Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 22
Filtrar
1.
J Child Neurol ; 32(5): 482-487, 2017 04.
Artigo em Inglês | MEDLINE | ID: mdl-28068857

RESUMO

This secondary analysis of a large (n = 241), randomized, double-blind study evaluated the efficacy of 2 doses of abobotulinumtoxinA + standard of care (SOC) versus placebo + SOC in enabling children with dynamic equinus due to cerebral palsy to achieve their functional goals using Goal Attainment Scaling. Most parents/caregivers selected goals targeting aspects of gait improvement as most relevant. Mean (95% confidence interval) Goal Attainment Scaling T scores at week 4 were higher for both abobotulinumtoxinA groups versus placebo (treatment difference vs placebo: 10 U/kg/leg: 5.32 [2.31, 8.32], P = .0006, and 15 U/kg/leg 4.65 [1.59, 7.71], P = .0031). Superiority of both abobotulinumtoxinA doses versus placebo was maintained at week 12. Best goal attainment T scores were higher in the abobotulinumtoxinA groups versus placebo for the common goals of improved walking pattern, decreased falling, decreased tripping, and improved endurance. These findings demonstrate that single injections of abobotulinumtoxinA (10 and 15 U/kg/leg) significantly improved the ability of pediatric cerebral palsy patients to achieve their functional goals.


Assuntos
Toxinas Botulínicas Tipo A/uso terapêutico , Paralisia Cerebral/tratamento farmacológico , Pé Equino/tratamento farmacológico , Marcha/efeitos dos fármacos , Fármacos Neuromusculares/uso terapêutico , Adolescente , Toxinas Botulínicas Tipo A/farmacologia , Paralisia Cerebral/complicações , Criança , Pré-Escolar , Método Duplo-Cego , Pé Equino/etiologia , Feminino , Objetivos , Humanos , Masculino , Fármacos Neuromusculares/farmacologia , Resultado do Tratamento
2.
J Back Musculoskelet Rehabil ; 29(3): 575-80, 2016 Aug 10.
Artigo em Inglês | MEDLINE | ID: mdl-26836832

RESUMO

BACKGROUND/PURPOSE: The purpose of this study was to evaluate the neuropathic symptoms after local steroid injection in CTS. Since 2001, neuropathic pain scales have been used in the assessment and follow-up of neuropathic pain. DN4 and LANSS pain questionnaires have been applied to groups, mostly consisted of radiculopathy and polyneuropathy cases, before and after various treatments and the results have been compared with the electrophysiologic findings. However to our knowledge there is yet no such study focusing on neuropathic complaints and the relationship between neuropathic pain and electrophysiological findings before and after local corticosteroid injection. METHODS: Forty-one patients aged 22-65 years and diagnosed with carpal tunnel syndrome by nerve conduction studies who were also found to have neuropathic symptoms were included in the study. All patients received local steroid injection into the carpal tunnel while the questionnaires and nerve conduction studies were performed before and 2 months after the injection. RESULTS: Local steroid injection was found effective on clinical and electrophysiologic parameters as well as on DN4 and LANSS scores in CTS patients (p< 0.05). Electrophysiologic severity exhibited no statistically significant relationship with DN4 and LANSS scores, before and after treatment (p> 0.05). CONCLUSION: These findings suggests that the treatment of neuropathic complaints should be planned independently from the electrophysiologic findings and minimally invasive local steroid injection appears to be effective with regard to clinical and electrophysiologic aspects in CTS patients with neuropathic complaints.


Assuntos
Corticosteroides/uso terapêutico , Síndrome do Túnel Carpal/diagnóstico , Neuralgia/diagnóstico , Adulto , Idoso , Síndrome do Túnel Carpal/tratamento farmacológico , Síndrome do Túnel Carpal/fisiopatologia , Eletrodiagnóstico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neuralgia/fisiopatologia , Índice de Gravidade de Doença , Inquéritos e Questionários , Resultado do Tratamento , Adulto Jovem
5.
J Clin Rheumatol ; 19(6): 341-3, 2013 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-23965473

RESUMO

Prolactin-secreting adenomas represent nearly 40% to 60% of all pituitary adenomas. Prolactin inhibits the secretion of gonadotropin-releasing hormone that is responsible for the synthesis and secretion of gonadotropins. Sex steroids have an important effect on the regulation of bone metabolism in men. Decreased libido and impotence are the most common presenting symptoms of hyperprolactinemia in males. These symptoms are easily neglected by both patients and some physicians. We present a 22-year-old man with multiple osteoporotic fractures associated with prolactinoma despite the use of teriparatide for 18 months. We emphasize and highlight the importance of hyperprolactinemia and fractures caused by high prolactin levels.


Assuntos
Osteoporose/diagnóstico , Osteoporose/etiologia , Neoplasias Hipofisárias/complicações , Neoplasias Hipofisárias/diagnóstico , Prolactinoma/complicações , Prolactinoma/diagnóstico , Índice de Gravidade de Doença , Conservadores da Densidade Óssea/uso terapêutico , Gerenciamento Clínico , Humanos , Masculino , Osteoporose/tratamento farmacológico , Fraturas por Osteoporose/diagnóstico , Fraturas por Osteoporose/etiologia , Prolactina/metabolismo , Teriparatida/uso terapêutico , Resultado do Tratamento , Adulto Jovem
6.
Rheumatol Int ; 33(5): 1345-9, 2013 May.
Artigo em Inglês | MEDLINE | ID: mdl-22147111

RESUMO

Juvenile rheumatoid arthritis is a common chronic inflammatory disease in the childhood and it can differentiate rarely into spondiloarthropaties. It is one of the important causes of chronic pain and disability. Some of the drugs used for the treatment have immunosupressive activity. One of the serious side-effects of immunosupressive treatment is activation of opportunistic pathogens. Hepatitis B virus (HBV) is one of these pathogens, and the rate of carriers in the population is considerably high. It can cause liver damage and death if reactivated. Thus, the management of oppotunistic pathogens becomes a complex issue when treating rheumatic diseases with immunosupressive drugs. In this case report, we present a juvenile rheumatoid arthritis patient whose liver enzymes raised while he was under treatment and afterwards HBV reactivation was determined as the cause. When reactivation was detected, we started controlled antiviral therapy. We achieved successful clinical and laboratory results after adding biological agents to the treatment. Careful evaluation of the patients who have indication for immunosuppressive agents and regular follow-up in case of infection may be protective from severe morbidity and/or mortality.


Assuntos
Antivirais/uso terapêutico , Artrite Juvenil/tratamento farmacológico , Guanina/análogos & derivados , Vírus da Hepatite B/efeitos dos fármacos , Hepatite B/tratamento farmacológico , Imunossupressores/efeitos adversos , Infecções Oportunistas/tratamento farmacológico , Ativação Viral/efeitos dos fármacos , Artrite Juvenil/sangue , Artrite Juvenil/diagnóstico , Artrite Juvenil/imunologia , Biomarcadores/sangue , Substituição de Medicamentos , Etanercepte , Guanina/uso terapêutico , Hepatite B/sangue , Hepatite B/diagnóstico , Hepatite B/imunologia , Hepatite B/virologia , Vírus da Hepatite B/imunologia , Vírus da Hepatite B/patogenicidade , Humanos , Imunoglobulina G/uso terapêutico , Imageamento por Ressonância Magnética , Masculino , Infecções Oportunistas/sangue , Infecções Oportunistas/diagnóstico , Infecções Oportunistas/imunologia , Infecções Oportunistas/virologia , Receptores do Fator de Necrose Tumoral/uso terapêutico , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
7.
Rheumatol Int ; 33(10): 2699-701, 2013 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-22837026

RESUMO

Causes for low back pain usually involve damages in bone, muscle or nerve tissues of spine. Hereditary sclerosing bone disorders are rarely presented with low back pain. This report is intended to remind that osteopetrosis type 2, which is a rare disorder in differential diagnosis of low back pain, should be taken into consideration.


Assuntos
Dor Crônica/etiologia , Dor Lombar/etiologia , Vértebras Lombares/diagnóstico por imagem , Osteopetrose/complicações , Dor Crônica/diagnóstico por imagem , Diagnóstico Diferencial , Humanos , Dor Lombar/diagnóstico por imagem , Masculino , Osteopetrose/diagnóstico por imagem , Radiografia , Adulto Jovem
8.
Clin Rheumatol ; 32(3): 309-15, 2013 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-23138883

RESUMO

The objective of this study was to test the hypothesis that dry needling is more effective than sham dry needling in the treatment of myofascial pain syndrome (MPS). This was a prospective, double-blinded, randomized-controlled study conducted in an outpatient clinic. Thirty-nine subjects with established myofascial trigger points were randomized into two groups: study group (N = 22) and placebo group (N = 17). Dry needling was applied using acupuncture needles, and sham dry needling was applied in the placebo group. The treatment was composed of six sessions which were performed in 4 weeks; the first four sessions were performed twice a week (for 2 weeks) and the last two, once a week (for 2 weeks). The visual analog scale (VAS) and Short Form-36 (SF-36) were used. When compared with the initial values, VAS scores of the dry needling group following the first and sixth sessions were significantly lower (p = 0.000 and p < 0.000, respectively). When VAS scores were compared between the groups, the first assessment scores were found to be similar, but the second and third assessment scores were found to be significantly lower in the dry needling group (p = 0.034 and p < 0.001, respectively). When SF-36 scores of the groups were compared, both the physical and mental component scores were found to be significantly increased in the dry needling group, whereas only those of vitality scores were found to be increased significantly in the placebo (sham needling) group. The present study shows that the dry needling treatment is effective in relieving the pain and in improving the quality of life of patients with MPS.


Assuntos
Terapia por Acupuntura/métodos , Síndromes da Dor Miofascial/terapia , Adulto , Método Duplo-Cego , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Síndromes da Dor Miofascial/psicologia , Medição da Dor , Estudos Prospectivos , Qualidade de Vida , Resultado do Tratamento
10.
Aviat Space Environ Med ; 80(10): 898-9, 2009 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-19817244

RESUMO

Reported here is a 37-yr-old professional diving instructor who had developed complaints of back pain and weakness in the lower extremities after diving. He was eventually diagnosed as having spinal cord decompression sickness along with a likely diagnosis of anterior spinal artery (artery of Adamkiewicz) syndrome. Additionally, since the transthoracic echocardiography revealed patent foramen ovale, we hypothesized that it might have been a potential route for gas bubbles to occlude the anterior spinal artery in this diver.


Assuntos
Síndrome da Artéria Espinal Anterior/diagnóstico , Doença da Descompressão/etiologia , Mergulho/efeitos adversos , Adulto , Síndrome da Artéria Espinal Anterior/epidemiologia , Comorbidade , Doença da Descompressão/epidemiologia , Doença da Descompressão/terapia , Forame Oval Patente/epidemiologia , Humanos , Oxigenoterapia Hiperbárica , Masculino
11.
Ann Thorac Surg ; 88(4): 1354-6, 2009 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-19766845

RESUMO

We report a 20-year-old man with Poland syndrome who suffered from weakness, pain, numbness, and discoloration in the left upper extremity. He was eventually diagnosed as also having thoracic outlet syndrome. The concomitance of these two disorders is discussed with a special emphasis on the underlying mechanisms.


Assuntos
Síndrome de Poland/complicações , Síndrome do Desfiladeiro Torácico/etiologia , Diagnóstico Diferencial , Terapia por Exercício/métodos , Humanos , Masculino , Síndrome de Poland/diagnóstico por imagem , Síndrome do Desfiladeiro Torácico/diagnóstico por imagem , Síndrome do Desfiladeiro Torácico/terapia , Ultrassonografia Doppler , Adulto Jovem
12.
Clin Rheumatol ; 28(11): 1309-14, 2009 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-19685294

RESUMO

Ankylosing spondylitis (AS) is a systemic chronic inflammatory disease primarily affecting the axial skeleton. Work disability can be one of the major consequences of AS, and the knowledge about the burden of AS to the patient and society is not well-established yet. The objective of this study was to investigate work disability among patients with AS in the national service and to put forward the related factors and differences among disabled and nondisabled groups. A total of 121 male AS patients were included in the study. Patient demographics and duration of disease were noted, and employment status and disability were questioned. Measures of functionality, axial mobility, health-related quality of life, and depression were used. It was found that 38 patients (31.4%) continued their work lives with no change, 54 patients (44.6%) changed to a lighter job, and 29 patients (24%) were retired due to AS. Differences in age at onset of the disease, time since the diagnosis, C-reactive protein (CRP) levels, and hip involvement were statistically significant. The mean retirement age of the patients was 36 +/- 4.2 years. Frequency of hip involvement was higher in the work-disabled group. Spine was evidently affected more seriously, and CRP values were higher in the work-disabled group. Older age at onset, longer time since the diagnosis, longer diagnosis delay, and some physical impairments like decrease in spinal mobility and hip involvement may preclude AS patients from leading a productive work life.


Assuntos
Pessoas com Deficiência , Espondilite Anquilosante/fisiopatologia , Desemprego/estatística & dados numéricos , Avaliação da Capacidade de Trabalho , Adulto , Idoso , Nível de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Índice de Gravidade de Doença , Adulto Jovem
14.
Photomed Laser Surg ; 27(1): 119-25, 2009 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-19196106

RESUMO

OBJECTIVE: The objective of this study was to investigate the effectiveness of splinting, ultrasound (US), and low-level laser (LLL) in the management of carpal tunnel syndrome (CTS). BACKGROUND DATA: CTS is the entrapment mononeuropathy most frequently seen in clinical practice, caused by compression of the median nerve at the wrist. Although several treatment modalities are routinely in use, there is no consensus about the best way to manage CTS. MATERIALS AND METHODS: In our study, patients were randomly allocated to three groups that received the following treatment protocols: splinting only, splinting plus US, and splinting plus LLL therapy. Patients were assessed with the Boston Questionnaire, patient satisfaction inquiry, visual analogue scale for pain, and electroneuromyography. RESULTS AND CONCLUSION: The study was completed with a total of 100 hands of 50 women patients with bilateral CTS at 3 mo after treatment. At the end of the follow-up period, each of the groups had improvements to varying degrees. It appeared that the combinations of US or LLL therapy with splinting were more effective than splinting alone in treating CTS. However, LLL therapy plus splinting was more advantageous than US therapy plus splinting, especially for the outcomes of lessening of symptom severity, pain alleviation, and increased patient satisfaction.


Assuntos
Síndrome do Túnel Carpal/terapia , Terapia com Luz de Baixa Intensidade , Contenções , Terapia por Ultrassom , Síndrome do Túnel Carpal/fisiopatologia , Feminino , Humanos , Pessoa de Meia-Idade , Condução Nervosa , Medição da Dor , Índice de Gravidade de Doença
17.
Clin Rheumatol ; 27(4): 457-62, 2008 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-17899306

RESUMO

Ankylosing spondylitis (AS) is a chronic, progressive, and disabling disease. Among the rheumatological diseases, the longest diagnosis delay is still found for AS. The aim of this cross-sectional study is to evaluate the diagnosis delay and possible reasons in AS. A secondary aim is to assess the relation between diagnosis delay and some clinical and laboratory features. One hundred eleven AS patients, (103 male, 8 female) were recruited. A face-to-face interview was applied to take medical history, and a questionnaire that contains some clinical aspects of disease was used. Diagnosis delay was described as the gap between first spondiloarthropathic symptom and correct diagnosis of AS. The average of diagnosis delay was 6.05 +/- 5.08 years. The average age of patients at disease onset was 23.18 +/- 9.59, the average disease duration was 10.44 +/- 8.11, and the average age at diagnosis was 27.88 +/- 11.63. The average diagnosis delay was 5. 3 +/- 3.5 in HLA B 27(+) AS patients, whereas it was 9.2 +/- 7.7 in HLA B 27(-) AS patients (p = 0.037). Diagnosis delay in patients with inflammatory back pain (+) (IBP) at disease onset was lower than IBP (-) patients (3.28 +/- 3.32, 8.57 +/- 8.54; respectively) (p = 0.001). The patients having positive family history had lower diagnosis delay than those with negative family history (4.60 +/- 4.44, 10.00 +/- 2.30; respectively) (p = 0.003). The diagnosis delay is a challenge and an important problem for patients with AS and physicians. HLA B27 and family history should be considered while making new criteria. Inflammatory back pain should be emphasized as the main screening criterion for primary care physicians. These clinical and laboratory features had positive effect on the average diagnosis delay in AS patients. Describing new diagnostic criteria, which is more useful to diagnosis of AS, is necessary.


Assuntos
Diagnóstico Precoce , Espondilite Anquilosante/diagnóstico , Adulto , Idoso , Dor nas Costas/diagnóstico , Dor nas Costas/etiologia , Estudos Transversais , Progressão da Doença , Feminino , Antígeno HLA-B27/sangue , Humanos , Masculino , Anamnese , Pessoa de Meia-Idade , Espondilite Anquilosante/complicações , Espondilite Anquilosante/imunologia , Fatores de Tempo
18.
Tohoku J Exp Med ; 212(4): 423-30, 2007 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-17660708

RESUMO

Rheumatic diseases are chronic inflammatory diseases which cause mild to severe functional loss and disability due to articular and extra-articular manifestations. One common form -ankylosing spondylitis (AS)- affects mainly the axial skeleton and sacroiliac joints, and certain extra-articular organs. The pulmonary involvement is a known manifestation of AS and emerges either in the form of interstitial lung disease or in the form of restricted pulmonary functions. The aim of this study is to determine the pulmonary functions in AS patients and to assess its relationship with quality of life, functionality and disease activity. Thirty-six AS patients and 34 healthy volunteers were recruited for the study. A detailed examination, pulmonary function tests, smoking inquiry and quality of life questionnaire were performed on all participants. Also patients were requested to complete functionality and disease activity indexes. The outcomes showed that 15 (41.7%) AS patients had pulmonary involvement: twelve patients with restrictive patterns, one with obstructive pattern, and two with both restrictive and obstructive patterns. Decreased forced expiratory volume in one second was associated with deteriorated functionality (p < 0.05). Decreased chest expansion was also accompanied with decreased forced vital capacity (p < 0.05). There was no statistically significant difference between the smoking and non-smoking patients in regard to disease activity, functionality and pulmonary function test variables (p > 0.05). In conclusion, the pulmonary involvement is common in AS and might have disturbed functionality and the quality of life in AS patients.


Assuntos
Qualidade de Vida , Testes de Função Respiratória , Doenças Reumáticas/fisiopatologia , Espondilite Anquilosante/fisiopatologia , Adulto , Feminino , Humanos , Pulmão/fisiologia , Pneumopatias/etiologia , Masculino , Doenças Reumáticas/complicações , Doenças Reumáticas/patologia , Espondilite Anquilosante/complicações , Espondilite Anquilosante/patologia
19.
Joint Bone Spine ; 74(5): 467-71, 2007 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-17587625

RESUMO

OBJECTIVE: Low back pain is a highly common problem and causes much morbidity and socioeconomic loss in the community. Although the use of caudal epidural injections in the management of the low back pain with radicular signs is commonplace, it has not been well investigated. We compare the effectiveness of caudal epidural injection versus non-steroidal anti-inflammatory drugs (NSAIDs) in the treatment of low back pain accompanied with radicular pain. METHODS: The study was a controlled prospective unblinded trial. A total of consecutive 64 patients with subacute or chronic low back pain accompanied with radicular pain were included. The patients were randomly allocated to two groups. First group was caudal epidural injection plus therapeutic exercise group, and the second group was NSAIDs plus therapeutic exercise group. Patients were assessed with 10 cm visual analogue scale for pain, straight leg raising test and Oswestry low back pain disability questionnaire at the beginning and at 15th day, 1st and 3rd month. RESULTS: It was seen that both groups' improvement were good and statistically significant. On the other hand, caudal epidural injection group's improvement was better and faster than the NSAID group's, and the differences between assessment scores of the groups were statistically significant, except the 3rd month Oswestry scores. CONCLUSION: Finally, caudal epidural injection in the management of the subacute/chronic low back and radicular pain is a preferable choice, if applied by experienced specialists.


Assuntos
Anti-Inflamatórios não Esteroides/uso terapêutico , Dor Lombar/tratamento farmacológico , Radiculopatia/tratamento farmacológico , Acetaminofen/uso terapêutico , Doença Aguda , Adulto , Analgésicos não Narcóticos/uso terapêutico , Anti-Inflamatórios não Esteroides/administração & dosagem , Doença Crônica , Humanos , Injeções Epidurais , Dor Lombar/complicações , Seleção de Pacientes , Radiculopatia/complicações
20.
Clin Rheumatol ; 26(10): 1607-13, 2007 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-17285222

RESUMO

This study has focused on sexual problems of male ankylosing spondylitis (AS) patients. Initially, patients' perceptions about the effects of disease on sexual intercourse were assessed. Secondly, we investigated the factors that relate to the disease and affect sexual intercourse negatively. Thirdly, we compared data from the patients whose sexual intercourse were affected negatively with of those whose sexual intercourse were unaffected. This is a cross-sectional and double-centered study. A total of 53 married or sexually active male patients, who were certainly diagnosed with AS according to modified New York criteria, were assessed. Twenty seven patients (50.94%) expressed that their sexual life was affected negatively by the AS in general (affected patients), and 26 patients (49.06%) expressed no negative effect (unaffected patients). Both affected and unaffected patients were compared with each other with regard to educational level, joint involvement, functionality, disease activity, quality of life, and depression status. Mean BASFI, BASDAI scores were worse in the affected group, and the difference was statistically significant (p = 0.012, p = 0.039, respectively). There were statistically significant differences between the groups with regard to lumbar column and hip involvement (p = 0.035, p = 0.021; respectively). The physical functioning, role limitations due to physical problems, vitality/energy/fatigue, general mental health, and general health perception subscale scores of SF-36 were worse in the affected group, and the differences were statistically significant (p = 0.027, p = 0.023, p = 0,013, p = 0.005, p = 0.045, respectively). Affected patients' Beck Depression Inventory scores were worse than those of unaffected patients, and the difference between the groups was statistically significant (p = 0.039). Sexual problems are common in AS patients and might usually be associated with joint involvement, decreased functionality, increased disease activity, decreased health quality, and depression. Therefore, while examining AS patients and managing their treatments, special attention must be given to all domains of life instead of only physical problems.


Assuntos
Relações Interpessoais , Sexualidade , Espondilite Anquilosante/complicações , Adulto , Idoso , Estudos Transversais , Depressão/etiologia , Emoções , Nível de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Atividade Motora , Qualidade de Vida , Espondilite Anquilosante/diagnóstico , Espondilite Anquilosante/psicologia , Inquéritos e Questionários
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...