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Nonanatomical sensory deficits have been described for hundreds of years. We use the term "nondermatomal somatosensory deficits" (NDSD) for the purposes of this study. A commonly held viewpoint associating these deficits with "psychogenic" or "nonorganic" pain is best expressed by the following statement: "Psychogenic sensory deficits are diagnosed by their variability, sharp midline transition, and non anatomic dermatomal distibution" 1 . In addition, the presence of these NDSD is one of several criteria for the diagnosis of "non organic" pain 2 . Our group has observed NDSD in chronic pain patients and their behavior under the influence of intravenous administration of sodium amytal, a medium action barbiturate MATERIALS AND METHODS The sample studied consisted of all subjects referred to the senior author (AM) for the purposes of an independent medical examination over the course of 3 years (1996)(1997)(1998)(1999). The following were collected at the time of evaluation: (a) standardized demographic data forms; (b) body maps where patients marked their pain areas; (c) standardized history with attention to original and current pain complaints; (d) behavior displayed through the interview and physical examination; (e) thorough neuromusculoskeletal examination; and (f) documentation of gross cutaneous and deep sensory abnormalities by the examiner in body maps identical to those used by the patient. Cutaneous sensation was tested via a soft brush (for light touch), a pinprick wheel for pain, and a cold roller for gross cold perception; and vibration sense was tested by a 128 Hz tuning fork. Pain arising from deep structures (muscles, periosteum, etc.) was tested by manual pressure in all cases and wherever possible by pressure algometry over multiple bone prominences in the upper and lower extremities. The latter method has been described Methods. Data were collected via standardized history, examination, and patient-as well as physician-drawn body maps in a consecutive series of 194 subjects seen for the purpose of an independent medical examination. Results. Forty-nine subjects (25.3%) with primarily widespread pain (often diagnosed as fibromyalgia) presented with hemisensory or quadrotomal deficits to pinprick and other cutaneous stimuli on the side of lateralized pain or worse pain. The NDSD limbs often had impairment of vibration sense (not infrequently associated with "forehead vibration split"), reduced strength, dexterity or movement, and extreme sensitivity to superficial skin palpation or profound insensitivity to deep pain. Spatial, temporal, qualitative, and evolutionary patterns of NDSD emerged associated with cognitive/affective symptoms. NDSD subjects were more often born outside Canada, more likely to be injured at work, present with abnormal pain behavior, and have negative investigations. Conclusion. NDSD are a prevalent problem associated with chronic pain. Future research should explore the prevalence of NDSD in other pain populations, the role of personality and related factors, and the underlying biological substrate of these deficits. (J Rheumatol 2001;28:1385-93

The Role of excitatory amino acids and lactic acidosis in hypoglycemic brain damage

Bibliography: p. 115-135

The accuracy of computed tomography in assessing hip reduction in developmental dysplasia of the hip

A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, in partial fulfillment of the requirements for the degree of Master of Medicine. Johannesburg, 2018.Introduction: Developmental dysplasia of the hip (DDH) is a condition that can have significant consequences on hip function in childhood and adult life if a concentric reduction is not obtained. Confirmation of reduction through a hip spica can be challenging especially when plain radiography relies on indirect measurements to identify the location of an un-ossified ossific nucleus. Imaging techniques such as computed tomography (CT) may add value in improving detection rates following attempts at hip reduction and maintenance of reduction. Hypothesis: CT adds value in more accurately assessing hip reduction after a closed or open reduction in the patient with DDH in a hip spica cast. Study Objectives: The primary objective is to assess the accuracy of hip reduction in a hip spica comparing X-rays and CT scans. The secondary objective is to establish measurement parameters that may be used in both these imaging modalities to assist in determining the adequacy of hip reduction. Methods: A retrospective analysis of X-rays and CT scans of 8 patients with DDH following hip reduction and application of a hip spica cast. Results: Eight children with nine dislocated hips were included in the study. Five required closed reduction and four required open reduction (with one femoral shortening). CT scans are more accurate and offer more measurable parameters in assessing hip reduction through a hip spica. Conclusion: Plain radiography may be misleading in confirming the presence or absence of hip reduction and may in certain scenarios lead to unnecessary revision surgery in cases of poor penetrance and improper anatomical definition. Limited CT reduces paediatric pelvic organ radiation exposure and assists in more accurately assessing hip reduction.LG201

Pain Characteristics and Demographics of Patients Attending a University-Affiliated Pain Clinic in Toronto, Ontario

BACKGROUND: Pain clinics tend to see more complex chronic pain patients than primary care settings, but the types of patients seen may differ among practices

Pain Characteristics and Demographics of Patients Attending a University-Affiliated Pain Clinic in Toronto, Ontario

BACKGROUND: Pain clinics tend to see more complex chronic pain patients than primary care settings, but the types of patients seen may differ among practices.OBJECTIVE: The aim of the present observational study was to describe the pain and demographic characteristics of patients attending a university-affiliated tertiary care pain clinic in Toronto, Ontario.METHODS: Data were collected on 1242 consecutive new patients seen over a three-year period at the Comprehensive Pain Program in central Toronto.RESULTS: Musculoskeletal problems affecting large joints and the spine were the predominant cause of pain (more prevalent in women), followed by neuropathic disorders (more prevalent in men) in patients with recognizable physical pathology. The most affected age group was in the 35- to 49-year age range, with a mean pain duration of 7.8 years before the consultation. While 77% of the Comprehensive Pain Program patients had relevant and detectable physical pathology for pain complaints, three-quarters of the overall study population also had significant associated psychological or psychiatric comorbidity. Women, in general, attended the pain clinic in greater numbers and had less apparent physical pathology than men. Finally, less than one in five patients was employed at the time of referral.CONCLUSIONS: The relevance of the data in relation to other pain clinics is discussed, as well as waiting lists and other barriers faced by chronic pain patients, pain practitioners and pain facilities in Ontario and Canada.Peer Reviewe

Ethnocultural and sex characteristics of patients attending a tertiary care pain clinic in Toronto, Ontario

BACKGROUND: Ethnocultural factors and sex may greatly affect pain perception and expression. Emerging literature is also documenting racial and ethnic differences in pain access and care

Ethnocultural and Sex Characteristics of Patients Attending a Tertiary Care Pain Clinic in Toronto, Ontario

BACKGROUND: Ethnocultural factors and sex may greatly affect pain perception and expression. Emerging literature is also documenting racial and ethnic differences in pain access and care.OBJECTIVE: To define the sex and ethnocultural characteristics of patients attending a tertiary care, university-affiliated pain clinic in Toronto, Ontario.METHODS: Data were collected on 1242 consecutive, new patients seen over a three-year period at the Comprehensive Pain Program (CPP) in downtown Toronto. Data were compared with the Canada 2001 Census.RESULTS: English-speaking, Canadian-born patients constituted 58.6% of the CPP population, similar to the 2001 Canadian Census data for the Greater Toronto Area. Certain visible minority groups (Indo-Pakistani and Chinese) were significantly under-represented, while European groups were over-represented. While women outnumbered men, they presented with lower levels of physical pathology in general, particularly in certain ethnic groups. Patients from Europe (representing primarily immigrants who arrived in Canada before 1960), were older, by 10 years to 15 years, than the average CPP population, and had a much higher incidence of physical or medical disorders.CONCLUSIONS: The implications of the study and the importance of sex and ethnicity in terms of presentation to Canadian pain clinics are discussed. Future well-designed studies are needed to shed light on the role of both patients’ and physicians’ ethnicity and sex in pain perception and expression, decision-making regarding pain treatments and acceptance of pain treatments.Peer Reviewe

Parieto-occipital encephalomalacia in children; clinical and electrophysiological features of twenty-seven cases

CONTEXT: Brain injuries occurring at a particular time may cause damages in well-defined regions of brain. Perinatal hypoxic ischemic encephalopathy and hypoglycemia are some of the most common types of brain injuries. Neonatal hypoglycemia can cause abnormal myelination in parietal and occipital lobes resulting in parieto-occipital encephalomalacia. There is a small number of studies about clinical and electroencephalographic (EEG) features of children with parieto-occipital encephalomalacia. They might have important neurologic sequelae such as cortical visual loss, seizures, and psychomotor retardation. AIMS: We aimed to evaluate the causes of parieto-occipital encephalomalacia and evaluate the clinical and electrophysiological features of children with parieto-occipital encephalomalacia. SETTINGS AND DESIGN: We evaluated clinical features and EEGs of 27 children with parieto-occipital encephalomalacia. STATISTICAL ANALYSIS USED: Descriptive statistics were used. RESULTS: Hospitalization during the neonatal period was the most common cause (88.9%) of parieto-occipital brain injury. Eleven patients (40.7%) had a history of neonatal hypoglycemia. Twenty-three patients (85.2%) had epilepsy and nine of the epileptic patients (39%) had refractory seizures. Most of the patients had bilateral (50%) epileptic discharges originating from temporal, parietal, and occipital lobes (56.2%). However, some patients had frontal sharp waves and some had continuous spike and wave discharges during sleep. Visual abnormalities were evident in 15 (55.6%) patients. Twenty-two (81.5%) had psychomotor retardation. Fine motor skills, social contact and language development were impaired more than gross motor skills. CONCLUSIONS: In our study, most of the patients with parieto-occipital encephalomalacia had an eventful perinatal history. Epilepsy, psychomotor retardation, and visual problems were common neurologic complications