Neurogenic Pruritus: Treatment by Acupuncture

2002 ◽  
Vol 20 (2-3) ◽  
pp. 123-139
Author(s):  
AJ Stellon

Introduction Notalgia paraesthetica is a condition associated with itching, and unassociated with a rash, that affects a segment of the body innervated by T2-T6 dorsal spinal nerves. It is believed to be a type of neuropathy. This single-handed practice reports one such case. It also describes a further eight cases of “neurogenic” pruritus which share similar characteristics to this condition but are in segments of the body innervated by cervical and lumbar spinal nerves. Traditional acupuncture has been described to help with skin conditions and this study was performed to see if it was successful in this type of pruritus. Patients and Methods Over a nine-year period in a practice with an average list size of 2000 patients, nine patients aged 41 to 79 years presenting with segmental itching were identified. Other causes of pruritus were excluded by clinical examination, as well as by haematological and biochemical tests. Drug induced causes were also excluded. Duration of pruritus was six weeks (range 4 – 52 weeks). In eight patients itching was restricted to dermatomes innervated by the spinal nerves of the cervical spine, in two by the dorsal spine and in two by the lumbar spine. In three patients pruritus occurred in dermatomes innervated by two separate areas of the spine. Clinical examination revealed restricted cervical or lumbar movements in seven patients. Paravertebral tenderness and/or spasm of the paravertebral muscles was found in the areas of pruritus in seven patients. Skin changes associated with sympathetic nerve over-activity were noted in five patients. Six of the nine patients had x-ray evidence of degeneration of the spine. Results All nine patients were treated by deep intramuscular stimulation of the paravertebral muscles in the dermatomes affected by pruritus. In total a median of three treatments (range 2 – 5) was required to resolve the pruritus. Recurrence of symptoms occurred in four patients within 8 to 12 months of their last treatment over a period of follow-up of 0.5 – 9 years (median one year). Repeat acupuncture treatment resolved the pruritus. Discussion The term neurogenic pruritus describes and encompasses all conditions associated with segmental itching unassociated with a rash. The clinical signs of this condition are suggestive of an early neuropathy as a result of a degenerative condition of the spine. This is the first report of symptoms of such a condition being treated successfully by acupuncture.

2002 ◽  
Vol 20 (4) ◽  
pp. 186-190 ◽  
Author(s):  
Anthony Stellon

Intractable localised segmental pruritus without a rash has been reported over the years under various titles depending on the area of the body affected. Notalgia paraesthetica and brachioradial pruritus are the two terms used for what is believed to be a form of neuropathy. The clinical observations reported here suggest that other localised cases of pruritus exist that share common clinical features, and the term neurogenic pruritus is suggested to encompass these under one clinical condition. Acupuncture has been used to treat skin conditions, of which pruritus is one symptom. This retrospective study looked at the symptomatic relief of neurogenic pruritus in 16 patients using acupuncture. In 12 cases the affected dermatomes of the body were innervated by cervical spinal nerves, seven innervated by dorsal spinal nerves and four innervated by the lumbar spinal nerves. Seven patients had areas affected by two different regions of the spine. Restricted neck or back movements were noted in patients as were areas of paravertebral spasm or tenderness of the muscles. Total resolution of symptoms as judged by VAS occurred in 75% of patients. Relapse occurred in 37% of patients within 1-12 months following treatment. Acupuncture appeared to be effective in alleviating the distressing symptom of itching in patients presenting with neurogenic pruritus.


2019 ◽  
Vol 7 (2) ◽  
pp. e000811
Author(s):  
Tatiana de Brito Lima ◽  
Laura Ordeix ◽  
Dolors Fondevila

A nine-year-old, entire male basset hound presented with one-year history of pruritus and patchy to diffuse alopecia accompanied by erythema, starting a few days after applying an implant of deslorelin for treatment of benign prostatic hyperplasia. Dermatopathological examination was diagnostic for follicular mucinosis, accompanied by a characteristic lymphocytic mural folliculitis at the level of the isthmus. Partial improvement with anti-inflammatory doses of prednisone was observed. Thereafter, oral ciclosporin was administered on a daily regimen until complete remission was achieved, after which it was gradually tapered until withdrawal. No other implants were applied thereafter, and two years later the patient remains free of clinical signs.


2021 ◽  
Vol 49 ◽  
Author(s):  
Filipe Krasinski Cestari ◽  
Monica Regina De Matos ◽  
Jéssica Gonçalves dos Santos ◽  
Giovane Franchesco De Carvalho ◽  
Karim Cristhine Pase Montagnini ◽  
...  

Background: Intravascular lymphoma (IL) is a rare disease characterized by presence of neoplastic lymphocytes in the lumen of blood vessels. Any tissue can be affected; however, the most frequently compromised areas of the body are the skin and the central nervous system (CNS). The clinical signs and macroscopic alterations caused by IL are nonspecific and are usually secondary to a continuous proliferative disorder, which leads to occlusion of the blood vessels with consequent thrombosis, hemorrhage and infarction. The objective of this work is to report a case of IL in a dog.Case: An 8-year-old male Rottweiler dog was referred to the Veterinary Hospital of the Federal University of Paraná with a history of cerebellar ataxia that had not improved after treatment. At the neurological examination, cerebellar ataxia and deficit of nasal reflex were detected. A complete blood count showed presence of slight anemia (4.8 million red blood cells/mm3; normal ranges= 5.5-8.5 million/mm3) and thrombocytopenia (176.000/mm3; normal ranges= 250.000-500.000/mm3). Biochemical tests revealed a small increase in alanine aminotransferase (42 IU/L; normal ranges= 14-38 IU/L) and a slight decrease in alkaline phosphatase (49 IU/L; normal ranges= 90-170 IU/L). The cerebrospinal fluid (CSF) exhibited an increased protein concentration (147.3 mg/dL; normal ranges= 18-44 mg/dL) and pleocytosis (8 cells/µL; normal ranges= up to 5 cells/µL). No alterations were observed at radiographic and ultrasonographic exams. A clinical treatment was prescribed; however, in view of the worsening of the clinical signs, euthanasia was performed, and the body was submitted to a Laboratory of Pathology. At necropsy, moderate multifocal ulcers were observed in the oral cavity and ventral side of the tongue; moderately infarcted areas were detected in the spleen. Additional alterations such as fatty liver degeneration, glomerulonephritis, and pulmonary edema were also observed. Consequently, fragments from various tissues were collected, fixed in 10% formaldehyde, and processed for paraffin embedding and microtomy. Sections with a thickness of 5 µm were cut, and stained with hematoxylin and eosin. Microscopically, the cerebral cortex exhibited a marked number of round neoplastic cells with well-defined edges and scant cytoplasm filling the vascular lumen. Similar cells were observed in the lumen of the blood vessels in the cerebellum, spinal cord, liver, lungs, kidneys, and mucocutaneous junction. The cerebellum, mucocutaneous junction, and kidneys were submitted to immunohistochemical evaluation. The results were consistent with T cell lymphoma in the telencephalon, in the mucocutaneous junction, and in the cerebellum; however, the neoplastic cells observed in the kidneys were not positively stained by the antibodies used.Discussion: Since, in this neoplasia, there is no formation of solid tumors as in other lymphomas, the diagnosis is more difficult both clinically and macroscopically, and hence a combination of immunohistochemistry and microscopy are indispensable. Immunohistochemistry for detection of the markers CD3, CD45RA, CD20, PAX5 and CD79a was essential to determine the cell type especially in the mucocutaneous junction, telencephalon, and cerebellum. Absence of staining for any of these markers on the neoplastic cells in the kidneys may be associated with a high degree of cellular undifferentiation, which worsens the prognosis. This case report highlights the importance of the combination of histopathological and immunohistochemical examinations with laboratory tests and the clinical picture of the animal for the diagnosis of this neoplasia, which can be difficult to identify.


2021 ◽  
Vol 49 ◽  
Author(s):  
Fernanda Aquino Franco ◽  
Fernanda Carlini Cunha Dos Santos ◽  
Gabriela Vicensi Da Costa ◽  
Henrique Ramos Oliveira ◽  
Lays Wouters Ugolini ◽  
...  

Background: Equine pituitary pars intermedia dysfunction, also known as equine Cushing’s syndrome, is a neurodegenerative disease. An important risk factor for Cushing’s is advanced aging and it is the most common endocrine disorder in older horses. The prevalence in horses aged over 10 and 15 years is reported as 9.3% and 21%, respectively. Due to the slow progressive nature of the disease, seasonal variation in hormone output and overlapping endocrine response to other events, accurate diagnosis is challenging. The diagnosis requires the combination of anamnesis, clinical signs, in addition to laboratory tests results. This study aimed to report Cushing’s syndrome in a Crioulo breed horse focusing on diagnostic methods.Case: A 13-year-old male Crioulo breed, orchiectomized, was attended at the Universidade de Passo Fundo (UPF), in Passo Fundo, RS, Brazil. The owner reported that the animal had progressive weight loss and coat abnormal growth, with curly appearance. From visual inspection, body condition score was 4 (1-9) bulging abdomen was noticed, hirsutism, depression and lethargy. Also, there was a large neoplastic mass on the left side of gluteal region. Later, this mass was classified in histopathological examination as a fibroblastic sarcoid and was treated. The animal presented physical parameters within the physiological limits of the specie. Normochromic normocytic anemia and neutrophilic leukocytosis were reported in the hematologic evaluation. In coproparasitological examination, there were 300 eggs per gram of feaces. Hyperadrenocorticism was suspected in the clinical examination and dexamethasone suppression test was performed to confirm the fact. Basal serum was collected at 17 h (M0) and subsequently 40 µg/kg of dexamethasone was administered intramuscularly. Serum samples were taken after 15 (M15) and 19 (M19) h, resulting in cortisol levels of 1.7 and 1.8 μg/dL, respectively. The M15 and M19 results were above reference values for horses (below 1 μg/dL). Combination of information gathered from anamnesis, clinical examination and dexamethasone suppression test resulted in the definitive diagnosis of hyperadrenocorticism, also known as Cushing’s syndrome. Paliative treatment included shearing all over the body and vitamin supplementation.Discussion: In animals without obvious clinical signs, Cushing's syndrome diagnosis is challenging. The most unique and specific clinical signs are the development of abnormal hair coat, mainly hirsutism, delayed or incomplete shedding, and in aged horse, lightening of coat color. The mechanistic cause of these signs is still barely understood. Cushing's is a collection of syndromes each with a unique set of clinical signs and hormone profiles, which varies according to each individual. Complementary examinations are extremely important and endocrine tests are highly recommended in addition to suggestive findings. However, despite the variety of existing tests, false negatives or false positives can frequently happen. Dexamethasone suppression test is considered the gold standard, well validated, practical and low cost for the diagnosis of this disease. In the present report, the combination of anamnesis (13 years old, weight loss, and abnormal coat), clinical exam (hirsutism) and dexamethasone suppression test (over 1 μg/dL of cortisol 15 h and 19 h after dexamethasone administration) resulted in the definitive diagnosis of Cushing’s syndrome. Measurements of plasma concentrations of cortisol and adrenocorticotropic hormone (ACTH), thyrotropin releasing hormone (TRH) stimulation test, serum insulin concentration and necropsy are other available tests. History, clinical signs and test results are important to achieve the definitive diagnoses, and when possible, it is advisable to perform post-mortem evaluation of the pituitary gland.


2017 ◽  
Vol 19 (4) ◽  
pp. 0-0
Author(s):  
Katarzyna Kozera ◽  
Bogdan Ciszek ◽  
Paweł Szaro

Spinal Dorsal Ramus Mediated Back Pain is the second most frequently described condition (the first one being Lumbar Facet Syndrome) originating from pathology involving posterior branches of lumbar spinal nerves. Spinal Dorsal Ramus Mediated Back Pain was described as “thoracolumbar junction syndrome” by Maigne in 1989. As a rule, Spinal Dorsal Ramus Mediated Back Pain presents unilaterally within posterior branches at the levels Th11-12 and L1-2. The pain is triggered by extension and/or rotation. Typical symptoms include pain that may radiate towards the gluteal area and posterior iliac crest and does not cross the body midline. Clinical symptoms may correlate with the area supplied by the whole spinal nerve of the given segment, including both the posterior and anterior branch. For this reason, patients may report not only low back pain, but also pseudovisceral pain in the hypogastric area, false sciatic neuralgia, tenderness of the pubic symphysis and hypersensitivity of the intestines. The above symptoms may lead to diagnostic difficulties. Diagnostic work-up may benefit from performance of the Kibler Fold Test to determine sensitivity of the tissues surrounding the iliac crest. Patients with Spinal Dorsal Ramus Mediated Back Pain respond well to manual manipulative techniques if these are delivered in a technically correct manner and address the appropriate segment. A recommended approach for patients with absolute contraindications to manipulation, i.e. advanced osteoporosis or osteogenesis imperfecta, is a block of the po­sterior branch of the spinal nerve involved.


2019 ◽  
Vol 47 ◽  
Author(s):  
Paula Elisa Brandão Guedes ◽  
Thaís Nascimento De Andrade Oliveira ◽  
Julian Andrade Dos Santos ◽  
Mario Sérgio Lima de Lavor ◽  
Fabiana Lessa Silva ◽  
...  

Background: Cryptococcosis is a mycosis that primarily affects domestic cats and is caused by fungi of the genus Cryptococcus, resulting in cutaneous, ocular, respiratory, and neurological manifestations. Diagnosis is based on the microscopic evaluation of the lesions and isolation of the causative agent. The aim of this study was to describe a case of feline cryptococcosis diagnosed by cytology and treated at the Veterinary Hospital of the State University of Santa Cruz (HV-UESC). Case:A 5-year-old uncastrated male cat was taken to the HV-UESC small animal clinic, owing to a gradual increase in the volume of the nasal plane spanning over a year, accompanied by respiratory distress. Upon physical examination, the animal was found to have regular nutritional status, dehydration, hypocorous mucosae, and enlarged popliteal lymph nodes. In addition, multifocal areas of ulceration on the body as well as increased volume in the nasal plane (clown nose) were observed. Peripheral blood samples were collected for complete blood count and biochemical analysis. Due to clinical suspicion of fungal lesions, fine needle aspiration of the nasal lesion was performed and cytological slides were sent to the HV-UESC histopathology laboratory. Probable diagnoses included rhinosporidiosis, cryptococcosis, and histoplasmosis. The animal was subjected to thoracic radiography in the imaging division of the HV-UESC. Blood counts revealed thrombocytopenia (130,000/mm3) and biochemical tests presented hypoproteinemia (3.2 g/dL), with hypoalbuminemia (1.52 g/dL); however, chest radiography did not show pulmonary alterations. Results of cytological analysis indicated pyogranulomatous inflammation associated with intracellular organisms, demonstrating a pathogen morphology similar to that of Cryptococcus spp. Before the diagnosis, itraconazole 5 mg/kg (1 capsule, twice a day for 30 days) and fipronil (1 ampoule 0.5 mL, on the back) were prescribed. Follow-up after 40 days showed a slight improvement in cutaneous lesions and respiration, and no other abnormalities were observed. At the follow-up, the owner disclosed that medication could not be administered at the prescribed frequency because of the animal often ran away from home and stayed without prescription. Due to unsatisfactory response to the first treatment, the dosage of itraconazole1 was increased to 10 mg/kg (1 capsule, twice a day, for 30 days) with a new regimen and follow-up after 15 days. However, the owner did not make a follow-up visit. A year later, after several attempts to contact the owner, we were notified that the treatment had been discontinued and the cat still presents with lesions. Discussion: Although cryptococcosis is not endemic, the cat roamed freely on the streets and may have been infected by inhaling the microorganism spores present in the environment. The clinical signs exhibited by the animal were consistent with the findings associated with Cryptococcus spp. infection in cats, especially the "clown nose" lesion. The cat, besides being dehydrated at the time of care, had a regular nutritional status. Cytology, the only diagnostic technique used in this case through which it was possible to visually identify the fungus, was definitive for the diagnosis of cryptococcosis. Although the prescribed treatment is one of the most indicated in such cases, it was not effective, possibly due to inadequate administration. The length of infection, discontinuation of therapy, and absence of follow-ups for clinical reassessment certainly contributed to an unfavorable prognosis.


2021 ◽  
Vol 5 (1) ◽  
pp. 015-021
Author(s):  
Rodriguez Zullyt Zamora ◽  
Lemus Marielys ◽  
González Eduardo Fleitas ◽  
Lozano Oscar Ernesto Ledea

Background: The acaricidal action of Ozonized sunflower oil (OSO) has demonstrated in different clinical cases of different animal species, such as psoroptic rabbits and pig sarcoptic scabies and recently in demodesic goat. Objectives: This study evaluated the effectiveness of OSO as treatment for generalized demodicosis mange in dogs. Animals: Twenty dogs of different breeds, between six months and one year of age with generalized demodicosic mange that attended to Veterinary Clinic “José Luis Callejas” Havana, Cuba, during the year 2015, were included in the study. Methods: The demodicosis diagnostic was based on its clinical history, the mite’s presence by deep scraping and clinical signs. All cases had a history of receiving before conventional treatments without solution. OSO treatment was topically applied daily, every 12 hours, after shaving all affected areas. Monitoring of clinical signs, mite counting on scaling, pruritus and capillary regrowth (7, 14, 28, 56 and 84 days) were performed. Results: The results showed a significant reduction of mite counts, clinical signs and pruritus since the 7th day of application. The animals recovered the fur on more than 90% of the body surface. All the animals (100%) recovered from generalized demodesic mange in 84 days of treatment. Conclusion: The effectiveness and safety of OSO as election treatment of generalized demodicosis mange in dogs was demonstrated.


Phlebologie ◽  
2007 ◽  
Vol 36 (06) ◽  
pp. 309-312 ◽  
Author(s):  
T. Schulz ◽  
M. Jünger ◽  
M. Hahn

Summary Objective: The goal of the study was to assess the effectiveness and patient tolerability of single-session, sonographically guided, transcatheter foam sclerotherapy and to evaluate its economic impact. Patients, methods: We treated 20 patients with a total of 22 varicoses of the great saphenous vein (GSV) in Hach stage III-IV, clinical stage C2-C5 and a mean GSV diameter of 9 mm (range: 7 to 13 mm). We used 10 ml 3% Aethoxysklerol®. Additional varicoses of the auxiliary veins of the GSV were sclerosed immediately afterwards. Results: The occlusion rate in the treated GSVs was 100% one week after therapy as demonstrated with duplex sonography. The cost of the procedure was 207.91 E including follow-up visit, with an average loss of working time of 0.6 days. After one year one patient showed clinical signs of recurrent varicosis in the GSV; duplex sonography showed reflux in the region of the saphenofemoral junction in a total of seven patients (32% of the treated GSVs). Conclusion: Transcatheter foam sclerotherapy of the GSV is a cost-effective, safe method of treating varicoses of GSV and broadens the spectrum of therapeutic options. Relapses can be re-treated inexpensively with sclerotherapy.


2018 ◽  
Vol 52 (1-4) ◽  
pp. 1-9 ◽  
Author(s):  
MT Hussan ◽  
MS Islam ◽  
J Alam

The present study was carried out to determine the morphological structure and the branches of the lumbosacral plexus in the indigenous duck (Anas platyrhynchos domesticus). Six mature indigenous ducks were used in this study. After administering an anesthetic to the birds, the body cavities were opened. The nerves of the lumbosacral plexus were dissected separately and photographed. The lumbosacral plexus consisted of lumbar and sacral plexus innervated to the hind limb. The lumbar plexus was formed by the union of three roots of spinal nerves that included last two and first sacral spinal nerve. Among three roots, second (middle) root was the highest in diameter and the last root was least in diameter. We noticed five branches of the lumbar plexus which included obturator, cutaneous femoral, saphenus, cranial coxal, and the femoral nerve. The six roots of spinal nerves, which contributed to form three trunks, formed the sacral plexus of duck. The three trunks united medial to the acetabular foramen and formed a compact, cylindrical bundle, the ischiatic nerve. The principal branches of the sacral plexus were the tibial and fibular nerves that together made up the ischiatic nerve. Other branches were the caudal coxal nerve, the caudal femoral cutaneous nerve and the muscular branches. This study was the first work on the lumbosacral plexus of duck and its results may serve as a basis for further investigation on this subject.


Author(s):  
Nael Mohammed Sarheed ◽  
Osamah Faisal Kokas ◽  
Doaa Abd Alabas Muhammed Ridh

The plant of castor is widely spread in the Iraqi land, and characterized with containing ricin toxin, which has a very serious effects, and because the seeds of this plant scattered in the agricultural soil and rivers water, which increases the exposure of humans and animals to these beans. Objective: This experiment was designed to study the effect of high concentration of castor bean powder in some physiological and biochemical parameters and changes in some tissues of the body, as well as trying to use doxycycline to reduce the effects of ingestion of these seeds. Materials and Methods: In the experiment, 24 local rabbits were raised and fed in the Animal House of the Faculty of Medicine / Al-Muthanna University, then divided into four groups and treated for three weeks (21 days), Control group: treated with normal saline solution (0.9) orally throughout the experiment, G1: was treated orally with a concentration of 25 mg / kg of castor bean powder daily during the experiment, G2 : orally treated 25 mg / kg of castor bean and 25 mg / kg of doxycycline, G3: orally treated 25 mg / kg of castor powder with 50 mg / kg of doxycycline daily throughout the trial period. Results: The results of the experiment showed significant changes (P less than 0.05) in all physiological and biochemical blood tests when compared with control group. There was a significant decrease in PCV, Hb, RBC, T.protein and body weights, while demonstrated a significant increase in WBC, Urea, Creatinine, ALT, AST and ALP, with distortions in liver and kidney of animals that treated with Castor beans. In contrast, the treatment with doxycycline and caster beans showed significant improvement reflected by a normal proportion in physiological tests and biochemical tests with improvement in the tissues when compared to control group. Conclusions: It can be concluded from this study that castor bean has high toxic and pathogenic effects that may be dangerous to the life of the organism. Therefore, it is advisable to be cautious of these pills and avoid exposure to them, also recommended to take high concentrations of doxycycline treatment when infected with castor bean poisoning.


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