Brain and nerve = Shinkei kenkyū no shinpo
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On the occasion of my retirement as head of the Neurochirurgische Universitätsklinik Zürich on 31. May 2007, the changing aspects of neurosurgery in diseases dealt with and in their treatments during the last 70 years (from the foundation of the department by Prof. Krayenbuehl in 1937 successed by Prof. ⋯ It was the authors pleasure to have succeeded the Neurochirurgische Universitätsklinik Zürich directed by two foregoing giant neurosurgeons Prof. Krayenbühl and Prof. Yaşargil and therefore to have completed a hard task more or less and have experienced considerable changing aspects of modern neurosurgery as mentioned above.
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Injury to the peripheral nerves often induces produces spontaneous pain, hyperalgesia (increased responsiveness to noxious stimuli), and allodynia (painful responses to normally innocuous stimuli). In contrast to inflammatory pain, the currently available therapeutics for neuropathic pain are either relatively ineffective or accompanied by considerable side effects. Numerous animal models of chronic pain following nerve injury have been introduced. ⋯ Furthermore, compelling evidence suggests that the glial cells in the spinal cord may also play a role in the pathogenesis of neuropathic pain. Recent studies have shown that peripheral nerve injury results in the activation of mitogen-activated protein kinases (MAPK) in spinal glial cells and that MAPK inhibitors diminish nerve injury-induced pain hypersensitivity. This review mainly focuses on the DRG neurons and spinal glial cells and will review the roles of MAPK in the nociceptive pathways for neuropathic pain.
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Isolated traumatic oculomotor nerve palsy caused by minor head trauma is extremely rare. We report a case of this condition. A 65-year-old woman was transferred to our hospital after minor head injury. ⋯ After 8 months of the accident, the ptosis and limited eye movement were resolved. However, the right dilation of the right pupil persisted. Our case suggests that even minor head trauma can cause isolated oculomotor palsy, and that the posterior petroclinoid ligament is a candidate structure for causing oculomotor nerve palsy without intracranial hemorrhage and skull fracture.
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Intractable chronic pain is very difficult to treat. Nowadays, small amounts of drugs, that have different actions on the mechanism of pain relief are administered intravenously, and the effects of the test drugs on individual chronic pain patients are investigated by using the evaluation method of the visual analogue scale (VAS). This will enable elucidation of the mechanisms of pain in each chronic pain patient. ⋯ ATP exerts a positive effect in total pain management. Neurotropine and prostaglandine E1 are effective for the management of neuropathic pain and ischemic pain, respectively. These tests aid in the selection of drugs that maybe useful for the treatment of intractable chronic pain in patients.
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Intrathecal drug administration for the control of intractable pain has been practiced over many years in various countries; however, because of government regulation, no drugs except baclofen are approved for chronic intrathecal use in Japan. In this review, I have summarized the current international situation regarding the chronic intrathecal administration of various types of drugs for the control of intractable cancer and non-cancer pain. ⋯ A few new drugs such as ziconotide and gabapentin have been investigated, but the effective control of neuropathic pain, including complex regional pain syndrome, still appears difficult. Contrary to the general belief, intrathecal drug administration via an implantable pump is cost-effective, and I believe that this intrathecal drug delivery system should be used more extensively used for pain management in Japan.