Natural Scleroderma Relief
The rectoanal inhibitory reflex is thought to have a role in the fine adjustments of continence. Rectal distension, usually with small volumes (10-30mL), causes a contraction of the external anal sphincter followed by a pronounced internal anal sphincter relaxation. This reflex enables the sensory mucosa of the anal canal to sample the contents of the distal rectum and the patient to distinguish between gas, liquid, and solid stool. This reflex is absent or abnormal in patients with Hirschsprung's disease, Chagas' disease, dermatomyositis, and scleroderma.
Progressive, painless loss of trigeminal sensation. Normally unilateral and without trigeminal motor weakness, the sensory loss may affect one or all trigeminal divisions. This condition is often associated with established connective tissue disease (scleroderma, Sjogren's syndrome and mixed connective tissue disease (MCTD)). Diagnosis requires exclusion of intracranial granuloma and tumour compressing the trigeminal nerve -meningioma, schwannoma, epidermoid - by contrast enhanced MRI.
Immunosuppressive therapy is not recommended in patients with acute infectious or postinfectious myocarditis, but a small subset of patients with noninfectious myocarditis due to giant cell myocarditis, scleroderma, lupus erythematosus, polymyositis, or sarcoidosis may benefit from immunosuppressive therapy.
Intravenous epoprostenol has dramatically improved the outcome of patients with PAH, most impressively in patients with PPH. Results in patients with the scleroderma spectrum of disease are not as impressive, perhaps because they have a systemic disease and are generally older than patients with PPH. Compared to historical controls or to survival predicted by the NIH PPH Registry survival equation, survival with epoprostenol is significantly improved 10 . However, not all patients respond to therapy, and one third of patients with PPH still die within three years of starting treatment. This may be explained by the fact that although most patients improve clinically, hemodynamics remain markedly abnormal. After one year of therapy, mean pulmonary artery pressure only decreases 10 to 15mmHg, and pulmonary vascular resistance remains five to six times normal. Rarely do patients demonstrate normalization of pulmonary hemodynamics. This indicates that while most patients improve...
This may occur with chronic neurodermatitis, less frequently with other skin disorders such as scleroderma, poikiloderma, and chromic eczema. Characteristic signs include an anterior crest-shaped thickening of the protruding center of the capsule (Fig. 7.11).
Systemic diseases of the skin (e.g., psoriasis, lupus erythematosus, scleroderma) can affect the ear canal and eventually cause external canal obstruction. One important feature of psoriasis is that mild trauma to surrounding skin induces lesions localized to the area of injury.9 Therefore, patients with psoriasis in or near the ear canal should be asked to avoid manipulation of the lesions, so as to prevent stenosis. Cutaneous (contact dermatitis) reactions to shampoos, medications, and foreign material in the ear canal can be severe and may require rapid medical attention to prevent scarring and stenosis of the soft tissue of the canal.
Oesophageal motility problems can arise from diseases of smooth muscle (e.g. scleroderma) or the intrinsic nervous system (e.g. Chaga's disease). Many cases of oesophageal dysmotility are unexplained and can lead to psychiatric consultation. Though situational stress has not been conclusively linked to oesophageal dysmotility, major psychiatric illness has.(36) The majority of patients with oesophageal motility disorders have an Axis I psychiatric illness, especially major depressive disorder (52 per cent), generalized anxiety disorder (36 per cent), somatization disorder (20 per cent), and substance-related disorders (20 per cent). (37 Along with panic disorder, oesophageal dysmotility is a common cause of non-cardiac chest pain. (38 Though smooth muscle relaxants, such as calcium-channel blockers, are superior to psychiatric treatments in improving physiological measures (such as oesophageal motility testing), antidepressants and behavioural therapies produce more impressive changes...
Pseudoobstruction due to an idiopathic intestinal muscle disease or intestinal neuropathy may also cause delays in gastric emptying and intestinal transit. Rarer causes of delayed GI motil-ity include Chagas' disease, muscular dystrophy, scleroderma, and infiltrative diseases, such as amyloidosis. Decreased GI transit can occur acutely following electrolyte disorders and gastroenteritis. In addition, many medications, including anticholinergic medications, tri-cyclic antidepressants, levodopa, and (3-adrenergic agonists, inhibit GI motility.
Patients with fecal incontinence from a wide variety of causes have been treated successfully including deficits resulting from anal or rectal procedures, those with obstetric or neurologic trauma, scleroderma, systemic sclerosis, primary internal anal sphincter degeneration, and even sphincter disruption. The exact mechanism of action is unknown however, the sacral nerve roots are the most
Two major subgroups occur within the class Basidiomycetes. The subclass Homobasidiomycetidae comprises mushrooms, bracket fungi, and puffballs. The spores of these organisms constitute a significant portion of the spores found in the air during nocturnal periods and wet weather. These abundant spores are confirmed to be allergenic (134,145,146) and can provoke bronchoconstriction in sensitive asthmatic subjects (14.7). Numerous species, including Pleurotus ostreatus, Cantharellus cibarius, Clavata cyanthiformis, Geaster saccatum, Pisolithus tinctorius, Scleroderma aerolatum, Ganoderma lucidum, Psilocybe cubensis, Agaricus, Armillaria, and Hypholoma species, and Merulisus lacrymans ( dry rot ) have been identified as allergens.
There are a large number of disorders reportedly associated with RP, i.e., these disorders are considered primary, leading to a secondary RP. They are too numerous to review here and may or may not include microvascular studies. The most important group of secondary RP is found in connective tissue disease (CTD), especially in scleroderma (SD). 4. Scleroderma Spectrum Scleroderma spectrum (SDS) disorders Scleroderma (SD) and related disorders, such as CREST (calcinosis, RP, esophageal dysfunction, sclerodactyly, and telangiectasis), MCTD (mixed connective tissue disease), and UCTD (undifferentiated connective tissue disease), form a spectrum with many similarities in clinical and laboratory parameters including microvascular pathology. Dermato-myositis (DM, a closely related disease) shows similar but more acute, microvascular pathology. An overlap between SD and DM sometimes occurs. Figure 4 Cuticle deposits in a scleroderma patient compared to a normal control. (a)...
The esophagus must transport swallowed material from the mouth to the stomach while minimizing reflux of stomach contents. Symptoms associated with impaired function are dysphagia, pain or regurgitation. Motility disorders can be primary or secondary (Table 1) and result from smooth muscle disorders (e.g., scleroderma) or disorganization of the intrinsic nervous system (e.g., achalasia, Chagas' disease, and diabetes). The identification of these disorders can be aided by nuclear esoph-ageal motility studies though classification is still conventionally described in relation to esophageal manometry Scleroderma The lower part of the esophagus (smooth muscle) shows a reduced amplitude of contractions with hypotension of the LES. Collagen vascular disease (esp. scleroderma)