Nerve Compression Syndromes

Common nerve compression syndromes include carpal tunnel syndrome, cubital tunnel syndrome, and radial tunnel syndrome. Compression of nerves often causes paresthesias; these paresthesias can often be reproduced by tapping the compressed nerve, usually with the examiner's fingertip (Tinel's sign). Suspected nerve compression can be confirmed by testing nerve conduction velocity and distal latencies, which accurately measure motor and sensory nerve conduction. Initial treatment is usually conservative, but surgical decompression may be necessary if conservative measures fail or if there are significant motor or sensory deficits.

Carpal Tunnel Syndrome

Carpal tunnel syndrome is compression of the median nerve as it passes through the carpal tunnel in the wrist. Symptoms include pain and paresthesias in the median nerve distribution. Diagnosis is suggested by symptoms and signs and is confirmed by nerve conduction velocity testing. Treatments include ergonomic improvements, analgesia, splinting, and sometimes corticosteroid injection or surgery.

Carpal tunnel syndrome is very common and most often occurs in women aged 30 to 50. Risk factors include RA or other wrist arthritis (sometimes the presenting manifestation), diabetes mellitus, hypothyroidism, acromegaly, amyloidosis, hemodialysis, and pregnancy-induced edema in the carpal tunnel. Activities or jobs that require repetitive flexion and extension of the wrist may contribute, but rarely. Most cases are idiopathic.

Symptoms and Signs

Symptoms include pain of the hand and wrist associated with tingling and numbness, classically distributed along the median nerve (the palmar side of the thumb, the index and middle fingers, and the radial half of the ring finger) but possibly involving the entire hand. Typically, the patient wakes at night with burning or aching pain and with numbness and tingling and shakes the hand to obtain relief and restore sensation. Thenar atrophy and weakness of thumb opposition and abduction may develop late.

Diagnosis

• Clinical evaluation
• Nerve conduction testing

The diagnosis is strongly suggested by Tinel's sign, in which median nerve paresthesias are reproduced by tapping at the volar surface of the wrist over the site of the median nerve in the carpal tunnel. Reproduction of tingling with wrist flexion (Phalen's sign) is also suggestive. However, clinical differentiation from other types of peripheral neuropathy may sometimes be difficult. If symptoms are severe or the diagnosis is uncertain, nerve conduction testing should be done on the affected arm for diagnosis and to exclude a more proximal neuropathy.

Treatment

• Splinting
• Sometimes corticosteroid/anesthetic injection
• Sometimes surgical decompression

Changing the position of computer keyboards and making other ergonomic corrections may occasionally provide relief. Otherwise, treatment includes wearing a lightweight neutral wrist splint (see Fig. 4: Hand Disorders: Neutral wrist splint.), especially at night, and taking mild analgesics (eg, acetaminophen, NSAIDs). If these measures fail to control symptoms, a corticosteroid (eg, a mixture of 1.5 mL dexamethasone, 4 mg/mL, and 1.5 mL 1% lidocaine) should be injected into the carpal tunnel at a site just ulnar to the palmaris longus tendon and proximal to the distal crease at the wrist. If bothersome symptoms persist or recur or if hand weakness and thenar wasting develop, the carpal tunnel can be surgically decompressed by using an open or endoscopic technique.

Cubital Tunnel Syndrome

(Ulnar Neuropathy)

Cubital tunnel syndrome is compression or traction of the ulnar nerve at the elbow.

The ulnar nerve is commonly irritated at the elbow or, rarely, the wrist. Cubital tunnel syndrome is most often caused by leaning on the elbow or by prolonged and excessive elbow flexion. It is less common than carpal tunnel syndrome. Baseball pitching (particularly sliders), which can injure the medial elbow ligaments, confers risk.

Symptoms and Signs

Symptoms include numbness and paresthesia along the ulnar nerve distribution (in the ring and little fingers and the ulnar aspect of the hand) and elbow pain. In advanced stages, weakness of the intrinsic muscles of the hand and the flexors of the ring and little fingers may develop. Weakness interferes with pinch between the thumb and index finger and with hand grip.

Diagnosis

Diagnosis is often possible clinically. However, if clinical diagnosis is equivocal and when surgery is being considered, nerve conduction studies are done. Cubital tunnel syndrome is differentiated from ulnar nerve entrapment at the wrist (in Guyon's canal) by the presence of sensory deficits (on sensory testing or with Tinel's sign) over the ulnar dorsal hand and by the presence of ulnar nerve deficits proximal to the wrist on muscle testing or nerve conduction velocity testing.

Treatment

Treatment involves splinting at night, with the elbow extended at 45°, and use of an elbow pad during the day. Surgical decompression can help if conservative treatment fails.

Radial Tunnel Syndrome

(Posterior Interosseous Nerve Syndrome)

Radial tunnel syndrome is compression of the radial nerve in the proximal forearm.

Compression at the elbow can result from trauma, ganglia, lipomas, bone tumors, or radiocapitellar (“elbow”) synovitis.

Symptoms and Signs

Symptoms include lancinating pain in the dorsum of the forearm and lateral elbow. Pain is precipitated by attempted extension of the wrist and fingers and forearm supination. Sensory loss is rare because the radial nerve is principally a motor nerve at this level. This disorder is sometimes confused with backhand tennis elbow (lateral epicondylitis). When weakness of the extensor muscles is the primary finding, the condition is referred to as posterior interosseus nerve palsy.

Diagnosis

Lateral epicondylitis can cause similar tenderness around the lateral epicondyle but does not cause Tinel's sign or tenderness along the course of the radial nerve.

Treatment

Splinting allows avoidance of the forceful or repeated motion of supination or wrist dorsiflexion, reducing pressure on the nerve. If wristdrop or weakened digital extension develops, or conservative treatment fails to provide relief after 3 mo, surgical decompression may be needed.

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OHSU finds association between Epstein-Barr virus, inflammatory diseases of the mouth

2008 NOV 24 -- Researchers at Oregon Health & Science University's School of Dentistry (www.ohsu.edu/sod) have found that a significant percentage of dental patients with the inflammatory diseases irreversible pulpitis and apical periodontitis also have the Epstein-Barr virus. The Epstein-Barr virus is an important human pathogen found in more than 90 percent of the world population. It is associated with many diseases, including infectious mononucleosis, malignant lymphomas, and naspharyngeal carcinoma.

The findings are published online (www.jendodon.com/article/S0099-2399(08)00879-0/abstract) in the Journal of Endodontics, one of the leading peer-reviewed endodontology journals. The study also is expected to be published in the December 2008 (volume 34, issue 12) issue of the Journal of Endodontics.

Although the number of studies examining the role of herpesviruses in oral disease has been increasing, the majority of studies have focused on periodontitis, with no systematic attempt to examine herpesvirus in endodontic patients with varying inflammatory diseases. The OHSU study assessed the presence of human cytomegalovirus (HCMV), Epstein-Barr virus (EPV), herpes simplex virus (HSV-1), and Varicella zoster virus (VZV) in 82 endodontic patients, including patients with irreversible pulpitis and apical periodontitis, and compared them with 19 healthy patients. The goal of the study was to determine the potential association of herpesvirus with clinical symptoms, including acute pain and size of radiographic bone destruction.

Using a variety of methods, the OHSU team found the Epstein-Barr virus DNA and RNA in significantly higher percentages (43.9 percent and 25.6 percent respectively) compared with healthy patients (0 percent). Human cytomegalovirus DNA and RNA were found in measurable numbers in both endodontic patients (15.9 percent and 29.3 percent respectively) and in healthy patients (42.1 percent and 10.5 percent respectively). Herpes simplex virus DNA was found in low percentages of endodontic patients (13.4 percent) and only one patient showed the presence of Varicella zoster virus.

While a previous study examined the incidence of herpes viruses in apical periodontitis, "this is the first time irreversible pulpitis has been analyzed for the presence of herpes viruses and associated with Epstein-Barr virus," noted Curt Machida, Ph.D., OHSU professor of integrative biosciences and principal investigator, whose lab was host for the study. "The incidence of irreversible pulpitis and apical periodontitis, caused by bacteria and possibly the latent herpes virus, is painful and can greatly impair the body's natural immune system. Studies such as ours could someday lead to more effective treatments of inflammatory diseases of the mouth."

Keywords: Carcinoma, Chickenpox, Chronic Fatigue Syndrome, Cytomegalovirus, Dentistry, EBV, Endodontics, Epstein-Barr Virus, HSV-1, Hematology, Herpes Zoster Virus, Herpesvirus, Infectious Disease, Infectious Mononucleosis, Lymphoma, Oncology, Periodontitis, Pulpitis, Varicella Zoster, Varicella-Zoster Virus, Viral Research, Virology, Oregon Health & Science University.

This article was prepared by Clinical Oncology Week editors from staff and other reports. Copyright 2008, Clinical Oncology Week via NewsRx.com.

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Can Seaweed Battle Cancer?

If you read my article about the health effects of ginger, you already know that I am an avid fan of sushi. Having grown up in California where sushi is commonplace and fresh fish is caught by the hour, the delicacy consisting of raw fish, rice, spices, and seaweed, is a luxury we often take for granted. While I usually drool over the ginger, fresh fish, and soy-sauce laden rice, science might be telling me to start appreciating the thin black “skin” of seaweed wrapped around them instead.

While many beachgoers and ocean swimmers get tied up or tangled in the slimy legs of seaweed, the term “seaweed” is actually a blanket word for any variety of algae formed in the sea. Algae comes in red, green, or brown and is harvested for a number of commercial uses. Besides being an additive in some products such as toothpaste, paint, or cosmetics, seaweed is also being developed as a weight-loss tool, fertilizer, as a potential biofuel, and it could be the next “superfood” if more uses are found.

In the food spectrum, seaweed is not just used to wrap sushi or cut up into Asian-style soups. Seaweed is known around the globe as a tasty treat and can be made into pasta like spaghetti in Italy or in a type of bread in Scotland.

Seaweed has been found to be a large source of iodine, an element that is necessary for the health and maintenance of the thyroid gland and when left untreated, can lead to discomfort and possibly a goiter. The strength and elasticity found in strips of this sea-faring organism is sometimes used to dress wounds and has also been documented as used in molds for dental work. Seaweed has been used in many studies hoping to find cures or lessening agents within it against diseases like tuberculosis, annoying ailments such as arthritis or tapeworms, even the common influenza has been tested with seaweed. The results of these tests have been relatively inconclusive and no generalizations could be made.

However, most of the studies in recent years that have been done regarding the effects of seaweed, are against cancer. Hoping to find the ability to shrink tumors with algae, many researchers have devoted years to observing the patterns and data surrounding this important compound.

A 2005 study conducted at the Georgia Institute of Technology found a small strain of red algae off the coast of Fiji called Callophycus serratus, that looks promising for a new, natural cure for cancer. With ten new natural compounds from the strain to work with, researchers found that some of the compounds were born antibacterial fighters and have held up in the lab against known diseases that resist antibiotics. It was said that the natural germ-killers were made by the seaweed to ward off predators and disease. Another compound was able to kill tumor cells in the lab by being able to turn on the suicide switch in the individual cells, which scientists call a head start to a new possible line of anticancer drugs. Georgia Tech biochemists insist that they are only in the “test tube level” and many more studies will be conducted.

Four years ago the researchers speculated that if the studies continue to work, that it may take at least a decade for any of these types of drugs to become available to the public. Another downside to these findings is a common one among researchers, the dosage of the drug would have to be incredibly high in order for it to work and it may do more harm than good for the patients. Another Georgia Tech biologist Mark Hay says that curing cancer is easy, but making it easier on the patient is completely different,

“We can cure cancer with a shotgun, so curing cancer is not the problem…. Curing cancer without harming patients is a whole different thing that's very difficult to figure out. Many compounds have been found to have a negative effect on cancer cells, but almost none of them have gone to market because of adverse side effects that make them unusable.”

While it may be awhile before we are able to take seaweed capsules to ward off cancer or those extra few inches around the middle, it looks like seaweed is a great source of nutrition and shouldn’t be shooed away from the table.

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Multiple Sclerosis Relapse Rate Reduced By Nearly Half With Use of Two New Drugs

Cladribine and fingolimod, two new oral drugs, have been shown to decrease the relapse rate in people who suffer from multiple sclerosis. The drugs could become the first treatments for the disease that does not require regular injections or infusions, if they gain approval by the U.S. Food and Drug Administration (FDA).

Multiple sclerosis (MS) is a chronic and frequently disabling disease that attacks the central nervous system. According to the National Multiple Sclerosis Society, the condition affects about 400,000 Americans and is the most frequent cause of neurological disability other than trauma in people from ages 20 to 50. Symptoms vary among patients and can range from mild to severe and may cause numbness of the limbs, paralysis and even loss of vision. The progression and severity of the disease are unpredictable.

Relapsing/Remitting Multiple Sclerosis (RRMS) is one of four recognized forms of MS. However, approximately 85 percent of people presenting with Multiple Sclerosis are first diagnosed with RRMS. This form of MS is characterized by relapses that may last for days, weeks or even months, during which new symptoms can appear and old symptoms may resurface or worsen. These relapses are followed by periods of remission in which the patient fully or partially recovers from the effects that occur during relapse periods. Recovery may be gradual or practically instantaneous.

In the Phase III study of 1,200 patients with the RRMS, approximately 80 percent of MS patients who took the drug cladribine remained relapse-free for two years compared to only 61 percent of those participants given a placebo. Side effects of cladribine were mild and included headaches, colds, flu, and nausea. The patients were followed for almost two years and monitored with the use of MRI scans. The study participants all had been living with MS for an average of six to seven years, and suffered from at least one relapse in the year prior to the study.

During the study, led by Gavin Giovannoni, M.D., of the Barts and London School of Medicine and Dentistry, participants received either four courses of low-dose cladribine tablets, six courses of higher-dose cladribine tablets, or a placebo. According to Giovannoni, this means, “that individuals with MS only have to take tablets for 8 to 20 days a year. That should improve compliance.”

The study participants who received cladribine were found to be 55 to 58 percent less likely to suffer from a relapse within a year than those given a placebo. In addition, the cladribine recipients were 33 percent less likely to experience deterioration in their disabilities, such as increase in the difficulties of walking. Based on MRI scans, participants taking cladribine were also found to have considerably brain and spinal cord lesions that are typical for MS patients.

Cladribine is already licensed and marketed under the name Leustatin for the treatment of leukemia and is believed to work in the fight against MS by suppressing the autoimmune responses thought to cause the disease. Merck Serono plans to apply for FDA approval within months.

In another successful phase III study of over 1,200 patients with RRMS, 80 to 84 percent of MS patients who were given daily dosages of the drug fingolimod remained relapse-free after one year in comparison to only 67 percent of study participants who received Avonex, a typical injectable drug used to treat MS. Participants in this study had been living with MS for an average of seven years, and all had suffered from an average of two relapses within two years prior to the study. Jeffrey Cohen, M.D., of the Cleveland Clinic, led the study.

Participants taking fingolimod were found to be 38 to 52 percent less likely to suffer from a relapse within a year and also experienced fewer lesions than participants who received the Avonex injections. The length of the study was insufficient to allow conclusions to be drawn on fingolimod’s effects on disabilities. The most common side effects experienced included, headache, head colds and fatigue. However, eight cases of skin cancer as well as four cases of breast cancer did occur and it remains unclear as to whether or not fingolimod was responsible for these events.

Fingolimod also suppresses the autoimmune responses thought to cause MS. There are two other ongoing studies of fingolimod for which results are expected within a few months. The maker of the drug, Novartis, anticipates application to the FDA for approval by the end of this year.

The phase III studies for both cladribine and fingolimod were presented at the annual meeting of the American Academy of Neurology. Because both drugs suppress the autoimmune responses, concerns remain regarding the safety of long-term use, as T cells are necessary for fighting infections, and particularly viral infections. Cladribine damages the ability of the T cells to reproduce and proliferate while fingolimod locks T cells inside the lymph nodes, preventing them from traveling through the bloodstream and into the brain and spinal cord. More studies of both drugs will be required to determine safe measures for their use.

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Tincture Tonics?

When watching an older movie, particularly one that is set prior to 1950, oftentimes terms are used that are rare or extinct in modern day life. Such as when characters would faint in a scene, a smaller role would always be advised to procure the “smelling salts” because the ill person had “the vapors.” The word tincture reminds me of this old-timey speak, although I admit that I did not know exactly what one was. Apparently tinctures are still widely used today and relevant in modern alternative medicine for a variety of ailments.

Common in chemistry classes (a course I was never good in), a tincture is a solution that uses alcohol as the main ingredient acting as a solvent to dissolve the solid portion of the solution. A tincture involves the mixing of the leaves, stems, or crushed seeds of a plant/medicinal herb distilled over time in a high percentage of alcohol (usually 40 to 60, but can also be up to 90 percent ethanol alcohol).

To make a healing tincture, herb bits are placed in a small jar and ethanol is poured over them. After letting this mixture stand for several weeks, while stirring occasionally, your tincture is ready for consumption (but should only be consumed in the event of an actual ailment). This process using alcohol helps to keep the herbs lasting for many years past their normal expiration because they are living compounds. It should be noted that tinctures can also be made with vinegar, although this type doesn’t last as long as the alcohol version.

Easily stored and travel-sized, most tinctures are made in small glass or plastic vials—around one ounce in size—perfect for a first aid kit or toiletries bag. Ready to use, these tinctures are easily administered either under the tongue or a few drops mixed into water, juices, or teas.

If you do not have the resources to purchase a high-quality tincture (they can be expensive depending on the uniqueness of the herb being used, time it took the herbalist, and where you find them), it is just as easy to make one yourself. However, make sure you use a recipe so the percentages are just right and use them with caution and as recommended. Favorite alcohol-based tonics that are made as tinctures are formuated with gin, brandy, and vodka, mainly because they are the top 100-proof alcohols available for purchase. Cheap alcohol will make the tincture less effective, so buy the best you can afford (or the best-tasting in your opinion).

Tinctures are generally used for chronic pain conditions like arthritis and ongoing persistent or recurring ailments such as bronchitis, asthma, menopause, migraines, joint and muscle spasms, stomach and bowel problems such as colitis, irritable bowel syndrome, motion sickness, nausea, tremors associated with Parkinson’s disease, and many others.

These tiny potions can be taken as often as a couple of times a day or just a few times a week or monthly as necessary. Always check with your nutritionist or physician before self-medicating or using a tincture as a complement to Western medical treatments and always make sure the herbs being used or mixed are supposed to combine in order to treat your specific condition. If you happen to be on medication, also check with your healthcare provider in case you are unable to use a tincture based on alcohol content or possibly because of the drug interaction with different herbs.

Next time you watch an old movie and someone with tuberculosis needs a tincture in order to get through his or her day, maybe you (as I will) know what exactly that means, even if you don’t venture to your nearest health food store or attempt to make your own alternative tonic.

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Corneal diseases

Cornea - a front part of an external fibrous envelope of an eyeball; nonvascular, high-sensitivity, transparent, an optically homogeneous envelope with smooth, a smooth surface. Except for protective and basic function the cornea is the main refracting surface of optical system of an eye.

Diseases of a cornea makes about 25 % of the general number of diseases of eyes, and quite often are the reasons of blindness and lowering of vision.

Diseases of a cornea are rather various. Most often there are inflammatory diseases of a cornea (keratitis), differing greater variety of forms and being one of principal causes of decrease in sight and blindness, and also keratikonus. The Most frequent reasons of keratitis and keratoconjunctivitis are virus and bacterial infections.

Keratikonus - a condition of an eye at which the normal spherical form of a cornea is broken, the cornea is bent. On a surface of an eye the camber similar to a cone that leads to strong easing of sight develops.

Dystrophies and degenerations of a cornea happen primary and secondary. In a basis primary local and general infringements of a metabolism with adjournment in a cornea of products of a pathological exchange lay. Secondary dystrophies develop after transferred keratitis, traumas, burns of eyes.

For the prevention of heavy complications of diseases of a cornea are required: proper diagnostics, duly and active treatment. Various medicinal substances are applied to local treatment in the form of drops, injections. Methods of electrophoresis, phonophoresis, treatment by laser radiation are used also.

For carrying out of purposeful treatment bacterial keratitis definition of sensitivity of microflora to antibiotics by crop of defeat separated from the center is necessary.

Instruction to the patient after change of a cornea

To you the microsurgery of change of a cornea is lead. The thin seam keeping a donor fabric, can long-standing time (about one year) to remain in a cornea. It allows you to start to work with the moderate physical activity earlier. At the same time, it is necessary to remember the periodic medical control over a condition of a seam.
Durable healing of a wound after change of a cornea comes only in 6-10 months after operation. Therefore after an extract from a hospital it is necessary for you to continue the recommended treatment in house conditions. Instilling drops or loading ointments can be made the purest hands before a mirror or in a prone position, as well as by means of relatives, using those receptions with which you have got acquainted in a hospital.

During the first month to sleep it is necessary on a back or on the party opposite to the operated eye. The food can be usual, it is necessary to exclude alcoholic drinks. Surplus of sweets is not desirable. Easy gymnastic exercises without jumps, run and inclinations are useful. During rest and walks during the first year after operation it is necessary to avoid stay on the bright sun. It is impossible to sunbathe. It is possible to use the blacked out glasses. The replaced cornea during several months, and sometimes several years, has the lowered sensitivity. Therefore it is impossible to rub sharply an eye a scarf or a hand, it is necessary to be cautious at washing, to cover the operated eye during a strong wind and to avoid walks in frosty days even on the second or the next years after operation. It will help to save a cornea from damages and freezing injury.

You can watch TV, go to museums, cinema and theatre if it is not connected with difficult and close moving to transport. It is possible to start the usual or limited work in 2-4 months depending on a condition of the operated eye and working conditions. Expansion of the general mode should be carried out one step at a time, however during the first year work with a slope of a head downwards, outdoor games, run, heavy physical work is absolutely counter-indicative. After an output for work do not forget to show to the oculist each 2-3 months within the first year after operation, especially if it is not removed an encircling stitch.

In case of occurrence of reddening and an ache in an eye, and blear-eyedness to you it is necessary for photophobia to see a doctor promptly. Only early the begun treatment can prevent deterioration of vision.

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Dystonia and Botox Injections

The first thing you notice about "Joey" is that his head is turned and tipped to one side; his left ear rests on his hunched-up left shoulder. He has to turn his whole upper body to look at you. Joey has torticollis, also known as cervical dystonia, meaning that his neck muscles are in an involuntary spasm that forces his head into its painful, abnormal position.

Can affect any part of the body
Dystonia--those painful muscle spasms--can affect any part of the body including:

• eyelids (blepharospasm)
• face (oromandibular)
• vocal cords (dysphonia)
• arms, legs, or trunk

"Writer's cramp" is dystonia in the hand or arm muscles.

Causes
Dystonia affects people of all ages and ethnic backgrounds. Some forms of it can be inherited; researchers have identified more than 10 genes or chromosome locations associated with the disorder. Dystonia may also occur due to birth injury, traumatic injury, toxins (such as manganese), certain medications (such as haloperidol), stroke, or be part of another disorder such as Parkinson's disease. It generally develops gradually, and symptoms can appear at any age.

Diagnosis
There is no specific test for dystonia, so it is usually diagnosed based on the symptoms. Dystonia can come and go, so some people who experience it may have a hard time convincing health care providers that it exists. The spasms may change significantly with different actions. For example, hand dystonia may occur when trying to write but not during other activities.

Treatment
For most people with dystonia, the disorder does not shorten life, but it does cause pain and discomfort, and may interfere with basic activities such as walking, dressing, or eating.

There are a number of medications that can treat dystonia, either alone or in combination. One of the most common treatments is Botox (botulinum toxin) injections (marketed as Vistabel in Europe). Dysport is another brand available in Europe. Another formulation of botulinum toxin used is called Myobloc (U.S.) or Neurobloc (Europe).

Botox injections
Although most people in the U.S. know Botox as a vanity treatment for facial lines, it was originally developed in 1989 as an orphan drug to treat dystonia and muscle spasms. Injection of the drug causes weakness in the targeted muscle, thus relaxing the spasm and relieving dystonia.

Information for this article was taken from:
- Molloy, F. M. (2002). Botulinum toxin (Botox): Dystonia treatment. eMedicine, accessed at http://www.emedicine.com/neuro/topic585.htm
- Dystonia Medical Research Foundation

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