Arch Neurol Chicago
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Advances in cancer pain research and management are an example of the advances that have occurred within the field of neuro-oncology, the medical discipline that includes the diagnosis and treatment of primary central nervous system neoplasms, metastatic and nonmetastatic neurological complications of cancer originating outside the nervous system, and pain associated with cancer. Progress in the diagnosis and treatment of cancer, coupled with advances in our understanding of the anatomy, physiology, pharmacology, and psychology of pain perception, has led to improved care of the patient with pain of malignant origin. Currently, specialized methods of cancer diagnosis and treatment provide the most direct approach to treating cancer pain by treating the cause of the pain. Yet, before the introduction of successful antitumor therapy, when treatment of the cause of the pain has failed or when injury to bone, soft tissue, or nerve has occurred as a result of therapy, appropriate pain management is essential.
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Arch Neurol Chicago · Dec 1998
Clinical TrialGamma knife radiosurgery for trigeminal neuralgia: results and expectations.
Trigeminal neuralgia is a disabling pain syndrome responsive to both medical and surgical therapies. Stereotactic radiosurgery using the gamma knife can be used to inactivate a specified volume in the brain by cross firing 201 photon beams. We evaluated pain relief and treatment morbidity after trigeminal neuralgia radiosurgery. ⋯ Gamma knife radiosurgery is a minimally invasive technique to treat trigeminal neuralgia. It is associated with a low risk of facial paresthesias, an approximate 80% rate of significant pain relief, and a low recurrence rate in patients who initially attain complete relief. Longer-term evaluations are warranted.
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Arch Neurol Chicago · Dec 1998
Epidermal nerve fiber density: normative reference range and diagnostic efficiency.
The sensitivity of neuron-specific antibodies permit the identification of the small unmyelinated nerve fibers within the skin. ⋯ We have established a reference range for intraepidermal nerve fiber density in normal humans by means of a simple quantitation method based on enumeration of individual intraepidermal nerve fibers on vertical sections of punch skin biopsy specimens stained with the sensitive panaxonal marker anti-protein gene product 9.5. The utility of the density measurement was confirmed for sensory neuropathy with a diagnostic efficiency of 88%. Skin biopsies may be useful to assess the spatial distribution of involvement in peripheral nerve disease and the response to neurotrophic and other restorative therapies.
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Arch Neurol Chicago · Sep 1998
Case ReportsDevelopment of Wernicke-Korsakoff syndrome after long intervals following gastrectomy.
Surgical exclusion of portions of the gastrointestinal tract is a predisposing risk factor for the development of Wernicke-Korsakoff syndrome. When this disease occurs, it is usually within weeks after the gastrointestinal surgery. However, it is not well known that Wernicke-Korsakoff syndrome may occur after a long latent interval following gastrectomy. ⋯ In addition to a long-standing latent deficiency in thiamin levels due to defective absorption following gastrectomy or gastrojejunostomy, other minor factors that may influence the intake of thiamin and the need for thiamin in subjects who have undergone gastrectomy may cause a state of thiamin deficiency resulting in Wernicke-Korsakoff syndrome. Results from our study indicate that the following measures are mandatory: educating patients about proper dietary habits, carefully monitoring their thiamin intake, recognizing Wernicke-Korsakoff syndrome early, and treating it immediately with appropriate measures.