Cortical evoked responses and transcutaneous electrotherapy.

Percutaneous electrostimulation, acupuncture, and direct stimulation of the central nervous system are supposed to be capable of reducing painful sensation by releasing enkephalins and endorphins. We treated six volunteers with electrotherapy, obtaining in all cases a clear reduction of the pain induced by electric stimulation of the median nerve at the wrist. During the treatment, the administration of naloxone, an antagonist of morphine, in four subjects provoked a short but clear and immediate return of pain. In the other two cases, the drug provoked a further decrease of the painful sensation. During electro-stimulation in all patients, the somatosensory evoked potentials showed a statistically significant decrease. In the four "naloxone-responsive" subjects, the cortical evoked responses returned to basal amplitude after naloxone. In the two patients with a clinically paradoxic response, nonsignificant modification in the cortical evoked potentials was noted.

Percutaneous glossopharyngeal thermocoagulation complicated by syncope and seizures.

We describe the case of a patient who, during the percutaneous thermocoagulation of the petrous ganglion of Andersch, suffered a serious vagal response resulting in cardiac arrest, collapse, and generalized convulsions. Notwithstanding such major symptoms, the postoperative examination revealed no lesions of the vagus nerve and the glossopharyngeal lesion was shown to be isolated and selective.

Traumatic intracranial internal carotid aneurysm due to gunshot wound. Case report.

This patient developed an intracranial carotid artery aneurysm after a bullet wound. A review of the related literature, and the pathogenesis of traumatic false and true aneurysms are presented.

Evaluation of endorphin content in the CSF of patients with trigeminal neuralgia before and after Gasserian ganglion thermocoagulation.

The beta-endorphin content in cerebrospinal fluid (CSF) was evaluated in 10 patients with idiopathic trigeminal neuralgia during medical treatment (with or without carbamazepine) and after selective thermocoagulation of the Gasserian ganglion. These values were compared with those obtained in a control group of seven patients without pain problems. No statistically significant difference was found between patients suffering from trigeminal neuralgia and those without pain. Furthermore, neither pharmacological treatment nor surgery changed CSF endorphin values. It is concluded that there is no pathogenetic relationship between trigeminal neuralgia and endorphins.

Age-related changes of methionine-enkephalin and beta-endorphin/beta-lipotropin immunoreactivity in human CSF.

Methionine-enkephalin (ME-IR) and beta-endorphin (BE-IR) immunoreactive material CSF concentrations have been measured in subjects of different ages affected by lumbar or cervical disk hernia. The two peptides exhibited different age-related trends. ME-IR levels rose significantly with age while no changes were observed in the case of BE-IR.

Indications for the use of bleomycine-Co57 in brain scanning.

The Authors report on their experience with a new radio-active tracer, Bleomycine-Co57, which was studied in 40 patients who had previously undergone brain scanning with Indium113m. The results obtained with these two different tracers are compared and the following conclusions advanced: 1) Bleomycine-Co57 is the radio-active tracer of choice in identification of cerebral metastases, especially in those cases where brain scanning with Indium113m was non-diagnostic; 2) glioblastomas evidence less uptake of the tracer than do metastases; 3) the scarce affinity of this tracer for benign tumors is stressed; 4) owing to the long half-life of this tracer, it is preferable to use it only with those subjects suspected of having a malignant neoplasia.

Traumatic cerebral aneurysm in pediatric age. Case report.

Cerebral aneurysm following head trauma in pediatric age is a rare complication particularly in the absence of skull fractures or penetrating brain wounds as in the present case. In the presence of rapid worsening of neurological conditions after head trauma, one may take into consideration this complication among other possible vascular accidents.

Reconstruction of a large post-traumatic cranial defect with a customized titanium plaque.

The treatment of serious cranial defects has always been a fascinating and controversial issue for craniofacial surgeons and in the last years many solutions have been proposed. One of the most effective method is a personalized titanium plaque prepared by processing anatomical data obtained with a CAT of the patient. A case of wide cranial defect on the left fronto-parietal region in a 56-year-old man treated with a personalized titanium plaque obtained by processing the data of a spiral CAT of the skull is described. No complications were observed in the postoperative course and follow-up after 6 moths showed that the patient was in good general condition.

Disendocrine manifestations during non tumoral aqueductal stenosis.

Disendocrine manifestations during aqueductal stenosis are more and more frequently reported in literature. In the present study, 20 cases of benign aqueductal stenosis associated with disendocrine features as amenorrhea, obesity, polydipsia and polyuria, dwarfism, acromegalic features, hypogonadism, precocious puberty, gigantism are stressed. Authors discuss clinical findings and pathogenetic hypothesis on the base of endocrine, neurological and peculiar radiological features with the support of a wide literature review.

Alterations of facial sensitivity induced by percutaneous thermocoagulation for trigeminal neuralgia.

Sixty patients with essential trigeminal neuralgia underwent selective percutaneous thermocoagulation of the gasserian ganglion. Immediate and long-term modifications of pain and tactile facila sensitivity, recurrences of pain, and occurrences of facial paresthesias were evaluated. Pin-prick and von Frey hair tests and somatosensory-evoked potentials were used to study facila sensitivity. Patients with mild alterations of sensitivity-treated with low temperatures of coagulation (60 degrees-70 degrees C)--had a lower incidence of paresthesias, although a higher risk of recurrence. Patients with severe alterations of sensitivity--a consequence of a temperature of coagulation above 70 degrees C--had a high incidence of paresthesias and a low risk of recurrence. In our opinion, the first kind of results are better.

Selective percutaneous thermolesions of the ninth cranial nerve by lateral cervical approach: report of eight cases.

Percutaneous radiofrequency thermolesion of the petrous ganglion at the jugular foramen was employed for the treatment of glossopharyngeal neuralgia in eight cases, three with essential and five with symptomatic pain from oropharyngeal cancer. Because of its technical simplicity, the lateral cervical approach was preferred to the anterior lateral approach. Immediate and subsequent surgical results were satisfactory. No neurological complication was noted, except for transitory bradycardia and hypotension during the procedure.

[Transcutaneous electroanalgesia and naloxone. Clinical aspects (author's transl)]. / Modification de l'action antalgique de l'électrothérapie transcutanée après tracutanée après traitement avec naloxone. Note préliminaire.

Recently, Mayer (1977) and Adams (1976) proved that both acupuncture and direct electrostimulation of deep encephalic structures produce an analgesic effect releasing a neurotransmitter similar to morphine (endorphine). We have verified this hypothesis, using the transcutaneous electrotherapy in five patients with chronic pain at the back (postherpetic neuralgia in 3, pain cancer in 2). All patients related a certain analgesic effect during electrotherapy, with a reduction in pain of more than 50 per cent. During electroanalgesia we administered Naloxone (an antagonist of morphine). In 3 cases we observed a clear, although short, return of algic symptomatology. At the contrary, in other two patients Naloxone caused briefly a further and clear reduction in the pain.