Archives of physical medicine and rehabilitation
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Arch Phys Med Rehabil · Aug 1979
Sphenopalatine (nasal) ganglion: remote effects including "psychosomatic" symptoms, rage reaction, pain, and spasm.
Many articles implicate the nasal ganglion in the production of remote symptoms and discuss treatment. Symptoms are primarily spastic, involving both visceral and voluntary muscles including muscle spasm in the neck, shoulder, and low back; asthma, hypertension, intestinal spasm; diarrhea, angina pectoris, uterine spasm; intractable hiccup, and many others. All these symptoms appear to have 2 common denominators. ⋯ The SPG is a major point of entry to the autonomic system exposed to pathologic influences and readily accessible for therapeutic influences and readily accessible for therapeutic intervention. 3. A wide variety of symptoms are produced or maintained by alteration in autonomic system tonus and some of these may be affected by intervention on the SPG. 4. The possible relationship of some symptoms and "psychosomatic" conditions to the autonomic nervous system and the rage reaction must be considered.20
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Intramuscular neutrolysis with phenol has been used for 10 years in the management of spasticity in children. Best results depend on fastidious technique and realistic use of the procedure. Sedation or anesthesia was used in all cases -- 5% phenol in water was used for all procedures. ⋯ Generally training was required after the procedure to obtain improved function. A representative sample of muscles treated, repeat procedures, and later surgery is discussed. The procedure is recommended for use in the management of spasticity in children as a way of improving function and/or care.
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Arch Phys Med Rehabil · Jul 1978
Case ReportsParaplegia: succinylcholine-induced hyperkalemia and cardiac arrest.
The rapid development of hyperkalemia leading to cardiac arrest can occur in patients with spinal cord injuries and other conditions when succinylcholine is used during the induction of anesthesia. Three patients with thoracolumbar spinal cord injuries resulting in lower motor neuron lesions or lesions above the lower extremity motor units developed hyperkalemia followed by cardiac arrest after succinylcholine administration. The mechanism by which succinylcholine leads to hyperkalemia from denervated muscle is described and precautions to be taken are mentioned. Physicians caring for patients with denervated muscle due to spinal cord injuries should be aware of this danger and nondepolarizing muscle relaxants should be used instead of succinylcholine.
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Tension in flexor tendons during wrist flexion may play a role in otherwise unexplained instances of the carpal tunnel syndrome. As the wrist is flexed, the median nerve in the tunnel bends around the taut flexor retinaculum. At the same time, the nerve is subject to compression against this ligament by tensed overlying flexor tendons that also bend around the ligament. ⋯ A pressure transducer has been substituted for the median nerve in the tunnel and registered sizable pressures when tension was applied to the flexor digitorum profundus tendons of the second and third digits during varying degrees of wrist flexion. If the profundus tendons are not tensed, pressure in the tunnel remains negligible until wrist flexion reaches its extreme. Thus, repetitive hand activities involving pinch or grasp during wrist flexion may be a contributing factor in some instances of the carpal tunnel syndrome.