitalized at rheumatology department as right hand lymphedema, condition after erysipelas, cervicobrachial syndrome and ulnar epicondylitis of right elbow. Lymphatic drainage of right hand was performed, but with no effect. In the seventh month of the disease, the diagnosis of eosinophilic faciitis was established and started treatment with corticosteroids. Besides mentioned, dizziness, tremor, balance disorders, impaired hearing and pain in the cervical and lumbar spine were apeared. The therapy was introduced with levodopa and ropanirol and there is a slight improvement of neurological manifestations of extrapyramidal syndrome. After 18 months of disease the patient has a contracture of his right shoulder, induration and painful movements right forearm, pronounced tremor of the head and hands, balance disorders, neck pain and back pain, difficulty in walking.

Comparison of the effects of land-based and water-based therapeutic exercises on the range of motion and physical disability in patients with chronic low-back pain: single-blinded randomized study.

The aim of the study was to compare the effect ofwater-based exercise in thermal mineral water versus land-based exercise therapy on the lumbar spine range of motion and physical disability in adult patients with chronic low back pain. Out of 72 patients hospitalized for inpatient treatment in a special rehabilitation hospital, 36 patients performed a 3-week standardized program of group water-based exercises and the other 36 performed a program of group land-based exercises. All patients were also treated with electro analgesic therapy and underwater massage. The patients were assessed for lumbar spine motion using standardized measures with flexible tape, while physical disability was measured by the Physical Disability Index. Evaluations were performed at the beginning and at the end of treatment. Compared with baseline, a statistically significant improvement was detected in both groups regarding both primary outcome measures. At the end of treatment, there was no statistically significant difference between the two exercise treatments in any parameter of interest (p < 0.01). In conclusion, in our sample of patients with chronic low back pain, exercise treatment improved lumbar motion and decreased the level of physical disability. However, comparison of land-based exercises and water-based exercises in thermal mineral water did not demonstrate any significantly different result.

Lumboischialgia as the first sign of stomach cancer.

The paper reports on a case of a seventy-three-year-old male patient, whose disease was initially manifested by severe low back pain and lumboischialgia of the right leg as the first and only, and later, the leading symptom of disseminated adenocarcinoma of the stomach. The unusual presentation of stomach cancer confirms the necessity of simultaneous treatment of pain and determination of its etiology. It also indicates the need for re-evaluation of diagnosis when there is no favorable clinical effect of applied therapy.

Acute paroxysmal praecordial pain as a somatosensory elementary partial onset of epileptic seizure.

It presents a 60-year-old female patient with acute paroxysmal intensive pain attacks in the praecordial area that spread to the left hand and were associated with mild transient left hemiparesis, progressing to a myoclonic focal seizure in the region of left abdomen. The diagnostic procedure was interrupted several times by intensive pain attacks, but excluded acute thoracic pathological process, whilst a brain scan found a large, partially necrotic tumour with incipient bleeding and severe oedema subcortically in the right parietal lobe. We are describing a clinical presentation of symptomatic, simple focal, somatosensory epileptic seizure with dominance of intensive pain that progress in myoclonic, somatomotor focal seizure and Todd's Palsy as the first sign of glioblastoma bleeding.

Diagnoses of suicidum and tentamen suicidi in the registers of patients of the Kingdom of Yugoslavia's Banovina Public General Hospital in Bjelovar from 1931-1940.

Suicide has been a subject of research of philosophy, ethics, religion and medicine for centuries. Attitudes towards it changed during the history, from condemnation of suicide as an unethical act to the theory of suicide as the utmost expression of a human as an individual. Croatia, with the annual suicide rate above 20 percent belongs to the high-risk countries. Suicide frequency varies from region to region, while the suicide rates for the County Bjelovarsko-bilogorska have been well above Croatia's average for decades. The aim of this retrospective study was to establish some epidemiological features of hospital patients with the diagnoses of "suicidum" and "tentamen suicidi" on the basis of records available in the registers of patients of General Hospital in Bjelovar in the period between 1931 and 1940. In the observed period, thirty-three people were treated in hospital for suicide attempt, seven of them dying. An equal number of men and women attempted suicide (13:13), while in the group of those who died, the ratio was more in favour of women (4:3). Suicide incidence was highest in November, followed by May and June, with the most common method for suicide being acetic acid.

Differential diagnosis of acute abdominal pain - acute intermittent porphyria.

Acute intermittent porphyria (AIP) is a rare autosomal dominant disorder of heme biosynthesis in liver due to deficiency of porphobilinogen deaminase enzyme. Clinically, AIP is dominated by a colicky type pain, which does not subside after taking usual analgesics. Additional frequent symptoms are vomiting, hypertension, peripheral neuropathy, seizures, depression, delirium and coma. This paper reported a case of a twenty-five- year-old female patient, who had undergone a period of six days between the first presentation to the medical department and the diagnosis confirmation. It has accentuated possible mistakes in symptomatic therapy administration as well as dangers of a delayed diagnosis.

Failure in long-term treatment of chronic pain in cervical spondylotic myelopathy.

Cervical spondylotic myelopathy is a disease of high variability and its progressive form leads to severe disability. This paper reports on a case of a 31-year-old woman with whiplash neck injury sustained at the age of 11, and subsequent neck pain and numbness of arms. Slow progression of symptoms led to tetraparesis, and C3C4 disc herniation along with cervical myelopathy were revealed at the age of 26. Previously, she started a treatment for hypothyroidism. She underwent anterior cervical discectomy and fusion. Two additional operative treatments were done during the next two years due to lack of clinical improvement. Because of chronic pain the number of medications and the number of symptoms have gradually increased. We emphasize the problem of long-term treatment for chronic non-malignant pain and therapeutic dilemma in situations of inadequate analgesia.

Red ear syndrome--chronic pain syndrome of low prevalence.

A case is described of a 72-year-old woman that presented to our outpatient neurology clinic complaining of relapsing attacks of severe pain in and around the left ear and ipsilateral side of the face, accompanied by objectively visible cutaneous erythema with burning sensation throughout the attack. There was no alteration in her neurologic status. Comprehensive tests were done to exclude the possible primary diseases. The findings were within the limits of physiological values. Attempts at treating the pain with various analgesics and a combination of analgesics and first generation anticonvulsants did not prove effective. The pain was slightly relieved with pregabalin in maximum dosage. Because of various potential pathophysiological mechanisms, literature does not indicate any unique potential treatment approach, and some patients are resistant to any kind of therapy.