Fortschritte der Neurologie-Psychiatrie
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Fortschr Neurol Psychiatr · Sep 1991
Review[Prognostic factors in rehabilitation after severe craniocerebral injuries].
Even with modern standards of intensive care management and rehabilitation services, severe head injury often results in permanent disability. A review of the literature concerning predictors of outcome after severe head injury is presented. The early identification of those factors which are of greatest significance in determining outcome is of essential value in the appropriate management of rehabilitation therapy. ⋯ The presence of previous brain damage also seems extremely important. In contrast, the prognostic value of pretraumatic personality factors and of the psychosocial status of the head injured patient requires additional research. Comparison among studies is hindered by differences in patient samples, timing of assessments, and various outcome measures with respect to rehabilitation management.
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Fortschr Neurol Psychiatr · Sep 1991
Historical Article[Placebos: aspects in medical history and approaches to definition].
The historic roots of the term placebo, its development from religious to secular use and finally its establishment as a medical terminus at the end of the 18th century are described. After the first and rare placebo publications in the 30ties and 40ties a sudden increase in the number of published placebo articles took place since 1950. In the following decades the progress in experimental placebo investigations was overwhelming and placebo phenomena more and more became a subject of scientific inquiry in its own. ⋯ In particular the 'myth of the non-specificity of placebos' will be critical reviewed and reconsidered. Finally, after a short retrospective view to placebo definitions in medical dictionaries since the 19th century the actual controversy between pharmacological and general placebo definitions is outlined. Two modern definitory propositions of Shapiro and Morris, 1978, and Brody, 1980, are presented and discussed in detail.
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Fortschr Neurol Psychiatr · May 1990
Review[Ethical and legal aspects of the use of placebos in research and practice].
The discussion of ethical and legal problems concerning placebo application is suggested as an essential constituent of modern placebo research. Implications of distinctions between inadvertent and intended placebo applications and between single case and sample applications of placebos are examined. ⋯ In the following ethical and legal aspects of placebo application in practice (with clinical patients) and in research (sample tests) are elaborated. Finally actual issues of law concerning placebo applications in the Federal Republic of Germany are discussed.
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Fortschr Neurol Psychiatr · Apr 1989
Review[Significance of the neurotoxin 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine for the etiology and therapy of idiopathic Parkinson disease].
Exposure of drug addicts to MPTP (1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine) has caused a Parkinsonian syndrome accompanied by a selective destruction of dopamine containing neurones in the pars compacta of the substantia nigra. MPTP in the human causes a severe irreversible state that very closely resembles idiopathic Parkinson's disease both in its clinical features and response to pharmacological treatment. Interest in potential environmental agents that might play a role in the aetiology of idiopathic Parkinson's disease is likely to increase as the result of the discovery of the relatively simple molecule MPTP which is highly toxic to the substantia nigra. ⋯ The model of MPTP-treated monkeys appears to provide a useful testbed for the evaluation of future treatments for the disease. The precise mechanism of MPTP toxicity has yet to be determined and may provide the clue to the mechanism of neuronal death in Parkinson's disease. After entering the brain MPTP is oxidized to MPP+ (1-methyl-4-phenylpyridine) at an extraneuronal site.(ABSTRACT TRUNCATED AT 250 WORDS)