Muscle & nerve
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Causalgia, reflex sympathetic dystrophy, and sympathetically maintained pain (SMP) are a complex group of disorders, with symptoms of spontaneous/stimulus-induced pain and vasomotor, sudomotor or skeletomotor dysfunction of the involved area. Sympatholysis has been recommended for diagnosis/classification and treatment of these patients. Lack of adequate placebo control makes the physiologic response to this intervention unclear. ⋯ Vasomotor disturbances may result from antidromic vasodilatation, vasoparalytic dilatation, normal somatosympathetic reflexes, and denervation supersensitivity. There is conflicting information regarding the use of phentolamine and clonidine in these pain syndromes. Treatment of these patients remains a challenge given the many potential underlying mechanisms.
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Comment Letter Case Reports
Improvement of the exercise test after therapy in thyrotoxic periodic paralysis.
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A MEDLINE review suggested a lack of recent studies about the entrapments seen with underlying diabetic neuropathy. Suggested protocols for research in diabetic peripheral neuropathy have not included the concepts of entrapments as an early--indeed, first manifestation of the neuropathy. ⋯ Also, analysis of the action potentials elicited by stimulation of the ulnar and radial nerves and their comparison with the median nerve is often helpful. Finally careful inspection of the action potential when stimulating proximal and distal to the entrapment will establish the degree of nerve compromise relative to the underlying diabetic neuropathy.