[Objective assessment of mental nerve local anesthesia]. / Ob''ektivnaia otsenka urovnia mestnogo obezbolivaniia podborodochnogo nerva.

AIM: To study the reaction of the mental nerve to selective stimulation of thin nerve fibers by thermal stimuli during conduction anesthesia. MATERIAL AND METHOD: The pilot study involved 24 healthy volunteers: 13 subjects were injected with a 4% solution of articaine-containing anesthetic with a vasoconstrictor in a ratio of 1:200 000 (pH 4.8-5.4) and 11 subjects - a 3% solution of mepivacaine-containing local anesthetic without a vasoconstrictor (pH value 5.8-6.4). The registration of evoked potentials was performed twice: before local anesthesia and 5 minutes after anesthesia. With the help of disposable carpal dental injectors, local anesthesia was performed near the mental foramen in order to anesthetize the innervation region of the mental nerve through a conductive type. The evoked potentials (VP) were recorded on a Nicolet instrument (USA) with Bravo evoked potentials software. The study of thermal EPs was performed using a Contact heat evoked potential stimulator (CHEPS) device ('Medoc Ltd, Ramat Yishai', Israel). The base and peak temperature were set at 33 and 54 °C, correspondingly. RESULTS: The evoked potentials for thermal stimulation demonstrated a significant decrease in the amplitude of all components and the elongation of the LP of the main negative-positive N2-P2 complex after anesthesia compared with the initial thermal EP. The complete disappearance of thermal responses was observed in 14 (58%) of 24 study participants, minor changes were seen in 3 (12.5%) cases only. The total response disappearance was observed in 10 (77%) of 13 participants after articaine and in 3 (27%) of 11 - after mepivacaine (p<0.05), weak changes were registered in 2 (15%) cases in the articaine group and in 1 (9%) case in the mepivacaine group. CONCLUSION: A 4% solution of articaine is somewhat more effective for pain relief of teeth and bone since it often causes deeper anesthesia, and a 3% solution of mepivacaine without a vasoconstrictor is physiologically more suitable for working with soft tissues.

[Headaches of tension and psychogenic headaches: assessment of the treatment with venlafaxine].

The modern classifications of headaches include primary headaches, e.g., migraines and headaches of tension (HAT), and secondary psychogenic headaches of tension (PHT). Forty-one patients with chronic variants of HAT and PHT were studied. In the first step, 12 patients with HAT and 11 patients with PHT were compared by clinical and psychometric scores on the following scales (the VAS, the McGill Pain Questionnaire, the MMPI). In the second step, 11 patients with HAT and 7 with PHT were treated with venlafaxine XR (velaxin) in dose 75 mg/d during 2 months. It has been shown that PHT differs from HAT by pain intensity and relationship with functional-neurologic symptoms as well as by personality deviations measured with MMPI and correlations between the pain intensity and MMPI peaks. The 2 month treatment with velaxin has improved significantly the state of patients. The significant decrease of pain severity, amount of analgesics and pain-associated symptoms as well as the normalization of functions of antinociceptive systems (the increase in nociceptive flexor reflex threshold) were noted in both groups. It has been concluded that venlafaxine is an effective drug in the treatment of both HAT and PHT.

[Anxiodepressive and neuromediatory disorders in hypertensive patients. Effects of cypramil therapy].

AIM: To investigate psychic status and characteristics of neuromediatory metabolism in hypertensive patients, efficacy of antihypertensive therapy with lisinopril and hydrochlorthiaside with adjuvant citalopram (cipramil) which is a selective inhibitor of serotonin reuptake. MATERIAL AND METHODS: Fifty patients with hypertension stage II (37 females, 13 males, mean age 48 years, mean duration of the disease 10.6 years) have undergone psychometric examination, estimation of evoked potentials P-300, 24-h monitoring of blood pressure. Plasma levels of epinephrine and norepinephrine, plasma and platelet levels of serotonin and 5-OIAA were measured at high-performance liquid chromatography. RESULTS: Hypertensive patients were found to have high levels of depression, reactive and personality anxiety, subnormal quality of life. Blood pressure lowered more in patients given adjuvant cipramil. CONCLUSION: Hypertensive patients have anxiodepressive disorders accompanied by monoamines disbolism. Cipramil effectively corrects these disorders.

[Neurophysiological pain and sensory disorders correlates in patients with syringomyelia]. / Neirofiziologicheskie korreliaty boli i chuvstvitel'nykh rasstroistv u bol'nykh siringomieliei.

Short-latent and pain-related long-latent somatosensory evoked potentials (SEP) in response to electrical stimulation of n. medianus, n. tibialis and n. mandibularis were studied in 28 patients with syringomyelia. During stimulation in the area of pain-temperature sensitivity disturbance, reduced amplitude of early components N13, N18 and late components P3, N3, P4, N4 (100-500 ms) was detected. In patients with neuropathic pain, increased amplitude of the middle latency waves P2, N2 (40-100 ms) and low amplitude ratio P4/P2 (normal values = 1.5) were found. Patients with stimulus-evoked pain (allodynia and hyperaesthesia) had shortened N18 peak latency, decreased motor threshold and grossly attenuated and delayed P3, N3, P4 (100-350 ms) in SEP after stimulation of the hypersensitive side. In patients without pain, the amplitude of the late tibial SEP was elevated. The results obtained can be used as diagnostic criteria of syringomyelia. The character of SEP changes in patients with neuropathic pain support the hypothesis of central sensitization and abnormal pain transmission through the fast conducting of pain and temperature afferents.

[Results of open post-registration clinical trials of copaxone in patients with multiple sclerosis]. / Rezul'taty otkrytykh postregistratsionnykh klinicheskikh ispytanii preparata kopakson u bol'nykh rasseiannym sklerozom.

Results of the 2-year open postregistration study of Copaxone (glatiramer acetate), conducted in 3 Moscow leading medical centres are given. 32 MS patients with remitting-relapsing MS were investigated in accordance with international requirements (neurological scales, MRI of the brain, multimodal evoked potential). Significant reduction of annual relapse rate for 70.3%, stabilization of neurological status and benign safety profile were demonstrated during Copaxone treatment. Practical recommendations for Copaxone use are given.

[Familial paroxysmal ataxia]. / Semeinaia paroksizmal'naia ataksiia.

The paper provides clinical and paraclinical findings on 3 patients from one family (two brothers and father) suffering from familial paroxysmal ataxia. The authors observed psychosensory disturbances not typical, according to the literature for attacks of ataxia, dysarthria and nystagmus. The evidence obtained on cerebral and spinal evoked potentials made it possible to diagnose multilevel impairment of nervous impulse conduction in the somatosensory system which may be due to metabolic disturbances underlying the disease.

[The painful leg and moving toe syndrome]. / Sindrom boleznennykh nog i dvizhushchikhsia pal'tsev stop.

The paper reports a case of painful-legs-and-moving-toes syndrome in a 75-year-old woman who developed it after a paralytic ischias attack at the age of 70. The syndrome was characterized by persistent pains in distal parts of the legs and feet and constant involuntary flexion-extension wave-like toe movements. SSEP studies revealed a defect of conduction in high-speed myelinated fibers of the lumbo-sacral radices of both sides. A cortical motor potential corresponding to the toe hyperkinetic movement was present. It the base of the hyperkinesis a reflectory mechanism may underlie initiated from radiculo-spinal nociceptive systems disinhibited in consequence of the deficiency of inhibitory control from high speed rear column afferents. Neurophysiological data suggest participation of cerebral mechanisms in realization of the hyperkinesis.

[Hyperventilation syndrome and its clinico-pathogenetic importance in autonomic disorders of a psychogenic nature]. / Giperventiliatsionnyi sindrom i ego kliniko-patogeneticheskoe znachenie pri vegetativnykh rasstroistvakh psikhogennoi prirody.

The role of hyperventilation-induced shifts in the pathogenesis of different kinds of autonomic disorders (autonomic paroxysms, syncopal states, allergic signs) was investigated in 156 patients. This role should be considered in therapeutic interventions, especially in respiratory training aimed at correcting the respiratory pattern in order to achieve psychoautonomic stabilization. Distinct pathogenic mechanisms of combined hyperventilation and autonomic disorders are discussed.