RESUMO
The results of intraspinal narcotic analgesia (INA) in 43 patients with chronic nonmalignant pain syndromes are reviewed. A protocol has been established to improve proper patient selection and includes three phases of study. Most of the patients have had INA for 2 years now. In those patients qualifying for continuous delivery systems (CDS), 65% had good to excellent relief of pain while 34% were considered failures for a variety of reasons. Apparent tolerance development in many of the patients was, in fact, due to technical problems with the epidural catheter instead.
Assuntos
Analgesia , Entorpecentes , Manejo da Dor , Analgesia/efeitos adversos , Doença Crônica , Implantes de Medicamento , Estudos de Avaliação como Assunto , Humanos , Injeções Espinhais , Entorpecentes/efeitos adversosRESUMO
An explanation for leg pain on the opposite side of the myelographic defect in one case is reported. Disc herniation was located superior to the exit of the root and thus displaced the dura and compressed the root on the opposite side against the pedicle producing contralateral leg pain.
Assuntos
Deslocamento do Disco Intervertebral/diagnóstico por imagem , Perna (Membro) , Mielografia , Dor/etiologia , Humanos , Deslocamento do Disco Intervertebral/complicações , Vértebras Lombares/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Síndromes de Compressão Nervosa/etiologia , Manejo da Dor , Raízes Nervosas Espinhais/cirurgiaRESUMO
Chronic lumbar radiculopathy following spinal surgery is reported, in which 7 of 25 patients reviewed developed a postoperative syndrome immediately after their original surgery. Later, sometimes years later, all 7 patients developed severe chronic spinal arachnoiditis. This syndrome was characterized by transient violent spasms in the legs, muscle cramps, increased radicular pain, and often fever and chills. The recognition of this syndrome and a proposed method of treatment is discussed.
Assuntos
Aracnoidite/etiologia , Laminectomia/efeitos adversos , Doenças da Coluna Vertebral/etiologia , Adulto , Idoso , Feminino , Humanos , Deslocamento do Disco Intervertebral/cirurgia , Vértebras Lombares/cirurgia , Masculino , Pessoa de Meia-Idade , Mielografia/efeitos adversos , Dor/etiologia , Raízes Nervosas Espinhais , SíndromeRESUMO
Six patients with classical transient ischemic attacks that were not directly related to extracranial carotid disease are presented. These cases were selected to include a variety of pathologic conditions: one case each of brain tumor, arteriovenous malformation, chronic subdural hematoma, cervical spondylosis, and two cases of giant intracranial aneurysms. These case histories are significant because they illustrate that without complete angiographic investigation, tragic results could have and did occur in some cases. Transient ischemic attacks should be considered as a symptom of various possible pathologic conditions, and a careful search for the cause must be pursued aggressively.
