Bone metastases mimicking Complex Regional Pain Syndrome I: a case report

INTRODUCTION: Since there are no valid tools available for the diagnosis of Complex Regional Pain Syndrome I, exclusion of other underlying conditions plays an important role in the diagnostic process. CASE PRESENTATION: A 77-year-old Caucasian man was referred with painful swelling and dysfunction of the right knee. Based on the history and clinical presentation, the referring physician assumed a case of Complex Regional Pain Syndrome I. However, after careful evaluation of the differential diagnosis, a metastatic urothelial carcinoma was diagnosed. CONCLUSION: Even if the clinical picture resembles Complex Regional Pain Syndrome I, the differential diagnosis must be evaluated carefully

High Precision Femtosecond Laser Ablation ICP‐MS Measurement of Benthic Foraminiferal Mn‐Incorporation for Paleoenvironmental Reconstruction: A Case Study From the Plio‐Pleistocene Caribbean Sea

Closure of the Central American Seaway (CAS) and hydrology of the Caribbean Sea triggered Northern Hemisphere Glaciation and played an important role in the Pliocene to modern-day climate re-establishing the deep and surface ocean currents. New data on Mn/Ca obtained with femtosecond laser ablation inductively coupled plasma mass spectrometry on well-preserved tests of the epibenthic foraminifer Cibicidoides wuellerstorfi and infaunal C. mundulus contribute to the interpretation of paleoenvironmental conditions of the Caribbean Sea between 5.2 and 2.2 Ma (million years) across the closure of the CAS. Hydrothermal activity at the Lesser Antilles may be a primary source of Mn in the well-oxygenated Plio-Pleistocene Caribbean Sea. Incorporation of Mn in the benthic foraminifer shell carbonate is assumed to be affected by surface ocean nutrient cycling, and may hence be an indicator of paleoproductivity. Key Points - Femtosecond-laser ablation inductively coupled plasma mass spectrometry provides a new approach on distinguishing Mn of the ontogenetic shell calcite from Mn of the authigenic coatings - Ontogenetic Mn within the foraminifer shell calcite may result from the regional nutrient cycle - Mn in the deep eastern Caribbean Sea may mainly derive from hydrothermal sources along the Antilles Island Ar

Exercise for health: a randomized, controlled trial evaluating the impact of a pragmatic, translational exercise intervention on the quality of life, function and treatment-related side effects following breast cancer

Exercise for Health was a randomized, controlled trial designed to evaluate two modes of delivering (face-to-face [FtF] and over-the-telephone [Tel]) an 8-month translational exercise intervention, commencing 6-weeks post-breast cancer surgery (PS). Outcomes included quality of life (QoL), function (fitness and upper body) and treatment-related side effects (fatigue, lymphoedema, body mass index, menopausal symptoms, anxiety, depression and pain). Generalised estimating equation modelling determined time (baseline [5 weeks PS], mid-intervention [6 months PS], post-intervention [12 months PS]), group (FtF, Tel, Usual Care [UC]) and time-by-group effects. 194 women representative of the breast cancer population were randomised to the FtF (n = 67), Tel (n = 67) and UC (n = 60) groups. There were significant (p < 0.05) interaction effects on QoL, fitness and fatigue with differences being observed between the treatment groups and the UC group. Trends observed for the treatment groups were similar. The treatment groups reported improved QoL, fitness and fatigue over time and changes observed between baseline and post-intervention were clinically relevant. In contrast, the UC group experienced no change, or worsening QoL, fitness and fatigue, mid-intervention. Although improvements in the UC group occurred by 12-months post-surgery, the change did not meet the clinically relevant threshold. There were no differences in other treatment-related side effects between groups. This translational intervention trial, delivered either FtF or Tel, supports exercise as a form of adjuvant breast cancer therapy that can prevent declines in fitness and function during treatment and optimise recovery post-treatment

Trace Metals and Their Isotopes in the Tropical Atlantic Ocean - Cruise No. M81/1, February 04 – March 08, 2010, Las Palmas (Canary Islands, Spain) – Port of Spain (Trinidad & Tobago)

Summary Meteor Cruise M81/1 was dedicated to the investigation of the distribution of dissolved and particulate trace metals and their isotopic compositions (TEIs) in the full water column of the tropical Atlantic Ocean and their driving factors including main external inputs and internal cycling and ocean circulation. The research program is embedded in the international GEOTRACES program (e.g. Henderson et al., 2007), which this cruise was an official part of and thus corresponds to GEOTRACES cruise GA11. This cruise was completely dedicated to the trace metal clean and contamination-free sampling of waters and particulates for subsequent analyses of the TEIs in the home laboratories of the national and international participants. Besides a standard rosette for the less contaminant prone metals, trace metal clean sampling was realized by using a dedicated and coated trace metal clean rosette equipped with Teflon-coated GO-FLO bottles operated via a polyester coated cable from a mobile winch that was thankfully made available by the U.S. partners of the GEOTRACES program for this cruise. The particulate samples were also collected under trace metal clean conditions using established in-situ pump systems. The cruise track led the cruise southward from the Canary Islands to 11°S and then continued northwestward along the northern margin of South America until it reached Port of Spain, Trinidad & Tobago. The track crossed areas of major external inputs including exchange with the volcanic Canary Islands, the Saharan dust plume, as well as the plume of the Amazon outflow. In terms of internal cycling the equatorial high biological productivity band, as well as increased productivity associated with the Amazon Plume were covered. All major water masses contributing the Atlantic Meridional Overturning Circulation, as well as the distinct narrow equatorial surface and subsurface east-west current bands were sampled. A total of 17 deep stations were sampled for the different dissolved TEIs, which were in most cases accompanied by particulate sampling. In addition, surface waters were continuously sampled under trace metal clean conditions using a towed fish

A modified score to identify and discriminate neuropathic pain: a study on the German version of the neuropathic pain symptom inventory (NPSI)

<p>Abstract</p> <p>Background</p> <p>Neuropathic pain must be correctly diagnosed for optimal treatment. The questionnaire named Neuropathic Pain Symptom Inventory (NPSI) was developed in its original French version to evaluate the different symptoms of neuropathic pain. We hypothesized that the NPSI might also be used to differentiate neuropathic from non-neuropathic pain.</p> <p>Methods</p> <p>We translated the NPSI into German using a standard forward-backward translation and administered it in a case-control design to patients with neuropathic (n = 68) and non-neuropathic pain (headache and osteoarthritis, n = 169) to validate it and to analyze its discriminant properties, its sensitivity to change, and to detect neuropathic pain subgroups with distinct profiles.</p> <p>Results</p> <p>Using a sum score (the NPSI-G score), we found sensitivity to change (r between 0.37 and 0.5 for pain items of the graded chronic pain scale) and could distinguish between neuropathic and other pain on a group basis, but not for individual patients. Post hoc development of a discriminant score with optimized diagnostic properties to distinguish neuropathic pain from non-neuropathic pain resulted in an instrument with high sensitivity (91%) and acceptable specificity (70%). We detected six different pain profiles in the patient group with neuropathic pain; three profiles were found to be distinct.</p> <p>Conclusions</p> <p>The NPSI-G potentially combines the properties of a diagnostic tool and an instrument to identify subtypes of neuropathic pain.</p

Derangement of body representation in complex regional pain syndrome: report of a case treated with mirror and prisms

Perhaps the most intriguing disorders of body representation are those that are not due to primary disease of brain tissue. Strange and sometimes painful phantom limb sensations can result from loss of afference to the brain; and Complex Regional Pain Syndrome (CRPS)—the subject of the current report—can follow limb trauma without pathology of either the central or peripheral nervous system. This enigmatic and vexing condition follows relatively minor trauma, and can result in enduring misery and a useless limb. It manifests as severe pain, autonomic dysfunction, motor disability and ‘neglect-like’ symptoms with distorted body representation. For this special issue on body representation we describe the case of a patient suffering from CRPS, including symptoms suggesting a distorted representation of the affected limb. We report contrasting effects of mirror box therapy, as well as a new treatment—prism adaptation therapy—that provided sustained pain relief and reduced disability. The benefits were contingent upon adapting with the affected limb. Other novel observations suggest that: (1) pain may be a consequence, not the cause, of a disturbance of body representation that gives rise to the syndrome; (2) immobilisation, not pain, may precipitate this reorganisation of somatomotor circuits in susceptible individuals; and (3) limitation of voluntary movement is neither due to pain nor to weakness but, rather, to derangement of body representation which renders certain postures from the repertoire of hand movements inaccessible

Same task rules, different responses:Goal neglect, stimulus-response mapping and response modalities

To complete complex tasks, individuals must actively maintain task rules to direct behavior correctly. Failure to use task rules appropriately, termed goal neglect, has been shown across both vocal and manual response modalities. However, previous goal maintenance studies have differed not only in the response modality that they require, but also in the complexity of the stimulus–response mappings that participants must use during the task. The present study examines the effects of both response modality and stimulus–response mapping complexity, separately, on the rate of goal neglect in a modification of a classic goal maintenance task. Seventy-two younger adults were administered a shape-monitoring task, with three between-subjects response conditions: a vocal response with a simple stimulus–response mapping, a vocal response with a complex stimulus–response mapping, and a manual response with a complex stimulus–response mapping. Contrasting the rate at which task rules were neglected between response conditions showed that participants using complex stimulus–response mappings committed more frequent goal neglect than those using simple mappings, but that participants using vocal or manual responses did not differ in their rate of goal neglect once both responses required complex mappings. This suggests that the need to represent novel and complex stimulus–response mappings, of any modality, at the same time as novel task rules within working memory leads to some task rules being insufficiently maintained

Regulation of peripheral blood flow in Complex Regional Pain Syndrome: clinical implication for symptomatic relief and pain management

Background. During the chronic stage of Complex Regional Pain Syndrome (CRPS), impaired microcirculation is related to increased vasoconstriction, tissue hypoxia, and metabolic tissue acidosis in the affected limb. Several mechanisms may be responsible for the ischemia and pain in chronic cold CPRS. Discussion. The diminished blood flow may be caused by either sympathetic dysfunction, hypersensitivity to circulating catecholamines, or endothelial dysfunction. The pain may be of neuropathic, inflammatory, nociceptive, or functional nature, or of mixed origin. Summary. The origin of the pain should be the basis of the symptomatic therapy. Since the difference in temperature between both hands fluctuates over time in cold CRPS, when in doubt, the clinician should prioritize the patient's report of a persistent cold extremity over clinical tests that show no difference. Future research should focus on developing easily applied methods for clinical use to differentiate between central and peripheral blood flow regulation disorders in individual patients