[25 years of experience in the treatment of Raynaud's disease and Raynaud-like syndromes]

Reference is made to a series of 620 cases of Raynaud's phenomenon observed at the University of Milan between 1951 and 1977. The following parameters are analysed: sex, age, aetiology (where known), incidence of involvement of the four limbs, presence or otherwise of a complete sign, percentage of trophic lesions, arteriographic picture, lab examinations performed. 534 thoracic sympathectomies were performed in 464 patients with Raynaud or Raynaud-like forms. The results are described.

A technique for continuous intercostal nerve block analgesia following thoracotomy

Early after thoractomy, incisional chest pain may lead to a sequence of undersirable effects on respiratory function, in addition to causing patient discomfort. Pharmacologic blockade of the intercostal nerves innervating the incisional area can improve respiratory function as well as patient comfort. The postoperative production of continuous intercostal nerve blockade can be accomplished by the insertion of indwelling analgesic catheters at the time of thoracotomy closure.

Diabetic truncal mononeuropathy: electromyographic evaluation

Fifteen diabetic subjects wih thoracic radiculopathy were studied wih paraspinal electromyography. The majority were elderly, mature onset diabetics presenting with unilateral hyperesthesia in a thoracic radicular pattern. None was under adequate control at onset, but control did not seem to alter the symptoms. Electromyography demonstrated localized paraspinal positive waves at the appropriate clinical level. Although not all subjects presented wih peripheral neuropathy, the majority showed electromyographic alteration. This should be an important adjunct in evaluation of diabetic patients with truncal mononeuropathy.

[Neurovascular compression syndroms of the shoulder girdle (author's transl)]

Shoulder girdle compression syndroms appear intermittently and according to body carriage. Very seldom they are caused by neck ribs, mostly by a costoclavicular narrowness. Important for the symptoms is the nerval plexus compression, for diagnostic reasons the blood vessel compression. Essential are provocating tests, subclavia phonogramms and in doubtful cases, angiography. Oszillo- and sonography often fail, EMG and nerval conductive measurement are only of differential diagnostik importance. In all together 120 healthy persons compression was shown phonographically, phlebographically and manometrically in 58--88%. Only the symptomatic and distinct compression are abnormal. Physiotherapy should be applied, only operative decompression is a causal treatment. The transaxilar resection of the first rib with scalenotomy and eventually also resection of a neck rib is by fat better than any other method. This is a report of 112 operated patients.

Continuous intercostal nerve block for pain relief after lumbar incision

To relieve postoperative pain along a lumbar incision in 9 patients the intercostal nerves were blocked with catheters for continuous epidural anesthesia. The catheters were inserted near the intercostal nerves, above and beneath the incision, just before the wound was closed and 0.25% bupivacaine hydrochloride solution was infused periodically through the catheters. With this technique 5 of 9 patients had a satisfactory analgesic effect and could breathe deeply or cough without pain. The other 4 patients did not have satisfactory results and this was believed to be owing to inadequate insertion of the catheters. None of the patients had any complications. The technique is simple and can produce an analgesic effect repeatedly without causing pain for the patient.

Localized pruritus-notalgia paresthetica

Notalgia paresthetica, possibly an isolated sensory neuropathy involving the posterior primary rami of thoracic nerves T2 through T6, and appearing as pruritus of the back, is apt to be encountered by both dermatologists and neurologists. Two cases illustrate this disorder.

Opsomyoclonus and neuroblastoma. Response to ACTH

Children with neuroblastoma whose opsomyoclonus recurs or persists after initial surgery should be carefully evaluated for tumor. If no tumor is detectable, therapy with ACTH should be considered in patients whose symptomatology is severe enough to compromise normal development.

Outpatient breast surgery under intercostal block anesthesia

During the past 3 years, we have performed various breast operations in 320 patients under local anesthesia, using intercostal nerve block. The amount of local anesthetic solution required has been about 20 ml 1% lidocaine for blocking both sides, and an additional 24 ml of 0.5% lidocaine during the surgery. This dosage is well within safe limits. We have found that various breast operations, ranging from augmentation mammaplasty to a staged reconstruction after mastectomy, can be done with this method of anesthesia. The complications attributable to the nerve block were nil in our series.

Intercostal nerve block with thoracoabdominal incision

A double-blind study was done on 30 patients undergoing thoracoabdominal incisions for retroperitoneal lymphadenectomy in testicular carcinoma to determine the effect of intraoperative intercostal nerve block with bupivacaine. The postoperative pain, day of ambulation and day of oral fluid intake were analyzed. In this homogeneous group we found a significant reduction in the amount of postoperative analgesia required but no difference in the day of ambulation or fluid intake.

Unusual response to extradural analgesia in the presence of an intradural spinal tumour

A patient is presented in whom indications of the presence of an intradural, extramedullary tumour became apparent during the induction of an extradural block. It is suggested that a combination of signs should arouse suspicions of such a tumour close to the puncture site. Pain within an area covered by an extradural block does not indicate necessarily a supraspinal cause for the pain.

Intercostobrachial nerve entrapment syndrome

Five patients with intercostobrachial nerve entrapment syndrome are reported. The pain in this syndrome has three aspects: somatic stimulus, perceptual surround, and behavioral response. Each must be dealt with appropriately. The distribution of the pain, its anatomic basis, and its treatment are discussed.

Diabetic truncal mononeuropathy--a new clinical syndrome

Although diabetic mononeuropathy affecting the cranial and peripheral nerves is well recognized, there is little known or documented about diabetic mononeuropathy affecting the thoracic nerves, i.e., the truncal nerves. This series of 40 cases attests to its frequency; equal sex distribution; significance in differential diagnosis including coronary artery disease, intra-abdominal surgical diseases such as gallbladder pathology and appendicitis, pleurisy, and neoplasms. Truncal mononeuropathy has characteristics that differ from those of other diabetic mononeuropathies in that it is primarily sensory and typically not a first manifestation of clinical diabetes, whereas the other forms of diabetic mononeuropathy are primarily motor in effect and not infrequently may be the initial clinical presenting manifestation of diabetes. Finally, diabetic truncal mononeuropathy has a good prognosis.