Long-Term Outcome of Hemimasticatory Spasm

The aim of our study was to ascertain the efficacy of low-molecular-weight heparin (LMWH) in the treatment of patients with SVT. A group of 336 outpatients with clinical diagnosis of SVT was evaluated in this prospective study. At the beginning of the study all patients were examined by clinical investigation, laboratory tests and duplex ultrasound investigation (examination). All patients included into the study were treated with LMWH. Clinical and ultrasound evaluation was carried out on days 10, 30 and 90 of the follow-up. This clinical study of SVT treatment with LMWH was organized in 18 outpatient departments in the Slovak Republic. After 10 days of treatment with LMWH in full therapeutic dosage, an improvement in the clinical symptoms was demonstrated in 93 % of patients; a complete resolution of clinical symptoms was demonstrated in 4 % of patients. On day 30 (after 10 days of LMWH treatment in full therapeutic dosage and further treatment in halved therapeutic dosage up to 20 days) a complete resolution of clinical symptoms was observed in 59 % (n = 189) of patients. Patients were further clinically evaluated on day 90, after two months of no anticoagulation treatment. The clinical evaluation revealed a complete resolution of symptoms in 88 % (n = 283) of patients and improvement in symptoms in 11.6 % (n = 34). Two patients developed pulmonary embolization; extension of SVT was seen in one patient and SVT recurrence in two patients. Superficial vein thrombosis can propagate into the deep veins with the risk of pulmonary embolism. The results indicate that current ambulatory treatment regimen using LMWH in the treatment of SVT is effective and safe (Fig. 4, Ref. 30).

Successful treatment of the Meige's syndrome with navigated repetitive transcranial magnetic stimulation: A case report

Aneurysms of the posterior circulation may manifest with neurological deficits related to mass effect on the brainstem. We present an unusual case of an aneurysm resulting in selective lower-extremity weakness and gait instability. A 61-year-old man presents with progressively worsening gait instability over the course of several months. A magnetic resonance image and computed tomographic angiogram demonstrate a persistent hypoglossal artery associated with an aneurysm invaginating into the pontomedullary junction. The patient manifested only lower-extremity symptoms. An endovascular approach through the right internal carotid artery and persistent primitive hypoglossal artery was assayed, coiling off the aneurysm with complete angiographic occlusion. One month after the procedure, the patient reported marked improvement in symptoms with residual difficulty walking. At the 1-year postprocedure interval, he reported nearly complete resolution of symptoms. Endovascular therapy of an aneurysm invaginating into the brainstem is safe and efficacious.

Prediction of symptom improvement in children with biliary dyskinesia

Persistent Symptoms Following Treatment of Early Lyme Disease: False Hope?

Case of the spring season

Political decision adversely affects women's health

BACKGROUND:Bacterial infections are involved in more than a half of the exacerbations of chronic obstructive pulmonary disease (COPD).AIM:To evaluate the efficacy and safety of moxifloxacin in the outpatient treatment of moderate exacerbations of bacterial origin in the COPD patients.METHODS:We performed a prospective, observational study including 64 COPD patients with moderate exacerbation of bacterial origin empirically treated with moxifloxacin. In 31 of them, moxifloxacin was used as an initial antibiotic (Group 1), whereas in 33 of them moxifloxacin was used after treatment failure with another antibiotic (Group 2). All patients have treated 7 days with moxifloxacin 400 mg once daily per os, and they were followed up for 20 days, with an intermediate visit at 3, 5 and 7 days at which the duration of symptoms and the side effects of the drug were evaluated.RESULTS:We registered high clinical success rate, i.e. the complete resolution of the symptoms or their return to the baseline severity, similar in both groups (84.3% in all study subjects, 83.9% in the Group 1 and 84.8% in the Group 2). The mean time to complete resolution of the cardinal symptoms or their return to the baseline severity was 5.2 ± 1.1 days. Also, the mean time to complete resolution of the certain cardinal symptoms (increased dyspnea, increased sputum volume and increased sputum purulence) or their return to the baseline severity is given 4.9, 4.7 and 4.2 days, respectively. The incidence of adverse effects during the treatment with moxifloxacin in all study subjects was 10.9%, 9.6% in Group 1 and 12.1% in Group 2. There was no serious adverse effect that required discontinuation of the treatment. Relapse during a 20 days follow-up period was registered in 7.4% of the all study subjects with complete resolution of the cardinal symptoms or their return to the baseline severity, i.e. in two patients from both Group 1 and Group 2 (7.6% and 7.1%, respectively). 4CONCLUSION:Our findings suggest high efficacy and good tolerability of moxifloxacin in the treatment of moderate COPD exacerbations of bacterial origin.

Tumor invasion of the spinal canal is detected radiographically in approximately 15% of patients with newly diagnosed neuroblastoma (NB). The optimal clinical approach to maintain excellent survival outcomes while minimizing long-term sequelae is yet to be defined. Patients with intermediate-risk neuroblastoma (IR-NB) and radiographically identified intraspinal tumors who were treated on the Children's Oncology Group study ANBL0531 were studied prospectively to evaluate neurologic outcomes related to cord compression. Patients were defined as being symptomatic versus asymptomatic based on reporting of neurologic motor deficits at diagnosis. Patient characteristics, tumor biology, chemotherapy treatment, surgical interventions, and neurologic and disease outcomes are reported. Of the 92 patients with intraspinal tumors, 42 (46%) were symptomatic and most (73%) had complete resolution of symptoms. Age, degree of motor deficit, and duration of symptoms at diagnosis were not associated with complete resolution. While symptomatic patients were more likely to undergo upfront laminectomy, laminectomy was not associated with improvement of motor symptoms. Administration of additional chemotherapy beyond initial treatment assigned per protocol to achieve the treatment end point was not associated with achieving symptom resolution. Patients presenting with motor deficits due to intraspinal tumor had excellent survival and favorable neurologic outcomes, with the majority reporting complete resolution of motor symptoms regardless of severity and duration of symptoms at diagnosis or neurosurgical intervention. Prompt diagnosis and initiation of first-line chemotherapy treatment remain priority, while neurosurgical intervention should be reserved for patients with rapid neurologic deterioration. Biology-based therapy and tumor response should continue to be used to maintain favorable outcomes.

Parry-Romberg syndrome is a rare craniofacial disorder characterized by progressive hemifacial atrophy with systematic manifestations. The combination with hemimasticatory spasm is rare, with only 9 patients reported before. In this study, a study of a young male patient with Parry-Romberg syndrome and hemimasticatory spasm on his left side was presented. Radiologic examinations showed severe atrophy limited to subcutaneous tissue and electromyography demonstrated as hemimasticatory spasm. Injection of botulinum toxin type A was applied for the treatment of hemimasticatory spasm and after 2 separated injections, the patient was significantly relieved from symptom. The theory of focal demyelination of the trigeminal nerve peripheral brunches is the possible link between hemifacial atrophy and hemimasticatory spasm, although the pathogenesis of both diseases requires further study and current therapeutic methods are still limited to symptomatic treatments. Injection of botulinum toxin type A is an effective way to treat hemimasticatory spasm and autologous fat transplant is a promising solution to correct facial asymmetry.

Phlebotomy in Secondary Polycythemia: Does It Improve Clinical Symptoms? a Systematic Review

To evaluate the long-term results of treatment and the outlook for women with vulvar dysesthesia (vulvodynia) or vulvar vestibulodynia (vulvar vestibulitis), a follow-up questionnaire was mailed to 234 patients with this diagnosis at least 6 months after they had undergone treatment. Return questionnaires were received from 104 patients. Forty percent of participants had been diagnosed with vulvar dysesthesia and 60% with vulvar vestibulodynia. The 2 groups were similar except that those with dysesthesia were older (mean age, 47.5 years vs. 37 years for patients with vestibulodynia, P = 0.001). On average, women had experienced vulvar pain for a total of 7.1 years and for 2.7 years before diagnosis. Over half of the respondents (52%) associated the onset of their pain, whether sudden (23.9%) or gradual (76.1%), with a specific incident. Yeast infection and intercourse were most commonly cited (19% and 17%, respectively), allowed by surgery (11%), menopause (7%), childbirth (7%), and stress (7%). For 44% of women, vulvar pain was present with their first sexual intercourse, and 25% had pain with their first tampon insertion. Most women had tried a variety of treatments for vulvar pain. Treatment outcomes are listed in Table 1. In all, 11 patients felt they had a complete resolution of symptoms, and 60 said that their pain was under control but not cured. One third of the women reported a greater than 75% diminution of pain levels, and 21% noted a 50% to 75% reduction. The level of pain that was currently experienced was significantly lower than the level reported at diagnosis (on a scale of 0-6, the average pain level had dropped from 4.5 at diagnosis to a current level of 1.5, P = 0.0000). When women taking antidepressants or anticonvulsant medications alone or together were considered, over half (36 of 63) of those who had ever used antidepressants alone and 2 of 6 who had ever taken anticonvulsants alone reported a greater than 50% improvement in symptoms. More than 50% improvement was noted in 6 of 22 patients who had ever taken both drugs in combination. Nine of 14 patients who had never used either medication reported a greater than 50% improvement, including 3 women who felt their condition was resolved. In general, there was no difference in response to treatments between women with vulvar dysesthesia and those with vulvar vestibulodynia. However, those with vestibulodynia had a greater response to topical steroid cream and derived greater benefit from biofeedback. Patients with vulvar pain reported a drop in the quality and quantity of sexual activity (3 points and 2.7 points, respectively, on a 7-point scale; P <0.0001 for both) compared with pre-onset levels. However, the range of sexual activities was not affected and was similar for those with greater than 50% or less than 50% improvement in pain symptoms. Seventeen women became pregnant with vulvar pain. Seven of them (41%) said that the pregnancy did not affect their pain levels, and 5 each (29%) reported improved or worsened symptoms. Other pain syndromes reported by the 104 patients included headaches (32%), irritable bowel syndrome (25%), low back pain (27%), pelvic pain (12%), and interstitial cystitis (9.8%). Pelvic pain was associated with more severe recent vulvar pain (on a 7-point scale, 2.6 in the past week vs. 1.5, P = 0.001) and a lesser degree of improvement of vulvar pain symptoms (P = 0.006).

Efficacy Evaluation of Temporomandibular Arthroscopic-Assisted Masseter Nerve Avulsion on Hemimasticatory Spasm

Endoscope-Assisted Avulsion of the Masseter Nerve Attached to the Temporomandibular Joint Disc for the Treatment of Hemimasticatory Spasm: A Report of Two Cases

Reflux Masquerader: Acute <i>Helicobacter pylori</i> Infection in Neonates and Infants