ISSN:0749-8047    

出版商:OVID    

年代:1992

数据来源: OVID

ISSN:0749-8047    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

SummaryTemporomandibular disorders (TMDs) are likely the most common cause of persistent pain in the head and neck. Treatment for TMDs can be quite varied although, in general, favorable treatment outcome is reported to be on the order of 75–80%, regardless of treatment approach. However, it has been reported that patients suffering from posttraumatic TMDs, and, in particular, patients who have been involved in motor vehicle accidents (MVAs), do not respond as well to therapy. Therefore, this study was undertaken to elucidate some of the historical and clinical features of posttraumatic TMDs and to compare this with the features of TMDs that developed independent of identifiable trauma. Furthermore, a comparison between recovery rates in the two populations was undertaken as well as a comparison of the treatment modalities used in the two groups. Fifty-two posttraumatic TMD patients were compared to an age-and sex-matched population of “routine” TMD patients whose conditions developed independent of trauma. Treatment, consisting of various accepted modalities, ranged from 3 to 5 years after the MVA, with progress assessed at each visit. The data indicate that 48% of posttraumatic TMD and 75% of TMD patients reported recovery with treatment (p< 0.001). The posttraumatic TMD patients required significantly more treatment than the control TMD population. The findings suggest further that 60% of MVA TMD patients suffer from symptoms suggestive of affective disorder compared to only 14% of TMD patients. In view of the above, it appears that posttraumatic TMD patients do not respond to therapy as well as the control subjects. While the mechanisms underlying this finding are not clear, it could be related to a difference in underlying pathophysiology. The data showing that posttraumatic TMD patients develop significantly more symptoms suggestive of affective disorders than control TMD patients could imply that there is a relationship between these findings that requires further study.

ISSN:0749-8047    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

SummaryThis study used a radionuclide imaging technique to map the spread and density contours of phenol in glycerin injected into the epidural space of cancer patients. Correlations were made between phenol injectate volume, sequence of injection, position of patient, and resultant epidural spread and analgesic outcome. Fifteen patients with cancer pain (average age of 61 years) were treated with serial epidural phenol in glycerin injections. Phenol in glycerin is miscible with [99mTc]sulfur colloid. An assumption was made that the admixture injected epidurally was inseparable prior to absorption and the spread was recorded by continuous gamma camera observations with computer collection for 30 min postinjection. The spread of injectate volumes of 2, 3, and 4 ml were compared and further correlations made between observed spread and sequence of injections (first to fifth in series within each patient) and position of patient. Small volumes of phenol may spread extensively in the epidural space (3 ml spreads a mean 13.6 segments) with wide variation among patients. Initial phenol injections spread further than subsequent injections. Maximum spread is achieved by 15 min postinjection and epidural distribution is mostly uniform, independent of patient position. Good analgesia was obtained in 14 patients (93%). Epidural neurolysis using serial injections of small volumes of phenol in glycerin is an effective, safe technique for cancer pain relief. Injectate volumes larger than 3 ml may be unnecessary and potentially dangerous.

ISSN:0749-8047    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

AbstractTrigeminal neuralgia may be treated in several ways. In the present study, the efficacy of a selective percutaneous radiofrequency (RF) neurolysis in the gasserian ganglion was evaluated in 240 patients. The recurrence rate after a single treatment was 28.3% within 2 years. After multiple treatments (n = 68), the recurrence rate had decreased to 8.3% (n = 20). Thus, the overall success rate at the end of the follow-up period was 91.7%. The mean follow-up period was 50 months (range 12–96 months). Except for corneal anesthesia in 3.7% of the patients, no serious complications occurred.

ISSN:0749-8047    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

SummaryHeadache is the most common symptom patients present to their doctors. Current systems classify the most common recurring headaches as either migraine or tension-type. Review of the literature brings into question this traditional approach to headache classification. These two “types” of headache patterns appear, instead, to be different expressions of the same pathophysiological process, having overlapping symptomatic presentations with certain features emphasized to a greater or lesser extent. Additionally, the same therapies have been demonstrated to be effective for patients traditionally classified in either headache group. This article reviews the overlap of clinical symptoms, pathophysiology, and effective treatments for headaches traditionally diagnosed as migraine and tension-type. An alternative continuum classification model is suggested.

ISSN:0749-8047    

出版商:OVID    

年代:1992

数据来源: OVID

ISSN:0749-8047    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

AbstractThe choice of an appropriate control group has been recognized as one of the most difficult problems in the methodology of case/control studies, both in theory and in practice. In the study of chronic pain, a “well control group” has frequently been employed. Although this design has intuitive appeal, it contains the potential for bias and error. In order to obtain the proper control group, the same exclusion criteria should be applied to cases and controls. Second, controls should be selected independently of exposure to the putative risk factors under investigation. To illustrate the nature of this problem we present two numerical examples, using a chronic pain disorder.

ISSN:0749-8047    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

AbstractChronic paroxysmal hemicrania has gradually become a well-established headache entity. However, the fact that the condition can also occur episodically is less well known. Both episodic and chronic paroxysmal hemicrania respond well to treatment with indomethacin. This makes it particularly important to recognize these conditions and to differentiate them from cluster headache, which is treated with other medications than indomethacin. In this article we describe additional cases of episodic and chronic paroxysmal hemicrania to illustrate the clinical features of these conditions.

ISSN:0749-8047    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

AbstractIntrathecal methylprednisolone acetate (IT-MPA) treatments have been reported to be beneficial and safe for the treatment of low back problems and especially “failed back” problems, which include adhesive arachnoiditis. Other reports, however, have stressed the potential dangers of this treatment and have advised against its use. Many of these papers implicate the propylene glycol included in the methyl-prednisolone as being potentially harmful. Since the literature is rather extensive and clearly conflicting, it is difficult for those who treat patients with “failed back” problems to ascertain the risk/benefit ratio of this form of treatment, so a literature review and analysis has been undertaken. Published literature clearly attests to the usefulness and general safety of IT-MPA when used within certain limits. Although several studies implicate IT-MPA as a potential cause of arachnoiditis or other neurologic injury, most of the evidence is circumstantial and most complications followed multiple, large-dose, or frequent injections.

ISSN:0749-8047    

出版商:OVID    

年代:1992

数据来源: OVID