Symptoms

The most typical symptom is a rather diffuse pain in the legs that comes on after walking a certain distance or on standing for a period. This is called neurogenic claudication. Patients have often noticed that the distance they are able to walk has gradually been getting less for some time before the pain starts. The pain is usually relieved by movements that bend the lower back forward slightly. This maneuver widens the spinal canal slightly. Patients with spinal stenosis often describe a...

Treatment and Outcome

There are several different treatments for myasthe-nia that can be divided into three groups (1) drugs that increase the concentrations of the neurotrans-mitter acetylcholine (2) drugs that modulate the immune response and (3) surgical removal of the thymus gland. Several drugs such as aminoglyco-side antibiotics, tricyclic antidepressants, and phenytoin can worsen the symptoms of myasthe-nia and should be avoided if possible. Drugs that increase the concentrations of the neurotransmitter...

Biceps tendon rupture

Inflammation of superficial veins that lie just under the skin can cause them to clot and form painful cords that can be felt (superficial thrombophlebitis). inflammation of larger, deep veins increases the risk of deep vein thrombosis. inflammation of arteries can lead to formation of aneurysms or to narrowing and blockage of an artery. if the blood flow to an organ is not adequate to supply oxygen and nutrients to the organ, then gangrene and death of tissue will occur....

Corticosteroids

Tablets prednisone Deltasone, Orasone methylprednisolone Medrol dexamethasone Dexone Injections methylprednisolone SoluMedrol hydrocortisone Solu-Cortef dexamethasone Decadron intra- methylprednisolone acetate Depo- injections triamcinolone Aristocort, Aristospan, Kenalog Corticosteroids are also called glucocorticoids or sometimes just steroids. They are related to cortisone, a stress hormone produced by the adrenal gland, and differ from anabolic steroids used by some athletes to increase...

Symptoms Limited Scleroderma

Many patients with limited scleroderma have the five classical symptoms that comprise the CREST syndrome calcinosis, Raynaud's phenomenon, esophageal dysmotility, sclerodactyly, and telang-iectasia. The term CREST syndrome is derived from the first letter of each of these symptoms, but it is also often used to describe patients with limited scleroderma who have only three or four of the symptoms of CREST. Some physicians use the terms CREST syndrome and limited scleroderma interchangeably. Skin...

Idiopathic thrombocytopenic purpura See thrombocytopenia

Immune response A complex system of related defenses against foreign organisms. Immunity is innate and acquired. The innate immune response can act immediately and does not require previous exposure to an organism or the production of antibodies. Innate immunity is provided by phagocytic cells that engulf and digest invading organisms as well as a particular type of lymphocyte called the natural killer or NK cell. Acquired immunity is targeted against specific parts of organisms called antigens...

Diagnosis

Dry eyes, dry mouth, and intermittent swelling of the parotid glands strongly suggest Sj gren's syndrome. Strictly speaking this should be confirmed with a biopsy of the minor salivary glands (from inside the lower lip) showing typically increased collections of lymphocytes. However, in practice a positive anti-Ro (SSA) antibody with the typical clinical findings is often considered a firm diagnosis. While many Sj gren's patients will have a positive antinuclear antibodies (ANA) test (see...

Cholesterol emboli syndrome

More recently chiropractic has evolved into a practice that mostly restricts itself to using manipulation to treat problems of muscles and joints. Osteopathy (see osteopath), which like chiropractic was based on the concept that manipulation of bones and soft tissues could alleviate symptoms and was also originally thought to be useful for treating most types of illness, has evolved differently. Over the years many osteopaths have increasingly incorporated traditional...

CRP Creactive protein See esr and crp

Cryoglobulins These are abnormal immunoglob-ulins that precipitate when blood is cooled to less than 37 C and that redissolve on warming. The type of immunoglobulin found is used to classify the type of cryoglobulinemia. Within each class of immunoglobulin, antibodies may be produced by one B lymphocyte and its progeny (monoclonal) or many different unrelated lymphocytes (poly-clonal). In type I cryoglobulinemia, there is one monoclonal immunoglobulin, usually IgM. In type ii, there is both...

Metabolic

Disorders of glycogen metabolism may be inherited and have their major effect on muscle. The best known of these is McArdle's disease, but there are many others. Disorders of fat metabolism are even less common but can cause similar problems. A number of inherited abnormalities of mito-chondrial function may lead to myopathy (and other effects) occurring at different ages. Mitochondria are small organelles within cells that are crucial in energy processing. Myoadenylate deaminase deficiency...

Plasmapheresis therapeutic plasma exchange

Removal and replacement of a patient's plasma in order to remove large molecules such as antibodies and other proteins. The rationale for plasmaphere-sis is simple if a disease is caused by antibodies, removing them should improve the disease. Plasmapheresis is performed by drawing blood out of a vein and passing it into a centrifuge that separates cells from plasma. The patient's plasma is removed and replaced with saline and albumin or plasma from the blood bank. The reconstituted blood is...

Anticardiolipin antibody See antiphospholipid

Anticentromere antibody Autoantibodies are antibodies directed against molecules within human cells, on the cell surface, or in blood or other fluids. Many of them give useful information because they are associated with particular diseases or manifestations of disease. The anticentromere antibody has been found in 60-95 percent of patients with CREST syndrome or limited scleroderma. However, the test is not very specific, and it is also found in a small number of patients with diffuse...

Adultonset Stills disease

Several types of acupuncture practice may be found in the Western world. Traditional Chinese acupuncture is based on traditional diagnoses and aims at restoring yin and yang and normal qi flow. Cookbook acupuncture consists of techniques borrowed from Chinese acupuncture but used to treat disorders based on a Western medical diagnosis. An example is the commonly used auricular acupuncture to help with smoking cessation. A small but increasing number of Western medical...

Diffuse scleroderma diffuse systemic sclerosis

This involves rapid onset of skin changes that affect the hands, face, and central parts of the body such as the trunk, back, and abdomen within a year of developing Raynaud's phenomenon. Organs such as the lungs, Gi tract, and kidneys are often affected. Very rarely scleroderma can affect the internal organs and not the skin. This is called scleroderma sine scleroderma. Limited scleroderma (limited cutaneous systemic sclerosis, CREST syndrome) This involves gradual skin tightening limited to...

Diffuse idiopathic skeletal hyperostosis DISH

Also known as Forestier's disease, DISH is a condition in which there is exuberant bone growth at characteristic sites. it is very common, being found in approximately 10 percent of people over the age of 65 years. It is found twice as often in men as in women and becomes increasingly common with age. DISH is found in all parts of the world. Typical changes of DISH have been found in the spines of dinosaur skeletons, Egyptian mummies, and other ancient skeletons. Although there are well-known...

HHC is common

There are relatively easy tests to determine carrier status (the C282Y and H63D genes) and iron overload (transferrin saturation and ferritin). Treatment is cheap, technically easy, and acceptable to most patients. Early treatment can prevent considerable disability, suffering, and costly treatment of the complications of HHC. Despite these arguments, most public health bodies and governments are not recommending screening. Their arguments revolve around the fact that not everyone who has two...

Myositis and Myopathy

Drugs can cause inflammation or degeneration of muscle, resulting in weakness, pain, and sometimes elevated blood levels of muscle enzymes such as creatine kinase. A class of drugs used to lower cholesterol known as the statins or HMG coenzyme reductase inhibitors, for example lovastatin and simvastatin, occasionally causes myositis. Myalgia occurs in approximately 2 percent of patients treated with a statin, but less than five in 1,000 develop significant myositis with symptoms and levels of...

Cause

Although hyperuricemia (high blood levels of urate) is not the same as gout, it is the major risk factor for gout. Generally speaking, anything that tends to raise the blood urate level is a risk factor for gout. However, not everyone with raised urate levels will get gout. About 95 percent of uric acid in the blood combines with sodium to form molecules of monosodium urate, which is much more soluble than uric acid in both blood and joints. Many people use the terms uric acid and urate...

Epicondylitis tennis elbow golfers elbow

The bony prominences on the inner and outer side of the elbow are known as the epicondyles. They are the lower part of the humerus (upper arm bone) and form the attachment of muscles that move the wrist. Muscles that move the hand away from the palm (as in a backhand stroke in tennis) attach to the outer or lateral epicondyle. Those that move the hand in the palmar direction (as in a forehand stroke) attach to the inner or medial epicondyle. When these attachments become inflamed, the condition...

Hypertrophic pulmonary osteoarthropathy HPOA

This can lead to quite rapid onset of pain that usually affects hands, wrists, and ankles but also occasionally the elbows and knees. Typically the area around the nail bed becomes swollen, giving the fingers a drumstick appearance, a finding called clubbing. The pain may be described as deep and burning, and there may be associated sweating in the hands and feet. The affected areas are mildly swollen, warm, and dusky red. A careful examination may show that the swelling extends beyond the...

Nonselective NSAIDs

Most of the older NSAIDs inhibit both COX-1 and COX-2 and thus have anti-inflammatory and antiplatelet effects and increase the risk of peptic ulcers. Aspirin is a unique nonselective COX-inhibitor because in very low doses it binds to the COX-1 enzyme of platelets and irreversibly inactivates it, making those platelets less sticky for their life span, usually about a week. The antiplatelet effects of other nonselective COX inhibitors are much shorter because they block only the enzyme while...