Update on the challenges of treating trigeminal neuralgia

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Obermann M

2015-04-01

Full Text Available Mark Obermann Department of Neurology, University of Duisburg-Essen, Essen, Germany Abstract: Despite the multitude of treatment options currently available for trigeminal neuralgia, its management remains challenging in a considerable number of patients. The response to any particular treatment can be quite variable interindividually, and personalized treatment options are both resource-consuming and time-consuming. Anticonvulsant drugs, muscle relaxants, and neuroleptic agents are the preferred medical treatment for trigeminal neuralgia. Large placebo-controlled clinical trials are scarce, and no specific established substance has been developed for the treatment of trigeminal neuralgia. Promising new treatment options currently in clinical evaluation are botulinum neurotoxin type A injections and CNV1014802, a novel sodium channel blocker that selectively blocks the Nav1.7 sodium channel. Patients who do not respond to medical therapy may be eligible for more invasive treatment options, such as percutaneous Gasserian ganglion techniques, gamma knife surgery, and microvascular decompression. Keywords: trigeminal neuralgia, treatment, current, future, options, orphan drugs 

Postherpetic neuralgia: epidemiology, pathophysiology, and pain management pharmacology

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Mallick-Searle T

2016-09-01

Full Text Available Theresa Mallick-Searle,1 Brett Snodgrass,2 Jeannine M Brant,3 1Pain Management Center, Stanford Health Care, Redwood City, CA, 2LifeLinc Pain Centers, Cordova, TN, 3Billings Clinic, Billings, MT, USA Abstract: Herpes zoster, also known as shingles, is a distinctive clinical condition caused by the reactivation of latent varicella zoster (chickenpox virus following an initial infection. Approximately 1 million cases of herpes zoster occur annually in the US, and one in every three people develops herpes zoster during their lifetime. Postherpetic neuralgia is a neuropathic pain syndrome characterized by pain that persists for months to years after resolution of the herpes zoster rash. It stems from damage to peripheral and central neurons that may be a byproduct of the immune/inflammatory response accompanying varicella zoster virus reactivation. Patients with postherpetic neuralgia report decreased quality of life and interference with activities of daily living. Approaches to management of postherpetic neuralgia include preventing herpes zoster through vaccination and/or antiviral treatment, and administering specific medications to treat pain. Current guidelines recommend treatment of postherpetic neuralgia in a hierarchical manner, with calcium channel α2-δ ligands (gabapentin and pregabalin, tricyclic antidepressants (amitriptyline, nortriptyline, or desipramine, or topical lidocaine patches as first-line drugs. The safety and tolerability of pharmacologic therapies for pain are important issues to consider as postherpetic neuralgia affects primarily an older population. Patients should be educated on appropriate dosing, titration if applicable, the importance of adherence to treatment for optimal effectiveness, and possible side effects. Health-care professionals play a key role in helping to ameliorate the pain caused by postherpetic neuralgia through early recognition and diligent assessment of the problem; recommending evidence

Ophthalmic branch radiofrequency thermocoagulation for atypical trigeminal neuralgia:a case report.

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Du, Shibin; Ma, Xiaoliang; Li, Xiaoqin; Yuan, Hongjie

2015-01-01

Trigeminal neuralgia is an intense neuralgia involving facial areas supplied by trigeminal nerve. The pain is characterized by sudden onset, short persistence, sharp or lancinating. Trigeminal neuralgia commonly affects frontal areas, infraorbital or paranasal areas, mandibular areas and teeth. While Trigeminal neuralgia affecting merely the upper eyelid is rare. Here we report a case of atypical Trigeminal neuralgia confined to the upper eyelid. The patient was pain free during the follow-up period of 6 months after unusual ophthalmic branch radiofrequency thermocoagulation. A 55-year-old female patient was diagnosed as primary trigeminal neuralgia involving the right upper eyelid. As the pain could not be controlled by drug therapy, peripheral nerve branch radiofrequency thermocoagulation was recommended. A combination of infratrochlear, supratrochlear and lacrimal radiofrequency thermocoagulation was implemented in this case. The point where the bridge of the nose abuts the supraorbital ridge and the point slightly above the lateral canthus along outer border of the orbit were selected respectively as the puncture sites. After positive diagnostic test, radiofrequency thermocoagulation of the above-mentioned nerve branches was performed respectively. The patient was pain free immediately after the treatment and during the follow-up period of 6 months. Trigeminal neuralgia is a common severe and chronic facial neuralgia which requires accurate diagnosis and effective therapy. With typical clinical symptoms, normal neurological signs, normal CT and MRI findings, the patient was diagnosed as classic trigeminal neuralgia. As the patient was drug resistant, some invasive treatments were considered. Peripheral branch neurolysis was chosen for its minimal invasiveness, convenience, low risk and not affecting further invasive treatments. According to the anatomic data and the diagnostic test results, infratrochlear, supratrochlear and lacrimal nerve were responsible

Small-fiber dysfunction in trigeminal neuralgia

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Cruccu, G.; Leandri, M.; Iannetti, G. D.

2001-01-01

Background: In patients with trigeminal neuralgia, results of clinical examination of sensory function are normal. Reflex and evoked potential studies have already provided information on large-afferent (non-nociceptive) function. Using laser-evoked potentials (LEP), the authors sought information...... was significantly longer than that of the age-matched controls. The nonpainful-side latency correlated significantly with the carbamazepine dose. Conclusions: LEP detect severe impairment of the nociceptive afferent system on the painful side of patients with idiopathic as well as symptomatic trigeminal neuralgia...

Peptic ulcer as a risk factor for postherpetic neuralgia in adult patients with herpes zoster.

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Chen, Jen-Yin; Lan, Kuo-Mao; Sheu, Ming-Jen; Tseng, Su-Feng; Weng, Shih-Feng; Hu, Miao-Lin

2015-02-01

Postherpetic neuralgia is the most common complication of herpes zoster. Identifying predictors for postherpetic neuralgia may help physicians screen herpes zoster patients at risk of postherpetic neuralgia and undertake preventive strategies. Peptic ulcer has been linked to immunological dysfunctions and malnutrition, both of which are predictors of postherpetic neuralgia. The aim of this retrospective case-control study was to determine whether adult herpes zoster patients with peptic ulcer were at greater risk of postherpetic neuralgia. Adult zoster patients without postherpetic neuralgia and postherpetic neuralgia patients were automatically selected from a medical center's electronic database using herpes zoster/postherpetic neuralgia ICD-9 codes supported with inclusion and exclusion criteria. Consequently, medical record review was performed to validate the diagnostic codes and all pertaining data including peptic ulcer, Helicobacter pylori (H. pylori) infection and ulcerogenic medications. Because no standard pain intensity measurement exists, opioid usage was used as a proxy measurement for moderate to severe pain. In total, 410 zoster patients without postherpetic neuralgia and 115 postherpetic neuralgia patients were included. Multivariate logistic regressions identified 60 years of age and older, peptic ulcer and greater acute herpetic pain as independent predictors for postherpetic neuralgia. Among etiologies of peptic ulcer, H. pylori infection and usage of non-selective nonsteroidal anti-inflammatory drugs were significantly associated with the increased risk of postherpetic neuralgia; conversely, other etiologies were not significantly associated with the postherpetic neuralgia risk. In conclusion, 60 years of age and older, peptic ulcer and greater acute herpetic pain are independent predictors for postherpetic neuralgia in adult herpes zoster patients. © 2014 Wiley Periodicals, Inc.

Reappraisal of glossopharyngeal neuralgia

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Sameer Albahkaly

2018-03-01

We describe a 42-year old Saudi male suffering from glossopharyngeal neuralgia with transitory unconsciousness due to cardiac asystole and arterial hypotension accompanying the attack of pain. We review pathogenesis, diagnosis, treatment and prognosis.

Gamma Knife® radiosurgery for trigeminal neuralgia.

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Yen, Chun-Po; Schlesinger, David; Sheehan, Jason P

2011-11-01

Trigeminal neuralgia is characterized by a temporary paroxysmal lancinating facial pain in the trigeminal nerve distribution. The prevalence is four to five per 100,000. Local pressure on nerve fibers from vascular loops results in painful afferent discharge from an injured segment of the fifth cranial nerve. Microvascular decompression addresses the underlying pathophysiology of the disease, making this treatment the gold standard for medically refractory trigeminal neuralgia. In patients who cannot tolerate a surgical procedure, those in whom a vascular etiology cannot be identified, or those unwilling to undergo an open surgery, stereotactic radiosurgery is an appropriate alternative. The majority of patients with typical facial pain will achieve relief following radiosurgical treatment. Long-term follow-up for recurrence as well as for radiation-induced complications is required in all patients undergoing stereotactic radiosurgery for trigeminal neuralgia.

Comparison of Trigeminal and Postherpetic Neuralgia

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C Peter N Watson

1996-01-01

Full Text Available Although postherpetic neuralgia and trigeminal neuralgia (tic douloureux are common causes of facial pain, they have very little in common aside from lancinating pain (other qualities of pain in each disorder are different. Each disorder affects different areas of the face and the treatment of each is quite dissimilar. The pathogenesis of these two disorders quite likely involves different mechanisms. This report reviews aspects of these two difficult pain problems, particularly with reference to the work of the late Gerhard Fromm, to whom this is dedicated.

Intractable Occipital Neuralgia Caused by an Entrapment in the Semispinalis Capitis

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Kim, Deok-ryeong; Lee, Sang-won

2013-01-01

Occipital neuralgia is a rare pain syndrome characterized by periodic lancinating pain involving the occipital nerve complex. We present a unique case of entrapment of the greater occipital nerve (GON) within the semispinalis capitis, which was thought to be the cause of occipital neuralgia. A 66-year-old woman with refractory left occipital neuralgia revealed an abnormally low-loop of the left posterior inferior cerebellar artery on the magnetic resonance imaging, suggesting possible vascular compression of the upper cervical roots. During exploration, however, the GON was found to be entrapped at the perforation site of the semispinalis capitis. There was no other compression of the GON or of C1 and C2 dorsal roots in their intracranial course. Postoperatively, the patient experienced almost complete relief of typical neuralgic pain. Although occipital neuralgia has been reported to occur by stretching of the GON by inferior oblique muscle or C1-C2 arthrosis, peripheral compression in the transmuscular course of the GON in the semispinalis capitis as a cause of refractory occipital neuralgia has not been reported and this should be considered when assessing surgical options for refractory occipital neuralgia. PMID:24278663

Neuralgias of the Head: Occipital Neuralgia.

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Choi, Il; Jeon, Sang Ryong

2016-04-01

Occipital neuralgia is defined by the International Headache Society as paroxysmal shooting or stabbing pain in the dermatomes of the greater or lesser occipital nerve. Various treatment methods exist, from medical treatment to open surgical procedures. Local injection with corticosteroid can improve symptoms, though generally only temporarily. More invasive procedures can be considered for cases that do not respond adequately to medical therapies or repeated injections. Radiofrequency lesioning of the greater occipital nerve can relieve symptoms, but there is a tendency for the pain to recur during follow-up. There also remains a substantial group of intractable patients that do not benefit from local injections and conventional procedures. Moreover, treatment of occipital neuralgia is sometimes challenging. More invasive procedures, such as C2 gangliotomy, C2 ganglionectomy, C2 to C3 rhizotomy, C2 to C3 root decompression, neurectomy, and neurolysis with or without sectioning of the inferior oblique muscle, are now rarely performed for medically refractory patients. Recently, a few reports have described positive results following peripheral nerve stimulation of the greater or lesser occipital nerve. Although this procedure is less invasive, the significance of the results is hampered by the small sample size and the lack of long-term data. Clinicians should always remember that destructive procedures carry grave risks: once an anatomic structure is destroyed, it cannot be easily recovered, if at all, and with any destructive procedure there is always the risk of the development of painful neuroma or causalgia, conditions that may be even harder to control than the original complaint.

NEURO-VASCULAR CONFLICT AS CAUSATIVE FACTOR IN IDI-OPATHIC TRIGEMINAL NEURALGIA

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Mumtaz Ali

2010-12-01

Full Text Available Introduction Trigeminal neuralgia is one of the most unbearable pain syndromes in one or more branches of trigeminal nerve. The basic pathology is still poorly understood 1. Two divergent view points, central versus peripheral have been presented to explain the possible mechanism 2. In spite of numerous favorable reports, the neurovascular conflict theory remains contra-vertical 3. Nevertheless, whether or not, neurovascular compression is accessory or predominant in the mechanism of trigeminal neuralgia is not yet determined. Although neurovascular compression and global atrophy of the root, a focal arachnoid thickening and angulated root on crossing over the petrous ridge have been observed. Yet, neurovascular conflict has made responsible as the main cause of this neuralgia 4. This lead to focal demylination of the nerve due to its pulsatile compression. Demylination result in short circuiting of neuronal flow and hence trigeminal neuralgia 5.      Present study was therefore designed as to appreciate neurovascular conflict as causative agent in idiopathic trigeminal neuralgia. Material and Methods This prospective observational study was conducted in department of Neurosurgery Government Lady Reading Hospital Peshawar where microvascular decompression is performed as a primary procedure of choice for patients with trigeminal neuralgia. The duration of this study was from May 2003 – to June 2007. Total number of patients operated was 86. Drug resistant cases of trigeminal neuralgia that were   willing for operation was selected and proper clinical record was documented. MRI was done in all patients to exclude secondary causes of trigeminal Neuralgia. Under general Anesthesia in lateral position, small 2.5x2.5cm retro-mastoid craniotomy was performed. All these cases were operated by one surgeon with a team of associate’s doctors. Microscopic per-operative anatomical findings were recorded. Any possible per-operative complications

Supratrochlear Neuralgia: A Prospective Case Series of 15 Patients.

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Pareja, Juan A; López-Ruiz, Pedro; Mayo, Diego; Villar-Quiles, Rocío-Nur; Cárcamo, Alba; Gutiérrez-Viedma, Álvaro; Lastarria, Carlo P; Romeral, María; Yangüela, Julio; Cuadrado, María-Luz

2017-10-01

The aim of this study was to describe clinical features unique to supratrochlear neuralgia. The supratrochlear nerve supplies the medial aspect of the forehead. Due to the intricate relationship between supraorbital and supratrochlear nerves, neuralgic pain in this region has been traditionally attributed to supraorbital neuralgia. No cases of supratrochlear neuralgia have been reported so far. From 2009 through 2016, we prospectively recruited patients with pain confined to the territory of the supratrochlear nerve. Fifteen patients (13 women, 2 men; mean age 51.4 years, standard deviation 14.9) presented with pain in the lower paramedian forehead, extending to the eyebrow in two patients and to the internal angle of the orbit in another. Pain was unilateral in 11 patients (six on the right, five on the left), and bilateral in four. Six patients had continuous pain and nine described intermittent pain. Palpation of the supratrochlear nerve at the medial third of the supraorbital rim resulted in hypersensitivity in all cases. All but one patient exhibited sensory disturbances within the painful area. Fourteen patients underwent anesthetic blockades of the supratrochlear nerve, with immediate relief in all cases and long-term remission in three. Six of them had received unsuccessful anesthetic blocks of the supraorbital nerve. Five patients were treated successfully with oral drugs and one patient was treated with radiofrequency. Supratrochlear neuralgia is an uncommon disorder causing pain in the medial region of the forehead. It may be differentiated from supraorbital neuralgia and other similar headaches and neuralgias based on the topography of the pain and the response to anesthetic blockade. © 2017 American Headache Society.

Comparative efficacy of phenytoin, steroid and carbamazepine in herpes zoster and post herpetic neuralgia

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Agarwal S

1991-01-01

Full Text Available Three hundred patients of different ages were sequentially assigned three therapy groups (100 in each group viz. phenytoin, steroid (prednisolone and carbamazepine. Effect of these drugs on herpes zoster neuralgia and in prevention of post herpetic neuralgia was studied. Phenytoin was found to be superior to both steroid and carbamazepine in relieving the pain of herpes zoster and in reducing the incidence of post herpetic neuralgia. Only 16.1% of the patients in phenytoin treated group developed post herpetic neuralgia lasting for 2-4 weeks while 22.7% and 29.6% of the steroid and carbamazepine treated patients respectively developed post herpetic neuralgia and that too lasting for longer duration. No patient under 40 years developed post herpetic neuralgia.

Infratrochlear neuralgia.

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Pareja, Juan A; Casanova, Ignacio; Arbex, Andrea; Cuadrado, María L

2015-11-01

The infratrochlear nerve supplies the medial aspect of the upper eyelid, the superolateral aspect of the nose and the lacrimal caruncle. This nerve may contribute to the pain stemming from the trochlea, but infratrochlear neuralgia has not been identified as a specific cause of pain. Over a 10-year period we have been recruiting patients with pain in the internal angle of the orbit that did not show features of trochlear pain. Seven patients (six female, one male; mean age, 46.1 ± 18.9) presented with pain in the territory of the infratrochlear nerve. The pain appeared in the internal angle of the orbit and upper eyelid (n = 3), the superolateral aspect of the nose (n = 3), or the lacrimal caruncle (n = 1). All patients had a paroxysmal pain, with the attacks lasting five to 30 seconds. Pain attacks were mostly spontaneous, but two patients had triggers. Between attacks, all patients had local allodynia. Pain did not increase with vertical eye movements. Six patients were treated with gabapentin with complete response, and one patient experienced long-lasting relief with an anesthetic blockade of the infratrochlear nerve. Infratrochlear neuralgia should be considered as a possible cause of pain in the internal angle of the orbit. © International Headache Society 2015.

Linear accelerator radiosurgery for trigeminal neuralgia: case report

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Yun, Hyong Geun [Dongguk University International Hospital, Goyang (Korea, Republic of)

2006-06-15

Trigeminal neuralgia is defined as an episodic electrical shock-like sensation in a dermatomal distribution of the trigeminal nerve. When medications fail to control pain, various procedures are used to attempt to control refractory pain. Of available procedures, stereotactic radiosurgery is the least invasive procedure and has been demonstrated to produce significant pain relief with minimal side effects. Recently, linear accelerators were introduced as a tool for radiosurgery of trigeminal neuralgia beneath the already accepted gamma unit. Author have experienced one case with trigeminal neuralgia treated with linear accelerator. The patient was treated with 85 Gy by means of 5 mm collimator directed to trigeminal nerve root entry zone. The patient obtained pain free without medication at 20 days after the procedure and remain pain free at 6 months after the procedure. He didn't experience facial numbness or other side effects.

Peripheral neurostimulation for control of intractable occipital neuralgia.

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Weiner, R L; Reed, K L

1999-07-01

Objective. To present a novel approach for treatment of intractable occipital neuralgia using percutaneous peripheral nerve electrostimulation techniques. Methods. Thirteen patients underwent 17 implant procedures for medically refractory occipital neuralgia. A subcutaneous electrode placed transversely at the level of C1 across the base of the occipital nerve trunk produced paresthesias and pain relief covering the regions of occipital nerve pain Results. With follow-up ranging from 1-½ to 6 years, 12 patients continue to report good to excellent response with greater than 50% pain control and requiring little or no additional medications. The 13th patient (first in the series) was subsequently explanted following symptom resolution. Conclusions. In patients with medically intractable occipital neuralgia, peripheral nerve electrostimulation subcutaneously at the level of C1 appears to be a reasonable alternative to more invasive surgical procedures following failure of more conservative therapies.

Occipital neuralgia associates with high cervical spinal cord lesions in idiopathic inflammatory demyelinating disease.

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Kissoon, Narayan R; Watson, James C; Boes, Christopher J; Kantarci, Orhun H

2018-01-01

Background The association of trigeminal neuralgia with pontine lesions has been well documented in multiple sclerosis, and we tested the hypothesis that occipital neuralgia in multiple sclerosis is associated with high cervical spinal cord lesions. Methods We retrospectively reviewed the records of 29 patients diagnosed with both occipital neuralgia and demyelinating disease by a neurologist from January 2001 to December 2014. We collected data on demographics, clinical findings, presence of C2-3 demyelinating lesions, and treatment responses. Results The patients with both occipital neuralgia and multiple sclerosis were typically female (76%) and had a later onset (age > 40) of occipital neuralgia (72%). Eighteen patients (64%) had the presence of C2-3 lesions and the majority had unilateral symptoms (83%) or episodic pain (78%). All patients with documented sensory loss (3/3) had C2-3 lesions. Most patients with progressive multiple sclerosis (6/8) had C2-3 lesions. Of the eight patients with C2-3 lesions and imaging at onset of occipital neuralgia, five (62.5%) had evidence of active demyelination. None of the patients with progressive multiple sclerosis (3/3) responded to occipital nerve blocks or high dose intravenous steroids, whereas all of the other phenotypes with long term follow-up (eight patients) had good responses. Conclusions A cervical spine MRI should be considered in all patients presenting with occipital neuralgia. In patients with multiple sclerosis, clinical features in occipital neuralgia that were predictive of the presence of a C2-3 lesion were unilateral episodic symptoms, sensory loss, later onset of occipital neuralgia, and progressive multiple sclerosis phenotype. Clinical phenotype predicted response to treatment.

Trigeminal neuralgia

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Maarbjerg, Stine; Di Stefano, Giulia; Bendtsen, Lars

2017-01-01

-occupying lesion affecting the trigeminal nerve. Differential diagnosis and treatment Important differential diagnoses include trigeminal autonomic cephalalgias, posttraumatic or postherpetic pain and other facial pains. First line treatment is prophylactic medication with sodium channel blockers, and second line......Introduction Trigeminal neuralgia (TN) is characterized by touch-evoked unilateral brief shock-like paroxysmal pain in one or more divisions of the trigeminal nerve. In addition to the paroxysmal pain, some patients also have continuous pain. TN is divided into classical TN (CTN) and secondary TN...

Treatment of Refractory Idiopathic Supraorbital Neuralgia Using Percutaneous Pulsed Radiofrequency.

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Luo, Fang; Lu, Jingjing; Ji, Nan

2018-02-26

No ideal therapeutic method currently exists for refractory idiopathic supraorbital neuralgia patients who do not respond to conservative therapy, including medications and nerve blocks. Pulsed radiofrequency is a neuromodulation technique that does not produce sequelae of nerve damage after treatment. However, the efficacy of percutaneous pulsed radiofrequency for the treatment of refractory idiopathic supraorbital neuralgia is still not clear. The purpose of our study was to evaluate the efficacy and safety of pulsed radiofrequency treatment of the supraorbital nerve for refractory supraorbital neuralgia patients. We prospectively investigated the long-term effects of ultrasound-guided percutaneous pulsed radiofrequency in the treatment of 22 refractory idiopathic supraorbital neuralgia patients. A reduction in the verbal pain numeric rating scale score of more than 50% was used as the standard of effectiveness. The effectiveness rates at different time points within 2 years were calculated. After a single pulsed radiofrequency treatment, the effectiveness rate at 1 and 3 months was 77%, and the rates at 6 months, 1 year, and 2 years were 73%, 64%, and 50%, respectively. Except for a small portion of patients (23%) who experienced mild upper eyelid ecchymosis that gradually disappeared after approximately 2 weeks, no obvious complications were observed. In conclusion, the results of our study demonstrate that for patients with refractory idiopathic supraorbital neuralgia, percutaneous pulsed radiofrequency may be an effective and safe treatment choice. © 2018 World Institute of Pain.

Herpes Zoster and Postherpetic Neuralgia: An Examination of Psychological Antecedents

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Sansone, Randy A.; Sansone, Lori A.

2014-01-01

Herpes zoster and an associated complication, postherpetic neuralgia, are both attributable to the varicella zoster virus. This virus, which lies dormant within the affected sensory ganglia after an initial infection, appears to be triggered in part by a decrease in immunity. According to available research, stress, stressful life events, and depressive symptoms are identified antecedents to outbreaks of herpes zoster. Likewise, the development of postherpetic neuralgia has been associated wi...

[Treatment of Occipital Neuralgia by Electroacupuncture Combined with Neural Mobilization].

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Wang, Yan; Guo, Zi-Nan; Yang, Zhen; Wang, Shun

2018-03-25

To observe the effect of electroacupuncture (EA) combined with neural mobilization (NM) in the treatment of occipital neuralgia. A total of 62 occipital neuralgia patients were randomized into EA group (19 cases), NM group (22 cases) and EA＋NM group (21 cases). EA was applied at acupoint-pairs as Yuzhen (BL 9)- Tianzhu (BL 10), Fengchi (GB 20)- Wangu (GB 12), etc. NM intervention consisted of occipital muscle group mobilization, C 2 spinous process mobilization, cervical joint passive movement management mobilization, etc., was performed at the impaired cervical spine segment. The two methods were used in combination for patients in the EA＋NM group. All the treatment was given once a day for 2 weeks. Before and after treatment, the visual analogue scale (VAS) and the 6-point (1－6 points) behavioral rating scale (BRS-6) of headache were used to assess the severity of pain. The therapeutic effect was evaluated according to the "Criteria for Diagnosis and Cure-Improvement of Clinical Conditions" formulated by State Administration of Traditional Chinese Medicine of the People's Republic of China in 1994. After treatment, both VAS and BRS-6 scores were significantly lower than those before treatment in each of the three groups ( P occipital neuralgia, and EA＋NM has a synergic analgesic effect for occipital neuralgia.

Phenytoin and carbamazepine in trigeminal neuralgia: marketing-based versus evidence-based treatment

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Keppel Hesselink JM

2017-07-01

Full Text Available Jan M Keppel Hesselink,1 Michael E Schatman2,31Institute for Neuropathic Pain, Bosch en Duin, the Netherlands; 2Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA; 3Boston Pain Care, Waltham, MA, USAIntroductionMost review articles support carbamazepine as a first-line pharmacotherapy for idiopathic trigeminal neuralgia.1–3 However, the empirical support for this recommendation is somewhat suspect. Phenytoin, as the prototype for all anticonvulsants, was already positioned as an analgesic compound 70 years ago. Since these initial findings, the data that have been gathered have supported the use of anticonvulsants as painkillers – from phenytoin up to and including more recent anticonvulsants such as gabapentin and pregabalin. Since 1942, a number of papers supported phenytoin’s therapeutic effects in trigeminal neuralgia (Table 1. The introduction of carbamazepine in 1962 by Geigy shifted the interest of neurologists from phenytoin as a treatment for trigeminal neuralgia to carbamazepine, without sound scientific evidence. To date, no convincing randomized controlled trials (RCTs have been published supporting the role of carbamazepine in trigeminal neuralgia, and we could not identify a single study comparing the effects of phenytoin with those of carbamazepine. Accordingly, phenytoin should probably be considered more often as a viable therapy for (treatmentresistant trigeminal neuralgia.

Occipital Neuralgia Diagnosis and Treatment: The Role of Ultrasound.

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Narouze, Samer

2016-04-01

Occipital neuralgia is a form of neuropathic type of pain in the distribution of the greater, lesser, or third occipital nerves. Patients with intractable occipital neuralgia do not respond well to conservative treatment modalities. This group of patients represents a significant therapeutic challenge and may require interventional or invasive therapeutic approaches. Occipital neuralgia frequently occurs as a result of nerve entrapment or irritation by a tight muscle or vascular structure, or nerve trauma during whiplash injury. Although the entrapment theory is most commonly accepted, it lacks strong clinical evidence to support it. Accordingly, the available interventional approaches have been targeting the accessible part of the occipital nerve rather than the entrapped part. Bedside sonography is an excellent imaging modality for soft tissue structures. Ultrasound not only allows distinguishing normal from abnormal entrapped occipital nerves, it can identify the level and the cause of entrapment as well. Ultrasound guidance allows precise occipital nerve blocks and interventions at the level of the "specific" entrapment location rather than into the site of "presumed" entrapment. © 2016 American Headache Society.

Oxcarbazepine: Drug of the future in the treatment of trigeminal neuralgia

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Revant H Chole

2011-01-01

Full Text Available Background: The aim of the study was to estimate the efficacy of oxcarbazepine in trigeminal neuralgia. Oxcarbazepine is a novel antiepilepfic drug, and its effect on trigeminal neuralgia has not been studied extensively previously. Materials and methods: Fifty-three patients with trigeminal neuralgia (34 men and 19 women took a mean dose of 600 mg of oxcarbazepine for a period of three weeks. Pain intensity was measured by using visual analog scale. Results: Of the 53 patients, 42 (79% were completely or well controlled by OXC, and nine (17% partially but acceptably controlled. Treatment with OXC was therefore satisfactory initially in 51 (96% of the patients. In seven of these patients, mild transient side effects occurred but did not necessitate cessation of treatment Conclusion: OXC appears to be an effective substitute for carbamazepine in those patients intolerant of this agent, or experiencing significant side effects.

Percutaneous micro-balloon compression for treatment of high risk idiopathic trigeminal neuralgia

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Zou Jianjun; Ma Yi; Wang Bin; Li Yanfeng; Huang Haitao; Li Fuyong

2008-01-01

Objective: To evaluate the clinical effectiveness and complications of percutaneous micro- balloon compression (PMC) of trigeminal ganglion for high risk idiopathic trigeminal neuralgia. Methods: To analyze retrospectively the clinical data of 3053 cases of idiopathic trigeminal nemalgia, of which 804 cases were in high risk, who underwent PMC from Jan. 2001 to Dec. 2007 in our department. Results: 833 procedures were performed on these 804 patients. The immediate effective rate was 97.3%; with recurrence rate of 6.8%, ipsilateral paresthesia incidence 3.7%; and no keratohelcosis with approximately 2/3 masticator, muscles weakness and diplopia 0.2%. Mean follow-up time was 36 months. Conclusions: PMC procedure is very effective for idiopathic trigeminal neuralgia especially in high risk patients, and especially prefer for the pain involved the first branch neuralgia. (authors)

Percutaneous microsphere compression for the treatment of bilateral primary trigeminal neuralgia

International Nuclear Information System (INIS)

Li Yanfeng; Ma Yi; Huang Haitao; Zou Jianjun; Wang Bin; Li Fuyong; Wang Quancai

2010-01-01

Objective: To evaluate the clinical effectiveness of percutaneous microsphere compression (PMC) in treating bilateral primary trigeminal neuralgia and to discuss the optimal contralateral operation time after one side trigeminal neuralgia was treated with PMC. Methods: From Dec.2000 to Aug. 2009 PMC was performed in 74 patients with bilateral primary trigeminal neuralgia. The clinical data were retrospectively analyzed. Based on the pain-relieving degree the therapeutic effect was evaluated. Complete disappearance of pain was regarded as the criteria of a successful procedure. According to the recovery of mastication function of the operated side, the operation time for the contralateral side was decided. Results: A total of 145 PMC procedures were carried out in 74 patients,including three repeated operations in 3 cases due to recurrent pain after initial PMC. The postoperative instant effective rate was 96.5%. The recurrence rate was 2.1% during a mean follow-up period of 2.9 years (ranged 1-7 years). Of the 74 patients, bilateral PMC was accomplished in 68, and among them 57 patients received the contralateral operation within 1-3 months after the initial procedure was finished. Conclusion: Percutaneous microsphere compression is a quite effective treatment for bilateral primary trigeminal neuralgia. Usually, PMC for the contralateral side can be considered to perform in 1-3 months after the initial procedure. (authors)

Ultrasound-Guided Greater Occipital Nerve Blocks and Pulsed Radiofrequency Ablation for Diagnosis and Treatment of Occipital Neuralgia

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VanderHoek, Matthew David; Hoang, Hieu T; Goff, Brandon

2013-01-01

Occipital neuralgia is a condition manifested by chronic occipital headaches and is thought to be caused by irritation or trauma to the greater occipital nerve (GON). Treatment for occipital neuralgia includes medications, nerve blocks, and pulsed radiofrequency ablation (PRFA). Landmark-guided GON blocks are the mainstay in both the diagnosis and treatment of occipital neuralgia. Ultrasound is being utilized more and more in the chronic pain clinic to guide needle advancement when performing...

Percutaneous high-frequency selective rhizotomy in the trigeminal neuralgia therapy in multiple sclerosis

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V. M. Tyurnikov

2012-01-01

Full Text Available Trigeminal neuralgia is a rare symptom of multiple sclerosis affecting the disability. Multiple sclerosis related trigeminal neuralgia has been attributed to a demyelinating lesion in the pons. When the adequate pain drug-relieve therapy is not possible or when the patient becomes refractory to the treatment or can not continue pharmacological treatment because of the side effects, surgical intervention, including percutaneous radiofrequency rhizotomy is being discussed. Literature review and the data upon the efficiency and safety of this neurosurgical treatment in 16 patients with multiple sclerosis have been analyzed. Percutaneous radiofrequency rhizotomy has been proved to be a safe, reproducible and effective method of the symptomatic surgical treatment of trigeminal neuralgia in patients with multiple sclerosis in cases of the intolerance/inefficiency of the pharmacological therapy.

Management of Trigeminal Neuralgia using Amitriptyline and ...

African Journals Online (AJOL)

Trigeminal neuralgia (TN) is a clinical condition presenting with severe, paroxysmal facial pain, often described by patients also known as tic douloureux. Carbamazepine (CBZ) is the drug of choice, but some patients develop adverse effects and some others may become unresponsive to CBZ. We present three cases of TN ...

Laser heat stimulation of tiny skin areas adds valuable information to quantitative sensory testing in postherpetic neuralgia.

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Franz, Marcel; Spohn, Dorothee; Ritter, Alexander; Rolke, Roman; Miltner, Wolfgang H R; Weiss, Thomas

2012-08-01

Patients suffering from postherpetic neuralgia often complain about hypo- or hypersensation in the affected dermatome. The loss of thermal sensitivity has been demonstrated by quantitative sensory testing as being associated with small-fiber (Aδ- and C-fiber) deafferentation. We aimed to compare laser stimulation (radiant heat) to thermode stimulation (contact heat) with regard to their sensitivity and specificity to detect thermal sensory deficits related to small-fiber dysfunction in postherpetic neuralgia. We contrasted detection rate of laser stimuli with 5 thermal parameters (thresholds of cold/warm detection, cold/heat pain, and sensory limen) of quantitative sensory testing. Sixteen patients diagnosed with unilateral postherpetic neuralgia and 16 age- and gender-matched healthy control subjects were tested. Quantitative sensory testing and laser stimulation of tiny skin areas were performed in the neuralgia-affected skin and in the contralateral homologue of the neuralgia-free body side. Across the 5 thermal parameters of thermode stimulation, only one parameter (warm detection threshold) revealed sensory abnormalities (thermal hypoesthesia to warm stimuli) in the neuralgia-affected skin area of patients but not in the contralateral area, as compared to the control group. In contrast, patients perceived significantly less laser stimuli both in the affected skin and in the contralateral skin compared to controls. Overall, laser stimulation proved more sensitive and specific in detecting thermal sensory abnormalities in the neuralgia-affected skin, as well as in the control skin, than any single thermal parameter of thermode stimulation. Thus, laser stimulation of tiny skin areas might be a useful diagnostic tool for small-fiber dysfunction. Copyright © 2012 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

Neuronavigator-guided percutaneous radiofrequency thermocoagulation in the treatment of trigeminal neuralgia.

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Zhang, W C; Zhong, W X; Li, S T; Zheng, X S; Yang, M; Shi, J

2012-03-01

Although radiofrequency thermocoagulation is considered as a primary treatment for most patients with trigeminal neuralgia, neuronavigator-guided percutaneous radiofrequency thermocoagulation has been rarely reported. The object of this study was to assess the clinical value of neuronavigator-guided percutaneous radiofrequency thermocoagulation in the treatment of trigeminal neuralgia. The radiofrequency thermocoagulation was performed in 100 cases of trigeminal neuralgia. The patients were positioned supine or sitting, under Hartel's technique (reported by Sweet and Wepsic J Neurosurg 40:143-156, 1974), by anterior lateral facial approaches. The Gasserian ganglions were acupunctured, assisted by intraoperative CT scanning (3-digital reconstruction) and electrophysiology in order to accurately locate target. The needles located in oval foramen at the first puncture, the direction and position could be defined according to the electrophysiology examination. The pain alleviated immediately after operation. There occurred no serious complication and other nerve injury in all patients despite face numbness only. 3D-CT and electrophysiology Gasser's ganglion locations can raise the success rate of puncture, enhance the safety and reduce the incidence of complication, showing high academic value and its promising future.

Occipital Nerve Stimulation for the Treatment of Refractory Occipital Neuralgia: A Case Series.

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Keifer, Orion P; Diaz, Ashley; Campbell, Melissa; Bezchlibnyk, Yarema B; Boulis, Nicholas M

2017-09-01

Occipital neuralgia is a chronic pain syndrome characterized by sharp, shooting pains in the distribution of the occipital nerves. Although relatively rare, it associated with extremely debilitating symptoms that drastically affect a patient's quality of life. Furthermore, it is extremely difficult to treat as the symptoms are refractory to traditional treatments, including pharmacologic and procedural interventions. A few previous case studies have established the use of a neurostimulation of the occipital nerves to treat occipital neuralgia. The following expands on that literature by retrospectively reviewing the results of occipital nerve stimulation in a relatively large patient cohort (29 patients). A retrospective review of 29 patients undergoing occipital nerve stimulation for occipital neuralgia from 2012 to 2017 at a single institution with a single neurosurgeon. Of those 29 patients, 5 were repair or replacement of previous systems, 4 did not have benefit from trial stimulation, and 20 saw benefit to their trial stage of stimulation and went on to full implantation. Of those 20 patients, even with a history of failed procedures and pharmacological therapies, there was an overall success rate of 85%. The average preoperative 10-point pain score dropped from 7.4 ± 1.7 to a postoperative score of 2.9 ± 1.7. However, as with any peripheral nerve stimulation procedure, there were complications (4 patients), including infection, hardware erosion, loss of effect, and lead migration, which required revision or system removal. Despite complications, the results suggest, overall, that occipital nerve stimulation is a safe and effective procedure for refractory occipital neuralgia and should be in the neurosurgical repertoire for occipital neuralgia treatment. Copyright © 2017 Elsevier Inc. All rights reserved.

A simplified CT-guided approach for greater occipital nerve infiltration in the management of occipital neuralgia.

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Kastler, Adrian; Onana, Yannick; Comte, Alexandre; Attyé, Arnaud; Lajoie, Jean-Louis; Kastler, Bruno

2015-08-01

To evaluate the efficacy of a simplified CT-guided greater occipital nerve (GON) infiltration approach in the management of occipital neuralgia (ON). Local IRB approval was obtained and written informed consent was waived. Thirty three patients suffering from severe refractory ON who underwent a total of 37 CT-guided GON infiltrations were included between 2012 and 2014. GON infiltration was performed at the first bend of the GON, between the inferior obliqus capitis and semispinalis capitis muscles with local anaesthetics and cortivazol. Pain was evaluated via VAS scores. Clinical success was defined by pain relief greater than or equal to 50 % lasting for at least 3 months. The pre-procedure mean pain score was 8/10. Patients suffered from left GON neuralgia in 13 cases, right GON neuralgia in 16 cases and bilateral GON neuralgia in 4 cases. The clinical success rate was 86 %. In case of clinical success, the mean pain relief duration following the procedure was 9.16 months. Simplified CT-guided infiltration appears to be effective in managing refractory ON. With this technique, infiltration of the GON appears to be faster, technically easier and, therefore, safer compared with other previously described techniques. • Occipital neuralgia is a very painful and debilitating condition • GON infiltrations have been successful in the treatment of occipital neuralgia • This simplified technique presents a high efficacy rate with long-lasting pain relief • This infiltration technique does not require contrast media injection for pre-planning • GON infiltration at the first bend appears easier and safer.

Trigeminal neuralgia: successful antiepileptic drug combination therapy in three refractory cases

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Prisco L

2011-08-01

Full Text Available Lara Prisco1, Mario Ganau2, Federica Bigotto1, Francesca Zornada11Department of Anaesthesiology, Intensive Care and Emergency Medicine, University Hospital of Cattinara, 2Graduate School of Nanotechnology, University of Trieste, ItalyAbstract: Antiepileptic drug combination therapy remains an empirical second-line treatment approach in trigeminal neuralgia, after treatment with one antiepileptic drug or other nonantiepileptic drugs have failed. The results in three patients followed in our clinic are not sufficient to draw definitive conclusions, but suggest the possibility of developing this type of therapeutic approach further.Keywords: trigeminal neuralgia, antiepileptic drugs, combination therapy

Update on neuropathic pain treatment for trigeminal neuralgia

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Al-Quliti, Khalid W.

2015-01-01

Trigeminal neuralgia is a syndrome of unilateral, paroxysmal, stabbing facial pain, originating from the trigeminal nerve. Careful history of typical symptoms is crucial for diagnosis. Most cases are caused by vascular compression of the trigeminal root adjacent to the pons leading to focal demyelination and ephaptic axonal transmission. Brain imaging is required to exclude secondary causes. Many medical and surgical treatments are available. Most patients respond well to pharmacotherapy; carbamazepine and oxcarbazepine are first line therapy, while lamotrigine and baclofen are considered second line treatments. Other drugs such as topiramate, levetiracetam, gabapentin, pregabalin, and botulinum toxin-A are alternative treatments. Surgical options are available if medications are no longer effective or tolerated. Microvascular decompression, gamma knife radiosurgery, and percutaneous rhizotomies are most promising surgical alternatives. This paper reviews the medical and surgical therapeutic options for the treatment of trigeminal neuralgia, based on available evidence and guidelines. PMID:25864062

Pharmaceutical management of trigeminal neuralgia in the elderly

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Oomens, M.A.E.M.; Forouzanfar, T.

2015-01-01

Classical trigeminal neuralgia (CTN) is a severe neuropathic pain in the distribution of one or more branches of the trigeminal nerve, which occurs in recurrent episodes, causing deterioration in quality of life, affecting everyday habits and inducing severe disability. The aim of this review is to

Pharmaceutical Management of Trigeminal Neuralgia in the Elderly

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Oomens, M.A.E.; Forouzanfar, T.

2015-01-01

Classical trigeminal neuralgia (CTN) is a severe neuropathic pain in the distribution of one or more branches of the trigeminal nerve, which occurs in recurrent episodes, causing deterioration in quality of life, affecting everyday habits and inducing severe disability. The aim of this review is to

Hemifacial Pain and Hemisensory Disturbance Referred from Occipital Neuralgia Caused by Pathological Vascular Contact of the Greater Occipital Nerve

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Son, Byung-chul; Choi, Jin-gyu

2017-01-01

Here we report a unique case of chronic occipital neuralgia caused by pathological vascular contact of the left greater occipital nerve. After 12 months of left-sided, unremitting occipital neuralgia, a hypesthesia and facial pain developed in the left hemiface. The decompression of the left greater occipital nerve from pathological contacts with the occipital artery resulted in immediate relief for hemifacial sensory change and facial pain, as well as chronic occipital neuralgia. Although re...

Effect of the gamma knife treatment on the trigeminal nerve root in Chinese patients with primary trigeminal neuralgia.

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Song, Zhi-Xiu; Qian, Wei; Wu, Yu-Quan; Sun, Fang-Jie; Fei, Jun; Huang, Run-Sheng; Fang, Jing-Yu; Wu, Cai-Zhen; An, You-Ming; Wang, Daxin; Yang, Jun

2014-01-01

To understand the mechanism of the gamma knife treating the trigeminal neuralgia. Using the MASEP-SRRS type gamma knife treatment system, 140 Chinese patients with trigeminal neuralgia (NT) were treated in our hospital from 2002 to 2010, in which the pain relief rate reached 95% and recurrence rate was 3% only. We investigated the effect of the gamma knife treatment on the trigeminal nerve root in 20 Chinese patients with primary trigeminal neuralgia by the magnetic resonance imager (MRI) observation. 1) The cross-sectional area of trigeminal nerve root became smaller and MRI signals were lower in the treatment side than those in the non-treatment side after the gamma knife treatment of primary trigeminal neuralgia; 2) in the treatment side, the cross-sectional area of the trigeminal nerve root decreased significantly after the gamma knife treatment; 3) there was good correlation between the clinical improvement and the MRI findings; and 4) the straight distance between the trigeminal nerve root and the brainstem did not change after the gamma knife treatment. The pain relief induced the gamma knife radiosurgery might be related with the atrophy of the trigeminal nerve root in Chinese patients with primary trigeminal neuralgia.

Hemifacial Pain and Hemisensory Disturbance Referred from Occipital Neuralgia Caused by Pathological Vascular Contact of the Greater Occipital Nerve.

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Son, Byung-Chul; Choi, Jin-Gyu

2017-01-01

Here we report a unique case of chronic occipital neuralgia caused by pathological vascular contact of the left greater occipital nerve. After 12 months of left-sided, unremitting occipital neuralgia, a hypesthesia and facial pain developed in the left hemiface. The decompression of the left greater occipital nerve from pathological contacts with the occipital artery resulted in immediate relief for hemifacial sensory change and facial pain, as well as chronic occipital neuralgia. Although referral of pain from the stimulation of occipital and cervical structures innervated by upper cervical nerves to the frontal head of V1 trigeminal distribution has been reported, the development of hemifacial sensory change associated with referred trigeminal pain from chronic occipital neuralgia is extremely rare. Chronic continuous and strong afferent input of occipital neuralgia caused by pathological vascular contact with the greater occipital nerve seemed to be associated with sensitization and hypersensitivity of the second-order neurons in the trigeminocervical complex, a population of neurons in the C2 dorsal horn characterized by receiving convergent input from dural and cervical structures.

Glossopharyngeal neuralgia secondary to vascular compression in a patient with multiple sclerosis: a case report

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Gaitour Emil

2012-07-01

Full Text Available Abstract Introduction Glossopharyngeal neuralgia is an uncommon, painful syndrome, characterized by paroxysms of pain in the sensory distribution of the 9th cranial nerve. Idiopathic glossopharyngeal neuralgia may be due to compression of the glossopharyngeal nerve by adjacent vessels, while secondary glossopharyngeal neuralgia is associated with identifiable lesions affecting the glossopharyngeal nerve at different levels of its neuroanatomic pathway. Glossopharyngeal neuralgia is rare in the general population, but is more common in patients with multiple sclerosis. Case presentation A 56-year-old Caucasian woman with multiple sclerosis and migraine presented to our facility with intermittent lancinating pain to the right of her throat, tongue, and the floor of her mouth that had been occurring for the past year. The pain was intense, sharp, and stabbing, which lasted two to six seconds with radiation to the right ear. Initially, the attacks were infrequent, however, they had become more intense and frequent over time. Our patient reported weight loss, headache, painful swallowing, and the inability to maintain sleep due to painful attacks. A neurological examination revealed a right-handed woman with trigger points in the back of the tongue and throat on the right side. She also had dysphagia, hoarseness, and pain in the distribution of the right glossopharyngeal nerve. Mild right hemiparesis, hyperreflexia, dysmetria, and an ataxic gait were present. A magnetic resonance imaging scan of the brain was consistent with multiple sclerosis and magnetic resonance angiography demonstrated a loop of the posterior inferior cerebellar artery compressing the right glossopharyngeal nerve. She responded satisfactorily to carbamazepine. Microvascular decompression and Gamma Knife® radiosurgery were discussed in case of failure of the medical treatment; however, she declined these options. Conclusions Glossopharyngeal neuralgia in multiple sclerosis may

MRI analysis of vascular compressive trigeminal neuralgia

International Nuclear Information System (INIS)

Tang Ling; Chai Weimin; Song Qi; Ling Huawei; Miao Fei; Chen Kemin

2006-01-01

Objective: To analyze the offending vessels of vascular compressive trigeminal neuralgia by magnetic resonance tomographic angiography (MRTA). Methods: MRTA images of 235 asymptomatic trigeminal nerves and 147 symptomatic trigeminal nerves were analyzed by two radiologists who were blinded to the clinical findings. Judgment was made on if there were some vessels close to the trigeminal nerve. The diameter of the offending vessel, the distance from the offending vessel's contact point to the pons and the direction of the vessel toward the nerve were also recorded at the same time. Group t-test and Chi-Square test were used for statistics. Results: Two hundred and forty-two trigeminal nerves of all 382 nerves can be detected offending vessels on MRTA images, 111 of 242 trigeminal nerves were asymptomatic, the rest 131 were symptomatic. Statistical analysis indicated that the distance from the offending vessel's contact point to the pons in symptomatic group (the median is 2 mm) was shorter than that in the asymptomatic group (the median is 4 mm) (P<0.01). In 89.3% cases (117/131) of the symptomatic group the angle between the vessel and the nerve is larger than 45 degree, but only in 67.6% cases (75/111) in the asymptomatic group the angle is larger than 45 degree. That means significant difference is between the two groups (P<0.01). Vessel-nerve compression can be seen in 1 case of asymptomatic group (0.4%, 1/235) and 45 eases in symptomatic group (30.6%, 45/147). The vessel-nerve compression rate of the symptomatic group was much higher than that of the asymptomatic group (P<0.01). Conclusion: MR is a useful tool to evaluate the offending vessels of vascular compressive trigeminal neuralgia. The distance from the offending vessel's contact point to the pons and the direction of the vessel toward the nerve are related to the onset of vascular compressive trigeminal neuralgia. (authors)

Linear accelerator stereotactic radiosurgery for trigeminal neuralgia.

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Varela-Lema, Leonor; Lopez-Garcia, Marisa; Maceira-Rozas, Maria; Munoz-Garzon, Victor

2015-01-01

Stereotactic radiosurgery is accepted as an alternative for patients with refractory trigeminal neuralgia, but existing evidence is fundamentally based on the Gamma Knife, which is a specific device for intracranial neurosurgery, available in few facilities. Over the last decade it has been shown that the use of linear accelerators can achieve similar diagnostic accuracy and equivalent dose distribution. To assess the effectiveness and safety of linear-accelerator stereotactic radiosurgery for the treatment of patients with refractory trigeminal neuralgia. We carried out a systematic search of the literature in the main electronic databases (PubMed, Embase, ISI Web of Knowledge, Cochrane, Biomed Central, IBECS, IME, CRD) and reviewed grey literature. All original studies on the subject published in Spanish, French, English, and Portuguese were eligible for inclusion. The selection and critical assessment was carried out by 2 independent reviewers based on pre-defined criteria. In view of the impossibility of carrying out a pooled analysis, data were analyzed in a qualitative way. Eleven case series were included. In these, satisfactory pain relief (BIN I-IIIb or reduction in pain = 50) was achieved in 75% to 95.7% of the patients treated. The mean time to relief from pain ranged from 8.5 days to 3.8 months. The percentage of patients who presented with recurrences after one year of follow-up ranged from 5% to 28.8%. Facial swelling or hypoesthesia, mostly of a mild-moderate grade appeared in 7.5% - 51.9% of the patients. Complete anaesthesia dolorosa was registered in only study (5.3%). Cases of hearing loss (2.5%), brainstem edema (5.8%), and neurotrophic keratoplasty (3.5%) were also isolated. The results suggest that stereotactic radiosurgery with linear accelerators could constitute an effective and safe therapeutic alternative for drug-resistant trigeminal neuralgia. However, existing studies leave important doubts as to optimal treatment doses or the

Magnetic Resonance in trigeminal neuralgia: Presentation of three cases

International Nuclear Information System (INIS)

Ochoa Escudero, Martin; Echeverri Betancourt, Alejandro; Vargas Velez, Sergio Alberto

2005-01-01

Trigeminal neuralgia is characterized by episodes of acute facial pain. lt can be caused by diverse pathologies that affect anyone of the segments of the V cranial nerve. Magnetic resonance is of choice when imaging studies are necessary. Three cases evaluated by this modality and confirmed by surgery are shown

Intramuscular Lipoma-Induced Occipital Neuralgia on the Lesser Occipital Nerve.

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Han, Hyun Ho; Kim, Hak Soo; Rhie, Jong Won; Moon, Suk Ho

2016-06-01

Occipital neuralgia (ON) is commonly characterized by a neuralgiform headache accompanied by a paroxysmal burning sensation in the dermatome area of the greater, lesser, or third occipital nerve. The authors report a rare case of ON caused by an intramuscular lipoma originating from the lesser occipital nerve.A 52-year-old man presented with sharp pain in the left postauricular area with a 3 × 2-cm palpable mass. Computed tomography revealed a mass suspiciously resembling an intramuscular lipoma within splenius muscle. In the operation field, a protruding mass causing stretching of the lesser occipital nerve was found. After complete resection, the neuralgiform headache symptom had resolved and the intramuscular lipoma was confirmed through histopathology.Previous studies on the causes of ON have reported that variation in normal anatomic structures results in nerve compression. Occipital neuralgia, however, caused by intramuscular lipomas in splenius muscles have not been previously reported, and the dramatic resolution following surgery makes it an interesting case worth reporting.

Small Radiation Beam Dosimetry for Radiosurgery of Trigeminal Neuralgia: One Case Analysis

International Nuclear Information System (INIS)

Garcia-Garduno, O. A.; Larraga-Gutierrez, J. M.; Rodriguez-Villafuerte, M.; Martinez-Davalos, A.; Moreno-Jimenez, S.; Suarez-Campos, J. J.; Celis, M. A.

2008-01-01

The use of small radiation beams for trigeminal neuralgia (TN) treatment requires high precision and accuracy in dose distribution calculations and delivery. Special attention must be kept on the type of detector to be used. In this work, the use of GafChromic EBT registered radiochromic and X-OMAT V2 radiographic films for small radiation beam characterization is reported. The dosimetric information provided by the films (total output factors, tissue maximum ratios and off axis ratios) is compared against measurements with a shielded solid state (diode) reference detector. The film dosimetry was used for dose distribution calculations for the treatment of trigeminal neuralgia radiosurgery. Comparison of the isodose curves shows that the dosimetry produced with the X-OMAT radiographic film overestimates the dose distributions in the penumbra region

Computed tomography-guided percutaneous ozone injection of the Gasserian ganglion for the treatment of trigeminal neuralgia

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An JX

2018-01-01

Full Text Available Jian-Xiong An,1,2 Hui Liu,1 Ruo-Wen Chen,1,2 Yong Wang,1 Wen-Xing Zhao,1 Derek Eastwood,3 John P Williams4 1Department of Anesthesiology, Pain Medicine & Critical Care Medicine, Aviation General Hospital of China Medical University & Beijing Institute of Translational Medicine, Chinese Academy of Sciences, 2Department of Anesthesiology, Weifang Medical University, Beijing, People’s Republic of China; 3Department of Pain Services, Wirral University Teaching Hospital, Wirral, Merseyside, UK; 4Department of Anesthesiology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA Objective: The aim of this study was to evaluate the therapeutic effect of computed tomography (CT-guided percutaneous ozone injection for refractory trigeminal neuralgia. Design: A retrospective evaluation was performed in the study. Setting: The study was conducted at a university hospital pain center. Patients and methods: A total of 29 patients with a clinical diagnosis of refractory trigeminal neuralgia were enrolled. All patients were treated with a percutaneous ozone injection and one patient was excluded. There were 21 patients with classical trigeminal neuralgia (group A and seven patients with painful trigeminal neuropathy caused by post-herpetic neuralgia (group B. The percutaneous injection was an oxygen–ozone mixture at an ozone concentration of 30 mg/­mL into the Gasserian ganglion performed under CT guidance. The number of ­procedures performed varied from one to as many as 16. Outcomes were evaluated using visual analog scale (VAS pain scores. Results: The combined VAS scores were 7.11 ± 1.23 pretreatment, 2.86 ± 1.69 posttreatment (P < 0.05 and 3.25 ± 2.01 after 6-month follow-up (P < 0.05. In group A, the VAS scores were 7.10 ± 1.04 pretreatment and 2.90 ± 1.84 posttreatment (P < 0.05. In group B, the VAS scores were 7.14 ± 1.77 pretreatment and 2.71 ± 1.25 posttreatment (P < 0.05. After 6-months follow-up, the VAS score was 3.38 �

Neuralgia associated with transcutaneous electrical nerve stimulation therapy in a patient initially diagnosed with temporomandibular disorder.

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Omolehinwa, Temitope T; Musbah, Thamer; Desai, Bhavik; O'Malley, Bert W; Stoopler, Eric T

2015-03-01

Head and neck neoplasms may be difficult to detect because of wide-ranging symptoms and the presence of overlapping anatomic structures in the region. This case report describes a patient with chronic otalgia and temporomandibular disorder, who developed sudden-onset neuralgia while receiving transcutaneous electrical nerve stimulation (TENS) therapy. Further diagnostic evaluation revealed a skull base tumor consistent with adenoid cystic carcinoma. To our knowledge, this is the first report of TENS-associated neuralgia leading to a diagnosis of primary intracranial adenoid cystic carcinoma. Copyright © 2015 Elsevier Inc. All rights reserved.

Bi-modal radiofrequency treatment for coexisting neuralgia and neuropathy in adjacent divisions of the trigeminal nerve.

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Bhatjiwale, M; Bhatjiwale, M; Naik, L D; Chopade, P

2018-05-29

Trigeminal neuralgia and deafferentation neuropathic pain, or trigeminal neuropathy, are different symptomatologies, rarely reported to present together. The case of a 65-year-old gentleman suffering from trigeminal neuralgia of the maxillary and mandibular division is reported. He first underwent an infraorbital neurectomy that was complicated by deafferentation neuropathic pain, whilst his mandibular neuralgia continued. He was treated successfully for both the neuropathic and neuralgic symptoms in the same session using ultra-extended euthermic pulsed radiofrequency treatment for the maxillary division (V2) and radiofrequency thermocoagulation for the mandibular division (V3). This report is novel in describing the use of dual modalities in the same session for two distinct coexisting clinical entities in two different divisions of the same cranial nerve. The use of ultra-extended pulsed radiofrequency treatment for neuropathic pain in this case is also unique. Nearly 2years after the procedure, the patient continues to have complete pain relief. Copyright © 2018 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

Management of uncommon secondary trigeminal neuralgia related to a rare Arnold Chiari type I malformation

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Zafar Ali Khan

2017-12-01

Full Text Available Background Trigeminal neuralgia (TN may sometimes present secondary to an intra-cranial cause. Arnold Chiari Malformation (ACM is downward herniation of the cerebellar tonsils through the foramen magnum that may be a cause of TN like pain in very rare cases. Aims The aim of this brief report is to suggest the proper management of uncommon secondary trigeminal neuralgia related to a rare Arnold Chiari type I malformation. Methods A male patient presented electric shock like stabbing pain on the right side of the face for more than ten years. The symptoms were typical of trigeminal neuralgia except that there was loss of corneal reflex on the right side and the patient also complained of gait & sleep disturbances. Complex and multilevel diagnosis was made. Results A multiplanar imaging through brain acquiring T1/T2W1 revealed ACM Type I Malformation with caudal displacement of cerebellar tonsils through foramen magnum. Conclusion Dental surgeons and oral and Maxillofacial Surgeons should exclude intra-cranial causes by Magnetic Resonance Imaging(MRI in patients of TN presenting with loss of corneal reflex, gait and sleep disturbances due to night time pain episodes.

A Comparative Study between Oxcarbazepine and Gabapentin Regarding Therapeutic Efficiency and Tolerability in the Treatment of Trigeminal Neuralgia

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Fakir Mohan Debta

2010-01-01

Recently two newer anticonvulsant oxcarbazepine (OXC a ketoderivative of carbamazepine and gabapentin (GBP has been trailed in trigeminal neuralgia in different open clinical trial as monotherapy with encouraging results. These drugs have convenient dosage and surprisingly fewer side effects. These facts that trigeminal neuralgia responds to newer anticonvulsant (oxcarbazepine, gabapentin in a better perspective, enabled me to conduct the present clinical trial on 54 patients (both in newly diagnosed TN patient and refractive patient of trigeminal neuralgia who were made two randomized group for separate monotherapy study for a period of six months. The therapeutic effect of OXC and gabapentin (GBP in relation to reduction in number of attacks of pain and severity of pain were evaluated. All the scoring data showed OXC is more therapeutic efficacious cost-effective and well-tolerated profile than gabapentin and an emerging as a drug for treatment of TN in both new and refractive patients.

MRI volumetry for the preoperative diagnosis of trigeminal neuralgia

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Kress, Bodo; Schindler, Markus; Haehnel, Stefan; Sartor, Klaus; Stippich, Christoph [University of Heidelberg, Division of Neuroradiology, Department of Neurology, Medical Center, 69120 Heidelberg (Germany); Rasche, Dirk; Tronnier, Volker [University of Heidelberg, Department of Neurosurgery, Medical Center, 69120 Heidelberg (Germany)

2005-07-01

To assess whether quantitative measuring methods can help improve the reliability of MRI-based evaluations of the pathological role of a neurovascular conflict between an artery and the trigeminal nerve. In a prospective study, magnetic resonance images were obtained from 62 patients with unilateral facial pain and 50 healthy test subjects. In coronal T1- and T2-weighted sequences volume measurements were performed by regions of interest and compared intraindividually (healthy versus affected side in the patient populations and right versus left side in the group of test subjects) and on the basis of the different clinical pictures (t test for dependent and independent samples, p<0.05). In patients with trigeminal neuralgia, the affected nerve showed a smaller volume than the trigeminal nerve on the healthy side (p<0.001). Such a volume difference was noted neither in the other patients nor in the healthy test subjects. Quantitative MRI measurements allow a pathological neurovascular conflict to be distinguished from a nonpathological condition where an artery is in close proximity to the trigeminal nerve. The measured volume difference between the healthy and the affected nerve in patients with neuralgia is indicative of trigeminal nerve atrophy resulting from damage to the nerve. (orig.)

SU-E-T-669: Radiosurgery Failure for Trigeminal Neuralgia: A Study of Radiographic Spatial Fidelity

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Howe, J [Associates In Medical Physics, Louisville, KY (United States); Spalding, A [Norton Cancer Institute, Louisville, Kentucky (United States)

2015-06-15

Purpose: Management of Trigeminal Neuralgia with radiosurgery is well established, but often met with limited success. Recent advancements in imaging afford improvements in target localization for radiosurgery. Methods: A Trigeminal Neuralgia radiosurgery specific protocol was established for MR enhancement of the trigeminal nerve using a CISS scan with slice spacing of 0.7mm. Computed Tomography simulation was performed using axial slices on a 40 slice CT with slice spacing of 0.6mm. These datasets were registered using a mutual information algorithm and localized in a stereotactic coordinate system. Image registration between the MR and CT was evaluated for each patient by a Medical Physicist to ensure accuracy. The dorsal root entry zone target was defined on the CISS MR by a Neurosurgeon and dose calculations performed on the localized CT. Treatment plans were reviewed and approved by a Radiation Oncologist and Neurosurgeon. Image guided radiosurgery was delivered using positioning tolerance of 0.5mm and 1°. Eight patients with Trigeminal Neuralgia were treated with this protocol. Results: Seven patients reported a favorable response to treatment with average Barrow Neurological Index pain score of four before treatment and one following treatment. Only one patient had a BNI>1 following treatment and review of the treatment plan revealed that the CISS MR was registered to the CT via a low resolution (5mm slice spacing) T2 MR. All other patients had CISS MR registered directly with the localized CT. This patient was retreated 6 months later using direct registration between CISS MR and localized CT and subsequently responded to treatment with a BNI of one. Conclusion: Frameless radiosurgery offers an effective solution to Trigeminal Neuralgia management provided appropriate technology and imaging protocols (utilizing submillimeter imaging) are established and maintained.

SU-E-T-669: Radiosurgery Failure for Trigeminal Neuralgia: A Study of Radiographic Spatial Fidelity

International Nuclear Information System (INIS)

Howe, J; Spalding, A

2015-01-01

Purpose: Management of Trigeminal Neuralgia with radiosurgery is well established, but often met with limited success. Recent advancements in imaging afford improvements in target localization for radiosurgery. Methods: A Trigeminal Neuralgia radiosurgery specific protocol was established for MR enhancement of the trigeminal nerve using a CISS scan with slice spacing of 0.7mm. Computed Tomography simulation was performed using axial slices on a 40 slice CT with slice spacing of 0.6mm. These datasets were registered using a mutual information algorithm and localized in a stereotactic coordinate system. Image registration between the MR and CT was evaluated for each patient by a Medical Physicist to ensure accuracy. The dorsal root entry zone target was defined on the CISS MR by a Neurosurgeon and dose calculations performed on the localized CT. Treatment plans were reviewed and approved by a Radiation Oncologist and Neurosurgeon. Image guided radiosurgery was delivered using positioning tolerance of 0.5mm and 1°. Eight patients with Trigeminal Neuralgia were treated with this protocol. Results: Seven patients reported a favorable response to treatment with average Barrow Neurological Index pain score of four before treatment and one following treatment. Only one patient had a BNI>1 following treatment and review of the treatment plan revealed that the CISS MR was registered to the CT via a low resolution (5mm slice spacing) T2 MR. All other patients had CISS MR registered directly with the localized CT. This patient was retreated 6 months later using direct registration between CISS MR and localized CT and subsequently responded to treatment with a BNI of one. Conclusion: Frameless radiosurgery offers an effective solution to Trigeminal Neuralgia management provided appropriate technology and imaging protocols (utilizing submillimeter imaging) are established and maintained

Percutaneous radiofrequency rhizotomy and neurovascular decompression of the trigeminal nerve for the treatment of facial pain Rizotomia percutânea por radiofreqüência e a descompressão neurovascular do nervo trigêmeo no tratamento das algias faciais

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Manoel J. Teixeira

2006-12-01

Full Text Available OBJECTIVE: To determine the outcomes of 354 radiofrequency rhizotomies and 21 neurovascular decompressions performed as treatment for 367 facial pain patients (290 idiopathic trigeminal neuralgia, 52 symptomatic trigeminal neuralgia, 16 atypical facial pain, 9 post-herpetic neuralgia. METHOD: Clinical findings and surgery success rate were considered for evaluation. A scale of success rate was determined to classify patients, which considered pain relief and functional/sensorial deficits. RESULTS: Radiofrequency rhizotomy was performed in 273 patients with idiopathic trigeminal neuralgia and in all other patients, except for trigeminal neuropathy; neurovascular decompression was performed in 18 idiopathic trigeminal neuralgia patients; 100% idiopathic trigeminal neuralgia, 96.2% symptomatic trigeminal neuralgia, 37.5% atypical facial pain and 88.9% post-herpetic neuralgia had pain relief. CONCLUSION: Both techniques for idiopathic trigeminal neuralgia are usefull. Radiofrequency rhizotomy was also efficient to treat symptomatic facial pain, and post-herpetic facial pain, but is not a good technique for atypical facial pain.OBJETIVO: Determinar eficácia e achados pós-operatórios após 354 rizotomias por radiofreqüência e 21 descompressões neurovasculares como tratamento de 367 pacientes com dor facial (290 neuralgia idiopática do trigêmeo, 52 neuralgia sintomática do trigêmeo, 16 dor facial atípica, 9 neuralgia pós-herpética. MÉTODO: Achados clínicos e taxa de sucesso das cirurgias foram considerados para a avaliação. Uma escala avaliando alívio da dor e complicações sensoriais e funcionais foi utilizada para classificar os pacientes. RESULTADOS: A rizotomia por radiofreqüência foi realizada em 273 pacientes com neuralgia idiopática do trigêmeo e em todos os outros pacientes, exceto neuropatia trigeminal; descompressão neurovascular foi realizada em 18 pacientes com neuralgia idiopática do trigêmeo; 100% dos pacientes

Botulinum as a Toxin for Treating Post-herpetic Neuralgia

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DING, Xu-Dong; ZHONG, Jing; LIU, Yan-Ping; CHEN, Hua-Xian

2017-01-01

Background: We aimed to study the curative effects of botulinum A toxin (BTX-A) on the treatment of post-herpetic neuralgia (PNH). Methods: We enrolled 58 PNH patients and treated them with hypodermic injection of BTX-A in Xiangyang No.1 People?s Hospital, Hubei University of Medicine, Hubei, China. We measured and compared the Visual Analog Score (VAS), Neuropathy Pain Scale (NPS), Quality of Life Scale (SF-36) score, PNH seizure severity degree, seizure duration, frequency of attack and the...

Pain in trigeminal neuralgia: neurophysiology and measurement: a comprehensive review.

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Kumar, S; Rastogi, S; Kumar, S; Mahendra, P; Bansal, M; Chandra, L

2013-01-01

Trigeminal neuralgia (TN) is defined as sudden, usually unilateral, severe, brief, stabbing recurrent episodes of pain within the distribution of one or more branches of the trigeminal nerve. It is the most frequent cranial neuralgia, the incidence being 1 per 1,000,00 persons per year. Pain attacks start abruptly and last several seconds but may persist 1 to 2 minutes. The attacks are initiated by non painful physical stimulation of specific areas (trigger points or zones) that are located ipsilateral to the pain. After each episode, there is usually a refractive period during which stimulation of the trigger zone will not induce the pain. According to the European Federation of Neurological Societies (EFNS) guidelines on neuropathic pain assessment and the American Academy of Neurology (AAN)-EFNS guidelines on TN management the neurophysiological recording of trigeminal reflexes represents the most useful and reliable test for the neurophysiological diagnosis of trigeminal pains. The present article discusses different techniques for investigation of the trigeminal system by which an accurate topographical diagnosis and profile of sensory fiber pathology can be determined. With the aid of neurophysiological recordings and quantitative sensory testing, it is possible to approach a mechanism-based classification of orofacial pain.

Clinical observation on thoracic paravertebral nerve block with ozone treatment in patients with postherpetic neuralgia

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GUO Xiang-fei

2013-10-01

Full Text Available Objective To analyze the clinical efficacy of thoracic paravertebral nerve block with ozone in the treatment of postherpetic neuralgia. Methods Eighty-five patients suffered postherpetic neuralgia were divided into 4 groups: Group A (oral drugs + intramuscular injection of vitamin B12 + local nerve block of lesion area, Group B (oral drugs + intramuscular injection of compound trivitamin B + local nerve block of lesion area, Group C (oral drugs + intramuscular injection of compound trivitamin B + thoracic paravertebral nerve block + local nerve block of lesion area, Group D (oral drugs + intramuscular injection of compound trivitamin B + thoracic paravertebral nerve block with ozone + local nerve block of lesion area. Treatment outcomes were evaluated by Visual Analogue Scale (VAS, Quality of Sleep (QS, Self-Rating Depression Scale (SDS and C-reactive protein (CRP before treatment and 4 weeks after treatment. Results After treatment, VAS, QS and SDS scores of 4 groups were lower than that before treatment, and the differences were statistically significant (P 0.05, for all, while a significant change in CRP was observed in patients of group D between before and after treatment (P < 0.05. The improvement of VAS, QS and SDS scores of group D was significantly better than other 3 groups (P < 0.05, for all. Conclusion Thoracic paravertebral nerve block combined with ozone is a quick and effective method for postherpetic neuralgia patients.

Improvement in clinical outcomes after dry needling in a patient with occipital neuralgia

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Bond, Bryan M.; Kinslow, Christopher

2015-01-01

The primary purpose of this case report is to outline the diagnosis, intervention and clinical outcome of a patient presenting with occipital neuralgia. Upon initial presentation, the patient described a four-year history of stabbing neck pain and headaches. After providing informed consent, the patient underwent a total of four dry needling (DN) sessions over a two-week duration. During each of the treatment sessions, needles were inserted into the trapezii and suboccipital muscles. Post-intervention, the patient reported a 32-point change in her neck disability index score along with a 28-point change in her headache disability index score. Thus, it appears that subsequent four sessions of DN over two weeks, our patient experienced meaningful improvement in her neck pain and headaches. To the best of our knowledge, this is the first case report describing DN to successfully improve clinical outcomes in a patient diagnosed with occipital neuralgia. PMID:26136602

Percutaneous CT-guided cryoablation for the treatment of refractory pudendal neuralgia

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Prologo, J.D.; Williams, Roger [Emory University Hospital, Department of Radiology and Imaging Sciences Division of Interventional Radiology and Image-Guided Medicine, Atlanta, GA (United States); Lin, Roger C. [University Hospitals Case Medical Center, Department of Radiology, Cleveland, OH (United States); Corn, David [Case Western Reserve University, Department of Biomedical Engineering, Cleveland, OH (United States)

2015-05-01

To evaluate the safety and efficacy of percutaneous CT-guided cryoablation of the pudendal nerve for the treatment of refractory pudendal neuralgia. Eleven patients were selected to undergo percutaneous CT-guided cryoablation of the pudendal nerve based on established diagnostic criteria. Brief Pain Inventory questionnaires were administered prior to the procedure, during the immediate 24 h post procedure, and 45 days and 6 months following the procedure. Prior to treatment, the average level of pain on a scale from 0 (no pain) to 10 (worst pain imaginable) was 7.6, with pain described as ''burning'' (80%), ''pulling'' (37.5%), ''crushing'' (50%), ''pressure'' (84.5%), ''throbbing'' (50%), ''knife-life'' (52%), and ''other'' (60%). At 24 h, 45 days, and 6 months post-treatment, pain intensity dropped to 2.6, 3.5, and 3.1, respectively (p < 0.005). There were no procedure-related complications. CT-guided percutaneous cryoablation may represent a safe and efficacious option for selected patients with refractory pudendal neuralgia. (orig.)

Significance of neurovascular contact in classical trigeminal neuralgia

DEFF Research Database (Denmark)

Maarbjerg, Stine; Wolfram, Frauke; Gozalov, Aydin

2015-01-01

and degree of neurovascular contact. Severe neurovascular contact was defined as displacement or atrophy of the trigeminal nerve. A total of 135 patients with classical trigeminal neuralgia were included. Average age of disease onset was 53.0 years (95% confidence interval mean 40.5-55.5) and current age...... was 60.1 years (95% % confidence interval mean 57.5-62.7). Eighty-two (61%, 95% confidence interval 52-69%) patients were female. Neurovascular contact was prevalent both on the symptomatic and asymptomatic side [89% versus 78%, P = 0.014, odds ratio = 2.4 (1.2-4.8), P = 0.017], while severe...

Repeat Gamma Knife Radiosurgery for Trigeminal Neuralgia

International Nuclear Information System (INIS)

Aubuchon, Adam C.; Chan, Michael D.; Lovato, James F.; Balamucki, Christopher J.; Ellis, Thomas L.; Tatter, Stephen B.; McMullen, Kevin P.; Munley, Michael T.; Deguzman, Allan F.; Ekstrand, Kenneth E.; Bourland, J. Daniel; Shaw, Edward G.

2011-01-01

Purpose: Repeat gamma knife stereotactic radiosurgery (GKRS) for recurrent or persistent trigeminal neuralgia induces an additional response but at the expense of an increased incidence of facial numbness. The present series summarized the results of a repeat treatment series at Wake Forest University Baptist Medical Center, including a multivariate analysis of the data to identify the prognostic factors for treatment success and toxicity. Methods and Materials: Between January 1999 and December 2007, 37 patients underwent a second GKRS application because of treatment failure after a first GKRS treatment. The mean initial dose in the series was 87.3 Gy (range, 80–90). The mean retreatment dose was 84.4 Gy (range, 60–90). The dosimetric variables recorded included the dorsal root entry zone dose, pons surface dose, and dose to the distal nerve. Results: Of the 37 patients, 81% achieved a >50% pain relief response to repeat GKRS, and 57% experienced some form of trigeminal dysfunction after repeat GKRS. Two patients (5%) experienced clinically significant toxicity: one with bothersome numbness and one with corneal dryness requiring tarsorraphy. A dorsal root entry zone dose at repeat treatment of >26.6 Gy predicted for treatment success (61% vs. 32%, p = .0716). A cumulative dorsal root entry zone dose of >84.3 Gy (72% vs. 44%, p = .091) and a cumulative pons surface dose of >108.5 Gy (78% vs. 44%, p = .018) predicted for post-GKRS numbness. The presence of any post-GKRS numbness predicted for a >50% decrease in pain intensity (100% vs. 60%, p = .0015). Conclusion: Repeat GKRS is a viable treatment option for recurrent trigeminal neuralgia, although the patient assumes a greater risk of nerve dysfunction to achieve maximal pain relief.

Repeat Gamma Knife Radiosurgery for Trigeminal Neuralgia

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Aubuchon, Adam C., E-mail: acaubuchon@gmail.com [Department of Radiation Oncology, Wake Forest University School of Medicine, Winston-Salem, NC (United States); Chan, Michael D. [Department of Radiation Oncology, Wake Forest University School of Medicine, Winston-Salem, NC (United States); Lovato, James F. [Department of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC (United States); Balamucki, Christopher J. [Department of Radiation Oncology, University of Florida, Gainesville, FL (United States); Ellis, Thomas L.; Tatter, Stephen B. [Department of Neurosurgery, Wake Forest University School of Medicine, Winston-Salem, NC (United States); McMullen, Kevin P.; Munley, Michael T.; Deguzman, Allan F.; Ekstrand, Kenneth E.; Bourland, J. Daniel; Shaw, Edward G. [Department of Radiation Oncology, Wake Forest University School of Medicine, Winston-Salem, NC (United States)

2011-11-15

Purpose: Repeat gamma knife stereotactic radiosurgery (GKRS) for recurrent or persistent trigeminal neuralgia induces an additional response but at the expense of an increased incidence of facial numbness. The present series summarized the results of a repeat treatment series at Wake Forest University Baptist Medical Center, including a multivariate analysis of the data to identify the prognostic factors for treatment success and toxicity. Methods and Materials: Between January 1999 and December 2007, 37 patients underwent a second GKRS application because of treatment failure after a first GKRS treatment. The mean initial dose in the series was 87.3 Gy (range, 80-90). The mean retreatment dose was 84.4 Gy (range, 60-90). The dosimetric variables recorded included the dorsal root entry zone dose, pons surface dose, and dose to the distal nerve. Results: Of the 37 patients, 81% achieved a >50% pain relief response to repeat GKRS, and 57% experienced some form of trigeminal dysfunction after repeat GKRS. Two patients (5%) experienced clinically significant toxicity: one with bothersome numbness and one with corneal dryness requiring tarsorraphy. A dorsal root entry zone dose at repeat treatment of >26.6 Gy predicted for treatment success (61% vs. 32%, p = .0716). A cumulative dorsal root entry zone dose of >84.3 Gy (72% vs. 44%, p = .091) and a cumulative pons surface dose of >108.5 Gy (78% vs. 44%, p = .018) predicted for post-GKRS numbness. The presence of any post-GKRS numbness predicted for a >50% decrease in pain intensity (100% vs. 60%, p = .0015). Conclusion: Repeat GKRS is a viable treatment option for recurrent trigeminal neuralgia, although the patient assumes a greater risk of nerve dysfunction to achieve maximal pain relief.

Bee venom treatment for refractory postherpetic neuralgia: a case report.

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Lee, Seung Min; Lim, Jinwoong; Lee, Jae-Dong; Choi, Do-Young; Lee, Sanghoon

2014-03-01

Bee venom has been reported to have antinociceptive and anti-inflammatory effects in experimental studies. However, questions still remain regarding the clinical use of bee venom. This report describes the successful outcome of bee venom treatment for refractory postherpetic neuralgia. A 72-year-old Korean man had severe pain and hypersensitivity in the region where he had developed a herpes zoster rash 2 years earlier. He was treated with antivirals, painkillers, steroids, and analgesic patches, all to no effect. The patient visited the East-West Pain Clinic, Kyung Hee University Medical Center, to receive collaborative treatment. After being evaluated for bee venom compatibility, he was treated with bee venom injections. A 1:30,000 diluted solution of bee venom was injected subcutaneously along the margins of the rash once per week for 4 weeks. Pain levels were evaluated before every treatment, and by his fifth visit, his pain had decreased from 8 to 2 on a 10-point numerical rating scale. He experienced no adverse effects, and this improvement was maintained at the 3-month, 6-month, and 1-year phone follow-up evaluations. Bee venom treatment demonstrates the potential to become an effective treatment for postherpetic neuralgia. Further large-sample clinical trials should be conducted to evaluate the overall safety and efficacy of this treatment.

Genitofemoral neuralgia: adding to the burden of chronic vulvar pain

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Verstraelen H

2015-11-01

Full Text Available Hans Verstraelen,1 Eline De Zutter,1 Martine De Muynck2 1Department of Obstetrics and Gynaecology, Vulvovaginal Disease Clinic, Ghent University Hospital, Ghent, Belgium; 2Department of Physical Medicine and Rehabilitation, Ghent University Hospital, Ghent, Belgium Abstract: The vulva is a particularly common locus of chronic pain with neuropathic characteristics that occurs in women of any age, though most women with neuropathic type chronic vulvar pain will remain undiagnosed even following multiple physician visits. Here, we report on an exemplary case of a middle-aged woman who was referred to the Vulvovaginal Disease Clinic with debilitating vulvar burning and itching over the right labium majus that had been persisting for 2 years and was considered intractable. Careful history taking and clinical examination, followed by electrophysiological assessment through somatosensory evoked potentials was consistent with genitofemoral neuralgia, for which no obvious cause could be identified. Adequate pain relief was obtained with a serotonin–noradrenaline reuptake inhibitor and topical gabapentin cream. We briefly discuss the epidemiology, diagnosis, and treatment of genitofemoral neuralgia and provide a series of clues to guide clinicians in obtaining a presumptive diagnosis of specific neuropathic pain syndromes that may underlie chronic vulvar pain. We further aim to draw attention to the tremendous burden of chronic, unrecognized vulvar pain. Keywords: vulvar pain, genitofemoral nerve, neuropathic pain, vulvodynia, vulvar disease

Economic Burden of Herpes Zoster and Post-Herpetic Neuralgia in Adults 60 Years of Age or Older: Results from a Prospective, Physician Practice-Based Cohort Study in Kushiro, Japan.

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Nakamura, Hiroyuki; Mizukami, Akiko; Adachi, Koichi; Matthews, Sean; Holl, Katsiaryna; Asano, Kazuhiro; Watanabe, Akihiro; Adachi, Riri; Kiuchi, Mariko; Kobayashi, Keiju; Sato, Keiko; Matsuki, Taizo; Kaise, Toshihiko; Curran, Desmond

2017-12-01

Herpes zoster has a high incidence rate among people aged ≥ 60 years and can lead to serious complications such as post-herpetic neuralgia. There are currently no data on the economic burden of herpes zoster and post-herpetic neuralgia in Japan, and the objective of this study was to address this gap. A total of 412 patients aged ≥ 60 years diagnosed with herpes zoster were recruited. Demographic, clinical, and healthcare resource utilization data on patients with herpes zoster or post-herpetic neuralgia collected via case report forms were used to estimate direct medical cost. Data obtained from a questionnaire survey among patients with herpes zoster/post-herpetic neuralgia were used to estimate transportation cost and productivity loss. The mean number of outpatient visits was 5.7. Prescription medications were the main cost driver accounting for 60% of the direct medical cost. The mean direct medical and total herpes zoster-related costs per patient were ¥43,925 and ¥57,112, respectively, and were higher in patients with post-herpetic neuralgia than in those with herpes zoster without complications. Direct medical cost represented 77%, productivity loss 19%, and transportation cost 4% of the total. This is the first study of the economic burden of herpes zoster and post-herpetic neuralgia in Japan and it demonstrated substantial direct medical cost as a result of the multiple outpatient visits and prescription medications required. These findings provide baseline data for possible future economic evaluations of new herpes zoster/post-herpetic neuralgia interventions. This cost analysis is part of a prospective, physician practice-based cohort study conducted between June 2013 and February 2015 in Kushiro, Japan (Clinicaltrials.gov identifier NCT01873365, registered on 6 June, 2013).

Trigeminal Neuralgia and Multiple Sclerosis: A Historical Perspective.

Science.gov (United States)

Burkholder, David B; Koehler, Peter J; Boes, Christopher J

2017-09-01

Trigeminal neuralgia (TN) associated with multiple sclerosis (MS) was first described in Lehrbuch der Nervenkrankheiten für Ärzte und Studirende in 1894 by Hermann Oppenheim, including a pathologic description of trigeminal root entry zone demyelination. Early English-language translations in 1900 and 1904 did not so explicitly state this association compared with the German editions. The 1911 English-language translation described a more direct association. Other later descriptions were clinical with few pathologic reports, often referencing Oppenheim but citing the 1905 German or 1911 English editions of Lehrbuch. This discrepancy in part may be due to the translation differences of the original text.

Surgical Management of Familial Trigeminal Neuralgia With Different Inheritance Patterns: A Case Report

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Claudia Cervera-Martinez

2018-05-01

Full Text Available IntroductionTrigeminal neuralgia is a disorder characterized by unilateral electric shock-like pain, distributed in one or more trigeminal nerve branches and triggered by usually innocuous stimuli. Among the few case reports and literature reviews on familial trigeminal neuralgia (FTN, the results of several suggest the involvement of genes associated with biochemical alterations or atherosclerotic vascular malformations.BackgroundWe present four cases of FTN within two families (family A: two brothers; family B: two sisters. All patients were submitted to surgical treatment by the same surgeon.DiscussionCases 1 and 2 (family A exhibited FTN with an uncommon autosomal recessive pattern and clinical features consistent with previous literature reviews and case reports. However, in cases 3 and 4 (family B, we found FTN with a dominant autosomal pattern and an unusual physiopathology characterized by arachnoid adhesions.ConclusionWe conclude, in this case report, that there are several inheritance patterns as well as physiopathology that may be involved in FTN, and that both patterns described in our reported cases were successfully managed with surgery.

Oxcarbazepine: a new drug in the management of intractable trigeminal neuralgia.

OpenAIRE

Zakrzewska, J M; Patsalos, P N

1989-01-01

The efficacy and tolerability of oxcarbazepine, a keto derivative of carbamazepine, has been assessed in six patients (two males, four females; mean age 61 years, range 42-77), with trigeminal neuralgia refractory to carbamazepine therapy, over a period of 6 months. An excellent therapeutic response to oxcarbazepine was seen in all patients with pain control correlating well with serum drug concentrations of oxcarbazepine and its primary active metabolite 10-OH-carbazepine. Onset of the effec...

Altered regional homogeneity of spontaneous brain activity in idiopathic trigeminal neuralgia

OpenAIRE

Wang, Yanping; Zhang, Xiaoling; Guan, Qiaobing; Wan, Lihong; Yi, Yahui; Liu, Chun-Feng

2015-01-01

Yanping Wang,1,2 Xiaoling Zhang,2 Qiaobing Guan,2 Lihong Wan,2 Yahui Yi,2 Chun-Feng Liu1 1Department of Neurology, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, 2Department of Neurology, The Second Hospital of Jiaxing City, Jiaxing, Zhejiang Province, People’s Republic of China Abstract: The pathophysiology of idiopathic trigeminal neuralgia (ITN) has conventionally been thought to be induced by neurovascular compression theory. Recent structural ...

Influence of anatomic location of lidocaine patch 5% on effectiveness and tolerability for postherpetic neuralgia

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Nalamachu S

2013-06-01

Full Text Available Srinivas Nalamachu,1 Matthew Wieman,2 Leah Bednarek,2 Surya Chitra21International Clinical Research Institute, Overland Park, KS, 2Endo Pharmaceuticals Inc, Malvern, PA, USAPurpose: Lidocaine patch 5% is recommended as a first-line therapy for postherpetic neuralgia pain in neuropathic pain guidelines. Postherpetic neuralgia can occur anywhere on the body but often follows acute herpes zoster occurring in trigeminal and brachial plexus dermatomes. An analysis was conducted to determine whether the anatomic location of lidocaine patch 5% is associated with variations in effectiveness or tolerability in patients with postherpetic neuralgia.Methods: This was a post hoc analysis by anatomic site of patch placement (head [including neck], trunk [chest, abdomen, back, hips], and extremities [arm, leg] of a 4-week, multicenter, open-label study that enrolled patients with persistent pain following herpes zoster infection. Effectiveness was measured by Brief Pain Inventory (BPI average pain intensity (0 [no pain] to 10 [worst imaginable pain] and the BPI subscale for pain relief (0% [no relief] to 100% [complete relief]. Tolerability was assessed on the basis of patient-reported adverse events.Results: Of 332 enrolled patients (59.6% women [n = 198]; 92.5% white [n = 307]; mean [standard deviation] age, 71.2 [13.9] years, those (n = 203 who applied lidocaine patch 5% to a single anatomic site only and had baseline and postbaseline pain score data were analyzed (trunk, n = 130; head, n = 41; extremities, n = 32. The frequency of adverse events differed significantly by anatomic location, with significantly more adverse events reported with patch placement on the head versus the extremities (P = 0.006 or trunk (P = 0.02. BPI average pain improved significantly from baseline in each of the three anatomic areas (mean score decrease, 1.50–2.04; P ≤ 0.002, with no significant difference in effectiveness by patch location.Conclusion: Lidocaine 5% patch was

Acute herpes zoster neuralgia: retrospective analysis of clinical aspects and therapeutic responsiveness.

Science.gov (United States)

Haas, N; Holle, E; Hermes, B; Henz, B M

2001-01-01

Although the efficacy of modern antiviral agents for the treatment of herpes zoster is unquestioned, their ability to affect the associated pain remains controversial. We have therefore evaluated the inpatient hospital records of 550 patients with herpes zoster with regard to pain-related clinical aspects and therapeutic responsiveness. Intensity of pain was quantified by calculating a daily pain equivalence index (PEI) on the basis of different classes of pain medication and the number of tablets used in each category. The mean age of patients was 66.7 years, cranial segments were predominantly involved (55%), 64% of patients suffered from associated diseases and 77% experienced herpes-related pain. The PEI was 0.90 in the entire patient population, with significantly higher values in women and in patients with 3 or more associated diseases. It was lower in sacral and cranial nerve involvement, and it decreased rapidly in patients prior to discharge from hospital. Although there were significant differences in hospital stay between patients who received aciclovir and those who did not (mean 20.3 vs. 23.8 days), and for high- versus low-dose oral or intravenous administration, no significant differences were noted between the two groups for initial PEI values and during the course of observation, irrespective of the route of administration or the dose of aciclovir and the individual patient's PEI value. The groups were otherwise closely similar with regard to basic demographic and clinical data. 23.3% predominantly aged female patients with more associated diseases than the total patient population had a persistently elevated PEI and stayed in hospital beyond 21 days (mean 35.1 days), representing patients who went on to postherpetic neuralgia. These data further delineate clinical aspects of acute herpes zoster neuralgia, underline the unsolved therapeutic problems associated with this condition despite otherwise effective antiviral treatment, and characterise a

After microvascular decompression to treat trigeminal neuralgia, both immediate pain relief and recurrence rates are higher in patients with arterial compression than with venous compression.

Science.gov (United States)

Shi, Lei; Gu, Xiaoyan; Sun, Guan; Guo, Jun; Lin, Xin; Zhang, Shuguang; Qian, Chunfa

2017-07-04

We explored differences in postoperative pain relief achieved through decompression of the trigeminal nerve compressed by arteries and veins. Clinical characteristics, intraoperative findings, and postoperative curative effects were analyzed in 72 patients with trigeminal neuralgia who were treated by microvascular decompression. The patients were divided into arterial and venous compression groups based on intraoperative findings. Surgical curative effects included immediate relief, delayed relief, obvious reduction, and invalid result. Among the 40 patients in the arterial compression group, 32 had immediate pain relief of pain (80.0%), 5 cases had delayed relief (12.5%), and 3 cases had an obvious reduction (7.5%). In the venous compression group, 12 patients had immediate relief of pain (37.5%), 13 cases had delayed relief (40.6%), and 7 cases had an obvious reduction (21.9%). During 2-year follow-up period, 6 patients in the arterial compression group experienced recurrence of trigeminal neuralgia, but there were no recurrences in the venous compression group. Simple artery compression was followed by early relief of trigeminal neuralgia more often than simple venous compression. However, the trigeminal neuralgia recurrence rate was higher in the artery compression group than in the venous compression group.

Treatment strategy for trigeminal neuralgia: a thirty years experience.

Science.gov (United States)

Broggi, Giovanni; Ferroli, Paolo; Franzini, Angelo

2008-05-01

Trigeminal neuralgia is an invalidating disease when become drug-resistant. The only possible treatment is surgery with different modalities, percutaneous, open surgery or radiosurgery. The thirty years experience at the Fondazione Istituto Neurologico C. Besta, Milano, Italy suggests that these surgical strategies are successful in pain control in short and long term period in more than 90% of cases, with a low rate of side effects and high improvement of quality of life. The type of surgery should be tailored on the particular patient considering age, general physical condition, neuroradiological assessment in which MRI with dedicated sequences are mandatory, and also patient's attitude.

Prevention strategies for herpes zoster and post-herpetic neuralgia

Science.gov (United States)

Levin, Myron J.; Gershon, Anne A.; Dworkin, Robert H.; Brisson, Marc; Stanberry, Lawrence

2017-01-01

SUMMARY Impairment of varicella zoster virus (VZV)-specific cell-mediated immunity, including impairment due to immunosenescence, is associated with an increased risk of developing herpes zoster (HZ), whereas levels of anti-VZV antibodies do not correlate with HZ risk. This crucial role of VZV-specific cell-mediated immunity suggests that boosting these responses by vaccination will be an effective strategy for reducing the burden of HZ. Other strategies focus on preventing the major complication of HZ – post-herpetic neuralgia. These strategies include pre-emptive treatment with drugs such as tricyclic antidepressants, anticonvulsants and analgesics. PMID:20510262

Keyhole craniotomy through retrosigmoid approach followed by microvascular decompression for primary trigeminal neuralgia:a report of 23 cases

Directory of Open Access Journals (Sweden)

Gang-ge CHENG

2011-03-01

Full Text Available Objective To explore the surgical technique,effects,and complications of keyhole craniotomy through retrosigmoid approach followed by microvascular decompression for primary trigeminal neuralgia.Methods The craniotomy with a keyhole incision above postauricular hairline followed by microvascular decompression was performed in 23 patients with primary trigeminal neuralgia.Dissection of intracranial part of trigeminal nerve under microscope was done to search for the offending vessels,which were thereby freed and between which and the root entry zone(REZ of trigeminal nerve the Teflon grafts were placed.Effects and complications were observed in follow-up,ranging from 1 month to 2 years.Results Out of 23 patients who were all found compression in REZ of trigeminal nerves by the offending vessels in operation,disappearance of symptoms post-surgery was found in 22 cases,face numbness on the surgical side in 3 cases and no effects in 1 case.Recurrence of pain was not observed in patients who had initially benefited from the surgery at the follow-up.Conclusion The keyhole craniotomy through retrosigmoid approach followed by microvascular decompression is safe and effective for primary trigeminal neuralgia,in which accurate technique during operation plays a vital role in the decrease of complications and the outcome post-surgery.

Advances in diagnosis and treatment of trigeminal neuralgia

Science.gov (United States)

Montano, Nicola; Conforti, Giulio; Di Bonaventura, Rina; Meglio, Mario; Fernandez, Eduardo; Papacci, Fabio

2015-01-01

Various drugs and surgical procedures have been utilized for the treatment of trigeminal neuralgia (TN). Despite numerous available approaches, the results are not completely satisfying. The need for more contemporaneous drugs to control the pain attacks is a common experience. Moreover, a number of patients become drug resistant, needing a surgical procedure to treat the neuralgia. Nonetheless, pain recurrence after one or more surgical operations is also frequently seen. These facts reflect the lack of the precise understanding of the TN pathogenesis. Classically, it has been related to a neurovascular compression at the trigeminal nerve root entry-zone in the prepontine cistern. However, it has been evidenced that in the pain onset and recurrence, various neurophysiological mechanisms other than the neurovascular conflict are involved. Recently, the introduction of new magnetic resonance techniques, such as voxel-based morphometry, diffusion tensor imaging, three-dimensional time-of-flight magnetic resonance angiography, and fluid attenuated inversion recovery sequences, has provided new insight about the TN pathogenesis. Some of these new sequences have also been used to better preoperatively evidence the neurovascular conflict in the surgical planning of microvascular decompression. Moreover, the endoscopy (during microvascular decompression) and the intraoperative computed tomography with integrated neuronavigation (during percutaneous procedures) have been recently introduced in the challenging cases. In the last few years, efforts have been made in order to better define the optimal target when performing the gamma knife radiosurgery. Moreover, some authors have also evidenced that neurostimulation might represent an opportunity in TN refractory to other surgical treatments. The aim of this work was to review the recent literature about the pathogenesis, diagnosis, and medical and surgical treatments, and discuss the significant advances in all these fields

Gabapentin for once-daily treatment of post-herpetic neuralgia: a review

Directory of Open Access Journals (Sweden)

Beal B

2012-07-01

Full Text Available Benjamin Beal,1 Tobias Moeller-Bertram,1,2 Jan M Schilling,1 Mark S Wallace11Division of Pain Medicine, Department of Anesthesiology, University of California, 2VA San Diego Healthcare System, San Diego, CA, USAAbstract: Post-herpetic neuralgia is a neuropathic pain syndrome resulting from an insult to the peripheral and central nervous systems caused by the varicella zoster virus. Spontaneous pain may result in the persistent sensation of burning, tingling, or aching and may be associated with thermally or mechanically provoked pain, resulting in hyperalgesia or allodynia. The majority of cases occur in patients over the age of 50 years. Gabapentin is a structural analog of gamma aminobutyric acid that binds to the α2-δ site of voltage-dependent calcium channels and modulates the influx of calcium, with a resulting reduction in excitatory neurotransmitter release. Gabapentin is effective in reducing neuropathic pain due to post-herpetic neuralgia when given at least three times per day, due to its short half-life, resulting in demonstrable fluctuations in plasma levels. Gabapentin has dose-limiting side effects that prevent some patients from achieving therapeutic plasma levels, such as somnolence (27.4%, dizziness (23.9%, and ataxia (7.1%. Gralise™ is a once-daily extended-release formulation of gabapentin that has been developed using AcuForm™ technology. AcuForm is a polymer-based drug delivery system that retains the tablet in the stomach and upper gastrointestinal tract for a sustained period of time. Once-daily dosing has been shown to provide comparable drug exposure with an identical daily dose of the immediate-release formulation when administered three times daily. Participants given Gralise 1800 mg daily had a statistically significant reduction in average daily pain intensity scores compared with placebo, reduced sleep interference due to pain, and a greater percent of participants reporting being much or very much improved on

Streptomycin-lidocaine injections for the treatment of postherpetic neuralgia: Report of three cases with literature review.

Science.gov (United States)

Waghray, Shefali; Asif, Shaik Mohammed; Duddu, Mahesh Kumar; Arakeri, Gururaj

2013-09-01

The sudden, stabbing, paroxysmal pain of neuralgia is the fiercest agony that a patient may experience in his life. Many varied medical treatments and surgical procedures have been suggested in the literature for neuralgic pain. Most of the patients fail to respond to medical treatments or succumb to complications of total anesthesia owing to surgical procedures. Herein, we tried a new treatment modality in patients suffering from postherpetic neuralgia with appreciable success in all the three cases that are presented in this paper. Streptomycin sulfate dissolved in 2% lidocaine solution was deposited at the peripheral branches on the involved nerves targeting the trigger zones, given weekly once for a maximum of 6 week period and continued once in 2 weeks if symptoms persisted. All patients were followed-up for 1 year and there was a marked improvement on follow-up.

Oxcarbazepine: a new drug in the management of intractable trigeminal neuralgia.

Science.gov (United States)

Zakrzewska, J M; Patsalos, P N

1989-01-01

The efficacy and tolerability of oxcarbazepine, a keto derivative of carbamazepine, has been assessed in six patients (two males, four females; mean age 61 years, range 42-77), with trigeminal neuralgia refractory to carbamazepine therapy, over a period of 6 months. An excellent therapeutic response to oxcarbazepine was seen in all patients with pain control correlating well with serum drug concentrations of oxcarbazepine and its primary active metabolite 10-OH-carbazepine. Onset of the effect was observed within 24 hours in all cases. An overall serum therapeutic concentration range, in the six patients, of 50-110 mumol/l of 10-OH-carbazepine corresponding to a daily effective dose range of 1200-2400 mg (14.6-35.6 mg/kg body weight) oxcarbazepine, was observed. There was a significant correlation between oxcarbazepine dose and serum oxcarbazepine (r = 0.695, p less than 0.05) and 10-OH-carbazepine (r = 0.957, p less than 0.001) concentrations. Oxcarbazepine was well tolerated and no significant side effects were identified, though a mild hyponatraemia was observed during high doses (greater than 28 and greater than 35 mg/kg/day) in two patients. It is concluded that oxcarbazepine has potent antineuralgic properties in the absence of significant side effects and therefore may be useful in the management of intractable trigeminal neuralgia. Images PMID:2738589

Quantitative sensory testing in classical trigeminal neuralgia-a blinded study in patients with and without concomitant persistent pain

DEFF Research Database (Denmark)

Younis, Samaira; Maarbjerg, Stine; Reimer, Maren

2016-01-01

The diagnostic criteria of the third International Classification of Headache Disorders state that there should be no neurological deficits in patients with classical trigeminal neuralgia (TN) at clinical examination. However, studies demonstrating sensory abnormalities at bedside examination in TN...... scores were calculated to process frequency analyses and Z-profiles. We found increased mechanical detection threshold on the symptomatic side (47.2% vs 0%, P = 0.008), asymptomatic side (33.3% vs 0%, P = 0.011), and hand (36% vs 0%, P ... increased mechanical detection threshold on the symptomatic side compared with the asymptomatic side (-2.980 vs -2.166, P = 0.040). Thermal and mechanical hyperalgesia was detected bilaterally in the face and the hand. Trigeminal neuralgia patients with concomitant persistent pain tended to have higher mean...

Does increased nerve length within the treatment volume improve trigeminal neuralgia radiosurgery? a prospective double-blind, randomized study

International Nuclear Information System (INIS)

Flickinger, John C.; Pollock, Bruce E.; Kondziolka, Douglas; Phuong, Loi K.; Foote, Robert L.; Stafford, Scott L.; Lunsford, L. Dade

2001-01-01

Purpose: To test the hypothesis that increasing the nerve length within the treatment volume for trigeminal neuralgia radiosurgery would improve pain relief. Methods and Materials: Eighty-seven patients with typical trigeminal neuralgia were randomized to undergo retrogasserian gamma knife radiosurgery (75 Gy maximal dose with 4-mm diameter collimators) using either one (n=44) or two (n=43) isocenters. The median follow-up was 26 months (range 1-36). Results: Pain relief was complete in 57 patients (45 without medication and 12 with low-dose medication), partial in 15, and minimal in another 15 patients. The actuarial rate of obtaining complete pain relief (with or without medication) was 67.7%±5.1%. The pain relief was identical for one- and two-isocenter radiosurgery. Pain relapsed in 30 of 72 responding patients. Facial numbness and mild and severe paresthesias developed in 8, 5, and 1 two-isocenter patients vs. 3, 4, and 0 one-isocenter patients, respectively (p=0.23). Improved pain relief correlated with younger age (p=0.025) and fewer prior procedures (p=0.039) and complications (numbness or paresthesias) correlated with the nerve length irradiated (p=0.018). Conclusions: Increasing the treatment volume to include a longer nerve length for trigeminal neuralgia radiosurgery does not significantly improve pain relief but may increase complications

Prolonged vertigo and ataxia after mandibular nerve block for treatment of trigeminal neuralgia

OpenAIRE

Arvind Chaturvedi; H H Dash

2011-01-01

Common complications of neurolytic mandibular nerve block are hypoesthesia, dysesthesia, and chemical neuritis. We report a rare complication, prolonged severe vertigo and ataxia, after neurolytic mandibular blockade in a patient suffering from trigeminal neuralgia. Coronoid approach was used for right sided mandibular block. After successful test injection with local anesthetic, absolute alcohol was given for neurolytic block. Immediately after alcohol injection, patient developed nausea and...

Do carbamazepine, gabapentin, or other anticonvulsants exert sufficient radioprotective effects to alter responses from trigeminal neuralgia radiosurgery?

Science.gov (United States)

Flickinger, John C; Kim, Hyun; Kano, Hideyuki; Greenberger, Joel S; Arai, Yoshio; Niranjan, Ajay; Lunsford, L Dade; Kondziolka, Douglas; Flickinger, John C

2012-07-15

Laboratory studies have documented radioprotective effects with carbamazepine. We sought to determine whether carbamazepine or other anticonvulsant/neuroleptic drugs would show significant radioprotective effects in patients undergoing high-dose small-volume radiosurgery for trigeminal neuralgia. We conducted a retrospective review of 200 patients undergoing Gamma Knife (Elekta Instrument AB, Stockholm, Sweden) stereotactic radiosurgery for trigeminal neuralgia between February 1995 and May 2008. We selected patients treated with a maximum dose of 80 Gy with 4-mm diameter collimators, with no previous microvascular decompression, and follow-up ≥6 months (median, 24 months; range, 6-153 months). At the time of radiosurgery, 28 patients were taking no anticonvulsants, 62 only carbamazepine, 35 only gabapentin, 21 carbamazepine plus gabapentin, 17 carbamazepine plus other anticonvulsants, and 9 gabapentin plus other anticonvulsants, and 28 were taking other anticonvulsants or combinations. Pain improvement developed post-radiosurgery in 187 of 200 patients (93.5%). Initial complete pain relief developed in 84 of 200 patients (42%). Post-radiosurgery trigeminal neuropathy developed in 27 of 200 patients (13.5%). We could not significantly correlate pain improvement or initial complete pain relief with use of carbamazepine, gabapentin, or use of any anticonvulsants/neuroleptic drugs or other factors in univariate or multivariate analysis. Post-radiosurgery numbness/paresthesias correlated with the use of gabapentin (1 of 36 patients with gabapentin vs. 7 of 28 without, p = 0.017). In multivariate analysis, decreasing age, purely typical pain, and use of gabapentin correlated (p = 0.008, p = 0.005, and p = 0.021) with lower risks of developing post-radiosurgery trigeminal neuropathy. New post-radiosurgery numbness/paresthesias developed in 3% (1 of 36), 5% (4 of 81), and 13% (23 of 187) of patients on gabapentin alone, with age ≤70 years, and Type 1 typical

Do Carbamazepine, Gabapentin, or Other Anticonvulsants Exert Sufficient Radioprotective Effects to Alter Responses From Trigeminal Neuralgia Radiosurgery?

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Flickinger, John C. [Department of Radiation Oncology, University of Pittsburgh School of Medicine, Pittsburgh, PA (United States); College of Arts and Sciences, University of Pittsburgh, Pittsburgh, PA (United States); Kim, Hyun [Department of Radiation Oncology, University of Pittsburgh School of Medicine, Pittsburgh, PA (United States); Kano, Hideyuki [Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA (United States); Greenberger, Joel S.; Arai, Yoshio [Department of Radiation Oncology, University of Pittsburgh School of Medicine, Pittsburgh, PA (United States); Pittsburgh Cancer Institute, Pittsburgh, PA (United States); Niranjan, Ajay [Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA (United States); Lunsford, L. Dade; Kondziolka, Douglas [Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA (United States); Pittsburgh Cancer Institute, Pittsburgh, PA (United States); Department of Radiation Oncology, University of Pittsburgh School of Medicine, Pittsburgh, PA (United States); Flickinger, John C., E-mail: flickingerjc@upmc.edu [Department of Radiation Oncology, University of Pittsburgh School of Medicine, Pittsburgh, PA (United States); Pittsburgh Cancer Institute, Pittsburgh, PA (United States); Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA (United States)

2012-07-15

Purpose: Laboratory studies have documented radioprotective effects with carbamazepine. We sought to determine whether carbamazepine or other anticonvulsant/neuroleptic drugs would show significant radioprotective effects in patients undergoing high-dose small-volume radiosurgery for trigeminal neuralgia. Methods and Materials: We conducted a retrospective review of 200 patients undergoing Gamma Knife (Elekta Instrument AB, Stockholm, Sweden) stereotactic radiosurgery for trigeminal neuralgia between February 1995 and May 2008. We selected patients treated with a maximum dose of 80 Gy with 4-mm diameter collimators, with no previous microvascular decompression, and follow-up {>=}6 months (median, 24 months; range, 6-153 months). At the time of radiosurgery, 28 patients were taking no anticonvulsants, 62 only carbamazepine, 35 only gabapentin, 21 carbamazepine plus gabapentin, 17 carbamazepine plus other anticonvulsants, and 9 gabapentin plus other anticonvulsants, and 28 were taking other anticonvulsants or combinations. Results: Pain improvement developed post-radiosurgery in 187 of 200 patients (93.5%). Initial complete pain relief developed in 84 of 200 patients (42%). Post-radiosurgery trigeminal neuropathy developed in 27 of 200 patients (13.5%). We could not significantly correlate pain improvement or initial complete pain relief with use of carbamazepine, gabapentin, or use of any anticonvulsants/neuroleptic drugs or other factors in univariate or multivariate analysis. Post-radiosurgery numbness/paresthesias correlated with the use of gabapentin (1 of 36 patients with gabapentin vs. 7 of 28 without, p = 0.017). In multivariate analysis, decreasing age, purely typical pain, and use of gabapentin correlated (p = 0.008, p = 0.005, and p = 0.021) with lower risks of developing post-radiosurgery trigeminal neuropathy. New post-radiosurgery numbness/paresthesias developed in 3% (1 of 36), 5% (4 of 81), and 13% (23 of 187) of patients on gabapentin alone, with age

Do Carbamazepine, Gabapentin, or Other Anticonvulsants Exert Sufficient Radioprotective Effects to Alter Responses From Trigeminal Neuralgia Radiosurgery?

International Nuclear Information System (INIS)

Flickinger, John C.; Kim, Hyun; Kano, Hideyuki; Greenberger, Joel S.; Arai, Yoshio; Niranjan, Ajay; Lunsford, L. Dade; Kondziolka, Douglas; Flickinger, John C.

2012-01-01

Purpose: Laboratory studies have documented radioprotective effects with carbamazepine. We sought to determine whether carbamazepine or other anticonvulsant/neuroleptic drugs would show significant radioprotective effects in patients undergoing high-dose small-volume radiosurgery for trigeminal neuralgia. Methods and Materials: We conducted a retrospective review of 200 patients undergoing Gamma Knife (Elekta Instrument AB, Stockholm, Sweden) stereotactic radiosurgery for trigeminal neuralgia between February 1995 and May 2008. We selected patients treated with a maximum dose of 80 Gy with 4-mm diameter collimators, with no previous microvascular decompression, and follow-up ≥6 months (median, 24 months; range, 6–153 months). At the time of radiosurgery, 28 patients were taking no anticonvulsants, 62 only carbamazepine, 35 only gabapentin, 21 carbamazepine plus gabapentin, 17 carbamazepine plus other anticonvulsants, and 9 gabapentin plus other anticonvulsants, and 28 were taking other anticonvulsants or combinations. Results: Pain improvement developed post-radiosurgery in 187 of 200 patients (93.5%). Initial complete pain relief developed in 84 of 200 patients (42%). Post-radiosurgery trigeminal neuropathy developed in 27 of 200 patients (13.5%). We could not significantly correlate pain improvement or initial complete pain relief with use of carbamazepine, gabapentin, or use of any anticonvulsants/neuroleptic drugs or other factors in univariate or multivariate analysis. Post-radiosurgery numbness/paresthesias correlated with the use of gabapentin (1 of 36 patients with gabapentin vs. 7 of 28 without, p = 0.017). In multivariate analysis, decreasing age, purely typical pain, and use of gabapentin correlated (p = 0.008, p = 0.005, and p = 0.021) with lower risks of developing post-radiosurgery trigeminal neuropathy. New post-radiosurgery numbness/paresthesias developed in 3% (1 of 36), 5% (4 of 81), and 13% (23 of 187) of patients on gabapentin alone, with

Safety and efficacy of a Nav1.7 selective sodium channel blocker in patients with trigeminal neuralgia

DEFF Research Database (Denmark)

Zakrzewska, Joanna M; Palmer, Joanne; Morisset, Valerie

2017-01-01

BACKGROUND: Current standard of care for trigeminal neuralgia is treatment with the sodium channel blockers carbamazepine and oxcarbazepine, which although effective are associated with poor tolerability and the need for titration. BIIB074, a Nav1.7-selective, state-dependent sodium-channel blocker...

[Experience of professor FANG Jianqiao treating trigeminal neuralgia at different stages].

Science.gov (United States)

Sun, Jing; Fang, Jianqiao; Shao, Xiaomei; Chen, Lifang

2016-02-01

Trigerninal neuralgia is a common refractory disease in clinic. Professor FANG Jianqiao has rich experience through diagnosing and treating the disease for many years. In the first diagnosis, professor FANG underlines the position of damaged neuron and syndrome differentiation. He considers acupuncture should be implemented by stages,namely according to whether the patients are in the period of pain attack, different acupuocture prescriptions are made. Acupuncture manipulation and needle-retention time should be adjusted according to the condition of disease. And the appropriate application of electroacupuncture and transcutaneous electrical acupoint stimulation can strengthen the effect.

Advances in diagnosis and treatment of trigeminal neuralgia

Directory of Open Access Journals (Sweden)

Montano N

2015-02-01

Full Text Available Nicola Montano,1 Giulio Conforti,1 Rina Di Bonaventura,1 Mario Meglio,2 Eduardo Fernandez,1 Fabio Papacci1 1Institute of Neurosurgery, Catholic University, Rome, 2Institute of Neurosurgery, Azienda Ospedaliera Universitaria Integrata, Verona, Italy Abstract: Various drugs and surgical procedures have been utilized for the treatment of trigeminal neuralgia (TN. Despite numerous available approaches, the results are not completely satisfying. The need for more contemporaneous drugs to control the pain attacks is a common experience. Moreover, a number of patients become drug resistant, needing a surgical procedure to treat the neuralgia. Nonetheless, pain recurrence after one or more surgical operations is also frequently seen. These facts reflect the lack of the precise understanding of the TN pathogenesis. Classically, it has been related to a neurovascular compression at the trigeminal nerve root entry-zone in the prepontine cistern. However, it has been evidenced that in the pain onset and recurrence, various neurophysiological mechanisms other than the neurovascular conflict are involved. Recently, the introduction of new magnetic resonance techniques, such as voxel-based morphometry, diffusion tensor imaging, three-dimensional time-of-flight magnetic resonance angiography, and fluid attenuated inversion recovery sequences, has provided new insight about the TN pathogenesis. Some of these new sequences have also been used to better preoperatively evidence the neurovascular conflict in the surgical planning of microvascular decompression. Moreover, the endoscopy (during microvascular decompression and the intraoperative computed tomography with integrated neuronavigation (during percutaneous procedures have been recently introduced in the challenging cases. In the last few years, efforts have been made in order to better define the optimal target when performing the gamma knife radiosurgery. Moreover, some authors have also evidenced that

SU-E-T-420: Failure Effects Mode Analysis for Trigeminal Neuralgia Frameless Radiosurgery

Energy Technology Data Exchange (ETDEWEB)

Howe, J [Associates In Medical Physics, Louisville, KY (United States)

2015-06-15

Purpose: Functional radiosurgery has been used successfully in the treatment of trigeminal neuralgia but presents significant challenges to ensuring the high prescription dose is delivered accurately. A review of existing practice should help direct the focus of quality improvement for this treatment regime. Method: Failure modes and effects analysis was used to identify the processes in preparing radiosurgery treatment for TN. The map was developed by a multidisciplinary team including: neurosurgeon, radiation oncology, physicist and therapist. Potential failure modes were identified for each step in the process map as well as potential causes and end effect. A risk priority number was assigned to each cause. Results: The process map identified 66 individual steps (see attached supporting document). Corrective actions were developed for areas of high risk priority number. Wrong site treatment is at higher risk for trigeminal neuralgia treatment due to the lack of site specific pathologic imaging on MR and CT – additional site specific checks were implemented to minimize the risk of wrong site treatment. Failed collision checks resulted from an insufficient collision model in the treatment planning system and a plan template was developed to address this problem. Conclusion: Failure modes and effects analysis is an effective tool for developing quality improvement in high risk radiotherapy procedures such as functional radiosurgery.

SU-E-T-420: Failure Effects Mode Analysis for Trigeminal Neuralgia Frameless Radiosurgery

International Nuclear Information System (INIS)

Howe, J

2015-01-01

Purpose: Functional radiosurgery has been used successfully in the treatment of trigeminal neuralgia but presents significant challenges to ensuring the high prescription dose is delivered accurately. A review of existing practice should help direct the focus of quality improvement for this treatment regime. Method: Failure modes and effects analysis was used to identify the processes in preparing radiosurgery treatment for TN. The map was developed by a multidisciplinary team including: neurosurgeon, radiation oncology, physicist and therapist. Potential failure modes were identified for each step in the process map as well as potential causes and end effect. A risk priority number was assigned to each cause. Results: The process map identified 66 individual steps (see attached supporting document). Corrective actions were developed for areas of high risk priority number. Wrong site treatment is at higher risk for trigeminal neuralgia treatment due to the lack of site specific pathologic imaging on MR and CT – additional site specific checks were implemented to minimize the risk of wrong site treatment. Failed collision checks resulted from an insufficient collision model in the treatment planning system and a plan template was developed to address this problem. Conclusion: Failure modes and effects analysis is an effective tool for developing quality improvement in high risk radiotherapy procedures such as functional radiosurgery

The Role of Nav1.9 Channel in the Development of Neuropathic Orofacial Pain Associated with Trigeminal Neuralgia.

Science.gov (United States)

Lulz, Ana Paula; Kopach, Olga; Santana-Varela, Sonia; Wood, John N

2015-01-01

Trigeminal neuralgia is accompanied by severe mechanical, thermal and chemical hypersensitivity of the orofacial area innervated by neurons of trigeminal ganglion (TG). We examined the role of the voltage-gated sodium channel subtype Nav1.9 in the development of trigeminal neuralgia. We found that Nav1.9 is required for the development of both thermal and mechanical hypersensitivity induced by constriction of the infraorbital nerve (CION). The CION model does not induce change on Nav1.9 mRNA expression in the ipsilateral TG neurons when evaluated 9 days after surgery. These results demonstrate that Nav1.9 channels play a critical role in the development of orofacial neuropathic pain. New routes for the treatment of orofacial neuropathic pain focussing on regulation of the voltage-gated Nav1.9 sodium channel activity should be investigated. © 2015 Luiz et al.

Intractable trigeminal neuralgia: A single institution experience in 26 patients treated with stereotactic gamma knife radiosurgery

International Nuclear Information System (INIS)

Mark, Rufus J.; Duma, Christopher M.; Jacques, Dean B.; Kopyov, Oleg V.; Copcutt, Brian

1996-01-01

Purpose: In patients with trigeminal neuralgia, severe pain can persist, or recur despite aggressive medical management and open surgery. Recently, Gamma Knife radiosurgery has been used with promising results. We report on our series of 26 patients with intractable trigeminal neuralgia treated with stereotactic Gamma Knife radiosurgery. Materials and Methods: Between 1991 and 1995, 26 patients with intractable trigeminal neuralgia were treated at our institution using stereotactic Gamma Knife radiosurgery. Medical management had failed in all cases. In addition, 13 patients underwent a total of 20 open surgeries, with transient, or no pain relief. There were 19 females, and 7 males. Patient ages ranged from 37 to 87 years, with a median of 74 years. All patients were treated with a 201 source Cobalt-60 Gamma Knife unit. All patients underwent placement of the Leksell frame, followed by MRI scanning and computer treatment planning. The target in all patients was the fifth cranial nerve root entry zone into the brainstem. Twenty-five patients received between 64.3 to 70 Gy prescribed to Dmax in one shot. One patient received 120 Gy to Dmax in one shot. The 4 mm collimator was used in 22 cases, and the 8 mm in 4 cases. Follow-up ranged from 5 to 55 months, with a median of 19 months. Complete resolution (CR) of pain was scored when the patient reported being pain free off all medication. Partial resolution (PR) was scored when the patient reported > 50% pain reduction after Gamma Knife treatment. Results: At last follow-up, 84.6% ((22(26))) reported CR or PR of pain after Gamma Knife treatment. Forty-two percent ((11(26))) of patients reported CR, and 42%((11(26))) reported PR of pain. There was a dose response. In patients receiving < 70 Gy, 25% ((3(12))) reported CR, while 57% ((8(14))) of those receiving ≥ 70 Gy reported CR. Complications occurred in two (8%) patients. One patient developed transient numbness of the face after 70 Gy, and a second patient

Straightening the trigeminal nerve axis by complete dissection of arachnoidal adhesion and its neuroendoscopic confirmation for trigeminal neuralgia without neurovascular compression

Directory of Open Access Journals (Sweden)

Mami Ishikawa, MD, PhD

2017-12-01

Conclusions: Straightening the trigeminal nerve axis by complete dissection of the arachnoidal adhesion around the trigeminal nerve was effective for typical trigeminal neuralgia without neurovascular compression.

Epidermoid cyst in the cerebellopontine angle cistern presenting as trigeminal neuralgia. Diagnostic values of the orbicularis oculi reflex and metrizamide CT cisternography - case report -

Energy Technology Data Exchange (ETDEWEB)

Ueda, Takashi; Goya, Tomokazu; Kinoshita, Kazuo (Miyazaki Medical College, Miyazaki (Japan)); Fukui, Masashi

1983-05-01

This 29-year-old male had been suffering from left trigeminal neuralgia one year prior to admission. Admission was prompted by the development of pain in the third division of the left trigeminal nerve. Physical and neurological examinations were not remarkable except for the facial pain. The orbicularis oculi reflex showed delayed latency of R/sub 1/ on the affected side. CT scans performed pre- and post-contrast enhancement revealed a low density area in the left cerebellopontine angle cistern. Metrizamide CT cisternography clearly revealed the margin of the lesion as the contrast media did not enter into the low density area. A left suboccipital craniectomy was performed. The trigeminal nerve was surrounded by a thin-capsulated mass and cholesteatoma materials. Histological diagnosis was epidermoid cyst. Since this surgical procedure, the trigeminal neuralgia has not recurred for one year. Without objective neurological deficits, it is difficult to distinguish symptomatic trigeminal from idiopathic neuralgia. Therefore, minor change of the orbicularis oculi reflex should help in objectively detecting dysfunction of the trigeminal nerve. Metrizamide CT cisternography is also useful in diagnosis of cystic lesions.

Magnetic resonance neurography for the identification of pudendal neuralgia

Directory of Open Access Journals (Sweden)

Claudia P. Cejas

2017-06-01

Full Text Available The pudendal nerve entrapment is an entity understudied by diagnosis imaging. Various causes are recognized in relation to difficult labors, rectal, perineal, urological and gynecological surgery, pelvic trauma fracture, bones tumors and compression by tumors or pelvic pseudotumors. Pudendal neuropathy should be clinically suspected, and confirmed by different methods such as electrofisiological testing: evoked potentials, terminal motor latency test and electromyogram, neuronal block and magnetic resonance imaging. The radiologist should be acquainted with the complex anatomy of the pelvic floor, particularly on the path of pudendal nerve studied by magnetic resonance imaging. High resolution magnetic resonance neurography should be used as a complementary diagnostic study along with clinical and electrophysiological examinations in patients with suspected pudendal nerve neuralgia.

Obturator Neuralgia: A Rare Complication of Tension-free Vaginal Tape Sling-Complete Resolution After Laparoscopic Tension-free Vaginal Tape Removal.

Science.gov (United States)

Miklos, John R; Moore, Robert D; Chinthakanan, Orawee

2015-01-01

To show a technique of retropubic tension-free vaginal tape (TVT) removal using both a transvaginal and laparoscopic approach in the treatment of a rare condition, obturator neuralgia. A step-by-step explanation of the patient's condition, diagnosis, surgical technique, and postoperative results using video, pictures, and medical illustrations (education video). TVT retropubic slings have become the gold standard for the treatment of stress urine incontinence over the last decade. Despite high cure rates, the TVT is not without potential complications. Typical complications include urine retention, incomplete bladder emptying, frequency, urgency, urethral erosion, vaginal extrusion, vaginal pain, and dyspareunia. The most common complication for sling removal/revision is chronic pain. The TVT obturator neuralgia is a rare and specific type of chronic pain that is normally associated with transobturator tape slings. The purpose of this video is to present an extremely rare complication of TVT retropubic slings, present symptoms and signs of obturator nerve compression, show the normal and the actual position of this patient's TVT sling, describe the laparoscopic removal of the TVT sling, and present the postoperative course and resolution of the patient's pain. The patient signed a release for her video to be used for educational and teaching purposes. A combined transvaginal and laparoscopic approach in a patient with lower abdominal, levator, and obturator-type pain after a TVT retropubic procedure. In patients suffering from obturator neuralgia after a retropubic sling, surgeons should include the sling as a potential causative factor in the differential diagnosis. Surgeons should consider removing the sling based on the patient's symptoms. If the patient suffers from only vaginal pain and dyspareunia, then the surgeon should consider only the removal of the vaginal portion of the sling. In patients with obturator neuralgia, retropubic, and/or lower abdominal

[Clinical observation of post-herpetic neuralgia treated with TCM herbal cupping therapy].

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Wu, Xi; Hu, Hui; Guo, Liang; Wang, Hui

2013-02-01

To compare the difference in the efficacy on post-herpetic neuralgia among TCM herbal cupping therapy, Chinese medicine thermal compressing therapy and mecobalamine. Fifty-seven cases were randomized into a TCM herbal cupping group, a thermal compressing group and a western medicine group, 19 cases in each one. The oral administration of ibuprofen was applied in every group. In the herbal cupping group, the bamboo cups soaked in the boiled Chinese herbal decoction were sucked on the most significant painful area. In the thermal compressing group, the towel soaked in the boiled Chinese herbal decoction was compressed on the most significant painful area. In the medication group, the muscular injection of mecobalamine was adopted. The treatment was given once a day, for 2 weeks totally in each group. SF-MPQ score and clinical efficacy before and after treatment were observed in each group. The remarkable effective rates were 78.9% (15/19), 36.8% (7/19) and 5.3% (1/19) in the TCM herbal cupping group, thermal compressing group and western medicine group separately. The efficacy in the TCM herbal cupping group was significantly superior to the thermal compressing group and western medicine group (all P cupping group was reduced more significantly as compared with the thermal compressing group and western medicine group (all P cupping therapy achieves the superior efficacy for post-herpetic neuralgia and relieves pain effectively of the patients, which is more advantageous than CM herbal thermal compressing therapy and Mecobalamine.

INFILTRACIÓN DEL NERVIO PUDENDO GUIADA POR TOMOGRAFÍA AXIAL COMPUTADA, POR VÍA TRANSGLÚTEA: TERAPIA FRENTE AL DOLOR OCASIONADO POR NEURALGIA DEL NERVIO PUDENDO

OpenAIRE

Ricci A, Paolo; Lema C, Rodrigo; Solà D, Vicente; Wash F, Alex; Pardo S, Jack

2009-01-01

Antecedentes: La neuralgia del nervio pudendo pocas veces es sospechada y menos diagnosticada. Por esta razón, las pacientes que la padecen, consultan múltiples veces antes de llegar a un diagnóstico definitivo. Objetivo: Revisar la seguridad y eficacia de la infiltración de nervio pudendo, en el tratamiento del dolor en pacientes con neuralgia del nervio pudendo. Método: Seguimiento prospectivo de cinco pacientes ingresadas bajo el diagnóstico de síndrome de atrapamiento del nervio pudendo. ...

Practical considerations of linear accelerator-based frameless extracranial radiosurgery for treatment of occipital neuralgia for nonsurgical candidates.

Science.gov (United States)

Denton, Travis R; Shields, Lisa B E; Howe, Jonathan N; Shanks, Todd S; Spalding, Aaron C

2017-07-01

Occipital neuralgia generally responds to medical or invasive procedures. Repeated invasive procedures generate increasing complications and are often contraindicated. Stereotactic radiosurgery (SRS) has not been reported as a treatment option largely due to the extracranial nature of the target as opposed to the similar, more established trigeminal neuralgia. A dedicated phantom study was conducted to determine the optimum imaging studies, fusion matrices, and treatment planning parameters to target the C2 dorsal root ganglion which forms the occipital nerve. The conditions created from the phantom were applied to a patient with medically and surgically refractory occipital neuralgia. A dose of 80 Gy in one fraction was prescribed to the C2 occipital dorsal root ganglion. The phantom study resulted in a treatment achieved with an average translational magnitude of correction of 1.35 mm with an acceptable tolerance of 0.5 mm and an average rotational magnitude of correction of 0.4° with an acceptable tolerance of 1.0°. For the patient, the spinal cord was 12.0 mm at its closest distance to the isocenter and received a maximum dose of 3.36 Gy, a dose to 0.35 cc of 1.84 Gy, and a dose to 1.2 cc of 0.79 Gy. The brain maximum dose was 2.20 Gy. Treatment time was 59 min for 18, 323 MUs. Imaging was performed prior to each arc delivery resulting in 21 imaging sessions. The average deviation magnitude requiring a positional or rotational correction was 0.96 ± 0.25 mm, 0.8 ± 0.41°, whereas the average deviation magnitude deemed within tolerance was 0.41 ± 0.12 mm, 0.57 ± 0.28°. Dedicated quality assurance of the treatment planning and delivery is necessary for safe and accurate SRS to the cervical spine dorsal root ganglion. With additional prospective study, linear accelerator-based frameless radiosurgery can provide an accurate, noninvasive alternative for treating occipital neuralgia where an invasive procedure is contraindicated. © 2017

Oral Squamous Cell Carcinoma Found Inline with the Fields of Repeat Stereotactic Radiosurgery for Recurrent Trigeminal Neuralgia.

Science.gov (United States)

Berti, Aldo; Granville, Michelle; Jacobson, Robert E

2018-01-12

A case of an extremely healthy, active, 96-year-old patient, nonsmoker, is reviewed. He was initially treated for left V1, V2, and V3 trigeminal neuralgia in 2001, at age 80, with stereotactic radiosurgery (SRS) with a dose of 80 Gy to the left retrogasserian trigeminal nerve. He remained asymptomatic for nine years until his trigeminal pain recurred in 2010. He was first treated medically but was intolerant to increasing doses of carbamazepine and gabapentin. He underwent a second SRS in 2012 with a dose of 65.5 Gy to the same retrogasserian area of the trigeminal nerve, making the total cumulative dose 125.5 Gy. In late 2016, four years after the 2 nd SRS, he was found to have invasive keratinizing squamous cell carcinoma in the left posterior mandibular oral mucosa. Keratinizing squamous cell carcinoma is seen primarily in smokers or associated with the human papillomavirus, neither of which was found in this patient. A review of his two SRS plans shows that the left lower posterior mandibular area was clearly within the radiation fields for both SRS treatments. It is postulated that his cancer developed secondary to the long-term radiation effect with a very localized area being exposed twice to a focused, cumulative, high-dose radiation. There are individual reports in the literature of oral mucositis immediately after radiation for trigeminal neuralgia and the delayed development of malignant tumors, including glioblastoma found after SRS for acoustic neuromas, but there are no reports of delayed malignant tumors developing within the general radiation field. Using repeat SRS is an accepted treatment for recurrent trigeminal neuralgia, but physicians and patients should be aware of the potential effects of higher cumulative radiation effects within the treatment field when patients undergo repeat procedures.

Epidemiologic assessment of trigeminal neuralgia in patients referred to the Imam clinic of Hamedan city during 2013-2015

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Masoud Ghiasian

2018-01-01

Full Text Available Background: Trigeminal neuralgia is the most common disease of the fifth cranial nerve. This study aimed at evaluating the epidemiology of patients with the trigeminal neuralgia referred to Imam Clinic in Hamedan City, Iran. Materials and Methods: In this descriptive cross-sectional study, 40 patients with trigeminal neuralgia symptoms were studied. Diagnosis of patients was made based on the history, physical examination and paraclinical tests. Results: This study was conducted on 27 (67.5% females and 13 (32.5% males with the mean ages of 43.3±16.9 and 51.7±21.5 years, respectively (P=0.526.The incidence of this disease was higher among young women than others. The right side involvement was detected in 47.5%, left side involvement in 40% and bilateral involvement in 12.5% of the cases. Regarding the engaged nerve branch, simultaneous engagement of maxillary and mandibular nerves was seen in 47.5%, mandibular in 27.5%, maxillary in 20%, and ophthalmic in 5% of the individuals. The primary causes were seen in 42.5% and secondary causes in 57.5% of the cases. Among the secondary causes, face surgery and multiple sclerosis had the highest rate (39.1%, followed by tumors (21.7%. Also, 65% of the patients had normal MRI and 35% had abnormal one. Conclusion: Due to the similar symptoms of the disease such as dental pain, and also maxillofacial surgery in the elderly as one of the most common secondary causes of this disease, facial surgeons and dentists should know more about this disease to avoid unnecessary surgeries.

[Linear accelerator-based stereotactic radiosurgery for the treatment of trigeminal neuralgia. Nine years' experience in a single institution].

Science.gov (United States)

Serrano-Rubio, A A; Martinez-Manrique, J J; Revuelta-Gutierrez, R; Gomez-Amador, J L; Martinez-Anda, J J; Ponce-Gomez, J A; Moreno-Jimenez, S

2014-09-16

INTRODUCTION. Pharmacological treatment is the first therapeutic step towards controlling pain in trigeminal neuralgia, but 25-50% of patients become medication resistant. There are currently several surgical alternatives for treating these patients. AIM. To evaluate the effectiveness and safety of stereotactic radiosurgery for the treatment of patients with trigeminal neuralgia. PATIENTS AND METHODS. A follow-up study was conducted on 30 patients who underwent radiosurgery using a Novalis linear accelerator. Eighty per cent of the dosage was calculated at the isocentre, the entry zone of the root of the trigeminal nerve. The mean follow-up time was 27.5 months (range: 1-65 months). RESULTS. The mean age was 66 years (range: 36-87 years), with a time to progression of 7.1 years (range: 4-27 years). The distribution of the pain was from the right side (63.3%). Of the 30 patients, 27 experienced an improvement (90%) 1.6 months (range: 1 week-4 months) after the treatment; 10 patients (33.3%) scored grade I, and 17 patients (56.6%) obtained a score of grade II. During the follow-up, four patients (14.2%) suffered a relapse; two underwent re-irradiation. Time without recurrence was 62.7 months (range: 54.6-70.8 months). The rate of side effects was 76.7% and only three patients developed facial anaesthesia with loss of the corneal reflex. CONCLUSIONS. The use of the linear accelerator is an effective therapeutic option in the treatment of trigeminal neuralgia, since it provides adequate long-term control of the pain, reduces the use of medication and improves the quality of life.

Glossopharyngeal neuralgia with syncope as a sign of neck cancer recurrence Neuralgia glossofaríngea com síncope como um sinal de recidiva de câncer do pescoço

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Reinaldo Teixeira Ribeiro

2007-12-01

Full Text Available Glossopharyngeal neuralgia with syncope as a sign of neck cancer is a very rare condition. A review of the literature revealed only 29 cases formerly reported. We present the first Brazilian case of such association. A 68-year-old man presented with paroxysmal excruciating pain over the right side of the neck, sometimes followed by syncope. Given the suspicion of recurrent tumor from a previously treated neck malignancy, a computed tomography scan was performed and a right parapharyngeal tumor was shown. Pain and syncope were successfully controlled with carbamazepine and the patient underwent palliative radiotherapy.Neuralgia glossofaríngea com síncope como um sinal de câncer do pescoço é uma condição muito rara. Uma revisão da literatura revelou apenas 29 casos relatados anteriormente. Apresentamos o primeiro caso brasileiro de tal associação. Um homem de 68 anos se apresentou com dores paroxísticas insuportáveis no lado direito do pescoço, algumas vezes seguidas de síncope. Dada a suspeita de recidiva tumoral derivada de uma malignidade cervical tratada previamente, realizou-se um exame de tomografia computadorizada que evidenciou um tumor parafaríngeo direito. As dores e as síncopes foram controladas satisfatoriamente com carbamazepina e o paciente foi submetido à radioterapia paliativa.

Field-testing of the ICHD-3 beta diagnostic criteria for classical trigeminal neuralgia

DEFF Research Database (Denmark)

Maarbjerg, Stine; Sørensen, Morten Togo; Gozalov, Aydin

2015-01-01

INTRODUCTION: We aimed to field-test the beta version of the third edition of the International Classification of Headache Disorders (ICHD-3 beta) diagnostic criteria for classical trigeminal neuralgia (TN). The proposed beta draft of the 11th version of the International Classification of Diseases...... (ICD-11 beta) is almost exclusively based on the ICHD-3 beta classification structure although slightly abbreviated. We compared sensitivity and specificity to ICHD-2 criteria, and evaluated the needs for revision. METHODS: Clinical characteristics were systematically and prospectively collected from...

Assessment of neurovascular compression in patients with trigeminal neuralgia with a boundary fusion three-dimensional magnetic resonance cisternogram/angiogram

International Nuclear Information System (INIS)

Satoh, Toru; Omi, Megumi; Ohsako, Chika; Onoda, Keisuke; Date, Isao

2007-01-01

Precise assessment of the complex nerve-vessel relationship at the root entry zone (REZ) of the trigeminal nerve is useful for the planning of the microvascular decompression (MVD) in patients with trigeminal neuralgia. We have applied a boundary imaging of fusion three-dimensional (3D) magnetic resonance (MR) cisternogram/angiogram. The boundary imaging allows virtual assessment of the spatial relationship of the neurovascular compression at the REZ of the trigeminal nerve. The boundary images depicted complex anatomical relationship of the offending vessels to the trigeminal nerve REZ. The presence of offending vessels, compressive site, and degree of neurovascular compression were assessed from various viewpoints in the cistern and virtually through the brainstem and trigeminal nerve per se. The 3D visualization of the nerve-vessel relationship with fusion images was consistent with the intraoperative findings. The boundary fusion 3D MR cisternogram/angiogram may prove a useful adjunct for the diagnosis and decision-marking process to execute the MVD in patients with trigeminal neuralgia. (author)

[Treatment of neuralgia after surgical repair of inguinal hernia. Apropos of 47 cases].

Science.gov (United States)

Gatt, M T; Chevrel, J P

1991-01-01

A semiologic study is performed and therapeutic proposals are made on the basis of the anatomical and physiopathological data relating to residual neuralgia after the cure of a hernia. A series of 47 patients, 41 of whom were treated at the Multidisciplinary Pain Treatment Center of Avicenne Hospital (Bobigny) is analysed. The results are the following: 16 cures, 22 improvements, 6 failures, 3 patients lost to follow-up. The authors emphasize the difficulties of treatment, the poor effectiveness of second surgery as a rule, and the necessity of a general management.

Microvascular Decompression for Classical Trigeminal Neuralgia Caused by Venous Compression: Novel Anatomic Classifications and Surgical Strategy.

Science.gov (United States)

Wu, Min; Fu, Xianming; Ji, Ying; Ding, Wanhai; Deng, Dali; Wang, Yehan; Jiang, Xiaofeng; Niu, Chaoshi

2018-05-01

Microvascular decompression of the trigeminal nerve is the most effective treatment for trigeminal neuralgia. However, when encountering classical trigeminal neuralgia caused by venous compression, the procedure becomes much more difficult, and failure or recurrence because of incomplete decompression may become frequent. This study aimed to investigate the anatomic variation of the culprit veins and discuss the surgical strategy for different types. We performed a retrospective analysis of 64 consecutive cases in whom veins were considered as responsible vessels alone or combined with other adjacent arteries. The study classified culprit veins according to operative anatomy and designed personalized approaches and decompression management according to different forms of compressive veins. Curative effects were assessed by the Barrow Neurological Institute (BNI) pain intensity score and BNI facial numbness score. The most commonly encountered veins were the superior petrosal venous complex (SPVC), which was artificially divided into 4 types according to both venous tributary distribution and empty point site. We synthetically considered these factors and selected an approach to expose the trigeminal root entry zone, including the suprafloccular transhorizontal fissure approach and infratentorial supracerebellar approach. The methods of decompression consist of interposing and transposing by using Teflon, and sometimes with the aid of medical adhesive. Nerve combing (NC) of the trigeminal root was conducted in situations of extremely difficult neurovascular compression, instead of sacrificing veins. Pain completely disappeared in 51 patients, and the excellent outcome rate was 79.7%. There were 13 patients with pain relief treated with reoperation. Postoperative complications included 10 cases of facial numbness, 1 case of intracranial infection, and 1 case of high-frequency hearing loss. The accuracy recognition of anatomic variation of the SPVC is crucial for the

Altered regional homogeneity of spontaneous brain activity in idiopathic trigeminal neuralgia

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Wang Y

2015-10-01

Full Text Available Yanping Wang,1,2 Xiaoling Zhang,2 Qiaobing Guan,2 Lihong Wan,2 Yahui Yi,2 Chun-Feng Liu1 1Department of Neurology, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, 2Department of Neurology, The Second Hospital of Jiaxing City, Jiaxing, Zhejiang Province, People’s Republic of China Abstract: The pathophysiology of idiopathic trigeminal neuralgia (ITN has conventionally been thought to be induced by neurovascular compression theory. Recent structural brain imaging evidence has suggested an additional central component for ITN pathophysiology. However, far less attention has been given to investigations of the basis of abnormal resting-state brain activity in these patients. The objective of this study was to investigate local brain activity in patients with ITN and its correlation with clinical variables of pain. Resting-state functional magnetic resonance imaging data from 17 patients with ITN and 19 age- and sex-matched healthy controls were analyzed using regional homogeneity (ReHo analysis, which is a data-driven approach used to measure the regional synchronization of spontaneous brain activity. Patients with ITN had decreased ReHo in the left amygdala, right parahippocampal gyrus, and left cerebellum and increased ReHo in the right inferior temporal gyrus, right thalamus, right inferior parietal lobule, and left postcentral gyrus (corrected. Furthermore, the increase in ReHo in the left precentral gyrus was positively correlated with visual analog scale (r=0.54; P=0.002. Our study found abnormal functional homogeneity of intrinsic brain activity in several regions in ITN, suggesting the maladaptivity of the process of daily pain attacks and a central role for the pathophysiology of ITN. Keywords: trigeminal neuralgia, resting fMRI, brain, chronic pain, local connectivity

Microvascular decompression for trigeminal neuralgia: comments on a series of 250 cases, including 10 patients with multiple sclerosis.

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Broggi, G; Ferroli, P; Franzini, A; Servello, D; Dones, I

2000-01-01

To examine surgical findings and results of microvascular decompression (MVD) for trigeminal neuralgia (TN), including patients with multiple sclerosis, to bring new insight about the role of microvascular compression in the pathogenesis of the disorder and the role of MVD in its treatment. Between 1990 and 1998, 250 patients affected by trigeminal neuralgia underwent MVD in the Department of Neurosurgery of the "Istituto Nazionale Neurologico C Besta" in Milan. Limiting the review to the period 1991-6, to exclude the "learning period" (the first 50 cases) and patients with less than 1 year follow up, surgical findings and results were critically analysed in 148 consecutive cases, including 10 patients with multiple sclerosis. Vascular compression of the trigeminal nerve was found in all cases. The recurrence rate was 15.3% (follow up 1-7 years, mean 38 months). In five of 10 patients with multiple sclerosis an excellent result was achieved (follow up 12-39 months, mean 24 months). Patients with TN for more than 84 months did significantly worse than those with a shorter history (p<0.05). There was no mortality and most complications occurred in the learning period. Surgical complications were not related to age of the patients. Aetiopathogenesis of trigeminal neuralgia remains a mystery. These findings suggest a common neuromodulatory role of microvascular compression in both patients with or without multiple sclerosis rather than a direct causal role. MVD was found to be a safe and effective procedure to relieve typical TN in patients of all ages. It should be proposed as first choice surgery to all patients affected by TN, even in selected cases with multiple sclerosis, to give them the opportunity of pain relief without sensory deficits.

Gamma knife radiosurgery for trigeminal neuralgia. Analysis of a multi institutional study

International Nuclear Information System (INIS)

Takanashi, Masami; Ozaki, Yoshimaru; Satou, Kenichi; Oikawa, Mitsuteru; Nakamura, Hirohiko; Fukuoka, Seiji

2013-01-01

A multi-institutional study was conducted to evaluate the results of gamma knife radiosurgery (GKRS) for the treatment of trigeminal neuralgia. Eleven hundred and thirty-five patients at 39 centers were analyzed. Three hundred and sixty-nine patients had undergone percutaneous nerve block and 173 patients had undergone microvascular decompression (MVD) prior to GKRS. GKRS was performed for 69.4% of patients targeted at the nerve root entry zone (REZ) and for 20.4% of patients targeted at the retrogasserian region (RGR). The target dose of the GKRS used in the current study varied from 70 to 90 Gy (mean: 77.8 Gy). The median follow-up period after GKRS was 21.1 months (range 1 to 125 months). Six hundred and eighty-nine patients (66%) responded with excellent or good control (pain free), 157 (15%) obtained fair control (more than 50% relief), and 192 (19%) experienced treatment failure. After 3 years, 64% of cases were pain free and 80% had more than 50% pain relief. After 4 years, 37 patients underwent additional GKRS, 36 MVD and 36 percutaneous nerve block. Tolerable hypoesthesia or paresthesia occurred in 129 patients (11%), whereas bothersome symptoms developed in 8 patients (1%). But no patient developed deafferentation pain. Nine patients (1%) complained of dry eye, but no other abnormalities of the cornea and conjunctiva were found on ophthalmological examination. Higher maximum radiosurgical dose was associated with a significantly greater factor of complete pain relief (p=0.0101). GKRS is a safe and effective alternative treatment for trigeminal neuralgia, and is a minimally invasive treatment. In addition it provided benefit to a patient population unwilling or unable to undergo more invasive surgical approaches. (author)

Health economic evidence of 5% lidocaine medicated plaster in post-herpetic neuralgia

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Liedgens H

2013-11-01

Full Text Available Hiltrud Liedgens,1 Marko Obradovic,1 Mark Nuijten2 1Grunenthal GmbH, Aachen, Germany; 2Ars Accessus Medica, Amsterdam, the Netherlands Background: Post-herpetic neuralgia (PHN is the most common and most debilitating complication of herpes zoster, and involves considerable associated costs. Objective: This paper presents results from nine health economic studies undertaken in eight European countries that compared lidocaine medicated plaster with gabapentin and/or pregabalin in PHN. It aims to support the increasing need for published cost-effectiveness data for health care decision-making processes in Europe. Methods: All studies were based on a similar core Markov model with data derived from clinical trials, local Delphi panels, and official national price and tariff lists. The main outcome measure was cost per quality-adjusted life year gained; time without pain or intolerable adverse events was also included as a secondary outcome measure. All studies focused on an elderly population of patients with PHN who had insufficient pain relief with standard analgesics and could not tolerate or had contraindications to tricyclic antidepressants. Results: Despite considerable differences in many of the variables used, the results showed remarkable similarity and suggested that use of lidocaine medicated plaster offered cost-savings in many of the countries studied, where it proved a highly cost-effective alternative to both gabapentin and pregabalin. Conclusion: Lidocaine medicated plaster is a cost-effective alternative to gabapentin and pregabalin in the treatment of PHN. These savings are largely the result of the superior safety profile of the lidocaine medicated plaster. Keywords: post-herpetic neuralgia, zoster, cost-effectiveness, lidocaine, plaster

Outcome of radiosurgery treatment with a linear accelerator in patients with trigeminal neuralgia.

Science.gov (United States)

Cordero Tous, N; Cruz Sabido, J de la; Román Cutillas, A M; Saura Rojas, E J; Jorques Infante, A M; Olivares Granados, G

2017-04-01

An overview of the effectiveness of radiosurgery in patients diagnosed with trigeminal neuralgia with an analysis of potential predictors of good outcome. All patients treated with linear accelerator radiosurgery between 2004 and 2011 were analysed. A dose of 60Gy dose was administered 1 to 2mm from the root entry zone with a maximum isodose of 20% delivered to the brainstem. Clinical results for pain control and any side effects were analysed at 12 and 36 months (BNI score). The study included 71 patients (mean follow-up 50.5 months). Pain improvement at 12 months was observed in 68.11% of the total (28.98% with BNI score i-ii; 39.12% with BNI score iii) and at 36 months in 58.21% (23.88% BNI score i-ii; 34.32% BNI score iii). Average recovery time was 3.69 months and the relapse rate was 44.68%. Patients with typical pain displayed statistically significant differences in improvement rates at 12 and at 36 months (P<047 and P<.002). Onset of improvement was analysed using Kaplan-Meyer plots. Statistically significant differences were observed between patients with typical and atypical pain at 36 months (P<.012) in Kaplan-Meyer plots. Side effects were recorded in 15 patients (20.89%), including 9 cases of facial numbness (13.43%); only 2 cases were clinically relevant (2.98%). According to our results, radiosurgery is an effective treatment for trigeminal neuralgia, with few side effects. Typical pain seems to be a good predictor of pain relief. Copyright © 2015 Sociedad Española de Neurología. Publicado por Elsevier España, S.L.U. All rights reserved.

Prolonged vertigo and ataxia after mandibular nerve block for treatment of trigeminal neuralgia.

Science.gov (United States)

Chaturvedi, Arvind; Dash, Hh

2011-07-01

Common complications of neurolytic mandibular nerve block are hypoesthesia, dysesthesia, and chemical neuritis. We report a rare complication, prolonged severe vertigo and ataxia, after neurolytic mandibular blockade in a patient suffering from trigeminal neuralgia. Coronoid approach was used for right sided mandibular block. After successful test injection with local anesthetic, absolute alcohol was given for neurolytic block. Immediately after alcohol injection, patient developed nausea and vomiting along with severe vertigo, ataxia and hypertension. Neurological evaluation was normal except for the presence of vertigo and ataxia. Computerised tomography scan brain was also normal. Patient was admitted for observation and symptomatic treatment was given. Vertigo and ataxia gradually improved over 24 hours.

Pregabalin: in the treatment of postherpetic neuralgia.

Science.gov (United States)

Frampton, James E; Foster, Rachel H

2005-01-01

Pregabalin, the pharmacologically active S-enantiomer of 3-aminomethyl-5-methyl-hexanoic acid, has a similar pharmacological profile to that of its developmental predecessor gabapentin, but showed greater analgesic activity in rodent models of neuropathic pain. The exact mechanism of action of pregabalin is unclear, although it may reduce excitatory neurotransmitter release by binding to the alpha2-delta protein subunit of voltage-gated calcium channels. Oral pregabalin 150-600 mg/day, administered twice or three times daily, was superior to placebo in relieving pain and improving pain-related sleep interference in three randomised, double-blind, placebo-controlled, multicentre studies of 8-13 weeks' duration in a total of 776 evaluable patients with postherpetic neuralgia (PHN). Weekly mean pain scores (primary endpoint; assessed in all three studies) and weekly mean sleep interference scores (assessed in two studies) were significantly improved at 1 week. In two studies, significant improvements in daily mean pain scores were apparent on the first or second day of treatment with pregabalin administered three times daily. Pregabalin was generally well tolerated when force-titrated over 1 week to fixed dosages (maximum 600 mg/day) in clinical trials that enrolled most elderly PHN patients. Dizziness, somnolence and peripheral oedema of mild-to-moderate intensity were the most common adverse events.

Gamma knife radiosurgery for trigeminal neuralgia

International Nuclear Information System (INIS)

Tomida, Mihoko; Hayashi, Motohiro; Kawakami, Yoriko; Ishimaru, Jun-ichi

2009-01-01

Gamma knife surgery (GKS) has been employed for treating intractable pain such as trigeminal neuralgia (TN) and pain relief has been gained from the treatment, however, little is understood about the side effects of other sensitivities induced from GKS. We assessed ten patients (four men and six women; mean age 67 years) with TN who were investigated by questionnaire for symptoms and visual analog scale (VAS) of pain, and their threshold of touch sensation was examined using Semmes-Weinstein monofilaments, cold sensation and allodynia before and after GKS. MR and CT images were obtained after a Leksell head frame was applied to the head parallel to the trigeminal nerve. These images were uploaded to a computer system and retro-Gasserian area planned the target was correctly marked on the images of a computer in which gamma planning software was installed. All patients were irradiated with a maximum dose of 90 Gy at retro-Gasserian using a 4 mm collimator. The mean±standard deviation (SD) of VAS of pain was 8.5±1.3 and 8 patients had facial paresthesia before GKS. All patients experienced a significant reduction in pain without side effects such as effect on the peripheral nerves without 6 month after GKS. Allodynia, facial paresthesia or cold sensation numbness occurred in the patients before GKS disappeared according to complete pain relief. These results suggest that GKS is a safe and effective treatment for TN. (author)

SU-F-T-631: Linear Accelerator-Based Frameless Extracranial Radiosurgery for Treatment of Occipital Neuralgia for Non-Surgical Candidates

Energy Technology Data Exchange (ETDEWEB)

Denton, T; Howe, J [Associates In Medical Physics, Louisville, KY (United States); Spalding, A [The Norton Cancer Institute Radiation Center, Louisville, KY (United States)

2016-06-15

Purpose: Occipital neuralgia is a condition wherein pain is transmitted by the occipital nerves. Non-invasive therapies generally alleviate symptoms; however, persistent or recurring pain may require invasive procedures. Repeated invasive procedures upon failure are considered higher risk and are often contraindicated due to compounding inherent risk. SRS has not been explored as a treatment option largely due to the extracranial nature of the target (as opposed to the similar, more established trigeminal neuralgia), but advances in linear-accelerator frameless-based SRS now present an opportunity to evaluate the novel potential of this modality for this application. Methods: Patient presented with severe occipital pain following decompression and fusion of the cervical vertebrae with prior intervention attempted via radiofrequency ablation yielding temporary pain cessation. A 0.6 mm slice spacing CT was obtained for treatment planning, and a cervical spine oriented 1.0 mm slice spacing CT myelogram was obtained for the purpose of defining the targeted C2 occipital dorsal root ganglion (to receive 80 Gy to the isocenter) and spinal cord. Results: The spinal cord was most proximally 12.0 mm from the isocenter receiving a maximum dose of 3.36 Gy, and doses to 0.35 and 1.2 cc of 1.84 Gy and 0.79 Gy, respectively. The brain maximum dose was 2.29 Gy. The treatment was successfully performed with a NovalisTX (Varian) equipped with ExacTrac stereoscopic x-ray image guidance (BrainLAB). Treatment time was 59 minutes for 18,323 MUs. Imaging was performed prior to each arc delivery resulting in twenty-one imaging sessions (twelve requiring positional corrections with the remaining verified within tolerance). The average deviation magnitude requiring a positional or rotational correction was 0.96±0.25 mm, 0.8±0.41° while the average deviation magnitude deemed within tolerance was 0.41±0.12 mm, 0.57±0.28°. Conclusion: Linear accelerator-based frameless radiosurgery

SU-F-T-631: Linear Accelerator-Based Frameless Extracranial Radiosurgery for Treatment of Occipital Neuralgia for Non-Surgical Candidates

International Nuclear Information System (INIS)

Denton, T; Howe, J; Spalding, A

2016-01-01

Purpose: Occipital neuralgia is a condition wherein pain is transmitted by the occipital nerves. Non-invasive therapies generally alleviate symptoms; however, persistent or recurring pain may require invasive procedures. Repeated invasive procedures upon failure are considered higher risk and are often contraindicated due to compounding inherent risk. SRS has not been explored as a treatment option largely due to the extracranial nature of the target (as opposed to the similar, more established trigeminal neuralgia), but advances in linear-accelerator frameless-based SRS now present an opportunity to evaluate the novel potential of this modality for this application. Methods: Patient presented with severe occipital pain following decompression and fusion of the cervical vertebrae with prior intervention attempted via radiofrequency ablation yielding temporary pain cessation. A 0.6 mm slice spacing CT was obtained for treatment planning, and a cervical spine oriented 1.0 mm slice spacing CT myelogram was obtained for the purpose of defining the targeted C2 occipital dorsal root ganglion (to receive 80 Gy to the isocenter) and spinal cord. Results: The spinal cord was most proximally 12.0 mm from the isocenter receiving a maximum dose of 3.36 Gy, and doses to 0.35 and 1.2 cc of 1.84 Gy and 0.79 Gy, respectively. The brain maximum dose was 2.29 Gy. The treatment was successfully performed with a NovalisTX (Varian) equipped with ExacTrac stereoscopic x-ray image guidance (BrainLAB). Treatment time was 59 minutes for 18,323 MUs. Imaging was performed prior to each arc delivery resulting in twenty-one imaging sessions (twelve requiring positional corrections with the remaining verified within tolerance). The average deviation magnitude requiring a positional or rotational correction was 0.96±0.25 mm, 0.8±0.41° while the average deviation magnitude deemed within tolerance was 0.41±0.12 mm, 0.57±0.28°. Conclusion: Linear accelerator-based frameless radiosurgery

[Treatment of postherpetic neuralgia on the right side of nose: a case report].

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Tang, Jiyuan; Tang, Qiao

2015-11-01

Postherpetic neuralgia (PHN) is a difficult medical issue and symptomatic treatment with medication is common. One case of PHN was cured by nerve avulsion and microtherm plasma nerve block. The male patient was 48-year-old with PHN on the right side of the nose, suffering recurrent pains within one year. The symptoms occurred irregularly and lasted for several minutes to hours every time. Electroacupuncture and Chinese medicine treatments in other hospitals made little efficacy. Physical examination showed skin of right side of the nose and nasal mucosa was normal and all laboratory reports confirmed negative. After microtherm plasma treatment in nasal cavity and corresponding area of nasal septum, the pain disappeared.

Prolonged vertigo and ataxia after mandibular nerve block for treatment of trigeminal neuralgia

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Arvind Chaturvedi

2011-01-01

Full Text Available Common complications of neurolytic mandibular nerve block are hypoesthesia, dysesthesia, and chemical neuritis. We report a rare complication, prolonged severe vertigo and ataxia, after neurolytic mandibular blockade in a patient suffering from trigeminal neuralgia. Coronoid approach was used for right sided mandibular block. After successful test injection with local anesthetic, absolute alcohol was given for neurolytic block. Immediately after alcohol injection, patient developed nausea and vomiting along with severe vertigo, ataxia and hypertension. Neurological evaluation was normal except for the presence of vertigo and ataxia. Computerised tomography scan brain was also normal. Patient was admitted for observation and symptomatic treatment was given. Vertigo and ataxia gradually improved over 24 hours.

Repeat Gamma-Knife Radiosurgery for Refractory or Recurrent Trigeminal Neuralgia with Consideration About the Optimal Second Dose.

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Park, Seong-Cheol; Kwon, Do Hoon; Lee, Do Hee; Lee, Jung Kyo

2016-02-01

To investigate adequate radiation doses for repeat Gamma Knife radiosurgery (GKS) for trigeminal neuralgia in our series and meta-analysis. Fourteen patients treated by ipsilateral repeat GKS for trigeminal neuralgia were included. Median age of patients was 65 years (range, 28-78), the median target dose, 140-180). Patients were followed a median of 10.8 months (range, 1-151) after the second gamma-knife surgery. Brainstem dose analysis and vote-counting meta-analysis of 19 studies were performed. After the second gamma-knife radiosurgeries, pain was relieved effectively in 12 patients (86%; Barrow Neurological Institute Pain Intensity Score I-III). Post-gamma-knife radiosurgery trigeminal nerve deficits were mild in 5 patients. No serious anesthesia dolorosa was occurred. The second GKS radiation dose ≤ 60 Gy was significantly associated with worse pain control outcome (P = 0.018 in our series, permutation analysis of variance, and P = 0.009 in the meta-analysis, 2-tailed Fisher's exact test). Cumulative dose ≤ 140-150 Gy was significantly associated with poor pain control outcome (P = 0.033 in our series and P = 0.013 in the meta-analysis, 2-tailed Fisher's exact test). A cumulative brainstem edge dose >12 Gy tended to be associated with trigeminal nerve deficit (P = 0.077). Our study suggests that the second GKS dose is a potentially important factor. Copyright © 2016 Elsevier Inc. All rights reserved.

O EMPREGO DA TERAPIA LASER DE BAIXA INTENSIDADE NO TRATAMENTO DA HERPES-ZÓSTER E NEURALGIA PÓS-HERPÉTICA COM ACOMETIMENTO OROFACIAL

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Davidson Ribeiro Costa

2016-12-01

Full Text Available O herpes-zóster facial é definido como uma doença infecciosa, que durante seu desenvolvimento apresenta lesões dolorosas na região orofacial. A Neuralgia pós-herpética é uma complicação da HZ facial que é caracteriza pela sintomatologia  dolorosa. A terapia com laser  de baixa intensidade (TLBI tem sido amplamente divulgada nos meios científicos, devido o seu efeito positivo  na redução da dor em uma série de condições. Nesse contexto, o presente estudo objetivou analisar os principais efeitos da TLBI, com base na literatura, de forma a apresentar uma terapia alternativa, que pode ser empregada no tratamento da HZ facial e NPHT, salientando as doses e os possíveis locais para a irradiação em cada fase. A TLBI é uma terapia não invasiva, que não apresenta efeitos adversos, quando empregada de maneira correta. Essa terapia apresenta efeitos anti-álgico, anti-inflamatório, de reparo tecidual e neuronal, o que justifica a sua utilização no tratamento da HZ facial e NPHT.

Síncope cardíaca reflexa por "nevralgia" do glossofaríngeo: rara apresentação dessa doença Cardiac syncope induced by glossopharyngeal "neuralgia": a rare presentation

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Helio Korkes

2006-11-01

Full Text Available A primeira descrição de dor severa no trajeto do nervo glossofaríngeo foi realizada por Weisenberg, em 1910¹, em um paciente com tumor do ângulo ponto cerebelar. Entretanto, coube a Harris, em 1926², nomear como nevralgia do nervo glossofaríngeo esse raro quadro clínico, caracterizado por paroxismos de dor intensa, unilaterais, na região posterior da língua, no palato mole, na garganta e na região lateral e posterior da faringe, irradiando para o ouvido. A dor pode ser desencadeada por deglutição, tosse, bocejo ou mastigação e normalmente dura de segundos a minutos. A associaç��o de nevralgia do glossofaríngeo e síncope é muito rara e se deve a breves períodos de bradicardia, assistolia ou hipotensão, sendo a primeira descrição dessa associação, com essa fisiopatologia, realizada por Riley e cols., em 1942³.The first description of severe pain in the distribution of the glossopharyngeal nerve is credited to Weisenberg, in 1910¹, in a patient with cerebellopontine angle tumor. However, it was Harris, in 1926², who coined the term glossopharyngeal neuralgia to describe this rare condition characterized by paroxysms of excruciating pain located laterally at the back of the tongue, soft palate, throat, and lateral and posterior pharynx, radiating to the ear. Swallowing, coughing, yawning or chewing may trigger pain, which usually lasts from seconds to minutes. The association between glossopharyngeal neuralgia and syncope is very rare, being identified by brief episodes of bradycardia, asystole, and hypotension. Such an association, with this same pathophysiology, was first described by Riley et al³ in 1942.

Proposal for evaluating the quality of reports of surgical interventions in the treatment of trigeminal neuralgia: the Surgical Trigeminal Neuralgia Score.

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Akram, Harith; Mirza, Bilal; Kitchen, Neil; Zakrzewska, Joanna M

2013-09-01

The aim of this study was to design a checklist with a scoring system for reporting on studies of surgical interventions for trigeminal neuralgia (TN) and to validate it by a review of the recent literature. A checklist with a scoring system, the Surgical Trigeminal Neuralgia Score (STNS), was devised partially based on the validated STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) criteria and customized for TN after a literature review and then applied to a series of articles. These articles were identified using a prespecified MEDLINE and Embase search covering the period from 2008 to 2010. Of the 584 articles found, 59 were studies of interventional procedures for TN that fulfilled the inclusion criteria and 56 could be obtained in full. The STNS was then applied independently by 3 of the authors. The maximum STNS came to 30, and was reliable and reproducible when used by the 3 authors who performed the scoring. The range of scores was 6-23.5, with a mean of 14 for all the journals. The impact factor scores of the journals in which the papers were published ranged from 0 to 4.8. Twenty-four of the studies were published in the Journal of Neurosurgery or in Neurosurgery. Studies published in neurosurgical journals ranked higher on the STNS scale than those published in nonneurosurgical journals. There was no statistically significant correlation between STNS and impact factors. Stereotactic radiosurgery (n = 25) and microvascular decompression (n = 15) were the most commonly reported procedures. The diagnostic criteria were stated in 35% of the studies, and 4 studies reported subtypes of TN. An increasing number of studies (46%) used the recommended Kaplan-Meier methodology for pain survival outcomes. The follow-up period was unclear in 8 studies, and 26 reported follow-ups of more than 5 years. Complications were reported fairly consistently but the temporal course was not always indicated. Direct interview, telephone conversation

Therapeutic cranial nerve irradiation: results from a multi-center dose response study of radiosurgery for trigeminal neuralgia

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Kondziolka, D; Flickinger, J; Lunsford, L D; Young, R; Vermeulen, S; Duma, C; Jacques, D B; Rand, R; Regis, J; Peragut, J C; Epstein, M H; Lindquist, C

1995-07-01

Purpose/Objective: We performed a multi-institution study to evaluate the technique, dose-selection parameters, and results of gamma knife stereotactic radiosurgery in the management of trigeminal neuralgia. We hypothesized that MRI-stereotactic targeting of the trigeminal nerve and irradiation with a single 4 mm isocenter, 2-4 mm anterior to the brainstem, could be a safe and effective treatment for this disorder. Materials and Methods: Fifty patients at five centers had radiosurgery using a single 4 mm isocenter targeted at the root entry zone. All patients had typical trigeminal neuralgia. The mean patient age was 70 years, (range, 40-87). Thirty-two patients had undergone prior surgery, and the mean number of procedures performed was 2.8 (range, 1-7). Eighteen patients (36%) had not had prior surgery before radiosurgery. Maximum radiosurgery doses included 60 Gy (n=8), 65 Gy (n=3), 70 Gy (n=27), 75 Gy (n=2), 80 Gy (n=6) and 90 Gy (n=4). All patients were discharged within 24 hours and were studied in regard to the degree of pain relief, latency interval to pain relief, sensory loss, and the need for further therapy. Mean follow-up after radiosurgery was 9.2 months (range, 2-26 months). Results: At last follow-up, 25 patients (50%) had excellent control (pain-free), 17 (34%) had good control (50-90% relief), and 8 (16%) had failed (see Figure). The median time to pain relief was one month. We identified an actuarial response rate of 53% for complete pain relief at seven months, and 93% for pain reduction (50-100% relief). At 18 months, these results declined to 48% and 77% respectively. A significantly greater proportion of patients receiving a radiosurgery maximum dose of {>=} 70 Gy achieved complete pain relief (63% vs. 18%) and >50% pain reduction (96% vs. 80%) than those with doses <70 Gy. Patients without prior surgery had significantly better outcomes in univariate testing. Three patients (6%) developed increased facial paresthesiae after radiosurgery

Therapeutic cranial nerve irradiation: results from a multi-center dose response study of radiosurgery for trigeminal neuralgia

International Nuclear Information System (INIS)

Kondziolka, D.; Flickinger, J.; Lunsford, L.D.; Young, R.; Vermeulen, S.; Duma, C.; Jacques, D.B.; Rand, R.; Regis, J.; Peragut, J.C.; Epstein, M.H.; Lindquist, C.

1995-01-01

Purpose/Objective: We performed a multi-institution study to evaluate the technique, dose-selection parameters, and results of gamma knife stereotactic radiosurgery in the management of trigeminal neuralgia. We hypothesized that MRI-stereotactic targeting of the trigeminal nerve and irradiation with a single 4 mm isocenter, 2-4 mm anterior to the brainstem, could be a safe and effective treatment for this disorder. Materials and Methods: Fifty patients at five centers had radiosurgery using a single 4 mm isocenter targeted at the root entry zone. All patients had typical trigeminal neuralgia. The mean patient age was 70 years, (range, 40-87). Thirty-two patients had undergone prior surgery, and the mean number of procedures performed was 2.8 (range, 1-7). Eighteen patients (36%) had not had prior surgery before radiosurgery. Maximum radiosurgery doses included 60 Gy (n=8), 65 Gy (n=3), 70 Gy (n=27), 75 Gy (n=2), 80 Gy (n=6) and 90 Gy (n=4). All patients were discharged within 24 hours and were studied in regard to the degree of pain relief, latency interval to pain relief, sensory loss, and the need for further therapy. Mean follow-up after radiosurgery was 9.2 months (range, 2-26 months). Results: At last follow-up, 25 patients (50%) had excellent control (pain-free), 17 (34%) had good control (50-90% relief), and 8 (16%) had failed (see Figure). The median time to pain relief was one month. We identified an actuarial response rate of 53% for complete pain relief at seven months, and 93% for pain reduction (50-100% relief). At 18 months, these results declined to 48% and 77% respectively. A significantly greater proportion of patients receiving a radiosurgery maximum dose of ≥ 70 Gy achieved complete pain relief (63% vs. 18%) and >50% pain reduction (96% vs. 80%) than those with doses <70 Gy. Patients without prior surgery had significantly better outcomes in univariate testing. Three patients (6%) developed increased facial paresthesiae after radiosurgery

Selective percutaneous radiofrequency thermocoagulation in the treatment of trigeminal neuralgia:report on 1860 cases

Institute of Scientific and Technical Information of China (English)

吴承远; 孟凡刚; 徐淑军; 刘玉光; 王宏伟

2004-01-01

@@Trigeminal neuralgia (TN) is defined by the International Association for the Study of Pain as "a sudden, usually unilateral, severe, brief, stabbing, recurrent pain in the distribution of one or more branches of the fifth cranial nerve".1 The incidence rate is about three to five cases per year per 100000 persons and increases with age.2 In our hospital, percutaneous radiofrequency therapy was performed on 1860 patients with TN from June 1986 to April 2003, and percutaneous trigeminal ganglion radiofrequency therapy on 579 cases. Among this group of patients, X-ray, 3-D CT, and navigational localization of the oval foramen were performed on 42 cases. The indications, techniques, and results are reported here.

Detection of compression vessels in trigeminal neuralgia by surface-rendering three-dimensional reconstruction of 1.5- and 3.0-T magnetic resonance imaging.

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Shimizu, Masahiro; Imai, Hideaki; Kagoshima, Kaiei; Umezawa, Eriko; Shimizu, Tsuneo; Yoshimoto, Yuhei

2013-01-01

Surface-rendered three-dimensional (3D) 1.5-T magnetic resonance (MR) imaging is useful for presurgical simulation of microvascular decompression. This study compared the sensitivity and specificity of 1.5- and 3.0-T surface-rendered 3D MR imaging for preoperative identification of the compression vessels of trigeminal neuralgia. One hundred consecutive patients underwent microvascular decompression for trigeminal neuralgia. Forty and 60 patients were evaluated by 1.5- and 3.0-T MR imaging, respectively. Three-dimensional MR images were constructed on the basis of MR imaging, angiography, and venography data and evaluated to determine the compression vessel before surgery. MR imaging findings were compared with the microsurgical findings to compare the sensitivity and specificity of 1.5- and 3.0-T MR imaging. The agreement between MR imaging and surgical findings depended on the compression vessels. For superior cerebellar artery, 1.5- and 3.0-T MR imaging had 84.4% and 82.7% sensitivity and 100% and 100% specificity, respectively. For anterior inferior cerebellar artery, 1.5- and 3.0-T MR imaging had 33.3% and 50% sensitivity and 92.9% and 95% specificity, respectively. For the petrosal vein, 1.5- and 3.0-T MR imaging had 75% and 64.3% sensitivity and 79.2% and 78.1% specificity, respectively. Complete pain relief was obtained in 36 of 40 and 55 of 60 patients undergoing 1.5- and 3.0-T MR imaging, respectively. The present study showed that both 1.5- and 3.0-T MR imaging provided high sensitivity and specificity for preoperative assessment of the compression vessels of trigeminal neuralgia. Preoperative 3D imaging provided very high quality presurgical simulation, resulting in excellent clinical outcomes. Copyright © 2013 Elsevier Inc. All rights reserved.

Liposomal topical capsaicin in post-herpetic neuralgia: a safety pilot study

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Manoel Jacobsen Teixeira

2015-03-01

Full Text Available Topical treatments have gained popularity for general use as an adjunct to systemic drugs in neuropathic pain, but their use produces variable clinical results and local adverse events. Objective To evaluate the safety and analgesic effect of a formulation of liposomal capsaicin (LC (0.025% in patients with post herpetic neuralgia (PHN. Method Patients who remained symptomatic after first-and second-line treatment were randomized to receive LC for six weeks in a placebo-controlled, crossover design study. Clinical assessment was performed at baseline, in the second, fourth and sixth week of treatment. Results Thirteen patients completed both treatment periods. Visual Analog Scale (VAS was significantly decreased after the end of the study (p = 0.008, however the effect of treatment was not significant (p = 0.076. There was no difference on global impression of change and other pain characteristics. LC was safe and well tolerated. However, at the concentration used, its analgesic effects were marginal and not significant.

Epidemiology of Postherpetic Neuralgia in Korea

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Hong, Myong-Joo; Kim, Yeon-Dong; Cheong, Yong-Kwan; Park, Seon-Jeong; Choi, Seung-Won; Hong, Hyon-Joo

2016-01-01

Abstract Postherpetic neuralgia (PHN) is a disease entity defined as persistent pain after the acute pain of herpes zoster gradually resolves. It is associated with impaired daily activities, resulting in reduced quality of life. General epidemiological data on PHN is necessary for the effective management. However, data on the epidemiology of PHN in Korea is lacking. The aim of this study was to evaluate the epidemiological features of PHN in the general population. We used population-based medical data for 51,448,491 subscribers to the Health Insurance Service in the year of 2013 to analyze of PHN epidemiology in Korea, such as the incidence, regional distribution, seasonal variation, and healthcare resource utilization. Total number of patients and medical cost on PHN were analyzed from 2009 to 2013. Findings indicate that the incidence of PHN in Korea was 2.5 per 1000 person-years, which was strongly correlated with age and sex. There were no differences in seasonal variation or regional distribution. The medical cost increased steadily over the study period. When admitted to general hospitals, patients with PHN were mainly managed in the dermatology and anesthesiology departments. The incidence and prevalence rates of PHN in Koreans appear to be considerably higher compared to those in western populations, while the sex and age predisposition was similar. Considering that the pain associated with PHN can have a marked impact on a patient's quality of life resulting in a medicosocial economic burden, anesthesiology physicians have an important role in primary care in Korea. Future research on the cost-effectiveness of the management of PHN is needed. PMID:27057902

Altered functional connectivity density in patients with herpes zoster and postherpetic neuralgia

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Hong S

2018-04-01

Full Text Available Shunda Hong,1,* Lili Gu,2,* Fuqing Zhou,1 Jiaqi Liu,1 Muhua Huang,1 Jian Jiang,1 Laichang He,1 Honghan Gong,1 Xianjun Zeng1 1Department of Radiology, The First Affiliated Hospital, Nanchang University, Nanchang, Jiangxi, People’s Republic of China; 2Department of Pain, The First Affiliated Hospital, Nanchang University, Nanchang, Jiangxi, People’s Republic of China *These authors contributed equally to this work Purpose: The aim of this study was to explore intrinsic functional connectivity patterns in patients with herpes zoster (HZ and postherpetic neuralgia (PHN. Patients and methods: Thirty-three right-handed HZ patients (13 males; mean age 57.15±9.30 years, 22 right-handed PHN patients (9 males; mean age 66.13±6.77 years, and 28 well-matched healthy controls (HC (9 males; mean age 54.21±7.72 years underwent resting-state functional magnetic resonance imaging for intrinsic functional connectivity analyses. Functional connectivity density (FCD was calculated and compared among the PHN, HZ, and HC groups. In addition, the Pearson correlation coefficient was calculated to compare various clinical indices in the regions with abnormal FCD values. Results: Compared with the HC, both HZ and PHN patients showed significantly decreased FCD in the precuneus, and patients with HZ displayed significantly increased FCD in the brainstem/limbic lobe/parahippocampalgyrus, whereas patients with PHN displayed significantly increased FCD in the hippocampus (correlation thresholds r=0.25, voxel level of P<0.01 and Gaussian random field theory at a cluster level of P<0.05. However, the FCD was not significantly different between the PHN and HZ patients. Furthermore, the decreased FCD in the precuneus was positively correlated with the visual analog scale score in the PHN group (r=0.672; P=0.001. Conclusion: Decreased connectivity of the precuneus occurred in both HZ and PHN patients, indicating a disrupted default-mode network. Furthermore, in the HZ

Neuropatía sensitiva trigeminal secundaria a granuloma de colesterol de la punta del peñasco del temporal Trigeminal neuralgia secondary to cholesterol granuloma of the petrous bone apex

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M.A. Pons García

2009-10-01

Full Text Available La neuropatía aislada de la rama sensitiva del trigémino es una entidad poco habitual. Los pacientes suelen referir hipoestesia y /o disestesia generalmente a nivel de la segunda y tercera rama del trigémino, mientras que la neuralgia es muy infrecuente.¹ Su asociación con enfermedades sistémicas del tejido conectivo es bien conocida.² Se ha descrito asociada a distintas lesiones del SNC sobre todo tumores de fosa posterior o base de cráneo, así como neoplasias mandibulares.3,4 Presentamos una paciente con hipoestesia en el territorio V2-V3 asociada a dolor hemifacial paroxístico secundario a una lesión del peñasco del temporal.Trigeminal Neuralgia is an uncommon entity. The patients report hypoesthesia and/or dysesthesia of the second and third ramus of trigeminal nerve, while neuralgia is very rare.¹ Its association with systemic diseases of connective tissue is well know.² It has been described as being associated with different lesions of the central nervous system, especially with the posterior cavity or cranial base tumors, as well as jaw neoplasias.3,4 We presented a patient with hypoesthesia V2-V3 and hemi facial paroxysmal pain secondary to lesion of petrous apex of temporal bone.

Microvascular decompression for trigeminal neuralgia

International Nuclear Information System (INIS)

Khan, S.A.; Khan, B.; Khan, A.A.; Afridi, E.A.A.; Mehmood, S.; Muhammad, G.; Hussain, I.; Zadran, K.K.; Bhatti, S.N.

2015-01-01

Background: Trigeminal Neuralgia (TGN) is the most frequently diagnosed type of facial pain. In idiopathic type of TGN it is caused by the neuro-vascular conflict involving trigeminal nerve. Microvascular decompression (MVD) aims at addressing this basic pathology in the idiopathic type of TGN. This study was conducted to determine the outcome and complications of patients with idiopathic TGN undergoing MVD. Method: In a descriptive case series patients with idiopathic TGN undergoing MVD were included in consecutive manner. Patients were diagnosed on the basis of detailed history and clinical examination. Retromastoid approach with craniectomy was used to access cerebellopontine angle (CP-angle) and microsurgical decompression was done. Patients were followed up for 6 months. Results: A total of 53 patients underwent MVD with mean age of 51.6±4.2 years and male predominance. In majority of cases (58.4 percentage) both Maxillary and Mandibular divisions were involved. Per-operatively superior cerebellar artery (SCA) was causing the neuro-vascular conflict in 33 (62.2 percentage) of the cases, anterior inferior cerebellar artery (AICA) in 6 (11.3 percentage) cases, both CSA and AICA in 3 (5.6 percentage) cases, venous compressions in only 1 (1.8percentage) patient and thick arachnoid adhesions were seen in 10 (18.9 percentage) patients. Postoperatively, 33 (68 percentage) patients were pain free, in 14 (26.45 percentage) patients pain was significantly improved whereas in 3 (5.6 percentage) patients there was mild improvement in symptoms. Three (5.6 percentage) patients did not improve after the primary surgery. Cerebrospinal fluid (CSF) leak was encountered in 7 (13.2 percentage) patients post-operatively, 4 (7.5 percentage) patients developed wound infection and 1 (1.8 percentage) patient developed aseptic meningitis. Three (5.6 percentage) patients had transient VII nerve palsy while one patient developed permanent VII nerve palsy. Conclusion: MVD is a safe and

Reação cutânea grave induzida por carbamazepina no tratamento da neuralgia pós-herpética: relato de caso Reacción cutánea grave inducida por la carbamazepina en el tratamiento de la neuralgia postherpética: relato de caso Severe carbamazepine-induced cutaneous reaction in the treatment of post-herpetic neuralgia: case report

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João Batista Santos Garcia

2010-08-01

Full Text Available JUSTIFICATIVA E OBJETIVOS: O herpes zoster tem como principal complicação a neuralgia pós-herpética (NPH. Utiliza-se para o tratamento a carbamazepina (CXB, um anticonvulsivante bem tolerado, porém frequentemente associado a reações Cutâneas graves, como, por exemplo, a síndrome de Stevens-Johnson (SSJ e a necrólise epidérmica tóxica (NET. O objetivo deste trabalho é relatar um caso de SSJ/NET secundário ao uso de CBZ em paciente com NPH. RELATO DO CASO: Paciente do sexo feminino, com dor contínua em região torácica e dorso, intensa, em queimação, fisgada, choque, alteração de força de membro superior ipsilateral e sudorese. Apresentava lesões crostosas e eritematosas em região dorsal do tórax, com alodinia e disestesias em dermátomo acometido. Iniciou-se CBZ 300 mg.dia-1, amitriptilina (AMT 12,5 mg à noite e infiltração com anestésico local na região afetada. Após 15 dias, referia mal-estar, febre, dores musculares e artralgias com rash cutâneo leve e inespecífico. Retirou-se a carbamazepina imediatamente. Uma semana depois, foi internada com urticária e exantema generalizados, erupções Cutâneas eritematosas, bolhosas e máculas purpúricas por todo o corpo. A impressão era de SSJ/NET induzida por carbamazepina. Houve progressiva piora do quadro, com aumento do número e do tamanho das lesões Cutâneas, além de rash eritematoso macular generalizado, áreas de necrose e erosões, com destacamento simétrico da epiderme em face, pescoço, tórax, dorso e membros acometendo mais de 50% da área de superfície, além de envolvimento da mucosa bucal, conjuntival e genital com erosões vesiculares. Apresentou piora funcional progressiva, evoluindo com choque séptico e falência múltipla de órgãos, indo a óbito. CONCLUSÕES: A SSJ/NET é uma reação Cutânea grave com potencial para morbidade e mortalidade elevadas e que demanda intervenção rápida e tratamento adequado. Fica também o alerta para o uso

Prophylaxis and treatment of acute and chronic postherpetic neuralgia

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Anna Michalska-Bańkowska

2014-06-01

Full Text Available Herpes zoster (HZ is a disease caused by varicella zoster virus (VZV, where the initial contact leads to varicella. The low immunity of the patient might reactivate the virus and provoke symptoms of HZ, which is characterized by vesicles and blisters localized unilaterally and accompanied by pain. The greatest diagnostic problems occur in Zoster sine herpete and painless HZ. A significant complication of acute HZ infection is chronic postherpetic neuralgia (PHN, which manifests as dull and burning pain persisting for more than 3 months after the beginning of the rash. Senility, female gender, presence of prodromal pain, more severe skin lesions, dysaesthesia, and more intense acute PHN predispose to chronic PHN. Early diagnosis and treatment of HZ infection with antiviral medications prevent PHN. Use of local anesthetics is a very good choice in acute PHN treatment. Tricyclic antidepressants (amitriptyline, nortriptyline are conventional drugs which alleviate subacute PHN. Immunomodulatory drugs such as gabapentin help prevent or reduce the severity of PHN. The other therapeutic options are RFA (radiofrequency ablation, TENS (transcutaneous electrical nerve stimulation, physical methods such as magnetotherapy and laser therapy. The attenuated vaccine, used in patients over 60 years old, is expected to prevent the occurrence of PHN.

A RARE CASE OF PERSISTENT TRIGEMINAL ARTERY IN AN ADULT FEMALE WITH PARA POSTERIOR COMMUNICATING ARTERY ANEURYSM

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Banavathu Daya Bharath Singh

2015-05-01

Full Text Available Anastomosis found in the adulthood between the carotid and vertebro - basilar systems, apart from the posterior communicating artery, are extremely infrequent and are due to the persistence of vessels that joined both systems during the fetal period. This carotid - vertebrobasilar anastomosis are the trigeminal, otic, and hypoglossal and proatlantal arteries. P ersistent trigeminal artery is the commonest of the above mentioned four arteries. The reported incidence is about 0.2%. Patients may be asymptomatic or present symptoms due to low flow of posterior circulation or carotid microembolization from posterior circulation. PTA can cause trigemina l neuralgia. We report in this paper a case of a persistant trigeminal artery found in an adult female with a para p com aneurysm who had persistent trigeminal artery which was seen in C T angiogram .

Radiological Imaging Findings of a Case with Vertebral Osteoid Osteoma Leading to Brachial Neuralgia

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Erkan Gokce

2013-01-01

Full Text Available Osteoid osteoma is a small, benign osteoblastic tumor consisting of a highly vascularized nidus of connective tissue surrounded by sclerotic bone. Three-quarters of osteoid osteomas are located in the long bones, and only 7-12% in the vertebral column. The classical clinical presentation of spinal osteoid osteoma is that of painful scoliosis. Other clinical features include nerve root irritation and night pain. Osteoid osteoma has characteristic computed tomography (CT findings. Because magnetic resonance imaging (MRI findings of the osteoid osteomas causing intense perinidal edema can be confusing, these patients should be evaluated with clinical findings and other imaging techniques. In this study, we present X-ray, CT, and MRI findings of a case with osteoid osteoma located in thoracic 1 vertebra left lamina and transverse process junction leading to brachial neuralgia symptoms.

Multimodal Image-Based Virtual Reality Presurgical Simulation and Evaluation for Trigeminal Neuralgia and Hemifacial Spasm.

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Yao, Shujing; Zhang, Jiashu; Zhao, Yining; Hou, Yuanzheng; Xu, Xinghua; Zhang, Zhizhong; Kikinis, Ron; Chen, Xiaolei

2018-05-01

To address the feasibility and predictive value of multimodal image-based virtual reality in detecting and assessing features of neurovascular confliction (NVC), particularly regarding the detection of offending vessels, degree of compression exerted on the nerve root, in patients who underwent microvascular decompression for nonlesional trigeminal neuralgia and hemifacial spasm (HFS). This prospective study includes 42 consecutive patients who underwent microvascular decompression for classic primary trigeminal neuralgia or HFS. All patients underwent preoperative 1.5-T magnetic resonance imaging (MRI) with T2-weighted three-dimensional (3D) sampling perfection with application-optimized contrasts by using different flip angle evolutions, 3D time-of-flight magnetic resonance angiography, and 3D T1-weighted gadolinium-enhanced sequences in combination, whereas 2 patients underwent extra experimental preoperative 7.0-T MRI scans with the same imaging protocol. Multimodal MRIs were then coregistered with open-source software 3D Slicer, followed by 3D image reconstruction to generate virtual reality (VR) images for detection of possible NVC in the cerebellopontine angle. Evaluations were performed by 2 reviewers and compared with the intraoperative findings. For detection of NVC, multimodal image-based VR sensitivity was 97.6% (40/41) and specificity was 100% (1/1). Compared with the intraoperative findings, the κ coefficients for predicting the offending vessel and the degree of compression were >0.75 (P < 0.001). The 7.0-T scans have a clearer view of vessels in the cerebellopontine angle, which may have significant impact on detection of small-caliber offending vessels with relatively slow flow speed in cases of HFS. Multimodal image-based VR using 3D sampling perfection with application-optimized contrasts by using different flip angle evolutions in combination with 3D time-of-flight magnetic resonance angiography sequences proved to be reliable in detecting NVC

[Treatment of typical trigeminus neuralgias. Overview of the current state of drug and surgical therapy].

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Möbius, E; Leopold, H C; Paulus, W M

1984-10-11

Carbamazepine continues to be the most useful drug in the treatment of trigeminal neuralgia. Diphenylhydantoin may be given in addition to or instead of Carbamazepine. Refractory cases may benefit from combination with Baclofen or Chlorphenesin. In cases of persistent pain the concomitant use of tricyclic antidepressant drugs is recommended. If pain continues in spite of multiple medical therapies or if serious side effects develop, then surgical procedures such as percutaneous controlled thermocoagulation or microvascular decompression are indicated. Percutaneous thermocoagulation is associated with the lowest mortality and morbidity rate and can easily be repeated. Microvascular decompression should especially be offered to young patients, who want to avoid any sensory disturbance of the face, and recommended for other patients for whom all other forms of therapy including percutaneous thermocoagulation have failed.

Refractory Post-Herpetic Neuralgia As An Initial Presentation Of Olfactory Neuroblastoma-Related Ectopic ACTH Syndrome

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Hsiang-Hung Lin

2009-03-01

Full Text Available We report a woman aged 64 years with ectopic adrenocorticotropic hormone (ACTH syndrome caused by olfactory neuroblastoma as an initial presentation of refractory post-herpetic neuralgia. The manifestations such as cushingoid appearance and endocrine abnormalities are compatible with Cushing's syndrome. Brain computed tomography revealed a sellar mass. A biopsy revealed olfactory neuroblastoma. Immunohistochemical staining further defined the tumor as an ACTH-secreting neuroblastoma. Subsequent opportunistic infections by Candida glabrata fungemia and multiple drug-resistant Acinetobacter baumannii pneumonia occurred during hospitalization as a complication of severe hypercortisolism. Before any therapy for Cushing's syndrome and neuroblastoma could be initiated, the patient died from sepsis and multiorgan failure. We propose that Cushing's syndrome is more complex than what clinicians thought, and that meticulous cerebral imaging studies are crucial.

Effects of Pulsed Versus Conventional Versus Combined Radiofrequency for the Treatment of Trigeminal Neuralgia: A Prospective Study.

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Elawamy, Abdelraheem; Abdalla, Esam Eldein Mohamed; Shehata, Ghaydaa A

2017-09-01

During radiofrequency bursts of energy are applied to nervous tissue. The clinical advantages of this treatment remain unclear. We compared the effectiveness and pain relief for idiopathic trigeminal neuralgia (TN) after continuous radiofrequency (CRF), pulsed radiofrequency (PRF), and combined continuous and pulsed radiofrequency (CCPRF) treatment of the Gasserian ganglion (GG). We conducted a randomized prospective study. Forty-three patients were included. Eleven patients were treated with PRF at 42°C for 10 minutes (PRF group), 12 patients received CRF for 270 seconds at 75 °C (CRF group), and 20 patients received PRF for 10 minutes at 42°C followed by CRF for at 60°C for 270 seconds (CCPRF group). Assuit University Hospital, Pain and Neurology outpatient clinics. Patients were assessed for pain, satisfaction, and consumption of analgesics at baseline and 7 days, one month, 6 months, 12 months, and 24 months after the procedure. The incidence of complications, anesthesia dolorosa, weakness of muscles of mastication, numbness, and technical complications, was evaluated after the procedure. Excellent pain relief was achieved after 6, 12, and 24 months, respectively in 95%, 85%, and 70% of patients with CCPRF; 75%, 75%, and reduced to 50% among patients with CRF; and 82%, reduced to 9.1%, and 0% of patients with PRF. No complications were recorded in 75% of patients in the CCPRF and PRF groups. There was one case of anesthesia dolorosa, 4 cases of masseter muscle weakness, and 5 cases of severe numbness recorded in the CRF group. There was a small number of patients in each group. The best results were observed in the CCPRF group, followed by the CRF group, and then the PRF group.Key words: Pulsed, continuous, radiofrequency, trigeminal neuralgia, Gasserian ganglion.

Natural history and outcome of 200 outpatients with classical trigeminal neuralgia treated with carbamazepine or oxcarbazepine in a tertiary centre for neuropathic pain

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2014-01-01

Background The guidelines on trigeminal neuralgia management that have been agreed and jointly published by the American Academy of Neurology and the European Federation of Neurological Societies recommend carbamazepine (CBZ) and oxcarbazepine (OXC) as the first-choice medical treatments in patients with trigeminal neuralgia (TN). The aim of this retrospective study was to analyze the natural history of classical trigeminal neuralgia in a large cohort of patients, focusing on drug responsiveness, side effects related to CBZ and OXC, and changes in pain characteristics during the course of disease. Findings We selected the last 100 consecutive patients with typical TN who began treatment with CBZ and the last 100 with OXC. All had MRI scans and a complete neurophysiological study of trigeminal reflexes. Among them, 22 were excluded on the basis of neuroradiological or neurophysiological investigations, to avoid the inclusion of patients with possible secondary TN. The initial number of responders was 98% with CBZ with a median dose of 600 mg (range 200–1200), and of 94% with OXC, with a median dose of 1200 mg (range 600–1800). In a mean period of 8.6 months, 27% of responders to CBZ incurred in undesired effects to a level that caused interruption of treatment or a dosage reduction to an unsatisfactory level. In a mean period of 13 months, the same occurred to 18% of responders to OXC. Among patients who had a good initial response, only 3 patients with CBZ and 2 with OXC developed late resistance. During the course of disease, paroxysms worsened in intensity in 3% of patients, and paroxysms duration increased in 2%. We did not observe the onset of a clinically manifest sensory deficit at any time in any patient. Conclusions Unlike common notion, in our large patient sample the worsening of pain with time and the development of late resistance only occurred in a very small minority of patients. CBZ and OXC were confirmed to be efficacious in a large majority

PERCUTANEOUS BALLOON COMPRESSION OF GASSERIAN GANGLION FOR THE TREATMENT OF TRIGEMINAL NEURALGIA: AN EXPERIENCE FROM INDIA.

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Agarwal, Anurag; Dhama, Vipin; Manik, Yogesh K; Upadhyaya, M K; Singh, C S; Rastogi, V

2015-02-01

Trigeminal neuralgia (TN) is characterized by unilateral, lancinating, paroxysmal pain in the dermatomal distribution area of trigeminal nerve. Percutaneous balloon compression (PBC) of Gasserian ganglion is an effective, comparatively cheaper and simple therapeutic modality for treatment of TN. Compression secondary to PBC selectively injures the large myelinated A-alfa (afferent) fibers that mediate light touch and does not affect A-delta and C-fibres, which carry pain sensation. Balloon compression reduces the sensory neuronal input, thus turning off the trigger to the neuropathic trigeminal pain. In this current case series, we are sharing our experience with PBC of Gasserian Ganglion for the treatment of idiopathic TN in our patients at an academic university-based medical institution in India. During the period of August 2012 to October 2013, a total of twelve PBCs of Gasserian Ganglion were performed in eleven patients suffering from idiopathic TN. There were nine female patients and two male patients with the age range of 35-70 years (median age: 54 years). In all patients cannulation of foramen ovale was done successfully in the first attempt. In eight out of eleven (72.7%) patients ideal 'Pear-shaped' balloon visualization could be achieved. In the remaining three patients (27.3%), inflated balloon was 'Bullet-shaped'. In one patient final placement of Fogarty balloon was not satisfactory and it ruptured during inflation. This case was deferred for one week when it was completed successfully with 'Pear-shaped' balloon inflation. During the follow up period of 1-13 months, there have been no recurrences of TN. Eight out of eleven patients (72.7%) are completely off medicines (carbamazepine and baclofen) and other two patients are stable on very low doses of carbamazepine. All patients have reported marked improvement in quality of life. This case series shows that percutaneous balloon compression is a useful minimally invasive intervention for the

Frame and frameless linear accelerator-based radiosurgery for idiopathic trigeminal neuralgia.

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Chen, Allan Y; Hsieh, Yen; McNair, Steffanie; Li, Qijuan; Xu, Kevin Y; Pappas, Conrad

2015-01-01

We report outcome of linear accelerator (Linac)-based stereotactic radiosurgery (SRS) for trigeminal neuralgia (TGN) utilizing rigid head frame (RF) and facemask (FM) immobilization.Method: From November 2008 to October 2012, 48 patients with idiopathic TGN underwent primary SRS by a dedicated Linac. RF immobilization was utilized for 34 patients, and frameless image-guided radiosurgery (IGRS) with FM immobilization was performed in 14 patients. Treatment outcome was assessed by patient interviews with a 7-item questionnaire. Sub-millimeter targeting accuracy (0.71±0.31 mm) was recorded for frameless IGRS by a novel hidden-target phantom method. With a follow-up of 26 months, significant pain relief was recorded in 43 (89%) patients, including 26 (54%) complete and 17 (35%) partial responses; with a significant reduction of 2.4±1.3 points ( p < 0.01) on the 5-point Barrow Neurological Institute pain scale. No significant pain relief difference ( p = 0.23) was detected between patients immobilized by RF and FM. Notable pin site problems were reported in 9 (26%) of 34 patients immobilized by RF. Frameless IGRS with FM immobilization is more patient friendly and can achieve as excellent treatment outcome as with RF immobilization for idiopathic TGN.

An Open Study of Botulinum-A Toxin Treatment of Idiopathic Trigeminal Neuralgia

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Karim Nikkhah

2015-07-01

Full Text Available Introduction: Trigeminal Neuralgia (TN is a unilateral, recurrent, sharp facial pain disorder that is limited to the distribution of divisions of the trigeminal nerve. The aim of this study was to evaluate the efficacy of Botulinum neurotoxin type A (BTX-A for alleviating the frequency and severity of TN pain. Materials and Methods: This trial was performed as a before and after study. We treated 31 patients (15 male and 16 female with mean age of 52 year old that their diagnosis was made at least 4.5 years before. We injected BTX-A in various parts of face and particularly in the origin of mandibular and maxillary branches of trigeminal nerve. Injection volume was determined by the necessity and pain intensity measured with visual analog scale up to 100U. Patients were evaluated before and after the injection and were followed after week, and each month, for a three months period. Other related variables were recorded such as: toxin complications, pain status variations by brushing, chewing, cold weather and patient’s satisfaction with their therapy. Results: showed that after injection, pain intensity and frequency decreased after tooth brushing, chewing and cold weather (P

Diagnostic Accuracy of Selective 3-T MR Neurography-guided Retroperitoneal Genitofemoral Nerve Blocks for the Diagnosis of Genitofemoral Neuralgia.

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Fritz, Jan; Dellon, A Lee; Williams, Eric H; Rosson, Gedge D; Belzberg, Allan J; Eckhauser, Frederick E

2017-10-01

Purpose To determine if 3-T magnetic resonance (MR) neurography-guided retroperitoneal genitofemoral nerve (GFN) blocks are safe and effective for the diagnosis of genitofemoral neuralgia. Materials and Methods Following institutional review board approval and informed consent, 26 subjects (16 men, 10 women; mean age, 42 years [range, 24-78 years]; mean body mass index, 28 kg/m 2 [range, 20-35 kg/m 2 ]) with intractable groin pain were included. By using a 3-T MR imaging system, intermediate-weighted turbo spin-echo pulse sequences, and MR-conditional needles, diagnostic MR neurography-guided GFN blocks were performed in the retroperitoneum. Outcome variables included technical success, procedure time, complications, and rates of positive and negative GFN blocks in association with therapeutic outcomes. For the assessment of a learning curve, Mann-Whitney test was used. P values ≤ .05 were considered to indicate a statistically significant difference. Results In 26 subjects, 30 retroperitoneal GFN blocks were performed. Twelve (40%) were performed with an anterior needle path, 12 (40%) with a lateral needle path, and six (20%) with a posterior needle path. GFN blocks were technically successful in 24 of 26 (92%) subjects, achieving appropriate scrotal anesthesia. No complications occurred. The time required for a GFN block was 40 minutes (range, 18-67 minutes). The rate of a successful GFN intervention after a positive GFN block was 88% (14 of 16). The rate of a successful intervention of an alternative target after a negative GFN block was 71% (five of seven). Conclusion Selective retroperitoneally directed MR neurography-guided GFN blocks are safe and effective with high technical success and positive effect on surgical decision making in patients with presumed genitofemoral neuralgia. © RSNA, 2017 Online supplemental material is available for this article.

Altered regional homogeneity of spontaneous brain activity in idiopathic trigeminal neuralgia.

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Wang, Yanping; Zhang, Xiaoling; Guan, Qiaobing; Wan, Lihong; Yi, Yahui; Liu, Chun-Feng

2015-01-01

The pathophysiology of idiopathic trigeminal neuralgia (ITN) has conventionally been thought to be induced by neurovascular compression theory. Recent structural brain imaging evidence has suggested an additional central component for ITN pathophysiology. However, far less attention has been given to investigations of the basis of abnormal resting-state brain activity in these patients. The objective of this study was to investigate local brain activity in patients with ITN and its correlation with clinical variables of pain. Resting-state functional magnetic resonance imaging data from 17 patients with ITN and 19 age- and sex-matched healthy controls were analyzed using regional homogeneity (ReHo) analysis, which is a data-driven approach used to measure the regional synchronization of spontaneous brain activity. Patients with ITN had decreased ReHo in the left amygdala, right parahippocampal gyrus, and left cerebellum and increased ReHo in the right inferior temporal gyrus, right thalamus, right inferior parietal lobule, and left postcentral gyrus (corrected). Furthermore, the increase in ReHo in the left precentral gyrus was positively correlated with visual analog scale (r=0.54; P=0.002). Our study found abnormal functional homogeneity of intrinsic brain activity in several regions in ITN, suggesting the maladaptivity of the process of daily pain attacks and a central role for the pathophysiology of ITN.

Bipolar High-Voltage, Long-Duration Pulsed Radiofrequency Improves Pain Relief in Postherpetic Neuralgia.

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Wan, Cheng-Fu; Liu, Yan; Dong, Dao-Song; Zhao, Lin; Xi, Qi; Yu, Xue; Cui, Wen-Yao; Wang, Qiu-Shi; Song, Tao

2016-07-01

Postherpetic neuralgia (PHN) is often refractory to existing treatments. Treatment of the dorsal root ganglion (DRG) using monopolar pulsed radiofrequency (PRF), which is a non- or minimally neurodestructive technique, is not efficacious in all patients. This study aimed to determine the safety and clinical efficacy of bipolar high-voltage, long-duration PRF on the DRG in PHN patients. Self before-after controlled clinical trial. Department of Pain Medicine, the First Affiliated Hospital of China Medical University. Ninety patients diagnosed with PHN for > 3months were included. Bipolar high-voltage, long-duration PRF at 42°C for 900 seconds was applied after the induction of paresthesias covered the regions of hyperalgesic skin. The therapeutic effects were evaluated using a visual analog scale (VAS) and the 36-item Short Form health survey (SF-36) before treatment and one, 4, 8, and 12 weeks after PRF. The VAS scores at one, 4, 8, and 12 weeks after PRF treatment were significantly lower than before treatment (P DRG is an effective and safe therapeutic alternative for PHN patients. This treatment could improve the quality of life of PHN patients. NO ChiCTR-OCS-14005461.

Hydrocephalus: an underrated long-term complication of microvascular decompression for trigeminal neuralgia. A single institute experience.

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Muratorio, Francesco; Tringali, G; Levi, V; Ligarotti, G K I; Nazzi, V; Franzini, A A

2016-11-01

Hydrocephalus is a common complication of posterior fossa surgery, but its real incidence after microvascular decompression (MVD) for idiopathic trigeminal neuralgia (TN) still remains unclear. The aim of this study was to focus on the potential association between MVD and hydrocephalus as a surgery-related complication. All patients who underwent MVD procedure for idiopathic TN at our institute between 2009 and 2014 were reviewed to search for early or late postoperative hydrocephalus. There were 259 consecutive patients affected by idiopathic TN who underwent MVD procedure at our institution between 2009 and 2014 (113 men, 146 women; mean age 59 years, range 30-87 years; mean follow-up 40.92 months, range 8-48 months). Nine patients (3.47 %) developed communicating hydrocephalus after hospital discharge and underwent standard ventriculo-peritoneal shunt. No cases of acute hydrocephalus were noticed. Our study suggests that late communicating hydrocephalus may be an underrated potential long-term complication of MVD surgery.

Trigeminal neuralgia: how often are trigeminal nerve-vessel contacts found by MRI in normal volunteers

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Kress, B.; Schindler, M.; Haehnel, S.; Sartor, K.; Rasche, D.; Tronnier, V.

2006-01-01

Purpose: To assess prospectively how often contacts are found between the trigeminal nerve and arteries or veins in the perimesencephalic cistern via MRI in normal volunteers. Materials and methods: 48 volunteers without a history of trigeminal neuralgia were examined prospectively (MRI at 1.5T; T2-CISS sequence, coronal orientation, 0.9 mm slice thickness). Two radiologists decided by consensus whether there was a nerve-vessel contact in the perimesencephalic cistern. Results: In 27% of the volunteers, no contact was found between the trigeminal nerve and regional vessels, while in 73%, such a contact was present. In 61% of the cases, the offending vessel was an artery, in 39%, it was a vein. In 2 volunteers, a deformation of the nerve was noted. Conclusion: Contrary to what has been suggested by retrospective studies, the majority of normal volunteers, if studied prospectively, do show a contact between the trigeminal nerve and local vessels. A close proximity between the nerve and regional vessels is thus normal and is not necessarily proof of a pathological nerve-vessel conflict. (orig.)

Pharmacological versus microvascular decompression approaches for the treatment of trigeminal neuralgia: clinical outcomes and direct costs

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Almeida A

2011-08-01

Full Text Available Laurinda Lemos1,2, Carlos Alegria3, Joana Oliveira3, Ana Machado2, Pedro Oliveira4, Armando Almeida11Life and Health Sciences Research Institute (ICVS, School of Health Sciences, Campus de Gualtar, University of Minho, Braga, Portugal; 2Hospital Center of Alto Ave, Unit of Fafe, Fafe, Portugal; 3Department of Neurosurgery, Hospital São Marcos; 4Products and Systems Engineering, Campus de Azurém, University of Minho, Guimarães, PortugalAbstract: In idiopathic trigeminal neuralgia (TN the neuroimaging evaluation is usually normal, but in some cases a vascular compression of trigeminal nerve root is present. Although the latter condition may be referred to surgery, drug therapy is usually the first approach to control pain. This study compared the clinical outcome and direct costs of (1 a traditional treatment (carbamazepine [CBZ] in monotherapy [CBZ protocol], (2 the association of gabapentin (GBP and analgesic block of trigger-points with ropivacaine (ROP (GBP+ROP protocol, and (3 a common TN surgery, microvascular decompression of the trigeminal nerve (MVD protocol. Sixty-two TN patients were randomly treated during 4 weeks (CBZ [n = 23] and GBP+ROP [n = 17] protocols from cases of idiopathic TN, or selected for MVD surgery (n = 22 due to intractable pain. Direct medical cost estimates were determined by the price of drugs in 2008 and the hospital costs. Pain was evaluated using the Numerical Rating Scale (NRS and number of pain crises; the Hospital Anxiety and Depression Scale, Sickness Impact Profile, and satisfaction with treatment and hospital team were evaluated. Assessments were performed at day 0 and 6 months after the beginning of treatment. All protocols showed a clinical improvement of pain control at month 6. The GBP+ROP protocol was the least expensive treatment, whereas surgery was the most expensive. With time, however, GBP+ROP tended to be the most and MVD the least expensive. No sequelae resulted in any patient after drug

Clinical Outcomes of Gamma Knife Radiosurgery in the Treatment of Patients with Trigeminal Neuralgia

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Elaimy, Ameer L.; Hanson, Peter W.; Lamoreaux, Wayne T.; Mackay, Alexander R.; Demakas, John J.; Fairbanks, Robert K.; Cooke, Barton S.; Thumma, Sudheer R.; Lee, Christopher M.

2012-01-01

Since its introduction by Leksell, Gamma Knife radiosurgery (GKRS) has become increasingly popular as a management approach for patients diagnosed with trigeminal neuralgia (TN). For this reason, we performed a modern review of the literature analyzing the efficacy of GKRS in the treatment of patients who suffer from TN. For patients with medically refractory forms of the condition, GKRS has proven to be an effective initial and repeat treatment option. Cumulative research suggests that patients treated a single time with GKRS exhibit similar levels of facial pain control when compared to patients treated multiple times with GKRS. However, patients treated on multiple occasions with GKRS are more likely to experience facial numbness and other facial sensory changes when compared to patients treated once with GKRS. Although numerous articles have reported MVD to be superior to GKRS in achieving facial pain relief, the findings of these comparison studies are weakened by the vast differences in patient age and comorbidities between the two studied groups and cannot be considered conclusive. Questions remain regarding optimal GKRS dosing and targeting strategies, which warrants further investigation into this controversial matter. PMID:22229034

What do general neurologists need to know about neuropathic pain? O que os neurologistas gerais devem saber sobre dor neuropática?

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Pedro Schestatsky

2009-09-01

Full Text Available Neuropathic pain (NP is defined as pain caused by lesion or dysfunction of the somatosensory system, as a result of abnormal activation of the nociceptive pathway (small fibers and spinothalamic tracts. The most common causes of this syndrome are the following: diabetes, post-herpetic neuralgia, trigeminal neuralgia, stroke, multiple sclerosis, spinal cord injury, HIV infection, cancer. In the last few years, the NP has been receiving special attention for two main reasons: (1 therapeutical refractoriness of a variety of pain syndromes with predominant neuropathic characteristics and (2 the development of diagnostic tools for neuropathic pain complaints. The present review article provides relevant information on the understanding and recognition of NP, as well as evidence-based therapeutic approaches.A dor neuropática (DN é definida como dor causada por lesão ou disfunção do sistema somatossensitivo, como resultado da ativação anormal da via nociceptiva (fibras de pequeno calibre e trato espinotalâmico. As principais causas desta síndrome são: diabetes, neuralgia pós-herpética, neuralgia trigeminal, acidente vascular encefálico, esclerose múltipla, trauma raquimedular, infecção por HIV, câncer. Nos últimos anos, a DN vem recebendo especial atenção por dois motivos principais: (1 refratariedade terapêutica de várias síndromes dolorosas com componentes neuropáticos predominantes e (2 desenvolvimento de ferramentas diagnósticas para o reconhecimento deste tipo de dor. O presente artigo de revisão fornece informações relevantes para o entendimento e reconhecimento da DN, bem como de abordagens terapêuticas baseadas em evidência.

The Snapping Elbow Syndrome as a Reason for Chronic Elbow Neuralgia in a Tennis Player - MR, US and Sonoelastography Evaluation.

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Łasecki, Mateusz; Olchowy, Cyprian; Pawluś, Aleksander; Zaleska-Dorobisz, Urszula

2014-01-01

Ulnar neuropathy is the second most common peripheral nerve neuropathy after median neuropathy, with an incidence of 25 cases per 100 000 men and 19 cases per 100 000 women each year. Skipping (snapping) elbow syndrome is an uncommon cause of pain in the posterior-medial elbow area, sometimes complicated by injury of the ulnar nerve. One of the reason is the dislocation of the abnormal insertion of the medial triceps head over the medial epicondyle during flexion and extension movements. Others are: lack of the Osboune fascia leading to ulnar nerve instability and focal soft tissue tumors (fibromas, lipomas, etc). Recurrent subluxation of the nerve at the elbow results in a tractional and frictional neuritis with classical symptoms of peripheral neuralgia. As far as we know snapping triceps syndrome had never been evaluated in sonoelastography. A 28yo semi-professional left handed tennis player was complaining about pain in posterior-medial elbow area. Initial US examination suggest golfers elbow syndrome which occurs quite commonly and has a prevalence of 0.3-0.6% in males and 0-3-1.1% in women and may be associated (approx. 50% of cases) with ulnar neuropathy. However subsequently made MRI revealed unusual distal triceps anatomy, moderate ulnar nerve swelling and lack of medial epicondylitis symptoms. Followed (second) US examination and sonoelastography have detected slipping of the both ulnar nerve and the additional band of the medial triceps head. Snapping elbow syndrome is a poorly known medical condition, sometimes misdiagnosed as the medial epicondylitis. It describes a broad range of pathologies and anatomical abnormalities. One of the most often reasons is the slipping of the ulnar nerve as the result of the Osborne fascia/anconeus epitrochlearis muscle absence. Simultaneously presence of two or more "snapping reasons" is rare but should be always taken under consideration. There are no sonoelastography studies describing golfers elbow syndrome

Management of refractory trigeminal neuralgia using extended duration pulsed radiofrequency application.

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Thapa, Deepak; Ahuja, Vanita; Dass, Christopher; Verma, Parul

2015-01-01

Trigeminal neuralgia (TN) produces incapacitating facial pain that reduces quality of life in patients. Thermal radiofrequency (RF) ablation of gasserian ganglion (GG) is associated with masseter weakness and unpleasant sensations along the distribution of the ablated nerve. Pulsed radiofrequency (PRF) of GG has minimal side effects but literature is inconclusive regarding its benefit in refractory TN. Increasing the duration of PRF application to 6 minutes in TN produced encouraging results. PRF application to the saphenous nerve for 8 minutes reported improved pain relief and patient satisfaction. We report successful management of two patients of classic TN, which were refractory to medical management and interventional nerve blocks. The lesion site were confirmed with motor and sensory stimulation through a 22 G, 10 cm RF needle with 5 mm active tip. Both the patients received four cycles of PRF at 42 °C with each cycle of 120 seconds (8 minutes). The visual analogue scale (VAS) in case 1 reduced from pre-block score of 80 to score 10 post-block, while in case 2 the VAS reduced from pre-block score of 85 to score 15 post-block. During follow up both the patients are now pain free with minimal dose of carbamazepine at 12 and 6 months respectively. We used PRF for longer duration (8 minutes) in these patients, which resulted in improved VAS and WHOQOL-BREF score in these patients. PRF of mandibular division of GG for extended duration provided long-term effective pain relief and quality of life in patients of refractory classic TN.

[Impacts of bleeding and cupping therapy on serum P substance in patients of postherpetic neuralgia].

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Tian, Hao; Tian, Yong-Jing; Wang, Bing; Yang, Li; Wang, Ying-Ying; Yang, Jin-Sheng

2013-08-01

To observe the effect of bleeding and cupping therapy on postherpetic neuralgia (PHN) and preliminarily discuss the analgesic mechanism. Sixty-four cases of PHN were randomized into two groups, 32 cases in each one. In the bleeding and cupping group, the local pricking with syringe needle and cupping was applied in the local painful area, once every two days. And totally 8 treatments were required. In the pregabalin group, pregabalin was prescribed for oral administration, 150mg/time, twice a day. And totally 16 days of medication were required. Visual analogue scale (VAS) score and the changes of P substance content in the peripheral and local serum before and after treatment were observed in the two groups. VAS score and peripheral serum P substance after treatment were lower significantly than those before treatment in the two groups (all Pcupping group was much more significant (Pcupping group [(93.86 +/- 9.87) pg/mL vs (46.13 +/- 6.31) pg/mL, Pcupping therapy achieves the definite efficacy on PHN and it can reduce significantly peripheral and local serum P substance content in the patients. It is possibly one of the mechanisms of analgesic effect.

Trigeminal neuralgia--a coherent cross-specialty management program.

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Heinskou, Tone; Maarbjerg, Stine; Rochat, Per; Wolfram, Frauke; Jensen, Rigmor Højland; Bendtsen, Lars

2015-01-01

Optimal management of patients with classical trigeminal neuralgia (TN) requires specific treatment programs and close collaboration between medical, radiological and surgical specialties. Organization of such treatment programs has never been described before. With this paper we aim to describe the implementation and feasibility of an accelerated cross-speciality management program, to describe the collaboration between the involved specialties and to report the patient flow during the first 2 years after implementation. Finally, we aim to stimulate discussions about optimal management of TN. Based on collaboration between neurologists, neuroradiologists and neurosurgeons a standardized program for TN was implemented in May 2012 at the Danish Headache Center (DHC). First out-patient visit and subsequent 3.0 Tesla MRI scan was booked in an accelerated manner. The MRI scan was performed according to a special TN protocol developed for this program. Patients initially referred to neurosurgery were re-directed to DHC for pre-surgical evaluation of diagnosis and optimization of medical treatment. Follow-up was 2 years with fixed visits where medical treatment and indication for neurosurgery was continuously evaluated. Scientific data was collected in a structured and prospective manner. From May 2012 to April 2014, 130 patients entered the accelerated program. Waiting time for the first out-patient visit was 42 days. Ninety-four percent of the patients had a MRI performed according to the special protocol after a mean of 37 days. Within 2 years follow-up 35% of the patients were referred to neurosurgery after a median time of 65 days. Five scientific papers describing demographics, clinical characteristics and neuroanatomical abnormalities were published. The described cross-speciality management program proved to be feasible and to have acceptable waiting times for referral and highly specialized work-up of TN patients in a public tertiary referral centre for headache

Herpes zoster and postherpetic neuralgia in Catalonia (Spain).

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Salleras, Luis; Salleras, Montse; Salvador, Patricia; Soldevila, Núria; Prat, Andreu; Garrido, Patricio; Domínguez, Angela

2015-01-01

The objective of the study was to analyze the descriptive epidemiology and costs of herpes zoster (HZ) and postherpetic neuralgia (PHN) in people aged ≥50 years in Catalonia (Spain). The incidence of HZ in Catalonia was estimated by extrapolating the incidence data from Navarre (Spain) to the population of Catalonia. The incidence of PHN was estimated according to the proportion of cases of HZ in the case series of the Hospital del Sagrado Corazón de Barcelona that evolved to PHN. Drug costs were obtained directly from the prescriptions included in the medical record (according to official prices published by the General Council of the College of Pharmacists). The cost of care was obtained by applying the tariffs of the Catalan Health Institute to the number of outpatient visits and the number and duration of hospital admissions. The estimated annual incidence of HZ was 31 763, of which 21 532 (67.79%) were in patients aged ≥50 years. The respective figures for PHN were 3194 and 3085 (96.59) per annum, respectively. The mean cost per patient was markedly higher in cases of PHN (916.66 euros per patient) than in cases of HZ alone (301.52 euros per patient). The cost increased with age in both groups of patients. The estimated total annual cost of HZ and its complications in Catalonia was € 9.31 million, of which 6.54 corresponded to HZ and 2.77 to PHN. This is the first Spanish study of the disease burden of HZ in which epidemiological data and costs were collected directly from medical records. The estimated incidence of HZ is probably similar to the real incidence. In contrast, the incidence of PHN may be an underestimate, as around 25% of patients in Catalonia attend private clinics financed by insurance companies. It is also probable that the costs may be an underestimate as the costs derived from the prodromal phase were not included. In Catalonia, HZ and PHN cause an important disease burden (21 532 cases of HZ and 3085 de PHN with an annual cost

Dysregulation of Pain- and Emotion-Related Networks in Trigeminal Neuralgia

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Yanyang Zhang

2018-03-01

Full Text Available Classical trigeminal neuralgia (TN is a severe neuropathic facial pain disorder associated with increased risks of anxiety and depression. Converging evidence suggests that chronic pain pathophysiology involves dysfunctional pain-related and emotion-related networks. However, whether these systems are also among the culprit networks for TN remains unclear. Here, we aimed to assess TN-related anatomical and functional brain anomalies in pain-related and emotion-related networks. We investigated differences in gray matter (GM volume and the related resting-state functional connectivity (rsFC between 29 classical TN patients and 34 matched healthy controls. Relationships between brain measurement alterations, clinical pain and emotional states were identified. A longitudinal observation was further conducted to determine whether alterations in the brain could renormalize following pain relief. Reduced GM volumes in the bilateral amygdala, periaqueductal gray (PAG and right insula were found in TN patients compared with healthy control subjects. Whole-brain rsFC analyses with the four above-mentioned anatomical regions as seeds identified three significantly altered functional circuits, including amygdala-DLPFC, amygdala-mPFC and amygdala-thalamus/putamen circuitry. The amygdala-DLPFC and amygdala-mPFC circuits were associated with clinical pain duration and emotional state ratings, respectively. Further longitudinal analysis found that rsFC strength abnormalities in two fronto-limbic circuits (left amygdala/left DLPFC and right amygdala/right PFC were resolved after pain relief. Together, structural and functional deficits in pain-related and emotion-related networks were associated with TN patients, as demonstrated by our multimodal results. Pain relief had protective effects on brain functional connectivity within fronto-limbic circuits. Our study provides novel insights into the pathophysiology of TN, which may ultimately facilitate advances in

Report of cases in patients with acute herpetic neuralgia using a Mangifera indica extract

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Beatriz Garrido-Suárez

2011-12-01

Full Text Available It has been accepted that neuroinflammation, oxidative stress and glial activation are involved in the central sensitization underlying neuropathic and inflammatory pain. Vimang® is the brand name of an aqueous extract of Mangifera indica L., Anacardiaceae, traditionally used in Cuba for its antioxidant, antiinflammatory, analgesic, and immunomodulatory properties. In the present study, we determined the possible effects of Vimang formulations in acute herpes zoster (n=12 patients, that received a daily dose of 1800 mg of extract (two coated Vimang tablets, 300 mg each, three times daily before meals associated to low doses of amitriptyline (10-25 mg/d. In addition to the tablets, they utilized compresses containing Vimang dissolution at 2% on skin lesions for thirty days. The average daily pain score using a Likert scale and variations in concomitant drug daily dosage were determined. The analgesic effect was observed from week 1 (p<0.001 with respect to baseline data and none showed post-herpetic neuralgia. Significant reduction of antidepressant medication (p<0.01 and analgesic rescue dosages (p=0.0035 with respect to the initial daily dosage were showed. No adverse events were reported. The results obtained in this report of cases suggest that Vimang supplementation might be beneficial to prevent and treat neuropathic pain.

Topical amitriptyline and ketamine for post-herpetic neuralgia and other forms of neuropathic pain.

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Sawynok, Jana; Zinger, Celia

2016-01-01

Neuropathic pain (NP) has several therapeutic options but efficacy is limited and adverse effects occur, such that additional treatment options are needed. A topical formulation containing amitriptyline 4% and ketamine 2% (AmiKet) may provide such an option. This report summarizes both published and unpublished results of clinical trials with AmiKet. In post-herpetic neuralgia (PHN), AmiKet produces a significant analgesia which is comparable to that produced by oral gabapentin. In diabetic painful neuropathy, AmiKet showed a strong trend towards pain reduction. In mixed neuropathic pain, case series reports suggest a favourable response rate, but are limited by trial characteristics. AmiKet is absorbed minimally following topical administration. Over 700 patients have now received topical AmiKet in clinical regimens, and it is well-tolerated with the adverse effects mainly being application site reactions. Both agents are polymodal, and several mechanisms may contribute to the peripheral efficacy of AmiKet. Topical AmiKet has the potential to be a first-line treatment option for PHN, and to be useful in other NP conditions. Furthermore, AmiKet has the potential to be an adjunct to systemic therapies, with the targeting of a peripheral compartment in addition to central sites of action representing a rational drug combination.

Report of cases in patients with acute herpetic neuralgia using a Mangifera indica extract

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Beatriz Garrido-Suárez

2011-07-01

Full Text Available It has been accepted that neuroinflammation, oxidative stress and glial activation are involved in the central sensitization underlying neuropathic and inflammatory pain. Vimang® is the brand name of an aqueous extract of Mangifera indica L., Anacardiaceae, traditionally used in Cuba for its antioxidant, antiinflammatory, analgesic, and immunomodulatory properties. In the present study, we determined the possible effects of Vimang formulations in acute herpes zoster (n=12 patients, that received a daily dose of 1800 mg of extract (two coated Vimang tablets, 300 mg each, three times daily before meals associated to low doses of amitriptyline (10-25 mg/d. In addition to the tablets, they utilized compresses containing Vimang dissolution at 2% on skin lesions for thirty days. The average daily pain score using a Likert scale and variations in concomitant drug daily dosage were determined. The analgesic effect was observed from week 1 (p<0.001 with respect to baseline data and none showed post-herpetic neuralgia. Significant reduction of antidepressant medication (p<0.01 and analgesic rescue dosages (p=0.0035 with respect to the initial daily dosage were showed. No adverse events were reported. The results obtained in this report of cases suggest that Vimang supplementation might be beneficial to prevent and treat neuropathic pain.

Feasibility of Multiple Repeat Gamma Knife Radiosurgeries for Trigeminal Neuralgia: A Case Report and Review of the Literature

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Jones, Guy C.; Elaimy, Ameer L.; Demakas, John J.; Jiang, Hansi; Lamoreaux, Wayne T.; Fairbanks, Robert K.; Mackay, Alexander R.; Cooke, Barton S.; Lee, Christopher M.

2011-01-01

Treatment options for trigeminal neuralgia (TN) must be customized for the individual patient, and physicians must be aware of the medical, surgical, and radiation treatment modalities to prescribe optimal treatment courses for specific patients. The following case illustrates the potential for gamma knife radiosurgery (GKRS) to be repeated multiple times for the purpose of achieving facial pain control in cases of TN that have been refractory to other medical and surgical options, as well as prior GKRS. The patient described failed to achieve pain control with initial GKRS, as well as medical and surgical treatments, but experienced significant pain relief for a period of time with a second GKRS procedure and later underwent a third procedure. Only a small subset of patients have reportedly undergone more than two GKRS for TN; thus, further research and long-term clinical followup will be valuable in determining its usefulness in specific clinical situations. PMID:21904556

Frameless Stereotactic Radiosurgery for Treatment of Multiple Sclerosis-Related Trigeminal Neuralgia.

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Conti, Alfredo; Pontoriero, Antonio; Iatì, Giuseppe; Esposito, Felice; Siniscalchi, Enrico Nastro; Crimi, Salvatore; Vinci, Sergio; Brogna, Anna; De Ponte, Francesco; Germanò, Antonino; Pergolizzi, Stefano; Tomasello, Francesco

2017-07-01

Trigeminal neuralgia (TN) affects 7% of patients with multiple sclerosis (MS). In such patients, TN is difficult to manage either pharmacologically and surgically. Radiosurgical rhizotomy is an effective treatment option. The nonisocentric geometry of radiation beams of CyberKnife introduces new concepts in the treatment of TN. Its efficacy for MS-related TN has not yet been demonstrated. Twenty-seven patients with refractory TN and MS were treated. A nonisocentric beams distribution was chosen; the maximal target dose was 72.5 Gy. The maximal dose to the brainstem was <12 Gy. Effects on pain, medications, sensory disturbance, rate, and time of pain recurrence were analyzed. Median follow-up was 37 (18-72) months. Barrow Neurological Institute pain scale score I-III was achieved in 23/27 patients (85%) within 45 days. Prescription isodose line (80%) accounting for a dose of 58 Gy incorporated an average of 4.85 mm (4-6 mm) of the nerve and mean nerve volume of 26.4 mm 3 (range 20-38 mm 3 ). Seven out of 27 patients (26%) had mild, not bothersome, facial numbness (Barrow Neurological Institute numbness score II). The rate of pain control decreased progressively after the first year, and only 44% of patients retained pain control 4 years later. Frameless radiosurgery can be effectively used to perform retrogasserian rhizotomy. Pain relief was satisfactory and, with our dose/volume constraints, no sensory complications were recorded. Nonetheless, long-term pain control was possible in less than half of the patients. This is a limitation that CyberKnife radiosurgery shares with other techniques in MS patients. Copyright © 2017 Elsevier Inc. All rights reserved.

Structural magnetic resonance imaging can identify trigeminal system abnormalities in classical trigeminal neuralgia

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Danielle DeSouza

2016-10-01

Full Text Available Classical trigeminal neuralgia (TN is a chronic pain disorder that has been described as one ofthe most severe pains one can suffer. The most prevalent theory of TN etiology is that the trigeminal nerve is compressed at the root entry zone (REZ by blood vessels. However, there is significant evidence showing a lack of neurovascular compression (NVC for many cases of classical TN. Furthermore, a considerable number of patients who are asymptomatic have MR evidence of NVC. Since there is no validated animal model that reproduces the clinical features of TN, our understanding of TN pathology mainly comes from biopsy studies that have limitations. Sophisticated structural MRI techniques including diffusion tensor imaging provide new opportunities to assess the trigeminal nerves and CNS to provide insight into TN etiology and pathogenesis. Specifically, studies have used high-resolution structural MRI methods to visualize patterns of trigeminal nerve-vessel relationships and to detect subtle pathological features at the trigeminal REZ. Structural MRI has also identified CNS abnormalities in cortical and subcortical gray matter and white matter and demonstrated that effective neurosurgical treatment for TN is associated with a reversal of specific nerve and brain abnormalities. In conclusion, this review highlights the advanced structural neuroimaging methods that are valuable tools to assess the trigeminal system in TN and may inform our current understanding of TN pathology. These methods may in the future have clinical utility for the development of neuroimaging-based biomarkers of TN.

The Snapping Elbow Syndrome as a Reason for Chronic Elbow Neuralgia in a Tennis Player – MR, US and Sonoelastography Evaluation

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Łasecki, Mateusz; Olchowy, Cyprian; Pawluś, Aleksander; Zaleska-Dorobisz, Urszula

2014-01-01

Ulnar neuropathy is the second most common peripheral nerve neuropathy after median neuropathy, with an incidence of 25 cases per 100 000 men and 19 cases per 100 000 women each year. Skipping (snapping) elbow syndrome is an uncommon cause of pain in the posterior-medial elbow area, sometimes complicated by injury of the ulnar nerve. One of the reason is the dislocation of the abnormal insertion of the medial triceps head over the medial epicondyle during flexion and extension movements. Others are: lack of the Osboune fascia leading to ulnar nerve instability and focal soft tissue tumors (fibromas, lipomas, etc). Recurrent subluxation of the nerve at the elbow results in a tractional and frictional neuritis with classical symptoms of peripheral neuralgia. As far as we know snapping triceps syndrome had never been evaluated in sonoelastography. A 28yo semi-professional left handed tennis player was complaining about pain in posterior-medial elbow area. Initial US examination suggest golfers elbow syndrome which occurs quite commonly and has a prevalence of 0.3–0.6% in males and 0–3–1.1% in women and may be associated (approx. 50% of cases) with ulnar neuropathy. However subsequently made MRI revealed unusual distal triceps anatomy, moderate ulnar nerve swelling and lack of medial epicondylitis symptoms. Followed (second) US examination and sonoelastography have detected slipping of the both ulnar nerve and the additional band of the medial triceps head. Snapping elbow syndrome is a poorly known medical condition, sometimes misdiagnosed as the medial epicondylitis. It describes a broad range of pathologies and anatomical abnormalities. One of the most often reasons is the slipping of the ulnar nerve as the result of the Osborne fascia/anconeus epitrochlearis muscle absence. Simultaneously presence of two or more “snapping reasons” is rare but should be always taken under consideration. There are no sonoelastography studies describing golfers elbow syndrome

Is magnesium sulfate effective for pain in chronic postherpetic neuralgia patients comparing with ketamine infusion therapy?

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Kim, Yang Hyun; Lee, Pyung Bok; Oh, Tak Kyu

2015-06-01

Postherpetic neuralgia (PHN) is a frequent debilitating complication and one of the most intractable pain disorders, particularly in elderly patients. Although tricyclic antidepressants, topical capsaicin, gabapentin, and oxycodone are effective for alleviating PHN, many patients remain refractory to current therapies. Here, the analgesic effects of ketamine or magnesium for PHN were assessed in an open prospective study. Thirty patients with severe, intractable PHN who were unresponsive to conservative therapy participated. The effects of ketamine hydrochloride (Ketara, Parke Davis) 1 mg/kg and magnesium sulfate (Magnesin) 30 mg/kg were investigated. The patients were randomly divided into 2 groups of 15 patients each, and ketamine 1 mg/kg or magnesium 30 mg/kg was administered intravenously for 1 hour after midazolam sedation. Pain was rated on a visual analog scale (VAS) during a 2-week follow-up. All patients also completed the Doleur Neuropathique 4 questionnaire at baseline and final visits. Response to treatment, defined as a 50% reduction in VAS score 2 weeks after, was recorded in 10 of 15 patients in the ketamine group and 7 of 15 patients in the magnesium group. The difference in VAS reduction was not significant between the 2 groups. Ketamine and magnesium showed significant analgesic effects in patients with PHN. Copyright © 2015 Elsevier Inc. All rights reserved.

Effect of beam channel plugging on the outcome of gamma knife radiosurgery for trigeminal neuralgia

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Massager, Nicolas; Nissim, Ouzi; Murata, Noriko; Devriendt, Daniel; Desmedt, Francoise; Vanderlinden, Bruno; Regis, Jean; Levivier, Marc

2006-01-01

Purpose: We studied the influence of using plugs for brainstem protection during gamma knife radiosurgery (GKR) of trigeminal neuralgia (TN), with special emphasis on irradiation doses delivered to the trigeminal nerve, pain outcomes, and incidence of trigeminal dysfunction. Methods and Materials: A GKR procedure for TN using an anterior cisternal target and a maximum dose of 90 Gy was performed in 109 patients. For 49 patients, customized beam channel blocking (plugs) were used to reduce the dose delivered to the brainstem. We measured the mean and integrated radiation doses delivered to the trigeminal nerve and the clinical course of patients treated with and without plugs. Results: We found that blocking increases the length of trigeminal nerve exposed to high-dose radiation, resulting in a significantly higher mean dose to the trigeminal nerve. Significantly more of the patients with blocking achieved excellent pain outcomes (84% vs. 62%), but with higher incidences of moderate and bothersome trigeminal nerve dysfunction (37% mild/10% bothersome with plugs vs. 30% mild/2% bothersome without). Conclusions: The use of plugs to protect the brainstem during GKR treatment for TN increases the dose of irradiation delivered to the intracisternal trigeminal nerve root and is associated with an important increase in the incidence of trigeminal nerve dysfunction. Therefore, beam channel blocking should be avoided for 90 Gy-GKR of TN

Association between neurovascular contact on MRI and response to gamma knife radiosurgery in trigeminal neuralgia

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Erbay, Sami H.; Bhadelia, Rafeeque A.; Gupta, Punita; O'Callaghan, Mark; Yun, Eric; Oljeski, Steven; Riesenburger, Ron

2006-01-01

Treatment with gamma knife radiosurgery (GKRS) provides adequate short-term pain control in about 70% of the patients with intractable trigeminal neuralgia (TN). The purpose of our study was to evaluate whether the presence of neurovascular contact (NVC) at the root entry zone of the trigeminal nerve on pre-gamma knife MR imaging predicts an increased likelihood of an adequate response to GKRS.We studied 40 consecutive patients who underwent GKRS for treatment of intractable TN. Two neuroradiologists blinded to the side of symptoms analyzed pre-treatment constructive interference in steady state (CISS) images to determine the presence of NVC by consensus. An adequate response was defined as freedom from pain with or without reduced need for medical therapy. Adequate short-term response to GKRS was seen in 29 (72.5%) of 40 patients. NVC was seen in 30 of the 40 patients. Twenty-five (83.3%) of 30 patients with NVC had adequate short-term response to GKRS. Only four (40%) of the 10 patients without NVC had adequate response to GKRS (X 2 =7.06; P<0.01). Patients with NVC were seven times more likely to have an adequate response to GKRS than those without NVC (odds ratio =7.5).The presence of NVC on pre-treatment MR imaging predicts an increased likelihood of an adequate response to GKRS. (orig.)

Magnetic resonance imaging of vascular compression in trigeminal neuralgia and hemifacial spasms

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Nagaseki, Yoshishige; Horikoshi, Tohru; Omata, Tomohiro; Sugita, Masao; Nukui, Hideaki; Sakamoto, Hajime; Kumagai, Hiroshi; Sasaki, Hideo; Tsuji, Reizou.

1991-01-01

We show how neurosurgical planning can benefit from the better visualization of the precise vascular compression of the nerve provided by the oblique-sagittal and gradient-echo method (OS-GR image) using magnetic resonance images (MRI). The scans of 3 patients with trigeminal neuralgia (TN) and of 15 with hemifacial spasm (HFS) were analyzed for the presence and appearance of the vascular compression of the nerves. Imaging sequences consisted of an OS-GR image (TR/TE: 200/20, 3-mm-thick slice) cut along each nerve shown by the axial view, which was scanned at the angle of 105 degrees taken between the dorsal line of the brain stem and the line corresponding to the pontomedullary junction. In the OS-GR images of the TN's, the vascular compressions of the root entry zone (REZ) of the trigeminal nerve were well visualized as high-intensity lines in the 2 cases whose vessels were confirmed intraoperatively. In the other case, with atypical facial pain, vascular compression was confirmed at the rostral distal site on the fifth nerve, apart from the REZ. In the 15 cases of HFS, twelve OS-GR images (80%) demonstrated vascular compressions at the REZ of the facial nerves from the direction of the caudoventral side. During the surgery for these 12 cases, in 11 cases (excepting the 1 case whose facial nerve was not compressed by any vessels), vascular compressions were confirmed corresponding to the findings of the OS-GR images. Among the 10 OS-GR images on the non-affected side, two false-positive findings were visualized. It is concluded that OS-GR images obtained by means of MRI may serve as a useful planning aid prior to microvascular decompression for cases of TN and HFS. (author)

Prospective Study of Neuroendoscopy versus Microscopy: 213 Cases of Microvascular Decompression for Trigeminal Neuralgia Performed by One Neurosurgeon.

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Xiang, Hui; Wu, Guangyong; Ouyang, Jia; Liu, Ruen

2018-03-01

To compare the efficacy and complications of microvascular decompression (MVD) by complete neuroendoscopy versus microscopy for 213 cases of trigeminal neuralgia (TN). Between January 2014 and January 2016, 213 patients with TN were randomly assigned to the neuroendoscopy (n = 105) or microscopy (n = 114) group for MVD via the suboccipital retrosigmoid approach. All procedures were performed by the same neurosurgeon. Follow-up was conducted by telephone interview. Statistical data were analyzed with the chi-square test, and a probability (P) value of ≤0.05 was considered statistically significant. Chi-square test was conducted using SAS 9.4 software (SAS Institute, Cary, North Carolina, USA). There were no statistical differences between the 2 groups in pain-free condition immediately post procedure, pain-free condition 1 year post procedure, hearing loss, facial hypoesthesia, transient ataxia, aseptic meningitis, intracranial infections, and herpetic lesions of the lips. There were no instances of death, facial paralysis, cerebral hemorrhage, or cerebrospinal fluid leakage in either group. There were no significant differences in the cure rates or incidences of surgical complications between neuroendoscopic and microscopic MVD. Copyright © 2017 Elsevier Inc. All rights reserved.

Effect of Concomitant Pain Medications on Response to Pregabalin in Patients with Postherpetic Neuralgia or Spinal Cord Injury-Related Neuropathic Pain.

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Schug, Stephan A; Parsons, Bruce; Almas, Mary; Whalen, Ed

2017-01-01

Patients with neuropathic pain (NeP) often receive combination therapy with multiple agents in the hopes of improving both pain and any comorbidities that may be present. While pregabalin is often recommended as a first-line treatment of NeP, few studies have examined the effects of concomitant medications on the efficacy of pregabalin. To examine the effects of concomitant medications on the efficacy and safety of pregabalin for the treatment of NeP. Data were derived from 7 randomized placebo-controlled trials of pregabalin (150, 300, 600, and flexible 150 - 600 mg/d) for the treatment of postherpetic neuralgia (PHN) and 2 randomized placebo-controlled trials for the treatment of NeP due to spinal cord injury (SCI-NeP). On each day, patients rated the severity of their pain and pain-related sleep interference (PRSI) over the previous 24 hours on a scale from 0 to 10, with higher scores indicating greater severity. Patients were also continually monitored for the occurrence of adverse events. A pooled retrospective analyses of data from randomized clinical trials. Changes from baseline in mean weekly pain and PRSI scores were compared between patients who received concomitant NeP medications and patients who did not receive concomitant NeP medications. Results of these comparisons are presented separately for the PHN (through 4, 8, and 12 weeks) and SCI-NeP (through 12 weeks) cohorts. Common adverse events are also presented for each treatment group. Pregabalin significantly improved both pain and PRSI scores relative to placebo at most dose levels and time points examined. Notably, little difference was observed in the extent of therapeutic response to pregabalin between patients who received concomitant NeP medications and patients who did not receive concomitant NeP medications. Additionally, the profile of treatment-emergent adverse events appeared to be largely unaffected by the use of concomitant NeP medications in the pooled patient population. Our analysis

Trigeminal Neuralgia: Evaluation of the Relationship Between the Region of Neuralgic Manifestation and the Site of Neurovascular Compression Under Endoscopy.

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Zhang, Wenhao; Chen, Minjie; Zhang, Weijie; Chai, Ying

2015-07-01

This study aimed to evaluate the relationship among the pain region, branches of trigeminal nerve, and the neurovascular compression (NVC) location. A total of 123 consecutive patients with trigeminal neuralgia (TN) underwent endoscope-assisted microvascular decompression according to positive preoperative tomographic angiography. V2 alone was in 51 cases and V3 alone was in 64 cases. The location of NVC was classified into cranial, caudal, medial, or lateral sites. Some patients with multiple regions were recorded as medial + cranial, lateral + cranial, medial + caudal, and lateral + caudal. Twenty-eight (71.8%) of 39 patients with TN (V2) had their NVC at the medial site of the nerve. Twenty-seven (64.3%) of 42 patients with TN (V3) had their NVC at the lateral site of the nerve. There was a statistically significant difference (P = 0.0011  0.01). Evaluation of the relationship between the pain region and the NVC location by endoscopic images during microvascular decompression is more accurate. The second branch is mostly distributed in the medial area, and third branch is mainly distributed in the lateral area.

Efficacy of botulinum toxin type a in trigeminal neuralgia in a South Asian Cohort

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Manjula Chandragomi Caldera

2018-01-01

Full Text Available Introduction: The antinociceptive effect of botulinum toxin-A (BTX-A in trigeminal neuralgia (TN has been described. We evaluated effects of BTX-A in relieving pain in patients with refractory TN at National Hospital of Sri Lanka. Materials and Methods: Pain in patients with TN was assessed using a visual analog from 0 to 10. Three months after commencement of drug therapy with ≥2 drugs including one first-line drug (carbamazepine/oxcarbazepine, pain scores were re-assessed. Twenty-two patients who did not report improvement of ≥50% at 90 days' posttreatment were recruited. They were given adjunct BTX-A directly to the trigger point (if identified or intradermal. Pain scores were assessed at 10, 20, 30, 60, and 90 days' posttreatment. Results: There was a statistically significant improvement in mean pain scores at 10, 20, 30, 60, and 90 days' posttreatment (5.59 [standard deviation (SD = 2.7], 5.68 [SD = 2.6], 5.27 [SD = 3.2], 4.77 [SD = 3.7], and 5.32 [SD = 4.0] compared to pre-BTX-A treatment (7.14, SD = 2.2. Percentage reduction in mean pain score ranged from 20.4% to 33.1%. Maximum response was at day 60 post-BTX-A (50% had ≥50% reduction in pain. No significant difference was found in response with higher doses and injection strategy. Conclusion: Consistent statistically significant reductions in pain scores at the aforesaid intervals compared to pretreatment means that there is a place for BTX in refractory TN.

Gasserian Ganglion and Retrobulbar Nerve Block in the Treatment of Ophthalmic Postherpetic Neuralgia: A Case Report.

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Huang, Jie; Ni, Zhongge; Finch, Philip

2017-09-01

Varicella zoster virus reactivation can cause permanent histological changes in the central and peripheral nervous system. Neural inflammatory changes or damage to the dorsal root ganglia sensory nerve fibers during reactivation can lead to postherpetic neuralgia (PHN). For PHN of the first division of the fifth cranial nerve (ophthalmic division of the trigeminal ganglion), there is evidence of inflammatory change in the ganglion and adjacent ocular neural structures. First division trigeminal nerve PHN can prove to be difficult and sometimes even impossible to manage despite the use of a wide range of conservative measures, including anticonvulsant and antidepressant medication. Steroids have been shown to play an important role by suppressing neural inflammatory processes. We therefore chose the trigeminal ganglion as an interventional target for an 88-year-old woman with severe ophthalmic division PHN after she failed to respond to conservative treatment. Under fluoroscopic guidance, a trigeminal ganglion nerve block was performed with lidocaine combined with dexamethasone. A retrobulbar block with lidocaine and triamcinolone settled residual oculodynia. At 1-year follow-up, the patient remained pain free and did not require analgesic medication. To our knowledge, this is the first reported case of ophthalmic division PHN successfully treated with a combination of trigeminal ganglion and retrobulbar nerve block using a local anesthetic agent and steroid for central and peripheral neural inflammatory processes. © 2016 World Institute of Pain.

Microvascular Decompression for Treatment of Trigeminal Neuralgia in Patient with Facial Nerve Schwannoma.

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Marinelli, John P; Van Gompel, Jamie J; Link, Michael J; Carlson, Matthew L

2018-05-01

Secondary trigeminal neuralgia (TN) is uncommon. When a space-occupying lesion with mass effect is identified, the associated TN is often exclusively attributed to the tumor. This report illustrates the importance of considering coexistent actionable pathology when surgically treating secondary TN. A 51-year-old woman presented with abrupt-onset TN of the V2 and V3 nerve divisions with hypesthesia. She denied changes in hearing, balance, or facial nerve dysfunction. Magnetic resonance imaging revealed a 1.6-cm contrast-enhancing cerebellopontine angle tumor that effaced the trigeminal nerve, consistent with a vestibular schwannoma. In addition, a branch of the superior cerebellar artery abutted the cisternal segment of the trigeminal nerve on T2-weighted thin-slice magnetic resonance imaging. Intraoperative electrical stimulation of the tumor elicited a response from the facial nerve at low threshold over the entire accessible tumor surface, indicating that the tumor was a facial nerve schwannoma. Considering the patient's lack of facial nerve deficit and that the tumor exhibited no safe entry point for intracapsular debulking, tumor resection was not performed. Working between the tumor and tentorium, a branch of the superior cerebellar artery was identified and decompressed with a Teflon pad. At last follow-up, the patient exhibited resolution of her TN. Her hearing and facial nerve function remained intact. Despite obstruction from a medium-sized tumor, it is still possible to achieve microvascular decompression of the fifth cranial nerve. This emphasizes the importance of considering other actionable pathology during surgical management of presumed tumor-induced TN. Further, TN is relatively uncommon with medium-sized vestibular schwannomas and coexistent causes should be considered. Copyright © 2018 Elsevier Inc. All rights reserved.

Thalamic metabolic alterations with cognitive dysfunction in idiopathic trigeminal neuralgia: a multivoxel spectroscopy study

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Wang, Yuan; Bao, Faxiu; Ma, Shaohui; Guo, Chenguang; Jin, Chenwang; Zhang, Ming [First Affiliated Hospital of Xi' an Jiaotong University, Department of Medical Imaging, Xi' an, Shaanxi (China); Li, Dan [First Affiliated Hospital of Xi' an Jiaotong University, Department of Respiratory and Critical Care Medicine, Xi' an, Shaanxi (China)

2014-08-15

Although abnormalities in metabolite compositions in the thalamus are well described in patients with idiopathic trigeminal neuralgia (ITN), differences in distinct thalamic subregions have not been measured with proton magnetic resonance spectroscopy ({sup 1}H-MRS), and whether there are correlations between thalamic metabolites and cognitive function still remain unknown. Multivoxel MRS was recorded to investigate the metabolic alterations in the thalamic subregions of patients with ITN. The regions of interest were localized in the anterior thalamus (A-Th), intralaminar portion of the thalamus (IL-Th), posterior lateral thalamus (PL-Th), posterior medial thalamus (PM-Th), and medial and lateral pulvinar of the thalamus (PuM-Th and PuL-Th). The N-acetylaspartate to creatine (NAA/Cr) and choline to creatine (Cho/Cr) ratios were measured in the ITN and control groups. Scores of the visual analogue scale (VAS) and the Montreal Cognitive Assessment (MoCA) were analyzed to correlate with the neuroradiological findings. The NAA/Cr ratio in the affected side of PM-Th and PL-Th in ITN patients was statistically lower than that in the corresponding regions of the thalamus in controls. The NAA/Cr ratio in the affected PM-Th was negatively associated with VAS and disease duration. Furthermore, decreases of NAA/Cr and Cho/Cr were detected in the affected side of IL-Th, and lower Cho/Cr was positively correlated with MoCA values in the ITN group. Our result of low level of NAA/Cr in the affected PM-Th probably serves as a marker of the pain-rating index, and decreased Cho/Cr in IL-Th may be an indicator of cognitive disorder in patients with ITN. (orig.)

Neuronavigator-guided percutaneous radiofrequency thermocoagulation in the treatment of intractable trigeminal neuralgia.

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Xu, Shu-jun; Zhang, Wen-hua; Chen, Teng; Wu, Cheng-yuan; Zhou, Mao-de

2006-09-20

Percutaneous radiofrequency thermocoagulation of the trigeminal ganglion (PRTTG) is regarded as the first choice for most patients with trigeminal neuralgia (TN) because of its safety and feasibility. However, neuronavigator-guided PRTTG has been seldom reported. The purpose of this study was to assess the safety and efficacy of neuronavigator-guided PRTTG for the treatment of intractable TN. Between January 2000 and December 2004, 54 patients with intractable TN were enrolled into this study and were randomly divided into two groups. The patients in navigation group (n = 26) underwent PRTTG with frameless neuronavigation, and those in control group (n = 28) received PRTTG without neuronavigation. Three months after the operation, the efficacy, side effects, and complications of the surgery were recorded. The patients in the control group were followed up for 10 to 54 months (mean, 34 +/- 5), and those in the navigation group were followed up for 13 to 58 months (mean, 36 +/- 7). Kaplan-Meier analyses of the pain-free survival curves were used for the censored survival data, and the log-rank test was used to compare survival curves of the two groups. The immediate complete pain-relief rate of the navigation group was 100%, whereas it was 95% in the control. The proportion of sustained pain-relief rates at 12, 24 and 36 months after the procedure were 85%, 77%, and 62% in the navigation group, and 54%, 40%, and 35% in the control. Recurrences in the control group were more common than that in the navigation group. Annual recurrence rate in the first and second years were 15% and 23% in the navigation group, and 46%, 60% in the control group. No side-effect and complication was noted in the navigation group except minimal facial hypesthesia. Neuronavigator-guided PRTTG is a safe and promising method for treatment of intractable TN with better short- and long-term outcomes and lower complication rate than PRTTG without neuronavigation.

Analgesic therapy in postherpetic neuralgia: a quantitative systematic review.

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Kathleen Hempenstall

2005-07-01

Full Text Available BACKGROUND: Postherpetic neuralgia (PHN is a complication of acute herpes zoster, which is emerging as a preferred clinical trial model for chronic neuropathic pain. Although there are published meta-analyses of analgesic therapy in PHN, and neuropathic pain in general, the evidence base has been substantially enhanced by the recent publication of several major trials. Therefore, we have conducted a systematic review and meta-analysis for both efficacy and adverse events of analgesic therapy for PHN. METHODS AND FINDINGS: We systematically searched databases (MEDLINE 1966-2004, EMBASE 1988-2004, CINAHL 1982-2002, and PubMed [29 October 2004] for trials of PHN. We also searched references of retrieved studies and review articles for further trials. We included trials that examined adult patients with PHN of greater duration than 3 mo, that were blinded, randomised, and had at least one measure of pain outcome. Dichotomous pain outcome data were extracted for 50% decrease in baseline pain using a hierarchy of pain/pain-relief measurement tools. Where available, dichotomous data were also collected for adverse events. Calculated estimates of efficacy included relative benefit and number needed to treat. Of 62 studies identified, 35 were randomised controlled trials. Of these, 31 were placebo controlled and suitable for meta-analysis, from which it was possible to extract dichotomous efficacy outcome data from 25. This meta-analysis revealed that there is evidence to support the use of the following orally administered therapies: tricyclic antidepressants, "strong" opioids, gabapentin, tramadol, and pregabalin. Topical therapies associated with efficacy were lidocaine 5% patch and capsaicin. Finally, a single study of spinal intrathecal administration of lidocaine and methyl prednisolone demonstrated efficacy, although this has yet to be replicated. Data suggest that the following therapies are not associated with efficacy in PHN: certain NMDA

Evolução branda de recidiva de infecção por varicela zoster após tratamento com fingolimode em paciente com esclerose múltipla: relato de casoBenign evolution of shingles with fingolimod in a patient with multiple sclerosis: case report

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Antonio Arlindo Morais

2016-03-01

Full Text Available Objetivo: Relatar o caso de um paciente com recidiva de herpes-zoster (HZ e evolução benigna mesmo diante de imunomodulação para esclerose múltipla (EM. Descrição de caso: Mulher de 48 anos com história de EM durante seis anos, previamente tratada com interferon1b, iniciou tratamento com fingolimode, desenvolvendo HZ após 10 meses de tratamento. Mesmo sem tratamento com acyclovir, a paciente desenvolveu um curso brando, sem posterior desenvolvimento de neuralgia pós-herpética. Conclusões: As novas terapias para EM podem estar associadas a novos tipos de eventos adversos. Apesar da potencial gravidade, nem todos os pacientes com HZ em uso das novas terapias para EM têm curso desfavorável, sendo necessários estudos para identificar fatores de risco para as formas graves.

Vestibular schwannoma (acoustic neuroma mimicking temporomandibular disorders: a case report Schwannoma vestibular (neurinoma do acústico imitando desordens temporomandibulares: um relato de caso

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Maurício A. Bisi

2006-12-01

Full Text Available Approximately 6 to 16% of patients with trigeminal neuralgia symptoms present intracranial tumors, the most common being the vestibular schwannoma (acoustic neuroma. Some symptoms reported by patients include hearing loss, tinnitus, headaches, vertigo and trigeminal disturbances. An increased muscle response in the surrounding head and neck musculature may also be observed, which mimics signs and symptoms of temporomandibular disorders. In these cases, magnetic resonance imaging (MRI has proved to be a useful tool in tumor diagnosis. The differential diagnosis between myofascial and neuralgic pain is important, as both may present similar characteristics, while being of different origin, and demanding special treatment approaches. The purpose of this paper is to demonstrate the relationship among trigeminal neuralgia symptoms, intracranial tumors and temporomandibular dysfunction by presenting a clinical case.Aproximadamente 6 a 16% dos pacientes com sintomas de neuralgia trigeminal apresentam tumores intracranianos, sendo mais comum o schwannoma vestibular (neurinoma do acústico. Alguns sintomas relatados pelos pacientes são perda da audição, zumbido, dores de cabeça, vertigens e distúrbios trigeminais. Uma resposta muscular aumentada na musculatura associada da cabeça e do pescoço também pode ser observada, o que pode mimetizar sinais e sintomas de desordens temporomandibulares. Nestes casos é de grande valia o uso de imagem de ressonância magnética (IRM para detecção de tumores. É importante, também, a diferenciação de dores miofasciais e neurálgicas, pois ambas podem apresentar características semelhantes, mas com origens e tratamentos diferentes. O objetivo desse trabalho foi demonstrar através de relato de caso clínico a associação entre sintomas de neuralgia trigeminal, tumores intracranianos e disfunção temporomandibular.

Presurgical visualization of the neurovascular relationship in trigeminal neuralgia with 3D modeling using free Slicer software.

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Han, Kai-Wei; Zhang, Dan-Feng; Chen, Ji-Gang; Hou, Li-Jun

2016-11-01

To explore whether segmentation and 3D modeling are more accurate in the preoperative detection of the neurovascular relationship (NVR) in patients with trigeminal neuralgia (TN) compared to MRI fast imaging employing steady-state acquisition (FIESTA). Segmentation and 3D modeling using 3D Slicer were conducted for 40 patients undergoing MRI FIESTA and microsurgical vascular decompression (MVD). The NVR, as well as the offending vessel determined by MRI FIESTA and 3D Slicer, was reviewed and compared with intraoperative manifestations using SPSS. The k agreement between the MRI FIESTA and operation in determining the NVR was 0.232 and that between the 3D modeling and operation was 0.6333. There was no significant difference between these two procedures (χ 2  = 8.09, P = 0.088). The k agreement between the MRI FIESTA and operation in determining the offending vessel was 0.373, and that between the 3D modeling and operation was 0.922. There were significant differences between two of them (χ 2  = 82.01, P = 0.000). The sensitivity and specificity for MRI FIESTA in determining the NVR were 87.2 % and 100 %, respectively, and for 3D modeling were both 100 %. The segmentation and 3D modeling were more accurate than MRI FIESTA in preoperative verification of the NVR and offending vessel. This was consistent with surgical manifestations and was more helpful for the preoperative decision and surgical plan.

Descompresión microvascular en neuralgia del trigémino: Reporte de 36 casos y revisión de la literatura

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Campero, Alvaro; Ajler, Pablo; Campero, Abraham Agustín

2014-01-01

Objetivo: El propósito del presente trabajo es presentar los resultados de 36 pacientes con diagnóstico de neuralgia del trigémino (NT), en los cuales se realizó una descompresión microvascular (DMV). Material y Método: Desde junio de 2005 a mayo de 2012, 36 pacientes con diagnóstico de NT fueron operados por el primer autor (AC), realizando una DMV. Se evaluó: Edad, sexo, tiempo de sintomatología previo a la cirugía, hallazgos intraoperatorios (a través de los videos quirúrgicos), y resultados postoperatorios. Resultados: De los 36 pacientes operados, 25 fueron mujeres y 11 varones. El promedio de edad fue de 48 años. El seguimiento postoperatorio fue en promedio de 38 meses. De los 36 pacientes, 32 (88%) evolucionaron sin dolor hasta la fecha. De los 4 casos con recurrencia de dolor, en dos pacientes se observó como hallazgo intraoperatorio un conflicto venoso. Conclusión: La DMV como tratamiento de la NT es un procedimiento efectivo y seguro. El hallazgo intraoperatorio de una “compresión” venosa podría indicar una evolución postoperatoria desfavorable. PMID:25379343

Gamma knife radiosurgery for typical trigeminal neuralgia: An institutional review of 108 patients

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Elaimy, Ameer L.; Lamm, Andrew F.; Demakas, John J.; Mackay, Alexander R.; Lamoreaux, Wayne T.; Fairbanks, Robert K.; Pfeffer, Robert D.; Cooke, Barton S.; Peressini, Benjamin J.; Lee, Christopher M.

2013-01-01

Background: In this study, we present the previously unreported pain relief outcomes of 108 patients treated at Gamma Knife of Spokane for typical trigeminal neuralgia (TN) between 2002 and 2011. Methods: Pain relief outcomes were measured using the Barrow Neurological Institute (BNI) pain intensity scale. In addition, the effects gender, age at treatment, pain laterality, previous surgical treatment, repeat Gamma Knife radiosurgery (GKRS), and maximum radiosurgery dose have on patient pain relief outcomes were retrospectively analyzed. Statistical analysis was performed using Andersen 95% confidence intervals, approximate confidence intervals for log hazard ratios, and multivariate Cox proportional hazard models. Results: All 108 patients included in this study were grouped into BNI class IV or V prior to GKRS. The median clinical follow-up time was determined to be 15 months. Following the first GKRS procedure, 71% of patients were grouped into BNI class I-IIIb (I = 31%; II = 3%; IIIa = 19%; IIIb = 18%) and the median duration of pain relief for those patients was determined to be 11.8 months. New facial numbness was reported in 19% of patients and new facial paresthesias were reported in 7% of patients after the first GKRS procedure. A total of 19 repeat procedures were performed on the 108 patients included in this study. Following the second GKRS procedure, 73% of patients were grouped into BNI class I-IIIb (I = 44%; II = 6%; IIIa = 17%, IIIb = 6%) and the median duration of pain relief for those patients was determined to be 4.9 months. For repeat procedures, new facial numbness was reported in 22% of patients and new facial paresthesias were reported in 6% of patients. Conclusions: GKRS is a safe and effective management approach for patients diagnosed with typical TN. However, further studies and supporting research is needed on the effects previous surgical treatment, number of radiosurgery procedures, and maximum radiosurgery dose have on GKRS clinical

Para-Hermitian and para-quaternionic manifolds

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Ivanov, S.; Zamkovoy, S.

2003-10-01

A set of canonical para-Hermitian connections on an almost para-Hermitian manifold is defined. A Para-hermitian version of the Apostolov-Gauduchon generalization of the Goldberg-Sachs theorem in General Relativity is given. It is proved that the Nijenhuis tensor of a Nearly para-Kaehler manifolds is parallel with respect to the canonical connection. Salamon's twistor construction on quaternionic manifold is adapted to the para-quaternionic case. A locally conformally hyper-para-Kaehler (hypersymplectic) flat structure with parallel Lee form on the Kodaira-Thurston complex surfaces modeled on S 1 x SL (2, R)-tilde is constructed. Anti-self-dual locally conformally hyper-para-Kaehler (hypersymplectic) neutral metrics with non vanishing Weyl tensor are obtained on the Inoe surfaces. An example of anti-self-dual neutral metric which is not locally conformally hyper-para-Kaehler (hypersymplectic) is constructed. (author)

Para-Hermitian and para-quaternionic manifolds

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Ivanov, S [University of Sofia ' St. Kl. Ohridski' , Faculty of Mathematics and Informatics, Sofia (Bulgaria) and Abdus Salam International Centre for Theoretical Physics, Trieste (Italy); Zamkovoy, S [University of Sofia ' St. Kl. Ohridski' , Faculty of Mathematics and Informatics, Sofia (Bulgaria)

2003-10-01

A set of canonical para-Hermitian connections on an almost para-Hermitian manifold is defined. A Para-hermitian version of the Apostolov-Gauduchon generalization of the Goldberg-Sachs theorem in General Relativity is given. It is proved that the Nijenhuis tensor of a Nearly para-Kaehler manifolds is parallel with respect to the canonical connection. Salamon's twistor construction on quaternionic manifold is adapted to the para-quaternionic case. A locally conformally hyper-para-Kaehler (hypersymplectic) flat structure with parallel Lee form on the Kodaira-Thurston complex surfaces modeled on S{sup 1} x SL (2, R)-tilde is constructed. Anti-self-dual locally conformally hyper-para-Kaehler (hypersymplectic) neutral metrics with non vanishing Weyl tensor are obtained on the Inoe surfaces. An example of anti-self-dual neutral metric which is not locally conformally hyper-para-Kaehler (hypersymplectic) is constructed. (author)

Clinical study of patients with persistent orofacial pain Estudo clínico de pacientes com dor orofacial persistente

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José Tadeu Tesseroli de Siqueira

2004-12-01

Full Text Available OBJETIVE: To evaluate a sample of patients with persistent facial pain unresponsive to prior treatments. METHODS: Hospital records of 26 patients with persistent facial pain were reviewed (20 female and 6 male. RESULTS: Patients were classified into three groups according to their presenting symptoms: aGroup I, eight patients (30.7% with severe, diffuse pain at the face, teeth or head; bGroup II, eight patients (30.7% with chronic non-myofascial pain and; cGroup III, ten patients with chronic myofascial pain (38.4%. We find 11 different diagnoses among the 26 patients: pulpitis(7, leukemia(1, oropharyngeal tumor(1, atypical odontalgia(1, Eagle's syndrome(1, trigeminal neuralgia(4, continuous neuralgia(1, temporomandibular disorders (9, fibromyalgia (2, tension-type headache(1, conversion hysteria(2. After the treatment program all patients had a six-month follow-up period with pain relief, except the patient with tumor. CONCLUSION: The wide variability of orofacial pain diagnosis (benign to life-threatening diseases indicates the necessity to reevaluate patients presenting recurrent pain that is refractory to the usual treatments.OBJETIVO: Avaliar uma amostra de doentes com dor facial persistente. MÉTODO: Foram revisados 26 prontuários de doentes com dor facial persistente (20 mulheres e 6 homens. RESULTADOS: Classificação dos doentes, após o diagnóstico: aGrupo I, oito pacientes (30,7% com dor facial difusa de fortíssima intensidade; bGrupo II, oito pacientes (30,7% com dor crônica de natureza não-miofascial e; cGrupo III, dez pacientes com dor crônica miofascial (38,4%. Foram encontrados 11 diagnósticos diferentes entre os 26 pacientes: pulpites(7, leucemia(1, tumor de orofaringe(1, odontalgia atípica(1, síndrome de Eagle(1, neuralgia idiopática do trigêmeo(4, neuralgia atípica(1, disordens temporomandibular (9, fibromialgia(2 cefaléia tipo-tensão(1, histeria de conversão(2. O acompanhamento dos doentes, após receberem a

Sensory abnormalities and masticatory function after microvascular decompression or balloon compression for trigeminal neuralgia compared with carbamazepine and healthy controls.

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Ichida, Michelle Cristina; de Almeida, Antonio Nogueira; da Nobrega, Jose Claudio Marinho; Teixeira, Manoel Jacobsen; de Siqueira, José Tadeu Tesseroli; de Siqueira, Silvia R D T

2015-06-01

Idiopathic trigeminal neuralgia (iTN) is a neurological condition treated with pharmacotherapy or neurosurgery. There is a lack of comparative papers regarding the outcomes of neurosurgery in patients with iTN. The objective of this study was to investigate sensory thresholds and masticatory function in 78 patients with iTN who underwent microvascular decompression (MVD) or balloon compression (BC), and compare these treatments with carbamazepine and 30 untreated healthy controls. The authors conducted a case-controlled longitudinal study. Patients were referred to 1 of 3 groups: MVD, BC, or carbamazepine. All patients were evaluated before and after treatment with a systematic protocol composed of a clinical orofacial questionnaire, Research Diagnostic Criteria for temporomandibular disorders, Helkimo indices, and a quantitative sensory-testing protocol (gustative, olfactory, cold, warm, touch, vibration, superficial, and deep pain thresholds). Both MVD and BC were effective at reducing pain intensity (p = 0.012) and carbamazepine doses (p sweet (p = 0.014) and salty (p = 0.003) thresholds. The sour threshold decreased (p = 0.003) and cold and warm thresholds increased (p sensorial and motor deficits after BC need to be included as targets directly associated with the success of the surgery and need to be assessed and relieved as goals in the treatment of iTN.

Approach-related morbidity in transthoracic anterior spine surgery: a clinical study and review of literature Morbilidad relacionada con el abordaje torácico anterior de la columna: estudio clínico y revisión de la literatura Morbidade relacionada à abordagem transtorácica anterior da coluna: estudo clínico e revisão da literatura

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Juliane Zenner

2010-03-01

presente estudio fue observar los resultados relacionados con la morbilidad de la toracotomía abierta para la corrección de la deformidad de la columna vertebral y toracotomía para la colocación de tubo de drenaje torácica, utilizando ese grupo como Control. MÉTODOS: con base en un cuestionario respondido por los pacientes; y relacionado con la evaluación de la morbilidad del abordaje anterior de la columna torácica y utilizando criterios estrictos de inclusión de los pacientes, fueron evaluados 43 pacientes sometidos a toracotomía abierta para tratamiento de la escoliosis; y 30 pacientes portadores de otras enfermedades de menor gravedad, que fueron sometidos a la toracotomía para la colocación de dreno de tórax después del procedimiento. RESULTADOS: el promedio de edad de los pacientes sometidos al procedimiento en el tórax y a la toracotomía para la colocación de dreno o toracotomía abierta para tratamiento de escoliosis fue, respectivamente: 50.2 años y 16.5 años; el seguimiento clínico fue de 32.2 meses y 54.8 meses; y la extensión de la incisión de la piel 2.5 cm y 25 cm. El promedio del número de vértebras artrosadas fue 5.8 en el grupo sometido a la toracotomía abierta para la corrección de deformidad. La morbilidad promedio (variando de 0% - ninguna morbilidad a 100% - alta morbilidad en el grupo de pacientes sometidos a la toracotomía para colocación de dreno de tórax fue de 10.8±15.4 (0-59.5%, y un 42% de los pacientes no presentaron morbilidad. En el grupo sometido a la toracotomía abierta para la colocación del dreno de tórax fue observada neuralgia intercostal en 16.7%, y 35% de los pacientes presentaron morbilidad mayor que 10% (pormedio de un 27.5%. La morbilidad fue definida como la presencia de dolor crónico después de la toracotomía. En el grupo sometido a la toracotomía abierta para tratamiento de escoliosis el promedio de la morbilidad fue 7.0±12.7% (0-52.1%, y 44% no presentaron morbilidad. Señales de neuralgia

Effect of duration of postherpetic neuralgia on efficacy analyses in a multicenter, randomized, controlled study of NGX-4010, an 8% capsaicin patch evaluated for the treatment of postherpetic neuralgia

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Rauck Richard

2010-10-01

Full Text Available Abstract Background Postherpetic neuralgia (PHN is a painful and difficult to treat complication of acute herpes zoster. Current treatment options provide only partial relief and are often limited by poor tolerability. We evaluated the safety and efficacy of a single 60-minute application of NGX-4010, an 8% capsaicin patch, in patients with PHN. Methods This multicenter, double-blind, controlled study randomized 155 patients 2:1 to receive either NGX-4010 or a 0.04% capsaicin control patch. Patients were at least 18 years old with PHN for at least 3 months, and an average Numeric Pain Rating Scale (NPRS score of 3 to 9. The primary efficacy endpoint was the percentage change in NPRS score from baseline to weeks 2-8. Results The mean percent reduction in "average pain for the past 24 hours" NPRS scores from baseline to weeks 2-8 was greater in the NGX-4010 group (36.5% compared with control (29.9% although the difference was not significant (p = 0.296. PGIC analysis demonstrated that more NGX-4010 recipients considered themselves improved (much, or very much compared with control at weeks 8 and 12, but the differences did not reach statistical significance. Post hoc analyses of patients with PHN for at least 6 months showed significantly greater reductions in "average pain for the past 24 hours" NPRS scores from baseline to weeks 2-8 in NGX-4010 patients compared to controls (37.6% versus 23.4%; p = 0.0291. PGIC analysis in this subgroup demonstrated that significantly more NGX-4010 recipients considered themselves much or very much improved compared with control at week 12 (40% versus 20%; p = 0.0403;. Conclusions Although treatment appeared to be safe and well tolerated, a single 60-minute application of NGX-4010 failed to show efficacy in this study which included patients with PHN for less than 6 months. Large reductions in pain observed among control patients with pain for less than 6 months may have been due to spontaneous resolution of PHN

Combination of low frequency electroacupuncture plus subdissociative doses of ketamine in post-herpetic neuralgia patients. A pilot study

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Bárbara B. Garrido-Suárez

2017-11-01

Full Text Available Context: Pain processing implicates multiple concurrent mechanisms of nociceptive transmission and modulation. Electroacupuncture (EA analgesia involves mainly the activation of the endogenous anti-nociceptive systems that modulate pain transmission in addition to the regulation of glial activity and inhibition of pro-inflammatory cytokines in the spinal cord. Aims: To examine the potential anti-hyperalgesic effects the EA and the combination EA-ketamine in patients with post-herpetic neuralgia (PHN. Methods: Sixty-eight patients with PHN irritable nociceptor type were randomly allocated to 3 groups: group I (n=26, that received treatment with EA (10 Hz, 2-3 mA, 0.5 ms, 20 min/15 sessions alone, group II (n=21 with a combination EA-ketamine (0.25-0.5 mg/kg, i.m. or group III (n=21 with sham EA-ketamine for 15 days. The average daily pain score (ADPS using the Likert scale, area and rate of dynamic allodynia, the rate of thermal allodynia, and frequency of intermittent lancinating pain were evaluated during five visits – before treatment and at 15, 30, 60, 90 days. Results: ADPS and sensory abnormalities decreased significantly concerning baseline data at 90 days in the three groups, but patients treated with the combination EA-ketamine significantly improved compared with the other groups. Conclusions: These results suggest that the combination EA-ketamine shows an early and long-term anti-hyperalgesic effect in PHN patients. However, a controlled clinical trial is necessary to confirm this hypothesis.

Patterns of neurovascular compression in patients with classic trigeminal neuralgia: A high-resolution MRI-based study

International Nuclear Information System (INIS)

Lorenzoni, José; David, Philippe; Levivier, Marc

2012-01-01

Purpose: To describe the anatomical characteristics and patterns of neurovascular compression in patients suffering classic trigeminal neuralgia (CTN), using high-resolution magnetic resonance imaging (MRI). Materials and methods: The analysis of the anatomy of the trigeminal nerve, brain stem and the vascular structures related to this nerve was made in 100 consecutive patients treated with a Gamma Knife radiosurgery for CTN between December 1999 and September 2004. MRI studies (T1, T1 enhanced and T2-SPIR) with axial, coronal and sagital simultaneous visualization were dynamically assessed using the software GammaPlan™. Three-dimensional reconstructions were also developed in some representative cases. Results: In 93 patients (93%), there were one or several vascular structures in contact, either, with the trigeminal nerve, or close to its origin in the pons. The superior cerebellar artery was involved in 71 cases (76%). Other vessels identified were the antero-inferior cerebellar artery, the basilar artery, the vertebral artery, and some venous structures. Vascular compression was found anywhere along the trigeminal nerve. The mean distance between the nerve compression and the origin of the nerve in the brainstem was 3.76 ± 2.9 mm (range 0–9.8 mm). In 39 patients (42%), the vascular compression was located proximally and in 42 (45%) the compression was located distally. Nerve dislocation or distortion by the vessel was observed in 30 cases (32%). Conclusions: The findings of this study are similar to those reported in surgical and autopsy series. This non-invasive MRI-based approach could be useful for diagnostic and therapeutic decisions in CTN, and it could help to understand its pathogenesis.

Microstructural abnormalities in the trigeminal nerves of patients with trigeminal neuralgia revealed by multiple diffusion metrics

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Liu, Yaou [Department of Radiology, Xuanwu Hospital, Capital Medical University, Beijing 100053 (China); Beijing Key laboratory of MRI and Brain Informatics, Beijing (China); Li, Jiping [Department of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing 100053 (China); Butzkueven, Helmut [Department of Medicine, University of Melbourne, Parkville 3010 (Australia); Duan, Yunyun; Zhang, Mo [Department of Radiology, Xuanwu Hospital, Capital Medical University, Beijing 100053 (China); Shu, Ni [State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing 100875 (China); Li, Yongjie [Department of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing 100053 (China); Zhang, Yuqing, E-mail: yuqzhang@sohu.com [Department of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing 100053 (China); Li, Kuncheng, E-mail: kunchengli55@gmail.com [Department of Radiology, Xuanwu Hospital, Capital Medical University, Beijing 100053 (China)

2013-05-15

Objective: To investigate microstructural tissue changes of trigeminal nerve (TGN) in patients with unilateral trigeminal neuralgia (TN) by multiple diffusion metrics, and correlate the diffusion indexes with the clinical variables. Methods: 16 patients with TN and 6 healthy controls (HC) were recruited into our study. All participants were imaged with a 3.0 T system with three-dimension time-of-flight (TOF) magnetic resonance angiography and fluid attenuated inversion recovery (FLAIR) DTI-sequence. We placed regions of interest over the root entry zone of the TGN and measured fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD) and radial diffusivity (RD). The mean values of FA, MD, AD and RD were compared between the affected and unaffected sides in the same patient, and to HC values. The correlation between the side-to-side diffusion metric difference and clinical variables (disease duration and visual analogy scale, VAS) was further explored. Results: Compared with the unaffected side and HC, the affected side showed significantly decreased FA and increased RD; however, no significant changes of AD were found. A trend toward significantly increased MD was identified on the affected side comparing with the unaffected side. We also found the significant correlation between the FA reduction and VAS of pain (r = −0.55, p = 0.03). Conclusion: DTI can quantitatively assess the microstructural abnormalities of the affected TGN in patients with TN. Our results suggest demyelination without significant axonal injury is the essential pathological basis of the affected TGN by multiple diffusion metrics. The correlation between FA reduction and VAS suggests FA as a potential objective MRI biomarker to correlate with clinical severity.

Microstructural abnormalities in the trigeminal nerves of patients with trigeminal neuralgia revealed by multiple diffusion metrics

International Nuclear Information System (INIS)

Liu, Yaou; Li, Jiping; Butzkueven, Helmut; Duan, Yunyun; Zhang, Mo; Shu, Ni; Li, Yongjie; Zhang, Yuqing; Li, Kuncheng

2013-01-01

Objective: To investigate microstructural tissue changes of trigeminal nerve (TGN) in patients with unilateral trigeminal neuralgia (TN) by multiple diffusion metrics, and correlate the diffusion indexes with the clinical variables. Methods: 16 patients with TN and 6 healthy controls (HC) were recruited into our study. All participants were imaged with a 3.0 T system with three-dimension time-of-flight (TOF) magnetic resonance angiography and fluid attenuated inversion recovery (FLAIR) DTI-sequence. We placed regions of interest over the root entry zone of the TGN and measured fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD) and radial diffusivity (RD). The mean values of FA, MD, AD and RD were compared between the affected and unaffected sides in the same patient, and to HC values. The correlation between the side-to-side diffusion metric difference and clinical variables (disease duration and visual analogy scale, VAS) was further explored. Results: Compared with the unaffected side and HC, the affected side showed significantly decreased FA and increased RD; however, no significant changes of AD were found. A trend toward significantly increased MD was identified on the affected side comparing with the unaffected side. We also found the significant correlation between the FA reduction and VAS of pain (r = −0.55, p = 0.03). Conclusion: DTI can quantitatively assess the microstructural abnormalities of the affected TGN in patients with TN. Our results suggest demyelination without significant axonal injury is the essential pathological basis of the affected TGN by multiple diffusion metrics. The correlation between FA reduction and VAS suggests FA as a potential objective MRI biomarker to correlate with clinical severity

Complex regional pain syndrome (CRPS) impairs visuospatial perception,whereas post-herpetic neuralgia does not: possible implications for supraspinal mechanism of CRPS.

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Uematsu, Hironobu; Sumitani, Masahiko; Yozu, Arito; Otake, Yuko; Shibata, Masahiko; Mashimo, Takashi; Miyauchi, Satoru

2009-11-01

Complex regional pain syndrome (CRPS) patients show impaired visuospatial perception in the dark, as compared to normal patients with acute nociceptive pain. The purpose of this study is 2-fold: (i) to ascertain whether this distorted visuospatial perception is related to the chronicity of pain, and (ii) to analyse visuospatial perception of CRPS in comparison with another neuropathic pain condition. We evaluated visual subjective body-midline (vSM) representation in 27 patients with post-herpetic neuralgia (PHN) and 22 with CRPS under light and dark conditions. A red laser dot was projected onto a screen and moved horizontally towards the sagittal plane of the objective body-midline (OM). Each participant was asked to direct the dot to a position where it crossed their vSM. The distance between the vSM and OM was analysed to determine how and in which direction the vSM deviated. Under light condition, all vSM judgments approximately matched the OM. However, in the dark, CRPS patients, but not PHN patients, showed a shifted vSM towards the affected side. We demonstrated that chronic pain does not always impair visuospatial perception. The aetiology of PHN is limited to the peripheral nervous system, whereas the distorted visuospatial perception suggests a supraspinal aetiology of CRPS.

Herpes zoster chronification to postherpetic neuralgia induces brain activity and grey matter volume change

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Cao, Song; Qin, Bangyong; Zhang, Yi; Yuan, Jie; Fu, Bao; Xie, Peng; Song, Ganjun; Li, Ying; Yu, Tian

2018-01-01

Objective: Herpes zoster (HZ) can develop into postherpetic neuralgia (PHN), which is a chronic neuropathic pain (NP). Whether the chronification from HZ to PHN induced brain functional or structural change is unknown and no study compared the changes of the same brains of patients who transited from HZ to PHN. We minimized individual differences and observed whether the chronification of HZ to PHN induces functional and pain duration dependent grey matter volume (GMV) change in HZ-PHN patients. Methods: To minimize individual differences induced error, we enrolled 12 patients with a transition from HZ to PHN. The functional and structural changes of their brains between the two states were identified with resting-state functional MRI (rs-fMRI) technique (i.e., the regional homogeneity (ReHo) and fractional aptitude of low-frequency fluctuation (fALFF) method) and the voxel based morphometry (VBM) technology respectively. The correlations between MRI parameters (i.e., ΔReHo, ΔfALFF and ΔVBM) and Δpain duration were analyzed too. Results: Compared with HZ brains, PHN brains exhibited abnormal ReHo, fALFF and VBM values in pain matrix (the frontal lobe, parietal lobe, thalamus, limbic lobe and cerebellum) as well as the occipital lobe and temporal lobe. Nevertheless, the activity of vast area of cerebellum and frontal lobe significantly increased while that of occipital lobe and limbic lobe showed apparent decrease when HZ developed to PHN. In addition, PHN brain showed decreased GMV in the frontal lobe, the parietal lobe and the occipital lobe but increased in the cerebellum and the temporal lobe. Correlation analyses showed that some of the ReHo, fALFF and VBM differential areas (such as the cerebellum posterior lobe, the thalamus extra-nuclear and the middle temporal gyrus) correlated well with Δpain duration. Conclusions: HZ chronification induced functional and structural change in cerebellum, occipital lobe, temporal lobe, parietal lobe and limbic lobe

Obturator Neuromodulation with Laparoscopic Placement of an Obturator Lead for the Treatment of Intractable Opioid Dependent Chronic Pelvic Pain due to Obturator Neuralgia.

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Marvel, Richard P

2018-05-12

Chronic pelvic pain(CPP) is a common condition in women that can have a devastating effect on quality of life. Some of the most severe forms of CPP are related to peripheral nerve injuries causing persistent neuropathic pain. This is a case of a young woman with severe opioid dependent chronic pelvic and right groin pain due to obturator neuralgia. She had failed a multitude of treatments including multiple medications, manual physical therapy, nerve blocks, surgical neurolysis and spinal cord stimulation without significant benefit. She underwent a trial of peripheral neuromodulation of the obturator nerve with laparoscopic placement of a quadripolar lead. During the 6-day trial she had almost complete relief of her pain; therefore, she underwent permanent implantation of an intermittent pulse generator. Over the next 6 months she was completely weaned completely off her chronic opioids. At 23 months post implantation, she had essentially no pain and is no longer on any analgesic, antidepressant or membrane stabilizing medications. Peripheral Neuromodulation has the potential to alleviate pain and significantly improve quality of life in women with longstanding neuropathic chronic pelvic pain who have failed multimodal conservative therapy. Copyright © 2018. Published by Elsevier Inc.

Spatial–temporal signature of resting-state BOLD signals in classic trigeminal neuralgia

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Wang Y

2017-12-01

Full Text Available Yanping Wang,1 Congying Xu,1 Liping Zhai,1 Xudong Lu,1 Xiaoqiang Wu,1 Yahui Yi,2 Ziyun Liu,1 Qiaobing Guan,1 Xiaoling Zhang1 1Department of Neurology, the Second Hospital of Jiaxing City, Jiaxing, Zhejiang, 2Department of Radiology, the Second Hospital of Jiaxing City, Jiaxing, Zhejiang, China Abstract: Resting-state functional magnetic resonance imaging (R-fMRI signals are spatiotemporally organized. R-fMRI studies in patients with classic trigeminal neuralgia (CTN have suggested alterations in functional connectivity. However, far less attention has been given to investigations of the local oscillations and their frequency-specific changes in these patients. The objective of this study was to address this issue in patients with CTN. R-fMRI data from 17 patients with CTN and 19 age- and gender-matched healthy controls (HCs were analyzed using amplitude of low-frequency fluctuation (ALFF. The ALFF was computed across different frequencies (slow-4: 0.027–0.073 Hz; slow-5: 0.01–0.027 Hz; and typical band: 0.01–0.08 Hz in patients with CTN compared to HCs. In the typical band, patients with CTN showed increases of ALFF in bilateral temporal, occipital, and left middle frontal regions and in the left middle cingulate gyrus, as well as decreases of ALFF in the right inferior temporal region and in regions (medial prefrontal regions of default mode network. These significant group differences were identified in different sub-bands, with greater brainstem findings in higher frequencies (slow-4 and extensive default mode network and right postparietal results in lower frequencies (slow-5. Furthermore, significant relationships were found between subjective pain ratings and both amplitudes of higher frequency (slow-4 blood oxygen level-dependent (BOLD signals in pain localization brain regions and lower frequencies (slow-5 in pain signaling/modulating brain regions in the patients, and decreased ALFF within the prefrontal regions was significantly

Identification of offending vessele in trigeminal neuralgia and hemifacial spasm using SPGR-MRI and 3D-TOF-MRA

International Nuclear Information System (INIS)

Niwa, Yoshikazu; Shiotani, Masahiro; Karasawa, Hidetake; Ohseto, Kiyoshige; Naganuma, Yoshikazu

1996-01-01

We investigated 100 consecutive patients with trigeminal neuralgia (TN) and 53 patients with hemifacial spasm (HFS) concerning the anatomical relationship between the root entry (exit) zone (REZ) of cranial nerve and the offending artery, using spoiled GRASS MRI (SPGR-MRI) and three dimensional-time of fly-MRA (MRA). In 67 of 100 (67%) patients with TN, this new radiological method, SPGR-MRI and MRA demonstrated the relationship between the fifth cranial nerve root and offending artery causing neurovascular compression (NVC), and in 46 of 53 (87%) with HFS, demonstrated the similar relationship between seventh and eighth nerve complex and offending artery. Microvascular decompression (MVD) was performed in 10 with HFS, and NVC of the REZ of the facial nerve caused by the offending artery was exactly predicted by SPGR-MRI and MRA in 9 (90%). The combination of SPGR-MRI and MRA is very useful for demonstrating NVC as the cause of TN and HFS. On the other hand, we investigated asymptomatic 206 trigemimal and 253 facial nerves about the relationship between their REZ and the surrounding structures using the similar method. The contact of REZ of cranial nerve with surrounding artery is demonstrated in 31.6% of trigeminal nerves and in 22.5% of facial nerves. These results indicate that the contact of REZ of cranial nerve with surrounding artery is not rare in healthy subjects, though causing TN and HFS in particular patients. In this context, we discussed the difference between the contact which is asymptomatic and the compression which is symptomatic. (author)

Prospective comparison of long-term pain relief rates after first-time microvascular decompression and stereotactic radiosurgery for trigeminal neuralgia.

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Wang, Doris D; Raygor, Kunal P; Cage, Tene A; Ward, Mariann M; Westcott, Sarah; Barbaro, Nicholas M; Chang, Edward F

2018-01-01

OBJECTIVE Common surgical treatments for trigeminal neuralgia (TN) include microvascular decompression (MVD), stereotactic radiosurgery (SRS), and radiofrequency ablation (RFA). Although the efficacy of each procedure has been described, few studies have directly compared these treatment modalities on pain control for TN. Using a large prospective longitudinal database, the authors aimed to 1) directly compare long-term pain control rates for first-time surgical treatments for idiopathic TN, and 2) identify predictors of pain control. METHODS The authors reviewed a prospectively collected database for all patients who underwent treatment for TN between 1997 and 2014 at the University of California, San Francisco. Standardized collection of data on preoperative clinical characteristics, surgical procedure, and postoperative outcomes was performed. Data analyses were limited to those patients who received a first-time procedure for treatment of idiopathic TN with > 1 year of follow-up. RESULTS Of 764 surgical procedures performed at the University of California, San Francisco, for TN (364 SRS, 316 MVD, and 84 RFA), 340 patients underwent first-time treatment for idiopathic TN (164 MVD, 168 SRS, and 8 RFA) and had > 1 year of follow-up. The analysis was restricted to patients who underwent MVD or SRS. Patients who received MVD were younger than those who underwent SRS (median age 63 vs 72 years, respectively; p 5 years of follow-up (60 of 164 and 64 of 168 patients, respectively). Immediate or short-term (making depends upon many factors. This information can help physicians counsel patients with idiopathic TN on treatment selection.

Measuring the burden of herpes zoster and post herpetic neuralgia within primary care in rural Crete, Greece

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Lionis Christos D

2011-12-01

Full Text Available Abstract Background Research has indicated that general practitioners (GPs have good clinical judgment in regards to diagnosing and managing herpes zoster (HZ within clinical practice in a country with limited resources for primary care and general practice. The objective of the current study was to assess the burden of HZ and post herpetic neuralgia (PHN within rural general practices in Crete, Greece. Methods The current study took place within a rural setting in Crete, Greece during the period of November 2007 to November 2009 within the catchment area in which the Cretan Rural Practice-based Research Network is operating. In total 19 GP's from 14 health care units in rural Crete were invited to participate, covering a total turnover patient population of approximately 25, 000 subjects. For the purpose of this study an electronic record database was constructed and used as the main tool for monitoring HZ and PHN incidence. Stress related data was also collected with the use of the Short Anxiety Screening Test (SAST. Results The crude incidence rate of HZ was 1.4/1000 patients/year throughout the entire network of health centers and satellite practices, while among satellite practices alone it was calculated at 1.3/1000 patients/year. Additionally, the standardised incidence density within satellite practices was calculated at 1.6/1000 patients/year. In regards to the stress associated with HZ and PHN, the latter were found to have lower levels of anxiety, as assessed through the SAST score (17.4 ± 3.9 vs. 21.1 ± 5.7; p = 0.029. Conclusions The implementation of an electronic surveillance system was feasible so as to measure the burden of HZ and PHN within the rural general practice setting in Crete.

Sphenopalatine ganglion treatment with radiofrequency in a Sluder syndrome young patient

OpenAIRE

Carmelo Costa; Marilina Schembari

2014-01-01

Sluder's neuralgia or sphenopalatine ganglion neuralgia is a pain syndrome first described by Sluder in 1908. The clinical picture is characterised by pain starting around the eye and the route of nose. Typically the pain is accompanied by parasympathetic disautonomic signs such as lacrimation and/or rhinorrhea. However, many official headache classifications do not mention the Sluder's neuralgia at all, which is instead classified as a cluster headache (CH). In case of resistance to pharmaco...

Sphenopalatine ganglion treatment with radiofrequency in a Sluder syndrome young patient

Directory of Open Access Journals (Sweden)

Carmelo Costa

2014-12-01

Full Text Available Sluder's neuralgia or sphenopalatine ganglion neuralgia is a pain syndrome first described by Sluder in 1908. The clinical picture is characterised by pain starting around the eye and the route of nose. Typically the pain is accompanied by parasympathetic disautonomic signs such as lacrimation and/or rhinorrhea. However, many official headache classifications do not mention the Sluder's neuralgia at all, which is instead classified as a cluster headache (CH. In case of resistance to pharmacological management pain the physician could recur to sphenopalatine ganglion (GSP neurolytic block with continuous radiofrequency (CRF or its no ablative alternative with pulsed radiofrequency (PRF. We are presenting a case of a 16-year-old woman who suffered from a typical Sluder's neuralgia successfully treated with GSP PRF.

Evolução favorável de recidiva de infecção por varicela zoster (cobreiro durante uso de natalizumabe em paciente com esclerose múltipla: relato de caso

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Diego Rafhael Soares Carvalho Feitosa

2017-04-01

Full Text Available Objetivo: Relatar o caso de recidiva de herpes-zoster (HZ em paciente com esclerose múltipla (EM em uso de tratamento imunomodulador (natalizumabe com evolução favorável. Descrição de caso: Mulher de 39 anos com diagnóstico de EM há 1 ano e 6 meses, previamente tratada com interferon 1a, começou tratamento com natalizumabe, desenvolvendo HZ após três meses de tratamento. HZ foi tratado com aciclovir, por sete dias, via oral. Seguimento ambulatorial após três meses de tratamento mostrou resolução completa das lesões, sem desencadeamento de neuralgia pós-herpética. Conclusões: As novas terapias para a EM podem estar relacionadas a diferentes tipos de efeitos adversos. Nem todos os casos de HZ, associados com novas terapias para EM, evoluem de forma desfavorável. Estudos são necessários para reconhecer os fatores de riscos para as formas graves de HZ em tais pacientes.

[Data mining analysis of professor Li Fa-zhi AIDS herpes zoster medical record].

Science.gov (United States)

Wang, Dan-Ni; Li, Zhen; Xu, Li-Ran; Guo, Hui-Jun

2013-08-01

Analysis of professor Li Fa-zhi in the treatment of AIDS drug laws of herpes zoster and postherpetic neuralgia, provide reference for the use of Chinese medicine treatment of AIDS, herpes zoster and postherpetic neuralgia. By using the method of analyzing the complex network of Weishi county, Henan in 2007 October to 2011 July during an interview with professor Li Fa-zhi treatment of AIDS of herpes zoster and postherpetic neuralgia patients, patients are input structured clinical information collection system, into the analysis of the data, carries on the research analysis theory of traditional Chinese medicine compatibility system algorithm and complex network analysis the use of complex networks. The use of multi-dimensional query analysis of AIDS drugs, the core of herpes zoster and postherpetic neuralgia treated in this study are Scutellariae Radix, Glucyrrhizae Radix, Carthame Flos, Plantaginis Semen, Trichosamthis Fructus, Angelicae Sinensis Radix, Gentianae Radix; core prescription for Longdan Xiegan decoction and Trichosanthes red liquorice decoction. Professor Li Fa-zhi treatment of AIDS, herpes zoster and postherpetic neuralgia by clearing heat and removing dampness and activating blood circulation to.

Simultaneous display of MRA and MPR in detecting vascular compression for trigeminal neuralgia or hemifacial spasm: comparison with oblique sagittal views of MRI

International Nuclear Information System (INIS)

Arbab, A.S.; Aoki, S.; Yoshikawa, T.; Kumagai, H.; Araki, T.; Nishiyama, Y.; Nagaseki, Y.; Nukui, H.

2000-01-01

A new technique, simultaneous display of magnetic resonance angiography (MRA) and multiplanar reconstruction (MPR), was performed by a workstation to identify the involved vessels in patients with trigeminal neuralgia (TN) or hemifacial spasm (HFS), and the results were compared with those of oblique sagittal MRI technique. Twelve patients with either HFS or TN were prospectively assessed by simultaneous display of MRA and MPR, and oblique sagittal techniques, to point out the neurovascular compression and to identify the involved vessels. Three-dimensional (3D) time-of-flight (TOF) spoiled gradient-echo (SPGR) images were acquired to create MRA and MPR. Oblique sagittal views were also created and displayed on films. A total of 15 vessels in 12 patients were identified as compressing vessels during surgery. Simultaneous display of MRA and MPR technique pointed out the presence of vessels at and/or around root entry/exit zone (REZ) in all 12 patients, but proper identification by the name of the individual vessel was correct in 13 of 15 cases. However, oblique sagittal technique indicated the presence of vessels at and/or around REZ in 11 patients, but only 8 of 14 vessels were correctly identified. Our new method, simultaneous display of MRA-MPR, facilitated correct identification of the involved vessels compared with the oblique sagittal view method. (orig.)

Serie: Madera para construcción Acabados para madera

OpenAIRE

Sáenz-Muñoz, Marta; Instituto Tecnológico de Costa Rica

2012-01-01

Durante mucho tiempo, la madera ha sido utilizada como material de construcción para resolver principalmente objetivos estructurales; sin embargo, actualmente, el uso de la madera ha tomado mucho auge en la estética de las construcciones, para brindar apariencia y calidez. En la actualidad, el mercado ofrece una amplia gama productos para dar diversos “acabados” a la madera, los cuales sirven para resaltar la belleza de algunas de ellas, realzar características como el color y la veta, o bien...

Trigeminal Neuralgia Treated With Stereotactic Radiosurgery: The Effect of Dose Escalation on Pain Control and Treatment Outcomes

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Kotecha, Rupesh [Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio (United States); Kotecha, Ritesh [MidMichigan Medical Center, Midland, Michigan (United States); Modugula, Sujith [Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio (United States); Murphy, Erin S. [Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio (United States); Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, Ohio (United States); Jones, Mark; Kotecha, Rajesh [MidMichigan Medical Center, Midland, Michigan (United States); Reddy, Chandana A. [Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio (United States); Suh, John H. [Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio (United States); Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, Ohio (United States); Barnett, Gene H. [Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, Ohio (United States); Department of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland, Ohio (United States); Neyman, Gennady [Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio (United States); Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, Ohio (United States); Machado, Andre; Nagel, Sean [Department of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland, Ohio (United States); Chao, Samuel T., E-mail: chaos@ccf.org [Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio (United States); Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, Ohio (United States)

2016-09-01

Purpose: To analyze the effect of dose escalation on treatment outcome in patients undergoing stereotactic radiosurgery (SRS) for trigeminal neuralgia (TN). Methods and Materials: A retrospective review was performed of 870 patients who underwent SRS for a diagnosis of TN from 2 institutions. Patients were typically treated using a single 4-mm isocenter placed at the trigeminal nerve dorsal root entry zone. Patients were divided into groups based on treatment doses: ≤82 Gy (352 patients), 83 to 86 Gy (85 patients), and ≥90 Gy (433 patients). Pain response was classified using a categorical scoring system, with fair or poor pain control representing treatment failure. Treatment-related facial numbness was classified using the Barrow Neurological Institute scale. Log-rank tests were performed to test differences in time to pain failure or development of facial numbness for patients treated with different doses. Results: Median age at first pain onset was 63 years, median age at time of SRS was 71 years, and median follow-up was 36.5 months from the time of SRS. A majority of patients (827, 95%) were clinically diagnosed with typical TN. The 4-year rate of excellent to good pain relief was 87% (95% confidence interval 84%-90%). The 4-year rate of pain response was 79%, 82%, and 92% in patients treated to ≤82 Gy, 83 to 86 Gy, and ≥90 Gy, respectively. Patients treated to doses ≤82 Gy had an increased risk of pain failure after SRS, compared with patients treated to ≥90 Gy (hazard ratio 2.0, P=.0007). Rates of treatment-related facial numbness were similar among patients treated to doses ≥83 Gy. Nine patients (1%) were diagnosed with anesthesia dolorosa. Conclusions: Dose escalation for TN to doses >82 Gy is associated with an improvement in response to treatment and duration of pain relief. Patients treated at these doses, however, should be counseled about the increased risk of treatment-related facial numbness.

Trigeminal Neuralgia Treated With Stereotactic Radiosurgery: The Effect of Dose Escalation on Pain Control and Treatment Outcomes

International Nuclear Information System (INIS)

Kotecha, Rupesh; Kotecha, Ritesh; Modugula, Sujith; Murphy, Erin S.; Jones, Mark; Kotecha, Rajesh; Reddy, Chandana A.; Suh, John H.; Barnett, Gene H.; Neyman, Gennady; Machado, Andre; Nagel, Sean; Chao, Samuel T.

2016-01-01

Purpose: To analyze the effect of dose escalation on treatment outcome in patients undergoing stereotactic radiosurgery (SRS) for trigeminal neuralgia (TN). Methods and Materials: A retrospective review was performed of 870 patients who underwent SRS for a diagnosis of TN from 2 institutions. Patients were typically treated using a single 4-mm isocenter placed at the trigeminal nerve dorsal root entry zone. Patients were divided into groups based on treatment doses: ≤82 Gy (352 patients), 83 to 86 Gy (85 patients), and ≥90 Gy (433 patients). Pain response was classified using a categorical scoring system, with fair or poor pain control representing treatment failure. Treatment-related facial numbness was classified using the Barrow Neurological Institute scale. Log-rank tests were performed to test differences in time to pain failure or development of facial numbness for patients treated with different doses. Results: Median age at first pain onset was 63 years, median age at time of SRS was 71 years, and median follow-up was 36.5 months from the time of SRS. A majority of patients (827, 95%) were clinically diagnosed with typical TN. The 4-year rate of excellent to good pain relief was 87% (95% confidence interval 84%-90%). The 4-year rate of pain response was 79%, 82%, and 92% in patients treated to ≤82 Gy, 83 to 86 Gy, and ≥90 Gy, respectively. Patients treated to doses ≤82 Gy had an increased risk of pain failure after SRS, compared with patients treated to ≥90 Gy (hazard ratio 2.0, P=.0007). Rates of treatment-related facial numbness were similar among patients treated to doses ≥83 Gy. Nine patients (1%) were diagnosed with anesthesia dolorosa. Conclusions: Dose escalation for TN to doses >82 Gy is associated with an improvement in response to treatment and duration of pain relief. Patients treated at these doses, however, should be counseled about the increased risk of treatment-related facial numbness.

Preoperative assessment of trigeminal neuralgia and hemifacial spasm using constructive interference in steady state-three-dimensional fourier transformation magnetic resonance imaging

Energy Technology Data Exchange (ETDEWEB)

Yamakami, Iwao; Kobayashi, Eiichi; Hirai, Shinji; Yamaura, Akira [Chiba Univ. (Japan). School of Medicine

2000-11-01

Results of microvascular decompression (MVD) for trigeminal neuralgia (TN) and hemifacial spasm (HFS) may be improved by accurate preoperative assessment of neurovascular relationships at the root entry/exit zone (REZ). Constructive interference in steady state (CISS)-three-dimensional Fourier transformation (3DFT) magnetic resonance (MR) imaging was evaluated for visualizing the neurovascular relationships at the REZ. Fourteen patients with TN and eight patients with HFS underwent MR imaging using CISS-3DFT and 3D fast inflow with steady-state precession (FISP) sequences. Axial images of the cerebellopontine angle (CPA) obtained by the two sequences were reviewed to assess the neurovascular relationships at the REZ of the trigeminal and facial nerves. Eleven patients subsequently underwent MVD. Preoperative MR imaging findings were related to surgical observations and results. CISS MR imaging provided excellent contrast between the cranial nerves, small vessels, and cerebrospinal fluid (CSF) in the CPA. CISS was significantly better than FISP for delineating anatomic detail in the CPA (trigeminal and facial nerves, petrosal vein) and abnormal neurovascular relationships responsible for TN and HFS (vascular contact and deformity at the REZ). Preoperative CISS MR imaging demonstrated precisely the neurovascular relationships at the REZ and identified the offending artery in all seven patients with TN undergoing MVD. CISS MR imaging has high resolution and excellent contrast between cranial nerves, small vessels, and CSF, so can precisely and accurately delineate normal and abnormal neurovascular relationships at the REZ in the CPA, and is a valuable preoperative examination for MVD. (author)

Preoperative assessment of trigeminal neuralgia and hemifacial spasm using constructive interference in steady state-three-dimensional fourier transformation magnetic resonance imaging

International Nuclear Information System (INIS)

Yamakami, Iwao; Kobayashi, Eiichi; Hirai, Shinji; Yamaura, Akira

2000-01-01

Results of microvascular decompression (MVD) for trigeminal neuralgia (TN) and hemifacial spasm (HFS) may be improved by accurate preoperative assessment of neurovascular relationships at the root entry/exit zone (REZ). Constructive interference in steady state (CISS)-three-dimensional Fourier transformation (3DFT) magnetic resonance (MR) imaging was evaluated for visualizing the neurovascular relationships at the REZ. Fourteen patients with TN and eight patients with HFS underwent MR imaging using CISS-3DFT and 3D fast inflow with steady-state precession (FISP) sequences. Axial images of the cerebellopontine angle (CPA) obtained by the two sequences were reviewed to assess the neurovascular relationships at the REZ of the trigeminal and facial nerves. Eleven patients subsequently underwent MVD. Preoperative MR imaging findings were related to surgical observations and results. CISS MR imaging provided excellent contrast between the cranial nerves, small vessels, and cerebrospinal fluid (CSF) in the CPA. CISS was significantly better than FISP for delineating anatomic detail in the CPA (trigeminal and facial nerves, petrosal vein) and abnormal neurovascular relationships responsible for TN and HFS (vascular contact and deformity at the REZ). Preoperative CISS MR imaging demonstrated precisely the neurovascular relationships at the REZ and identified the offending artery in all seven patients with TN undergoing MVD. CISS MR imaging has high resolution and excellent contrast between cranial nerves, small vessels, and CSF, so can precisely and accurately delineate normal and abnormal neurovascular relationships at the REZ in the CPA, and is a valuable preoperative examination for MVD. (author)

Randomized, double-blind, comparative-effectiveness study comparing pulsed radiofrequency to steroid injections for occipital neuralgia or migraine with occipital nerve tenderness.

Science.gov (United States)

Cohen, Steven P; Peterlin, B Lee; Fulton, Larry; Neely, Edward T; Kurihara, Connie; Gupta, Anita; Mali, Jimmy; Fu, Diana C; Jacobs, Michael B; Plunkett, Anthony R; Verdun, Aubrey J; Stojanovic, Milan P; Hanling, Steven; Constantinescu, Octav; White, Ronald L; McLean, Brian C; Pasquina, Paul F; Zhao, Zirong

2015-12-01

Occipital neuralgia (ON) is characterized by lancinating pain and tenderness overlying the occipital nerves. Both steroid injections and pulsed radiofrequency (PRF) are used to treat ON, but few clinical trials have evaluated efficacy, and no study has compared treatments. We performed a multicenter, randomized, double-blind, comparative-effectiveness study in 81 participants with ON or migraine with occipital nerve tenderness whose aim was to determine which treatment is superior. Forty-two participants were randomized to receive local anesthetic and saline, and three 120 second cycles of PRF per targeted nerve, and 39 were randomized to receive local anesthetic mixed with deposteroid and 3 rounds of sham PRF. Patients, treating physicians, and evaluators were blinded to interventions. The PRF group experienced a greater reduction in the primary outcome measure, average occipital pain at 6 weeks (mean change from baseline -2.743 ± 2.487 vs -1.377 ± 1.970; P occipital pain through 3 months (mean change from baseline -1.925 ± 3.204 vs -0.541 ± 2.644; P = 0.043), and average overall headache pain through 6 weeks (mean change from baseline -2.738 ± 2.753 vs -1.120 ± 2.1; P = 0.037). Adverse events were similar between groups, and few significant differences were noted for nonpain outcomes. We conclude that although PRF can provide greater pain relief for ON and migraine with occipital nerve tenderness than steroid injections, the superior analgesia may not be accompanied by comparable improvement on other outcome measures.

Men and IC

Science.gov (United States)

... Bowel Syndrome Lupus Pelvic Floor Dysfunction Pudendal Neuralgia Sjogren’s Syndrome Vulvodynia Newly Diagnosed Toolkit IC Awareness Toolkit Know ... Bowel Syndrome Lupus Pelvic Floor Dysfunction Pudendal Neuralgia Sjogren’s Syndrome Vulvodynia Newly Diagnosed Toolkit IC Awareness Toolkit Know ...

IC Treatment: Surgical Procedures

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... Bowel Syndrome Lupus Pelvic Floor Dysfunction Pudendal Neuralgia Sjogren’s Syndrome Vulvodynia Newly Diagnosed Toolkit IC Awareness Toolkit Know ... Bowel Syndrome Lupus Pelvic Floor Dysfunction Pudendal Neuralgia Sjogren’s Syndrome Vulvodynia Newly Diagnosed Toolkit IC Awareness Toolkit Know ...

IC: Frequently Asked Questions

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... Bowel Syndrome Lupus Pelvic Floor Dysfunction Pudendal Neuralgia Sjogren’s Syndrome Vulvodynia Newly Diagnosed Toolkit IC Awareness Toolkit Know ... Bowel Syndrome Lupus Pelvic Floor Dysfunction Pudendal Neuralgia Sjogren’s Syndrome Vulvodynia Newly Diagnosed Toolkit IC Awareness Toolkit Know ...

General IC Symptoms

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... Bowel Syndrome Lupus Pelvic Floor Dysfunction Pudendal Neuralgia Sjogren’s Syndrome Vulvodynia Newly Diagnosed Toolkit IC Awareness Toolkit Know ... Bowel Syndrome Lupus Pelvic Floor Dysfunction Pudendal Neuralgia Sjogren’s Syndrome Vulvodynia Newly Diagnosed Toolkit IC Awareness Toolkit Know ...

IC Associated Conditions

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... Bowel Syndrome Lupus Pelvic Floor Dysfunction Pudendal Neuralgia Sjogren’s Syndrome Vulvodynia Newly Diagnosed Toolkit IC Awareness Toolkit Know ... Bowel Syndrome Lupus Pelvic Floor Dysfunction Pudendal Neuralgia Sjogren’s Syndrome Vulvodynia Click to learn more about these and ...

Hunner's Ulcers

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... Bowel Syndrome Lupus Pelvic Floor Dysfunction Pudendal Neuralgia Sjogren’s Syndrome Vulvodynia Newly Diagnosed Toolkit IC Awareness Toolkit Know ... Bowel Syndrome Lupus Pelvic Floor Dysfunction Pudendal Neuralgia Sjogren’s Syndrome Vulvodynia Newly Diagnosed Toolkit IC Awareness Toolkit Know ...

Para-bosons and Para-fermions in Quantum Mechanics

International Nuclear Information System (INIS)

Cattani, M.S.D.; Fernandes, N.C.

1982-01-01

Within the framework of the ordinary quantum mechanics, a detailed study of the energy eigenfunctions of N identical particles using the irreducible representations of the permutation group in the Hilbert space is performed. It is shown that the para-states, as occurs with the boson and fermion states, are compatible with the postulates of quantum mechanics and with the principle of indistinguishability. A mathematical support for the existence of para-bosons and para-fermions is given. Gentile's quantum statistics is, in a certain sense, justified. (Author) [pt

Spontaneous pain attacks: neuralgic pain

NARCIS (Netherlands)

de Bont, L.G.

2006-01-01

Paroxysmal orofacial pains can cause diagnostic problems, especially when different clinical pictures occur simultaneously. Pain due to pulpitis, for example, may show the same characteristics as pain due to trigeminal neuralgia would. Moreover, the trigger point of trigeminal neuralgia can either

Preoperative evaluation of neurovascular relationship by using contrast-enhanced and unenhanced 3D time-of-flight MR angiography in patients with trigeminal neuralgia

International Nuclear Information System (INIS)

Qin, Zhou; Zhiling, Liu; Chuanfu, Li; Qingshi Zeng; Chuncheng, Qu; Shilei, Ni

2011-01-01

Background Microvascular decompression is an etiological strategy for the therapy of trigeminal neuralgia (TN). Preoperative identification of neurovascular compression, therefore, could have an impact on the determination of appropriate treatment for TN. Purpose To evaluate the value of contrast-enhanced and unenhanced three-dimensional (3D) time-of-flight (TOF) MR angiography in the visualization of neurovascular relationship in patients with TN. Material and Methods Thirty-seven patients with unilateral TN underwent unenhanced and contrast-enhanced 3D TOF MR angiography with a 3.0-T MR system. Images were reviewed by a radiologist blinded to clinical details. Vascular contact with the trigeminal nerve was identified, and the nature of the involved vessels (artery or vein) was determined. All patients underwent microvascular decompression. Results In 37 patients with TN, contrast-enhanced 3D TOF MR angiography identified surgically verified neurovascular contact in 35 of 36 symptomatic nerves, and there was no false-positive. Based on surgical findings, the sensitivity of MR imaging was 97.2% and specificity 100%. The nature of the offending vessel was correctly identified in 94.4% of the patients by using the combination of contrast-enhanced and unenhanced MR angiography. Conclusion Contrast-enhanced 3D TOF MR angiography is useful in the detection of vascular contact with the trigeminal nerve in patients with TN, and this MR imaging in combination with unenhanced MR angiography could help in the identification of the nature of the responsible vessels

Marcadores para la Realidad Aumentada para fines educativos

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María Reina Zarate Nava

2013-12-01

Full Text Available La Realidad Aumentada (AR es considerada por algunos expertos como la tecnología en crecimiento para el 2014, en diferentes sectores: ingeniería, educación, juegos y negocios, siendo este último el más usado en él 2013. Sin embargo en el sector educativo la AR se presenta en algunos proyectos que se han desarrollado para diferentes áreas de las ciencias, como Química, Física y Matemáticas, lo anterior con el objetivo de facilitar el proceso de Enseñanza-Aprendizaje. En el presente artículo se presenta el modelo de patrones utilizado para un Proyecto AR enfocado en Química, el cual presenta un conjunto de patrones que fueron valorados para facilitar el rastreo de los objetos y a su vez el entendimiento de algunos materiales de los laboratorios de Química I.

Trigeminal Nerve Root Demyelination Not Seen in Six Horses Diagnosed with Trigeminal-Mediated Headshaking

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Veronica L. Roberts

2017-05-01

Full Text Available Trigeminal-mediated headshaking is an idiopathic neuropathic facial pain syndrome in horses. There are clinical similarities to trigeminal neuralgia, a neuropathic facial pain syndrome in man, which is usually caused by demyelination of trigeminal sensory fibers within either the nerve root or, less commonly, the brainstem. Our hypothesis was that the neuropathological substrate of headshaking in horses is similar to that of trigeminal neuralgia in man. Trigeminal nerves, nerve roots, ganglia, infraorbital, and caudal nasal nerves from horse abattoir specimens and from horses euthanized due to trigeminal-mediated headshaking were removed, fixed, and processed for histological assessment by a veterinary pathologist and a neuropathologist with particular experience of trigeminal neuralgia histology. No histological differences were detected between samples from horses with headshaking and those from normal horses. These results suggest that trigeminal-mediated headshaking may have a different pathological substrate from trigeminal neuralgia in man.

Epidemiology and long-term disease burden of herpes zoster and postherpetic neuralgia in Taiwan: a population-based, propensity score-matched cohort study.

Science.gov (United States)

Lu, Wan-Hsuan; Lin, Chih-Wan; Wang, Chen-Yu; Chen, Liang-Kung; Hsiao, Fei-Yuan

2018-03-20

The objectives of this study were to characterize the burden of herpes zoster, as well as the longitudinal and incremental changes of healthcare service utilization among individuals with herpes zoster and postherpetic neuralgia (PHN) compared to those without. Using the National Health Insurance Research Database (NHIRD), we established a herpes zoster cohort of people diagnosed with herpes zoster between 2004 and 2008 as study cases. Another subset of the NHIRD, which was randomly selected from all elderly beneficiaries between 2004 and 2008 served as a non-herpes-zoster elderly control pool. Each case was then assigned one matched control according to age, gender, index date and propensity score. PHN cases were defined as those with persisting pain for more than 90 days after the onset of herpes zoster. Between 2004 and 2008, about 0.6 million patients were newly diagnosed with herpes zoster. The incidence increased with age, and most cases were identified during the summer period. Herpes zoster cases were found to have higher consumption of all types of healthcare services in the first year after the index date. Such increases were particularly obvious for patients with PHN, who showed incremental increases on average of 16.3 outpatient visits, 0.4 emergency room visits and 0.24 inpatient admissions per year. The incidence of herpes zoster increased with age and changed according to the seasons. Patients with herpes zoster were associated with higher healthcare utilization and this increase in healthcare utilization was most obvious for herpes zoster patients with PHN.

Generating para-water from para-hydrogen: A Gedankenexperiment.

Science.gov (United States)

Ivanov, Konstantin L; Bodenhausen, Geoffrey

2018-07-01

A novel conceptual approach is described that is based on the transfer of hyperpolarization from para-hydrogen in view of generating a population imbalance between the two spin isomers of H 2 O. The approach is analogous to SABRE (Signal Amplification By Reversible Exchange) and makes use of the transfer of spin order from para-hydrogen to H 2 O in a hypothetical organometallic complex. The spin order transfer is expected to be most efficient at avoided level crossings. The highest achievable enrichment levels of para- and ortho-water are discussed. Copyright © 2018 Elsevier Inc. All rights reserved.

Persistent pelvic pain following transvaginal mesh surgery: a cause for mesh removal.

Science.gov (United States)

Marcus-Braun, Naama; Bourret, Antoine; von Theobald, Peter

2012-06-01

Persistent pelvic pain after vaginal mesh surgery is an uncommon but serious complication that greatly affects women's quality of life. Our aim was to evaluate various procedures for mesh removal performed at a tertiary referral center in cases of persistent pelvic pain, and to evaluate the ensuing complications and outcomes. A retrospective study was conducted at the University Hospital of Caen, France, including all patients treated for removal or section of vaginal mesh due to pelvic pain as a primary cause, between January 2004 and September 2009. Ten patients met the inclusion criteria. Patients were diagnosed between 10 months and 3 years after their primary operation. Eight cases followed suburethral sling procedures and two followed mesh surgery for pelvic organ prolapse. Patients presented with obturator neuralgia (6), pudendal neuralgia (2), dyspareunia (1), and non-specific pain (1). The surgical treatment to release the mesh included: three cases of extra-peritoneal laparoscopy, four cases of complete vaginal mesh removal, one case of partial mesh removal and two cases of section of the suburethral sling. In all patients with obturator neuralgia, symptoms were resolved or improved, whereas in both cases of pudendal neuralgia the symptoms continued. There were no intra-operative complications. Post-operative Retzius hematoma was observed in one patient after laparoscopy. Mesh removal in a tertiary center is a safe procedure, necessary in some cases of persistent pelvic pain. Obturator neuralgia seems to be easier to treat than pudendal neuralgia. Early diagnosis is the key to success in prevention of chronic disease. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

Interventional therapy for neuropathic pain

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YANG Yang

2013-10-01

Full Text Available Neuropathic pain (NP is a common clinical refractory pain for which there are limited methods to treat. In this article, based on typical diseases, such as postherpetic neuralgia (PHN, trigeminal neuralgia, complex regional pain syndrome (CRPS, lower back pain with radiculopathy and failed back surgery syndrome (FBSS, phantom pain, the general treatment principle and method for NP are expatiated. Interventional methods for NP, including intraspinal block, radiofrequeney rhizotomy of trigeminal neuralgia, selective nerve root block, spinal cord stimulation (SCS and motor cortex stimulation (MCS are introduced, especially their indications, complications and matters needing attention.

Uma ferramenta para planejamento de estudos para concursos

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Leonardo Pimentel

2015-11-01

Full Text Available De acordo com a constituição brasileira, a única forma de se tornar um empregado do governo é passar em um concurso público. O exame de conhecimento do cargo é um dos componentes mais importantes de um concurso. Estudar para esse exame é uma tarefa que requer planejamento. Um meio de obter um bom planejamento é construir uma grade de horários que relacione as matérias a serem estudadas com os respectivos horários disponíveis para o estudo. Esse tipo de problema se assemelha bastante à gerência de projetos, em que se procura estabelecer a distribuição das atividades ao longo do tempo disponível. Assim, torna-se interessante explorar a dinâmica de estudos para concursos como um projeto. O presente trabalho apresenta a ferramenta de apoio ao estudos - Passe-me, baseada no ciclo PDCA (do inglês, Plan-Do-Check-Act. Por se tratar de uma ferramenta web, o tempo de resposta para produzir uma grade de estudos é fundamental. A ferramenta faz uso de algoritmo genético para calcular a grade de horários priorizando a velocidade de resposta. A ferramenta foi avaliada em diferentes cenários de uso e obteve desempenho satisfatório durante a produção da grade de estudos.

Docencia para el logro y educación para emprender

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Luis Gerardo Rodríguez Gómez

1994-05-01

Full Text Available RESUMEN En el primer artículo, el autor plasmó los elementos relevantes para una propuesta de educación para emprender. En este describe el desarrollo docente como expresión de una intensión, saber y un quehacer, encaminados a la formación del hombre emprendedor. El artículo se divide en tres partes. En la primera, se reseña los factores que orientan la intensión docente para emprender, a partir de un discurso y formas metodológicas establecidas con esa intención. En segundo lugar, se asume el espacio y tiempo la clase como unidad de análisis, para lograr objetivos de tipo institucional, programático y temático y en la parte final, se examina la evaluación docente y se hacen consideraciones generales para una propuesta de evaluación,  que surge al investigar la actuación del maestro.

Cognitive effects of electro-acupuncture and pregabalin in a trigeminal neuralgia rat model induced by cobra venom

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Chen RW

2017-08-01

Full Text Available Ruo-Wen Chen,1,2 Hui Liu,2 Jian-Xiong An,1,2 Xiao-Yan Qian,2 Yi-De Jiang,2 Doris K Cope,3 John P Williams,3 Rui Zhang,1 Li-Na Sun1 1Department of Anesthesiology, Weifang Medical University, Weifang City, Shandong, 2Department of Anesthesiology, Pain Medicine and Critical Care Medicine, Aviation General Hospital of China Medical University and Beijing Institute of Translational Medicine, Chinese Academy of Sciences, Beijing, China; 3Department of Anesthesiology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA Objective: The objective of this study was to investigate the effects of electro-acupuncture (EA and pregabalin on cognition impairment induced by chronic trigeminal neuralgia (TN in rats. Design: Controlled animal study. Setting: Department of Anesthesiology, Pain Medicine and Critical Care Medicine, Aviation General Hospital of China Medical University. Subjects: Forty adult male Sprague Dawley rats. Methods: Rats were randomly divided into four groups. The TN model was induced by administration of cobra venom to the left infraorbital nerve. On postoperative day 14, either EA or pregabalin was administered, free behavioral activities were observed. Spatial learning and memory abilities were determined in the Morris water maze. The ultrastructural alterations of the Gasserian ganglion, medulla oblongata and hippocampus were examined by electron microscopy. The changes on long-term potentiation were investigated. Results: After treatment, the exploratory behavior increased and the grooming behavior decreased (P<0.05 for the EA group and pregabalin group compared with the cobra venom group; moreover, demyelination of neurons in Gasserian ganglion and medulla oblongata was reversed. The number of platform site crossings, the average percentages of time in the target quadrant and the field excitatory postsynaptic potential slopes increased (P<0.05 in the EA group compared to the cobra venom group. However, the pregabalin group

Modelos para estimar consumo e exigências nutricionais para poedeiras comerciais

OpenAIRE

Palma Bendezu, Hilda Cristina [UNESP

2016-01-01

O objetivo deste trabalho foi elaborar um modelo para calcular as ingestões de aminoácidos e energia para a fase de maturação sexual e produção de ovos. As exigências de energia, aminoácidos e consumo de ração foram calculados pelo método fatorial, considerando na fase de maturação sexual a quantidade de nutrientes requerida para mantença e a quantidade de nutrientes necessários para crescimento e deposição de nutrientes corporais em cada componente do corpo (ovário, oviduto, corpo livre de ...

Gamma Knife radiosurgery for glossopharyngeal neuralgia: A study of 21 patients with long-term follow-up.

Science.gov (United States)

Borius, Pierre-Yves; Tuleasca, Constantin; Muraciole, Xavier; Negretti, Laura; Schiappacasse, Luis; Dorenlot, Antoine; Marguet, Maud; Zeverino, Michele; Donnet, Anne; Levivier, Marc; Regis, Jean

2018-03-01

Objective Glossopharyngeal neuralgia (GPN) is a very rare condition, affecting the patient's quality of life. We report our experience in drug-resistant, idiopathic GPN, treated with Gamma Knife radiosurgery (GKRS), in terms of safety and efficiency, on a very long-term basis. Methods The study was opened, self-controlled, non-comparative and bicentric (Marseille and Lausanne University Hospitals). Patients treated with GKRS between 2003 and 2015 (models C, 4C and Perfexion) were included. A single 4-mm isocentre was positioned in the cisternal portion of the glossopharyngeal nerve, with a targeting based both on magnetic resonance imaging (MRI) and computed tomography (CT). The mean maximal dose delivered was 81.4 ± 6.7 Gy (median = 85 Gy, range = 60-90 Gy at the 100% isodose line). Results Twenty-one patients (11 women, 10 men) benefited from 25 procedures. The mean follow-up period was 5.2 ± 3 years (range = 0.9-12.1 years). Seventeen (81%) were initially pain-free after GKRS. At three months, six months and one year after radiosurgery, the percentage of patients with good outcome (BNI classes I to IIIA) was 87.6%, 100% and 81.8%, respectively. Ten cases (58.8%) from the initial pain-free ones had a recurrence, after a mean period of 13.6 ± 10.4 months (range = 3.1-36.6 months). Only three patients (14.2%) had recurrences (two for each one of them) requiring further surgeries. Three patients underwent a second GKRS procedure; one case needed a third GKRS. The former procedures were performed at 7, 17, 19 and 30 months after the first one, respectively. Furthermore, two patients needed additional interventions. At last follow-up, 17 cases (80.9%) were still pain-free without medication. The actuarial pain relief without new surgery was 83%. A transient complication (paraesthesia of the edge of the tongue) was seen in one case (4.8%). Conclusion GKRS is a valuable, minimally invasive, surgical alternative for idiopathic GPN

Modelos para estimar as exigências de energia metabolizável para poedeiras

OpenAIRE

Sakomura,Nilva Kazue; Basaglia,Roberta; Sá-Fortes,Cristina M. L.; Fernandes,João Batista K.

2005-01-01

Objetivou-se, com este trabalho, elaborar um modelo para estimar as exigências de energia metabolizável (EM) para poedeiras leves da linhagem Lohmann LSL, utilizando-se o método fatorial. Para determinar o efeito da temperatura sobre as exigências de EM para mantença, foram conduzidos experimentos em câmaras climáticas com temperaturas constantes de 12, 22 e 31ºC, utilizando a técnica do abate comparativo. A exigência de energia líquida para o ganho de peso foi determinada por meio da regress...

Epidemiology, treatment and prevention of herpes zoster: A comprehensive review.

Science.gov (United States)

Koshy, Elsam; Mengting, Lu; Kumar, Hanasha; Jianbo, Wu

2018-01-01

Herpes zoster is a major health burden that can affect individuals of any age. It is seen more commonly among individuals aged ≥50 years, those with immunocompromised status, and those on immunosuppressant drugs. It is caused by a reactivation of varicella zoster virus infection. Cell-mediated immunity plays a role in this reactivation. Fever, pain, and itch are common symptoms before the onset of rash. Post-herpetic neuralgia is the most common complication associated with herpes zoster. Risk factors and complications associated with herpes zoster depend on the age, immune status, and the time of initializing treatment. Routine vaccination for individuals over 60 years has shown considerable effect in terms of reducing the incidence of herpes zoster and post-herpetic neuralgia. Treatment with antiviral drugs and analgesics within 72 hours of rash onset has been shown to reduce severity and complications associated with herpes zoster and post-herpetic neuralgia. This study mainly focuses on herpes zoster using articles and reviews from PubMed, Embase, Cochrane library, and a manual search from Google Scholar. We cover the incidence of herpes zoster, gender distribution, seasonal and regional distribution of herpes zoster, incidence of herpes zoster among immunocompromised individuals, incidence of post-herpetic neuralgia following a zoster infection, complications, management, and prevention of herpes zoster and post-herpetic neuralgia.

Characteristics, treatment, and health care expenditures of Medicare supplemental-insured patients with painful diabetic peripheral neuropathy, post-herpetic neuralgia, or fibromyalgia.

Science.gov (United States)

Johnston, Stephen S; Udall, Margarita; Alvir, Jose; McMorrow, Donna; Fowler, Robert; Mullins, Daniel

2014-04-01

To describe the characteristics, treatment, and health care expenditures of Medicare Supplemental-insured patients with painful diabetic peripheral neuropathy (pDPN), post-herpetic neuralgia (PHN), or fibromyalgia. Retrospective cohort study. United States clinical practice, as reflected within a database comprising administrative claims from 2.3 million older adults participating in Medicare supplemental insurance programs. Selected patients were aged ≥65 years, continuously enrolled in medical and prescription benefits throughout years 2008 and 2009, and had ≥1 medical claim with an International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis code for DPN, PHN, or fibromyalgia, followed within 60 days by a medication or pain intervention procedure used in treating pDPN, PHN, or fibromyalgia during 2008-2009. Utilization of, and expenditures on, pain-related and all-cause pharmacotherapy and medical interventions in 2009. The study included 25,716 patients with pDPN (mean age 75.2 years, 51.2% female), 4,712 patients with PHN (mean age 77.7 years, 63.9% female), and 25,246 patients with fibromyalgia (mean age 74.4 years, 73.0% female). Patients typically had numerous comorbidities, and many were treated with polypharmacy. Mean annual expenditures on total pain-related health care and total all-cause health care, respectively, (in 2010 USD) were: $1,632, $24,740 for pDPN; $1,403, $16,579 for PHN; and $1,635, $18,320 for fibromyalgia. In age-stratified analyses, pain-related health care expenditures decreased as age increased. The numerous comorbidities, polypharmacy, and magnitude of expenditures in this sample of Medicare supplemental-insured patients with pDPN, PHN, or fibromyalgia underscore the complexity and importance of appropriate management of these chronic pain patients. Wiley Periodicals, Inc.

Significados da gravidez e da maternidade: discursos de primíparas e multíparas

OpenAIRE

Silva, Flavia Baroni; Souza, Laura Vilela e; Scorsolini-Comin, Fabio

2013-01-01

Resumo: O objetivo foi compreender os sentidos sobre maternidade e as vivências da gravidez em gestantes primíparas e multíparas. Foram entrevistadas seis gestantes, sendo três primíparas e três multíparas. Nas falas, foram trazidos temas como dificuldades físicas, alterações corporais, repercussão da gravidez no relacionamento conjugal, planejamento da gravidez e envolvimento paterno. Observou-se, nas primíparas, que a inexperiência trouxe insegurança, ao passo que, em algumas multíparas, ho...

Estrategias para negociaciones exitosas.

OpenAIRE

José B. Parra V; Evelinda Santiago J.; Misael Murillo M.; Candy Atonal N.

2010-01-01

Las estrategias de negociación son herramientas para disminuir conflictos o para intercambiar bienes y servicios. Una negociación exitosa crea relaciones de solidaridad y propicia reciprocidad, cooperación y confianza para quienes tendrán relaciones permanentes de negociación con beneficios para ambas partes. Una estrategia de negociación exitosa requiere manejar el desarrollo del ambiente social del grupo de personas, con la finalidad de tener presente las fronteras que no pueden irrumpirse....

Glycerol rhizotomy versus gamma knife radiosurgery for the treatment of trigeminal neuralgia: An analysis of patients treated at one institution

International Nuclear Information System (INIS)

Henson, Clarissa Febles; Goldman, H. Warren; Rosenwasser, Robert H.; Downes, M. Beverly; Bednarz, Greg; Pequignot, Edward C.; Werner-Wasik, Maria; Curran, Walter J.; Andrews, David W.

2005-01-01

Background: Medically refractory trigeminal neuralgia (TN) has been treated with a variety of minimally invasive techniques, all of which have been compared with microvascular decompression. For patients not considered good surgical candidates, percutaneous retrogasserian glycerol rhizotomy (GR) and gamma knife (GK) radiosurgery are two minimally invasive techniques in common practice worldwide and used routinely at Jefferson Hospital for Neuroscience. Using a common pain scale outcomes questionnaire, we sought to analyze efficacies and morbidities of both treatments. Methods and Materials: Between June 1994 and December 2002, 79 patients were treated with GR and 109 patients underwent GK for the treatment of TN. GR was performed with fluoroscopic guidance as an overnight inpatient procedure. GK was performed using a single 4-mm shot positioned at the root exit zone of the trigeminal nerve. Radiation doses of 70-90 Gy prescribed to the 100% isodose line were used. Treatment outcomes including pain response, pain recurrence, treatment failure, treatment-related side effects, and overall patient satisfaction with GK and GR were compared using a common outcomes scale. Using the Barrow Neurologic Institute pain scale, patients were asked to define their level of pain both before and after treatment: I, no pain and no pain medication required; I, occasional pain not requiring medication; IIIa, no pain and pain medication used; IIIb, some pain adequately controlled with medication; IV, some pain not adequately controlled with medication; and V, severe pain with no relief with medication. We used posttreatment scores of I, II, IIIa, and IIIb to identify treatment success, whereas scores of IV and V were considered treatment failure. Results were compiled from respondents and analyzed using SAS software. Statistical comparisons used log-rank test, univariate and multivariate logistic regression, Fisher's exact test, and Wilcoxon test with significance established at p < 0

Cambios en la presión sanguínea durante la microcompresión retrogasseriana

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Leonardo Zulueta Nocedo

1997-12-01

Full Text Available La microcompresión percutánea del ganglio trigémino es una alternativa terapéutica en la neuralgia trigeminal, que induce cifras elevadas de tensión arterial durante el transoperatorio y otros riesgos de complicaciones cardiovasculares. Se describe brevemente la técnica quirúrgica. En este estudio se utilizó atropina en la premedicación; se administró anestesia general a todos los pacientes e hidralazina para el control de la presión arterial. Se demuestran los resultados de cambios en la presión arterial durante los distintos niveles de tratamiento. Las complicaciones inmediatas fueron: el incremento significativo de la presión arterial, la hemorragia subconjuntival y la punción de la arteria carótidaPercutaneous microcompression of the trigeminal ganglion is a therapeutic alternative in trigeminal neuralgia that induces high readings of arterial pressure during the transoperative and other risks of cardiovascular complications. The surgical technique is briefly described. Atropine was used in the premedication of this study. General anesthesia was administered to all patients and hidrizaline was given to control the arterial pressure. The changes observed in the arterial pressure during the different levels of treatment are shown. The immediate complications were: the significant increase of arterial pressure, the subconjunctival hemorrhage, and the carotid artery puncture

Para-equilibrium phase diagrams

International Nuclear Information System (INIS)

Pelton, Arthur D.; Koukkari, Pertti; Pajarre, Risto; Eriksson, Gunnar

2014-01-01

Highlights: • A rapidly cooled system may attain a state of para-equilibrium. • In this state rapidly diffusing elements reach equilibrium but others are immobile. • Application of the Phase Rule to para-equilibrium phase diagrams is discussed. • A general algorithm to calculate para-equilibrium phase diagrams is described. - Abstract: If an initially homogeneous system at high temperature is rapidly cooled, a temporary para-equilibrium state may result in which rapidly diffusing elements have reached equilibrium but more slowly diffusing elements have remained essentially immobile. The best known example occurs when homogeneous austenite is quenched. A para-equilibrium phase assemblage may be calculated thermodynamically by Gibbs free energy minimization under the constraint that the ratios of the slowly diffusing elements are the same in all phases. Several examples of calculated para-equilibrium phase diagram sections are presented and the application of the Phase Rule is discussed. Although the rules governing the geometry of these diagrams may appear at first to be somewhat different from those for full equilibrium phase diagrams, it is shown that in fact they obey exactly the same rules with the following provision. Since the molar ratios of non-diffusing elements are the same in all phases at para-equilibrium, these ratios act, as far as the geometry of the diagram is concerned, like “potential” variables (such as T, pressure or chemical potentials) rather than like “normal” composition variables which need not be the same in all phases. A general algorithm to calculate para-equilibrium phase diagrams is presented. In the limit, if a para-equilibrium calculation is performed under the constraint that no elements diffuse, then the resultant phase diagram shows the single phase with the minimum Gibbs free energy at any point on the diagram; such calculations are of interest in physical vapor deposition when deposition is so rapid that phase

Herpes Zoster Immunization in Older Adults Has Big Benefits.

Science.gov (United States)

Breivik, Harald

2015-09-01

A case of acute herpes zoster neuralgia (shingles) in a 78-year-old patient is described. The value and importance of immunizing against herpes zoster to decrease the incidence and severity of both acute herpes zoster neuralgia and postherpetic neuralgia are described. --This report is adapted from paineurope 2015: Issue 1, ©Haymarket Medical Publications Ltd., and is presented with permission. paineurope is provided as a service to pain management by Mundipharma International, Ltd., and is distributed free of charge to health care professionals in Europe. Archival issues can be viewed via the Web site: www.paineurope.com , at which health professionals can find links to the original articles and request copies of the quarterly publication and access additional pain education and pain management resources.

Estrategia para elevar la motivación laboral; factor imprescindible para mejorar nuestra productividad.

OpenAIRE

Reina de los Ángeles Carballé Piñón

2015-01-01

Este trabajo "Estrategia para elevar la motivación laboral; factor imprescindible para mejorar nuestra productividad" resulta de la investigación realizada para tesis de maestría; se realizó el estudio de 2 entidades, nos permitió conocer las principales posiciones que sobre motivación existen, factores que la influencian, cómo incide en el desempeño laboral y que acciones diseñar para elevarla. Las 2 entidades seleccionadas, claves en el desempeño empresarial son un centro de interfase y un...

Estrategias para negociaciones exitosas.

Directory of Open Access Journals (Sweden)

José B. Parra V

2010-01-01

Full Text Available Las estrategias de negociación son herramientas para disminuir conflictos o para intercambiar bienes y servicios. Una negociación exitosa crea relaciones de solidaridad y propicia reciprocidad, cooperación y confianza para quienes tendrán relaciones permanentes de negociación con beneficios para ambas partes. Una estrategia de negociación exitosa requiere manejar el desarrollo del ambiente social del grupo de personas, con la finalidad de tener presente las fronteras que no pueden irrumpirse. Otro aspecto importante, es el lenguaje corporal utilizado por las personas y las tácticas que se practican. El manejo de esta información permite diseñar diferentes modelos de negociaciones para cada caso específico. Este documento propone la utilización de la herramienta MONACO, diseñada por los autores, que es un software útil para encontrar los mejores tácticas posibles dentro de una negociación; basándose en el lenguaje corporal que muestra el negociante oponente durante cada oferta monetaria. El uso de este software da al negociador la oportunidad de manejar las negociaciones con mayor control, el negociador que usa el software puede elegir una estrategia de acuerdo a las relaciones que espera mantener con el negociador oponente.

Postherpetic Neuralgia

Science.gov (United States)

... can develop: Depression Fatigue Difficulty sleeping Lack of appetite Difficulty concentrating Prevention The herpes zoster vaccine (Zostavax) has been shown to greatly decrease the risk of shingles. The vaccine is approved by the ...

Glossopharyngeal Neuralgia

Science.gov (United States)

... sclerosis. GN primarily affects the elderly. View Full Definition Treatment Most doctors will attempt to treat the pain first with drugs. Some individuals respond well to anticonvulsant drugs, such ...

¿Argumentar para definir o definir para argumentar?

OpenAIRE

Silva, Luz; Samper, Carmen

2013-01-01

Se presenta y se ilustra un marco de referencia de un estudio en curso para obtener el título de Maestría en Docencia de la Matemática de la Universidad Pedagógica Nacional (Colombia); estudio sobre la conexión entre las acciones de definir y argumentar, que puede contribuir a la práctica de profesores en ejercicio y en formación. La habilidad para construir una definición es un posible indicio de comprensión, mientras que saberla de memoria no garantiza la comprensión del concepto (Vinner, 1...

Comparison of tolerability and adverse symptoms in oxcarbazepine and carbamazepine in the treatment of trigeminal neuralgia and neuralgiform headaches using the Liverpool Adverse Events Profile (AEP).

Science.gov (United States)

Besi, E; Boniface, D R; Cregg, R; Zakrzewska, J M

2015-01-01

Adverse effects of drugs are poorly reported in the literature . The aim of this study was to examine the frequency of the adverse events of antiepileptic drugs (AEDs), in particular carbamazepine (CBZ) and oxcarbazepine (OXC) in patients with neuralgiform pain using the psychometrically tested Liverpool Adverse Events Profile (AEP) and provide clinicians with guidance as to when to change management. The study was conducted as a clinical prospective observational exploratory survey of 161 patients with idiopathic trigeminal neuralgia and its variants of whom 79 were on montherapy who attended a specialist clinic in a London teaching hospital over a period of 2 years. At each consultation they completed the AEP questionnaire which provides scores of 19-76 with toxic levels being considered as scores >45. The most common significant side effects were: tiredness 31.3 %, sleepiness 18.2 %, memory problems 22.7 %, disturbed sleep 14.1 %, difficulty concentrating and unsteadiness 11.6 %. Females reported significantly more side effects than males. Potential toxic dose for females is approximately 1200 mg of OXC and 800 mg of CBZ and1800mg of OXC and 1200 mg of CBZ for males. CBZ and OXC are associated with cognitive impairment. Pharmacokinetic and pharmacodynamic differences are likely to be the reason for gender differences in reporting side effects. Potentially, females need to be prescribed lower dosages in view of their tendency to reach toxic levels at lower dosages. Side effects associated with AED could be a major reason for changing drugs or to consider a referral for surgical management.

Evaluation of the effect of the herpes zoster vaccination programme 3 years after its introduction in England: a population-based study.

Science.gov (United States)

Amirthalingam, Gayatri; Andrews, Nick; Keel, Philip; Mullett, David; Correa, Ana; de Lusignan, Simon; Ramsay, Mary

2018-02-01

In 2013, a herpes zoster vaccination programme was introduced in England for adults aged 70 years with a phased catch-up programme for those aged 71-79 years. We aimed to evaluate the effect of the first 3 years of the vaccination programme on incidence of herpes zoster and postherpetic neuralgia in this population. In this population-based study, we extracted data from the Royal College of General Practitioners sentinel primary care network on consultations with patients aged 60-89 years for herpes zoster and postherpetic neuralgia occurring between Oct 1, 2005, and Sept 30, 2016, obtaining data from 164 practices. We identified individual data on herpes zoster vaccinations administered and consultations for herpes zoster and postherpetic neuralgia, and aggregated these data to estimate vaccine coverage and incidence of herpes zoster and postherpetic neuralgia consultations. We defined age cohorts to identify participants targeted in each year of the programme, and as part of the routine or catch-up programme. We modelled incidence according to age, region, gender, time period, and vaccine eligibility using multivariable Poisson regression with an offset for person-years. Our analysis included 3·36 million person-years of data, corresponding to an average of 310 001 patients aged 60-89 years who were registered at an RCGP practice each year. By Aug 31, 2016, uptake of the vaccine varied between 58% for the recently targeted cohorts and 72% for the first routine cohort. Across the first 3 years of vaccination for the three routine cohorts, incidence of herpes zoster fell by 35% (incidence rate ratio 0·65 [95% 0·60-0·72]) and of postherpetic neuralgia fell by 50% (0·50 [0·38-0·67]). The equivalent reduction for the four catch-up cohorts was 33% for herpes zoster (incidence rate ratio 0·67 [0·61-0·74]) and 38% for postherpetic neuralgia (0·62 [0·50-0·79]). These reductions are consistent with a vaccine effectiveness of about 62% against herpes zoster

Guias ópticos para sensores

OpenAIRE

Marcos de Castro Pacitti

1993-01-01

Neste trabalho foram estudados guias ópticos para atuarem como sensores ou em sistemas sensores. Ênfase especial foi dada em guias ópticos retangulares, para dispositivos ópticos integrados, e fibras ópticas elípticas. A analise de fibras ópticas elípticas resultou em um modelamento pratico para projeto das mesmas em aplicações onde se deseja operar com dois modos guiados, situação esta que se mostra muito atraente para implementação de diversos tipos de sensores a fibra óptica. A seguir es...

Labbtex: Toolbox para generación de informes en LATEX para Matlab

Directory of Open Access Journals (Sweden)

José Luis Almazán Gárate

2012-10-01

Full Text Available En este artículo se presenta el software desarrollado por el Equipo H3lite dentro del Departamento de Ingeneniería Civil. Transportes de la Escuela de Ingenieros de Caminos, Canales y Puertos de la Universidad Politécnica de Madrid para la generación de informes enLATEX mediante el software Matlab® y la integración en sus rutinas, Labbtex.La librería Labbtex proporciona un marco flexible para mezclar texto y código Matlab® para la generación automática de documentos. Un rchivo fuente simple contiene el texto de documentación y el código Matlab, al correr la aplicación se genera un documento final LATEX que contiene el texto, gráficos y tablas indicados con el formato de un documento LATEX. El código Matlab genera un documento LATEX usando la sintaxis. Así, LATEX (para composición de texto de alta calidad y Matlab® (para cálculo matemático pueden usarse simultáneamente. Esto permite la generación de informes en tiempo real con un uso de recursos mínimo.

Quantitative sensory testing in the German Research Network on Neuropathic Pain (DFNS): reference data for the trunk and application in patients with chronic postherpetic neuralgia.

Science.gov (United States)

Pfau, Doreen B; Krumova, Elena K; Treede, Rolf-Detlef; Baron, Ralf; Toelle, Thomas; Birklein, Frank; Eich, Wolfgang; Geber, Christian; Gerhardt, Andreas; Weiss, Thomas; Magerl, Walter; Maier, Christoph

2014-05-01

Age- and gender-matched reference values are essential for the clinical use of quantitative sensory testing (QST). To extend the standard test sites for QST-according to the German Research Network on Neuropathic Pain-to the trunk, we collected QST profiles on the back in 162 healthy subjects. Sensory profiles for standard test sites were within normal interlaboratory differences. QST revealed lower sensitivity on the upper back than the hand, and higher sensitivity on the lower back than the foot, but no systematic differences between these trunk sites. Age effects were significant for most parameters. Females exhibited lower pressure pain thresholds (PPT) than males, which was the only significant gender difference. Values outside the 95% confidence interval of healthy subjects (considered abnormal) required temperature changes of >3.3-8.2 °C for thermal detection. For cold pain thresholds, confidence intervals extended mostly beyond safety cutoffs, hence only relative reference data (left-right differences, hand-trunk differences) were sufficiently sensitive. For mechanical detection and pain thresholds, left-right differences were 1.5-2.3 times more sensitive than absolute reference data. The most sensitive parameter was PPT, where already side-to-side differences >35% were abnormal. Compared to trunk reference data, patients with postherpetic neuralgia exhibited thermal and tactile deficits and dynamic mechanical allodynia, mostly without reduced mechanical pain thresholds. This pattern deviates from other types of neuropathic pain. QST reference data for the trunk will also be useful for patients with postthoracotomy pain or chronic back pain. Copyright © 2014 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

Cost-effectiveness analysis of a vaccination program for the prevention of herpes zoster and post-herpetic neuralgia in adults aged 50 and over in Germany.

Science.gov (United States)

Préaud, Emmanuelle; Uhart, Mathieu; Böhm, Katharina; Aidelsburger, Pamela; Anger, Delphine; Bianic, Florence; Largeron, Nathalie

2015-01-01

Herpes zoster (HZ; shingles) is a common viral disease that affects the nerves and surrounding skin causing a painful dermatomal rash and leading to debilitating complications such as, mainly, post-herpetic neuralgia (PHN). Currently, there is no effective treatment for HZ and PHN. The objective of this study was to assess the cost-effectiveness of a HZ vaccination program in Germany. An existing Markov Model was adapted to the German healthcare setting to compare a vaccination policy to no vaccination on a lifetime time-horizon, considering 2 scenarios: vaccinating people starting at the age of 50 or at the age of 60 years, from the perspective of the statutory health insurance (SHI) and the societal perspective. According to the perspective, vaccinating 20% of the 60+ German population resulted in 162,713 to 186,732 HZ and 31,657 to 35,793 PHN cases avoided. Corresponding incremental cost-effectiveness ratios (ICER) were 39,306 €/QALY from the SHI perspective and 37,417 €/QALY from a societal perspective. Results for the 50+ German population ranged from 336,468 to 394,575 HZ and from 48,637 to 56,087 PHN cases avoided from the societal perspective. Corresponding ICER were 39,782 €/QALY from a SHI perspective and 32,848 €/QALY from a societal perspective. Sensitivity analyses showed that results are mainly impacted by discount rates, utility values and use of alternative epidemiological data.The model indicated that a HZ vaccination policy in Germany leads to significant public health benefits and could be a cost-effective intervention. The results were robust and consistent with local and international existing literature.

Internet como instrumento para la Yihad

Directory of Open Access Journals (Sweden)

Alfonso Merlos García

2006-01-01

Full Text Available Las extraordinarias ventajas que ofrece Internet lo han convertido en un instrumento clave y dinámico en la estrategia de los yihadistas. Los medios de comunicación, la clase política y las agencias de seguridad e información han tendido a concentrar sus esfuerzos en la neutralización del ciberterrorismo sin prestar suficiente atención a los múltiples usos de Internet que están haciendo los neosalafistas: para la propaganda y para la guerra psicológica, para el reclutamiento y para la financiación, para la documentación y para la planificación de atentados. Las democracias deberían considerar el coste que tendrá la derrota frente al movimiento yihadista globalizado en la batalla por el ciberespacio

FV-100 versus valacyclovir for the prevention of post-herpetic neuralgia and the treatment of acute herpes zoster-associated pain: A randomized-controlled trial.

Science.gov (United States)

Tyring, Stephen K; Lee, Patricia; Hill, Gordon T; Silverfield, Joel C; Moore, Angela Yen; Matkovits, Theresa; Sullivan-Bolyai, John

2017-07-01

This prospective, parallel-group, randomized, double-blind, multicenter study compared the efficacy and safety of FV-100 with valacyclovir for reducing pain associated with acute herpes zoster (HZ). Patients, ≥50 years of age, diagnosed with HZ within 72 h of lesion appearance who had HZ-associated pain, were randomized 1:1:1 to a 7-day course of either FV-100 200 mg QD (n = 117), FV-100 400 mg QD (n = 116), or valacyclovir 1000 mg TID (n =117). Efficacy was evaluated on the basis of the burden of illness (BOI; Zoster Brief Pain Inventory scores); incidence and duration of clinically significant pain (CSP); pain scores; incidence and severity of post-herpetic neuralgia (PHN); and times to full lesion crusting and to lesion healing. Safety was evaluated on the basis of adverse event (AE)/SAE profiles, changes in laboratory and vital signs values, and results of electrocardiograms. The burden of illness scores for pain through 30 days were 114.5, 110.3, and 118.0 for FV-100 200 mg, FV-100 400 mg, and valacyclovir 3000 mg, respectively. The incidences of PHN at 90 days for FV-100 200 mg, FV-100 400 mg, and valacyclovir 3000 mg were 17.8%, 12.4%, and 20.2%, respectively. Adverse event and SAE profiles of the two FV-100 and the valacyclovir groups were similar and no untoward signals or trends were evident. These results demonstrate a potential for FV-100 as an antiviral for the treatment of shingles that could both reduce the pain burden of the acute episode and reduce the incidence of PHN compared with available treatments. © 2016 Wiley Periodicals, Inc.

Cross-elicitation responses to 2-methoxymethyl-para-phenylenediamine in para-phenylenediamine-allergic individuals

NARCIS (Netherlands)

Schuttelaar, M.-L.; Coenraads, P.-J.; Blömeke, B.; Goebel, C.

2016-01-01

The introduction of a methoxymethyl side chain into para-phenylenediamine (PPD) resulted in the development of a new hair dye molecule: 2-methoxymethyl-para-phenylenediamine (Me-PPD). Besides having excellent hair colouring properties, this PPD derivate has significantly lower skin-sensitizing

Oro para Colombia

OpenAIRE

Rubio Forero, María Claudia

2016-01-01

Las mujeres han debido atravesar un largo camino partiendo de la discriminación hasta empezar un proceso de equidad en la sociedad y en el deporte, de esta manera llegar a ser parte de un evento como los Juegos Olímpicos. Esta tesis toma el caso de tres atletas colombianas y describe su proceso de formación para lograr dos medallas de oro para el país.

Self-regulation of brain activity in patients with postherpetic neuralgia: a double-blind randomized study using real-time FMRI neurofeedback.

Science.gov (United States)

Guan, Min; Ma, Lijia; Li, Li; Yan, Bin; Zhao, Lu; Tong, Li; Dou, Shewei; Xia, Linjie; Wang, Meiyun; Shi, Dapeng

2015-01-01

A pilot study has shown that real-time fMRI (rtfMRI) neurofeedback could be an alternative approach for chronic pain treatment. Considering the relative small sample of patients recruited and not strictly controlled condition, it is desirable to perform a replication as well as a double-blinded randomized study with a different control condition in chronic pain patients. Here we conducted a rtfMRI neurofeedback study in a subgroup of pain patients - patients with postherpetic neuralgia (PHN) and used a different sham neurofeedback control. We explored the feasibility of self-regulation of the rostral anterior cingulate cortex (rACC) activation in patients with PHN through rtfMRI neurofeedback and regulation of pain perception. Sixteen patients (46-71 years) with PHN were randomly allocated to a experimental group (n = 8) or a control group (n = 8). 2 patients in the control group were excluded for large head motion. The experimental group was given true feedback information from their rACC whereas the control group was given sham feedback information from their posterior cingulate cortex (PCC). All subjects were instructed to perform an imagery task to increase and decrease activation within the target region using rtfMRI neurofeedback. Online analysis showed 6/8 patients in the experimental group were able to increase and decrease the blood oxygen level dependent (BOLD) fMRI signal magnitude during intermittent feedback training. However, this modulation effect was not observed in the control group. Offline analysis showed that the percentage of BOLD signal change of the target region between the last and first training in the experimental group was significantly different from the control group's and was also significantly different than 0. The changes of pain perception reflected by numerical rating scale (NRS) in the experimental group were significantly different from the control group. However, there existed no significant correlations between BOLD signal

Hypnotherapy: A useful adjunctive therapeutic modality in hansen′s disease

Directory of Open Access Journals (Sweden)

E N Abdul Latheef

2014-01-01

Full Text Available Hypnotherapy is a useful adjunctive psychotherapeutic procedure used in various conditions such as pain disorders, atopic dermatitis, and alopecia areata. However, it is less utilized in the field of dermatology. Only limited data exist on its role in the management of various skin diseases. There is dearth of literature on the role of hypnotherapy in Hansen′s disease (HD. We report two cases of HD, one with very resistant neuralgia and the other with recurrent erythema nodosum leprosum (ENL. Both the patients were assessed using hospital anxiety and depression scale, dermatology life quality index and the neuralgia was assessed using the visual analog scale. Three sessions of hypnotherapy were given to both the patients. There was dramatic improvement in the incidence of ENL and neuralgia and we could rapidly reduce the dose of drugs used for both conditions.

Infraestructura para laboratorios de acceso remoto

Directory of Open Access Journals (Sweden)

López Luro, Francisco

2009-01-01

Full Text Available Las tecnologías de Internet permiten el uso de sistemas de software distribuido para el acceso en forma remota a laboratorios físicos y virtuales, para llevar a cabo actividades de investigación experimental a distancia. A partir de los marcos teóricos que definen los estructurantes de los laboratorios, los implementadores de laboratorios de acceso remoto deben diseñar y desarrollar arquitecturas de servicios que permitan un acceso flexible y controlado. Este trabajo define una infraestructura para la implementación de aplicaciones para el acceso remoto a laboratorios físicos y virtuales y para la gestión de los mismos. Se presentan conceptos que permiten extender la modalidad tradicional de conexión con un dispositivo, para llevar adelante actividades prácticas de laboratorio colaborativas y concurrentes.

Increased Incidence of Herpes Zoster and Postherpetic Neuralgia in Adult Patients following Traumatic Brain Injury: A Nationwide Population-Based Study in Taiwan.

Directory of Open Access Journals (Sweden)

Yi-Ching Tung

Full Text Available The aims of this study were to estimate the incidences of herpes zoster (HZ and postherpetic neuralgia (PHN in patients after traumatic brain injury (TBI. Furthermore, we aimed to explore the risk factors of the development of HZ and PHN in patients after TBI. This population-based, longitudinal analysis was conducted using the Taiwan National Health Insurance Research Database (consisting of 1,000,000 beneficiaries from 1996 to 2010. Using the longitudinal National Health Insurance Research Database, we conducted a retrospective population-based cohort study to evaluate the incidence of HZ and PHN in adult TBI patients and controls. Kaplan-Meier analysis and Cox regression were used to compare differences in the development of HZ and PHN. The effects of gender, comorbidity and surgery on the risk of HZ and PHN development were assessed by subgroup analyses. Over a 15-year follow-up, the cumulative incidence of HZ in 28,234 TBI patients (604.00/100,000 person-years was significantly higher than 34,085 controls (322.21/100,000 person-years (P<0.0001, by log-rank test. Females showed a significantly higher incidence of HZ than males (p for interaction = 0.0010. The time to HZ development in the follow-up period was 5.9 years in TBI patients compared to 9.9 years in the control set (p <0.0001. TBI patients were 2.93 and 2.11 times likely to develop HZ and PHN, respectively, than the general population. The incidences of HZ and PHN in TBI patients were also significantly greater than for controls in the CCI = 0 subgroup. To our knowledge, this is the first population-based cohort study to reveal that TBI is an independent risk factor for HZ and PHN in TBI patients, especially in females. Physician should pay attention to the possibility of HZ and PHN in TBI patients and be aware that HZ vaccination early after brain trauma may lower the incidence of HZ and PHN.

Neuronavigated percutaneous approach to the sphenopalatine ganglion.

Science.gov (United States)

Benedetto, Nicola; Perrini, Paolo

2017-02-01

The sphenopalatine ganglion (SPG) has been assumed to be involved in the genesis of several types of facial pain, including Sluder's neuralgia, trigeminal neuralgia, persistent idiopathic facial pain, cluster headache, and atypical facial pain. The gold standard treatments for SPG-related pain are percutaneous procedures performed with the aid of fluoroscopy or CT. In this technical note the authors present, for the first time, an SPG approach using the aid of a neuronavigator.

Diseño de imágenes para ciegos, material didáctico para niños con discapacidad visual.

OpenAIRE

FUENTES NIEVES, FABIOLA MIREYA

2014-01-01

El objetivo de este proyecto es contribuir investigación para la creación, la aplicación, la transformación del quehacer profesional del diseño gráfico en el conocimiento y las habilidades, en la formación de profesionales en el área del diseño para material didáctico para esta disciplina, por lo cual es necesario cambiar respuestas para lo local y/o para la globalización. En la historia del diseño, se plantea, proyectar para la globalización, para la humanidad. Ahora el planteamiento de r...

Possible analgesic effect of vigabatrin in animal experimental chronic neuropathic pain Possível efeito analgésico da vigabatrina na dor neuropática crônica experimental animal

Directory of Open Access Journals (Sweden)

NILZA D. ALVES

1999-12-01

Full Text Available Since anticonvulsants have been used for treating neuralgias, an interest has arisen to experimentally test vigabatrin for its gabaergic mechanism of action. For this, 41 Wistar rats were used, and in 25 of them a constrictive sciatic neuropathy was induced (Bennet & Xie model. For testing pain symptoms, spontaneous (scratching and evoked behaviors to noxious (46o C and non-noxious (40o C thermal stimuli were quantified. Moreover, a comparative pharmacological study of vigabatrin with other analgesic anticonvulsant drugs was also performed. The results showed a possible dose-dependent analgesic effect of vigabatrin (gamma-vinyl-GABA on experimental neuropathic pain, as shown by the significant (pO uso de anticonvulsivantes no tratamento de neuralgias despertou um interesse em testar novas drogas anticonvulsivantes, e dentre essas a vigabatrina por possuir mecanismo de ação gabaérgico. Para isso, foram usados 41 ratos Wistar e em 25 deles induziu-se neuropatia ciática constritiva (modelo de Bennett & Xie. Para testar sintomas de dor, foram quantificados comportamentos espontâneos (coçar-se e evocados, por meio de estímulos térmicos nocivos (46oC e não-nocivos (40oC. Além disso, realizou-se estudo comparativo da vigabatrina com outros anticonvulsivantes analgésicos. Os resultados mostraram um possível efeito analgésico, dose-dependente, de vigabatrina (gama-vinil-GABA em dor neuropática experimental. Isso foi evidenciado pela diminuição significativa (p<0,05 do comportamento de coçar-se e pelo aumento significativo (p<0,05 da latência de retirada da pata posterior direita a estímulos térmicos nocivos. Isso foi corroborado por achados semelhantes em experimentos com anticonvulsivantes (carbamazepina, fenitoína e ácido valpróico analgésicos. Esse possível efeito analgésico da vigabatrina (ainda não descrito na literatura não é mediado pelo sistema opióide.

Predictive Nomogram for the Durability of Pain Relief From Gamma Knife Radiation Surgery in the Treatment of Trigeminal Neuralgia

International Nuclear Information System (INIS)

Lucas, John T.; Nida, Adrian M.; Isom, Scott; Marshall, Kopriva; Bourland, John D.; Laxton, Adrian W.; Tatter, Stephen B.; Chan, Michael D.

2014-01-01

Purpose: To determine factors associated with the durability of stereotactic radiation surgery (SRS) for treatment of trigeminal neuralgia (TN). Methods and Materials: Between 1999 and 2008, 446 of 777 patients with TN underwent SRS and had evaluable follow-up in our electronic medical records and phone interview records. The median follow-up was 21.2 months. The Barrow Neurologic Institute (BNI) pain scale was used to determine pre- and post-SRS pain. Dose-volume anatomical measurements, Burchiel pain subtype, pain quality, prior procedures, and medication usage were included in this retrospective cohort to identify factors impacting the time to BNI 4-5 pain relapse by using Cox proportional hazard regression. An internet-based nomogram was constructed based on predictive factors of durable relief pre- and posttreatment at 6-month intervals. Results: Rates of freedom from BNI 4-5 failure at 1, 3, and 5 years were 84.5%, 70.4%, and 46.9%, respectively. Pain relief was BNI 1-3 at 1, 3, and 5 years in 86.1%, 74.3%, and 51.3% of type 1 patients; 79.3%, 46.2%, and 29.3% of type 2 patients; and 62.7%, 50.2%, and 25% of atypical facial pain patients. BNI type 1 pain score was achieved at 1, 3, and 5 years in 62.9%, 43.5%, and 22.0% of patients with type 1 pain and in 47.5%, 25.2%, and 9.2% of type 2 patients, respectively. Only 13% of patients with atypical facial pain achieved BNI 1 response; 42% of patients developed post-Gamma Knife radiation surgery (GKRS) trigeminal dysfunction. Multivariate analysis revealed that post-SRS numbness (hazard ratio [HR], 0.47; P<.0001), type 1 (vs type 2) TN (HR, 0.6; P=.02), and improved post-SRS BNI score at 6 months (HR, 0.009; P<.0001) were predictive of a durable pain response. Conclusions: The durability of SRS for TN depends on the presenting Burchiel pain type, the post-SRS BNI score, and the presence of post-SRS facial numbness. The durability of pain relief can be estimated pre- and posttreatment by using our

Predictive Nomogram for the Durability of Pain Relief From Gamma Knife Radiation Surgery in the Treatment of Trigeminal Neuralgia

Energy Technology Data Exchange (ETDEWEB)

Lucas, John T., E-mail: johnthomas75@gmail.com [Department of Radiation Oncology, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina (United States); Nida, Adrian M. [Biomedical Informatics Center, Medical University of South Carolina, Charleston, South Carolina (United States); Isom, Scott [Department of Biostatistical Sciences, Section of Biostatistics, Wake Forest School of Medicine, Winston-Salem, North Carolina (United States); Marshall, Kopriva [Wake Forest School of Medicine, Winston-Salem, North Carolina (United States); Bourland, John D. [Department of Radiation Oncology, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina (United States); Laxton, Adrian W.; Tatter, Stephen B. [Department of Neurosurgery, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina (United States); Chan, Michael D. [Department of Radiation Oncology, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina (United States)

2014-05-01

Purpose: To determine factors associated with the durability of stereotactic radiation surgery (SRS) for treatment of trigeminal neuralgia (TN). Methods and Materials: Between 1999 and 2008, 446 of 777 patients with TN underwent SRS and had evaluable follow-up in our electronic medical records and phone interview records. The median follow-up was 21.2 months. The Barrow Neurologic Institute (BNI) pain scale was used to determine pre- and post-SRS pain. Dose-volume anatomical measurements, Burchiel pain subtype, pain quality, prior procedures, and medication usage were included in this retrospective cohort to identify factors impacting the time to BNI 4-5 pain relapse by using Cox proportional hazard regression. An internet-based nomogram was constructed based on predictive factors of durable relief pre- and posttreatment at 6-month intervals. Results: Rates of freedom from BNI 4-5 failure at 1, 3, and 5 years were 84.5%, 70.4%, and 46.9%, respectively. Pain relief was BNI 1-3 at 1, 3, and 5 years in 86.1%, 74.3%, and 51.3% of type 1 patients; 79.3%, 46.2%, and 29.3% of type 2 patients; and 62.7%, 50.2%, and 25% of atypical facial pain patients. BNI type 1 pain score was achieved at 1, 3, and 5 years in 62.9%, 43.5%, and 22.0% of patients with type 1 pain and in 47.5%, 25.2%, and 9.2% of type 2 patients, respectively. Only 13% of patients with atypical facial pain achieved BNI 1 response; 42% of patients developed post-Gamma Knife radiation surgery (GKRS) trigeminal dysfunction. Multivariate analysis revealed that post-SRS numbness (hazard ratio [HR], 0.47; P<.0001), type 1 (vs type 2) TN (HR, 0.6; P=.02), and improved post-SRS BNI score at 6 months (HR, 0.009; P<.0001) were predictive of a durable pain response. Conclusions: The durability of SRS for TN depends on the presenting Burchiel pain type, the post-SRS BNI score, and the presence of post-SRS facial numbness. The durability of pain relief can be estimated pre- and posttreatment by using our

The para-petroleum industry

International Nuclear Information System (INIS)

2002-07-01

The para-petroleum industry includes societies that realize studies and installations for the deposits exploitation. This document presents the situation of the para-petroleum industry in 2001, the world investment growth of the activity, the french societies financial results and an inventory of the main operations in the amalgamation domain. (A.L.B.)

Adesao ao guia alimentar para populacao brasileira

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Eliseu Verly Junior

2013-12-01

Full Text Available OBJETIVO : Analisar a adesão ao Guia Alimentar para População Brasileira. MÉTODOS : Amostra composta por participantes do Inquérito de Saúde de São Paulo (n = 1.661 que preencheram dois recordatórios de 24 horas. Foi utilizado modelo bivariado de efeito misto para a razão entre o consumo de energia do grupo de alimentos e o consumo calórico total. A razão estimada foi utilizada para calcular o percentual de indivíduos com consumo abaixo ou acima da recomendação. RESULTADOS : Pelo menos 80,0% da população consome abaixo do recomendado para: leite e derivados; frutas e sucos de frutas; e cereais, tubérculos e raízes; aproximadamente 60,0% para legumes e verduras; 30,0% para feijões; e 8,0% para carnes e ovos. Adolescentes apresentaram a maior inadequação para legumes e verduras (90,0%, e o estrato de maior renda foi associado à menor inadequação para óleos, gorduras e sementes oleaginosas (57,0%. CONCLUSÕES : Foi observado consumo inadequado dos grupos de alimentos relacionados com aumento do risco de doenças crônicas.

Skin reaction to carbamazepine or DRESS syndrome: a case presentation

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Emigdio Jesús Cabrera Fundora

2016-03-01

Full Text Available La carbamazepina es un medicamento de empleo habitual que puede producir efectos secundarios y en algunos casos reacciones adversas como vértigos, somnolencia y reacciones cutáneas que pueden ser severas como el síndrome DRESS (Drug Rash with Eosinophilia and Systemic Symptoms. Se caracteriza por erupción cutánea tardía y lenta progresión, linfocitos atípicos con eosinofilia y síntomas sistémicos como fiebre, adenopatías, hepatopatía y trastornos renales, pudiendo llegar a la muerte del paciente. Se presenta un caso para destacar la importancia del diagnóstico temprano del síndrome DRESS, que garantice un manejo adecuado para la supervivencia del paciente. Es una paciente bajo tratamiento con carbamazepina para neuralgia del trigémino, que al tiempo comienza con lesiones cutáneas que se interpretan como reacción de hipersensibilidad. Al no mejorar con tratamiento inicial y empeorar el cuadro cutáneo, acompañándose de síntomas generales, se realizan análisis complementarios y se plantea el diagnóstico de síndrome DRESS que se resuelve definitivamente con esteroides.

Algoritmos para problemas de empacotamento

OpenAIRE

Eduardo Candido Xavier

2006-01-01

Resumo: Neste trabalho estudamos diversos problemas de empacotamento considerados NP-difíceis. Assumindo a hipótese de que P ? NP, sabemos que não existem algoritmos eficientes (complexidade de tempo polinomial) exatos para resolver tais problemas. Uma das abordagens consideradas para tratar tais problemas é a de algoritmos de aproximação, que são algoritmos eficientes e que geram soluções com garantia de qualidade. Neste trabalho apresentamos alguns algoritmos aproximados para problemas de e...

Construcción de un indicador para medir competencias básicas para la vida

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Andrea Collado Chaves

2006-01-01

Full Text Available La necesidad de construir un indicador para cuantificar el nivel de Competencias Básicas para la Vida (CBV, nace con la evaluación los resultados de un proyecto dirigido a población joven. El propósito de ese proyecto es construir capital humano y empleabilidad en hombres y mujeres con edades entre 13 y 18 años, desertores o en riesgo de desertar del sistema educativo, sin empleo formal y que viven en ambientes de pobreza y exclusión. Una de las dimensiones de empleabilidad son las Competencias Básicas para la Vida. La dimensión de competencias básicas para la vida se refiere a aspectos de personalidad asociados con el desempeño del individuo en sus relaciones consigo mismo y con los demás. Los datos provienen de una investigación cuyo propósito consiste en evaluar los resultados de una intervención en población joven de comunidades pobres y excluidas. La construcción del indicador uso técnicas psicométricas para la validación de las distintas subdimensiones que pertenecen al concepto de competencias básicas para la vida. Según el marco conceptual este indicador está compuesto por seis dimensiones, la validación empírica hecha en este artículo incluye solamente cuatro de ellas, todas de carácter actitudinal. El indicador posee algunas ventajas en términos de la capacidad de discriminación debido a que su distribución tiende a ser normal. Sin embargo se ve afectaba por valores extremos a la izquierda del promedio y valores modales a una desviación estándar (positiva del promedio. Estos resultados serán útiles para discusiones futuras sobre los puntos de corte (baremos, el comportamiento del indicador cuando se correlaciona con deseabilidad social y la integración de la dimensión de Competencias Básicas para la Vida en el indicador de empleabilidad.

Propuesta metodológica para hacer un diagnóstico de la Educación para el Desarrollo

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Francisco Javier Gómez González

2012-01-01

Full Text Available El presente artículo quiere dar a conocer el diseño metodológico para la elaboración de un diagnóstico de situación de la educación para el desarrollo en Castilla y León, que se ha ideado desde el Observatorio de Cooperación Internacional de la Universidad de Valladolid con el fin de que el conocimiento sobre la situación actual de la educación para el desarrollo en Castilla y León sirva de base para la formulación de una futura estrategia de acción en educación para el desarrollo en la Comunidad.

Requisitos de clientes para o desenvolvimento de um implemento a fim de fechar taipas abertas para drenagem

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Ulisses Giacomini Frantz

2015-04-01

Full Text Available O arroz irrigado é cultivado na maior parte do RS com aplainamento da superfície do solo em desnível e sistema de cultivo mínimo. Com a semeadura em solo seco, há necessidade de conformar drenos, que cortam transversalmente as taipas, na área de cultivo. Para o estabelecimento da lâmina de água definitiva, essas taipas abertas para drenagem devem ser fechadas e, para essa finalidade, não existe um equipamento específico que execute tal atividade com devida agilidade e qualidade, sendo necessário o desenvolvimento de um implemento com este fim. Ainda, para o processo de desenvolvimento de máquinas agrícolas, faz-se necessário o levantamento de uma série de informações. Na fase de projetação, essas informações são necessárias para o estabelecimento das necessidades dos clientes/usuários e dos requisitos dos clientes, para posteriormente serem transformadas em requisitos de projeto e estabelecidas as especificações de projeto. Desse modo, este trabalho objetivou determinar os requisitos dos clientes, a partir das suas necessidades, para o projeto de um implemento com a função de fechamento de taipas abertas para drenagem no arroz irrigado. As informações foram levantadas a partir de pesquisas bibliográficas e aplicação de questionários a futuros clientes/usuários. Como resultados, foram identificadas as necessidades dos clientes, assim como 25 requisitos de clientes

Hiperacumulación de metales : ¿una ventaja para la planta y para el hombre?

OpenAIRE

Llugany i Ollé, Mercè; Tolrà Pérez, Roser; Poschenrieder, Charlotte; Barceló Coll, Juan

2007-01-01

La hiperacumulación es la capacidad que tienen algunas plantas para concentrar metales en sus tejidos a niveles muy por encima de los normales sin presentar síntomas de toxicidad. Estas plantas hiperacumuladoras han desarrollado mecanismos internos de tolerancia a la toxicidad por metales. Esta peculiaridad las hace útiles para el hombre como herramienta en las nuevas tecnologías de fitoremediación. Sin embargo, ¿cual es el beneficio de esta hiperacumulación de metales para la propia planta? ...

Hiperacumulación de metales: ¿una ventaja para la planta y para el hombre?

OpenAIRE

M. Llugany; R. Tolrà; C. Poschnrieder; J. Barceló

2007-01-01

La hiperacumulación es la capacidad que tienen algunasplantas para concentrar metales en sus tejidos a niveles muy por encima de los normales sin presentar síntomas de toxicidad. Estas plantas hiperacumuladoras han desarrollado mecanismos internos de tolerancia a la toxicidad por metales. Esta peculiaridad las hace útiles para el hombre como herramienta en las nuevas tecnologías de fitoremediación. Sin embargo, ¿cual es el beneficio de esta hiperacumulación de metales para la propia planta? S...

¿Para que la historia?

OpenAIRE

Jaime Jaramillo Uribe

1998-01-01

Para qué sirve la historia?. ¿Puede el conocimiento del pasado darnos pautas para comprender el presente? Sobre este, como sobre tantos problemas teóricos de la historia, se han realizado largos e inacabados debates entre historiadores y filósofos. En este ensayo se acepta como eficaz la hipótesis de que conocer el origen y el desarrollo de un proceso es buen fundamento para explicarse una situación final. En el caso de la historia colombiana, se parte de la base de que al producirse la indep...

Subvenciones para instituciones Directrices para gastos de ...

International Development Research Centre (IDRC) Digital Library (Canada)

IDRC CRDI

División de Administración de Subvenciones ... En la Parte 2 del Acuerdo de Subvención estándar de IDRC se incluyen los límites ... pagar los costos de sustitución (tiempo libre para personal académico) de los investigadores principales.

Zoneamento agroclimático da palma forrageira (Opuntia sp. para o estado da Paraíba

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Bergson G. Bezerra

2014-07-01

Full Text Available A palma forrageira tornou-se, ao longo dos anos, uma importante alternativa forrageira no semiárido brasileiro (SAB principalmente em longos períodos de estiagens. Apesar de sua magnitude para a agropecuária, seu cultivo tem dispensando tratos culturais básicos e embasamento técnico-científico quanto às suas exigências climáticas. Assim, o principal objetivo deste estudo foi elaborar o zoneamento agroclimático da cultura da palma forrageira (Opuntia sp. para o estado da Paraíba. O zoneamento agroclimático da palma forrageira foi elaborado com base nos indicadores climáticos delineados na literatura e nos dados climatológicos de precipitação e temperatura (média, máxima e mínima de 97 localidades do estado da Paraíba. De acordo com os resultados obtidos, a mesorregião da Borborema é a que apresenta as condições climáticas mais favoráveis para o cultivo da palma forrageira. As mesorregiões do Agreste, Sertão e a parte do Litoral, são aptas porém com restrições. No entanto, recomenda-se o cultivo da palma forrageira em todo o território do estado da Paraíba, exceto para a parte costeira da mesorregião do Litoral e região em torno de Areia. Em ambos os casos a inaptidão ocorre em função do excesso de precipitação.

Plan estratégico para la empresa Global Logistics (GL) para el periodo 2017-2019

OpenAIRE

Castello Manky, Luis Fernando; Grados Iturrizaga, Miguel Augusto; Hudson Okumura, Ciro

2017-01-01

El presente trabajo de investigación tiene como finalidad el desarrollo de un plan estratégico para la empresa Global Logistics (GL) para los años 2017 a 2019. Inicia con el análisis y diagnóstico situacional, donde se analiza el macroentorno en base al análisis PESTEL y luego se procede a analizar la industria considerando las cinco fuerzas de Porter, para, finalmente, determinar las oportunidades y amenazas que enfrenta la empresa. Una vez concluido el análisis y diagnóstico situacional, se...

Procedimiento para el cierre de canteras de materiales para construcción en Cuba

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Julio Montero-Matos

2016-03-01

Full Text Available Con el propósito de facilitar a los concesionarios de canteras de materiales para la construcción una herramienta metodológica para efectuar el cierre de estas y garantizar una minería sostenible se propuso un procedimiento en seis etapas a partir del diagnóstico realizado en 22 canteras, ubicadas en tres regiones mineras cubanas. El procedimiento busca disminuir los impactos ambientales provocados por la explotación de las canteras y ofrecer a la industria un estándar para lograr uniformidad en la planificación y ejecución del cierre con un costo mínimo.

Desenvolvimento de filmes biodegradáveis para cobertura de solo, ensacamento de frutos e sacos para mudas

OpenAIRE

Ana Paula Bilck

2010-01-01

Filmes plásticos de polietileno e polipropileno derivados do petróleo são amplamente utilizados na agricultura para a confecção de estufas, sacos para produção de mudas e filmes para cobertura do solo. Estes filmes constituem um sério problema ambiental, pois devido ao seu elevado peso molecular e propriedades hidrofóbicas, possuem alta estabilidade química, levando um longo tempo para se decompor totalmente e também são de difícil reciclagem. A utilização de polímeros biodegradáveis é uma al...

Taller para desarrollar la creatividad

OpenAIRE

MARTÍNEZ GUEROLA, BEATRIZ

2015-01-01

[ES] Partimos de la base de que la creatividad es una capacidad realmente valiosa, no solo para el ámbito artístico, si no para cualquier aspecto de la vida. Este proyecto está enfocado a un taller diseñado para que a partir de técnicas de expresión gráfico-plásticas podamos estimular y desarrollar la creatividad, principalmente en niños de tercer ciclo de primaria. Con este proyecto relacionamos el arte y la creatividad que se asocia a esté con la educación. Martínez Guerola, B. (2015). T...

Sistema solar para aquecimento ambiente e aquecimento de piscinas: uma solução promissora para climas do Sul da Europa

OpenAIRE

Carvalho, M. J.; Neves, Ana

2006-01-01

A avaliação do sistema apresentado neste trabalho foi focada em sistemas que podem fornecer água quente, aquecimento ambiente e aquecimento de piscinas, e que são projectados para climas do Sul da Europa, especialmente para habitações uni-familiares. Pelas características climáticas do Sul da Europa, o aquecimento ambiente é apenas necessário para um curto período do ano, sendo para esta avaliação considerado um período de seis meses para aquecimento ambiente e um período de seis meses para a...

MODELO PARA DETERMINAR FUNÇÕES TRANSFERÊNCIA PARA ANÁLISE DE ESTABILIDADE DE VANTS

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Igor Mayer Soares

2017-01-01

Full Text Available Neste trabalho foi apresentado um modelo para determinar as funções de transferência para análise da estabilidade longitudinal de Veículos Aéreos Não Tripulados (VANT através do desenvolvimento simplificado das equações do movimento de aeronaves. O sistema foi simplificado considerando que o motor e o arrasto na superfície de comando não influenciam na dinâmica do veículo, pois o mesmo é significativamente menor que um avião. Analisamos também a resposta em função do tempo para as deflexões das superfícies de comando. Nos resultados apresentados é possível perceber que mesmo simples, o modelo oferece uma boa aproximação para análise dinâmica de VANTs e predizer sua estabilidade e qualidade de voo.

MODELO PARA LA CREACIÓN DEL CONOCIMIENTO PARA PYMES

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Marino Valencia Rodríguez

2009-01-01

Full Text Available La creciente importancia del conocimiento, como nuevo factor de producción, hace que la creación y transferencia se convierta en una de las principales prioridades de las organizaciones. El presente artículo describe tanto los fundamentos de la teoría de los recursos y capacidades de la empresa como el enfoque de la gestión del conocimiento, con sus procesos de generación y transferencia del conocimiento. Estos sirven de guía básica teórica para alcanzar el siguiente objetivo: Diseñar un modelo de generación y transferencia de conocimiento para los procesos de dirección, gestión humana y del conocimiento para PyMES, con el fin de que éstas alcancen mayores niveles de competitividad. El modelo se diseña, a partir del direccionamiento estratégico de la organización. Está conformado por tres etapas, articuladas con elementos y actividades. Las acciones se enfocan en dos factores clave de éxito: la cultura organizacional y la formación. La utilización del modelo permitirá a las PyMES optimizar los recursos y capacidades disponibles, lo cual se refleja en el desempeño del trabajador y en el fortalecimiento de la cultura organizacional.

Flora da Paraíba, Brasil: Loganiaceae Flora of Paraíba, Brazil: Loganiaceae

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Kiriaki Nurit

2005-06-01

Full Text Available Neste trabalho apresenta-se o tratamento taxonômico da família Loganiaceae, como parte do projeto "Flora da Paraíba", que vem sendo realizado com o objetivo de identificar e catalogar as espécies da flora local. Realizouse coletas e observações de campo para as identificações, descrições e ilustrações botânicas que foram efetuadas após estudos morfológicos, com o auxílio da bibliografia especializada, complementados pela análise de fotos de tipos, espécimes dos herbários EAN, JPB e IPA, e comparação com material identificado por especialistas. Registrou-se para a Paraíba quatro espécies: Spigelia anthelmia L., com ampla distribuição, e três espécies de Strychnos, somente coletadas em remanescentes de Mata Atlântica, S. atlantica Krukoff & Barneby, S. parvifolia A. DC. e S. trinervis (Vell. Mart.This work constitutes a taxonomic treatment of the Loganiaceae family as part of the project "Flora da Paraíba", which have been carried out with the objective to identify and catalogue the species of the local flora. The botanical identifications and illustrations were made by morphological studies supported by bibliography, analysis of the types, specimens from herbaria EAN, JPB and IPA, and comparison with samples previously identified by specialists, complemented by field observations. Four species of Loganiaceae belonging two genera were found in State of Paraíba: Spigelia anthelmia L. that has wide distribution and three species of Strychnos, found on remains of Atlantic forest, which are S. atlantica Krukoff & Barneby, S. parvifolia A. DC. and S. trinervis (Vell. Mart.

Educación para emprender una alternativa para el siglo XXI

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Luis Gerardo Rodríguez Gómez

2015-05-01

Full Text Available RESUMEN El artículo describe la experiencia educativa del programa Físico- Deportivo orientado a estimular la actitud para emprender dentro de una concepción de forma integral, mediante Asignaturas de contenido Sico- físico, como parte del desarrollo curricular en Facultades de Administración de Empresas e ingeniería de Sistemas en la Escuela de Administración de Negocios (EAN. El desarrollo temático hace énfasis en un proceso orientado  a superar formas de educación encaminadas al logro de habilidades técnicas para el ejercicio de un empleo y propone desde  la educación delas conductas  motrices, modos de encausar la energía sicosomática con el fin de asimilar la incertidumbre del momento histórico que se vive en los países de lento desarrollo, para corresponder a un mundo que empuña la bandera de la diversidad, el cambio acelerado y la competencia tecnológica.

La carrera profesional para el profesorado

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José Gimeno Sacristán

2010-01-01

Full Text Available La carrera del profesorado es un instrumento para el reconocimiento del mérito de los profesores en el desarrollo de su profesionalidad -lo cual supone atender a la mejora de sus capacidades cognitivas como a su competencia reflexivo-práctica- cuyos fines son la motivación para el ejercicio de sus funciones, reforzar su compromiso con la educación en general y como forma de reconocer con justicia el mérito de los mejores profesionales. Desde un punto de vista estrictamente educativo, la carrera debe servir para la mejora de las prácticas de enseñanza que incidan en la mejora de los aprendizajes. Esta pretensión nos exige explicitar los criterios para determinar lo que entendemos como buenas prácticas y precisar los criterios para su evaluación. La complejidad de la enseñanza requiere metodologías adecuadas para abordar procesos de índole cualitativa. La regulación de la carrera docente tiene que superar tanto el cuantitativismo fácil en los métodos y la regulación burocrática de niveles de calidad, así como contemplar un conjunto de incentivos no solamente salariales.

Tiempo para un cambio

Science.gov (United States)

Woltjer, L.

1987-06-01

En la reunion celebrada en diciembre dei ano pasado informe al Consejo de mi deseo de terminar mi contrato como Director General de la ESO una vez que fuera aprobado el proyecto dei VLT, que se espera sucedera hacia fines de este aAo. Cuando fue renovada mi designacion hace tres aAos, el Consejo conocia mi intencion de no completar los cinco aAos dei contrato debido a mi deseo de disponer de mas tiempo para otras actividades. Ahora, una vez terminada la fase preparatoria para el VLT, Y habiendose presentado el proyecto formalmente al Consejo el dia 31 de marzo, y esperando su muy probable aprobacion antes dei termino de este ano, me parece que el 10 de enero de 1988 presenta una excelente fecha para que se produzca un cambio en la administracion de la ESO.

Leasing: una alternativa de financiamiento para PYMES

OpenAIRE

Bedjan, María Belén

2008-01-01

En la actualidad las pequeñas y medianas empresas encuentran dificultades para acceder a las líneas tradicionales de créditos bancarios. Por otro lado las empresas necesitan actualizarse constantemente para poder ser competitivas en el mercado. Es aquí donde el leasing nace como una alternativa de financiación para las PyMEs. Este trabajo pretendió demostrar la conveniencia financiera del leasing con respecto a los préstamos bancarios para la compra de maquinarias agrícolas ...

Estrategia para elevar la motivación laboral; factor imprescindible para mejorar nuestra productividad.

Directory of Open Access Journals (Sweden)

Reina de los Ángeles Carballé Piñón

2015-12-01

Full Text Available Este trabajo "Estrategia para elevar la motivación laboral; factor imprescindible para mejorar nuestra productividad" resulta de la investigación realizada para tesis de maestría; se realizó el estudio de 2 entidades, nos permitió conocer las principales posiciones que sobre motivación existen, factores que la influencian, cómo incide en el desempeño laboral y que acciones diseñar para elevarla. Las 2 entidades seleccionadas, claves en el desempeño empresarial son un centro de interfase y un centro generador de conocimientos, nuestro objetivo principal es sugerir propuestas que eleven la motivación de los trabajadores del CIGET(centro de interfase y la Universidad de Sancti Spíritus(centro generador de conocimientos por desempeñar una mejor labor y lograr así aumento de la eficacia, eficiencia y productividad; este se concreta específicamente en determinar qué factores ocasionan desmotivación en los trabajadores del CIGET y la Universidad, identificar aquellos factores que realmente motivan a estas personas, de manera individual como colectivamente y trazar una estrategia con el objetivo de elevar la motivación de los trabajadores hacia la actividad que realizan y dotar a estos de herramientas para la identificación de actitudes positivas o negativas en el ámbito laboral y cómo potenciarlas o minimizarlas según sea el caso.

Competencia para desarrollar la alfabetización digital

OpenAIRE

González Rodríguez, José Santiago; Navarrete Aguirre, Mariana; Molina Zacate, Ma. Gabriela

2011-01-01

Introducción, Objetivos Generales, Temario: (1) ¿Qué significa la competencia para desarrollar la alfabetización digital? (2) ¿Por qué es relevante que adquiera la competencia para desarrollar la alfabetización digital en mi formación? (3) ¿Cómo aprendo la competencia para desarrollar la alfabetización digital? (4) ¿Cómo aplico la competencia para desarrollar la alfabetización digital? (5) ¿Cómo puedo autoevaluar mi competencia para desarrollar la alfabetización digital (...

Evaluation of trigeminal neurovascular compression in patients with trigeminal neuralgia with 3.0 T MRI

International Nuclear Information System (INIS)

Zhang Lirong; Wang Dehang; Wang Dongqing; Wu Min; Xu Guangming; Ma Cong

2012-01-01

Objective: To identify anatomical characteristics of neurovascular compression associated with trigeminal neuralgia (TN). Methods: Fifty patients with TN (23 of 50 patients underwent microvascular decompression) and 50 patients without facial pain underwent 3.0 T MRI scanning for analysis of 50 trigeminal nerves ipsilateral to TN symptoms, 50 contralateral to TN symptoms, and 100 in asymptomatic patients. MRI sequences included balanced fast-field echo and 3D MR angiography. Images were fused and reconstructed into virtual cisternoscopy images to determine the degree (severity of compression was defined as follows: 1=no compression; 2 =compressed by a vein; 3 =contacted by an artery; 4 =indented by an artery; and 5 =nerve displaced or distorted by an artery) and site of neurovascular compression (the point of each offending vascular structure: proximal was defined as located in 1/3 length of the cisternal segment of the trigeminal nerve near root entry zone; the place of superior was defined as above the cisternal segment of the trigeminal nerve). Reconstructed MPR images were used to measure nerve length and cross sectional area. The chi-square test was used for all 2 × 2 contingency tables. The t-test was used for dependent samples. The Logistic regression was used for prediction of occurrence of the event of TN. Results: Twenty-three of 50 patients with TN underwent microvascular decompression, which confirmed predicted neurovascular relationships in all cases, and 21 of 23 patients were pain free after the operation. The incidence of neurovascular compression on asymptomatic nerves (no. of level 1=79, level 2=5, level 3 =8, level 4 =8), on nerves contralateral to TN symptoms (no. of level 1=27, level 2 =6, level 3 =9, level 4 =8), and on nerves ipsilateral to TN symptoms (no. of level 1=4, level 2 =12, level 3 =12, level 4 =7, level 5 =15) was 21.0% (21/100), 46.0% (23/50), and 92.0% (46/50), respectively. The difference between symptomatic and asymptomatic

Motivacao para o tratamento. Dados psicometricos da escala SOCRATES 8D e estrategias psicoterapeuticas para motivar para o tratamento

OpenAIRE

Janeiro, Luís; Faísca, Luís

2008-01-01

A motivação para o tratamento é considerada um factor fundamental para o processo de mudança e tratamento do toxicodependente. Prochaska, Diclemente, e Norcross (1992) consideram que a motivação que o sujeito possui no início do tratamento determina directamente os resultados alcançados no mesmo. Diclemente, Bellino, e Neavins (1999) acrescentam, ainda, que a estreita relação entre os resultados obtidos no tratamento e a motivação aquando do seu início pode ser medida pela formação precoce de...

La estrategia educativa 2020 o las limitaciones del Banco Mundial para promover el "aprendizaje para todos"

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Antoni Verger

2011-12-01

Full Text Available LA NUEVA Estrategia Educativa 2020 del Banco Mundial establece las prioridades de reforma educativa en países en vías de desarrollo para la década siguiente. El título explícito de la estrategia, Aprendizaje para Todos, es un claro reconocimiento de que, más allá de políticas centradas en el acceso, se debe hacer algo más para asegurar que la educación derive en experiencias positivas de aprendizaje. Sin embargo, como este artículo sostiene, las opciones de políticas explícitas y latentes en la Estrategia 2020 no son las más adecuadas para lograr el Aprendizaje para Todos. El artículo desarrolla tres tipos de argumentos al respecto. El primero se refiere al fuerte apego del Banco a un conocimiento disciplinario y un enfoque metodológico que es insuficiente para entender lo que aprenden los niños en la escuela y por qué. El segundo argumento se refiere al sesgo pro-mercado de la Estrategia por lo que respecta a la reforma del sector público y a nuevas formas de oferta educativa. En tercer lugar, el artículo señala las principales ausencias de la Estrategia, con especial atención a las omisiones relacionadas con la compleja relación entre educación y pobreza.

Inteligencia Emocional para tiempos de crisis

OpenAIRE

Fernández-Berrocal, Pablo

2014-01-01

La Inteligencia Emocional se concibe como un conjunto de habilidades, tanto básicas como complejas, dirigidas a “unificar las emociones y el razonamiento”, esto es, usar las emociones para facilitar el razonamiento y los procesos de pensamiento, y usar nuestro razonamiento para pensar de forma inteligente acerca de nuestras emociones (Mayer y Salovey, 1997). En concreto, la IE se define como una habilidad mental que incluye “la capacidad para percibir, valorar y expresar las emociones con...

GRASP para o PQA: um limite de aceitação para soluções iniciais

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Range Maria Cristina

2000-01-01

Full Text Available O Problema Quadrático de Alocação (PQA pertence à classe dos problemas NP-Hard e desafia os pesquisadores tanto em sua teoria quanto em sua parte computacional. Pela sua alta complexidade muitos métodos heurísticos têm sido desenvolvidos para tentar resolvê-lo aproximadamente. A metaheurística GRASP (greedy randomized adaptive search procedures se mostrou bastante eficiente. Neste trabalho, uma proposta para descartar soluções iniciais supostamente ruins é apresentada com base na normalização de custos calculadas num intervalo entre limites de solução. Para este GRASP restrito, foi observada uma redução do tempo computacional para encontrar as soluções ótimas ou soluções viáveis de boa qualidade quando comparado ao GRASP original.

Paisajes para un desarrollo sustentable y participativo

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Rafael Mata Olmo

2014-11-01

Para terminar, el texto recoge una experiencia de proyecto territorial de paisaje, la del Plan Insular de Menorca (Islas Baleares, España, aprobado en 2003. Se sintetizan sus determinaciones sobre la protección de determinados terrenos por sus altos valores paisajísticos, sus directrices para que las políticas sectoriales (turismo, agricultura, infraestructuras, etc. incorporen criterios paisajísticos, y sus iniciativas para la gestión y mejora del paisaje y para el fomento del acceso público a su contemplación y disfrute.

Sistema de realidad aumentada para aplicaciones Android

OpenAIRE

Fernández Sánchez, Natalia Mercedes

2012-01-01

El objetivo principal de este proyecto es la creación de un sistema de realidad aumentada para el sistema operativo Android con idea de que sea utilizado para la creación de un videojuego, pero que a su vez sea lo suficientemente versátil como para poder utilizarse en otro tipo de aplicaciones. De este objetivo principal podemos obtener los objetivos secundarios: - Conocer las características que ofrecen los teléfonos móviles y como éstas pueden ser aprovechadas para la crea...

Marco de referencia para el desarrollo de un sistema de apoyo para la toma de decisiones para la gestión de inventarios

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Carlos Alberto Castro Zuluaga

2014-01-01

Full Text Available El principal objetivo de este artículo es presentar un marco de referencia para desarrollar un sistema de soporte a la toma de decisiones para la gestión de inventarios que permita definir técnicamente los parámetros de una política de control de inventario específica. El modelo propuesto puede ser utilizado de forma genérica en casi cualquier tipo de industria, el cual incluye las entradas fundamentales, una descripción de los procesos internos requeridos y las salidas esperadas. En la investigación se utilizaron métodos inductivos-deductivos para definir el marco de referencia propuesto, el cual se fundamenta en dos indicadores clave en la gestión de inventario: niveles de servicio y costos. Finalmente, mediante una simulación es posible concluir que utilizando los parámetros teóricos para el modelo de inventario punto de reorden-cantidad fija, que son encontrados por el marco de referencia propuesto, se obtienen aproximadamente los valores esperados tanto de los niveles de servicio como de los costos.

Meios e fins do desenvolvimento para Celso Furtado

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Fabio Antonio de Campos

2014-10-01

Full Text Available O objetivo desse artigo é expor o conceito de desenvolvimento para Celso Furtado. Para tanto, nos interessa apresentar o desenvolvimento nacional como um fim em sua abordagem sobre a formação social brasileira Para atingir tal estágio, os meios para o autor seriam assegurados por um típico desenvolvimento capitalista. Dentro dessa problemática, mostraremos também o alcance e os limites dessa concepção para o caráter dependente e subdesenvolvido do capitalismo brasileiro.

Metodología para un proceso de planeación estratégica para las PYMES

OpenAIRE

Bonilla Zhindón, Daniela

2014-01-01

Todas las organizaciones, grandes, medianas, pequeñas, públicas y privadas, requieren de un plan estratégico estructurado para determinar las posiciones futuras en las que desean estar, por este motivo el propósito del presente estudio es construir una metodología transversal para el levantamiento de la planeación estratégica para el sector de calzado en la ciudad de Cuenca, mediante un análisis del estado en la que se encuentran las empresas en cuanto al proceso de planificación estratégica,...

Coccocypselum pulchellum (Rubiaceae, nuevo registro para Argentina

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Elsa L. Cabral

2007-01-01

Full Text Available Se cita Coccocypselum pulchellum por primera vez para Argentina, en Predio Guaraní, Misiones. Esta es la tercera especie de Coccocypselum registrada para la flora de Argentina junto con C. hasslerianum y C. lanceolatum. Se incluyen descripciones, ilustraciones y una clave para reconocer las tres especies argentinas de Coccocypselum.

Ultrasound-Guided Intermediate Site Greater Occipital Nerve Infiltration: A Technical Feasibility Study.

Science.gov (United States)

Zipfel, Jonathan; Kastler, Adrian; Tatu, Laurent; Behr, Julien; Kechidi, Rachid; Kastler, Bruno

2016-01-01

Two studies recently reported that computed tomography (CT) guided infiltration of the greater occipital nerve at its intermediate site allows a high efficacy rate with long-lasting pain relief following procedure in occipital neuralgia and in various craniofacial pain syndromes. The purpose of our study was to evaluate the technical feasibility and safety of ultrasound-guided intermediate site greater occipital nerve infiltration. Retrospective study. This study was conducted at the imaging department of a 1,409 bed university hospital. Local institutional review board approval was obtained and written consent was waived. In this retrospective study, 12 patients suffering from refractory occipital neuralgia or craniofacial pain syndromes were included between April and October 2014. They underwent a total of 21 ultrasound-guided infiltrations. Infiltration of the greater occipital nerve was performed at the intermediate site of the greater occipital nerve, at its first bend between obliqus capitis inferior and semispinalis capitis muscles with local anestetics and cortivazol. Technical success was defined as satisfactory diffusion of added iodinated contrast media in the fatty space between these muscles depicted on control CT scan. We also reported first data of immediate block test efficacy and initial clinical efficacy at 7 days, one month, and 3 months, defined by a decrease of at least 50% of visual analog scale (VAS) scores. Technical success rate was 95.24%. Patients suffered from right unilateral occipital neuralgia in 3 cases, left unilateral occipital neuralgia in 2 cases, bilateral occipital neuralgia in 2 cases, migraine in one case, cervicogenic headache in one case, tension-type headache in 2 cases, and cluster headache in one case. Block test efficacy was found in 93.3% (14/15) cases. Clinical efficacy was found in 80% of cases at 7 days, in 66.7% of cases at one month and in 60% of cases at 3 months. No major complications were noted. Some of the

Modelo para determinar as exigências de proteína para poedeiras Modelling protein utilization in laying hens

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Nilva Kazue Sakomura

2002-11-01

Full Text Available O objetivo do trabalho foi elaborar um modelo para estimar as exigências de proteína bruta (PB para poedeiras leves, usando o método fatorial. Para determinar as exigências de proteína bruta (PB para manutenção foi utilizada a técnica do balanço de nitrogênio. A exigência de proteína bruta para o ganho de peso foi determinada em função do conteúdo de nitrogênio na carcaça e a eficiência de utilização do nitrogênio da dieta. A exigência de PB, para produção de ovos, foi determinada considerando o teor de PB determinado nos ovos e a eficiência de deposição do nitrogênio no ovo. A partir dos valores das exigências para manutenção, para o ganho e produção foi elaborada uma equação para predizer as exigências diárias de PB (g/ ave/ dia para poedeiras: PB = 1,94. P0,75 + 0,48.G + 0,301.O, em que P = peso corporal (kg, G = ganho de peso diário (g/dia e O = massa de ovos produzida (g/ave/dia.The objective of this study was to determine a model for crude protein requirements (CP for laying hen by the factorial method. The protein maintenance requirement was determine by the nitrogen balance technique . The crude protein requirement for weight gain was determined based on body nitrogen content and nitrogen efficiency for body deposition. The crude protein requirement for egg production was determined based on the nitrogen content of eggs and nitrogen efficiency for egg deposition. Considering the requirements for maintenance, egg production and weight gain, it was elaborated a protein requirement model for laying hen: PB = 1.94xW.75 + 0.480xG + 0,301x E, where PB = requirement (g/bird/day, W = body weight (kg, G = daily weight gain (g/day and E = egg mass (g/bird/day.

Trigeminal nerve anatomy in neuropathic and non-neuropathic orofacial pain patients.

Science.gov (United States)

Wilcox, Sophie L; Gustin, Sylvia M; Eykman, Elizabeth N; Fowler, Gordon; Peck, Christopher C; Murray, Greg M; Henderson, Luke A

2013-08-01

Trigeminal neuralgia, painful trigeminal neuropathy, and painful temporomandibular disorders (TMDs) are chronic orofacial pain conditions that are thought to have fundamentally different etiologies. Trigeminal neuralgia and neuropathy are thought to arise from damage to or pressure on the trigeminal nerve, whereas TMD results primarily from peripheral nociceptor activation. This study sought to assess the volume and microstructure of the trigeminal nerve in these 3 conditions. In 9 neuralgia, 18 neuropathy, 20 TMD, and 26 healthy controls, the trigeminal root entry zone was selected on high-resolution T1-weighted magnetic resonance images and the volume (mm(3)) calculated. Additionally, using diffusion-tensor images (DTIs), the mean diffusivity and fractional anisotropy values of the trigeminal nerve root were calculated. Trigeminal neuralgia patients displayed a significant (47%) decrease in nerve volume but no change in DTI values. Conversely, trigeminal neuropathy subjects displayed a significant (40%) increase in nerve volume but again no change in DTI values. In contrast, TMD subjects displayed no change in volume or DTI values. The data suggest that the changes occurring within the trigeminal nerve are not uniform in all orofacial pain conditions. These structural and volume changes may have implications in diagnosis and management of different forms of chronic orofacial pain. This study reveals that neuropathic orofacial pain conditions are associated with changes in trigeminal nerve volume, whereas non-neuropathic orofacial pain is not associated with any change in nerve volume. Crown Copyright © 2013. Published by Elsevier Inc. All rights reserved.

Postherpetic neuralgia - aftercare

Science.gov (United States)

... your everyday activities and make it hard to work. Affect how involved you are with friends and family. Cause feelings of frustration, resentment, and stress. These feelings may make your pain worse.

Tuberculose em Salvador: custos para o sistema de saúde e para as famílias

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Costa João G

2005-01-01

Full Text Available OBJETIVO: A tuberculose é uma das maiores causas de mortalidade no mundo, porém seus efeitos econômicos são pouco conhecidos. O objetivo do estudo foi o de estimar os custos do tratamento e prevenção da tuberculose para o sistema de saúde (público e privado e para as famílias. MÉTODOS: O estudo foi realizado no município de Salvador, BA, em 1999. Os dados para estimação dos custos para o sistema de saúde foram coletados nas secretarias de saúde, centros de saúde e em uma entidade filantrópica. Os custos públicos e privados foram estimados pela metodologia da contabilidade de custos. Os dados de custos para as famílias foram coletados por meio de questionários e incluem despesas com transporte, alimentação e outros, bem como as perdas de renda associadas à doença. RESULTADOS: O custo médio para tratamento de um caso novo de tuberculose foi de aproximadamente R$186,00 (US$103; para o tratamento de um paciente multiresistente o custo foi 27 vezes mais alto. Os custos para o serviço público corresponderam a 65% em internações, 32% em tratamento e apenas 3% em prevenção. As famílias comprometeram cerca de 33% da sua renda com despesas relacionadas a tuberculose. CONCLUSÕES: Apesar do fato das famílias não terem que pagar por medicamentos e tratamento, dado que este serviço é oferecido pelo Estado, os custos familiares ligados a perda de rendimentos devido a doença foram muito elevados. A proporção utilizada em prevenção pelo serviço público é pequena. Um maior investimento em campanhas de prevenção poderia não somente diminuir o número de casos, mas também, levar a um diagnósticos precoce, diminuindo os custos associados à hospitalização. A falta de um sistema integrado de custos não permite a visualização dos custos nos diversos setores.

UNA PROPUESTA EVALUATIVA PARA ACTIVIDADES DE EDUCACIÓN AMBIENTAL PARA LA SOSTENIBILIDAD

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Rosa M. Medir Huerta

2016-01-01

Full Text Available El propósito de este artículo es presentar una propuesta evaluativa para ac - tividades de educación ambiental para la sostenibilidad en el ámbito escolar ofrecidas desde entidades externas a la escuela. Para ello, se realiza una eva - luación real de un programa educativo de una administración pública que se orienta al refuerzo del currículo de educación infantil, primaria y secundaria. El objetivo de la evaluación es diagnosticar la presencia, en las actividades estudiadas, de principios clave de la educación ambiental para la sosteni - bilidad identificados por el equipo de investigación a partir de referencias internacionales. La metodología es la investigación evaluativa de programas dentro del paradigma crítico de la investigación educativa y con herramientas de tipo cuantitativo. Se utiliza, básicamente, un cuestionario expresamente diseñado que valora la presencia y la ausencia de los principios establecidos de la educación ambiental para la sostenibilidad. Los resultados nos aportan nuevas informaciones acerca de las fortalezas y las debilidades del desarrollo de actividades de educación ambiental. Se llega a una valoración cuantificada de los principios definidos en tres grupos, según su necesidad de mejora, y se determina que los principios mejor tratados en las actividades son los que se relacionan con los contenidos disciplinares más clásicos, tratados con buenos y distintos métodos didácticos. En cambio, las debilidades detectadas se refieren a aspectos cruciales de la educación ambiental tales como experimentar nuevas sensaciones, aprender a buscar información, pensamiento crítico, sentimiento de pertenencia a un lugar, trabajo en colaboración, adquirir una visión global de la realidad, y reflexionar sobre la vida cotidiana y sobre el futuro deseado.

MR imaging findings of neurosarcoidosis of the gasserian ganglion: an unusual presentation

Energy Technology Data Exchange (ETDEWEB)

Arias, Mercedes; Iglesias, Alfonso; Vila, Oscar; Brasa, Jose [Unidad de Resonancia Magnetica (MEDTEC), Hospital Xeral-Cies, 36204 Vigo (Spain); Conde, Cesareo [Servicio de Neurocirugia, Hospital Xeral-Cies, 36204 Vigo (Spain)

2002-11-01

We report the MR imaging findings of an unusual case of neurosarcoidosis of the gasserian ganglion associated with trigeminal neuralgia. No other neurological or extraneurological localization was found. Magnetic resonance imaging demonstrated a mass in the Meckel's diverticulum that was isointense on T1-weighted images and hypointense on T2-weighted images. Gadolinium-enhanced MR imaging showed heterogeneous enhancement. Although rare, sarcoid infiltration of the gasserian ganglion must be considered in the differential diagnosis of an isolated mass in this localization in patients with trigeminal neuralgia. (orig.)

MR imaging findings of neurosarcoidosis of the gasserian ganglion: an unusual presentation

International Nuclear Information System (INIS)

Arias, Mercedes; Iglesias, Alfonso; Vila, Oscar; Brasa, Jose; Conde, Cesareo

2002-01-01

We report the MR imaging findings of an unusual case of neurosarcoidosis of the gasserian ganglion associated with trigeminal neuralgia. No other neurological or extraneurological localization was found. Magnetic resonance imaging demonstrated a mass in the Meckel's diverticulum that was isointense on T1-weighted images and hypointense on T2-weighted images. Gadolinium-enhanced MR imaging showed heterogeneous enhancement. Although rare, sarcoid infiltration of the gasserian ganglion must be considered in the differential diagnosis of an isolated mass in this localization in patients with trigeminal neuralgia. (orig.)

TRABALHAR PARA ESTUDAR / ESTUDAR PARA TRABALHAR: REALIDADE E POSSIBILIDADES

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Janes Siqueira

2011-07-01

Full Text Available O trabalho que apresentamos é parte da pesquisa com os estudantes das licenciaturas e da pedagogia da Universidade de Santa Cruz do Sul-UNISC-RS-Brasil. Este está inserido na linha de pesquisa: educação, trabalho e emancipação. Queremos compreender, à luz do materialismo histórico e dialético e das categorias da crítica da economia política, os significados atribuídos pelos estudantes universitários ao fenômeno trabalho e estudo. É uma pesquisa preferentemente qualitativa de natureza dialética. Para Marx, a essência da realidade humana reside no trabalho, mas a fonte de toda a riqueza está na natureza. Logo, trabalho, natureza e sociedade estão em relação dialética. Trabalho, portanto, é a ideia central articuladora, e natureza e sociedade devem ser estudadas em conexão com o trabalho. Marx trata o trabalho, no modo de produção capitalista, como impedimento ao desenvolvimento humano. Propõe o mesmo como um ato de criação e auto-expressão humana que não deve ter um valor. A compreensão dessa premissa é necessária para que os trabalhadores possam significar e ressignificar o trabalho para além da ideologia dominante. Algumas categorias aparecem como relevantes para a análise: condições de trabalho e de estudo, necessidade de formação, predominância do trabalho sobre o estudo, dificuldade de conciliar tempo de estudo e de trabalho. Na relação com o objeto de estudo, ressaltaremos a crise estrutural do capital, a desregulamentação das leis do trabalho e sua flexibilização e as contradições entre trabalho e estudo bem como quais possibilidades emancipatórias são visualizadas ou sonhadas pelos trabalhadores-estudantes. PALAVRAS-CHAVE: contradições entre trabalho e educação, condições e significados, realidade e possibilidades.

Educación para la sostenibilidad

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Educadores por la sostenibilidad

2006-04-01

Full Text Available La importancia dada por los expertos en sostenibilidad al papel de la educación queda reflejada en el lanzamiento mismo de la Década de la Educación para el Desarrollo Sostenible o, mejor, para un futuro sostenible (2005-2014 a cuyo impulso y desarrollo esta destinado este artículo, así como la página web que la Organización de Estados Iberoamericanos ha habilitado dentro de su portal digital, para la celebración de la Década.

Obtención de ferromanganeso alto carbono y escoria para el desarrollo de materiales para soldar

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Lorenzo Perdomo-González

2000-03-01

Full Text Available En el presente trabajo se realiza un análisis de la posibilidad de empleo de pirolusita en el desarrollo de aleaciones al manganeso y escorias con un sistema de óxidos MnO-SiO2-CaO con características propias para el desarrollo de fundentes para la soldadura automática para arco sumergido (SAAS. A partir de la composición química del mineral de manganeso se realizan los cálculos del proceso de reducción con el empleo de la tecnología sin fundente en presencia de coque como reductor, obteniéndose las adecuadas composiciones y las propiedades de los productos del proceso. Se realiza una corrida experimental de obtención de ferromanganeso con adiciones de dolomita, caolín y fluorita como correctores de la escoria. Se conforma una matriz de fundente para arco sumergido con la escoria y se le evalúan las propiedades tecnológicas de soldadura.

Avaliação das competências de professores de enfermagem para desenvolver programas educativos para adultos

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Patricia Bover Draganov

2013-08-01

Full Text Available Avaliar o desempenho que o enfermeiro docente de enfermagem atribui a si, nas competências para desenvolver programas educativos para adultos, foi objetivo desse estudo descritivo, comparativo, transversal e quantitativo, desenvolvido com 226 docentes enfermeiros de cursos de graduação em enfermagem paulistanos. Os dados foram colhidos por escala de Likert, lançados em planilha Excel® e analisados por estatística descritiva e testes não paramétricos de Wilcoxon e Friedman. A população tinha predominantemente entre 46-55 anos (87/38,49%, eram mulheres (198/87, 61% e mestres (180/79, 65%. Os professores consideraram-se distantes das competências que almejavam alcançar. A menor habilidade esteve em construir desenhos de programas para atender às situações de aprendizagem e a maior, em avaliar programas de ensino. O maior desejo esteve em desenhar programas com formatos criativos e o menor desejo para usar conselhos, comitês e força-tarefa. Concluiuse que desenhar programas educativos para adultos ainda é algo pouco explorado e pouco experenciado por esses docentes.

Caminhos para a gestão integrada do território no Vale do Paraíba de 1950 a 2004

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José Luiz Ronca Caruso

2004-01-01

Full Text Available The Paraíba Valley region and its political-administrative frame. The region and its two phases of Planning: the economic development and the sustainable one. The Paraíba Valley Road System as a policy of the economic planning. The Paraíba Valley Region and its physical conformation: the Paraíba do Sul river basin. The water resources management in the Paraíba do Sul river basin. Two levels of management: the federal and the one of the State. The water resources Planning and its possibilities for a sustainable development of the region, through a comprehensive management

Universidades accesibles para todos

Directory of Open Access Journals (Sweden)

Roxana Stupp Kupiec

2001-01-01

Full Text Available Este trabajo pretende hacer conciencia sobrelos factores que inciden en la construcción colectiva deuniversidades dispuestas a innovar y transformar suideología, sus políticas, el currículum, los servicios estu-diantiles, la infraestructura física y administrativa y lasestrategias de comunicación e información, bajo el para-digma de la accesibilidad en el entorno. Se hace referen-cia al marco legal internacional y nacional que orientalas acciones que deben planificarse e implementarse enlas instituciones de Educación Superior.En la construcción de universidades accesibles para to-dos se requiere de un cambio en la concepción curricu-lar. Se analizan conceptos como la flexibilidad en la for-mación y el acceso a los planes de estudio para respondera las necesidades educativas de todos los estudiantes. Para promover estas transformaciones se proponen prin-cipios y prácticas tales como la interdisciplinareidad y lainclusión del tema de la discapacidad en todas las carre-ras. Además, se presentan ejemplos de aplicación en dife-rentes áreas del perfil profesional, en la formación deldocente universitario y en actividades de proyección so-cial, vida estudiantil e investigación. En el ámbito estu-diantil, se describen algunos servicios y procesos que sehan desarrollado en la Universidad de Costa Rica

Propuesta para el cálculo del Índice Dm para la validez de los ítemes

OpenAIRE

Dominguez Lara, Sergio

2013-01-01

Se presenta un programa en formato MS Excel para calcular el índice Dm para la validez de los ítemes. La validez es un proceso de acumulación de pruebas para apoyar la interpretación y el uso de las puntuaciones de los tests psicológicos, siendo las relaciones de los puntajes con otras variables externas una importante fuente de validación. Una variante es la llamada validez relacionada al criterio, en la cual se espera una correlación significativa con aquellos criterios externos que son teó...

Educación para el Ocio: Ha llegado la hora de un nuevo objetivo para una vieja idea.

Directory of Open Access Journals (Sweden)

Susan Hutchinson

2012-01-01

Full Text Available La Educación para el Ocio nos sitúa ante una vieja idea, que está siendo examinada con renovado vigor en Canadá. Profesionales e investigadores de diversas disciplinas (por ejemplo, en el ámbito de Salud, la Justicia, la Educación o la Recreación reconocen, cada vez más, que son muchas las personas que pueden beneficiarse del ocio y de las oportunidades de recreación en sus comunidades, aún cuando son bastantes las no pueden hacerlo porque carecen de alfabetización en ocio. Esto es, de los conocimientos, habilidades y confianza que se necesitan para darle un significado personal, que incida positivamente en su bienestar y calidad de vida. La Educación para el Ocio es un medio clave para mejorar la alfabetización en ocio. El texto presenta un modelo de educación para el ocio desarrollado por la Dra. Brenda Robertson, argumentando cómo y por qué la Educación para el Ocio es necesaria para abordar la salud mental y el bienestar de las personas que sufren marginación en sus comunidades. Complementariamente se presentan algunas recomendaciones para avanzar esta Educación, como un componente fundamental de la agenda nacional para la recreación en Canadá.--------------------------------------------------------------------Leisure education is an old idea that is being examined with renewed vigour in Canada. Practitioners and researchers from various disciplines (e.g., health, justice, education, recreation are recognising anew that many people who could benefit from leisure or recreation opportunities in their communities are unable to do so because they lack leisure literacy. Leisure literacy refers to the knowledge, skills and confidence to engage in personally meaningful, health-enhancing leisure. Leisure education is a key means to enhance leisure literacy. The paper presents a model of leisure education developed by Dr. Brenda Robertson and argues for how and why leisure education is needed to address the mental health and well

O efeito trabalhador adicional para filhos no Brasil

Directory of Open Access Journals (Sweden)

Elzira Lúcia de Oliveira

2014-06-01

Full Text Available O objetivo deste trabalho é testar a hipótese da existência do efeito trabalhador adicional para filhos no Brasil, procurando identificar se a situação de desemprego do chefe de família fará com que algum membro da família, cuja condição seja filho, transite para a População Economicamente Ativa - PEA. A base de dados utilizada foi a Pesquisa Mensal de Emprego - PME realizada pelo IBGE, que permite a construção de painéis para análise longitudinal de dados. A hipótese foi testada para pelo menos um filho com idade de 10 a 18 anos, entre 2002 e 2013, para as regiões metropolitanas de Belo Horizonte, Salvador, Porto Alegre, São Paulo, Rio de Janeiro e Recife, que compõem a área de abrangência da PME. Este trabalho admite a existência de diferencial por sexo do chefe para o efeito trabalhador adicional de filhos de 10 a 18 anos. Os resultados mostraram haver um efeito positivo maior para chefes homens do que para chefes mulheres, sendo que a variável de transição do filho para a atividade não apresentou significância estatística que permitisse assumir a existência do efeito. Corroborou-se a hipótese da existência de diferencial por sexo, contudo no sentido oposto ao da hipótese assumida.

Biocomercio: una alternativa para el desarrollo sostenible

Directory of Open Access Journals (Sweden)

Carlos Murillo R.

2008-01-01

Full Text Available El desarrollo sostenible en países ricos en biodiversidad dependerá de la capacidad de los gobiernos de implementar los arreglos institucionales necesarios para conciliar la preservación de los recursos naturales con el uso de los mismos para la producción de bienes y servicios que puedan potenciar el crecimiento económico y un mayor bienestar para las comunidades locales donde estos recursos se encuentren. Este es el objetivo de la Iniciativa de Biocomercio que ha venido impulsando la Conferencia de Naciones Unidas para el Comercio y el Desarrollo (UNCTAD en distintos países de Latinoamérica. En el tanto estos principios y los establecidos en el CDB se puedan viabilizar e inspiren los distintos Programas Nacionales de Biocomercio en los países de la región, parecería no haber dudas de que la Iniciativa abre nuevas puertas para el uso, aprovechamiento y desarrollo sostenible de los mismos.

ANÁLISE, MODELAGEM E IMPRESSÃO 3D DE UM FRAME PARA VANTs DO TIPO QUADRÍCOPTEROS PARA VOOS EM AMBIENTE INDOOR

Directory of Open Access Journals (Sweden)

Rafael Rocha Gomes

2017-01-01

Full Text Available O foco do projeto de pesquisa foi analisar, modelar e construir utilizando uma impressora 3D, um frame de um Veículo Aéreo Não Tripulado (VANT para voos em ambiente indoor. Esta aeronave será usada para experimentos laboratoriais, que exijam características especiais para ambientes indoor e de pesquisa, tais como, ser compacto, leve e uma estrutura que minimize os riscos aos operadores, pois dividirá espaço com pessoas. A motivação desta pesquisa se deu pelo fato dos frames disponíveis no mercado serem voltados para voos outdoor, como por exemplo, os utilizados para monitoramento. Com o intuito de proporcionar uma solução de aeronave para espaço laboratorial indoor, a proposta deste trabalho foi de modelar e imprimir em 3D um protótipo de frame que atenda todos os requisitos necessários para este tipo de voo.

Para una Mejor Comprensión del Desarrollo: Análisis conceptual, lógica para su abordaje e instrumentos para su medición

Directory of Open Access Journals (Sweden)

Héctor Cárcamo

2006-01-01

cross nacional para la realización de estudios vinculados al desarrollo. Se plantea una revisión de conceptos fundamentales como el de desarrollo y la necesidad de la equivalencia funcional. El documento continúa con una reflexión guiada desde la noción de desarrollo social; asumiendo críticamente que el desarrollo se ha plasmado como un intento por lograr una radiografía del todo que ha olvidado la integración de sus partes constituyentes, negando de esta manera la diversidad como condición esencial para dar sentido a la idea de una visión integradora. Finalmente se realiza una revisión de CASEN como instrumento para medir el desarrollo social en Chile.

GOOGLE DRIVE: POTENCIALIDADES PARA O DESIGN DE MATERIAL EDUCACIONAL DIGITAL (MED PARA ENSINO DE LÍNGUAS

Directory of Open Access Journals (Sweden)

Rosinda de Castro Guerra RAMOS

2017-07-01

Full Text Available Este trabalho tem como objetivo apresentar uma experiência sobre como o Google Drive pode ser usado para o desenho de MED (Material Educacional Digital para o ensino-aprendizagem de línguas, devido ao crescente uso das TDICs (Tecnologias Digitais de Informação e Comunicação na área de educação e aos desafios que o design de materiais educacionais para o ambiente digital nos lançam.  Para apresentar nossa experiência, faremos uma discussão teórica sobre os conceitos de desenvolvimento de material didático (TOMLINSON, 2003; RAMOS, 2009, de material educacional digital –MED – (BEHAR, 2009, multimodalidade (ROJO e BARBOSA, 2015, a lacuna existente em relação ao  letramento digital na formação de professores (LEFFA, 2013, os níveis/tipos  de interação em ambiente digital (HIRUMI, 2013 e sua relação na coconstrução de novos conhecimentos (VIGOTSKY, 1989, 1998; OLIVEIRA, 1997; BRASIL, 1998. Em seguida, descreveremos o Google Drive e as funcionalidades dos aplicativos de produtividade Google Documentos, Planilhas, Apresentações e Formulários. Finalizaremos com considerações sobre essa experiência e suas contribuições para a área de formação de professores de línguas.

Factores de riesgo para el neonato pequeño para la edad gestacional en un hospital de Lima, Perú

Directory of Open Access Journals (Sweden)

J. Eduardo Tejeda-Mariaca

Full Text Available Objetivos. Identificar factores de riesgo para neonatos a término pequeños para la edad gestacional. Materiales y métodos. Cohorte retrospectiva que utilizó datos del Sistema Informático Materno Perinatal del Hospital María Auxiliadora de Lima, del período 2000 a 2010. Se evaluó la edad materna, paridad, nivel educativo, estado civil, índice de masa corporal pregestacional, número de controles prenatales, presencia de patologías como preeclampsia, eclampsia, infección urinaria y diabetes gestacional como factores de riesgo en pequeños para edad gestacional. El peso para la edad gestacional fue calculado sobre la base de percentiles peruanos. Se calcularon los riesgos relativos crudos (RR y ajustados (RRa con sus intervalos de confianza al 95% usando modelos lineales generalizados log binomial. Resultados. Se incluyeron 64 670 gestantes. La incidencia de pequeños para la edad gestacional fue 7,2%. La preeclampsia (RRa 2,0; IC 95%: 1,86-2,15, eclampsia (RRa 3,22; IC 95%: 2,38-4,35, bajo peso materno (RRa 1,38; IC 95%: 1,23-1,54, nuliparidad (RRa 1,32; IC 95%: 1,23-1,42, edad ≥35 años (RRa 1,16; IC 95%: 1,04-1,29, tener controles prenatales de 0 a 2 (RRa 1,43; IC 95%: 1,32-1,55 y 3 a 5 (RRa 1,22; IC 95%: 1,14-1,32 fueron factores de riesgo para ser pequeños para la edad gestacional. Conclusiones. Es necesario identificar a las gestantes con factores de riesgo como los encontrados para disminuir la condición de pequeños para la edad gestacional. Se debe actuar poniendo énfasis en factores modificables, tales como la frecuencia de sus controles prenatales

Ciclo Hápticos: Para Quinteto de Sopros

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Jorge Luiz de Lima Santos

2016-06-01

Full Text Available Memorial e partitura de Ciclo Hápticos, escrita em 2014 para quinteto de sopros. O memorial descreve brevemente as ferramentas metodológicas empregadas para o planejamento e criação da obra. De um lado, para produção do material melódico-harmônico foi empregado o Sistema-Gr de composição musical, desenvolvido por Carlos Almada (2014. Do outro lado, para organização formal, utilizamos o software Partitions - que faz parte do conjunto de programas do Parsemat, elaborado por Pauxy Gentil-Nunes (2009 – o qual informa o conjunto total de possibilidades de partições de um dado número.

Palladium-mediated conversion of para-aminoarylboronic esters into para-aminoaryl- 11C-methanes

DEFF Research Database (Denmark)

Andersen, Valdemar Lykke; Herth, Matthias Manfred; Lehel, Szabolcs

2013-01-01

of free amines. Aryl boronic esters containing primary, secondary, and tertiary amines were successfully converted into corresponding labeled methyl derivatives in suf¿cient radiochemical yield to apply this method for tracer development. This procedure was applied to the labeling of CIMBI-712......Cross-couplings are an alternative to conventional 11C-methylations which are generally employed in PET tracer synthesis. Therefore, we set out to develop a general procedure for the synthesis of para-11CH3 labeled aromatic amines from the corresponding para-aminoarylboronic esters in the presence...

Sistema de autenticidad para aplicaciones de análisis de eventos para seguridad.

OpenAIRE

ESCAMILLA PARDO, TONI

2017-01-01

[ES] En este proyecto se afronta la creación de un sistema distribuido capaz de garantizar, en aplicaciones empleadas para el análisis de eventos de seguridad, la autenticidad de los datos transmitidos entre el host cliente y servidor con el fin de asegurar la integridad de los mismos en la transmisión entre ambas partes, así como evitar la posible alteración en el destino. Para ello, se utilizará la tecnología blockchain a modo de base de datos en la que se almacenen los hashe...

Para uma abordagem virtuosa do Jornalismo

Directory of Open Access Journals (Sweden)

Rogério Christofoletti

2012-06-01

Full Text Available As últimas décadas têm favorecido o crescimento do interesse e dos estudos sobre a ética jornalística. No Brasil e em outras praças, as abordagens deste tema têm sido na maioria das vezes por um caráter deontológico ou utilitarista. Neste artigo, chamamos a atenção para uma perspectiva que privilegie as virtudes como pontos de partida para os debates acerca das condutas dos profissionais. Uma ética das virtudes remete a Aristóteles e aos estoicos, mas vem sendo retomada por autores mais contemporâneos, como Macintyre e Comte-Sponville, entre outros. No jornalismo, esta abordagem não é definitiva ou totalizante, mas contribui para uma compreensão mais ampla da discussão, chamando inclusive a atenção para recomendações éticas úteis, práticas e atuais.

Educación para la Salud: espacio curricular optativo para los estudiantes de la carrera de Medicina

OpenAIRE

Susacasa, Sandra; Candreva, Anna; Cerasa, Silvana; Azanza, Marisa

2016-01-01

La educación para la salud adquiere relevancia en los programas institucionales internacionales. Estos se orientan a promover un mayor nivel de salud en la población. Sin embargo, las problemáticas vinculadas al campo de la educación para la salud, de acuerdo con los informes epidemiológicos, no están mejorando. Aún más, la situación se vuelve más crítica. En nuestro país las demandas sociales expresan la urgente necesidad de instalar la Educación para la Salud en espacios educativos y de sal...

Modelo para la implementación de controles internos para empresas constructoras.

OpenAIRE

Choez Chiquito, Wilton Antonio

2015-01-01

La presente investigación se refiere al tema Metodología para la implementación de nuevos métodos de Control para las empresas de construcción en el Ecuador. Donde las características principales de este sector ha sido su rápido crecimiento en las últimas dos décadas, con un alto número de trabajadores de obras con bajo o ningún nivel de educación, falta de compromiso por parte de los empleados de obra por el alto nivel de rotación que puede existir debido a que las construcciones son por per...

ELEMENTOS PARA LA CONSTRUCION DE UN PERFIL PARA EL GERENTE SOCIAL EN UN ENTORNO GLOBALIZADO

Directory of Open Access Journals (Sweden)

Antonio Bastidas Unigarro

2009-07-01

Full Text Available El perfil del gerente social adecuado para enfrentar los retos del mundo globalizado se ha estructurado a partir de cuatro requerimientos fundamentales: los conocimientos, la experiencia, las habilidades y las actitudes, los cuales se analizan como competencias indispensables para administrar la problemática compleja, llena de incertidumbres y desafíos del nuevo milenio. La propuesta para la construcción de un perfil de este gerente parte de considerar tres tipos de competencias: las funcionales, las comportamentales y los requisitos de estudio y experiencia. Su construcción parte del análisis de la Gerencia Social en el estado neoliberal, escenario, que reclama la formación de gerentes sociales comprometidos en la construcción de una sociedad mas justa, incluyente, participativa, democrática y solidaria.

Nuevo lenguaje para un nuevo medio

Directory of Open Access Journals (Sweden)

Inma Martín Herrera

2014-12-01

Full Text Available El concepto tradicional de comunicación unidereccional se ha roto para convertirse en comunicación pluridireccional que permitirá la retroalimentación informativa. Las nuevas formas de redactar, contar diseñar y presentar la información en Internet exige nuevos hábitos de lectura por parte de la audiencia. El lector deberá tomar conciencia de que está frente a un medio diferente con el que debe familiarizarse para hacer uso correcto del soporte digital, se informará adecuadamente para disfrutar de las ventajas del innovador medio, conocido como Periodismo de servicios o Nuevo Periodismo.

“Libros para niñas y libros para niños”: Presencia de estereotipos de género en una colección de libros para dibujar

Directory of Open Access Journals (Sweden)

Yolanda Cabrera García-Ochoa

2014-06-01

Full Text Available Los aprendizajes que se producen a partir de las propuestas imaginarias y simbólicas en los materiales didácticos pueden contener elementos sexistas. El objetivo del estudio consiste en determinar, a través de un análisis de contenido, si la colección de libros para dibujar “Doodle para niñas” y “Doodle para niños” representa roles estereotipados de género en sus imágenes y en el texto escrito. Tanto a nivel de representación gráfica como escrita, ambos libros utilizan roles estereotipados sobre todo en detrimento de la mujer. Aunque el sistema educativo español señala hace años un modelo igualitario para eliminar la discriminación, los avances conseguidos desde un prisma constitucional y legal, van muy por delante de unos sistemas culturales y sociales que apenas han evolucionado.

Long-term safety and efficacy of Gamma Knife surgery in classical trigeminal neuralgia: a 497-patient historical cohort study.

Science.gov (United States)

Régis, Jean; Tuleasca, Constantin; Resseguier, Noémie; Carron, Romain; Donnet, Anne; Gaudart, Jean; Levivier, Marc

2016-04-01

Gamma Knife surgery (GKS) is one of the surgical alternatives for the treatment of drug-resistant trigeminal neuralgia (TN). This study aims to evaluate the safety and efficacy of GKS in a large population of patients with TN with very long-term clinical follow-up. Between July 1992 and November 2010, 737 patients presenting with TN were treated using GKS. Data were collected prospectively and were further retrospectively evaluated at Timone University Hospital. The frequency and severity of pain, as well as trigeminal nerve function, were evaluated before GKS and regularly thereafter. Radiosurgery using the Gamma Knife (model B, C, 4C, or Perfexion) was performed with the help of both MR and CT targeting. A single 4-mm isocenter was positioned in the cisternal portion of the trigeminal nerve at a median distance of 7.6 mm (range 4-14 mm) anterior to the emergence of the nerve (retrogasserian target). A median maximum dose of 85 Gy (range 70-90 Gy) was prescribed. The safety and efficacy are reported for 497 patients with medically refractory classical TN who were never previously treated by GKS and had a follow-up of at least 1 year. The median age in this series was 68.3 years (range 28.1-93.2 years). The median follow-up period was 43.8 months (range 12-174.4 months). Overall, 456 patients (91.75%) were initially pain free in a median time of 10 days (range 1-180 days). Their actuarial probabilities of remaining pain free without medication at 3, 5, 7, and 10 years were 71.8%, 64.9%, 59.7%, and 45.3%, respectively. One hundred fifty-seven patients (34.4%) who were initially pain free experienced at least 1 recurrence, with a median delay of onset of 24 months (range 0.6-150.1 months). However, the actuarial rate of maintaining pain relief without further surgery was 67.8% at 10 years. The hypesthesia actuarial rate at 5 years was 20.4% and at 7 years reached 21.1%, but remained stable until 14 years with a median delay of onset of 12 months (range 1-65 months

Plan de mercadeo para una promotora de eventos corporativos

OpenAIRE

Burbano Zhindon, Andrea Cristina; Chavez Lopez, Maria Cecilia; Orlando Haro, Sofia Pierina; Miranda, Jorge Luis

2009-01-01

Este proyecto presenta una alternativa para todas aquellas empresas que realizan eventos frecuentemente, ofreciéndoles un servicio personalizado para la coordinación de cada uno de los detalles que conlleva la organización de un evento. El objetivo fundamental de este estudio es desarrollar un plan de mercadeo para el servicio antes mencionado, aplicando los principios del marketing para su correcta implementación.

Agricultura familiar para el desarrollo rural incluyente

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Laksmi Reddiar Krishnamurthy

2017-04-01

Full Text Available Las comunidades indígenas Mayas de la península de Yucatán han practicado la antigua tradición de agricultura familiar, en particular los huertos caseros, para garantizar su seguridad alimentaria. Con el objetivo de mejorar la práctica tradicional considerando paradigmas de la ciencia moderna, por una parte, se colectaron datos para definir la complejidad estructural y diversidad funcional a partir de 20 huertos familiares en cinco comunidades: X - Maben, X - Pichil, X - Yatil, San José II y Melchor Ocampo; y por otra, se organizaron grupos de discusión para dilucidar la estrategia de gestión practicada por las comunidades nativas. Los resultados mostraron que los huertos son manejados principalmente por las mujeres. También mostraron que el propósito principal del crecimiento y mantenimiento de los huertos familiares es garantizar la producción de alimentos nutritivos durante todo el año. Y, por último que los huertos caseros también sirven para propósitos secundarios tales como la provisión de productos y servicios para la medicina tradicional. El estudio sugiere que se debe de promover e invertir en huertos caseros para mejorar las estrategias de desarrollo incluyente en ambientes socio-culturales y biofísicos similares.

Patrones de diseño para mejorar la accesibilidad y uso de aplicaciones sociales para adultos mayores

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Huizilopoztli Luna García

2015-07-01

Full Text Available El objetivo de este artículo fue proponer una colección no exhaustiva de 36 patrones para el diseño de interacciones en aplicaciones sociales para adultos mayores. La propuesta representa un punto de partida confiable para facilitar, a diseñadores/desarrolladores, la integración de usabilidad en las interfaces de estas tecnologías con el fin de fomentar su aceptación, uso y adopción entre los adultos mayores. Esta propuesta se basa en esfuerzos previos comúnmente expresados como criterios y guías de diseño para definir los posibles problemas de usabilidad en este tipo de interfaces, y se concentra en reforzar estos enfoques mediante la integración de una mayor descripción de tales anomalías y alternativas de solución bajo una estructura de patrones útil para los diseñadores/desarrolladores. Se realizó un estudio de usabilidad con la técnica «evaluación heurística» (comúnmente utilizada en interacción hombre-máquina para obtener la percepción de los usuarios sobre un diseño particular. El trabajo se llevó a cabo desde dos perspectivas: el punto de vista de expertos técnicos y la percepción de un grupo social de adultos mayores. Los resultados reflejaron que los patrones propuestos propician la creación de interfaces bien diseñadas capaces de ofrecer una mejor experiencia de uso y promueven un impacto positivo en la calidad de vida de los adultos mayores.

Alimentos balanceados para perros en Costa Rica

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Ruth Vargas

2001-01-01

Full Text Available Diagnóstico de la comercialización de alimentos balanceados para perros en Costa Rica. Para ampliar los reportes oficiales de la comercialización de alimentos para perros se creó una base de datos que incluyó cantidad, costo, empaque y formulación durante el período 1998 a agosto del 2000. De 1995 a 1998 y de 1996 a 1999 la producción nacional incrementó un 90,4% y la importación un 42,56% respectivamente, ocupando los alimentos nacionales un 72% del tonelaje y un 70% del valor en dólares americanos. No fue posible determinar cuál es el empaque más comercializado, pero si que los alimentos extrusados son los que ocupan el primer lugar y que los alimentos recomendados para cachorros y adultos son los que más se comercializan. La ausencia de datos en las declaraciones sugiere la necesidad de incrementar el control en las mismas en caso de requerirse un estudio de mercado, ya que contrariamente a esta situación el mayor número de garantías inscritas corresponden separadamente para las fases de cachorros y adultos. Merece también atención que las garantías indican mayores porcentajes de proteína cruda que los recomendados por la AAFCO y que al menos 36 fórmulas son recomendadas para estados sanitarios específicos (p.e. para perros con problemas de alergias, cálculos renales, pérdidas de pelo, etc. sin que oficialmente se encuentre registrada ninguna fórmula medicada

Herpes zoster: Epidemiología y clínica Clinical and epidemiological aspects of Herpes zoster

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Claudia Vujacich

2008-04-01

Full Text Available El herpes zoster (HZ constituye una enfermedad de distribución mundial; sin embargo, existen es casos datos comunicados sobre la misma en países de Latinoamérica. Con el objetivo de evaluar aspectos clínicos y epidemiológicos de esta enfermedad en nuestra población, realizamos un análisis retrospectivo de historias clínicas de un centro privado de referencia en enfermedades infecciosas en Buenos Aires, Argentina (período: 2000-2005. Se realizó un análisis estadístico univariado para evaluar los factores asociados a neuralgia posherpética en este grupo de pacientes. Sobre un total de 302 casos evaluables, el 62% correspondieron a mujeres. La mediana de edad fue de 57 años. El 16.1% de los pacientes presentó condiciones predisponentes al desarrollo de zoster. Las localizaciones más frecuentes fueron la torácica, oftálmica y lumbosacra. El 7.75% presentó compromiso de más de dos metámeras. El 94% de los pacientes recibió medicación antiviral, siendo el aciclovir la droga más utilizada. El 94% recibió alguna medicación coadyuvante (antiinflamatorios no esteroideos, antineuríticos, corticoides. La complicación más frecuente fue la neuralgia posherpética (12% y se encontró estadísticamente asociada a edad mayor de 50 años.Herpes zoster (HZ is a public health problem worldwide. Although, there is paucity of data of this disease from South American countries. The objective of this study was to evaluate clinical and epidemiological aspects of HZ in a population of patients from South America. We underwent a retrospective analysis of clinical charts of an infectious diseases reference center (period: 2000-2005. Univariate analysis was performed to assess variables related to post herpetic neuralgia (PHN. From a total of 302 cases, 62% were in women. The median age was 57 years; 16.1% of the patients had a predisposing condition for the development of HZ. Most frequent dermatomes involved were: thoracic, ophthalmic and

Actitud Positiva: la base para la competitividad

Directory of Open Access Journals (Sweden)

Marco Anderson Espinoza

2008-04-01

Full Text Available Una estrategia empresarial enfocado en el mejoramiento continuo de la productividad para la competitividad, depende significativamente del manejo inteligente de tres variables visibles:Calidad, Entrega oportuna y Costo. No obstante, estas tres variables no suelen sersuficientes. La estrategia debe ser complementada con el manejo adecuado de variables intangibles como la Motivación y las Condiciones de Trabajo, con la aplicación de Tecnología Ambientalmente Amigable, en un marco de Actitud Positiva.A final de cuentas, la Actitud Positiva es fundamental para el recurso humano de cualquier organización, a fin de construir una plataforma sólida y estable que sirva de base para soportar un proceso sostenible de mejoramiento de la productividad, para aumentar la competitividad como estrategia empresarial exitosa.

Technological properties of kaolin from Para; Propriedades tecnologicas do caulin do Para

Energy Technology Data Exchange (ETDEWEB)

Hildebrando, E.; Martin-Cortes, G.R.; Esper, F.J.; Wiebeck, H.; Alves Junior, P.; Valenzuela-Diaz, F.R., E-mail: germac@usp.br [Universidade de Sao Paulo (PMT/EP/USP), Sao Paulo, SP (Brazil). Escola Politecnica. Departamento de Engenharia Metalurgica e de Materiais

2011-07-01

The NE of the State of Para, is notable for its large reserves of kaolin for paper. Kaolin is a mineral composed of hydrated aluminum silicates such as kaolinite and halloysite. The exploitation of these reserves to generate products with higher commercial value, especially in the industries of adsorbents and catalysts, is what motivates the continuous study of technological properties of the Amazon kaolin's. Thus, this paper presents a technological characterization of a sample of kaolin from Para State by X-ray diffraction, SEM - scanning electron microscopy and infrared spectroscopy. The results of preliminary tests indicate that the sample consists for the most part by kaolinite present in low concentrations of quartz and anatase. (author)

Desarrollo de manuales para la inspección y revisión de instalaciones petrolíferas para uso propio, para suministro a vehículos y transporte de mercancías peligrosas por carretera

OpenAIRE

Cardell Bilbao, Pablo Juan

2010-01-01

El objetivo de este proyecto es la realización de un manual que aúne y clarifique toda la documentación, la normativa y los procedimientos necesarios para cumplir las auditorías (revisiones e inspecciones) en las instalaciones existentes, los trámites para la apertura de nuevas instalaciones para suministro a vehículos (especialmente las Estaciones de Servicio (EESS), y para Usos Propios (UUPP) en Canarias, y el transporte de mercancías peligrosas por carretera (ADR), mostrando el procedimien...

Oxitocina: nuevas perspectivas para una droga antigua

OpenAIRE

Steven L. CLARK; Kathleen Rice SIMPSON; G. Eric KNOX; Thomas J. GARITE

2010-01-01

La oxitocina es el medicamento más comúnmente asociada con la prevención de complicaciones perinatales y recientemente fue incluida por el Instituto para la Administración Medicamentosa Segura (Institute for Safe Medication Practices - ISMP) en una pequeña lista de medicamentos “con alto grado de riesgos”, lo que puede “necesitar salvaguardas especiales para reducir el riesgo de error”. Las recomendaciones actuales para administrar este medicamento son vagas en relación a la indicación, tiemp...

INICIATIVAS PARA EL CAMBIO

Directory of Open Access Journals (Sweden)

César Alfonso Defrancisco-Larrañaga

2013-07-01

Full Text Available El planeta no atraviesa por su mejor momento en materia de conservación y renovación de sus recursos naturales. Claramente en los últimos tiempos los recursos hídricos han venido haciéndose cada vez menores; el hombre ha notado con preocupación y vivido en carne propia este fenómeno, que de no ser tratado a tiempo, podría atentar contra la existencia misma. Esto lo ha alentado a buscar métodos que sirvan como solución para contrarrestar éste mal y crear conciencia entre sus iguales, para así poder garantizar su permanencia y la de su entorno durante muchas generaciones. En países desarrollados del continente europeo y en algunos lugares de América del norte, el uso de sistemas de reutilización y tratamiento de aguas grises y aprovechamiento de las aguas lluvias se ha convertido en una constante y nos están dando las pautas para poder seguir el ejemplo y así de esta manera poder aportar a la causa ambiental y a su vez crear un ahorro en nuestros gastos mensuales de consumo.

AUTONOMÍA PARA APRENDER Y AUTONOMÍA PARA VIVIR

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Miryam Narváez Rivero

2005-04-01

Full Text Available RESUMEN: El sistema educativo tiene el reto actual de formar individuos autónomos. Esta autonomía no implica solo el que las personas tengan los recursos necesarios para aprender a aprender, sino que puedan convivir armónicamente en comunidad, escuchándose a sí mismos para tomar sus propias decisiones, sin estar determinados por deseos instintivos ni modelos coercitivos impuestos por la sociedad. Así, para desarrollar autonomía, le corresponde a la educación trabajar tres elementos: la voluntad, la libertad y la autoestima. De esta forma, una educación promotora de una verdadera autonomía deberá tener un carácter dialógico, haciendo hincapié en la integración solidaria de la persona con su comunidad. Nos referimos a una persona que no ha renunciado a sus metas ni aspiraciones, sino que sabe cómo guiarlas hacia un proyecto común de bienestar general. ABSTRACT: The educative system’s latest challenge is to educate independent individuals. This autonomy does not just imply that people have the necessary resources to learn to learn, but the ones they need to live together in harmony with others, listening to themselves to make their own decisions without being determined by instinctive desires nor coercive models imposed by the society. It is so, that to develop autonomy, the educational system must work with these three elements: will, freedom and self-esteem. Also, an educational system which promotes a true autonomy must have a dialogic character, insisting on the individual solidarity integration with the community; with this, we mean a person who has not resigned to his goals or aspirations, but that knows how to guide them towards a common project for the community well-being.

Significado de la calidad de vida del adulto mayor para sí mismo y para su familia

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Martha Vera

2007-09-01

Full Text Available Objetivo: Comprender el significado que la expresión lingüística ‘calidad de vida del adulto mayor’ tiene para el adulto mayor y para su familia. Diseño: Estudio cualitativo, descriptivo, interpretativo - comprensivo, fundamentado en la Teoría de las Representaciones Sociales. Lugar: Asentamiento Humano Laura Caller, en Los Olivos. Participantes: Adultos mayores y sus respectivos grupos familiares. Métodos: Las técnicas e instrumentos utilizados fueron la observación, entrevista a profundidad y grupos focales; guía de observación y dos cuestionarios con ocho preguntas norteadoras, previamente validados. Principales medidas de resultados: Significado de calidad de vida para el adulto mayor y para la familia. Resultados: Participaron dieciséis adultos mayores con sus respectivos grupos familiares, entre 2004 y 2006. Los discursos a través de la ‘objetivación’ y el ‘anclaje’ y los análisis general, ideográfico-axial y nomotético-selectivo permitieron la emergencia de cuatro representaciones sociales: a conocimiento sobre la vejez y ser un adulto mayor; b elementos principales y secundarios del significado de calidad de vida del adulto mayor; c valores y actitudes del adulto mayor y familia sobre la calidad de vida; y, d necesidades del adulto mayor como ser social y la calidad de vida. Conclusiones: Para el adulto mayor, calidad de vida significa tener paz y tranquilidad, ser cuidado y protegido por la familia con dignidad, amor y respeto, y tener satisfechas como ser social sus necesidades de libre expresión, decisión, comunicación e información. Para la familia, que el adulto mayor satisfaga sus necesidades de alimentación, vestido, higiene y vivienda.

ÉTICA PARA O DESENVOLVIMENTO SUSTENTÁVEL – UMA RESPONSABILIDADE PARA COM AS GERAÇÕES FUTURAS

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Patrícia Melo Silva

2011-02-01

Full Text Available O trabalho apresenta uma discussão sobre como a ética pode contribuir para a ciência se desenvolver de maneira sustentável com o intuito de garantir a biodiversidade em uma sociedade que cresce de acordo com a moral utilitarista. Os principais aspectos analisados foram questões da ética como proposta oposta à moral utilitarista, além de aspectos relacionados à economia global, ao sistema capitalista e à interdisciplinaridade. O principal objetivo do trabalho é analisar como a ética pode contribuir para o desenvolvimento sustentável e para o respeito à biodiversidade. A metodologia utilizada foi a de análise bibliográfica.

Nueva Sede para la Academia

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Mario Camacho Pinto

1994-06-01

Full Text Available

Una nueva sede adecuadamente dotada siempre estuvo en la mente de nuestros expresidentes Académicos César Augusto Pantoja, Hernando Groot, Pablo Gómez Martínez, Jorge Cavelier Gaviria y Efraim Otero-Ruiz, con quienes me tocó en suerte trabajar 12 años consecutivos, cerca de ellos a través de mi cargo de Coordinardor de la Comisión Permanente de Biblioteca y Publicaciones y de la Revista MEDICINA que se ha venido publicando sin interrupciones dentro de un compañerismo ejemplar; además de otras distinciones operativas que me inducen a expresar gratitud.

Ahora, además, como Secretario de la Coporación por elección unánime de la Asamblea hace dos años, he sido testigo ático de una intensa, inteligente e inagotable actividad que nuestro Presidente Académico Juan Jacobo Muñoz Delgado quien siempre con el visto bueno de la Junta Directiva, mediante un acelerado ritmo de trabajo se impuso la tarea de convertir en realidad inmediata tan anhelada y necesaria idea.

En efecto, la nueva sede fue inaugurada oficialmente el día 2 de septiembre de 1993.

Este Editorial es la constancia escrita de tal febril actividad que para proporcionar evidencia a los lectores de “MEDICINA” resumo en breves incisos que muestran el tránsito a un estado con superávit de excepción para esta clase de instituciones:

1. Terminación de la obra ya iniciada de la remodelación arquitectónica, tanto exterior de seguridad y aspecto como interior con suficientes y modernas instalaciones.

2. Cerramiento total con altas y elegantes rejas metálicas y doble portería por la calle 69 y la carrera 7a.

3. Aparcadero lujosamente adoquinado, amplio y seguro para 30 automóviles.

4. Decoración interior estéticamente consultada, bien lograda en cortinas y clásicas lámparas de cristal obsequiadas por conocidos académicos. Un par de originales urnas precolombianas en el hall de entrada.

5. Zona social doble, amplia

Hacia un nuevo diseño para el aprendizaje: escenarios educativos para la Web 2.0

Directory of Open Access Journals (Sweden)

Alejandro Canales Cruz

2014-10-01

Full Text Available En este artículo se retoma la caracterización de pedagogía en la virtualidad, la cual se fundamenta en la apropiación tecnológica en función de la educación y voluntad de los participantes. Se propone la convergencia del diseño tecnopedagógico, unido a la apropiación creativa y a los usos pedagógicos efectivos para maximizar el proceso educativo. Se plantea el empleo de la especificación IMS Learning Design (LD para la construcción de escenarios educativos como un proceso sistémico con actividades interrelacionadas que permiten crear ambientes que en verdad faciliten, de forma mediada, el proceso educativo. Finalmente, se presenta una herramienta para la autoría de escenarios educativos.

Modelo de negocio para bebidas funcionales Ceiba

OpenAIRE

Gil Giraldo, Jhonatan; Restrepo Mesa, Juan Eduardo

2017-01-01

El presente documento, modelo de negocio para bebidas naturales Ceiba, es el trabajo de grado realizado por los autores con el fin de optar al título de magíster en Administración (MBA) de la Universidad EAFIT -- El cual esta soportado en los diferentes conceptos y metodologías de modelo de negocio y planes de negocio -- Por tratarse de un prototipo que busca definir los elementos estratégicos necesarios para su desarrollo, arrojó como resultado que la metodología más adecuada para ser aplica...

Middleware Cerberus usando RFID para rastreabilidade bovina

OpenAIRE

Silva, Márcio Roberto

2009-01-01

A gerência na zootecnia de precisão é cada vez mais necessária para garantia de lucros e a conquista de novos mercados os quais exigem qualidade e certificação. Nesta dissertação é abordado um sistema de rastreabilidade para o controle na bovinocultura utilizando chips RFID. Sendo que a identificação segura dos animais é a base para a rastreabilidade bovina e bubalina. Em vista as exigências do mercado consumidor o governo brasileiro instituiu o Sistema Brasileiro de Identificação e Certifica...

Test para la profilaxis de la prematuridad

OpenAIRE

Cruz Laguna, Gladys María

2008-01-01

La prematuridad constituye un problema mundial de salud, la comunidad científica busca predictores para disminuir su incidencia. La investigación persiguió obtener una escala de puntuación que modele las características cervicales y permita diagnosticar la condición de riesgo de las gestantes para extender el período de gestación y lograr nacimientos al término. Se realizó un cuasiexperimento en gestantes con factores de riesgo para la prematuridad del municipio Holguín. La muestra fue confor...

para mujeres y niños vulnerables

International Development Research Centre (IDRC) Digital Library (Canada)

... a nivel global . 73. Generar confianza y crear espacio para el compromiso . 75 .... para construir sistemas de salud sólidos y han colaborado inmensamente con ..... instituciones sanitarias se ve obligado a recolectar información y a registrar ...

Modelo para la Gestión de la Innovación por Proyectos para Empresas que aplican el Perfeccionamiento Empresarial en Cuba

OpenAIRE

Antonio M. Navarro López

2008-01-01

Las Empresas que aplican el Perfeccionamiento Empresarial, no cuentan con un Modelo para la Gestión de la Innovación para el desarrollo Empresarial. Por lo que se propone éste Modelo para las mismas y generalizándose de esta forma el conocimiento de Gestión de la Innovación de la Empresa de Proyectos de Arquitectura e Ingeniería de Matanzas, Cuba, lo que permite el desarrollo Empresarial y la Implantación del Sub Sistema de Innovación para estas Empresas en Perfeccionamiento Empresarial. Se p...

Retos para la agricultura en Costa Rica

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Oscar Arias M.

2005-01-01

Full Text Available Retos para la agricultura en Costa Rica es un análisis crítico del desarrollo agrícola de Costa Rica de los últimos 25 años. La diversificación agrícola que promovió Costa Rica en la década de los ochenta, permitió ampliar la oferta exportable y reducir la vulnerabilidad de la dependencia económica de productos tradicionales, como café y banano. Los retos de la economía global y el establecimiento de tratados comerciales con muchos países, hacen necesario que el país promueva en el sector agrícola la exportación con mayor valor agregado, para lo cual es necesario una modernización y reconversión productiva, ya que el modelo actual está agotado. Debemos mejorar sustancialmente los bienes y servicios que ofrecemos; para este propósito, algunos aspectos como la imagen de marca del país con tradición democrática, respeto a los derechos laborales, así como las buenas prácticas de manejo ambiental, deben publicitarse. Como una herramienta clave para la incorporación de mayor valor agregado a nuestra producción agrícola, debemos promover la inversión en investigación y desarrollo, que históricamente ha sido escasa (0,4% del PIB. En vista de que el Estado Costarricense ha demostrado una incapacidad crónica para impulsar la ciencia y la tecnología como una herramienta para nuestro desarrollo, se propone un estímulo a la inversión privada y el fortalecimiento de una alianza con el Estado y las universidades. Se analiza la conveniencia del fortalecimiento de la autosuficiencia alimentaria y de que las empresas pequeñas y medianas jueguen un papel más activo en la agro-exportación. Respecto a los tratados comerciales que se han venido negociando, se considera la conveniencia para el país, ya que son instrumentos para integrar nuestro quehacer económico a nivel mundial, y nuestro deber es el de luchar para que el sector agropecuario tenga oportunidad de subsistir competitivamente según esas nuevas reglas y

Matemática para la familia

OpenAIRE

Cittadino, José

1994-01-01

Para muchos profesores de matemáticas ha sido de primordial interés encontrar estrategias didácticas apropiadas para orientar el aprendizaje de las matemáticas escolares de los niños (as) y jóvenes de manera que las clases se conviertan en encuentros agradables y la relación matemática-aprendizaje- profesor sea la mejor.

Educación para emprender, una opción para el mundo en desarrollo

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Luis Gerardo Rodríguez

2015-05-01

Full Text Available RESUMEN La búsqueda de las formas educativas para corresponder con el momento histórico que vive el mundo de hoy, ha sacudido de reformas, adecuaciones y reconversiones, la geografía de nuestros países aspirantes al desarrollo. En Latinoamérica la reforma educativa es una constante y este fenómeno implica, que como educadores estemos obligados a asumir en mayor o menor proporción, el impacto de tal explosión reformista. Construir desde el quehacer cotidiano, formas de educación para orientar de manera coherente la formación de hombres para dirigir organizaciones en el mundo  de hoy, implica general un proceso educativo acorde con la reforma de la educación superior en el macro de la apertura y globalización  de la economía, y  la cual problemática social en la que se vislumbran la inestabilidad del futuro, plasmada en la crisis de la certeza y el reto de la complejidad

Um Termômetro para as Macro-Prudenciais

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Fabio Kanczuk

2013-12-01

Full Text Available Desenvolvemos um modelo com fricções no crédito tanto para firmas como famílias. Crédito às firmas é tratado como nos modelos de acelerador financeiro (e.g. Bernanke e Gilchrist (1999. Os juros sobre os recursos emprestados às famílias dependem de seu endividamento, como em Curdia e Woodford (2010. O modelo é estimado para o Brasil, utilizado para estudar os episódios de desaceleração, e para a extração dos prêmios de financiamento (destilados a partir de dados não financeiros, os quais são comparados com informações sobre crédito às pessoas físicas e jurídicas. Dessa forma, o obtém-se um termômetro para mensurar como medidas prudenciais sobre o crédito afetam atividade e inflação.

Metodologia de la Administración Federal de Aviación para el Diseño de estructuras de Pavimento flexible para aeropuertos

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Julián Rodrigo Quintero González

2013-08-01

Full Text Available Se representan los aspectos técnicos fundamentales y principalesconsideraciones de la metodologia propuesta por la Administracion Federal de Aviación FAA para el diseño de estructuras de pavimento para aeropuertos. Se exponen los aspectos sobre las variables consideradas en el diseño (estructurales tránsito, factores ambientales y factores intrinsecos, se establecen las caracteristicas de las variables consideradas por el metodo (subrasante y materiales para la estructura, geometría del tren de aterrizaje, número de decolajes equivalentes y peso bruto maximo del decolaje y se explica el procedimiento utilizado para el tratamiento de la información requerida en diseño estructural de pavimentos flexibles para aeropuertos.

Construyendo campos para el aprendizaje creativo. Método del juego

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Paco Cerezo Sánchez

2008-01-01

Full Text Available Este documento presenta el marco teórico, el camino recorrido y los resultados de una experiencia piloto para la formación de formadores y de trabajadores del sector de transportes, experiencia hecha para desarrollar competencias interpersonales.Avanzamos desde el constructivismo y proponemos un método de aprendizaje en grupo, denominado Método del juego porque se basa en juegos sociales experienciados por los participantes (alumnos durante el taller.Aquí, hablo de los contenidos formativos - dirigidos especialmente a la formación de formadores- y también de la forma de aprender y de la estructura oculta en los procesos de aprendizaje. Describo un marco teórico que permite aplicar métodos de aprendizaje grupal y creativo para la formación continua, y aporto herramientas para que los formadores las adapten y construyan sus propios juegos didácticos. El marco creativo de aprendizaje y este método del juego nacen de experiencias entrenando a actores de teatro de calle (desde 1983, formadores y directivos (desde 1991 y aplicaciones para eLearning (1996-2007 en diferentes sectores y países europeos; experiencia consolidada con el equipo de www.formador.org (2005-2008. Al principio usaba juegos extraídos del circo, ahora son juegos sociales o de mesa.El marco creativo y el método del juego aquí propuestos sirven para desarrollar: el potencial humano, la autonomía personal, la creatividad y la innovación, las competencias interpersonales, de trabajo en equipo, para comprender y solucionar conflictos; la habilidad para comprender y solucionar problemas complejos; la habilidad para aprender a aprender.Así, esta propuesta para aprender jugando en grupo recoge las experiencias acumuladas durante 20 años formando formadores y complementa a otras investigaciones y productos1, muchos de ellos específicos para la formación de formadores. Para Aprender jugando en grupo hemos creado un paquete integrado por el marco teórico creador de

Headaches of otolaryngological interest: current status while awaiting revision of classification. Practical considerations and expectations.

Science.gov (United States)

Farri, A; Enrico, A; Farri, F

2012-04-01

In 1988, diagnostic criteria for headaches were drawn up by the International Headache Society (IHS) and is divided into headaches, cranial neuralgias and facial pain. The 2(nd) edition of the International Classification of Headache Disorders (ICHD) was produced in 2004, and still provides a dynamic and useful instrument for clinical practice. We have examined the current IHC, which comprises 14 groups. The first four cover primary headaches, with "benign paroxysmal vertigo of childhood" being the forms of migraine of interest to otolaryngologists; groups 5 to 12 classify "secondary headaches"; group 11 is formed of "headache or facial pain attributed to disorder of cranium, neck, eyes, ears, nose, sinuses, teeth, mouth or other facial or cranial structures"; group 13, consisting of "cranial neuralgias and central causes of facial pain" is also of relevance to otolaryngology. Neither the current classification system nor the original one has a satisfactory collocation for migraineassociated vertigo. Another critical point of the classification concerns cranio-facial pain syndromes such as Sluder's neuralgia, previously included in the 1988 classification among cluster headaches, and now included in the section on "cranial neuralgias and central causes of facial pain", even though Sluder's neuralgia has not been adequately validated. As we have highlighted in our studies, there are considerable similarities between Sluder's syndrome and cluster headaches. The main features distinguishing the two are the trend to cluster over time, found only in cluster headaches, and the distribution of pain, with greater nasal manifestations in the case of Sluder's syndrome. We believe that it is better and clearer, particularly on the basis of our clinical experience and published studies, to include this nosological entity, which is clearly distinct from an otolaryngological point of view, as a variant of cluster headache. We agree with experts in the field of headaches, such as

Science.gov (United States)

FARRI, A.; ENRICO, A.; FARRI, F.

2012-01-01

SUMMARY In 1988, diagnostic criteria for headaches were drawn up by the International Headache Society (IHS) and is divided into headaches, cranial neuralgias and facial pain. The 2nd edition of the International Classification of Headache Disorders (ICHD) was produced in 2004, and still provides a dynamic and useful instrument for clinical practice. We have examined the current IHC, which comprises 14 groups. The first four cover primary headaches, with "benign paroxysmal vertigo of childhood" being the forms of migraine of interest to otolaryngologists; groups 5 to 12 classify "secondary headaches"; group 11 is formed of "headache or facial pain attributed to disorder of cranium, neck, eyes, ears, nose, sinuses, teeth, mouth or other facial or cranial structures"; group 13, consisting of "cranial neuralgias and central causes of facial pain" is also of relevance to otolaryngology. Neither the current classification system nor the original one has a satisfactory collocation for migraineassociated vertigo. Another critical point of the classification concerns cranio-facial pain syndromes such as Sluder's neuralgia, previously included in the 1988 classification among cluster headaches, and now included in the section on "cranial neuralgias and central causes of facial pain", even though Sluder's neuralgia has not been adequately validated. As we have highlighted in our studies, there are considerable similarities between Sluder's syndrome and cluster headaches. The main features distinguishing the two are the trend to cluster over time, found only in cluster headaches, and the distribution of pain, with greater nasal manifestations in the case of Sluder's syndrome. We believe that it is better and clearer, particularly on the basis of our clinical experience and published studies, to include this nosological entity, which is clearly distinct from an otolaryngological point of view, as a variant of cluster headache. We agree with experts in the field of headaches

Confianza y capital social: evidencia para México

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Rubén Martínez-Cárdenas

2015-01-01

Full Text Available Desde la perspectiva económica la confianza entre los miembros de una sociedad está asociada al funcionamiento eficiente de los mercados, al reforzamiento de contratos y, en general, a la capacidad para generar desarrollo y bienestar. En este artículo exploramos empíricamente los determinantes de la confianza en México, en particular, aislamos la relación entre dos medidas de capital social, una para el individuo y otra para su entorno. Nuestros resultados muestran que la confianza aumenta con estas medidas de capital social y con ausencia de se - gregación es mayor en comunidades pequeñas, a mayor edad y para habitantes del centro-occidente, entre otras.

ESPIRITUALIDADE PARA OUTRO MUNDO POSSÍVEL

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Agenor Brighent

2007-01-01

Full Text Available Teve lugar, em Nairobi, o II Fórum Mundial de Teologia e Libertação, entre os dias 16e 19de janeiro de 2007.O primeiro havia sido realizado em Porto Alegre, em janeiro de 2005, cujos resultados estão publicados em L.C. SUSIN (org., Teologia para outro mundo possível, São Paulo: Paulinas, 2006 (485 pp.. O segundo teve como tema - "espiritualidade para outro mundo possível". Fizeram-se presentes 300participantes, oriundos dos cinco Continentes, em sua maioria da África, especialmente de Nairobi, seguida da Europa, América, Ásia e Oceania, respectivamente. Para além da reflexão e dos conteúdos, o simples encontro e cruzamento de buscas e realizações em esfera planetária, já justifica por si só o evento. Em tempos de crise de paradigmas e dos metarrelatos, a experiência se erige como lugar privilegiado para repensar a razão e as razões do existir, do mundo e da fé. Os trabalhos tiveram lugar no Carmelite Center, nos arredores da contrastante capital do Quênia.

Tithonia diversifolia: especie para ramoneo en sistemas silvopastoriles y métodos para estimar su consumo.

Directory of Open Access Journals (Sweden)

Estefanía Mejía-Díaz

2016-12-01

Full Text Available El objetivo del presente trabajo fue recopilar avances investigativos sobre aspectos agronómicos, nutricionales y productivos de T. diversifolia Hemsl. A Gray en sistemas silvopastorils (SSP como estrategia de producción ganadera y conocer metodologías para estimar el consumo de forraje de vacas bajo SSP. La introducción de sistemas silvopastoriles proporciona una vegetación estrati cada, además de generar diversos bienes, servicios ambientales y bienestar animal, constituyéndose, desde el punto de vista productivo, ecológico, económico y social, en una de las modalidades más prometedoras de los sistemas agroforestales. En la presente revisión se realizó una descripción de la arbustiva T. diversifolia Hemsl. A Gray, como especie estratégica para ser introducida en los sistemas silvopastoriles sean estos de baja o alta densidad, la cual por su calidad composicional ha sido reportada como una arbustiva con potencial para ser utilizada en la nutrición de rumiantes, teniendo un posible efecto positivo sobre índices productivos y económicos. Se discutieron tres técnicas utilizadas para estimar el consumo de forraje por bovinos en pastoreo, las cuales pueden ser aplicadas tanto en sistemas tradicionales como en sistemas silvopastoriles.

ParaChoice Model.

Energy Technology Data Exchange (ETDEWEB)

Heimer, Brandon Walter [Sandia National Lab. (SNL-CA), Livermore, CA (United States); Levinson, Rebecca Sobel [Sandia National Lab. (SNL-CA), Livermore, CA (United States); West, Todd H. [Sandia National Lab. (SNL-CA), Livermore, CA (United States)

2017-12-01

Analysis with the ParaChoice model addresses three barriers from the VTO Multi-Year Program Plan: availability of alternative fuels and electric charging station infrastructure, availability of AFVs and electric drive vehicles, and consumer reluctance to purchase new technologies. In this fiscal year, we first examined the relationship between the availability of alternative fuels and station infrastructure. Specifically, we studied how electric vehicle charging infrastructure affects the ability of EVs to compete with vehicles that rely on mature, conventional petroleum-based fuels. Second, we studied how the availability of less costly AFVs promotes their representation in the LDV fleet. Third, we used ParaChoice trade space analyses to help inform which consumers are reluctant to purchase new technologies. Last, we began analysis of impacts of alternative energy technologies on Class 8 trucks to isolate those that may most efficaciously advance HDV efficiency and petroleum use reduction goals.

Modificación del caldo extracto de levadura manitol para la producción a mediana escala de inoculantes para leguminosas

Directory of Open Access Journals (Sweden)

Ernesto Ormeño-Orrillo

2014-06-01

Full Text Available El caldo extracto de levadura manitol (LM, un medio ampliamente utilizado para el cultivo de rizobios, fue modificado para reducir su costo y utilizarlo en la producción a mediana escala de inoculantes para leguminosas. Los dos ingredientes más costosos, el extracto de levadura y el manitol, fueron reducidos o reemplazados con substratos más económicos. Se pudo reducir la concentración de extracto de levadura a 0,05 g/L sin afectar el crecimiento cuando se agregó 1,1 g/L de ácido glutámico o glutamato de sodio grado alimento. El manitol pudo ser substituido por 12,5 g/L de glicerina grado farmacéutico para las cepas de Bradyrhizobium o por 10 g/L de azúcar grado alimento para las cepas de Rhizobium. No se alteraron las propiedades simbióticas de las cepas cultivados en los medios modificados.

Comparative study of 3D TOF-SPGR and 3D FASE on the display of the relationship between cranial nerves and peripheral vessels

International Nuclear Information System (INIS)

Sun Wenge; Li Yanliang; Zhang Lina; Qi Xixun; Jin Anyu; Xu Ke; Tong Zhiyong; Liu Jing

2004-01-01

Objective: To select a better sequence which can supply reliable radiological information for vessel compression on cranial nerves in patients with facial spasm or trigeminal neuralgia. Methods: 3D TOF-SPGR and 3D FASE were used in 40 patients with facial spasm or trigeminal neuralgia to display the relationship between cranial nerves (facial nerve and trigeminal nerve) and peripheral vessels. Results: 38 patients got surgical results. 33 unilateral vessel compression or contact on facial nerves or trigeminal nerves was found on 3D TOF-SPGR, while no contact was found in 5. 26 unilateral vessel compression or contact on facial nerves or trigeminal nerves was found on 3D FASE, while no contact was found in 12. Significant difference between the two sequences on the display of vessel compression on facial nerves or trigeminal nerves was found by statistical analysis (χ 2 =5.14, P=0.016). Conclusion: 3D TOF-SPGR is better than 3D FASE on display of the relationship between nerves and peripheral vessels, and it should be the primary MRI sequence for patients with facial spasm or trigeminal neuralgia clinically. (author)

Plan de negocio para una empresa que alquila bombas sumergibles para el sector minero

OpenAIRE

Pérez León Corzo, Stepahnie Pamela

2016-01-01

El presente trabajo de investigación evalúa la viabilidad operativa y financiera para operar una pequeña empresa dedicada al alquiler de bombas sumergibles para la actividad de desagüe de medianas y pequeñas empresas del sector minero. Estructuralmente, la empresa estará constituida por la alta dirección conformada por tres socios quienes aportarán el 30% de la inversión inicial, el 70% restante se obtendrá mediante un financiamiento a mediano plazo con un banco local. La línea media estará c...

Experimental study of para- and ortho-H3+ recombination

International Nuclear Information System (INIS)

Plasil, R; Varju, J; Hejduk, M; Dohnal, P; KotrIk, T; Glosik, J

2011-01-01

Recombination of H 3 + with electrons is a key process for many plasmatic environments. Recent experiments on storage ring devices used ion sources producing H 3 + with enhanced populations of H 3 + ions in the para nuclear spin configuration to shed light on the theoretically predicted faster recombination of para states. Although increased recombination rates were observed, no in situ characterization of recombining ions was performed. We present a state selective recombination study of para- and ortho-H 3 + ions with electrons at 77 K in afterglow plasma in a He/Ar/H 2 gas-mixture. Both spin configurations of H 3 + have been observed in situ with a near infrared cavity ring down spectrometer (NIR-CRDS) using the two lowest energy levels of H 3 + . Using hydrogen with an enhanced population of H 2 molecules in para states allowed us to influence the [para-H 3 + ]/[ortho-H 3 + ] ratio in the discharge and in the afterglow. We observed an increase in the measured effective recombination rate coefficients with the increase of the fraction of para-H 3 + . Measurements with different fractions of para-H 3 + at otherwise identical conditions allowed us to determine the binary recombination rate coefficients for pure para-H 3 + p α bin (77 K) = (2.0±0.4)x10 -7 cm 3 s -1 and pure ortho-H 3 + o α bin (77 K) = (4±3)x10 -8 cm 3 s -1 .

Experimental study of para- and ortho-H3+ recombination

Science.gov (United States)

Plašil, R.; Varju, J.; Hejduk, M.; Dohnal, P.; Kotrík, T.; Glosík, J.

2011-07-01

Recombination of H3+ with electrons is a key process for many plasmatic environments. Recent experiments on storage ring devices used ion sources producing H3+ with enhanced populations of H3+ ions in the para nuclear spin configuration to shed light on the theoretically predicted faster recombination of para states. Although increased recombination rates were observed, no in situ characterization of recombining ions was performed. We present a state selective recombination study of para- and ortho-H3+ ions with electrons at 77 K in afterglow plasma in a He/Ar/H2 gas-mixture. Both spin configurations of H3+ have been observed in situ with a near infrared cavity ring down spectrometer (NIR-CRDS) using the two lowest energy levels of H3+. Using hydrogen with an enhanced population of H2 molecules in para states allowed us to influence the [para-H3+]/[ortho-H3+] ratio in the discharge and in the afterglow. We observed an increase in the measured effective recombination rate coefficients with the increase of the fraction of para-H3+. Measurements with different fractions of para-H3+ at otherwise identical conditions allowed us to determine the binary recombination rate coefficients for pure para-H3+ pαbin(77 K) = (2.0±0.4)×10-7 cm3s-1 and pure ortho-H3+ oαbin(77 K) = (4±3)×10-8 cm3s-1.

Exhibidor de cinturones para Montagne

OpenAIRE

Galletti, Julia

2017-01-01

En el exhibidor de cinturones diseñado para la marca de ropa deportiva Montagne se produjo un trabajo estético-formal en relación a la simbología característica de la marca. Su principal característica es ser un exhibidor 360°, es decir que desde cualquier punto de vista se puede obtener un buen panorama del producto expuesto. Está confeccionado en materiales livianos para facilitar su movilidad dentro del local estipulado (exhibición en vidriera o mostrador). Asimismo, es totalmente desarmab...

Educación para un nuevo humanismo

Directory of Open Access Journals (Sweden)

GUILLERMO HOYOS-VÁSQUEZ

2009-01-01

Full Text Available Se parte del tema de la responsabilidad social universitaria, evaluada muchas veces con base en indicadores, especialmente de pertinencia. Se advierten los peligros que esto conlleva para la educación en general, si no se toma como punto de partida el sentido mismo de universidad y de educación, es decir, si no se parte de la identidad propia de las instituciones educativas. Se sugiere, por tanto, volver a retomar la discusión en torno a la formación humanista en los procesos educativos, para lo cual se analizan muy brevemente la Carta sobre el humanismo, de Martin Heidegger; las Normas para el parque humano, de Peter Sloterdijk; la Universidad sin condición, de Jacques Derrida y El cultivo de la humanidad, de Martha Nussbaum. Se cierra el ensayo con la propuesta de Jürgen Habermas de una teoría comunicativa de la educación para la ciudadanía.

Actividad Física: Pasaporte Para La Salud

Directory of Open Access Journals (Sweden)

Sandra M.M. MATSUDO

2012-05-01

Full Text Available Las nuevas recomendaciones de actividad física para la salud, que cuentan con la aprobación de la oms, el cdc, el Colegio Americano de Medicina Deportiva (acsm y la American Heart Association, enfatizan que al menos 30 minutos diarios, por lo menos cinco días de la semana (de preferencia todos los días de la semana, de forma continua o en sesiones acumuladas de 10 o 15 minutos, de una actividad de intensidad moderada pueden ser suficientes para traer beneficios para la salud y la prevención, tratamiento, control y rehabilitación de las enfermedades crónicas no transmisibles. Por lo tanto, los especialistas en ciencias del deporte y las autoridades sanitarias recomiendan que toda persona incluya en su vida cotidiana, ya sea en el hogar, en el trabajo o en la comunidad, una actividad física regular para recuperar o mantener la salud.

Laboratory tests of headache disorders - Dawn of a new era?

DEFF Research Database (Denmark)

Schytz, Henrik Winther; Olesen, Jes

2016-01-01

secondary headaches. Background In this narrative review we present and discuss published tests that might be useful in phenotyping and/or diagnosis of long-lasting headache disorders such as migraine, tension-type headache, trigeminal autonomic cephalalgias, trigeminal neuralgia and persisting secondary...... headaches. Aim The palpometer test, quantitative sensory testing, nociceptive blink reflex and autonomic tests may be valuable to phenotype and/or diagnose subforms of migraine, tension-type headache, cluster headache, trigeminal neuralgia and medication-overuse headache. Provocation tests with glyceryl...... if well-reputed tertiary headache centers commence developing and implementing laboratory tests in order to improve the classification and treatment of headache patients....

Proposta de um instrumento para avaliar eventos adversos em odontologia

Directory of Open Access Journals (Sweden)

Claudia Dolores Trierweiler Sampaio de Oliveira Corrêa

2017-11-01

Full Text Available Resumo: O objetivo deste estudo foi propor um conjunto de rastreadores para a pesquisa de eventos adversos em odontologia ambulatorial no Brasil. O instrumento foi elaborado em duas etapas: (i para construir um conjunto preliminar de rastreadores foi realizada uma revisão da literatura, a fim de identificar a composição das ferramentas de rastreamento utilizadas nas demais áreas da saúde e os principais eventos adversos encontrados em odontologia; (ii para validar os rastreadores preliminarmente construídos foi organizado um painel de especialistas empregando o método Delphi modificado. Foram elaborados quatorze rastreadores para compor um instrumento com critérios explícitos para identificar potenciais eventos adversos no cuidado odontológico, essenciais para os estudos de revisão retrospectiva de prontuários. Pesquisas relacionadas à segurança do paciente em odontologia ainda são bastante incipientes em relação às demais áreas da saúde. Este trabalho pretendeu contribuir para a investigação nesse campo. O aporte da literatura e a ajuda da expertise do painel de especialistas permitiram a elaboração de um conjunto de rastreadores para a detecção de eventos adversos odontológicos, no entanto, são necessários estudos adicionais para testar a validade do instrumento.

Sistemática para avaliação da conformidade: uma proposta para uso de cão-guia

OpenAIRE

Brito, Joana D'Arc de

2009-01-01

O objetivo do presente estudo é identificar e propor quais os principais requisitos para a Avaliação dos Centros de Treinamento, de Treinadores e dos Instrutores Autônomos de cães-guia, de forma a atender o que prescreve a Lei n.º 11.126, de 27 de junho de 2005 no concernente às necessidades de adaptação dos segmentos envolvidos. Esta pesquisa foi estruturada em 3 (três) etapas. No primeiro momento utilizou-se de fontes bibliográficas para o levantamento de obras de referência para o desenvol...

Creación de materiales didácticos orales para la clase de lengua para la traducción

OpenAIRE

González Royo, Carmen; Chiapello, Stefania; Martín Sánchez, Teresa; Pascual Escagedo, Consuelo; Puigdevall Balafuy, Núria; Mura, G. Angela; Regagliolo, Alberto

2016-01-01

“Creación de materiales didácticos orales para la clase de lengua para la traducción” (3546) es una red que, desde una perspectiva de investigación-acción, investiga la implementación de materiales docentes para los currículos de lengua y traducción en las asignaturas de E/LE e I/LE en los grados de Lenguas Extranjeras y Traducción e Interpretación de la Universidad de Alicante, Università Suor Orsola Benincasa de Nápoles y Università degli Studi di Salerno. A partir de los materiales produci...

TV Móvel: onde estamos e para onde vamos

Directory of Open Access Journals (Sweden)

Clara-Luz Álvarez

2010-05-01

Full Text Available O artigo apresenta (1 as características técnicas da TV Móvel [Mobile TV] e sua diferença para o IPTV e a TV pela Internet [Internet TV], (2 as questões relativas a rede, espectro e equipamento que influenciarão o arcabouço normativo, (3 as oportunidades geradas para a TV Móvel quando da migração para a TV digital, e (4 um estudo de caso do México pertinente ao marco regulatório dos serviços de telecomunicações e de radiodifusão, aos atores do mercado, à disponibilidade de espectro, à migração para a TV digital e outras questões proeminentes para a TV Móvel.

Preparar para el futuro: el rol del educador

Directory of Open Access Journals (Sweden)

Myrna A. Cuevas Ruiz

2000-12-01

Full Text Available El artículo aborda el problema de la educación a la luz de las esperanzas y exigencias que se le plantean y de sus posibilidades reales para responder a los retos. En este marco, ubica la figura del educador, las cualidades que deben caracterizarlo para responder a las demandas de los retos educativos y los requerimientos que, en el contexto de la profesión docente, deben satisfacerse para impulsar los cambios.

QRLabel y Blackbird: 2 aplicaciones accesibles para Android

OpenAIRE

Mercade Aguila, Gisela

2012-01-01

El objetivo de este proyecto es el de realizar dos aplicaciones para dispositivos móviles con sistema operativo Android. Estas aplicaciones están ideadas para ser usadas por una persona invidente o con deficiencias visuales. El transcurso del desarrollo de cada aplicacion sirve para conocer y experimentar con diferentes herramientas que dispone este sistema operativo, y de este modo estudiar sus ventajas y limitaciones. Se presentan dispositivos y prototipos de dispositivos diseñados exclusiv...

Modified skin incision for avoiding the lesser occipital nerve and occipital artery during retrosigmoid craniotomy: potential applications for enhancing operative working distance and angles while minimizing the risk of postoperative neuralgias and intraoperative hemorrhage.

Science.gov (United States)

Tubbs, R Shane; Fries, Fabian N; Kulwin, Charles; Mortazavi, Martin M; Loukas, Marios; Cohen-Gadol, Aaron A

2016-10-01

Chronic postoperative neuralgias and headache following retrosigmoid craniotomy can be uncomfortable for the patient. We aimed to better elucidate the regional nerve anatomy in an effort to minimize this postoperative complication. Ten adult cadaveric heads (20 sides) were dissected to observe the relationship between the lesser occipital nerve and a traditional linear versus modified U incision during retrosigmoid craniotomy. Additionally, the relationship between these incisions and the occipital artery were observed. The lesser occipital nerve was found to have two types of course. Type I nerves (60%) remained close to the posterior border of the sternocleidomastoid muscle and some crossed anteriorly over the sternocleidomastoid muscle near the mastoid process. Type II nerves (40%) left the posterior border of the sternocleidomastoid muscle and swung medially (up to 4.5cm posterior to the posterior border of the sternocleidomastoid muscle) as they ascended over the occiput. The lesser occipital nerve was near a midpoint of a line between the external occipital protuberance and mastoid process in all specimens with the type II nerve configuration. Based on our findings, the inverted U incision would be less likely to injure the type II nerves but would necessarily cross over type I nerves, especially more cranially on the nerve at the apex of the incision. As the more traditional linear incision would most likely transect the type I nerves and more so near their trunk, the U incision may be the overall better choice in avoiding neural and occipital artery injury during retrosigmoid approaches. Copyright © 2016 Elsevier Ltd. All rights reserved.

Análise do EIA/RIMA do Terminal de Combustíveis da Paraíba (TECOP para fins de licenciamento ambiental

Directory of Open Access Journals (Sweden)

Valdeniza Delmondes Pereira

2016-09-01

Full Text Available O estudo de impacto ambiental precede ao licenciamento ambiental, sendo obrigatório para atividades efetiva ou potencialmente poluidoras ou capazes de degradar o meio ambiente. Este trabalho teve como objetivo fazer a análise do EIA/RIMA do Terminal de Combustíveis da Paraíba Ltda-TECOP, observando se foram cumpridas as exigências legais para a caracterização dos impactos ambientais, e verificando também a existência de medidas mitigadoras para os impactos adversos e indicação de monitoramento para os referidos impactos identificados. Trata-se de uma pesquisa descritiva e documental, que teve como objetos de estudo, o EIA/RIMA e o Processo de Licenciamento Ambiental do TECOP, cujos dados foram coletados junto ao Setor de Documentação da SUDEMA. O EIA/RIMA se mostrou extremamente superficial no que diz respeito à caracterização dos impactos ambientais, estes não sendo devidamente caracterizados conforme determina a Resolução Conama 01/86, artigo 6, inciso II. Os atributos para a correta caracterização dos impactos não foram levados em consideração sequer para os principais impactos adversos passíveis de ocorrerem na fase de operação do empreendimento. O estudo também não mostrou clareza quanto à proposição das medidas mitigadoras e monitoramento para os impactos identificados, pois nem todos os impactos adversos continham a indicação de mitigação e como seriam monitorados.

Modelos para gestão de riscos em cadeias de suprimentos: revisão, análise e diretrizes para futuras pesquisas

Directory of Open Access Journals (Sweden)

Robson Nogueira Tomas

2013-01-01

Full Text Available O objetivo deste artigo é apresentar uma revisão bibliográfica, que possa ser considerada completa e inédita na literatura científica nacional, tendo como foco modelos para gestão de riscos em cadeias de suprimentos. Para tanto, foram revisados 103 artigos científicos publicados entre 2000 e 2012. Inicialmente, buscou-se categorizar os tipos de riscos abordados nos artigos científicos segundo a descrição proposta por Christopher e Peck (2004, a saber: internos à empresa focal (operações, processo e controle; externos para a empresa focal, mas internos para a cadeia (fornecimento e demanda; e externos à cadeia (macroambiente. Buscou-se, também, identificar as etapas elementares na composição de um modelo para gestão de riscos em cadeias de suprimentos. Uma vez categorizados os tipos de riscos e identificadas as quatro etapas elementares, efetuou-se uma análise a partir de três perspectivas: i as opções de modelos disponíveis na literatura para a prática de tal gestão, considerando-se os tipos de riscos e etapas que os compõem; ii um modelo final a ser proposto; e iii elementos que podem ser acrescentados ao modelo final. As principais contribuições deste trabalho dizem respeito a possibilitar melhor entendimento dos tipos de riscos que podem incidir sobre uma cadeia de suprimentos, discutir os modelos mais adequados para geri-los, além de oferecer diretrizes para futuras pesquisas na temática em questão.

Tolerability of NGX-4010, a capsaicin 8% dermal patch, following pretreatment with lidocaine 2.5%/prilocaine 2.5% cream in patients with post-herpetic neuralgia

Directory of Open Access Journals (Sweden)

Webster Lynn R

2011-12-01

Full Text Available Abstract Background Post-herpetic neuralgia (PHN is a common type of neuropathic pain that can severely affect quality of life. NGX-4010, a capsaicin 8% dermal patch, is a localized treatment that can provide patients with significant pain relief for up to 3 months following a single 60-minute application. The NGX-4010 application can be associated with application-site pain and in previous clinical trials pretreatment with a topical 4% lidocaine anesthetic was used to enhance tolerability. The aim of the current investigation was to evaluate tolerability of NGX-4010 after pretreatment with lidocaine 2.5%/prilocaine 2.5% anesthetic cream. Methods Twenty-four patients with PHN were pretreated with lidocaine 2.5%/prilocaine 2.5% cream for 60 minutes before receiving a single 60-minute application of NGX-4010. Tolerability was assessed by measuring patch application duration, the proportion of patients completing over 90% of the intended treatment duration, application site-related pain using the Numeric Pain Rating Scale (NPRS, and analgesic medication use to relieve such pain. Safety was assessed by monitoring adverse events (AEs and dermal irritation using dermal assessment scores. Results The mean treatment duration of NGX-4010 was 60.2 minutes and all patients completed over 90% of the intended patch application duration. Pain during application was transient. A maximum mean change in NPRS score of +3.0 was observed at 55 minutes post-patch application; pain scores gradually declined to near pre-anesthetic levels (+0.71 within 85 minutes of patch removal. Half of the patients received analgesic medication on the day of treatment; by Day 7, no patients required medication. The most common AEs were application site-related pain, erythema, edema, and pruritus. All patients experienced mild dermal irritation 5 minutes after patch removal, which subsequently decreased; at Day 7, no irritation was evident. The maximum recorded dermal assessment

Construcción de un indicador para medir competencias básicas para la vida

OpenAIRE

Andrea Collado Chaves

2006-01-01

La necesidad de construir un indicador para cuantificar el nivel de Competencias Básicas para la Vida (CBV), nace con la evaluación los resultados de un proyecto dirigido a población joven. El propósito de ese proyecto es construir capital humano y empleabilidad en hombres y mujeres con edades entre 13 y 18 años, desertores o en riesgo de desertar del sistema educativo, sin empleo formal y que viven en ambientes de pobreza y exclusión. Una de las dimensiones de empleabilidad son las Competenc...

MODELO PARA LA GESTIÓN DEL CONOCIMIENTO ORGANIZACIONAL EN LA SUITE PARA LA DIRECCIÓN INTEGRADA POR PROYECTOS GESPRO

Directory of Open Access Journals (Sweden)

Anisleiby Fernández Hernández

2014-06-01

Full Text Available La economía mundial se dirige hacia un nuevo modelo basado en el conocimiento, aportando ventajas competitivas gracias a su gestión. La Dirección Integrada por Proyectos requiere de la aplicación de un modelo para la gestión del conocimiento, con el objetivo de garantizar la elevación de la calidad de los nuevos proyectos. En el trabajo se presenta un modelo que combina y complementa diferentes estrategias para identificar, adquirir, retener, desarrollar y utilizar el conocimiento necesario en la realización de los proyectos, apoyadas por el uso de las Tecnologías de la Informática y las Comunicaciones. Este modelo responde y está en correspondencia con la versión 13.05 de la Suite para la Dirección Integrada por Proyectos Gespro de Software libre perteneciente a la Universidad de las Ciencias Informáticas, que se presenta como proceso para la gestión del conocimiento.

"Colaborar para Competir"

Directory of Open Access Journals (Sweden)

Martha Liliana Hijuelos-Cárdenas

2015-06-01

Full Text Available De acuerdo con Michael Porter, los Clusters se definen como “Una agrupación de empresas e instituciones relacionadas entre sí, pertenecientes a un mismo sector o segmento de mercado, que se encuentran próximas geográficamente y que colaboran para ser más competitivas”. Los Clusters son en última instancia una herramienta de competitividad basada en la cooperación de sus miembros, y es una de las estrategias recientes, en el país, para incrementar la productividad y competitividad y las apuestas productivas desde el nivel local. Y es precisamente esta cercanía geográfica de las empresas de un mismo sector, lo que a la vez que genera la competencia entre ellas, también les facilita el acceso a insumos y a conocimientos específicos y en última instancia les permite promover la innovación.

ParaTrough v1.0: Librería en Modelica para Simulación de Plantas Termosolares

Directory of Open Access Journals (Sweden)

Juan A. Romera Cabrerizo

2017-10-01

Full Text Available Resumen: El presente trabajo describe una librería desarrollada en Modelica que utiliza el entorno Dymola 6.1 para modelar y simular plantas termosolares de tecnología de colector cilindro-parabólico. El actual software de modelado y simulación es cada vez más potente gracias a los avances en computación y programación, pudiendo conseguir estimaciones muy precisas del comportamiento de estas plantas térmicas. Como mejora a otras propuestas actuales, la librería ParaTrough se ofrece como una herramienta pública, gratuita bajo licencia Modelica License 2, de código libre, flexible, modular, y por lo tanto fácilmente ampliable y modificable para los requerimientos específicos de cada planta y proceso en particular. En la versión 1.0 contemplada en este artículo, esta librería se puede usar para el modelado y simulación del recurso solar y del sistema de fluido de transferencia calorífica sin cambio de fase. Los modelos han sido validados con datos reales de una planta en operación, Andasol 3, en los términos municipales de Aldeire y La Calahorra (Granada. El objetivo de ParaTrough es poder ser utilizada gratuitamente y de forma amigable por analistas de procesos para uno o varios de los siguientes casos: evaluación del rendimiento, detección de fallos, exploración de nuevos modos de operación y optimización de la planta. Aunque en futuras versiones se puedan añadir otros elementos, esta aportación cubre una nueva área de aplicación específica para el software de Modelica y en su estado actual facilita la operación y mantenimiento de estas plantas. Abstract: This paper describes a Modelica-based library developed to the modeling and simulation of solar thermal plants with parabolic trough collectors. The Dymola 6.1 environment has been used. Unlike other commercial tools, the ParaTrough library is offered as a free open source tool, under Modelica License 2. Its modular code makes it easily extensible and modifiable to

Higher dose rate Gamma Knife radiosurgery may provide earlier and longer-lasting pain relief for patients with trigeminal neuralgia.

Science.gov (United States)

Lee, John Y K; Sandhu, Sukhmeet; Miller, Denise; Solberg, Timothy; Dorsey, Jay F; Alonso-Basanta, Michelle

2015-10-01

Gamma Knife radiosurgery (GKRS) utilizes cobalt-60 as its radiation source, and thus dose rate varies as the fixed source decays over its half-life of approximately 5.26 years. This natural decay results in increasing treatment times when delivering the same cumulative dose. It is also possible, however, that the biological effective dose may change based on this dose rate even if the total dose is kept constant. Because patients are generally treated in a uniform manner, radiosurgery for trigeminal neuralgia (TN) represents a clinical model whereby biological efficacy can be tested. The authors hypothesized that higher dose rates would result in earlier and more complete pain relief but only if measured with a sensitive pain assessment tool. One hundred thirty-three patients were treated with the Gamma Knife Model 4C unit at a single center by a single neurosurgeon during a single cobalt life cycle from January 2006 to May 2012. All patients were treated with 80 Gy with a single 4-mm isocenter without blocking. Using an output factor of 0.87, dose rates ranged from 1.28 to 2.95 Gy/min. The Brief Pain Inventory (BPI)-Facial was administered before the procedure and at the first follow-up office visit 1 month from the procedure (mean 1.3 months). Phone calls were made to evaluate patients after their procedures as part of a retrospective study. Univariate and multivariate linear regression was performed on several independent variables, including sex, age in deciles, diagnosis, follow-up duration, prior surgery, and dose rate. In the short-term analysis (mean 1.3 months), patients' self-reported pain intensity at its worst was significantly correlated with dose rate on multivariate analysis (p = 0.028). Similarly, patients' self-reported interference with activities of daily living was closely correlated with dose rate on multivariate analysis (p = 0.067). A 1 Gy/min decrease in dose rate resulted in a 17% decrease in pain intensity at its worst and a 22% decrease

Framework Multi-LIBRAS para integração e colaboração de soluções para deficientes auditivos

Directory of Open Access Journals (Sweden)

Luciana Pereira Oliveira

2017-08-01

Full Text Available Vem crescendo o número de soluções para pessoas com deficiência auditiva. Por exemplo, vêm surgindo diversas soluções de tradutores de Português para LIBRAS para facilitar a comunicação entre ouvintes e surdos. Por outro lado, muitos projetos de pesquisa estão descontinuados, não sendo possível executar os aplicativos desenvolvidos e muito menos repetir experimentos descritos nos artigos. Então, como os pesquisadores poderiam trabalhar de maneira colaborativa a construção de novos aplicativos e melhorias dos softwares existentes? Seria possível distintos grupos de pesquisa criarem um dicionário de Português e LIBRAS aberto? Objetivando-se esse ambiente colaborativo, definiu-se o framework Multi-LIBRAS, que oferece flexibilidade e extensibilidade para integrar qualquer solução para LIBRAS e algoritmos de avaliação. O artigo irá apresentar uma visão geral, as camadas externas e internas do framework bem como exemplificar o uso do Multi-LIBRAS, que dá suporte a soluções descritas em qualquer linguagem de programação.

Pequenos para idade gestacional: fator de risco para mortalidade neonatal

Directory of Open Access Journals (Sweden)

Almeida Márcia Furquim de

1998-01-01

Full Text Available OBJETIVO: Estudar as variáveis contempladas na Declaração de Nascimento (DN como possíveis fatores de risco para nascimentos pequenos para a idade gestacional (PIG e o retardo de crescimento intra-uterino como fator de risco para a mortalidade neonatal. MATERIAL E MÉTODO: As variáveis existentes na DN foram obtidas diretamente de prontuários hospitalares. Os dados referem-se a uma coorte de nascimentos obtida por meio da vinculação das declarações de nascimento e óbito, correspondendo a 2.251 nascimentos vivos hospitalares, de mães residentes, ocorridos no Município de Santo André, Região Metropolitana de São Paulo, no período de l/1 a 30/6/1992, e aos óbitos neonatais verificados nessa coorte. RESULTADOS: Obteve-se a proporção de 4,3% de nascimentos PIG, significativamente maior entre os recém-nascidos de pré-termo e pós-termo, entre os nascimentos cujas mães tinham mais de 35 anos de idade e grau de instrução inferior ao primeiro grau completo. Os recém-nascidos PIG apresentam maior risco de morte neonatal que aqueles que não apresentavam sinais de retardo de crescimento intra-uterino. CONCLUSÕES: Em áreas com menor freqüência de baixo peso ao nascer, é importante investigar a presença de retardo de crescimento intra-uterino entre os nascimentos prematuros e não apenas nos nascimentos de termo. O registro da data da última menstruação (ou da idade gestacional em semanas não agregadas na DN facilitaria a detecção de PIGs na população de recém-nascidos.

Propuesta de implementación de un modelo de calidad para la selección de software base para servidores.

OpenAIRE

Espinel Mena, Gonzalo Patricio; Montaluisa Yugla, Franklin Javier

2012-01-01

La propuesta de implementación plantea la utilización de un modelo de calidad estructurado para ayudar a resolver el problema de adquirir paquetes de software de base que encajen normalmente dentro de un entorno organizacional. El modelo de calidad estructurado para un dominio de un paquete dado proporcionará una taxonomía de características de software de calidad, y métricas para calcular su valor. El modelo de calidad se basa la norma ISO/IEC 9126 de la ISO (Organización Internacional de No...

Desenvolvimento de uma abordagem computacional para a descoberta de compostos-líderes para fármacos anticancerígenos

OpenAIRE

Cruz, Sara Miguel Dinis Mamede da

2016-01-01

Atualmente o cancro é uma das principais causas de morte, causando uma crescente demanda para a descoberta de fármacos para o seu tratamento. O objetivo desta dissertação foi a construção de modelos computacionais para auxiliar a descoberta de novos compostos líder anticancerígenos contra o cancro do cólon. Foram realizados dois diferentes estudos da Relação Quantitativa Estrutura Atividade (QSAR), o primeiro intitulado Modelo A, que utilizou conjuntos de descritores estruturais e fingerpr...

Cubierta de madera para una nave industrial

Directory of Open Access Journals (Sweden)

Hossdorf, Heinz

1958-05-01

Full Text Available Para la ampliación de los talleres de Hans Schmidlin, de Basilea, Suiza, dedicados a la prefabricación de elementos de construcción de madera y metales ligeros para fachadas, se ha construido una nueva nave, rectangular, de 49x55,4 m en planta.

Secadores solares - térmicos para granos y frutas para utilizarlo en zonas remotas

OpenAIRE

Delgado, E.; Peralta, J.; Barriga, A.

2009-01-01

Los objetivos principales de esta investigación son: • Dar a conocer la ventaja que tiene el uso de la utilización de la energía solar térmica para sistemas de secadores solares en la disminución de la humedad de los producto. • Valorar la importancia de la conservación energética y ambiental a través del uso de energía limpia. • Dar a conocer diseños de sistema de secado solar para alimentos, principalmente granos y frutas acorde a las características del producto, geográficas, técnicas y so...

Novo teste para diagnóstico das afasias

Directory of Open Access Journals (Sweden)

José G. Albernaz

1953-06-01

Full Text Available Um novo teste para diagnóstico e contrôle do tratamento das diferentes formas de afasia, especialmente adaptado para a língua portuguêsa, é apresentado e descrito em detalhe. O teste, que será de valor para clínicos e psicólogos interessados no tratamento e reabilitação de pacientes afásicos, se executa em cêrca de 30 minutos, interpreta-se fàcilmente e fornece os elementos necessários para o planejamento da reeducação da linguagem. Além disso, a repetição do teste de tempos em tempos indicará os progressos do paciente e sugerirá modificações do plano de tratamento no momento oportuno.

Os motivos das relações entre orientação para mercado, orientação para aprendizagem e sucesso de novos produtos

Directory of Open Access Journals (Sweden)

Mauren do Couto Soares

2016-04-01

Full Text Available O objetivo deste trabalho é identificar os motivos das relações entre os construtos de orientação para mercado, orientação para aprendizagem e sucesso de novos produtos. Neste sentido, foram coletadas 32 entrevistas com executivos de empresas de setores representativos da economia brasileira. Os principais resultados indicam que: (1 grande parte dos motivos encontrados nas entrevistas corrobora as evidências levantadas na literatura; (2 algumas variáveis podem moderar as relações entre orientação para mercado, orientação para aprendizagem e sucesso de novos produtos, entre elas a motivação, a burocracia e os recursos humanos; e, (3 empresas que integram os construtos de orientação para mercado, orientação para aprendizagem e sucesso de novos produtos podem potencializar sua performance, facilitando a obtenção de uma vantagem competitiva sustentável.

Entrenamiento de fuerza para la salud

OpenAIRE

Ortiz Cervera, Vicente

1996-01-01

Este artículo describe de manera breve y clara los efectos del entrenamiento de fuerza sobre la salud, al mismo tiempo da pautas para la realización y programación de los entrenamientos de fuerza para la salud en distintas edades. Se muestran las diferentes variables del entrenamiento de la fuerza junto con ejemplos de entrenamientos, basándose en las pautas marcadas en la revisión bibliográfica descrita.

Páginas web para el aprendizaje

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Isabel ÁLVAREZ

2016-04-01

Full Text Available Este artículo plantea la construcción de paginas web como vehículo para facilitar la integracion de las tecnologias de la informacion y la comunicacion en el aula para futuros maestros. El término Página Web Coherente enfatiza la utilización de páginas cuyo objetivo principal es promover el aprendizaje siguiendo un proceso colaborativo, una estructura integradora y un contenido educativo.

Movement and equipositioning of plasmids by ParA filament disassembly

DEFF Research Database (Denmark)

Ringgaard, Simon; van Zon, Jeroen; Howard, Martin

2009-01-01

, plasmids consistently migrate behind disassembling ParA cytoskeletal structures, suggesting that ParA filaments pull plasmids by depolymerization. The perpetual cycles of ParA assembly and disassembly result in continuous relocation of plasmids, which, on time averaging, results in equidistribution...

Contribuição para o estudo de sistemas de tratamento de água para abastecimento associados à remoção de compostos farmacêuticos

OpenAIRE

Cid, Joana Ferraz Leal de Sobral

2011-01-01

Dissertação apresentada na Faculdade de Ciências e Tecnologia da Universidade Nova de Lisboa para obtenção do grau de Mestre em Engenharia do Ambiente, perfil Engenharia Sanitária Este trabalho pretende contribuir para o estudo de sistemas de tratamento de água para abastecimento associados à remoção de compostos farmacêuticos. Assim, para melhor compreender a importância da remoção dos compostos farmacêuticos da água para abastecimento surge uma abordagem sobre a presença dos compostos...

EL SOL COMO ALTERNATIVA PARA PRODUCIR ENERGÍA ELÉCTRICA: PROPUESTA PARQUE INFANTIL PARA LA CIUDAD DE CÚCUTA

Directory of Open Access Journals (Sweden)

Karla Yohana Sánchez-Mojica

2015-06-01

Full Text Available La problemática del consumo descontrolado de energía eléctrica en el mundo y su constante crecimiento, es el escenario para el desarrollo de esta investigación que busca adelantar una propuesta para crear un parque infantil por parte de estudiantes de la Institución educativa Carlos Ramírez Paris, que funcione con energía solar como estrategia de sensibilización a la comunidad en general sobre el uso de energías limpias en la ciudad y en Colombia. Los estudiantes plantean la idea desde el programa ondas en una investigación que responde a una necesidad inmediata que los motiva como lo es un parque de diversiones público, sin embargo, es una alternativa para pensar en proyectos macro de desarrollo para la ciudad. Con esta propuesta se pretende diseñar una maqueta de un parque infantil a pequeña escala donde los estudiantes plasmen su iniciativa y se muestre la aplicación de la energía solar para el funcionamiento de algunos atractivos; una de los principales objetivos del proyecto es responder a la curiosidad de los estudiantes por saber cómo es el funcionamiento de este tipo de energía haciendo uso de los paneles solares.

El concepto de desarrollo y las propuestas de comunicación para el desarrollo: hojas de ruta de la comunicación para la paz

OpenAIRE

Sala Valdés, Cristina

2011-01-01

La comunicación para el desarrollo y la comunicación para la paz han evolucionado de forma paralela durante los últimos cuarenta años, siendo la comunicación para la paz un área menos explorada teóricamente y por tanto más asentada en la práctica. El repaso histórico y análisis de los paradigmas que han ido vertebrando tanto el concepto de desarrollo como el de comunicación para el desarrollo permiten descubrir cuáles son los ejes teóricos y prácticos que pueden orientar la comunicación para ...

Plan de Mercadeo para una “FinTech”.

OpenAIRE

Escalante Lee, Maria Alejandra

2016-01-01

Las empresas deben contar con una misión clara, estableciendo los objetivos de apoyo, diseñando una cartera de negocio sólida y coordinar sus estrategias a futuro, con el fin de cumplir las metas propuestas para entregar e intercambiar ofertas que tienen valor para los consumidores, clientes, socios y la sociedad en general. El presente trabajo de grado tiene como objetivo proponer un plan de mercadeo para la empresa Comyno una FinTech ubicada en Frankfurt am Main, en Alemania. Este tiene ...

Oxitocina: nuevas perspectivas para una droga antigua

Directory of Open Access Journals (Sweden)

Steven L. CLARK

2010-12-01

Full Text Available La oxitocina es el medicamento más comúnmente asociada con la prevención de complicaciones perinatales y recientemente fue incluida por el Instituto para la Administración Medicamentosa Segura (Institute for Safe Medication Practices - ISMP en una pequeña lista de medicamentos “con alto grado de riesgos”, lo que puede “necesitar salvaguardas especiales para reducir el riesgo de error”. Las recomendaciones actuales para administrar este medicamento son vagas en relación a la indicación, tiempo de uso, dosis y el monitoreo de los efectos maternos y fetales. Una revisión de los datos clínicos y farmacológicos disponibles sugiere que las orientaciones específicas y basadas en evidencias para administrar oxitocina durante el parto puede derivarse de datos disponibles. Si implementadas, estas prácticas pueden reducir la probabilidad de daños al paciente. Esto sugiere el foco de las orientaciones para la administración electiva limitada de oxitocina, considerar estrategias que disminuyan la necesidad de usar oxitocina, confiar en terapéuticas de bajas dosis de oxitocina, la adhesión a definiciones semicuantitativas específicas sobre parto adecuado e inadecuado, y la aceptación de que, una vez que la actividad uterina adecuada sea alcanzada, es generalmente preferible esperar más tiempo que aumentar la infusión de oxitocina. El uso de protocolos conservadores y específicos para monitorear los efectos de la oxitocina en la madre y en el bebé tiende no sólo a aumentar los resultados, mas también a reducir los conflictos entre miembros del equipo obstétrico. Implementar estas orientaciones parece ser apropiada en una cultura cada vez más focalizada en la seguridad del paciente.

Estrategias de mercado para el frijol centroamericano

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Lourdes Mart\\u00EDnez

2004-01-01

Full Text Available Estrategias de mercado para el frijol centroamericano. En los últimos años, el sub-sector de frijol en Centro América ha sido testigo de varios cambios dinámicos. Si no se encuentran medidas para incrementar la competitividad regional de este sub-sector, los países centroamericanos experimentarán impactos negativos en las áreas sociales y económicas de considerable magnitud, especialmente ahora que Centro América necesita ajustar su economía a los nuevos requerimientos de mercados mas abiertos, como el Tratado Centroamericano de Libre Comercio con USA (TLC. Vendedores de frijoles a nivel intermediario y de consumo final, así como técnicos de oficinas gubernamentales dedicadas al mercadeo de frijoles en Centro América fueron entrevistados para documentar los cambios experimentados, identificar los obstáculos que frenan la viabilidad del sub-sector e identificar las oportunidades de incremento de mercados en el futuro para los productores y vendedores de frijol. Los resultados muestran que para que continúen siendo competitivos, los países centroamericanos deben incrementar la productividad a través del apoyo a las investigaciones para el mejoramiento de variedades de frijol, especialmente aquellas que los consumidores prefieren por características específicas (e.g. color. También es imprescindible el fortalecimiento de los programas de distribución de variedades mejoradas a los productores; las mejoras en la transmisión de información de mercado a los productores; el fortalecimiento de los contactos entre productores, comercializadores a nivel mayorista y supermercados; y una política más específica de apertura de mercados de exportación, especialmente con los Estados Unidos.

LOS DERECHOS HUMANOS EN AMÉRICA LATINA: POR QUÉ, PARA QUÉ Y PARA QUIÉN

Directory of Open Access Journals (Sweden)

Carmen M. Rodríguez Salgado

2001-01-01

Full Text Available Los interrogantes por qué, para qué y para quién hacen que cobre vigencia la importancia de seguir luchando por el respeto y defensa de los Derechos Humanos en América Latina. En este artículo se examina la situación en la cual gobiernos supuestamente democráticos agreden de manera brutal a la población civil al imponer leyes que perdonan las violaciones pasadas, e implementan y promueven condiciones de vida en las que el 1/3 de la población latinoamericana vive debajo del límite de pobreza. Debemos analizar esto junto a la carencia total de algunos derechos básicos. La situación social de violencia económica-política, física y psicológica a la que cotidianamente están sometidos los argentinos, la desocupación estructural, las muertes evitables, no son episodios extraordinarios sino situaciones cotidianas. Lo anterior ejercita la continuidad del autoritarismo, la impunidad, la estigmatización y la discriminación. En el siglo XX los fascismos construyeron sobre la base del odio una comunidad para la muerte. El terror impuesto por la última dictadura militar en la Argentina se vuelve a vivir con un Estado que hace desaparecer a los ciudadanos de su lugar social. Los trabajadores de la salud, sostiene la autora de este artículo, deben participar activamente para generar políticas que permitan transformar esta sociedad, y reconoce la memoria como la forma de resistencia al olvido.

MÁS QUE TÁCTICAS PARA SOBREVIVIR

Directory of Open Access Journals (Sweden)

ANA MARÍA ARBOLEDA ARANGO

2009-01-01

Full Text Available HOP es una empresa líder en suministros de oficina que enfrenta la problemática de contar con una gran variedad de eventos comerciales dirigidos a clientes de los diferentes canales. Permanentemente implementa nuevas tácticas para llegar al cliente y para estar notoriamente en el punto de venta. Sin embargo, la diversidad de actividades del canal está afectando su rentabilidad. Este comportamiento es sustentado por el departamento comercial como el único camino para ser competitivos. Además, la multiplicidad de actividades comerciales parece no estar jugando a favor sino en contra del cumplimento de los objetivos de venta. Con este marco, una serie de preguntas llevan al estudiante a pensar más allá de las tácticas con las que HOP reacciona en el día a día, para pasar a pensar en una estrategia comercial de largo plazo teniendo en cuenta un plan a tres años y una propuesta de evaluación y seguimiento.

AÇÕES EDUCATIVAS PARA TERCEIRA IDADE

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Rejane Millions Viana Meneses

2013-01-01

Full Text Available En el proceso del envejecimiento, anciano se enfrentan a la aparición de enfermedades crónicas que muchas veces reflejan en dificultades para el mantenimiento de la salud. En este contexto, es importante el trabajo con la tercera edad para promover la mejora del consiguiente estilo de vida. Este trabajo es un relato de experiencia de la ejecución de un proyecto de investigación de la Universidad Federal de Rio Grande do Norte , que lleva acciones educativas a la Asociación Inaraí (Natal/RN, con objetivo de divulgar actividades, así estimulando la formación de los grupos a que tienen como objetivo la promoción a salud de ancianos . Para desarrollar las acciones, según la informaciones recogidas en el perfil epidemiológico llevado previamente en la Asociación, por medio de reuniones semanales con anciano s, se buscó estimular buenos hábitos de vida , para llevar a cabo posible la mejora de lo estilo de vida y por lo tanto, promover salud de ese grupo.

The Regulation of para-Nitrophenol Degradation in Pseudomonas putida DLL-E4.

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Qiongzhen Chen

Full Text Available Pseudomonas putida DLL-E4 can efficiently degrade para-nitrophenol and its intermediate metabolite hydroquinone. The regulation of para-nitrophenol degradation was studied, and PNP induced a global change in the transcriptome of P. putida DLL-E4. When grown on PNP, the wild-type strain exhibited significant downregulation of 2912 genes and upregulation of 845 genes, whereas 2927 genes were downregulated and 891 genes upregulated in a pnpR-deleted strain. Genes related to two non-coding RNAs (ins1 and ins2, para-nitrophenol metabolism, the tricarboxylic acid cycle, the outer membrane porin OprB, glucose dehydrogenase Gcd, and carbon catabolite repression were significantly upregulated when cells were grown on para-nitrophenol plus glucose. pnpA, pnpR, pnpC1C2DECX1X2, and pnpR1 are key genes in para-nitrophenol degradation, whereas pnpAb and pnpC1bC2bDbEbCbX1bX2b have lost the ability to degrade para-nitrophenol. Multiple components including transcriptional regulators and other unknown factors regulate para-nitrophenol degradation, and the transcriptional regulation of para-nitrophenol degradation is complex. Glucose utilization was enhanced at early stages of para-nitrophenol supplementation. However, it was inhibited after the total consumption of para-nitrophenol. The addition of glucose led to a significant enhancement in para-nitrophenol degradation and up-regulation in the expression of genes involved in para-nitrophenol degradation and carbon catabolite repression (CCR. It seemed that para-nitrophenol degradation can be regulated by CCR, and relief of CCR might contribute to enhanced para-nitrophenol degradation. In brief, the regulation of para-nitrophenol degradation seems to be controlled by multiple factors and requires further study.

UMA METODOLOGIA VOLTADA PARA O DESENVOLVIMENTO DE LÍDERES

OpenAIRE

Carvalho, Leila de Moura

2003-01-01

Este trabalho aborda uma metodologia voltada para o desenvolvimento do grupo de líderes da Divisão Logística de uma empresa do setor de varejo. Em uma pesquisa realizada pela empresa, detectou-se uma deficiência no estilo de supervisão atual adotada pelo grupo de líderes e as conseqüências negativas geradas para a organização. A proposta deste trabalho é promover a educação e o treinamento do grupo de líderes para uma mudança de estilo de supervisão. Para isso, propõe-se a utilizar como base ...

APUNTES PARA EL DESARROLLO DE INTERVENCIONES DE PREVENCIÓN DE VIH/ITS PARA JÓVENES EN PUERTO RICO

Directory of Open Access Journals (Sweden)

Patricia L. Noboa-Ortega

2017-01-01

Full Text Available En este artículo presentamos los resultados de la implantación de tres grupos focales utilizados para adaptar una intervención para la prevención del VIH/ITS en jóvenes. Uno de los grupos fue celebrado con hombres, uno con mujeres, y otro con parejas donde participaron un total de 27 personas . Auscultamos el conocimiento sobre el VIH/ITS, las situaciones que los exponen a riesgo, el formato y contenido que una intervención debía ten er. Encontramos que aunque los y las jóvenes tenían un conocimiento básico, también tenían concepciones equivocadas como que el VIH/ITS se transmite por el beso y la saliva, y que la Clamidia se transmite por sentarse en inodoros públicos. Expresaron que una intervención debe abordar las diversas dificultades que los y las jóvenes enfrentan para el uso del condón y que debe utilizar testimonios reales de personas. El uso de grupos focales es una herramienta muy útil para identificar el formato y contenid o de intervenciones. .

Criterios para una acompañamiento familiar integral, con orientación personalista, para instituciones educativas

OpenAIRE

Marroquín Valdiviezo, Carmen Isabel del Pilar

2016-01-01

Frente a la crisis familiar que vivimos actualmente, la presente investigación cualitativa buscó proponer los criterios para un acompañamiento familiar integral, con orientación personalista, para instituciones educativas. En un primer momento, hemos identificado las bases teóricas: las perspectivas de la persona desde el personalismo y las teorías psicológicas sobre las familias. Dichas bases nos han permitido conocer diversas posturas en torno a la persona y su vínculo familiar. Además, se ...

Libertad religiosa, camino para la paz

Directory of Open Access Journals (Sweden)

Antonio Alonso

2011-01-01

Full Text Available La libertad religiosa es el núcleo del Mensaje para la XLIV Jornada Mundial de la Paz que ha dirigido Benedicto XVI. Cuestión, sin duda, extraordinariamente delicada, pues comporta graves implicaciones en materia de seguridad principalmente por dos motivos: primero, porque su violación supone una injusticia difícil de compaginar con el respeto a los Derechos Humanos; segundo, porque dicha libertad no puede ser esgrimida como pretexto para atropellar los derechos de los demás conciudadanos o incluso socavar la propia seguridad del Estado. El Santo Padre denuncia, a su vez, los estragos del relativismo y de los fanatismos, tanto religioso como anti-religioso, y propone el ejercicio del diálogo basado en la razón para superar los obstáculos en la convivencia interpuestos por estas amenazas a la paz y la seguridad.

Programa de conservacion para aves migratorias neotropicales

Science.gov (United States)

Deborah Finch; Marcia Wilson; Roberto Roca

1992-01-01

Mas de 250 especies de aves terrestres migran a Norte America durante la epoca reproductiva para aprovechar los sistemas templados. No obstante, las aves migratorias neotropicales pasan la mayor parte de su ciclo de vida en los habitat tropicales y subtropicales de paises latinoamericanos y caribefios donde viven en una asociacion cercana con las aves residentes. Para...

Fact Sheet: Trigeminal Neuralgia

Science.gov (United States)

... Health, is the federal government’s leading supporter of biomedical research on disorders of the brain and nervous system. ... by the National Institute of Dental and Craniofacial Research. One ... mucosa). Current drug therapy is absorbed through the body, which may lead ...

Kaatsu training : novas perspectivas para o treinamento resistido

OpenAIRE

Deus, Lysleine Alves de

2012-01-01

Para que um treinamento resistido possa contribuir de forma eficaz para o aumento de força e hipertrofia, muitos são os fatores que interferem na sua elaboração. Estudos ao longo dos anos vinham relatando que o treinamento resistido executado com cargas altas era o método mais eficaz para o aumento de força e hipertrofia. Em contradição a essas teorias pesquisadores japoneses desenvolveram uma nova técnica em que o treinamento resistido (TR) é executado com baixa intensidade e pouco peso asso...

HERRAMIENTAS PARA LA ESTIMACIÓN DEL RIESGO CARDIOVASCULAR

Directory of Open Access Journals (Sweden)

Dra. Sonia Kunstmann

2018-01-01

Existen diferentes herramientas para medir el riesgo cardiovascular, siendo las tablas de estratificación las más utilizadas para estos fines. Existen marcadores de riesgo que añaden poco a la estratificación y se recomiendan solo en evaluaciones del especialista. Algunas imágenes como Score de Calcio, son una nueva herramienta de evaluación del riesgo de presentar un evento cardiovascular en los próximos años. Esta revisión analiza diversas herramientas para la prevención cardiovascular

Pedagogía de la memoria y educación para el "nunca más" para la construcción de la democracia

Directory of Open Access Journals (Sweden)

Susana Sacavino

2015-01-01

Full Text Available La educación en derechos humanos es una mediación importante para la afirmación y la construcción de la democracia. En Brasil, en 2014, se cumplieron cincuenta años del golpe civil-militar que dio inicio a una larga dictadura de más de dos décadas, con prácticas sistemáticas de violación de los derechos humanos por parte del Estado. En este contexto es de fundamental importancia desarrollar una pedagogía de la memoria para educar para el nunca más en la línea de la cualificación y mejoramiento de la democracia. Desde un enfoque de (desconmemoración del cincuentenario de la dictadura civil-militar, este artículo se estructura en tres partes. En la primera, se presenta el origen de la expresión nunca más, su incorporación en la educación en derechos humanos y su relación con la memoria. Se profundiza también en diferentes sentidos de la memoria y sus contribuciones y articulaciones para la educación para el nunca más. Por último, se argumenta sobre por qué educar para el nunca más. En la segunda parte se presentan tres propuestas pedagógicas desde una óptica de (desconmemoración de los cincuenta años de la dictadura civil-militar para educar para el nunca más: una propuesta de carácter general, otra orientada a la formación de los docentes, y la tercera, para que el maestro pueda trabajar con sus alumnos en el aula de clase. Luego, se tejen algunas consideraciones sobre el tema del trabajo de la(s memoria(s y la educación para el nunca más.

AS CONSTANTES BARREIRAS ENFRENTADAS PARA ESCOLHA DO TEMA DE TCC

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Gabriel Aparecido Zucoloto

2016-11-01

Full Text Available O presente artigo busca analisar quais são as principais dificuldades encontradas na escolha de um tema para Trabalho de Conclusão de Curso - TCC. Para resolver este problema de pesquisa, foi necessário levantar as principais dificuldades encontradas por alunos na hora de escolher o tema do TCC. Para tanto, foi aplicado um questionário eletrônico, via Google Docs, como método de coleta de dados, cujo resultado fora tabulado e apontado um resultado estatístico para a pesquisa. O público-alvo da pesquisa foram 130 alunos do curso superior de análise de sistema de uma instituição de ensino público. Com o resultado encontrado a partir dos questionários, nota-se dificuldades como o a inexperiência das normas a serem seguidas para formatação de projetos, além do pouco conhecimento sobre o tema que gostariam de abordar, pode-se apurar que a escolha para um tema pode ser muito difícil levando-se em consideração fatores como conhecimento adquirido durante o curso e tempo para se dedicar ao trabalho.

Para hydrogen equilibration in the atmospheres of the outer planets

International Nuclear Information System (INIS)

Conrath, B.J.

1986-01-01

The thermodynamic behavior of the atmospheres of the Jovian planets is strongly dependent on the extent to which local thermal equilibration of the ortho and para states of molecular hydrogen is achieved. Voyager IRIS data from Jupiter imply substantial departures of the para hydrogen fraction from equilibrium in the upper troposphere at low latitudes, but with values approaching equilibrium at higher latitudes. Data from Saturn are less sensitive to the orth-para ratio, but suggest para hydrogen fractions near the equilibrium value. Above approximately the 200 K temperature level, para hydrogen conversion can enhance the efficiency of convection, resulting in a substantial increase in overturning times on all of the outer planets. Currently available data cannot definitively establish the ortho-para ratios in the atmospheres of Uranus and Neptune, but suggest values closer to local equilibrium than to the 3.1 normal ratio. Modeling of sub-millimeter wavelength measurements of these planets suggest thermal structures with frozen equilibrium lapse rates in their convective regions

FOTOBIORREACTOR: HERRAMIENTA PARA CULTIVO DE CIANOBACTERIAS

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Luis Guillermo Ramírez Mérida

2014-05-01

Full Text Available Las cianobactérias son organismos eficientes en la conversión de energía solar y producen una gran variedad de metabolitos. En la actualidad son el centro de atención para la producción de biocombustible, son usadas como biofertilizantes, control de contaminación ambiental y como fuente de nutrientes en alimentación humana y animal. Con el fin de proporcionar crecimiento y aprovechar el potencial de las cianobacterias, se requieren fotobiorreactores eficientes. Aunque se han propuesto muchos tipos de fotobiorreactores, no existe un reactor ideal, solo unos pocos pueden utilizarse para la producción de biomasa de cianobacterias. De hecho, la elección del fotobiorreactor más adecuado depende de la situación, ya que tanto las especies de algas disponibles y el destino final jugarán un papel importante. Uno de los principales factores que limita su aplicación práctica en cultivos de biomasa es la transferencia de masa. Por esto, entender el coeficiente de transferencia de masa en los fotobiorreactores es necesario para una operación eficiente del cultivo de biomasa en cianobacterias. En esta revisión, se discuten varios tipos de fotobiorreactores muy promisorios para la producción de biomasa de cianobacterias.

Immediate pain relief by microvascular decompression for idiopathic trigeminal neuralagia

International Nuclear Information System (INIS)

Haq, N.U.; Ali, M.; Khan, H.M.; Ishaq, M.; Khattak, M.I.

2016-01-01

Background: Trigeminal neuralgia is a common entity which is managed by neurosurgeons in day to day practice. Up-till now many treatment options have been adopted for it but micro-vascular decompression is much impressive in terms of pain control and recurrence rate in all of them. The objective of study was known the efficacy of micro vascular decompression for idiopathic trigeminal neuralgia by using muscle patch in terms of immediate pain relief. Methods: This descriptive study was carried out in Neurosurgery Department lady reading hospital, Peshawar from January 2010 to December 2012. All patients who underwent micro vascular decompression for idiopathic trigeminal neuralgia were included in the study. Patients were assessed 72 hours after the surgery by borrow neurological institute pain scale (BNIP scale) for pain relief and findings were documented on predesigned proforma. Data was analysed by SPSS-17. Results: Total 52 patients were included in this study. Among these 32 (61.53 percentage) were female and 20 (38.46 percentage) were males having age from 22-76 years (mean 49 years). Right side was involved in 36 (69.23 percentage) and left side in 16 (30.76 percentage) patients. Duration of symptoms ranged from 6 months to 16 years (mean 8 years). History of dental extraction and peripheral neurectomy was present in 20 (38 percentage) and 3(5.76 percentage) patients while V3 was most commonly involved branch with 28(57.69 percentage) frequency and combined V2,V3 involvement was 1 (11.53 percentage). Superior cerebellar artery was most common offending vessel in 46(88.46 percentage) while arachnoid adhesions were in 2(3.84 percentage) patients. We assessed patient immediate postoperatively using BNIP pain scale. Conclusion: Micro-vascular decompression is most effective mode of treatment for trigeminal neuralgia in terms of immediate pain relief. (author)

para asegurar un hijo sano

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Carmen Amarilis Guerra de Castillo

2006-01-01

Full Text Available Esta investigación etnográfica focalizada exploró las creencias, los valores, los hábitos y los padrones comportamentales de las embarazadas diabéticas atendidas en el Hospital Doctor Enrique Tejera, quienes residen en tres comunidades urbanas pobres de la ciudad de Valencia - Venezuela, con el objetivo de encontrar el significado del cuidado de si para dichas grávidas. Se utilizó como referencial teórico el Modelo del Análisis de la Salud y la Teoría Antropológica de la Salud, siendo fundamentales para revelar aquello que estaba implícito en el comportamiento de las mujeres con relación a su cuidado. Surgieron tres temas: la salud y la enfermedad - valores culturales del cuidado de si; las prácticas del cuidado de la salud y cuidándose en el embarazo garantiza tener un hijo más saludable. Los temas culturales revelaron que las creencias, los valores, los hábitos y los patrones culturales comportamentales, conforme las tres maneras de acción identificadas, pueden ser preservadas, acomodadas y re-estructuradas para proporcionar un cuidado culturalmente congruente.

Condiciones para el aprendizaje organizacional

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Delio Ignacio Castañeda

2015-01-01

Full Text Available El propósito de esta investigación es contribuir al entendimiento de algunas condiciones que favorecen el aprendizaje en las organizaciones, específicamente el rol de la cultura del aprendizaje, la formación, la claridad estratégica y el soporte organizacional. Se emplea una metodología cuantitativa con 613 participantes, empleados de una organización pública y 2 compañías privadas, las 3 entidades ubicadas en Bogotá, Colombia. Para la realización del estudio se conformó una muestra por conveniencia, con el apoyo de los jefes de recursos humanos de 3 organizaciones con sede en la ciudad de Bogotá, Colombia. Para la recolección de los datos se utilizó una escala Likert de 5 niveles de respuesta. Los resultados sugieren que las 4 condiciones estudiadas contribuyen al aprendizaje organizacional. Los hallazgos de este trabajo orientan a profesionales sobre dónde focalizar esfuerzos para promover la adquisición y la generación de conocimiento organizacional y aporta al trabajo investigativo ampliando la evidencia empírica sobre este campo de relevancia organizacional.

Condiciones para el aprendizaje organizacional

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Delio Ignacio Castañeda

2015-01-01

Full Text Available El propósito de esta investigación es contribuir al entendimiento de algunas condiciones que favorecen el aprendizaje en las organizaciones, específicamente el rol de la cultura del aprendizaje, la formación, la claridad estratégica y el soporte organizacional. Se emplea una metodología cuantitativa con 613 participantes, empleados de una organización pública y 2 compa˜nías privadas, las 3 entidades ubicadas en Bogotá, Colombia. Para la realización del estudio se conformó una muestra por conveniencia, con el apoyo de los jefes de recursos humanos de 3 organizaciones con sede en la ciudad de Bogotá, Colombia. Para la recolección de los datos se utilizó una escala Likert de 5 niveles de respuesta. Los resultados sugieren que las 4 condiciones estudiadas contribuyen al aprendizaje organizacional. Los hallazgos de este trabajo orientan a profesionales sobre dónde focalizar esfuerzos para promover la adquisición y la generación de conocimiento organizacional y aporta al trabajo investigativo ampliando la evidencia empírica sobre este campo de relevancia organizacional.

Plan de marketing para un vivero de planta ornamental

OpenAIRE

MARCH CUBERTORET, PAULA

2017-01-01

[ES] Se ha realizado un plan de marketing de un vivero de planta ornamental interior en Petrés (Valencia), así como un estudio de mercado para analizar las necesidades del consumidor y proponer mejorar el posicionamiento de la empresa para finalmente aumentar las ventas de sus productos. March Cubertoret, P. (2017). Plan de marketing para un vivero de planta ornamental. http://hdl.handle.net/10251/92819 TFGM

Propuesta para un plan de marketing para el Hotel Haro ubicado en la ciudad de Cuenca

OpenAIRE

López Zúniga, Susana Cristina; Yanza Barrera, Mariana de Jesús

2008-01-01

El plan de marketing es una herramienta de gestión que sirve de base para los otros planes de la empresa como puede ser el plan de producción o el financiero, determina responsabilidades, permite revisiones y controles periódicos para resolver los problemas con anticipación, evitar pérdidas económicas y ayuda a la empresa a estar lista frente a los riegos y oportunidades que se presenten en el mercado. En el espacio donde el mercado se convierte cada vez más competitivo hay menos posibilid...

Residencias estudiantiles universitarias, una oportunidad para la equidad y la educación para la salud

OpenAIRE

Vargas Benavides, D.; Avendaño Salas, M.

2017-01-01

Introducción: Desde el año 2000 se han realizado actividades para promover en la población de estudiantes, conductas de vida saludables, en el 2016 se reestructura el programa y se define: Promover el liderazgo estudiantil de la población residente, mediante el desarrollo de estrategias que favorezcan la equidad y la educación en salud, para contribuir al desarrollo de conductas saludables. Material y método: El Programa de Residencias estudiantiles de la UNA, atiende un total de 256 estudian...

Colombia competente para la paz

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Norma Sofía Vanegas Torres

2013-07-01

Full Text Available La paz y la convivencia en Colombia demandan el desarrollo de un enfoque humanístico, una competencia particular que como las restantes competencias implican un saber y un saber hacer dentro de un contexto, pero que en este caso se relacionan más concretamente con el saber vivir. Este artículo analiza el desarrollo de una posible de competencia para la paz y analiza la importancia de la academia como medio para su desarrollo e instrumentalización. Se analizan al mismo tiempo las connotaciones de esta competencia en el marco de la sociedad posmoderna contemporánea.

Compilador para lenguaje basado en continuaciones

OpenAIRE

Ramos Carreño, Carlos

2015-01-01

Las continuaciones son una construcción de algunos lenguajes de programación a partir de las cuales pueden elaborarse elementos más complejos, como fibras, generadores, excepciones y corrutinas. Sin embargo, hay poco soporte nativo para ellas en los lenguajes más populares, como por ejemplo Java. En este trabajo se estudia este concepto en profundidad, centrándonos en las llamadas “continuaciones delimitadas”. Para ello se ha implementado un lenguaje de bajo nivel con soport...

Augusto Boal: teatro para a transformação

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Irene Leonore Goldschmidt

2012-05-01

Full Text Available Embora o uso do teatro para mediar e enriquecer processos educacionais não seja uma ideia nova, a forma como é desenvolvido pode servir para a reprodução ou para a transformação da sociedade. O teatrólogo Augusto Boal desenvolveu uma metodologia, à qual denominou de Teatro do Oprimido, para, através da linguagem teatral promover autonomia e capacidade crítica, tornando o espectador em ator. Na sua última obra, editada em 2009, A Estética do Oprimido, levanta uma importante questão contemporânea sobre o papel da estética e suas relações com o poder.

Un almuerzo para llevar saludable (Packing Smart)

Centers for Disease Control (CDC) Podcasts

2011-08-22

En este podcast para niños, los chicos de Kidtastics hablan sobre almuerzos creativos para llevarse a la escuela, que ayuden a mantenerse con energía el resto del día.  Created: 8/22/2011 by National Center for Emerging and Zoonotic Infectious Diseases (NCEZID).   Date Released: 1/3/2012.

EL POLVO DE COCO COMO SUSTRATO ALTERNATIVO PARA LA OBTENCIÓN DE PLANTAS ORNAMENTALES PARA TRASPLANTE

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A. Ayala-Sierra

2008-01-01

Full Text Available La presente investigación se realizó con el objeto de evaluar la factibilidad de utilizar sustratos elaborados a base de polvo de coco para la germinación de semillas y desarrollo inicial de plantas para trasplante de seis especies ornamentales y determinar la posibilidad de remplazar al Peat Moss. Las especies seleccionadas para el estudio fueron: Dianthus chinensis (clavelina, Gazania rigens (gazania, Tagetes erecta (marigold, Viola wittrockiana (pensamiento, Antirrhinum majus (dragón y Petunia x hybrida (petunia. Las semillas de las seis especies fueron sembradas en tres sustratos: polvo de coco, Peat Moss y Peat Lite. Previo a la siembra, el polvo de coco fue acondicionado mediante el ajuste del pH a 6.2, la adición de cal dolomítica y KNO3 como carga de nutrientes. Posteriormente, se elaboró una mezcla a base de polvo de coco, perlita y vermiculita a razón de 70, 20 y 10 % (v/v, y Peat Moss, perlita y vermiculita en las mismas proporciones. El Peat Lite contenía 50 % de Peat Moss y 50 % de perlita (v/v. Se evaluó el efecto de los sustratos en la altura de planta, el peso seco del vástago y de raíz, el porcentaje de germinación y el porcentaje de plantas con valor comercial. Aunque el polvo de coco causó una disminución significativa en la altura de plantas de gazania (21 %, dragones (30 % y petunias (13 %, y en el peso seco del vástago de dragones (24 % y en el peso seco de raíz de clavelina (22 %, esto no estuvo asociado con una disminución en la calidad de las plantas. Por lo tanto, se concluye que el polvo de coco puede utilizarse como sustrato para la producción de plantas para trasplante de especies ornamentales.

Producción de microorganismos probióticos como aditivo para alimentos concentrados para ganado vacuno.

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Edgar Mauricio Vargas.

2004-11-01

Full Text Available Por años, las industrias y los laboratorios de investigación han buscado las aplicaciones de los organismos probióticos en animales. El uso de los probióticos como alternativa natural para mejorar el funcionamiento del metabolismo animal; ha demostrado resultados muy interesantes. Modernas granjas utilizan dietas alimenticias (a base probióticos que disminuyen el estrés, aumentan la microflora intestinal, lo que conlleva al animal a aumentar su resistencia a las infecciones (sistema inmunológico. Mejorar la salud animal, rendimiento en peso y funcionamiento metabólico, ha sido siempre la meta para los productores de ganado de carne y leche. Por esta razón el actual estudio fue concebido para evaluar el microencapsulamiento de microorganismos prebióticos (Lactobacillus Thuringenesis y Bifidobacterium Pseudulongum por los métodos de Emulsión y Extrusión. para obtener un alimento para levante de becerros, que ofrecería no solamente las ventajas de un suplemento de la alta calidad, sino también un producto con las ventajas de tener probióticos incorporados. / For years, industries and research labs have investigated probiotics for nonhuman applications. The use of probiotics as an alternative natural way of enhancing animal performance has shown promising results. Modern farm methods which include rearing conditions and diets induce stress and cause changes in the composition of the microflora, which compromises the animal's resistance to infection. The aim of the probiotic approach is to repair the deficiencies in the microflora and restore the animal's resistance to disease. Improving animal health and performance has always been the goal for farm and livestock producers. For this reason the present study was conducted to develop the microencapsulation of Probiotics (Lactobacillus Thuringenesis and Bifidobacterium Pseudulongum by the methods of Emulsion and Extrusion, to obtain a daily diet for calves that could offer not only the

Consentimiento Informado para Biobancos: Un debate ético abierto

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Norma Serrano-Díaz

2016-06-01

Full Text Available Los Biobancos con fines de Investigación están aumentando en número e importancia, con un gran potencial que contribuye a la generación de conocimiento pertinente para la solución de problemas en salud. El reclutamiento de donantes es vital para su éxito. Sin embargo, este proceso tiene implicaciones importantes de carácter ético, legal y social. El consentimiento informado requerido para la participación del donante impone desafíos éticos importantes en torno a la privacidad, confidencialidad, uso secundario de muestras y datos para estudios futuros, retorno de resultados, intercambio de datos, distribución de beneficios entre otras. Diferentes modelos de consentimiento informado han sido propuestos para responder a algunos de estos retos éticos . Sin embargo, no se ha llegado a un acuerdo, por lo tanto la discusión continúa abierta. Este trabajo pretende contribuir con la discusión, considerando fundamental el significado y el valor del proceso de consentimiento informado para la participación en investigación biomédica. Se discuten los diferentes tipos de consentimiento que se están utilizando actualmente evaluando el nivel de control y autodeterminación por parte del donante.

Escalas de depresión y ansiedad para personas transexuales

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José Miguel Rodríguez Molina

2015-01-01

Full Text Available La transexualidad es un fenómeno emergente. Es necesario evaluar no solo la presencia de transexualidad sino también todas las variables de proceso. Este estudio tuvo como objetivo presentar y analizar las propiedades psicométricas de dos instrumentos de evaluación en población transexual; uno para evaluar ansiedad y otro depresión. Se llevó a cabo la construcción cualitativa de las dos escalas y se validó su contenido mediante su aplicación a 154 sujetos. Se calcularon la validez de criterio y la fiabilidad mediante el Alfa de Cronbach y se ejecutó un Análisis Factorial Exploratorio. Se obtuvieron datos de alta significación estadística para la fiabilidad de las escalas (para ESANTRA un Alfa de Cronbach de .958 y correlación entre mitades de .926 y para ESDETRA un Alfa de Cronbach de .967 y correlación entre mitades de .958 y también para todos los elementos de ambas, así como una alta validez de criterio (para ESANTRA de .782 con p< .001 con el ISRA y para ESDETRA .829 con p< .001 con el BDI. El AFE mostró un único factor explicativo en cada escala (con varianza explicada del 45.71% ESANTRA y 51.55% ESDETRA. Las escalas ESANTRA y ESDETRA parecen ser útiles para la evaluación de ansiedad y depresión en personas transexuales.

Evaluación distintas metodologías para la preservación de Clostridium tetani, empleado en la producción de vacunas para uso humano.

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Elsie Iglesias

2000-03-01

Full Text Available En el presente estudio se evaluaron diferentes metodologías para la preservación de Clostridium tetani. Para verificar el sustento del cultivo se realizó un adecuado control de calidad, que incluyó comprobación de pureza, viabilidad y estabilidad de las propiedades de interés. En este trabajo se compararon dos procedimientos para liofilizar y se evaluó el método de congelación a –20 0C para preservar C. tetani. Para medir determinados parámetros se realizaron procesos a escala industrial, empleándose para esto un Biorreactor Chemap de 35 L. Con este trabajo se buscó Alternativas y soluciones a problemas presentados en su conservación. Los resultados obtenidos sugieren la posible inclusión en el Programa de Mantenimiento establecido

Cuestionarios Interactivos para Autoevaluación

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Sánchez García, Juan Francisco

2007-01-01

Full Text Available La autoevaluación es un instrumento valioso para que el propio alumno pueda medir el grado de conocimientos adquiridos de la materia en cuestión, al tiempo sirve para adiestrarlo en el tipo de prueba que se utilizará posteriormente en el examen. Por otro lado, dado que en la adaptación al Espacio Europeo de Educación Superior (E3S tiene particular importancia la labor realizada por el propio alumno, los pruebas de autoevalución adquieren, si cabe, una mayor relevancia. Por todo ello, hemos elaborado unos test interactivos con hoja de calculo, para cubrir el doble propósito de evaluar los conocimientos alcanzados por nuestros alumnos, relativos tanto a la materia, como al manejo en sí de la propia herramienta informática de la hoja de cálculo. Se muestran ejemplos concretos relacionados con las matemáticas y la hoja de cálculo Excel.

El sistema de trabajo metodológico para las disciplinas que conforman las carreras en la SUM. Una estrategia para San Luis

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Tania Alina Mena Silva

2009-09-01

Full Text Available La Globalización Neoliberal, la caída del Campo Socialista y los intentos de los Estados Unidos de adjudicarse el liderazgo internacional como protector de un mundo unipolar, han ejercido una gran influencia en el contexto sociopolítico latinoamericano actual al que la educación superior y las ciencias que se relacionan con su estudio no han estado ajenas. El propio perfeccionamiento que ha tenido lugar en la Educación Superior en Cuba ha obligado a redimensionar el trabajo metodológico de las disciplinas para poder lograr que se interactúe de forma tal, que se pueda aplicar el modelo de formación del profesional que se requiere en las condiciones de la Universalización. Para lo que se han reconsiderado los conceptos, las formas y las vías para las disciplinas de la SUM. Este trabajo persigue el objetivo de fundamentar teóricamente un sistema para el proceso de trabajo metodológico de las disciplinas en la SUM, de tal manera que permita elaborar el diseño de una Estrategia, para la gestión del proceso docente educativo en las condiciones de semipresencialidad y lograr que este sea, íntegro, sistémico y eficiente, pero flexible y centrado en el estudiante, teniendo en cuenta sus peculiaridades y las de los docentes así como el medio social donde se están formando, para lo que se necesita estar bien identificado con el proceso de transformación y adecuación, para poder implementar estos fundamentos en las disciplinas que conforman las carreras de la SUM.

Por y para en los manuales de ELE

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Sidoti, Rossana

2008-12-01

Full Text Available La oposición por / para es una de las cuestiones gramaticales que comportan mayor dificultad a la hora de acercarse al estudio del español como L2 sobre todo cuando remiten a conceptos lingüísticos difíciles de entender por no tener ésta referente alguno en el mundo extralingüístico. Si, por un lado, nos resulta fácil entender lo que tiene un referente en el mundo concreto; por otro, no podemos advertir el referente extralingüístico de preposiciones como por / para, si este no existe. Si las preposiciones son elementos abstractos, difíciles de aferrar de por sí, podemos sólo examinar los elementos que éstas ponen en relación y en qué contextos esta relación se determina. Para poder utilizar con precisión las dos preposiciones, es importante no reducirlas a una sola preposición como ocurre en otros idiomas, y sobre todo no relacionarlas sólo a los conceptos de causa y finalidad. Este trabajo se propone individualizar los manuales de español como lengua extranjera más utilizados en las universidades italianas para luego comparar las distintas fuentes de información sobre por / para y exponer comentarios, reflexiones y sugerencias sobre el tema con el fin de precisar en qué medida se puede mejorar lo que los manuales reducen o generalizan, puesto que para los estudiantes de ELE estos representan una herramienta valiosa a la que acudir.

Inmunopotenciadores para la acuicultura

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Rocmira Pérez

2014-04-01

Full Text Available La acuicultura es una de las actividades económicas de mayor crecimiento para la producción de alimentos. Uno de sus principales retos es la obtención de grandes volúmenes de producción con la mayor calidad posible. Esto conlleva a una reducción de la aplicación de antibióticos y productos quimioterapéuticos. Una de las estrategias más prometedoras es la aplicación de inmunopotenciadores, principalmente en los cultivos intensivos. El objetivo de este trabajo fue revisar los principales inmunopotenciadores, así como las tendencias y retos de su uso mundial. Se resumen las particularidades moleculares y funcionales de los mismos y se hace énfasis en los más estudiados: levamisol, ß-glucanos, lipopolisacárido, vitamina C, extractos de plantas y hormonas. Todos estos compuestos de naturaleza heterogénea inciden mayoritariamente en los componentes de la inmunidad innata de los peces, fortaleciendo y potenciando la resistencia a enfermedades; adicionalmente algunos de ellos tienen funciones antiestrés y favorecen su crecimiento. Se concluye que los inmunopotenciadores constituyen una estrategia viable para reducir las pérdidas por problemas sanitarios en el sector de la acuicultura; pero aún quedan por solucionar aspectos como la vía de administración y la etapa de inmunización adecuada para cada especie y tipo de cultivo.

Por que, Para que uma revista (tradução

Directory of Open Access Journals (Sweden)

Doralicia Furtado da Rosa

2007-06-01

Full Text Available Tempo. Poder-se-ia vê-la assim: mais que um desafio ao tempo, a revista é um desafío no tempo. A literatura seria essa possibilidade de desafiar o tempo em um lapso maior que o da proximidade, que o do próximo do presente. A revista, pelo contrário, trabalha para o presente, para a difusão do conto ou do poema ou do artigo ou do capítulo de romance. Logo, com sorte, esses textos estarão destinados a circular em livro ou então a ficarem pendentes no espaço cibernético até que alguém os recolha, até que alguém os “baixe” da internet. Ou se perderão para sempre ou se transformarão em referência de nota de rodapé em alguma tese de doutorado, para regozijo de eruditos ou como monótono insumo para a obtenção de um grau ou de um cargo universitário. Isso significa, como cria Borges, que “um periódico se lê para o olvido”, ao passo que “um livro se lê para a memória”? (BORGES, 1979, p.25.

UMA PROSPOSTA DEDUTIVISTA PARA PRINCÍPIOS CONTÁBEIS

OpenAIRE

Paulo Schmidt

2009-01-01

A proposta deste estudo a apresentar um breve relato sobre a evolução do pensamento cientifico ocorrida na física com a substituição dos princípios contábeis e filosófico, desde a Antiguidade grega ate os dias de hoje, como forma de fundamentar o posicionamento contrario ao raciocínio indutivo para o estabelecimento de uma estrutura conceitual para a contabilidade e para o desenvolvimento dos princípios contábeis. Apos essa incursão pelo campo filosófico, será aduzido um dos trabalhos d...

Un nuevo contexto para la experiencia de usuario

OpenAIRE

Capossio, Ana Paula

2014-01-01

¿Cómo afecta la incorporación de metodologías de diseño centrado en el usuario (DCU) al momento de diseñar una experiencia para una instalación interactiva? Uno de los factores más importantes para una obra de arte interactivo es el usuario, ya que es el que interactúa directamente con la interfaz de la obra. El desafío del artista es conseguir diseñar una interfaz que los usuarios comprendan y entiendan el significado de la obra. Para poder lograr una mejor experiencia de usuario, el arti...

Plan integral de negocios para la Empresa Rodeport

OpenAIRE

Banegas Lucero, Tania Maribel; Tacuri Flores, Diana Patricia

2007-01-01

El siguiente trabajo de investigación está dividido en 5 capítulos los cuales son de suma importancia para el desarrollo y aplicación de las estrategias para la empresa Rodeport. En el primer capítulo se habla sobre los conceptos principales de un área funcional muy importante en cualquier organización y esta es FINANZAS. La cual habla la manera en que la gente asigna recursos y divide el dinero, los costos que intervienen en esta área para el cálculo pero sobre todo, los principales estad...

Analizador de Frecuencia: una nueva aplicación docente para Android

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José A. Gómez-Tejedor

2014-03-01

Full Text Available En este trabajo se presenta una aplicación para dispositivo móvil Android capaz de medir la frecuencia fundamental de un sonido de forma muy precisa. Esta aplicación puede ser utilizada en campos tan diversos como la música para afinar instrumentos musicales, en física para la medida del efecto Doppler o en sistemas de reconocimiento del habla para determinar la frecuencia fundamental de la voz. En concreto, en este trabajo presentamos algunos ejemplos en el campo de la física relacionados con el efecto Doppler para ondas acústicas.

El Derecho Agrario como derecho para la paz

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Ricardo Zeledón Zeledón

2015-01-01

Full Text Available Contenido: El Derecho agrario surgido de la paz y para la consolidación de la paz, como fuente e instrumento para su cumplimiento. La visión de Carrozza como conjunto de reglas destinadas al fin de la paz, y la equidad. Explicación de un Derecho agrario vinculado a la paz por su origen en los Derechos Humanos Económicos y Sociales. Evolución del Derecho Agrario en los Derechos Humanos de la tercera generación (principalmente ambiente, desarrollo y paz, en las nuevas dimensiones del Derecho agrario del futuro. Derecho agrario como derecho para la paz y el respeto de los derechos humanos. Desarrollo sostenible y agricultura del futuro. La nueva orientación de los institutos del derecho agrario como instrumentos de paz, dirigidos a cumplir los fines de la justicia social, el desarrollo económico y el equilibrio ambiental. Desarrollo como respuesta a los problemas del ambiente, alimentario, de la pobreza, indígena y de la mujer rural. El rol de la justicia agraria y ambiental como derecho para la paz. El derecho agrario, disciplina forjada en una concepción iushumanista, acorde con los derechos humanos y la paz. El derecho agrario como derecho para la paz.

Proyecto curricular institucional: Una alternativa para el cambio

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Ruth Vallejo

2002-01-01

Full Text Available Enfrentar el desafío de la construcción del proyecto curricular institucional representa para la educación de este milenio una prioridad, esto sin lugar a dudas, requiere de un cambio en la estructura organizativa y de gestión en cada plantel; el Currículo Básico Nacional, en marcha, representa un avance significativo, para superar esta situación. Para que esta reforma constituya una alternativa válida, es necesario abordar la formación del docente de forma sistemática, continúa desde su praxis por medio de la investigación-acción, utilizando herramientas metodológicas para el diagnóstico y acompañando todo el proceso con una evaluación institucional que al mismo tiempo que se analiza e implementa permita la formación de los actores involucrados; la revisión y los ajustes permanentes conducen a la construcción de aproximaciones sucesivas que con el trabajo concertado garantizan la viabilidad del proyecto. Se recomienda asumirlo con un carácter cíclico y dinámico para decidir si se puede o no mantener a la luz de los cambios que ocurran dentro y fuera del proceso.

Imaging of limbic para-neoplastic encephalitis

International Nuclear Information System (INIS)

Rimmelin, A.; Sellat, F.; Morand, G.; Quoix, E.; Clouet, P.L.; Dietemann, J.L.

1997-01-01

Para-neoplastic limbic encephalitis is a rare syndrome mostly associated with small cell lung cancer. We present the case of a 69-year-old man with selective amnesia suggesting limbic encephalitis. A neuroendocrine cell lung cancer was found, confirming the diagnostics of para-neoplastic limbic encephalitis. Contrast-enhanced cerebral CT was normal whether magnetic resonance imaging showed signal abnormalities of the medial part of temporal lobes and hippocampal regions. Because neurologic improvement may follow treatment of the primary tumor, early diagnosis is important. (authors)

LOS BUENOS HÁBITOS DE ESCRITURA, EMPIEZAN EN LA ESCUELA, LO MISMO PARA DIESTROS QUE PARA ZURDOS

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José Quintanal Díaz

2011-01-01

Full Text Available Los buenos hábitos de escritura, empiezan en la escuela, lo mismo para diestros que zurdos. La escritura es uno de los aprendizajes que se automatizan con mayor rapidez en los primeros estadios del desarrollo infantil. Esto supone que la escuela deba estar atenta para conseguir su correcta aplicación, de modo que los pequeños integren este hábito con corrección. Lo mismo diestros que zurdos; para todos, un buen aprendizaje de esta destreza les va a suponer no sólo contar con una mejora en su comunicación, pues su escrito resultará más legible y presentará una mayor calidad técnica, sino que se prevendrán las secuelas propias de su posterior ejecución. El presente estudio analiza cómo adecuar el proceso de enseñanza de la escritura desde la escuela infantil.

Rituximab para la oftalmopatía asociada a la tiroides

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Neda Minakaran

2013-09-01

Conclusiones de los autores: Actualmente no hay pruebas suficientes para apoyar la administración de rituximab en los pacientes con OAT. Se necesitan ECA grandes que investiguen rituximab versus placebo o corticosteroides en pacientes con OAT activo para hacer valoraciones adecuadas sobre la eficacia y la seguridad de este tratamiento nuevo para esta enfermedad.

Jõhvis tuleb parasürrealistide näitus

Index Scriptorium Estoniae

2008-01-01

Jõhvi kontserdimajas avatakse parasürrealistide rühmituse PARA näitus "Panoraam". Osalevad Ilmar Malin (maalid), Jüri Palm (maalid), Elo Järv (nahkskulptuurid), Vello Vinn (graafika), Leonhard Lapin (akvarellid), Enn Tegova (maalid), Ahti Seppet (puuskulptuurid), Raivo Kelomees (maalid), Kristiina Viin (joonistused ja maalid)

para mejorar el %R

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Alfredo Díaz Mata

2001-01-01

Full Text Available En este trabajo se revisan dos indicadores técnicos bursátiles que están estrechamente relacionados, el oscilador estocástico %K de Lane y el oscilador %R de Williams; asimismo, se evalúa el uso de dos mecanismos asociados con el primero y que no suelen utilizarse con el %R: el proceso de frenado (slowing y el uso de un promedio móvil del propio oscilador estocástico como disparadores de señales de compra y de venta. Realizando simulaciones con 27 acciones y el Índice de Precios y Cotizaciones de la Bolsa Mexicana de Valores se verifica la hipótesis principal y se comprueba que, efectivamente, en muchos casos, el uso del proceso de frenado con el oscilador %R de Williams permite tomar mejores decisiones. Por otro lado, se concluye que de los dos disparadores de señales el que mejor funciona, tanto para %K como para %R es el uso de cotas inferior y superior. Este artículo surgió en el curso de una investigación sobre el análisis técnico bursátil de acciones que se puede realizar en su totalidad por computadora y que, esencialmente, excluye el análisis gráfico. Uno de los propósitos del estudio es determinar si es posible, y bajo qué mecanismos, establecer un sistema de análisis bursátil que le permita al inversionista tomar decisiones de inversión en acciones en la Bolsa Mexicana de Valores sin tener que emplear la considerable cantidad de tiempo que es necesario para el análisis gráfico tradicional. Durante este estudio se realizó un análisis preliminar de unos 120 indicadores técnicos para, por un lado, conocerlos con cierto detalle y, por otra parte, aislar aquellos que prometían ser de utilidad para el objetivo de la investigación. Fue en este proceso cuando se detectó que existen dos indicadores que están relacionados y que permiten un análisis por separado que tiene, cuando menos, dos ventajas. En primer lugar está el placer que da a quien gusta de estos temas encontrarse con indicadores que, de acuerdo

para la Depresión en Adolescentes (EADA

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Mirella Díaz-Santos

2008-01-01

Full Text Available Los instrumentos que miden autoeficacia en jóvenes son mayormente escalas para adultos adaptadas para evaluar adolescentes o escalas de autoeficacia general. El propósito de este estudio fue desarrollar y evaluar las propiedades psicométricas de la Escala de Autoeficacia para la Depresión en Adolescentes (EADA. Además, administramos la versión en español de la subescala de Autoeficacia Emocional del Self-Efficacy Questionnaire for Children, así como el Inventario de Depresión en Niños/as-Versión Corta, para evaluar la validez concurrente entre estas medidas. Participaron 116 adolescentes entre 13 a 17 años. Los resultados indican que la EADA posee una consistencia interna y una validez concurrente excelente. Los mismos apoyan su adecuación como instrumento que evalúa la auto-percepción de confianza del/de la adolescente al enfrentar situaciones típicas del Trastorno Depresivo Mayor.

PERFIL PARA REPRESENTAR UNA ARQUITECTURA DE COMPONENTES EN UML

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Fernando Orejas Valdés

2006-04-01

Full Text Available

El lenguaje unificado de modelado (Unified Modeling Language, UML es un lenguaje de modelado estándar para problemas generales, sin embargo, es necesario extenderlo para dominios específicos como puede ser el caso de determinadas arquitecturas. Aquí se presenta una extensión mediante un perfil para una arquitectura de componentes y conectores genéricos.

Educación para la paz

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Federico Mayor Zaragoza

2003-01-01

Full Text Available La educación para la paz ha experimentado un desarrollo importante en los últimos 20 años, y el 2000 ha sido declarado Año Internacional para la Cultura de Paz. Exige un esfuerzo de pariicipación y una capacidad crítica para facilitar el paso de una cultura de guerra a un cultura de paz. Se trata de ayudar a todos los ciudadanos a observar y reflexionar sobre el conjunto de la tierra y de quienes la habitan. De escuchar a los jóvenes y ser escuchado. La educación para la paz ha de ser considerada como contenido transversal de la educación. La situación actual, los conflictos interétnicos e interculturales , la exclusión y la marginalidad, las sociedades pobres y las ricas son cuestiones que reclaman una educación par la paz. De la cultura de imposición hemos de pasar a la cultura del diálogo y parti-cipación, solidaridad, compromiso, tolerancia y respeto. Es necesario construir otro mundo en el que podamos asegurar a nuestros descendientes el futuro. La paz es un comportamiento, es traducir a la práctica los principios de con-vivencia, de solidaridad, de fraternidad. Sólo así «vendrá el amanecer (y brilla-rá mucha luz en nuestro camino»

Processo de ensino e aprendizagem de Língua Portuguesa como L2 para surdos: elementos para o ensino de leitura

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Eliamar Godoi

2014-12-01

Full Text Available Esse estudo tem por finalidade compartilhar com o professor de salade aula de ensino regular que recebem surdos alfabetizados algunselementos para o ensino de leitura. Justifica-se pela escassez de pesquisassobre a prática pedagógica, recursos didáticos e tecnológicos para oensino de leitura para surdos. A partir de levantamento das principaisdificuldades relatadas por professores em relação ao ensino de leiturapara surdo, foi feita uma discussão que atualiza o docente em relaçãoàs frequentes dificuldades descritas nesse processo. Apresentamossugestões sobre como trabalhar e receber um aluno surdo na salaregular de ensino e ainda alguns aspectos linguísticos do ensino deLeitura para alunos surdos. A concepção desse trabalho permite váriosdesdobramentos, tanto na sua formulação teórica e prática quantona sua realização, uma vez que leva em consideração a formação deprofessores interessados em atuar na perspectiva inclusiva da Educação.O procedimento metodológico escolhido foi o debate mediado por umapesquisa bibliográfica pautada em abordagens de autores da LinguísticaTextual complementada pelos da Educação Especial e, ainda, por autoresdo ensino de Língua Portuguesa como L2 para Surdos. Dessa forma, estareflexão, busca apresentar a análise de algumas práticas de ensino de Leitura e de Língua Portuguesa para surdos e sugerir algumas ações. Apartir desse estudo, concluímos que, na sala regular de ensino, existemfatores que podem levar o surdo à produção de sentido e à constituiçãode um sujeito leitor que também escreve, nas aulas, sobretudo, deLíngua Portuguesa.

Polymorphism and modulation of para-substituted L-Phenylalanine

NARCIS (Netherlands)

Sögütoglu, Leyla-cann; Lutz, Martin; Meekes, Hugo; De Gelder, Rene; Vlieg, Elias

2017-01-01

The crystal structure of para-methyl-L-phenylalanine at 230 K resembles that of the para-fluorinated analogue from the literaturebut is commensurately modulated with seven molecules in the asymmetric unit (Z′ = 7). At 100 K, the superstructure loses its modulation, leading to a unit cell with Z′ =

Relojes de agua, una oportunidad para calcular integrales

OpenAIRE

Thiabut, Elena

2007-01-01

Este artículo propone una investigación sobre clepsidras (relojes de agua) para alumnos de 2º de bachillerato. El cálculo integral será la clave para descubrir cómo la geometría de los recipientes condiciona el funcionamiento de estos mecanismos milenarios.

Proyecto Estación Experimental Finca El Paraíso

OpenAIRE

Polliotto, Gabriela; Galíndez, Fernando; Lanusse, Mateo

2012-01-01

p. 27-31 El presente Proyecto desarrolla el diseño de un edificio destinado a estación experimental en Finca El Paraíso, ubicada en el departamento de Rivadavia Banda Norte, propiedad de la Universidad Católica de Salta. En el marco de la formulación de un plan de manejo sostenido para dicha finca, el edificio mencionado estará destinado a desarrollar las actividades necesarias para la gestión sostenible de la Finca, como así también para la realización de investigación, formación y extens...

INTRODUCCION A LA ESTADISTICA PARA ECONOMISTAS AGRICOLAS USANDO EL SPSS

OpenAIRE

Swinton, Scott M.; Labarta, Ricardo A.

2003-01-01

Este documento es un manual de estadística para economistas aplicados que usan el programa estadístico SPSS. Está diseñado para ser usado dentro de un taller de capacitación de una semana, y tiene como propósito familiarizar a profesionales de la investigación con procedimientos estadísticos básicos, necesarios para realizar análisis socioeconómicos a datos que provienen de encuestas. Este documento es una introducción para los usuarios en la creación y manipulación de las bases de datos, en ...

IDENTIDADE DE LUGAR E DISPOSIÇÃO PARA EMPREENDER

Directory of Open Access Journals (Sweden)

Priscila Balbino de Oliveira

2012-12-01

Full Text Available A presente pesquisa tem como objetivo verificar a disposição de estudantes universitários para empreender no local em que residem. Trata-se de um survey realizado com estudantes de três instituições de ensino superior localizadas na Zona Leste do Município de São Paulo (SP.  Para obtenção dos dados procedeu-se à seleção de uma amostra por acessibilidade constituída por 423 estudantes de diferentes cursos, tanto de bacharelado quanto de graduação tecnológica. A maioria dos estudantes indicou maior disposição para empreender no próprio bairro em que moram. Verificou-se a existência de correlação positiva entre a preferência por trabalhar por contra própria e a disposição para empreender no próprio bairro em que moram. Não se verificou, no entanto, relação significativa entre o nível de identificação com o bairro e a disposição para empreender nessa localidade. Conclui-se que os estudantes tem maior disposição para empreender no local em que residem em virtude do conhecimento que já tem desse local, ou do temor em abrir seu negócio em local menos conhecido.

Desarrollo de aplicaciones para Windows Phone

OpenAIRE

Castellanos de la Torre, Francisco José

2013-01-01

Desarrollar una aplicación para dispositivos móviles no es una tarea sencilla, ya que precisamos no solo tener conocimientos de programación, sino que también tenemos que familiarizarnos muy bien con el entorno de desarrollo y el sistema operativo para el cual pretendemos crear la aplicación. Esto consiste en conocer en profundidad tanto las características técnicas de los dispositivos como las distintas APIs que tenemos a nuestra disposición. Hemos elegido Windows Phone 7.5 porque ha sido...

Gobierno de las TI para universidades

OpenAIRE

Fernández Martínez, Antonio; Llorens Largo, Faraón

2011-01-01

Entre los objetivos de esta publicación están el establecer la importancia del gobierno de las TI, describir sus fundamentos y presentar las herramientas disponibles para implementarlo en una organización. Se presenta con detalle la norma ISO 38500, COBIT y el modelo GTI4U, que se ha desarrollado para ser utilizado en el ámbito universitario. Cabe destacar que incluye una descripción detallada de cómo implementar el gobierno de las TI en una universidad. La CRUE pretende que estos conten...

EMPREENDEDORISMO JOVEM: DA ESCOLA PARA O MERCADO DE TRABALHO

OpenAIRE

Gomes, Danilo Cortez; Professor de Administração no IFRN - Campus Currais Novos.; de Farias Silva, Luciano Alexandre; Aluno do curso técnico integrado em informática do IFRN - Campus Currais Novos.; D´Anjour, Miler Franco; PPGA/UFRN; Moreno Añez, Miguel Eduardo; PPGA/UFRN

2014-01-01

O empreendedorismo jovem apresenta-se como forma de inclusão de jovens no mercado de trabalho e em contrapartida é fator preponderante para promoção do desenvolvimento socioeconômico brasileiro (LIMA-FILHO, SPROESSER, MATINS, 2009). Nesta perspectiva, o objetivo central desse artigo é discutir o ensino do empreendedorismo para os jovens utilizando como “case” o projeto “Empreendedorismo jovem: da escola para o mercado de trabalho” que buscou estimular os alunos do IFRN – Campus Currais Novos ...

Propuesta de arquitectura segura para b-learning utilizando patrones

OpenAIRE

La Red Martínez, David L.; Acosta, Julio César

2012-01-01

En este trabajo se trata el problema de integrar la perspectiva tecnológica con la pedagógica, brindando una arquitectura para sistemas de blearning. Se adoptan principios educativos comprobados del enfoque centrado en la persona (person-centered approach) para impulsar procesos educativos, con utilización de la TICs de manera segura. Se propone un modelo en capas capaz de brindar soporte basado en Web para estos principios educativos. El trabajo se centra en la propuesta de una arquitectura ...

Para escrever é preciso pensar! As orientações dos livros didáticos para escrita de textos da ordem do argumentar no Brasil

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Telma Ferraz Leal

2010-01-01

Full Text Available El objetivo de este artículo es reflexionar sobre las actividads de producción de textos de siete colecciones de libros didácticos, analisando las orientaciones conducidas al desarollo de estrategias argumentativas de los niños. El destaque, en los análisis, es para las pocas inversiones que hay en este sentido. En las pocas propuestas, hay una concentración en la produción de géneros publicitarios. En resumen, aunque presentando condiciones favorables para la producción de textos, las colecciones investigadas no posibilitan el desarrollo de distintas estrategias para la expresión de puntos de vista, o para la articulación de justificativas, aunque sea para introducción de contra argumentos, en los casos en que eso se haga necesario. No hay también, en las actividades, orientaciones que ayuden a los alumnos a planificar la organización de los argumentos del texto.

CAPTCHA: ¿solución para la seguridad informática o problema para la accesibilidad/usabilidad web?

Directory of Open Access Journals (Sweden)

Omar Antonio Vega

2014-07-01

Full Text Available Los CAPTCHA, las pruebas humanas interactivas más utilizadas, aparecen como un método de diferenciación entre usuarios humanos y máquinas para brindar seguridad a la información en internet y evitar el spam, especialmente. Por ello, se hace una presentación introductoria de las pruebas humanas interactivas, para luego profundizar en los CAPTCHA, donde se trata su evolución, su clasificación, especificando sus técnicas de generación, algunas de sus aplicaciones y los tipos de ataques a los que se ven sometidos. Después, se tratan algunas repercusiones que han tenido sobre la usabilidad/accesibilidad de servicios de internet para usuarios humanos, lo que lleva a plantearse la inquietud de si los CAPTCHA, más que una solución, se han convertido en un nuevo problema por resolver.

Preparando um ambiente de desenvolvimento para a plataforma android

Directory of Open Access Journals (Sweden)

Felipe Pires de Oliveira

2015-11-01

Full Text Available Este artigo descreve as etapas para a criação de um ambiente de desenvolvimento para a plataforma Android. O artigo foi dividido em quatro partes: Primeiro uma introdução sobre o assunto. Na segunda seção são mostrados os passos necessários para a configuração do ambiente de desenvolvimento. Na terceira seção, é demonstrado como criar uma aplicação para dispositivo Android que calculo Índice de Massa Corporal (IMC. A quarta seção apresenta as considerações finais. A solução abordada tem como base a IDE Eclipse e o SDK do Android, bem como o Kit de Desenvolvimento Java da Oracle (JDK.

Preparando um ambiente de desenvolvimento para a plataforma android

Directory of Open Access Journals (Sweden)

Felipe Pires de Oliveira

2015-12-01

Full Text Available Este artigo descreve as etapas para a criação de um ambiente de desenvolvimento para a plataforma Android. O artigo foi dividido em quatro partes: Primeiro uma introdução sobre o assunto. Na segunda seção são mostrados os passos necessários para a configuração do ambiente de desenvolvimento. Na terceira seção, é demonstrado como criar uma aplicação para dispositivo Android que calculo Índice de Massa Corporal (IMC. A quarta seção apresenta as considerações finais. A solução abordada tem como base a IDE Eclipse e o SDK do Android, bem como o Kit de Desenvolvimento Java da Oracle (JDK.

The para-petroleum industry; L'industrie parapetroliere

Energy Technology Data Exchange (ETDEWEB)

NONE

2002-07-01

The para-petroleum industry includes societies that realize studies and installations for the deposits exploitation. This document presents the situation of the para-petroleum industry in 2001, the world investment growth of the activity, the french societies financial results and an inventory of the main operations in the amalgamation domain. (A.L.B.)

EXPERIENCIA INTEGRADORA PARA EDUCACIÓN AMBIENTAL

Directory of Open Access Journals (Sweden)

Jorge F. Coronel

2015-01-01

Full Text Available En este trabajo se relacionó la práctica experimental de laboratorio co n el análisis de problemas ambientales. El objetivo de este trabajo es analizar una propuesta que vinculó el trabajo experimental con la situación del ambiente local para promover el cuidado de la naturaleza y su uso con sostenibilidad . Esta estrategia brindó un enfoque integrador aportando a los alumnos de profesorado una alternativa de aprendizaje con exper iencias sencillas para el estudio cualitativo de l ambiente local y motivar a l análisis de problemas asociad o s. Las experiencias permitieron caracterizar las muestras de suelo, agua y aire del lugar de residencia de los alumnos. La información experimental obtenida potenció la discusión de la situación ambiental actual. E l enfoque de enseñanza basado en problemas socio - científicos posibilit ó la visión interdisciplinar del tema , redimensionando valores y acciones para el cuidado ambiental y el desarrollo sustentable.

Implantes personalizados de polimetilmetacrilato (PMMA) para aplicaciones en craneoplastia

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Arango Ospina, Marcela

2014-01-01

Los implantes a la medida para aplicaciones en craneoplastias tienen el objetivo de restaurar la protección del cerebro que el cráneo proporcionaba y mejorar el aspecto de la superficie después de sufrir un traumatismo o para corregir una malformación. Los principales inconvenientes del procedimiento de craneoplastia incluyen la individualización de la geometría y las propiedades mecánicas del implante para que sea funcional. El objetivo de nuestra investigación fue proponer un...

Rutina AUTOLISP para el despiece de columnas

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Lorena Cocunubo Carreño

2014-06-01

Full Text Available El proyecto de creación de una herramienta Autolisp para el dibujo automático de los despieces de vigas sometidas a flexión y a cortante se desarrolla en un ambiente de programación informática LISP. Se inicia con la programación en el Visual Lisp de AutoCAD del algoritmo que permite tomar información de anchos de luz, sección transversal y momentos resistentes la viga para que automáticamente ejecute los comandos y el resultado final sea un despiece detallado de los hierros por flexión junto con los estribos por cortante separados adecuadamente. Los resultados están sujetos a criterios de diseños de la NSR-10 para así garantizar la seguridad del diseño sísmico.

Comentarios para una crítica a los planes de ordenamiento territorial en Colombia. Inventario para una discusión desde las municipalidades

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Oscar Mauricio Espinosa Henao

2002-01-01

Full Text Available Fragilidades municipales, dificultades para la gobernabilidad y las distancias entre una planificación Estatal que no se compagina a cabalidad con la base social, son algunos ingredientes que plantean sustanciales desafíos para la gestión del desarrollo territorial en Colombia. El presente artículo ausculta estas situaciones en la medida en que se traducen en sabores y sinsabores al momento de delinear pautas para el adecuado desarrollo municipal y regional. Imaginarios sobre el ordenamiento territorial, limitaciones técnicas, económicas, sociales y administrativas, como también las cosas positivas, se escudriñan con el fin de aportar elementos para el debate sobre los Planes Municipales de Ordenamiento Territorial que deben aplicarse en la próxima década.

AVALIAÇÃO DE METODOLOGIA ALTERNATIVA PARA O TESTE DE TETRAZÓLIO PARA SEMENTES DE SOJA

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N.P. da COSTA

1998-05-01

Full Text Available Uma metodologia alternativa para o teste de tetrazólio, evidenciou a possibilidade de redução do período de embebição (pré-condicionamento das sementes de 16 horas à 25ºC para 6 horas à 41ºC. Como a metodologia foi testada, até o momento, em um número limitado de cultivares, permaneceu a dúvida se o procedimento alternativo (6h/41ºC era aplicável para uma gama maior de cultivares de soja. Assim sendo, executou-se a presente pesquisa onde foram avaliados três períodos de embebição (4h, 6h e 16 horas, duas temperaturas (41ºC e 25ºC em sementes das cultivares BR-13, EMBRAPA 4, EMBRAPA 48, FT-Abyara, FT-5, IAS 5, OCEPAR 13, OCEPAR 14, OCEPAR 16 e OCEPAR 17. Os seguintes testes foram realizados: grau de umidade e tetrazólio (determinando-se os índices de vigor, viabilidade, dano mecânico, deterioração por umidade e lesão de percevejo. Concluiu-se que: a o pré-condicionamento das sementes de soja à temperatura de 41ºC por 6 h possibilitou o desenvolvimento de coloração nítida para a leitura do teste de tetrazólio, fornecendo condições para uma avaliação precisa dos índices de vigor e de viabilidade, b o pré-condicionamento pelo período de 4 h à 41ºC afeta drasticamente o desenvolvimento da coloração das sementes, não permitindo identificar com precisão às classes de vigor e de viabilidade para todas as cultivares testadas; entretanto esse procedimento é eficiente para a caracterização das lesões causadas por percevejos.An alternative method of the tetrazolium test established that the preconditioning period of soybean seeds could be successfully shortened from the traditionally 16 hours at 25ºC to 6 hours at 41ºC. Since this alternative method has been tested so far with a limited number of soybean cultivars, it is imperative that it should be tested for additional cultivars. The applicability of this alternative procedure of seed preconditioning was tested in ten soybean cultivars: BR-13, EMBRAPA

Unión monetaria, factibilidad para América Latina

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Julio César César Valdés

2018-01-01

Full Text Available Como resultado de una serie de eventos y acontecimientos que en el orden económico tuvieron lugar a lo largo de la historia y que incidieron en la conducción política de los países, es que surge el interés de muchos continentes, regiones y países en diseñar una unión monetaria. El objetivo que se plantea para la presente investigación es analizar las condiciones existentes en América Latina para la posible implementación de una unión monetaria, para el desarrollo del objetivo nos apoyamos en el criterio de autores de relevante trayectoria internacional en las áreas de la economía y las finanzas como fueron Bayoumi y Eichengreen (2000, Powell y Sturzenegger (2003, también fueron consultados los premios nobel de economía Joseph Stiglitz (2016 y Robert Mundell (1965,sus significativos contribuciones resultaron de gran aporte para la presente investigación. La metodología empleada fue la realización de un análisis retrospectivo y transversal de la realidad de América Latina para implementar la unión monetaria. Tanto el objetivo planteado como la metodología, unida a otras técnicas de investigación nos permiten plantear como principales resultados, que los países latinoamericanos cuentan con insuficiencia en su capacidad para obtener la cantidad de divisas suficientes para mantener y/o estabilizar sus balanzas de pagos y cerrar sus cuentas internacionales, se plantea que el uso de numerosas monedas crea múltiples dificultades para el intercambio comercial regional. Se concluye como consideraciones finales que América Latinaaún no reúne las condiciones necesarias para que circule una moneda única ya que los modelos económicos de los diferentes países de la región son totalmente divergentes entre sí.

Selección de emplazamientos para vertederos controlados

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del Pozo Manrique, Marcos

1991-04-01

Full Text Available The objective of this article is to bring forward some ideas about the method for the correct election of sanitary landfill sites. Three subjects are developed: — Solid wasting problem and their technical solutions. — Territorial qualification for sanitary landfiliing. — Application to a particularly territory: the Alcalá de Henares area, in the Madrid province. The ground is the principal agent is sanitary landfiliing, so the correct design of sites is essential to obtain high levels of environmental safety.

El objetivo del presente trabajo es aportar algunas ideas sobre la estrategia básica para la correcta ubicación de vertederos controlados. Para ello se abordan tres temas: — Problemática de los residuos sólidos urbanos y soluciones técnicas aportadas por el vertido controlado, indicando su campo de aplicación así como las principales Interacciones con el medio de este tipo de instalación. — A la vista de esta información previa, definición de los principales requisitos exigibles a nuestro juicio al territorio para la ubicación de un vertedero, así como los criterios para su valoración y selección. — Por último, aplicación a la selección de emplazamientos para el vertido controlado en un territorio concreto, en este caso la comarca de Alcalá de Henares, en la provincia de Madrid. Debido a que el vertido controlado es un medio de eliminación en el que el principal agente técnico es el mismo terreno donde se asiente la instalación, pensamos que una correcta ubicación es la principal garantía para obtener unos niveles duraderos de seguridad ambiental y un comportamiento adecuado en las vertientes económica y social.