Bilateral leg pain and unilateral calf atrophy caused by polymyositis accompanying lumbar spinal stenosis and disc herniation: a case report

Polymyositis is a subgroup of idiopathic inflammatory myopathies characterized by symmetric proximal limb weakness and chronic skeletal muscle inflammation. We herein report the first case of bilateral leg pain and unilateral calf atrophy caused by polymyositis accompanying lumbar spinal stenosis and disc herniation. A 52-year-old man presented with intermittent claudication and calf pain that had become gradually aggravated during the last 3 months. Magnetic resonance imaging showed spinal stenosis at the L3/4 and L4/5 levels and lumbar disc herniation at the L4/5 level. Preoperative laboratory investigations revealed elevated muscle enzyme concentrations. Magnetic resonance imaging also showed atrophy, fatty degeneration, and edema in both calf muscles. Histological examination showed inflammatory myositis and fibrosis in the perifascicular connective tissues. The patient was diagnosed with polymyositis. We performed decompressive laminectomy at the L3/4 and L4/5 levels and discectomy at the L4/5 level. After administration of prednisolone for 6 months and methotrexate for 3 months, the patient’s bilateral calf pain and abnormal laboratory findings improved. The combination of surgical decompression and adequate medical treatment resulted in a successful recovery. Polymyositis should be suspected in patients with lumbar spinal stenosis or lumbar disc herniation who exhibit increased muscle enzyme concentrations or lower extremity muscle atrophy.

The usage and outcomes of dextran in the treatment of acute deep venous thrombosis

Objectives In this study, we retrospectively compared the outcomes of patients with acute deep vein thrombosis treated with dextran 40 infusion and unfractionated heparin with those of patients treated with unfractionated heparin alone. Methods We evaluated 104 patients with the diagnosis of acute deep vein thrombosis. The pain complaints of the patients at the time of admission and the pain complaints in the calf with dorsiflexion of the foot were evaluated with the visual analogue pain scale, and the calf diameter of affected limbs was measured. Fifty five patients had dextran 40 infusion and unfractionated heparin treatment concomitantly (Group HD), while 49 patients had unfractionated heparin treatment (Group H). Heparin dose was adjusted to obtain 1.5- to 2.5-fold of normal activated partial thromboplastin time in both groups. Oral anticoagulant, warfarin sodium, was administered in the first day and resumed. Unfractionated heparin infusion therapy was resumed until international normalized ratio values of 2–2.5 were obtained. Dextran 40 infusion therapy was administered for 3 days. Calf diameters, current pain, and calf pain at foot dorsiflexion were recorded at 48 h and 72 h. 65 patients were distal, and 39 patients were proximal and popliteal acute DVT. None of the patients had phlegmasia. All were acute DVT. Results At 48 and 72 h of therapy, it was determined that the decrease of the calf diameter and the pain were more significant both at 48th and 72nd hours in the Group HD. The calf circumference change, especially at 72 h, was 2.58 ± 0.39 cm in the group receiving heparin + dextran, while it was 1.76 ± 0.56 cm in the group receiving only heparin. ( p = 0.000). While there were only 1.24 ± 1.02 people in the group that received dextran at 72 h, leg pain persisted in 3.35 ± 1.11 people in the other group. ( p = 0.000). Evaluation was made only with calf vein diameter measurement. When patients with Homan’s sign were evaluated for their calf pain at foot dorsiflexion; both groups had decreased pain at 48th and 72nd hours. Conclusion In this study, we observed that the use of dextran 40 infusion therapy concomitantly with unfractionated heparin accelerates recovery substantially and decreases patient complaints significantly in early stages. In particular, reduction in leg pain and calf circumference reduction were more adequate in the dextran group. The early decrease in the calf circumference will have clinical consequences such as less heparin intake, earlier return to normal life, and a decrease in the total cost of treatment. Since the antithrombotic and anticoagulant effects of dextran are well known, we think that its use in this treatment as well as venous thromboembolism prophylaxis should be discussed.

Transcutaneous neurostimulatory treatment for peripheral polyneuropathy induced by hypereosinophilic syndrome - A case report -

Background: Hypereosinophilic syndrome is a rare disease that increases the number of circulating eosinophils in the body. It has many complications, including peripheral polyneuropathy. Peripheral polyneuropathy often does not respond well to conventional therapies. Transcutaneous neurostimulatory treatment, also known as scrambler therapy, is an alternative modality for the treatment of chronic retractable pain. Case: A 47-year-old woman presented with complaints of bilateral calf pain. She had been under treatment for peripheral polyneuropathy induced by hypereosinophilic syndrome for 7 years. Pharmacologic treatment did not affect the patient’s symptoms. Conclusions: Transcutaneous neurostimulatory treatment was administered to the patient. It was effective on her symptoms, and the effect of pain alleviation continued for 3 months.

IMPACT OF HIRDOTHERAPY ON VEGETATIVE DIS-ABILITIES AFTER CORONAVIRUS INFECTION

Вегетативно сосудистые и вегетативнотрофические изменения наблюдались у абсолютного большинства пациентов с ПКВИ с преобладанием частоты эмоциональных нарушений (страха смерти) 100%, генерализованный гипергидроз у 75,9%, наличие гипервентиляционного синдрома 71%, субфебрилитет, наличие вегетососудистых кризов, мигрени, склонности к обморокам 50,6%, боли в икроножных мыщах 48,1%, чувствительность к перемене климатических условий при ПКВИ наличие ухудшения самочувствия при смене погоды у 48,1% пациентов. Дисдинамические и дизритмические расстройства лабильности артериального давления (АД) с тенденцией к повышению и сердечного ритма с тенденцией к тахикардии 46,9% больных с ПКВИ. Под влиянием пятикратной и десятикратной применение грудотерапии обшое количество баллов симптомов вегетативных расстройств после перенесенной КВИ составили 557 баллов и 31 баллов и снизились на 82,4% и 99,1%. Индекс выраженности вегетативных нарушении сизились от 2,23±0,11 условных единиц (уе) на 0,39±0,01 и 0,02±0,001 уе.Результаты нейропсихологического тестирования у больных, принимавших гирудотерапии, показали объективное улучшение у них вегатативных нарушении, средний балл индекс выраженности вегетативных нарушении достоверно снизился после пятикратного и 10 дненого применение на 82,6% и 99,1% (р < 0,001) по сравнению с фоновым показателем.Таким образом, у больных с ПКВИ, принимавших 10 дневный курс гирудотерапии, показали объективное улучшение у них вегатативных функций. Autonomic vascular and autonomictrophic changes were observed in the vast majority of patients with PCVI with a predominant frequency of emotional disturbances (fear of death) 100%, generalized hyperhidrosis in 75.9%, the presence of hyperventilation syndrome 71% , subfebrile, presence of vegetovascular crises, migraine, tendency to fainting 50.6% , calf pain 48.1% , sensitivity to changes in climatic conditions in PCVI presence of worsening of wellbeing at a change of weather in 48.1% patients. Dysdynamic and dysrhythmic disorders of arterial pressure (BP) lability with a tendency to increase and cardiac rhythm with a tendency to tachycardia 46.9% of patients with PKVI. Under the influence of fivefold and tenfold application of chest therapy, the total score of symptoms of autonomic disorders after CPVI was 557 and 31 and decreased by 82.4% and 99.1%, respectively. The index of severity of autonomic disturbances sized up from 2.23±0.11 conventional units (ue) by 0.39±0.01 and 0.02±0.001 ue.The results of neuropsychological testing in the patients who took hirudotherapy showed the objective improvement of vegetative disturbances in them, the average index score of vegetative disturbances expression reliably decreased after 5 and 10 day application by 82,6 % and 99,1 % (p <0,001) in comparison with the background index.Thus, patients with PKVI who underwent hirudotherapy for 10 days showed objective improvement of vegetative functions.