[Controlled release hydromorphone for visceral, somatic and neuropathic pain]. / Retardiertes Hydromorphon bei viszeralen, somatischen und neuropathischen Schmerzen.

The aim of this multicentre, longitudinal investigation was to document the efficacy and tolerability profiles of controlled release hydromorphone in patients with heavy visceral, somatic or neuropathic pain under practical conditions. To this end, a prospective observational study was conducted in 57 centres in Switzerland, on a total of 196 patients. After an average of 43 days of treatment with controlled release hydromorphone, the intensity of momentary pain dropped by 46.5% and that of maximum pain dropped by 41.3%, with the efficacy of the treatment being most pronounced with visceral and somatic pain. At the same time, the prevalence of sleep disorders as a result of pain decreased from initially 86.7% to 21.0%. Controlled release hydromorphone was excellently tolerated in this group of elderly (average age 70.6 years), multimorbid pain patients receiving various medical treatments (average of 2.4 drugs in addition to pain medication), even in the voluntary long-term extension study of up to 96 days. No medical interactions were reported. Six and thirteen weeks after introducing the treatment, 89.8% and 85.2%, respectively, were still taking controlled release hydromorphone. Controlled release hydromorphone is a recommendable option for practical treatment of heavy and extremely heavy pain of various genesis.

[Outpatient management of common persistent low back pain]. / Prise en charge ambulatoire de la lombalgie commune persistante.

Non specific low back pain is commonly a persistent or recurrent problem associated sometimes with impairment to return to work. In this article, we study some treatments strategies through a typical history.

[Confronted with mono-arthritis: which tests?]. / Face à une monoarthrite: quelles investigations?

A monoarthritis may correspond to a localized inflammatory process or to the onset of rheumatoid disease that may later on spread over few or several of the other joints. In this article the different diagnostic and therapeutic steps to approach monoarthritis are presented. One of the first investigations consists in an analysis of the synovial fluid. It should take place before any therapeutic step is initiated and may allow to diagnose a microcrystalline or a septic arthritis. By means of a literature review monoarthritis is described as a disease, whose cause remains often undisclosed inspite of intensive investigations, whose further course, however, is often favorable.

[Stress fracture of the distal end of the tibia simulating ankle arthropathy]. / Fracture de contrainte de l'extrémité distale du tibia simulant une arthropathie de la cheville.

The authors report four cases of stress fracture of the distal tibia simulating acute arthritis of the ankle. Two patients had a noninflammatory tibiotarsal joint effusion whose cause is discussed.

[The pitfalls of cruralgia]. / Les pièges de la cruralgie.

Crural neuralgia can initially present as an involvement of the hip joint. We studied some clinical factors helpful for the diagnosis, which is sometimes difficult.

[Inaugural rachialgia in polyradiculoneuritis or meningoradiculitis]. / Rachialgies inaugurales lors de polyradiculonévrites ou de méningo-radiculites.

Meningoradiculitis or polyradiculoneuritis can manifest itself as a back pain of inflammatory nature. Two case reports give us information about the characteristics of a back pain at the onset of a neurological disease.

[Duration of rehabilitation and fate of patients with cerebral infarction]. / Durée de la rééducation et devenir des patients souffrant d'infarctus cérébraux.

We studied 61 patients with a first stroke, admitted in our rehabilitation center. Functional evolution is usually good, 84% of patients are able to return at home, after a mean of 4.6 months of rehabilitation. Age, sex, severity of the initial deficit, shoulder-hand syndrome, etiology and localisation of stroke are the factors which determine the functional recovery and duration of hospitalisation.

Cardiac sources of embolism and cerebral infarction--clinical consequences and vascular concomitants: the Lausanne Stroke Registry.

We studied clinical characteristics and coexisting causes of stroke in 305 patients admitted to a population-based primary care center with an initial ischemic stroke and a potential cardiac source of embolism (PCSE). Using systematic standardized cardiac, arterial, and cerebral investigations and the logistics of the prospective Lausanne Stroke Registry, we found that nonprogressive onset, hemianopia without hemiparesis or hemisensory disturbances, Wernicke's aphasia, ideomotor apraxia, involvement of specific territories (posterior division of middle cerebral artery, anterior cerebral artery, cerebellum, multiple territories), and a hemorrhagic component were associated with the presence of a PCSE, as compared with 1,006 initial ischemic stroke patients without PCSE. Although age and sex did not differ, the frequency of hypertension, diabetes, cigarette smoking, elevated blood cholesterol, and deep hemispheric or brainstem infarcts was higher in the patients without a PCSE. Nearly one-fourth of the patients with a PCSE had a coexisting potential arterial cause of stroke (large artery greater than or equal to 50% stenosis or small-vessel disease). In the majority of patients with a PCSE (76.7%), cardioembolism was the most likely cause of stroke, although a direct source of embolism was uncommon (4.3%) and intracranial embolic occlusions were present in less than one-half of the patients who were angiographed.

[Cardiac sources of cerebral embolism and infarction: results of the Lausanne register for cerebrovascular accidents]. / Sources cardiaques d'embolie et infarctus cérébraux: résultats du Registre lausannois des accidents vasculaires cérébraux.

We studied 305 patients with a first stroke and a potential cardiac source of embolism (PCSE), on the basis of the Lausanne Stroke Registry. We have compared these patients with 1006 patients with stroke but without PCSE, admitted into the Registry during the same period, in order to assess the potential role of PCSE and the coexistence of other causes of stroke. Analysis of the various types of PCSE suggests that some neurologic characteristics are more frequent in patients with than without PCSE (infarcts of the posterior division of middle cerebral artery with Wernicke's aphasia and lateral hemianopia; maximal neurologic deficit at onset; haemorrhagic infarcts).