Trigeminal neuralgia: evaluation of percutaneous neurodestructive procedures.

The treatment of trigeminal neuralgia (TN), which is resistant to medical therapy, has benefited from many surgical techniques. It is not possible, in light of the present level of knowledge, to establish exactly which method is the most suitable. It does, however, seem significant that certain side effects appear, in varying percentages, in all kinds of operations. In 13 years, 2,094 patients suffering from TN have been treated by the authors with percutaneous Gasserian neurolysis, 128 patients with radiofrequency trigeminal neurolysis, and 1,966 with selective ethanolic trigeminal neurolysis (SETN). Our experience treating TN with controlled increments of ethanol by means of a needle introduced through the oval foramen in the Gasserian ganglion is related here. The tip of the needle is accurately placed among the roots desired under fluoroscopic control. The clinical effects on the conscious patient of a prognostic block with local anesthetics are evaluated before producing the neurolysis. Follow-up has been long enough to show that SETN is a highly selective procedure, which shouldn't be underrated in the centers that use it routinely.

A "pitiful death": is it the response to a "painful life"?

The problem of pain and suffering in the terminal phase of illness such as cancer or Aids has not received adequate attention and has not been given valid solutions. The author tries to offer a new interpretation key for the problem starting from the Good Samaritan Novel that is considered a clear example of the capability of bringing help and assistance in concrete terms. The request for euthanasia will never be considered a superfluous problem unless a patient can receive concrete answers to his physical and emotional suffering and to the problem of his personal "quality of life".

Continuous spinal analgesia by means of micropumps[correction of micropumpus]: a report of 163 chronic pain patients.

Chronic pain in patients suffering from advanced cancer as well as unbearable chronic pain states depending on non-malignant pathology have always represented a test bench to verify results of advanced therapeutical programs as to more traditional approaches. The Authors present their experience resulting from longterm spinal infusion with peridural catheters connected to portable micropumps for the continuous administration of analgesic solutions. The availability of portable micropumps, a better understanding of spinal opioid receptors and advances in pharmacokinetics of opiate analgesics led in these years to a tremendous improvement of pain control possibilities and of the quality of life of patients.

Total parenteral nutrition (TPN) in the critically ill patient.

A study has been carried out on the effectiveness of a total parenteral nutrition (TPN) program on 12 patients in intensive care units (ICU). Conclusions have been drawn from biohumoral parameters during the first fornight's stay in the ICU. Results, relating to the re-equilibrium of the glycid and protydic sectors, varied in respect of their temporal distribution. There was in fact a stabilisation, if only temporary, in the glycemy, in the very first days, while the proteic metabolism figures showed a recovery leading to stabilisation only in the second week.

Cutaneous, musculoskeletal and bone flow scintiscan by intravenous infusion of 99mTc-MDP (Diphosphonate) in the evaluation and control of patients treated with spinal cord stimulation for ischaemic pain.

In patients affected by unbearable pain secondary to peripheral vascular disorders beyond surgical repair such as thromboangitis obliterans, diabetic microangiopathy, arteriosclerosis obliterans, there is a need to establish the degree of micro-circulation functionality before proceeding with invasive pain therapy, such as Spinal Cord Stimulation (SCS). From our series some cases of refractory ischaemic pain subjected to nuclear medicine techniques assessment before and after SCS implant will be presented; these data suggest that the use of radionuclides for quantifying regional perfusion, in view of the information it offers us both in the dynamic angiographic phase and in the later static phase, constitutes a very valid aid in the diagnosis and treatment of chronic pain conditions of ischaemic origin. Cutaneous, musculoskeletal and bone flow scintiscan is a non-invasive procedure which allowed us to make an objective selection of patients who are candidates for prolonged conservative treatment thus limiting the incidence of ineffective permanent SCS implants.

The epidural and intrathecal administration of somatotrophin-release inhibiting factor: native and synthetic analogues.

It is well-known that morphine is the king of analgesics. It is widely used, and administered in various ways for the control of acute and chronic pain states. There are, however, certain types of pain and certain clinical conditions in which morphine cannot be used due to the risk of possible complications. These are usually pain states associated with intracranial hypertension, the presence of serious respiratory problems, the onset of major opioid tolerance, persistent vomiting, and so on. The search for "alternative analgesics" has been in progress for a decade, alternatives that could be used alone or in combination for spinal administration in the treatment of complex chronic pain states and with a low incidence of secondary effects. Today, research is carefully assessing the clinical effectiveness and the side effects of a series of drugs for spinal administration, that is, epidural or intrathecal, such as the new narcotics, alpha-2 agonists, central muscle relaxants, calcitonin, and local anesthetics. In this alternative analgesic category we have to mention the somatotrophin-release inhibiting factor (SRIF), which is an ubiquitous native hormone with widespread, predominantly inhibitory actions, and octreotide, its synthetic analogue. In this article we review the literature on the natural drug and its synthetic analogue, paying particular attention to the problems connected with intraspinal administration and analgesic properties.