Revue médicale de Bruxelles
-
Pain represents the most frequent symptom faced by general practitioners and is associated with 60% of neurological troubles. Pain consists in a conscious, subjective, unpleasant and protective sensory experience transmitted by thermoalgic pathways in the central nervous system (nociceptive pain). Lesioning of peripheral or central sensory pathways can also generate pain associated with hypoesthesia (phantom or neuropathic pain). ⋯ However, the technique, when not sufficiently selective, can generate a neuropathic pain and then a short-lating pain relief. Increasing knowledge on pathophysiological mechanisms of pain allowed surgery to interfere with the functioning of the sensory circuits without lesioning and to modulate neuronal activity in order to reduce pain (neuromodulation). Non-lesioning modulating techniques (then reversible) appeared (deep brain stimulation, epidural spinal cord or motor cortex stimulation, intrathecal infusion, radiosurgery) and are currently applied to efficiently alleviate neuropathic pain.
-
Biography Historical Article
[Richard Doll. A surprising story of conflicts of interest].
Richard Doll is a very famous English physician epidemiologist. He is credited with discovering the link between smoking and lung cancer. His reputation was recently vitiated by two facts, ignorance of German studies prior to his work and the existence of major conflicts of interest with industry that led him to minimize the role of chemical products in carcinogenesis.
-
Man has for a long time searched means of fighting pain, by administration of plant extracts such as poppy seed, jimson weed, henbane, mandrake and alcohol. These substances were given in the form of cataplasms, potions or clysters. Somniferous sponges, applied on the face, were known since Antiquity and have been in use in some countries up to the 13th century. ⋯ Postoperative and intensive care units will appear in the years 1960's. Nowadays, anesthesiologists work in all hospital settings, and also organize One-day clinics and Pain clinics. In Belgium, the quality of the clinical and scientific training of anesthesiologists is widely acknowledged, as well as clinical and experimental research.
-
A 64 years old woman was admitted for persistent dry cough. The cough was lasting for one month and was associated with throat clearing, asthenia and low fever mainly at night. A thorough anamnesis also revealed the existence of mild occipital headache. ⋯ The results of bacteriological tests performed were negative. Given the age of the patient and the persistence of an inflammatory syndrome of unknown origin, the diagnosis of giant cell arteritis should be excluded, despite an unusual clinical presentation. This hypothesis was supported by a diagnostic biopsy of the right temporal artery, which histological analysis showed characteristic pattern.