The Medical journal of Australia
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On the basis of observation of 26 patients, we consider that the common cause in trigeminal neuralgia and hemifacial spasm is compression of the nerve-root entry zone at the brainstem by a blood vessel, usually an artery. By mobilising the vessel, and securing it away from the nerve, symptoms were relieved in 16 of 17 patients with trigeminal neuralgia and in seven of nine patients with hemifacial spasm for a follow-up period of up to four years. Trigeminal microvascular decompression had few complications, but three patients treated for facial hemispasm had postoperative deafness and one had a probable small brainstem infarct. The major advantage of this surgical approach is that is possible to relieve the symptoms without facial anaesthesia or paralysis.
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An analysis of restrictive measures taken by the Australian Drug Evaluation Committee (ADEC) over the period of 27 months (from March, 1976, to June, 1978) was made by two non-Australian observers. During this period, the ADEC took 32 useful restrictive measures (a little more than one a month). The analysis was limited only to cases in which ADEC took substantial action; if less comprehensive measures were included, the number of valid actions to counter the occurrence of iatrogenic complications would be much greater. It is concluded that, although it is an undisputed fact that many pharmaceutical companies maintain the highest ethical standards, there is a need for the type of objective and dispassionate control exercised by the Australian Drug Evaluation Committee.