RESUMEN
BACKGROUND: Essential tremor (ET) is one of the most common tremor disorders in adults and is characterized by kinetic and postural tremor. To develop this practice parameter, the authors reviewed available evidence regarding initiation of pharmacologic and surgical therapies, duration of their effect, their relative benefits and risks, and the strength of evidence supporting their use. METHODS: A literature review using MEDLINE, EMBASE, Science Citation Index, and CINAHL was performed to identify clinical trials in patients with ET published between 1966 and August 2004. Articles were classified according to a four-tiered level of evidence scheme and recommendations were based on the level of evidence. RESULTS AND CONCLUSIONS: Propranolol and primidone reduce limb tremor (Level A). Alprazolam, atenolol, gabapentin (monotherapy), sotalol, and topiramate are probably effective in reducing limb tremor (Level B). Limited studies suggest that propranolol reduces head tremor (Level B). Clonazepam, clozapine, nadolol, and nimodipine possibly reduce limb tremor (Level C). Botulinum toxin A may reduce hand tremor but is associated with dose-dependent hand weakness (Level C). Botulinum toxin A may reduce head tremor (Level C) and voice tremor (Level C), but breathiness, hoarseness, and swallowing difficulties may occur in the treatment of voice tremor. Chronic deep brain stimulation (DBS) (Level C) and thalamotomy (Level C) are highly efficacious in reducing tremor. Each procedure carries a small risk of major complications. Some adverse events from DBS may resolve with time or with adjustment of stimulator settings. There is insufficient evidence regarding the surgical treatment of head and voice tremor and the use of gamma knife thalamotomy (Level U). Additional prospective, double-blind, placebo-controlled trials are needed to better determine the efficacy and side effects of pharmacologic and surgical treatments of ET.
Asunto(s)
Antagonistas Adrenérgicos beta/uso terapéutico , Anticonvulsivantes/uso terapéutico , Temblor Esencial/tratamiento farmacológico , Temblor Esencial/cirugía , Fármacos Neuromusculares/uso terapéutico , Procedimientos Neuroquirúrgicos/normas , Ensayos Clínicos como Asunto/estadística & datos numéricos , Estimulación Encefálica Profunda/normas , Estimulación Encefálica Profunda/estadística & datos numéricos , Temblor Esencial/fisiopatología , Humanos , Procedimientos Neuroquirúrgicos/estadística & datos numéricos , Radiocirugia/normas , Radiocirugia/estadística & datos numéricos , Tálamo/fisiopatología , Tálamo/cirugía , Resultado del TratamientoRESUMEN
A mediastinal lymphocele occurring after esophagogastrectomy is demonstrated with CT following lymphography. This technique allows the definitive diagnosis of lymphocele, permitting differentiation from other post-operative mediastinal masses.
Asunto(s)
Quistes/diagnóstico por imagen , Enfermedades Linfáticas/diagnóstico por imagen , Quiste Mediastínico/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Aceite Etiodizado , Humanos , Linfografía , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/diagnóstico por imagenRESUMEN
The cases of three patients who developed combined central retinal artery/vein obstruction secondary to retrobulbar anesthesia are presented. In one case the obstruction was presumably present immediately after surgery, while in the other two it was observed to evolve over a period of several days. A dilated optic nerve sheath was demonstrated by contact B-scan ultrasonography in two cases and by computerized tomography in the third case, suggesting intravaginal sheath hemorrhage as a common underlying pathophysiologic process. Partial return of vision was evident in the latter case following orbitotomy with optic nerve sheath decompression.