The use of combined methods of magnetoelectrotherapy in treating polyneuropathies

A comparative evaluation by such parameters as alleviation of pain syndrome, improvement of peripheral resistance and vegetotrophic processes, a decline in pareses and sensory disorders has been performed in 3 groups of patients: group 1 underwent benzohexonium electrophoresis, group 2 benzohexonium electrophoresis in the magnetic field produced by the unit "Polyus-I" followed by low-frequency electrotherapy with bipolar impulse current, group 3 benzohexonium electrophoresis in the magnetic field from the unit "ADMT-Magnipuls" followed by low-frequency electrotherapy with bipolar impulse current. The best clinical and physiological results were reported in group 3 patients.     

Pancreaticoduodenectomy due to cancer in the elderly

The elderly have traditionally been excluded from pancreaticoduodenectomy due to the high morbimortality of this procedure. Six cases of pancreaticoduodenectomy) 5 cephalic and 1 total) for periampullary tumors in patients over 70 are reported. There was no mortality. We conclude that, in selected cases, pancreaticoduodenectomy can be performed safely in the elderly.     

Cerebral electrotherapeutic treatment of depressions.

30 female and 10 male depressive inpatients at a state hospital participated in 2 studies comparing electrosleep (cerebral electrotherapy) and placebo treatments. In both studies, differences between self-rated improvement associated with cerebral electrotherapy and placebo were not significant. It is concluded that clinical use of cerebral electrotherapy with hospitalized depressives should be tempered by the finding of the present and other studies that cerebral-electrotherapy-related improvement appears to be due in large part to positive expectation or placebo effects. (15 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Studies on the role of cephalic-vagal stimulation in the acid secretory response to eating in normal human subjects

These experiments were performed to determine the importance of cephalic-vagal stimulation in the acid secretory response to eating in normal human subjects. Cephalic stimulation was induced by a modified sham feeding (MSF) technique, during which subjects chewed and expectorated appetizing food. The response to MSF was compared with that to gastric distention with 600 ml NaCl, glucose, or food. In addition, we measured the extent to which cephalic stimulation augments acid secretion that has been stimulated simultaneously by these other mechanisms. Our conclusions are as follows: (a) cephalic stimulation accounts for approximately one-third of the acid secreted when all mechanisms act simultaneously (food-distention plus MSF); (b) within the limits imposed by the maximal secretory capacity, the response to MSF is approximately the same, regardless of whether acid secretion is otherwise unstimulated or is stimulated simultaneously by gastric distention with NaCl, glucose, or food; and (c) gastric distention prolongs the response to cephalic stimulation.     

Relief of cluster-tic syndrome by the combination of lithium and carbamazepine

This paper presents a further case of cluster-tic syndrome. Cluster headache and trigeminal neuralgia have coexisted in our patient for 18 years. Carbamazepine has selectively relieved the tic douloureux, while lithium has completely controlled the cluster headache. Our case shows again that the simultaneous occurrence of cluster headache and trigeminal neuralgia seems to be more than coincidental.     

Prevention of obstetrical damage to the perineum. Proposal for a fetal-pelvic index for the selection of parturients at risk

BACKGROUND: According to some authors, vaginal delivery always causes denervation of perineum and the greater the damage the longer the second labour phase (the so-called "delivering phase"). Therefore, it is necessary to reduce the number of too prolonged labours, but it is equally important to avoid an uncontrolled increase of cesarean sections. In order to achieve this objective, it is important to carry out a careful selection among laboring women and choose those most at risk for whom cesarean section is strongly recommended. On the basis of the data collected by the medical literature and in consideration of the pathogenetic role of the outlet dystocia, we have tried to identify a simple and effective prognostic index resulting from the different pelvimetric and ultrasonographic parameters. METHODS: In 72 full-term pregnant women, we have taken into account the ultrasonographic parameters expressing the fetal dimension (cephalic diameters, cephalic and abdominal circumferences, estimated fetal weight according to Haddlok), the outlet pelvic diameters (trans-ischial and coccygeal-pubic) and a fetal-pelvic index derived from these parameters. RESULTS: If taken individually, these parameters do not seem to have any direct connection with the length of the delivering phase, but the combination of the cephalic and external pelvimetric diameters has produced a significative statistical coefficient. CONCLUSIONS: On the basis of the data collected, it is suggested that a careful evaluation of external pelvimetric and cephalic parameters would be useful from the clinical point of view.     

A case of mosaic trisomy 2 diagnosed at amniocentesis in an abnormal fetus and confirmed in multiple fetal tissues

A female renal transplant recipient had intractable femoral neuralgia due to a large calcified disk herniation. She then developed an anterior epidural hematoma above the herniation, from T12 to L2, in the absence of clotting disorders. Spontaneous resorption of the hematoma occurred. The femoral neuralgia resolved after surgical treatment of the herniation. The location of the hematoma suggests that the calcified disk may have torn the fragilized epidural venous network.     

Genetic analysis of tissue interactions required for otic placode induction in the zebrafish

Development of the vertebrate inner ear begins during gastrulation with induction of the otic placode. Several embryonic tissues, including cephalic mesendoderm, notochord, and hindbrain, have been implicated as potential sources of otic-inducing signals. However, the relative contributions of these tissues have not been determined, nor have any genes affecting placode induction been identified. To address these issues, we analyzed otic placode induction in zebrafish mutants that are deficient in prospective otic-inducing tissues. Otic development was monitored by examining mutant embryos for morphological changes and, in some cases, by visualizing expression patterns of dlx-3 or pax-2.1 in preotic cells several hours before otic placode formation. In cyclops (cyc-) mutants, which develop with a partial deficiency of prechordal mesendoderm, otic induction is delayed by up to 1 h. In one-eyed pinhead (oep-) mutants, which are more completely deficient in prechordal mesendoderm, otic induction is delayed by 1.5 h, and morphology of the otic vesicles is abnormal. Expression of marker genes in other regions of the neural plate is normal, suggesting that ablation of prechordal mesendoderm selectively inhibits otic induction. In contrast, the timing and morphology of otic development is not affected by mutations in no tail (ntl) or floating head (flh), which prevent notochord differentiation. Similarly, a mutation in valentino (val), which blocks early differentiation of rhombomeres 5 and 6 in the hindbrain, does not delay otic induction, although subsequent patterning of the otic vesicle is impaired. To test whether inductive signals from one tissue can compensate for loss of another, we generated double or triple mutants with various combinations of the above mutations. In none of the multiple mutants do the flh or val mutations exacerbate delays in placode induction, although val does contribute additively to defects in subsequent patterning of the otic vesicle. In contrast, mutants homozygous for both oep and ntl, which interact synergistically to disrupt differentiation of cephalic and axial mesendoderm, show a delay in otic development of about 3 h. These data suggest that cephalic mesendoderm, including prechordal mesendoderm and anterior paraxial mesendoderm, provides the first otic-inducing signals during gastrulation, whereas chordamesoderm plays no discernible role in this process. Because val- mutants are deficient for only a portion of the hindbrain, we cannot rule out a role for that tissue in otic placode induction. However, if the hindbrain does provide otic-inducing signals, they apparently differ quantitatively or qualitatively from the signals required for vesicle patterning, as val disrupts only the latter.     

Anatomical and neurohistological observations on the heart of the rose ringed parakeet, Psittacula krameri

Anatomy, histology and innervation of the heart of the rose ringed parakeet, Psittacula krameri have been studied in the present investigation. The sinuatrial node is found to be well-developed. It is located towards the right side of the cephalic end of the interatrial septum and composed of a few nucleated cells and a large fibrous mass. The atrioventricular node is poorly defined, present at the caudal end of the interatrial septum. The node is somewhat triangular in shape and is composed of elongated and multinucleated specialized fibres. The node is not covered by any connective tissue sheath. The poor development of the atrio ventricular node and the absence of any sheath around it may be correlated with the fast rate of the heart beat. The atrioventricular bundle is observed at the cephalic end of the interventricular septum. A branch from the right limb of the atrioventricular bundle is noted to pass directly into the right atrioventricular valve. The heart is richly innervated. Ganglion cells along with nerve fibres have been observed at the sulcus terminalis and the atrioventricular junction. A direct nervous connection could be observed between the sinuatrial and atrioventricular nodes. It is argued that the impulse which originates in the sinuatrial node would reach the atrioventricular node through the unspecialized muscle fibres and nerve fibres of the interatrial septum. Nerve cells could not be traced in the substance of the sinuatrial node, atrioventricular node and atrioventricular bundle.     

Cephalic subcutaneous metastases from a urinary bladder carcinoma

We describe a papillary transitional cell carcinoma with subcutaneous metastases in the cephalic region in a 74-year old male patient who had been suffering from recurrent low grade bladder tumors for 7 years. Subcutaneous metastases from bladder carcinoma occur infrequently, and cephalic localization is even more unusual. The presentation, diagnosis and hospital course is given.     

Late modifications of cephalic circulation in head x-irradiated rats

A non-invasive and quantitative radioisotope method was applied to the assessment of late cephalic circulatory changes occurring 12 and 21 months after head irradiation at 500, 1000 or 1500 R in rats of two inbred strains. Analysis of the results concerning the tracer circulatory mean transit-time (t) as well as those of two indices measuring respectively the cephalic blood volume (VH) and the cephalic blood flow (FH), led us to conclude that: -- the radiation-induced late changes in cephalic circulation are more relevant to a reduction of the volume of blood flowing in the head than to a reduction of its rate -- even a dose as low as 500 R induces such a late effect but the delay is longer than one year -- a depression of the cardiac output can be an additional very late consequence of head irradiation -- there is an influence of the rat strain on the temporal development of the late cephalic circulatory changes.     

Acute psychosis associated with abrupt withdrawal of carbamazepine following intoxication

Carbamazepine is regularly used in the treatment of trigeminal neuralgia. Although exacerbation of psychosis has been described following abrupt discontinuation of carbamazepine in chronic schizophrenics, a withdrawal syndrome has not been reported previously in patients treated for trigeminal neuralgia. The case presented here suggests that abrupt withdrawal of toxic concentrations of carbamazepine may precipitate a withdrawal reaction, which is manifest some days after discontinuation of the drug. Therefore it may be advisable to withdraw therapy slowly in these situations.     

Malignant degeneration in a parapontine epidermoid (author's transl)]

A case of malignant degeneration in a right parapontine epidermoid cyst giving rise to leptomeningeal carcinomatosis in a 57 year old woman is presented. The malignant tissue had infiltrated the right cerebellar hemisphere and produced a symptomatic trigeminal neuralgia, a change in the psychological state of the patient, and an acute conus and cauda syndrome following metastasis implantation. Only eight unequivocal previous reports of malignant transformation of intracranial epidermoid cyst have been reported in the literature with metastases in four.     

Cerebral electrotherapy: Methodological problems in assessing its therapeutic effectiveness.

Attempts to assess the therapeutic efficacy of cerebral electrotherapy (CET) or electrosleep have yielded widely differing results. This may be attributable to considerable variation in the electrical characteristics of the apparatus used, the duration of the treatment, and the placement of the electrodes. In some double-blind studies, the placebo condition has differed significantly from the treatment, and in most the ideal situation with a blind machine operator, S, and assessor, has not been achieved. Until the methodology for assessment improves and the treatment procedure is standardized, it will be impossible to determine if CET is an effective treatment, and if it is, whether its mode of action is attributable to a direct effect on the brain or to relaxation, suggestion, or tactile stimulation. (31 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Middle fossa decompression of the trigeminal sensory root for trigeminal neuralgia--a re-appraisal and a modification of the technique

Twenty-three patients with intractable trigeminal neuralgia were treated by a modified technique of middle fossa extradural decompression of the trigeminal sensory root at the petrous ridge. After exposing the ganglion and the root at the petrous ridge, by an extradural Frazier's approach a thin layer of autogenous fat was interposed between the dura propria and the middle fossa dura anteriorly, and between the petrous ridge and the root posteriorly. The fat layers were used to prevent dural adhesions and to maintain a space between the petrous ridge and the root. The dura propria was preserved intact. All patients obtained immediate relief of pain following surgery. Twenty patients continue to remain pain free. Two patients have mild occasional pains and one has a persistent pain of moderate intensity. One patient developed a dense sensory loss and two had delayed facial weakness which recovered completely within a month. The mechanism of trigeminal neuralgia is discussed on the basis of anatomical, histopathological and electrophysiological findings and the rationale of middle fossa decompression of the root is stressed. This method is short, simple and safe and may serve as an alternative to the more recent methods of treating trigeminal neuralgia.     

Tyrosine kinases in neutrophils

Outcome after radiofrequency thermocoagulation in patients with trigeminal neuralgia was assessed in a prospective, longitudinal study. Forty-eight consecutive patients with chronic facial pain presenting for surgery to a neurosurgeon were studied. Patients were assessed preoperatively by an independent clinician both clinically, and with the use of two questionnaires: the McGill Pain Questionnaire (MPQ) and the Hospital Anxiety and Depression (HAD) scale. From these assessments, two groups of patients were identified: 31 with pure trigeminal neuralgia (TN group) and 17 with trigeminal neuralgia together with atypical facial pain and mixed trigeminal neuralgia (MTN group). All underwent radiofrequency thermocoagulation at the level of the Gasserian ganglion. Patients were reviewed by the same clinician 3 months later and then followed up by a self-administered questionnaire at 6 months, 1 year, 2 years and 3 years. The mean follow-up time was 30+/-12 months. The mean time to recurrence of pain was 40 months for the TN group and 36 months for the MTN group. Depression and anxiety dropped more significantly post-operatively in the TN group than the MTN group. TN group were more satisfied with their outcome, complained of fewer complications and were more willing to have repeat surgery if necessary than patients in MTN group. The number and severity of complications varied at different time points. Careful selection of patients for surgery using objective assessments will decrease morbidity and improve satisfaction. Physical morbidity and recurrence rates are insufficient to gauge outcomes. Psychological, sociological and patients' views must be included in evaluations.     

Dysostosis enchondralis polyepiphysaria in 2 pairs of sisters from different families

This is Part I of a study whose purpose is two-fold, that is, to arrive at a classification of diseases under investigation according to their responsiveness to acupuncture therapy, and to discuss and identify the most effective loci for the diseases investigated. In Part I of this study, over 500 patients afflicted with hyperthyroidism, trigeminal neuralgia or intercostal neuralgia were treated with acupuncture therapy. The results of the treatment, together with the selection of acupuncture loci and the techniques of needle manipulation are reported in detail. Over 80% of the patients were found to have made excellent improvement. The three diseases are therefore classified as diseases on which acupuncture therapy yields excellent results.     

Non-pharmacological therapies in osteoarthritis

Non-pharmacological therapies are very important in osteoarthritis. Each form of this treatment should be individually devised, taking into account the anatomical distribution, the phase and the progression rate of the disease. Indications, contraindications, dosage and precautions are as important in non-pharmacological therapy as they are in drug treatment. Therapeutic exercises decrease pain, increase muscle strength and range of joint motion as well as improve endurance and aerobic capacity. Exercise programmes should be designed, conducted and regularly supervised by professionally trained physiotherapists. Weight reduction is of proven benefit in obese patients with osteoarthritis of the knee. Walking aids, crutches, shoe insoles, braces and patellar taping are useful tools in some form of osteoarthritis. Patient education and the management of the psychosocial consequences are priority tasks. Therapeutic heat and cold, electrotherapy, ultrasound, acupuncture, hydrotherapy and spa treatment are widely used, although the effects and benefits have not been fully established. Non-pharmacological therapies should undergo rigorous randomized controlled trials in a similar manner to pharmacological studies.     

The contrast between physicians seen by the medical board and those seen in private practice

Twenty-two patients suffering from trigeminal neuralgia were treated by thermocoagulation from June 92 to June 94 at H?tel-Dieu de France Hospital. Epidemiological, clinical, para-clinical elements and the therapeutic approach were studied. The results after a median follow-up of one year were satisfactory in twenty patients (90.9%) who became asymptomatic. No major complication was noticed. Two recurrences occurred however, one responded to another thermolesion. We propose and discuss this technic for the treatment of the trigeminal neuralgia.