Efficacy and tolerability of diclofenac potassium sachets in migraine: a randomized, double-blind, cross-over study in comparison with diclofenac potassium tablets and placebo.

A randomized, controlled, cross-over trial compared single doses of 50 mg diclofenac potassium sachets and tablets with placebo in 328 patients with migraine pain, treating 888 attacks. For the primary endpoint 24.7% of the patients were pain free at 2 h postdose with sachets, 18.5% for tablets and 11.7% for placebo. Treatment differences were significant for sachets vs. placebo (P<0.0001), tablets vs. placebo (P=0.0040) and for sachets vs. tablets (P=0.0035). The numbers needed to treat compared with placebo to achieve pain free at 2 h were 7.75 [95% confidence interval (CI) 5.46, 13.35] for sachets and 15.83 (95% CI 8.63, 96.20) for tablets. Sachets were also statistically superior to tablets for sustained headache response, sustained pain free and reduction in headache intensity within the first 2 h postdose measured on a visual analogue scale (P<0.05). Onset of analgesic effect was 15 min for sachets and 60 min for tablets. Fewer patients needed rescue medication, and there were marked improvements in accompanying symptoms and working ability with both sachets and tablets vs. placebo. No safety issues were identified. This study demonstrates that sachets offer patients suffering from migraine pain a more effective treatment with a faster onset of analgesia when compared with tablets.

[Percutaneous vertebral surgery. Indications, technics and possibilities]. / Przezskórna plastyka kregów. Wskazania, technika i mozliwosci.

UNLABELLED: The authors report their own experience with percutaneous vertebroplasty, one of the so called--minimally invasive methods, used to treat a certain group of spinal lesions affecting the vertebral bodies. The paper contains a brief review of the current literature, basic problems, indications and operative technique. The authors remark, that insertion of the needle into the vertebral body gives an access for biopsy before cement injection. This procedure was realised in the case of diagnostic uncertainty. Technical details of transpedicular biopsy are described. The authors present 2 representative cases. FIRST CASE: a female with pathologic fracture of the Th7 vertebral body of osteoporotic origin. TREATMENT: combination of biopsy and vertebroplasty by percutaneous transpedicular approach. Second case: a female with cancer metastasis in L1 vertebral body, vertebroplasty was performed to support the anterior spinal column. Needle insertion was controlled either by radiofluoroscopy or by CT. The authors confirm pain relief related to vertebroplasty.

[Stereotactic biopsy and brachytherapy in the diagnostics and treatment of brain tumors--preliminary report]. / Wczesne wyniki zastosowania biopsji stereotaktycznej i brachyterapii w diagnostyce i leczeniu guzów mózgu.

Promising results have been obtained using brachytherapy in the treatment of brain tumors. Between November 99 and August 2000, 28 patients with brain tumors (15 newly diagnosed gliomas, 11 recurrent gliomas, 2 metastases) underwent implantation of temporary iridium 192 sources with stereotactic technique. This group received external beam radiation therapy (45 Gy) following implantation. Patients were followed-up with CT scans every 3 months. Serious complications occurred in two patients (postradiation brain oedema). Median survival has not been assessed due to short follow-up period and small number of patients. Further clinical assessment is required especially long-term follow-up. Brachytherapy appears to be a useful technique for the treatment of selected brain tumors.

Cerebral blood flow in Sjögren's syndrome using 99Tcm-HMPAO brain SPET.

Neuropsychiatric disturbances are frequent in connective tissue diseases. Little is known about the cerebral pathophysiology of Sjögren's syndrome, including cerebral blood flow disturbances. 99Tcm-HMPAO brain SPET was performed in 21 Sjögren's syndrome patients. We also studied 77 patients with systemic lupus erythematosus and 27 healthy individuals. Our results demonstrate the high rate of alterations in cerebral blood flow in Sjögren's syndrome, both psychoneurologically symptomatic and asymptomatic. Focal interhemispherical perfusion deficits were seen in 17 of 21 patients (80.9%) with Sjögren's syndrome: 13/15 symptomatic (86.6%) and 4/6 asymptomatic (66.6%). These changes were mostly localized in the prefrontal and frontal areas, occipital lobes and occipitoparietal area, and less frequently so in the temporal, parietal and central areas. Diffuse hypoperfusion of the frontal lobes (bilateral hypofrontality) was seen in 29% of patients in the Sjögren's group. An acetazolamide stress test was performed in seven patients. There was an increase in perfusion deficits in two patients, no change in two patients, and hypoperfusion decreased in three patients compared with baseline. The results indicate that most Sjögren's syndrome patients experience alterations in cerebral blood flow that are consistent with systemic lupus erythematosus, with heterogeneous reactivity to acetazolamide-induced hypercapnia. These alterations present as focal perfusion deficits and bilateral diffuse hypoperfusion of the lobes. The mechanism of cerebral blood flow alterations is unknown, although it might be the result of diffuse cerebral vasculitis.

[Peridural fibrosis in lumbar disc surgery--pathogenesis, clinical problems and prophylactic attempts]. / Blizna oponowa w operacjach odcinka ledzwiowego kregoslupa--mechanizm powstawania, problemy kliniczne i próby profilaktyki.

Postoperative peridural fibrosis is unavoidable adverse effect of lumbar disc surgery. This process is disadvantageous both to the patient and to the surgeon. It is assumed that peridural fibrosis is responsible for as much as 25% of all Failed Back Surgery Syndrome. In case of reherniated discs requiring reoperation epidural scar may cause technical difficulties. Thus the prevention or inhibition of postoperative peridural fibrosis and adhesions is an essential goal for successful lower back surgery. The authors review new opinions on pathophysiology of peridural fibrosis, clinical aspects of the process, results of experimental approaches for limiting peridural fibrosis and perspective of anti-adhesion gel Adcon-L.

[Binswanger's disease--diagnostic criteria and analysis of cases]. / Choroba binswangera--kryteria diagnostyczne i analiza przypadków.

Binswanger's disease(BD) in an effect of a vascular destruction of deep white matter structures following multiple infarcts leading to disturbances of perception functions, recent memory and characterological disorders. BD is a disease occurring in late 6th decade of life. Computerized tomography and magnetic resonance imaging demonstrate foci of microinfarcts which coexist with arterial hypertension, atheromatous lesions and general cerebral atherosclerosis. BD leads to dementia, certain Parkinson-like signs, pyramidal system involvement, depression, organic brain damage syndrome, dysbasia and sphincter control loss. Ten patients observed by the author are reported.

[Evaluation of anxiety and depression in patients with vascular brain damage]. / Ocena leku i depresji u chorych z naczyniopochodnym uszkodzeniem mózgu.

In 90 patients with vascular damage to the CNS an assessment was carried out of the intensity of anxiety on the basis of Anxiety State and Trait Inventory, of the degree of symptom intensity of depression syndrome on the basis of Hamilton Depression Scale and of personality and socioeconomic conditions on the basis of history data in' and Eysenck Personality Inventory. In the studies the hemispheric laterality of brain damage was taken into account. The results were analysed statistically comparing them with those obtained in the control group of healthy men aged 18-24 years. On the basis of the studies and calculations the following conclusions were drawn: 1--the intensity of anxiety and depression in patients treated for vascular CNS damage is greater than in the control group. 2--statistically higher depression intensity was found in patients with left hemisphere damage as compared with the group with right hemisphere damage. 3--in patients living in good social conditions and regarding their family relations as good, the intensity of anxiety and depression was statistically lower than in the group of patients with poor family and socioeconomic conditions.

[Neurologic complications in Wegener's granulomatosis]. / Powiklania neurologiczne ziarniniakowatosci Wegenera.

Nervous system involvement is relatively frequent in Wegener's granulomatosis (WG). It may be difficult to differentiate between the primary central nervous system involvement and complications secondary to concomitant arterial hypertension, renal insufficiency and iatrogenic effects of immunosuppressive therapy. The crucial role in the assessment of intracranial pathology may be ascribed to the diagnostic imaging techniques: magnetic resonance imaging (MRI), computed tomography (CT) and cerebral blood flow imaging utilising the single photon emission computed tomography (SPECT). SPECT may prove superior sensitivity to MRI. It may be especially useful in differentiating central nervous system involvement in WG with secondary changes of other origin.

[Tomographic cerebral blood flow scanning in diagnosis of psychiatric disorders]. / Tomograficzne badanie przeplywu mózgowego w diagnostyce chorób psychicznych.

The paper summarises the role of tomographic cerebral blood flow SPECT scanning in psychiatric diagnostics, its' physical and radiopharmaceutical basis, pathological physiology of cerebrovascular circulation in psychiatric disorders and interpretation of cerebral blood flow scanning results by the clinician. Cerebral blood flow scanning is, to some extent, a functional equivalent of CT/MRI scanning. In psychiatry cerebral blood flow SPECT scanning's basic application is the differentiation of dementia and cognitive impairment, in particular Alzheimer's disease, frontotemporal lobar degeneration and multi-infarct dementia. The other indications for brain SPECT scanning involve the organic brain lesions and medico-legal diagnostics, including the sequelae of cranio-cerebral trauma. Contraindications and economical aspects are underlined.

[Brain perfusion changes after head trauma assessed by cerebral SPECT with aminophylline test]. / Przeplyw mózgowy i reaktywnosc naczyniowa w odleglym okresie po urazie mózgowym badane przy pomocy tomografii emisyjnej SPECT z testem acetazolamidowym i aminofilinowym.

Tomographic cerebral blood flow SPECT scanning using Tc-99m-HMPAO was performed before and after i.v. administration of aminophylline in 36 patients between 6 months to 11 years after closed head trauma. Asymmetries of brain perfusion were found in 34 patients, normal rCBF distribution in 2 patients. Bi-focused asymmetries on the presumed line: trauma-contra coup were seen in 64% of the patients. In 70.4% of the patients with brain perfusion asymmetries the CT scan was normal. The aminophylline test improved the perfusion in 42% of the patients, indicating preserved perfusion reserve. Persistence of brain perfusion alterations after head trauma exists. Aminophylline test may be useful in the assessment of brain perfusion reserve in post-traumatic focus. Brain perfusion SPECT scans may be useful for medico-legal purposes.

[Tc-99m-MIBI and Tc-99m-HMPAO accumulation in primary and metastatic brain tumors assessed by brain SPECT]. / Akumulacja Tc-99m-MIBI i Tc-99m-HMPAO w pierwotnych i przerzutowych guzach mózgu ocenione tomografia emisyjna SPECT.

Imaging of intracranial lesions is frequently difficult in CT/MRI diagnosis. The introduction of the encephalic tracer MIBI seemed to be a promising alternative. We tried to compare the accumulation of Tc-99m-MIBI and HMPAO CT/MRI interpretationeally difficult intracranial lesions. We did SPECT scanning with single-head and triple-head gammacamera after i.v. administration of Tc-99m-HMPAO/MIBI. We performed HMPAO scanning in 34 patients, MIBI scanning in 41 pts. CT and MRI scanning was performed simultaneously. Histological diagnosis was done intra- and/or postoperatively. Increased accumulation of Tc-99m-MIBI was seen in 7/7 meningiomas (100%), 7/9 gliomas (77%), 10/15 brain metastases (66%), 2/4 unverified. In 5 cases with finally non-neoplastic diagnosis (stroke, a-v malformation) no MIBI accumulation was seen. Increased accumulation of HMPAO was seen in 3/11 gliomas, 2/7 meningiomas, 2/8 metastases and 2/4 unverified. In 4 cases non-neoplastic diagnosis was established. Our results seem to be less promising, than reported so far, particularly for heterogeneous accumulation of MIBI in metastatic tumours. The coupled Tc-99m-MIBI/HMPAO scanning may be useful in primary tumour diagnosis, particularly in meningiomas.

Cerebral blood flow assessed by brain SPECT with 99mTc-HMPAO utilising the acetazolamide test in systemic lupus erythematosus.

BACKGROUND: Cerebrovascular diseases are one of the most important complications of systemic lupus erythematosus (SLE). The diagnostic imaging of neuropsychiatric SLE complications presents many problems. This study was undertaken to investigate cerebral blood flow char s and its reactivity to hypercapnia by means of acetazolamide test in SLE patients. METHODS: Brain SPELT studies using 99mTc-HMPAO were performed in 50 patients with SLE. Acetazolamide test was performed in 35 patients 3 days after the baseline study by means of repetitive scanning 20 min after i.v. injection of 1.0 g of acetazolamide. RESULTS: Significant interhemispheric hypoperfusion areas were shown in 76.3% of all patients, 83.8% symptomatic and 63.1 % asymptomatic. Patients with antiphospholipid syndrome showed multifocal perfusion deficits. The reaction of cerebral perfusion to acetazolamide was heterogenous and showed increase, decrease, no change or mixed reaction of baseline-study-found focal hypoperfusion. Acetazolamide test revealed hypoperfusion in two patients with normal baseline study. MRI scanning revealed cerebral lesions in 41 % of patients. CONCLUSIONS: CBF asymmetries in symptomatic and asymptomatic patients with SLE are frequent. Regional CBF alterations seem to be different in patients with and without antiphospholipid syndrome. The part of the patients with SLE shows no or paradoxically inversed reaction to acetazolamide.

[Rare care of Ramsay Hunt syndrome associated with herpes zoster of the glossopharyngeal nerve]. / Rzadki przypadek wspólistnienia zespolu Ramsay Hunta z pólpascem nerwu jezykowo-gardlowego.

The authors describe a rare coexistence of Ramsay Hunt syndrome with glossopharyngeal zoster in a 67-year-old patient. A trial of systematization of the nomenclature of Ramsay Hunt syndrome is suggested, on the basis of certain anatomophysiological data. It is concluded that in zoster involvement of the sensory elements in the geniculate ganglion and in otic ganglion should be accompanied by taste sensitivity disturbances, but often the patients fail to notice these disturbances and routine taste testing shows also no such tase impairment. Routine use of electrogustometry is postulated since this makes possible diagnostic-prognostic assessment followed by selection of appropriate treatment.