Therapeutische Umschau. Revue thérapeutique
-
The hallmark of trigeminal neuralgia is the abrupt onset of short pains in the face or in a part of the face, described as stabbing, lightning or electric shocks. Attacks are often triggered by cutaneous stimuli to the face or the oral cavity, which may be such minor activities as talking, chewing, brushing the teeth, or even wind blowing on the face. As a result, facial hygiene as well as a good diet may be neglected. ⋯ If the trigeminal neuralgia may be considered as a nerve irritation, like the glossopharyngeal neuralgia and the nasociliary neuralgia, nerve lesion may elicit neurogenic or neuropathic pain, characterized by chronic burning pain; post-zoster pain, iatrogenic and posttraumatic pain illustrate this condition. Cluster headache (Horton neuralgia), Sluder's neuralgia and auriculotemporal neuralgia may be related to a dysfunction of the autonomous nervous system. Finally, lesion in the mandibular joint may cause unilateral facial pain.
-
Headache is a common symptom in patients suffering from cervical spine disorders. The percentage of headaches in association with degenerative changes of the cervical spine ranges from 13 to 79% and that in association with indirect trauma of the cervical spine from 48 to 82%. Based on neuroanatomical and neurophysiological studies, the relationship of the upper cervical spine and the trigeminal nuclei has been demonstrated and serves as an explanation for perceived head pain in cervical spine disorders. ⋯ In 1983, Sjaastad et al. postulated the concept of 'cervicogenic headaches': a migraine-like headache due to certain disorders of the cervical spine, strictly located unilaterally, its manifestations being in the temporal, frontal, and ocular areas, with associated symptoms such as slight lacrimation, conjunctival injections, tinnitus, runny nose, and erythema in the forehead ipsilaterally. As arguments in favour of a cervical origin, Sjaastad mentioned the following features: precipitation of the headaches either by neck movements or by pressure against certain tender spots on the neck, the possibility of homolateral shoulder or arm pain, stiffness and pain of the neck, and reduced mobility of the cervical spine. In 1988, the Headache Classification Committee of the International Headache Society set strict criteria for 'headaches' to be classified as to be of cervical origin.
-
Migraine is caused by intermittent brain dysfunction. Attacks result in severe unilateral headache with nausea, vomiting, photophobia, phonophobia and general weakness. The prevalence of migraine is 12 to 20% in women and 8 to 12% in man. ⋯ Substances of second choice are valproic acid, DHE, pizotifen, methysergide and magnesium. Homeopathic remedies are not superior to placebo. Nonpharmacological treatment consists of sport therapy and muscle relaxation techniques.
-
Since the controlled long-term study DCCT has clearly demonstrated that the progression of diabetic late complication is highly dependant on metabolic control an adaptation of insulin therapy became mandatory. In the eighties first successful attempts were made with the so-called Basis-Bolus-Principle (regular insulin before meals and depot-insulin at bedtime), the dosis being adapted depending on blood sugar tests. Near normoglycemia could only be achieved by a very strict time-schedule concerning meal-times and quantity of meals and still was accompanied by an increase of severe hypoglycemia. ⋯ In case of increased risk of hypoglycemia the target of blood sugar must be elevated. The goal of a good metabolic control while minimizing the risk of hypoglycemia and of increased flexibility in daily life can only be reached by special efforts of the teamwork between physician, diabetes nurse and dieticians with the diabetic patient. Different sorts of problems and recommendations of insulin treatment are discussed in a supplement.
-
With the identification and recombinant production of the hematopoietic growth factors, these cytokines have been evaluated in the treatment of primary bone marrow failure states and after myelosuppressive chemotherapy or radiotherapy. A lot of clinical trials with hematopoietic factors have been performed in patients with haematologic and oncologic diseases within the last decade. Granulocyte colony-stimulating factor [G-CSF], granulocyte macrophage colony-stimulating factor [GM-CSF], interleukin-3, interleukin-2, erythropoietin and in phase I/II trials thrombopoietin [TPO] are available for the clinical use. ⋯ This results in a marked reduction of infectious risks and a shortening of drug- and radiation-induced myelosuppression. CSFs are most important in mobilizing peripheral blood progenitor cells [PBPC] and have allowed high dose therapy to be given to patients who would not have been able to undergo conventional bone marrow transplantation. However, an improved outcome and improved survival rates with standard chemotherapy protocols couldn't be documented by studies up to now, even though higher chemotherapy doses are possible by the use of hematopoietic factors.