69 patients suffering from chronic therapy-resistant neurogenic pain of peripheral and/or central origin underwent a stereotactic medial thalamotomy. Medial thalamic unit recordings were performed peroperatively, allowing the physiological confirmation of the electrode location and the recognition of a specific physiopathology. Thanks to these recordings, a concept was developed, based on the presence of an imbalance between medial (nucleus centralis lateralis mainly) and lateral (nucleus ventroposterior) thalamic nuclei, resulting in an over-inhibition of both by the reticular thalamic nucleus, and then in a paradoxical activation of pain-related cortical areas. The medial thalamotomy, re-actualized by new technical, anatomical and physiological data, offers a 50-100% relief to 67% of all patients with peripheral as well as central neurogenic pain, on all body localizations, without producing neurological deficits and without risk for the development of iatrogenic pain.
{"title":"Chronic neurogenic pain and the medial thalamotomy.","authors":"D Jeanmonod, M Magnin, A Morel","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>69 patients suffering from chronic therapy-resistant neurogenic pain of peripheral and/or central origin underwent a stereotactic medial thalamotomy. Medial thalamic unit recordings were performed peroperatively, allowing the physiological confirmation of the electrode location and the recognition of a specific physiopathology. Thanks to these recordings, a concept was developed, based on the presence of an imbalance between medial (nucleus centralis lateralis mainly) and lateral (nucleus ventroposterior) thalamic nuclei, resulting in an over-inhibition of both by the reticular thalamic nucleus, and then in a paradoxical activation of pain-related cortical areas. The medial thalamotomy, re-actualized by new technical, anatomical and physiological data, offers a 50-100% relief to 67% of all patients with peripheral as well as central neurogenic pain, on all body localizations, without producing neurological deficits and without risk for the development of iatrogenic pain.</p>","PeriodicalId":21438,"journal":{"name":"Schweizerische Rundschau fur Medizin Praxis = Revue suisse de medecine Praxis","volume":"83 23","pages":"702-7"},"PeriodicalIF":0.0,"publicationDate":"1994-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"19009681","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The introduction of modern methods into research and daily diagnostic practice of pathology has brought about major advances. In the middle of our century electron microscopy gave new insights into the ultrastructure by increasing the resolution one thousand times as compared to classical light microscopy. Immunofluorescence and histochemistry allowed assessment of functional and morphologic changes. Important new information was gained by the introduction of immunohistochemistry. The ability of antibodies to bind to epitopes even in formalin-fixed and paraffin-embedded tissues allows the precise diagnosis in many poorly differentiated tumors. The combination of different techniques (as for example immunohistochemistry and electron microscopy in the case of immuno-electronmicroscopy) lead to important new findings. The application of molecular biologic methods was a major step forward. They allow to precisely detect genomic sequences. Complementary strands are synthesized (so called probes), labelled and allowed to hybridize to the nucleic acid sequence looked for. Several examples are shown. The detection of viral nucleic acids (many of which can not reliably be identified on routine histological sections) can be achieved by in situ hybridization. The demonstration of bacteria which are slowly growing (as mycobacteria) or cannot be successfully cultivated can be easily achieved after amplification of specific nucleic acid sequences by the polymerase chain reaction. Molecular biological techniques are indispensable in cancer research (as shown here by the demonstration of IGF2 in nephroblastomas) but are also important in the diagnosis of tumors (as shown by the presence of T-cell-receptor-rearrangement in the case of suspected T-cell-lymphoma).(ABSTRACT TRUNCATED AT 250 WORDS)
{"title":"[Current diagnosis in pathology].","authors":"J Briner","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The introduction of modern methods into research and daily diagnostic practice of pathology has brought about major advances. In the middle of our century electron microscopy gave new insights into the ultrastructure by increasing the resolution one thousand times as compared to classical light microscopy. Immunofluorescence and histochemistry allowed assessment of functional and morphologic changes. Important new information was gained by the introduction of immunohistochemistry. The ability of antibodies to bind to epitopes even in formalin-fixed and paraffin-embedded tissues allows the precise diagnosis in many poorly differentiated tumors. The combination of different techniques (as for example immunohistochemistry and electron microscopy in the case of immuno-electronmicroscopy) lead to important new findings. The application of molecular biologic methods was a major step forward. They allow to precisely detect genomic sequences. Complementary strands are synthesized (so called probes), labelled and allowed to hybridize to the nucleic acid sequence looked for. Several examples are shown. The detection of viral nucleic acids (many of which can not reliably be identified on routine histological sections) can be achieved by in situ hybridization. The demonstration of bacteria which are slowly growing (as mycobacteria) or cannot be successfully cultivated can be easily achieved after amplification of specific nucleic acid sequences by the polymerase chain reaction. Molecular biological techniques are indispensable in cancer research (as shown here by the demonstration of IGF2 in nephroblastomas) but are also important in the diagnosis of tumors (as shown by the presence of T-cell-receptor-rearrangement in the case of suspected T-cell-lymphoma).(ABSTRACT TRUNCATED AT 250 WORDS)</p>","PeriodicalId":21438,"journal":{"name":"Schweizerische Rundschau fur Medizin Praxis = Revue suisse de medecine Praxis","volume":"83 23","pages":"691-7"},"PeriodicalIF":0.0,"publicationDate":"1994-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"19009679","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Erythropoietin is a hormone whose production is stimulated by all forms of oxygen deficiency. The main production takes place in specialized fibroblasts in the kidney of adults and in liver cells during the fetal and neonatal period. The most important function of the hormone can be derived from its name: It stimulates erythropoiesis in the bone marrow and thus controls O2-capacity of blood. A thoroughly controlled feedback-mechanism between oxygen-supply erythropoietin release and renewal of erythrocytes provides for a constant level of erythrocytes in blood. This feedback mechanism is disturbed by chronic renal diseases, chronic inflammations and also in premature infants. Recombinant human erythropoietin is used as hormonal substitute in order to correct diverse types of anemia and may also be used in the context of re-transfusions.
{"title":"[Erythropoietin: from gene to therapeutic agent].","authors":"C Bauer","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Erythropoietin is a hormone whose production is stimulated by all forms of oxygen deficiency. The main production takes place in specialized fibroblasts in the kidney of adults and in liver cells during the fetal and neonatal period. The most important function of the hormone can be derived from its name: It stimulates erythropoiesis in the bone marrow and thus controls O2-capacity of blood. A thoroughly controlled feedback-mechanism between oxygen-supply erythropoietin release and renewal of erythrocytes provides for a constant level of erythrocytes in blood. This feedback mechanism is disturbed by chronic renal diseases, chronic inflammations and also in premature infants. Recombinant human erythropoietin is used as hormonal substitute in order to correct diverse types of anemia and may also be used in the context of re-transfusions.</p>","PeriodicalId":21438,"journal":{"name":"Schweizerische Rundschau fur Medizin Praxis = Revue suisse de medecine Praxis","volume":"83 23","pages":"698-701"},"PeriodicalIF":0.0,"publicationDate":"1994-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"19009680","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
In order to determine the risk of anesthesia the anesthesiologist has to assess both the physical and the psychological status of the patient. The essential basis of any preoperative medical evaluation are the history and complete physical examination of the patient. Few laboratory screening tests and, in case of pathological findings, specific diagnostic procedures will ensue. If possible, preoperative therapies must be considered in order to reduce the risk resulting from concomitant diseases. However, apart from the patients diseases, both the risks of the anesthetic and surgical procedures contribute to the overall perioperative risk. On the basis of the preoperative evaluation, the anesthesiologist determines the methods of anesthesia to be applied. He also informs the patient about the planned anesthesia, the sequence of further measures, the risk of anesthesia, and accompanying risks. The family doctor can help to facilitate the preoperative assessment by performing certain examinations himself and by providing the anesthesiologist with relevant informations. By giving a piece of advice to the patient he can help to prepare him for anesthesia and to reduce fear and apprehensiveness.
{"title":"[Risk assessment and patient information before anesthesia].","authors":"A Zollinger, T Pasch","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>In order to determine the risk of anesthesia the anesthesiologist has to assess both the physical and the psychological status of the patient. The essential basis of any preoperative medical evaluation are the history and complete physical examination of the patient. Few laboratory screening tests and, in case of pathological findings, specific diagnostic procedures will ensue. If possible, preoperative therapies must be considered in order to reduce the risk resulting from concomitant diseases. However, apart from the patients diseases, both the risks of the anesthetic and surgical procedures contribute to the overall perioperative risk. On the basis of the preoperative evaluation, the anesthesiologist determines the methods of anesthesia to be applied. He also informs the patient about the planned anesthesia, the sequence of further measures, the risk of anesthesia, and accompanying risks. The family doctor can help to facilitate the preoperative assessment by performing certain examinations himself and by providing the anesthesiologist with relevant informations. By giving a piece of advice to the patient he can help to prepare him for anesthesia and to reduce fear and apprehensiveness.</p>","PeriodicalId":21438,"journal":{"name":"Schweizerische Rundschau fur Medizin Praxis = Revue suisse de medecine Praxis","volume":"83 23","pages":"708-12"},"PeriodicalIF":0.0,"publicationDate":"1994-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"19009682","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The cornerstones of a travel health consultation are: information, advice on anti-mosquito measures, vaccinations, malaria chemoprophylaxis and guidelines for presumptive treatment. The art of travel medicine is the ability to focus on the realistic health needs of the traveller whilst leaving aside superfluous information. In this way, unnecessary adverse events, expenses and patient anxiety can be avoided.
{"title":"[Do's and don'ts in travel medicine advice].","authors":"R Steffen, I Klopfstein","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The cornerstones of a travel health consultation are: information, advice on anti-mosquito measures, vaccinations, malaria chemoprophylaxis and guidelines for presumptive treatment. The art of travel medicine is the ability to focus on the realistic health needs of the traveller whilst leaving aside superfluous information. In this way, unnecessary adverse events, expenses and patient anxiety can be avoided.</p>","PeriodicalId":21438,"journal":{"name":"Schweizerische Rundschau fur Medizin Praxis = Revue suisse de medecine Praxis","volume":"83 23","pages":"713-7"},"PeriodicalIF":0.0,"publicationDate":"1994-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"19014447","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The diagnostic term eczema refers to a group of skin diseases defined by the morphological criteria of erythema, papules, papulovesicles and, in the chronic stage, lichenification and desquamation. While the diagnostic workup should lead to a more specific diagnosis (irritant or allergic contact dermatitis, atopic, seborrheic or nummular dermatitis), the therapeutic approach is similar for most forms of eczema. In the present review, traditional and innovative therapeutic options are presented and discussed.
{"title":"[Current eczema therapy].","authors":"W Spirig, P Elsner","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The diagnostic term eczema refers to a group of skin diseases defined by the morphological criteria of erythema, papules, papulovesicles and, in the chronic stage, lichenification and desquamation. While the diagnostic workup should lead to a more specific diagnosis (irritant or allergic contact dermatitis, atopic, seborrheic or nummular dermatitis), the therapeutic approach is similar for most forms of eczema. In the present review, traditional and innovative therapeutic options are presented and discussed.</p>","PeriodicalId":21438,"journal":{"name":"Schweizerische Rundschau fur Medizin Praxis = Revue suisse de medecine Praxis","volume":"83 23","pages":"718-21"},"PeriodicalIF":0.0,"publicationDate":"1994-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"19014448","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The differential diagnosis of hip pain does not only include disorders limited to the hip joint itself but those of adjacent bones and periarticular soft tissues. In addition spine disorders, intraabdominal pathologies, peripheral vascular diseases and nerve entrapment syndromes should be considered. A careful clinical history and examination of the patient are essential for precise diagnosis. Some typical manifestations of disorders frequently seen in clinical practice are outlined.
{"title":"[Hip pain from a rheumatologic viewpoint].","authors":"P Brühlmann, B A Michel","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The differential diagnosis of hip pain does not only include disorders limited to the hip joint itself but those of adjacent bones and periarticular soft tissues. In addition spine disorders, intraabdominal pathologies, peripheral vascular diseases and nerve entrapment syndromes should be considered. A careful clinical history and examination of the patient are essential for precise diagnosis. Some typical manifestations of disorders frequently seen in clinical practice are outlined.</p>","PeriodicalId":21438,"journal":{"name":"Schweizerische Rundschau fur Medizin Praxis = Revue suisse de medecine Praxis","volume":"83 23","pages":"722-6"},"PeriodicalIF":0.0,"publicationDate":"1994-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"19014449","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Urolithiasis has always been a well known phenomenon to mankind. Whereas up to the beginning of the 19th century, open surgery for bladder stones was known to be a high risk operation due to its frequent complications, nowadays we are able to disintegrate renal and vesical calculi into spontaneously excretable fragments by means of shock waves generated extracorporeally (ESWL). The physical principles of shock waves and their impact on the stone are explained. By means of ESWL the time of hospitalisation as well as of recovery can be massively reduced saving billions to our economy.
{"title":"[Therapy of nephrolithiasis].","authors":"D Hauri","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Urolithiasis has always been a well known phenomenon to mankind. Whereas up to the beginning of the 19th century, open surgery for bladder stones was known to be a high risk operation due to its frequent complications, nowadays we are able to disintegrate renal and vesical calculi into spontaneously excretable fragments by means of shock waves generated extracorporeally (ESWL). The physical principles of shock waves and their impact on the stone are explained. By means of ESWL the time of hospitalisation as well as of recovery can be massively reduced saving billions to our economy.</p>","PeriodicalId":21438,"journal":{"name":"Schweizerische Rundschau fur Medizin Praxis = Revue suisse de medecine Praxis","volume":"83 22","pages":"670-4"},"PeriodicalIF":0.0,"publicationDate":"1994-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"19009673","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}