Schweizerische Rundschau für Medizin Praxis = Revue suisse de médecine Praxis
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Schweiz. Rundsch. Med. Prax. · Oct 1989
Review[Palliative neurosurgical treatment of chronic pain following peripheral nerve lesions].
Pathogenesis of pain after traumatic or iatrogenic lesions to peripheral nerves as well as local and conservative therapeutic possibilities are briefly reviewed. If pain subsides or in the case of relapse with establishment of a chronic pain-state the therapy of choice consists in implanting a programmable neuro-stimulator with the electrodes placed near the dorsal sensory roots in the cervical epidural space for the upper extremities or along the posterior columns of the medulla in the thoracic epidural space for the legs. With a success rate for long term pain control of approximately 80% this reversible method which is well tolerated by the nervous system should always be considered for deafferentation-pain (neurogenic pain).
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According to new findings, Sluder's neuralgia, cluster headache and sympathetic neuralgia in the face are likely to be of vascular origin from the branches of the external carotid artery. These vessels receive multiple innervation: sympathetic (constricting), parasympathetic (vasodilator) and through C-fibre liberating substance P. In addition enkephalins, known to act as antagonists to substance P, have been found in the vessels of the external and the internal carotid artery. ⋯ In chronic and drug-resistant cases surgical interventions can be helpful. The trigeminal nerve is the first target, as all C-fibres from the head, including the vessels, reach the trigeminal nerve. Of less importance for surgical intervention is the pterygopalatine ganglion, which is not only parasympathetic, but contains also sympathetic and C-fibres from the mucosa of nose and orbit.
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Schweiz. Rundsch. Med. Prax. · Jul 1989
Historical Article[The mind and epilepsy: opinions and viewpoints over the course of time].
Among the very few diseases that can be traced back to ancient times none has stimulated human phantasy as much as epilepsy, and the many names given to epilepsy reflects the different trends of thinking on the topic over the past two and a half thousand years. The ancient Greek believed epilepsy to be a sacred disease with the body being invaded by a God. The view that demons and evil spirits rather than Gods were responsible for the disease prevailed throughout the middle ages, influenced by Christian thinking. ⋯ The process of distinguishing epilepsy from insanity began with the development of neurology as a new and independent discipline, helped by the discovery of electroencephalography EEG and potent antiepileptic drugs. It became more widely accepted that most epileptic patients have normal mental states. It was argued that the psychiatric consequences of having epilepsy depended on the existence of pathological brain lesions, side-effects of inadequate drugs and the psychological stress of living with a chronic and debilitating disease.
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Schweiz. Rundsch. Med. Prax. · Jul 1989
Biography Historical Article[The 60th anniversary of clinical electroencephalography].
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A 71-year old man was admitted because of increasing dyspnea and fever. Myelomonocytic leukemia was diagnosed on blood films. ⋯ An unusually rapid improvement of the pulmonary infiltrates within 4 days was indicative of a leukemic infiltrate. The patient died a few days later and the diagnosis of diffuse leukemic pulmonary infiltrates was confirmed at autopsy.