To investigate the predictive value of the sympathetic skin response (SSR) in diagnosing complex regional pain syndrome (CRPS) by comparing three diagnostic modalities-SSR, three-phasic bone scans (TPBS), and thermography.
Thirteen patients with severe limb pain were recruited. Among them, 6 were diagnosed with CRPS according to the proposed revised CRPS clinical diagnostic criteria described by the International Association for the Study of Pain. SSR was measured in either the hands or feet bilaterally and was considered abnormal when the latency was prolonged. A positive TPBS finding was defined as diffuse increased tracer uptake on the delayed image. Thermographic findings were considered positive if a temperature asymmetry greater than 1.00℃ was detected between the extremities.
Five of 6 CRPS patients showed prolonged latency on SSR (83% sensitivity). TPBS was positive in the 5 CRPS patients who underwent TPBS (100% sensitivity). Thermography was positive in 4 of 5 CRPS patients who underwent the procedure (80% sensitivity). The remaining 7 non-CRPS patients differed on examination. SSR latencies within normal limit were noted in 4 of 7 non-CRPS patients (57% specificity). Results were negative in 4 of 5 non-CRPS patients who underwent TPBS (80% specificity), and negative in 3 of 5 non-CRPS patients who underwent thermography (60% specificity).
SSR may be helpful in detecting CRPS.
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Evaluation of the Sympathetic Skin Response in Men with Chronic Prostatitis: A Case-Control Study
To determine the useful tool for evaluating salivary aspiration in brain-injured patients with tracheostomy.
Radionuclide salivagram and laryngoscopy was done in 27 brain-injured patients with tracheostomy. During salivagram, 99mTc sulfur colloid was placed sublingually in the supine position, and 50-minute dynamic images and 2-hour delayed images were obtained. Salivary aspiration was detected when the tracer was entered into the major airways or lung parenchyma. Laryngoscopy was done by otolaryngologists, and saliva aspiration, saliva pooling, and vocal cord palsy were evaluated. Videofluoroscopic swallowing study was done in patients who were able to undergo the test.
The detection rate of salivary aspiration was 44.4% with salivagram, and 29.6% with laryngoscopy. The correlation of the two tests was 70.4%. Of the laryngoscopy findings, salivary pooling had significant correlation with positive salivagram results (p=0.04). Frequent need of suction correlated with salivary aspiration in both salivagram (p=0.01) and laryngoscopy (p=0.01). Patients with negative results in salivagram or laryngoscopy had higher rates of progressing to oral feeding or tapering tracheostomy. Two patients developed aspiration pneumonia, and both patients only showed aspiration in salivagram.
Brain-injured patients with tracheostomy have a high risk of salivary aspiration. Evaluation of salivary aspiration is important, as it may predict aspiration pneumonia and aids in clinical decisions of oral feeding or tracheostomy removal. Salivagram is more sensitive than laryngoscopy, but laryngoscopy may be useful for evaluating structural abnormalities or for follow-up examinations to assess the changes.
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