Foot orgasm syndrome: a case report in a woman.

INTRODUCTION: Spontaneous orgasm triggered from inside the foot has so far not been reported in medical literature. AIMS: The study aims to report orgasmic feelings in the left foot of a woman. METHODS: A woman presented with complaints of undesired orgasmic sensations originating in her left foot. In-depth interview, physical examination, sensory testing, magnetic resonance imaging (MRI-scan), electromyography (EMG), transcutaneous electrical nerve stimulation (TENS), and blockade of the left S1 dorsal root ganglion were performed. MAIN OUTCOME MEASURES: The main outcomes are description of this clinical syndrome, results of TENS application, and S1 dorsal root ganglion blockade. RESULTS: Subtle attenuation of sensory amplitudes of the left suralis, and the left medial and lateral plantar nerve tracts was found at EMG. MRI-scan disclosed no foot abnormalities. TENS at the left metatarso-phalangeal joint-III of the left foot elicited an instant orgasmic sensation that radiated from plantar toward the vagina. TENS applied to the left side of the vagina elicited an orgasm that radiated to the left foot. Diagnostic blockade of the left S1 dorsal root ganglion with 0.8 mL bupivacaine 0.25 mg attenuated the frequency and intensity of orgasmic sensation in the left foot with 50% and 80%, respectively. Additional therapeutic blockade of the same ganglion with 0.8 mL bupivacaine 0.50 mg combined with pulsed radiofrequency treatment resulted in a complete disappearance of the foot-induced orgasmic sensations. CONCLUSION: Foot orgasm syndrome (FOS) is descibed in a woman. Blockade of the left S1 dorsal root ganglion alleviated FOS. It is hypothesized that FOS, occurring 1.5 years after an intensive care emergency, was caused by partial nerve regeneration (axonotmesis), after which afferent (C-fiber) information from a small reinnervated skin area of the left foot and afferent somatic and autonomous (visceral) information from the vagina on at least S1 spinal level is misinterpreted by the brain as being solely information originating from the vagina.

Stronger evidence for small fiber sensory neuropathy in restless genital syndrome: two case reports in males.

INTRODUCTION: Restless genital syndrome (ReGS) is characterized by unwanted, unpleasant genital sensations, restless legs, and/or overactive bladder, as well as neuropathy of the dorsal nerve of the clitoris. So far, ReGS has only been reported in females. AIM: To report the occurrence of ReGS in two males. METHODS: Two males with unwanted genital sensations presented in our clinic. In-depth interview, routine and hormonal investigations, electro-encephalography, magnetic resonance imaging of brain and pelvis, manual examination of the pubic bone, and sensory testing of genital dermatomes were performed. In both males, conventional transcutaneous electrical nerve stimulation was applied bilaterally at the pudendal dermatome. MAIN OUTCOME MEASURES: Oral report, questionnaire on frequency and intensity of restless genital feelings, restless legs, overactive bladder, and satisfaction with the transcutaneous electrical nerve stimulation (TENS) treatment. RESULTS: ReGS in a 74-year-old male manifested as unpleasant genital sensations of being on the edge of an orgasm with overactive bladder, in the absence of erection and ejaculation. Genital sensory testing elicited bilateral points of static mechanical hyperesthesia in the pudendal dermatome. Manual examination of the dorsal nerve of the penis (DNP) elicited the genital sensations. TENS application resulted in a 90% reduction of genital sensations and complaints of overactive bladder syndrome (OAB). ReGS in a 38-year-old male manifested as unwanted and unpleasant spontaneous ejaculations and complaints of OAB. Genital sensory testing elicited bilateral points of static mechanical hyperesthesia in the pudendal dermatome. Manual examination of the DNP elicited the genital sensations. TENS application had no effect on genital complaints and complaints of OAB. CONCLUSIONS: ReGS is not a typical female disorder as it also affects males. This notion and the finding of typical sensory abnormalities of the genital end branches of the pudendal nerve in males and females--as previously reported--provides strong evidence for Small Fiber Sensory Neuropathy as a common cause of ReGS.

[Neck pain due to tendonitis of the longus colli muscle]. / Pijn in de nek door tendinitis longus colli.

Two patients presented to Accidents and Emergency with severe neck pain: a 70-year-old woman with acute, severe neck pain, which had developed a few days after outpatient resection of her left lingual tonsil. The patient was suspected to have spondylodiscitis. The other patient, a 54-year-old woman, was referred with severe neck pain and suspected meningitis. In both women, the pain was diagnosed as acute calcifying tendonitis of the longus colli muscle. This benign condition can present to many different specialities. Both patients responded well to treatment with NSAIDs. Acute calcifying tendonitis of the longus colli muscle can be diagnosed using various imaging techniques, such as X-ray, CT or MRI imaging. Calcification on cervical CT or a high signal on T2-weighted MRI images of the longus colli muscle are pathognomonic of tendonitis. A correct diagnosis can prevent further invasive diagnostics and/or unnecessary treatment.

Restless genital syndrome before and after clitoridectomy for spontaneous orgasms: a case report.

INTRODUCTION: Females despairing of restless genital syndrome (ReGS) may request clitoridectomy for treatment of unwanted genital sensations. Aim. The aim of this study was to report persistence of ReGS despite clitoridectomy. METHODS: Following a clitoridectomy for spontaneous orgasms, a 77-year-old woman was referred to our clinic for persistent unwanted genital sensations and feelings of imminent orgasm. An in-depth interview, routine and hormonal investigations, electroencephalography (EEG) and magnetic resonance imaging (MRI) of the brain and pelvis were performed. The localizations of genital sensations were investigated by manual examination of the ramus inferior of the pubic bone (RIPB) and by sensory testing of the skin of the genital area with a cotton swab. MAIN OUTCOME MEASURES: The main outcome measures included sensitivity of dorsal nerve of the clitoris in RIPB and MRI-pelvis. RESULTS: Genital dysesthesias, paresthesias, intolerance (allodynia) for tight clothes, aggravation of symptoms during sitting, restless legs, and overactive bladder were diagnosed. Laboratory assessments, and EEG and MRI of the brain were in agreement with aging, but all results were within the normal range. MRI of the pelvis disclosed varices of the uterus and of the left ovarian vein, and a visible scar in the region of the clitoris. Sensory testing of the genital area showed various points of static mechanical hyperesthesia at the left dermatome of the pudendal nerve. Manual examination of the RIPB also elicited the genital sensations at the left side of the vagina at about the 3 o'clock position. CONCLUSIONS: This patient fulfilled all clinical criteria of ReGS that is believed to be caused by neuropathy of the left pudendal nerve. Clitoridectomy abolished spontaneous orgasms for a great part but not completely, and it did not diminish the typical dysesthesias, paresthesias, and feelings of imminent orgasms that typically belong to ReGS. Clitoridectomy is no optional treatment of ReGS. There is a need for publications of ReGS in general medical journals.

Successful transcutaneous electrical nerve stimulation in two women with restless genital syndrome: the role of adelta- and C-nerve fibers.

INTRODUCTION: Currently, efficacious treatment of restless genital syndrome (ReGS) is not available. AIM: This study aimed to report the results of transcutaneous electrical nerve stimulation (TENS) for ReGS, being a combination of genital dysesthesias, imminent and/or spontaneous orgasms, and/or restless legs, and/or overactive bladder. METHODS: Two women with ReGS were referred to our clinic. In-depth interview, routine and hormonal investigations, electroencephalography, magnetic resonance imaging (MRI) of the brain and pelvis, manual examination of the ramus inferior of the pubic bone, and sensory testing of genital dermatomes were performed. Conventional TENS (frequency: 110 Hz; pulse width: 80 milliseconds) was applied bilaterally at the region of the pudendal dermatome in which immediate reduction of genital sensations occurred. Patients were instructed for self-application of TENS each day for 2 months. MAIN OUTCOME MEASURES: Oral report, questionnaires on frequency of imminent and/or spontaneous orgasms, combined with questions on intensity of restless genital feelings, restless leg syndrome (RLS), overactive bladder syndrome (OAB), and satisfaction with TENS treatment. RESULTS: ReGS in a 56-year-old woman manifested as multiple spontaneous orgasms, RLS, and OAB. TENS applied to the sacral region resulted in immediate reduction of complaints and a 90% reduction of spontaneous orgasms, RLS, and OAB in 2 months. ReGS in a 61-year-old woman manifested as a continuous restless genital feeling, imminent orgasms, and OAB. TENS applied to the pubic bone resulted in a complete disappearance of restlessness in the genital area as well as OAB complaints in 2 months. Both women reported to be very satisfied and did not want to stop TENS treatment. CONCLUSIONS: Conventional TENS treatment is a promising therapy for ReGS, but further controlled research is warranted. Preorgasmic and orgasmic genital sensations in ReGS are transmitted by Adelta and C fibers and are inhibited by Abeta fibers. A neurological hypothesis on the pathophysiology of ReGS encompassing its clinical symptomatology, TENS, and drug treatment is put forward.

New insights into restless genital syndrome: static mechanical hyperesthesia and neuropathy of the nervus dorsalis clitoridis.

INTRODUCTION: Systematic study of dysesthetic and paresthetic regions contributing to persistent genital arousal in women with restless genital syndrome (ReGS) is needed for its clinical management. AIM: To investigate distinct localizations of ReGS. METHODS: Twenty-three women, fulfilling all five criteria of persistent genital arousal disorder were included into the study. In-depth interviews, routine and hormonal investigations, electroencephalographs, and magnetic resonance imaging (MRI) of brain and pelvis were performed in all women. The localizations of genital sensations were investigated by physical examination of the ramus inferior of the pubic bone (RIPB) and by sensory testing of the skin of the genital area with a cotton swab (genital tactile mapping test or GTM test). MAIN OUTCOME MEASURES: Sensitivity of RIPB, GTM test. RESULTS: Of 23 women included in the study, 18(78%), 16(69%), and 12(52%) reported restless legs syndrome, overactive bladder syndrome, and urethra hypersensitivity. Intolerance of tight clothes and underwear (allodynia or hyperpathia) was reported by 19 (83%) women. All women were diagnosed with ReGS. Sitting aggravated ReGS in 20(87%) women. In all women, MRI showed pelvic varices of different degree in the vagina (91%), labia minora and/or majora (35%), and uterus (30%). Finger touch investigation of the dorsal nerve of the clitoris (DNC) along the RIPB provoked ReGS in all women. Sensory testing showed unilateral and bilateral static mechanical Hyperesthesia on various trigger points in the dermatome of the pudendal nerve, particularly in the part innervated by DNC, including pelvic bone. In three women, sensory testing induced an uninhibited orgasm during physical examination. CONCLUSIONS: ReGS is highly associated with pelvic varices and with sensory neuropathy of the pudendal nerve and DNC, whose symptoms are suggestive for small fiber neuropathy (SFN). Physical examination for static mechanical Hyperesthesia is a diagnostic test for ReGS and is recommended for all individuals with complaints of persistent restless genital arousal in absence of sexual desire.

Persistent genital arousal disorder in 18 Dutch women: Part I. MRI, EEG, and transvaginal ultrasonography investigations.

INTRODUCTION: Systematic blood analysis and electroencephalographic (EEG) and magnetic resonance imaging (MRI) study in women with persistent genital arousal disorder (PGAD) are needed to get more insight into the syndrome's etiology and pathogenesis. AIM: To investigate possible causes of PGAD. METHODS: Eighteen women fulfilling all five criteria of PGAD were included in the study. In-depth interviews and routine blood and hormonal investigations, together with EEG and MRI scans of the brain and pelvis, were performed in all women. Transvaginal ultrasonography (TVUS) and MRI scans with contrast were performed in subjects who had indications of abnormalities on MRI scans. MAIN OUTCOME MEASURES: Detailed descriptions of blood, neurophysiological, and (neuro)anatomical findings. RESULTS: The majority of women experienced PGAD symptoms during early menopause without existing laboratory abnormalities, besides those belonging to menopause. The EEG studies showed no severe diffuse or focal abnormalities. The MRI scans of the brain did not show any specific abnormalities, apart from an already known pericallosal aneurysm in one patient and postoperative findings of meningioma surgery in another patient. MRI scans of the pelvis showed clear to moderate-clear indications of pelvic varices in 55% of the women. TVUS confirmed the existence of pelvic varices in nine women; these had a mild, moderate, and severe extent in two, three, and four women. In three of the latter four patients, an additional MRI with gadolinium contrast disclosed mild to moderate dilation of ovarian veins; 39% of the women were known with varices of one or both legs. CONCLUSIONS: The current study did not show overt pathology that could causally explain PGAD sensations. As pelvic varices are a common finding in adult women, the current findings do not allow the conclusion that PGAD is causally related to pelvic varices. However, the high prevalence of pelvic and lower limb varices in the current group of women warrants further research of their role in PGAD.

Metastases in supraclavicular lymph nodes in lung cancer: assessment with palpation, US, and CT.

PURPOSE: To compare ultrasonography (US), computed tomography (CT), and palpation for diagnosing supraclavicular lung cancer metastases and to assess the effect of proved metastases on TNM stage and diagnostic work-up. MATERIALS AND METHODS: One hundred seventeen consecutive patients (91 men and 26 women; mean age, 64.0 years) underwent palpation, US, and CT of supraclavicular regions and chest and upper abdominal CT. Fine-needle aspiration cytologic (FNAC) analysis was performed in patients with nodes with a short-axis diameter of 5 mm or greater; cytologic diagnosis was used as the standard of reference. Sensitivities of palpation, US, and CT were compared with McNemar testing. Relationship between size and palpability of nodes with metastasis was evaluated with logistic regression. RESULTS: Supraclavicular metastases were diagnosed cytologically in 30 (26%) of 117 patients: eight (31%) of 26 patients with small cell lung cancer (SCLC) and 22 (24%) of 91 patients with non-small cell lung cancer (NSCLC). Sensitivities of US (1.00; 30 of 30 patients) and CT (0.83; 25 of 30 patients) for detection of metastases were significantly higher (P <.001 and P =.001, respectively) than that of palpation (0.33; 10 of 30 patients). Palpable nodes with metastasis (mean diameter, 25.2 mm) were significantly larger than nonpalpable nodes with metastasis (mean diameter, 13.7 mm) (P =.002). To have a 50% chance of being palpable, nodes with metastasis had to have a diameter of at least 22.3 mm. TNM stage was changed in three of 91 patients with NSCLC, and further invasive diagnostic procedures were prevented in 11 of such patients because it was proved that nonpalpable nodes had metastases. CONCLUSION: Supraclavicular lung cancer metastases were cytologically proved in 26% of patients. Nodes with metastasis were only palpable when markedly enlarged. US tripled the sensitivity of palpation for detection of metastases. Results of US and US-guided FNAC analysis can change the work-up in patients with lung cancer.

Overuse and sports-related injuries of the ankle and hind foot: MR imaging findings.

Professional and recreational sporting activities have increased substantially in recent years and have led to a rise in the number of sports-related and overuse injuries. Magnetic resonance (MR) imaging has become an important tool for evaluating the lower leg for providing the necessary information for patient management and rehabilitation following this injury. The purpose of this essay is to give an overview of the MR findings of common overuse injuries and sports-related injuries to the bones and soft-tissue structures of the hind foot and ankle.

Bone marrow ill-defined hyperintensities with tarsal coalition: MR imaging findings.

INTRODUCTION: To report the occurrence and pattern of ill-defined subchondral hyperintensities on Magnetic Resonance (MR) imaging in patients with talocalcaneal coalition (TCC). METHODS AND MATERIAL: MR imaging of both feet was performed in 10 consecutive patients with 14 TCCs. There were eight males and two females with ages ranging from 9-52 years (mean 25 years). Twelve of the 14 TCCs were symptomatic. MR imaging sequences included T1- and T2-weighted as well as STIR images. The images were evaluated for the presence, extent and location of ill-defined subchondral hyperintensities on MR images in the hindfoot. RESULTS: Ill-defined subchondral hyperintensities on MR imaging were present in 12 (86%) of the 14 hindfeet with TCCs. Two of these were without symptoms. No abnormalities were seen in two symptomatic hindfeet. DISCUSSION AND CONCLUSION: In our series hyperintensities located in the subchondral bone adjacent to the coalition was relatively common in TCC. The presence of this specific pattern in the subchondral bone adjacent to the coalition may be indicative of tarsal coalition.