Schweizerische Rundschau für Medizin Praxis = Revue suisse de médecine Praxis
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Schweiz. Rundsch. Med. Prax. · Feb 1990
Case Reports[The piriformis syndrome--a possible cause of sciatica].
In a 50-year-old patient with unilateral pain in the buttocks and in the sciatica, a radicular compression syndrome was diagnosed. Because conservative therapy failed, surgical intervention for herniated disc was suggested. ⋯ Through specific stretch exercises, quick recovery was effected. Based on this case report, typical clinical diagnoses and therapeutical possibilities for the piriformis syndrome are discussed.
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The 26-year-old man experienced symptoms of chronic airway obstruction with shortness of breath, cough and wheezing, which primarily led to a diagnosis of asthma bronchiale. Absence of adequate response to antiasthmatic treatment and development of hemoptysis and weight loss led to the tentative diagnosis of upper airway obstruction by tumor. Bronchoscopy revealed adenoid cystic carcinoma of the distal trachea.
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A 41-year-old homosexual man complained about weight loss of 14 kg over a period of 6 months. He developed exertional dyspnea and fever up to 39.6 degrees C. The ESR was elevated and the fraction of immature neutrophils increased. ⋯ HIV-serology was positive. Sulfamethoxazole/trimethoprim (1600/320 mg daily) and 100 mg of prednisolone/die led to reduction of fever. Prevention of P. carinii pneumonia relapse is currently underway with bi-weekly inhalation of pentamidine-isethionate aerosol.
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Exertional dyspnea and fatigue dominated the clinical picture of pernicious anemia in a 78 year old man. A disturbed gait indicated concomitant neurologic disorders. A reduced Vitamin B12 level, an abnormal Schillingtest, atrophy of gastric mucosa as well as maturation disturbance of erythrocytes and neutrophils were present as typical signs of the disease. Administration of Cyanocobalamine led to correction of blood values within three weeks.
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The state of the art in restoration of severed peripheral nerves is outlined. Discussion of the prerequisites for an optimal nerve-repair such as intraneural anatomy of peripheral nerves (topography of nerves in cross-section), techniques for preparation of nerve stumps, lesions in continuity, precise rotational orientation, nerve-suture, interfascicular dissection and nerve-grafting, including harvesting of autologous nerve grafts and finally the postoperative management after restoration of peripheral nerves are discussed.