Medical science monitor : international medical journal of experimental and clinical research
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Case Reports
Intravenous administration of vitamin C in the treatment of herpetic neuralgia: two case reports.
Acute herpetic neuralgia (AHN) due to a reactivated varicella zoster virus infection is a common problem. Furthermore, about 18% of all patients with confirmed herpes zoster (HZ) develop postherpetic neuralgia (PHN). The leading factors of the prognosis and persistence of symptoms are patient age and the size of the lesions. Animal studies came to a similar conclusions that in both AHN and PHN, inflammatory cytokines such as IL-6 and IL-8 could serve as predictive markers and that a positive influence of vitamin C administration, by modifying cytokine metabolism, could be demonstrated. ⋯ The use of the vitamin C appears to be an interesting component of alternative therapeutic strategies in the treatment of HZ. Especially for therapy-resistant cases of PHN, vitamin C administration should be examined as an additional option. To test and confirm the clinical findings, randomized clinical studies concerning the use of vitamin C in the concomitant treatment of zoster-associated neuralgia should be performed.
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With the popular use of the laryngeal mask airway (LMA), recurrent laryngeal nerve injury associated with the LMA, which might cause serious complications, has recently been reported. The true mechanism, however, remains unclear, which makes effective prevention and treatment of this disorder difficult. On the basis of the anatomical relationship of the laryngopharynx and the laryngeal mask and the progressive recovery in most reported cases, we hypothesize that demyelinating neuropraxia resulting from direct mechanical compression contributes to the recurrent nerve injury associated with the LMA. ⋯ Several animal studies also reveal that high laryngeal mask airway intra-cuff pressure might cause laryngopharyngeal mucosa damage, but there is no experimental research about LMA-related recurrent nerve injury. Therefore, further investigation by establishing an animal model might disclose the definite mechanism of the injury and evaluate the process of nerve recovery. The potential implications arising from this testable hypothesis might be helpful in developing clinical therapeutic approaches for this complication.