bluuebunny/crossref_metadata_2025_split huggingface dataset:
Neurology (55)
Authors: Dworkin Robert H. , Perkins Frederick M. , Nagasako Elna M. 
Published: September 2010

Prospects for the prevention of postherpetic neuralgia in herpes zoster patients. (University of Rochester School of Medicine and Dentistry, Rochester, NY) Clin J Pain 2000;16:S90–100.This review discussed the results of recent studies that have identified risk factors for the development of postherpetic neuralgia (PHN) and have implicated several peripheral and central mechanisms in its pathophysiology. These risk factors and mechanisms of PHN provide a basis for hypothesizing that combining antiviral therapy with analgesic treatment beginning as soon as possible after the onset of herpes zoster would reduce the risk of PHN beyond that achieved by antiviral therapy alone. Conclude this treatment approach would be expected to reduce the risk of PHN in herpes zoster patients by attenuating acute pain and thereby preventing the initiation of central mechanisms of chronic pain.
Neurology (56)
Authors: Backonja Misha‐Miroslav 
Published: September 2010

Anticonvulsants (antineuropathies) for neuropathic pain syndromes. (University of Wisconsin Hospital and Clinics, Madison, WI) Clin J Pain 2000;16:S67–72.This review concentrated on randomized clinical trials of anticonvulsants for neuropathic pain syndromes. The discussion included the use of phenytoin, benzodiazepines, valproic acid, lamotrigine, and gabapentin (GBP). GBP has a favorable side effects profile, and based on the results of these studies, it should be considered a first‐line treatment for neuropathic pain. GBP mechanisms of action are still not thoroughly defined, but GBP is effective in relieving indexes of allodynia and hyperalgesia in animal models. It still remains to be seen whether GBP is as effective in other painful disorders. One small clinical trial with lamotrigine demonstrated improved pain control in trigeminal neuralgia. Evidence in support of the efficacy of anticonvulsant drugs in the treatment of neuropathic pain continues to evolve, and benefits have been clearly demonstrated in the case of GBP and carbamazepine. More advances in our understanding of the mechanisms underlying neuropathic pain syndromes should further our opportunities to establish the role of anticonvulsants in the treatment of neuropathic pain. Comment by Enrique Reig, MD.The clinical efficacy of anticonvulsants is clearly established after years of use in patients with chronic neuropathic pain. However, there are few controlled studies to support their clinical efficacy. Not all anticonvulsant drugs have the same mode of action, which explains why their relief of the different symptoms of neuropathic pain (allodynia, hyperalgesia, burning pain, etc.) is varied. Gabapentine is a first‐choice drug for relieving allodynia and hyperalgesia, but it is usually less effective for decreasing paresthesia and dysaesthesia.This article does not refer to clonazepam (a benzodiazepine acting on GABA, which is useful in stabbing pain) or topiramate. The latter is an antiepileptic drug with a good profile for the treatment of neuropathic pain. It has a triple action mechanism: Na+ channel blockade, increased GABA transmission, and antagonism of the kainate‐glutamate/AMPA.
Neurology (58)
Authors: Baron Ralf 
Published: September 2010

Peripheral neuropathic pain: from mechanisms to symptoms. (Christian‐Albrechts‐Univerität Kiel, Kiel, Germany) Clin J Pain 2000;16:S12–20.This review concentrates on the several independent pathophysiological mechanisms in both the peripheral and central nervous system that are responsible for sensory symptoms as well as spontaneous and evoked pains in peripheral neuropathies. These mechanisms can operate in concert in a single disease entity and also in a single patient. Distinct pathophysiological mechanisms lead to specific sensory symptoms, for example, dynamic mechanical allodynia and cold hyperalgesia. It is also possible that the pain‐generating mechanism and the symptoms change during the course of the disease. A thorough analysis of sensory symptoms may reveal the underlying mechanisms that are mainly active in a particular patient. The treatment of neuropathic pain is currently unsatisfactory. In the future, drugs will be developed that address specifically the relevant combination of mechanisms. Comment by Enrique Reig, MD.This is an excellent article, which will be a landmark in the approach to the treatment of neuropathic pain. There are several pathophysiological mechanisms, which can cause sensitive symptoms and spontaneous or evoked pain. Mechanical or thermal hyperalgesia is caused by peripheral sensitization. Pinprick hyperalgesia is correlated to the “wind‐up” phenomenon. Allodynia has multiple triggering factors: central sensitization, central reorganization and loss of inhibitory control. Paresthesia is explained by ectopic discharges due to the accumulation of Na+ channels, as with stabbing or paroxysmal pain. A hot or burning pain can be explained by peripheral sensitization and loss of inhibitory mechanisms. This explains why not all painful syndromes respond with the same efficacy to a given treatment. Neuropathic pain can occur in very different forms. For instance, a diabetic neuropathy can be associated with allodynia and hyperalgesia, or with burning and paroxysmal pain. A different treatment is required for each of these symptoms. From now on, we must use a different criterion to label painful neuropathic syndromes. Keeping to the above example, we shall distinguish between diabetic neuropathy with allodynia and diabetic neuropathy with burning pain.
Neurosurgery (66)
Authors: Kemler Marius A. , Barendse Gerard A.M. , Van Kleef Maarten 
Published: September 2010

Spinal cord stimulation in patients with chronic reflex sympathetic dystrophy. (Maastricht University Hospital, Maastricht, The Netherlands) N Engl J Med 2000;343:618–624.This randomized trial involved patients who had had reflex sympathetic dystrophy for at least 6 months. Thirty‐six patients were assigned to receive treatment with spinal cord stimulation plus physical therapy, and 18 were assigned to receive physical therapy alone. The spinal cord stimulator was implanted only if test stimulation was successful. The intensity of pain was assessed (on a visual‐analogue scale from 0 cm [no pain] to 10 cm [very severe pain]), as well as the global perceived effect (on a scale from 1 [worst ever] to 7 [best ever]), functional status, and the health‐related quality of life. The test stimulation of the spinal cord was successful in 24 patients; the other 12 patients did not receive implanted stimulators. In an intention‐to‐treat analysis, the group assigned to receive spinal cord stimulation plus physical therapy had a mean reduction of 2.4 cm in the intensity of pain at 6 months, as compared with an increase of 0.2 cm in the group assigned to receive physical therapy alone (P < 0.001 for comparison between the 2 groups). In addition, the proportion of patients with a score of 6 (“much improved”) for the global perceived effect was much higher in the spinal cord stimulation group than in the control group (39% vs. 6%, P = 0.01). There was no clinically important improvement in functional status. The health‐related quality of life improved only in the 24 patients who actually underwent implantation of a spinal cord stimulator. Six of the 24 patients had complications that required additional procedures, including removal of the device in 1 patient. Conclude in carefully selected patients with chronic reflex sympathetic dystrophy, electrical stimulation of the spinal cord can reduce pain and improve health‐related quality of life. Conmment by R. Ruiz‐López, MD.This is a well‐written article describing a prospective, randomized, controlled trial of spinal cord stimulation (SCS) for reflex sympathetic dystrophy, which is also known as complex regional pain syndrome type I (CRPS I). The results show clearly that in carefully selected patients suffering from this pain syndrome, SCS can reduce pain and improve health‐related quality of life compared to patients treated only with physical therapy. Functional status did not improve in either group of patients as SCS treats pain, but not the disease itself. The authors note that the improvement in the overall score for health‐related quality of life was derived mainly from the alleviation of pain as in the study population, pain was the primary source of distress. This study represents a major reference for pain doctors and neurosurgeons treating CRPS and chronic pain.
Pharmacology (81)
Authors: Abs Roger , Verhelst Johan , Maeyaert Jan 
Published: September 2010

Endocrine consequences of long‐term intrathecal administration of opioids. (University of Antwerp, Edegem, Belgium) J Clin Endocrinol Metab 2000;85:2215–2222.This study involved 73 patients (29 men and 44 women) receiving opioids intrathecally for nonmalignant pain who were enrolled for extensive endocrine investigation. At the time of hormonal determination, the mean duration of opioid treatment was 26.6 ± 16.3 months; the mean daily dose of morphine was 4.8 ± 3.2 mg. The control group consisted of 20 patients (11 men and 9 women) with a comparable pain syndrome, but not treated with opioids. Decreased libido or impotency was present in 23 of 24 men receiving opioids. The serum testosterone level was below 9 nmol/L in 25 of 29 men and was significantly lower than that in the control group (P < 0.001). The free androgen index was below normal in 18 of 29 men and was significantly lower than that in the control group (P < 0.001). The serum LH level was less than 2 U/L in 20 of 29 men and was significantly lower than that in the control group (P < 0.001). Serum FSH was comparable in both groups. Decreased libido was present in 22 of 32 women receiving opioids. All 21 premenopausal females developed either amenorrhea or an irregular menstrual cycle, with ovulation in only 1. Serum LH, estradiol, and progesterone levels were lower in the opioid group. In all 18 postmenopausal females significantly decreased serum LH (P < 0.001) and FSH (P = 0.012) levels were found. The 24‐h urinary free cortisol excretion was below 20 μg/day in 14 of 71 opioid patients and was significantly lower than that in the control group (P = 0.003). The peak cortisol response to insulin‐induced hypoglycemia was below 180 μg/L in 9 of 61 opioid patients and was significantly lower than that in the nonopioid group (P = 0.002). The insulin‐like growth factor I sd score was below −2 sd in 12 of 73 opioid patients and was significantly lower than that in the control group (P = 0.002). The peak GH response to hypoglycemia was below 3 μg/L in 9 of 62 subjects and was significantly lower than that in the control group (P = 0.010). Thyroid function tests and PRL levels were considered normal. No metabolic disturbances were recorded, apart from significantly decreased high‐density lipoprotein cholesterol levels (P = 0.041) and elevated total/high density lipoprotein cholesterol ratio (P = 0.008) in the opioid group compared to the control group. Supplementation with gonadal steroids improved sexual function in most patients. Conclude of all patients receiving intrathecal opioids, the large majority of men and all women developed hypogonadotropic hypogonadism, about 15% developed central hypocorticism, and about 15% developed GH deficiency. These findings suggest that further investigations are required to determine the need for systematic endocrine work‐up in these patients and the necessity for substitutive therapy.
Pharmacology (83)
Authors: Warren P.M. , Taylor J.H. , Nicholson K.E. , Wraith P.K. , Drummond: G.B. 
Published: September 2010

Influence of tramadol on the ventilatory response to hypoxia in humans. (University of Edinburgh, Edinburgh, United Kingdom) Br J Anaesth 2000;85:211–216.In this study, the effect of tramadol on the ventilatory response to 7 min acute isocapnic hypoxia during steady mild hypercapnia in 14 healthy volunteers (7 male, 7 female) was studied. The acute hypoxic response was measured before and 1 h after oral placebo or tramadol (100 mg). After tramadol, ventilation during mild hypercapnia (mean 11.28 liters min−1) was significantly less (P < 0.05) than during placebo baseline (13.93 liters min−1), tramadol baseline (14.63 liters min−1), or after placebo (14.9 liters min−1), confirming that tramadol has a small depressive effect on the hypercapnic ventilatory response. There was no significant difference in the hypoxic ventilation/Spo2 response measured during the placebo baseline (0.99), placebo (1.18), tramadol baseline (0.78) or tramadol (0.68) runs. These data suggest that tramadol does not depress the hypoxic ventilatory response.
Physical Medicine and Rehabilitation (88)
Authors: Suputtitada: A. 
Published: September 2010

Managing spasticity in pediatric cerebral palsy using a very low dose of botulinum toxin type A: preliminary report. (Chulalongkorn University Hospital, Bangkok, Thailand) Am J Phys Med Rehabil 2000;79:320–326.This study was conducted to determine if very low doses of botulinum toxin type A (BTX‐A) could reduce spasticity and improve gait in cerebral palsied children when combined with rehabilitation therapy. The trainable (IQ> 80), ambulatory, spastic diplegic or hemiplegic cerebral palsied children, with no fixed contractures in at least one limb, were selected for this study. Patients with a score of 3 on a modified Ashworth scale received 0.5 units of BTX‐A/kg/muscle. Patients with an Ashworth score of 4 received 1.0 BTX‐A/kg/muscle. After BTX‐A injection, all patients received rehabilitation therapy and plastic ankle and foot orthoses for walking. Both groups exhibited improvement in Ashworth score and in gait within 72 h of injection with botulinum toxin. Beneficial effects persisted for 10 to 12 months in most patients, with 3 patients exhibiting benefits for at least 20 months. Conclude that a very low dose of BTX‐A combined with rehabilitation therapy resulted in a long‐lasting decrease in spasticity and an improvement in gait in children with cerebral palsy.
Physical Medicine and Rehabilitation (89)
Authors: Slipman Curtis W. , Lipetz Jason S. , Herzog Richard J. , Vresilovic: Edward J. 
Published: September 2010

Nonsurgical treatment for radicular pain of zygoapophyseal joint cyst origin: therapeutic selective nerve root block. (Hospital of the University of Pennsylvania, Philadelphia, PA) Arch Phys Med Rehabil 2000;81;1119–1122.This report discusses the first case of zygoapophyseal joint cyst‐induced radicular pain successfully treated with therapeutic selective nerve root block. A 56‐year‐old dentist presented with pain involving the lateral thigh, lateral calf, and foot dorsum that worsened with standing and walking. Magnetic resonance imaging of the lumbar spine showed a cyst emanating from the right L4‐L5 zygoapophyseal joint, resulting in central canal and lateral recess stenosis. The patient was treated with 2 fluoroscopically guided therapeutic L5 selective nerve root blocks. The patient remained pain free at 18‐month follow‐up.
Combined Modality of Mechanical Breakdown and Intraembolus Thrombolysis in Failed Systemic Thrombolysis of Subacute Pulmonary Embolism Patients
Authors: MOHAN BISHAV , MAHAJAN VINEET , CHHABRA SHIBBA T. 
Published: September 2010

Objectives:
Acute massive pulmonary embolism with failed systemic thrombolysis has a high morbidity and mortality with few treatment options available. This study assesses the role of combined modality of mechanical fragmentation and intralesional thrombolysis in failed systemic thrombolysis.
Methods:
Seven (13.5%) of 52 patients with massive pulmonary embolism with persistent cardiogenic shock that failed systemic thrombolysis underwent imaging to confirm pulmonary embolism, and then mechanical fragmentation and intralesional thrombolysis. Mechanical breakdown of embolus was accomplished with 5‐F multipurpose catheter to re‐establish flow, followed by intralesional infusion of urokinase (4,400 IU/kg over 10 minutes followed by 4,400 IU/kg per hour over 24 hours).
Results:
Four (57.1%) of 7 were unsuccessfully thrombolyzed outside the hospital by urokinase, 2 (28.6%) with recombinant tissue‐type plasminogen activator (rtPA) and 1 (14.3%) with streptokinase systemically before 24–48 hours of admission. At presentation, average heart rate and shock index were 121.7/min and 1.45, respectively. Average systolic pulmonary arterial pressure was 73 ± 2.65 mmHg at presentation, and postoperatively was significantly reduced to 39.7 ± 10.44 mmHg (P < 0.001). Mortality at 24 hours, 30 days, and 2 years follow‐up was 0% (0/7).
Conclusions:
Mechanical breakdown of thrombus followed by urokinase infusion may be a cost‐effective, minimally invasive, and potentially life‐saving procedure for the management of acute massive pulmonary embolism. Randomized controlled trials are required to compare this new strategy to contemporary conventional approaches. (J Interven Cardiol 2010;23:479–484)
Simultaneous versus two‐stage implant placement and guided bone regeneration in the canine: histomorphometry at 8 and 16 months
Authors: Artzi Zvi , Nemcovsky Carlos E. , Tal Haim , Weinberg Evgeny , Weinreb Miron , Prasad Hari , Rohrer Michael D. , Kozlovsky Avital 
Published: September 2010

Artz Z, Nemcovsky CE, Tal H Weinberg E, Weinreb M, Prasad H, Rohrer MD, Kozlovsky A. Simultaneous versus two‐stage implant placement and guided bone regeneration in the canine: histomorphometry at 8 and 16 months. J Clin Periodontol 2010; 37: 1029–1038. doi: 10.1111/j.1600‐051X.2010.01621.x.AbstractAim: To compare the effect of timing of implant placement and guided bone regeneration (GBR) procedure on osseointegration and newly formed bone at 8 and 16 months.Material and Methods: In seven dogs, four different sites were bilaterally established: (1) an implant placed in a 6‐month healed (6m‐GBR) bovine bone mineral (BBM) grafted site; (2) a simultaneously placed implant with the grafted BBM (Si‐GBR) followed by a membrane coverage; (3) an implant placed in a membrane‐protected non‐grafted defect; and (4) an implant placement in a naturally healed site (Cont). Histomorphometry was obtained at 8 and 16 months post‐implant placement. Bone–implant contact (BIC), crestal bone resorption (CBR), vertical intra‐bony (VIB) defect, bone (BAF) and particle (PAF) area fractions, and osteoconductivity (CON) levels were measured.Results: In all sites, BIC ranged between 62% and 79% with no significant differences. PAF ranged from 17% to 27%, with no effect of time. At 8 and 16 months, BAF was significantly smaller at the Si‐GBR site when compared with all other sites, CON was significantly greater at the 6m‐GBR site, and CBR and VIB were significantly smaller at the 6m‐GBR when compared with the Si‐GBR sites.Conclusions: The simultaneous and delayed techniques both showed a similar osseointegration level over time. However, the staged approach showed enhanced newly formed bone, higher osteoconduction around the grafted mineral, less CBR, and smaller vertical bone defect over time compared with the combined approach.
Eros as ‘Pteros’. Allegorical Mythology in Plato’s Phaedrus
Authors: Kluge Sofie 
Published: September 2010

While most experts agree that myth plays an important role in Plato’s dialogues, the more exact nature of this role still haunts Platonic studies. Critical perspectives have changed over the years, yet two essential positions continue to prevail, equally interlacing their interpretation of Plato’s view of myth with an estimation of his own qualities as a literary author: on one hand, negligence of the intrinsic aesthetico‐philosophical interest of Platonic myth and unreserved or qualified subordination of poetic mythos to philosophical logos; on the other hand, recognition of the significance of Plato’s myths and relaxation of the dichotomy of philosophy and myth conducing in some cases even to evaluation of poetic myth over philosophical dialectic.In order to appreciate the fundamental interaction of literature and philosophy in these myths, I suggest that we approach them armed with the tools of close textual analysis and a redefined concept of allegory – tools frequently employed in relation to Platonic myth, albeit generally in a thoroughly negative or, at best, imprecise way. On the basis of a close reading of the myth in Phaedrus 246a–256e, key passage to understanding the status of myth in Plato’s work, I tie Platonic writing to an allegorical aesthetics intricately entwined with the philosophical core of the dialogue.
“Beauty lies in the eye of the beholder”? Aspects of beauty and attractiveness
Authors: Borelli Claudia , Berneburg Mirjam 
Published: September 2010

SummaryDiscussing aesthetic issues and their management with patients is a growing area of dermatologic practice. Sometimes treatment options within one's own discipline are rapidly discussed, without a clear idea of the various aspects of the face which all combine to produce beauty and attractiveness. We review various features leading to the impression of beauty and attractiveness. Familiarity with these concepts should facilitate a broader discussion with the patient on the aspects of beauty and attractiveness beyond the borders of one's own discipline and also lead to multidisciplinary treatment options. We also examine the question how much the personality of the beholder himself is involved in the perception of attractiveness and beauty (of the person sitting opposite to him).The “ideal” face has an average profile with slightly protrusive and full lips. Attractiveness increases with average features and symmetry. Moreover, particular features such as the scheme of childlike characteristics combined with aspects of maturity and expression make a female face appear especially beautiful. Which attributes contribute to attractiveness of a man's face are controversial. Clear male signals such as a strong chin are likely not to increase attractiveness.
Rapidly metastatic carcinoma in lupo in a patient with lupus vulgaris for more than 50 years
Authors: Wulff‐Woesten Andrea , Hildebrandt Uwe , Leverkus Martin , Ulrich Jens 
Published: September 2010

SummaryAccording to current statistics of the WHO, tuberculosis is the infectious disease that causes the most deaths worldwide. Its most common cutaneous manifestation is lupus vulgaris which is seldom diagnosed today. A 69‐year old immunocompetent woman complained of a partly elevated, partly sclerotic plaque on her left thigh which had been present for more than 55 years before slowly becoming ulcerated. After biopsy and subsequent excision of the 13 cm ulcer, the diagnosis of carcinoma in lupo with lymph node metastasis was made. Cutaneous and additional nodal metastases appeared rapidly. Tuberculostatic therapy was initiated. Despite systemic chemotherapy the tumor subsequently progressed and the patient died of metastatic carcinoma in lupo 15 months after the initial diagnosis. Early diagnosis and treatment of lupus vulgaris might have prevented the development of carcinoma in lupo and ensuing metastatic death of the patient.