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3 results

  • Chapter 20 - Thoracic Outlet Syndrome

  • from Part V - Extremities
  • Edited by Omar Viswanath, Creighton University, Omaha, Ivan Urits, Southcoast Brain & Spine Center, Wareham
  • Book:
    Cambridge Handbook of Pain Medicine
    Published online:
    01 December 2023
    Print publication:
    14 December 2023, pp 157-163

  • Summary

    Thoracic outlet syndrome is a collection of conditions that lead to the compression of the nerves and blood vessels in the thoracic outlet area. Symptoms such as pain, numbness, weakness, and discoloration may occur depending on the specific structures affected. There is currently no agreed-upon diagnostic criteria, but a detailed patient history, physical examination, and appropriate imaging tests can help with diagnosis. The first-line treatment for thoracic outlet syndrome usually involves conservative measures like physical therapy, lifestyle changes, medications such as NSAIDs and injections like botulinum toxin A, steroids, and local anesthetics. If conservative treatments fail, surgical decompression may be considered. This chapter aims to provide a review of the epidemiology, causes, anatomy, symptoms, diagnosis, and treatment of thoracic outlet syndrome.

  • Tonsillectomy may cause altered tongue sensation in adult patients

  • A Smithard, C Cullen, A S Thirlwall, C Aldren
  • Journal:
    The Journal of Laryngology & Otology / Volume 123 / Issue 5 / May 2009
    Published online by Cambridge University Press:
    30 July 2008, pp. 545-549
    Print publication:
    May 2009
  • Objectives:

    To determine the frequency of altered tongue sensation following tonsillectomy, and its relationship to different surgical techniques.

    Design:

    Case–control study.

    Setting:

    District general hospital.

    Participants:

    One hundred and four consecutive adults undergoing tonsillectomy, and 43 control patients.

    Main outcome measures:

    Altered tongue sensation.

    Results:

    Twenty-eight of 100 patients described altered tongue sensation post-tonsillectomy. No patients in the control group experienced altered tongue sensation. There was a difference in rates of altered sensation between tonsillectomy patient groups undergoing bipolar diathermy and ‘cold steel’ techniques (p < 0.019). Three months after surgery, 22/23 contactable patients reported complete recovery of tongue sensation. One patient experienced tongue paraesthesia persisting until one year post-tonsillectomy.

    Conclusion:

    Tonsillectomy resulted in altered tongue sensation in 28 per cent of our study group. Bipolar diathermy dissection was significantly more likely to cause altered sensation than cold steel dissection. Ninety-six per cent of these disturbances resolved by three months, all by one year. Possible alteration of tongue sensation should be discussed whilst obtaining consent for tonsillectomy.

  • 15 - Guillain-Barré Syndrome

  • from SECTION III - SPECIFIC NEUROLOGICAL CONDITIONS
    • By Sandeep Rana, Department of Neurology Allegheny General Hospital Pittsburgh, Pennsylvania, Sid M. Shah, Assistant Clinical Professor Michigan State University
  • Edited by Sid M. Shah, Michigan State University, Kevin M. Kelly, Drexel University, Philadelphia
  • Book:
    Principles and Practice of Emergency Neurology
    Published online:
    06 August 2009
    Print publication:
    18 February 2003, pp 175-179

  • Summary

    Guillain-Barré syndrome (GBS) is a form of acute inflammatory (demyelinating) polyneuropathy. It causes rapidly ascending numbness and weakness. In the early phase, a high index of suspicion for GBS is essential in the presence of ascending numbness and weakness because ancillary tests may not help. A normal cerebrospinal fluid (CSF) protein level in the early phase or a finding of numerous lymphocytes does not exclude the diagnosis of GBS. By end of first week of illness, CSF analysis usually reveals normal CSF pressure and elevated protein without leukocytosis termed albuminocytological dissociation. Despite advances in the treatment of GBS, good supportive care is still the most important determinant of favorable outcome. Cardiac monitoring is routine for patients with severe findings. Respiratory status is assessed with periodic vital capacities. Elective endotracheal intubation for ventilatory support is considered when the vital capacity is below 15 ml/kg.