J Neurosurg Sci
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Between 1973 and 1980 a solution of phenol in glycerin into the cisterna magna was injected in 38 patients suffering from advanced intractable pain due to neoplasm of faciocephalic area. Owing to the poor neurological and general condition of our patients, surgical procedures were discarded. Patient's age ranged from 36 to 76 years and pain diffusion involved many cranial and cervical nerves. ⋯ No significant relationship between pain relief and sensory deficit was found. The pathophysiological mechanisms of pain suppression, induced by phenol injection in the faciocephalic area are discussed. The value of this simple technique is briefly assessed in comparison to other analgesic procedures.
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The Authors have studied five coagulation parameters (platelets count, prothrombin time, activated partial thromboplastin time, fibrinogen and fibrinogen degradation products) in 60 head traumatized patients. These parameters were alterated in a high percentage of patients. ⋯ DIC could be an important factor of mortality in the head traumatized patients. So coagulation system must be carefully evaluated in any patient with head injury.
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A 59 year old man suffering from intractable chronic pain from sacral coccygeal relapsing neoplasia with pelvic invasion, operated and irradiated more than once, after a first partial success with subarachnoid intermittent morphine infusion by means of a subcutaneous reservoir, refilled transcutaneously, has been treated with continuous intrathecal low-dose morphine infusion with a totally implantable pump. This device not only greatly resolves many of the problems connected to spinal administration of morphine, but it also allows to obtain constant concentrations of the drug, so that an efficacious therapeutic action is already present at low doses, reducing the risks of overdose and supraspinal redistribution as well as the development of tolerance. This case represents the first example in Italy of the use of a completely implantable pump for this purpose.
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Comparative Study
Spontaneous intracerebral hemorrhage: medical or surgical treatment.
Eighty-six cases of spontaneous intracerebral haemorrhage, some treated by surgery, some by medical therapy, were studied retrospectively. The two groups, characterized on the basis of numerous parameters were compared: the findings are discussed and interpreted in the hopes of indicating a correct therapeutic strategy.