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A benefit-risk assessment of baclofen in severe spinal spasticity
No full textBaclofen is used for treatment of the spasticity of spinal origin,that is a common sequela of spinal cord injury and multiple sclerosis; spasticity occurs in about 50% of patients affected by these disorders.In open-label studies of oral baclofen, the drug improved spasticity in 70-87% of patients; additionally, improvement in spasms was reported in 75-96% of patients.. In double-blind, crossover, placebo-controlled trials, baclofen was reported to be effective, producing statistically significant. improvements in spasticity. Tizanidine is the antispasticity drug that has been most widely compared with oral baclofen; studies have generally found the. two drugs to have equivalent efficacy. However, tizanidine, has better tolerability, in particular weakness was reported to be occur less frequently with tizanidine than with baclofen.The main adverse effects of oral baclofen include: sedation or somnolence, excessive weakness, vertigo and psychological disturbances. The incidence of adverse effects is reported to range from 10% to 75%. The majority of adverse effects are not severe; most are dose related, transient and/or reversible. The main risks of oral baclofen administration are related to withdrawal: seizures, psychic symptoms and hyperthemia can occur. These symptoms improve after the reintroduction of baclofen, usually without sequelae. When not related to withdrawal; these symptoms mainly present in patients with brain damage and in the elderly. The limited data on baclofen toxicity in patients with renal disease suggest that administration of the drug in these persons may carry an unnecessarily high risk.Intrathecal baclofen is indicated for use in patients with spasticity of spinal origin unresponsive to treatment with maximum doses of oral baclofen, tizanidine and/or dantrolene. The benefits of continuous intrathecal baclofen infusion have been demonstrated: > 80% and > 65% of patients have improvement in tone and spasms, respectively. The main risks of intrathecal baclofen infusion are symptoms related to overdose or withdrawal; the latter is more important because of the associated severe effects on clinical status and the possibility of death, but it is responsive to rapid treatment. Overdose primarily arises from drug test doses or human error during refill and programming of the pump, and withdrawal most commonly occurs as a result of a problem with the delivery system.Since the adverse consequences do not exceed the benefits of oral and intrathecal baclofen for patients with spinal spasticity, the benefit/risk assessment is favourable
Lo Spedale di Poveri, the hospital for the poor in Milan: 15th to 20th century
No full textTHE CONSTRUCTION OF the Hospital for the Poor was begun in Milan in 1451 at the instigation of Francesco Sforza, Duke of Milan. In contrast to what had happened during the Dark Ages of the Medieval period, the new hospital was extraordinary both in construction and in medical organization. Wards for the patients were separated according to diseases, infective and noninfective, and according to sex. Each patient had his or her own bed and was fed adequately and kept warm. Patients were no longer treated by astrologers or monks but rather by doctors who had studied medicine at the University of Pavia. Each ward had its own doctor and surgeon, and from 1558 on, there was a doctor on duty in the hospital 24 hours a day. The hospital had its own pharmacy and drug reference book. The Hospital for the Poor, or Ca Granda (Big House), or the Ospedale Maggiore, as it was variously called from the 15th to the 19th centuries, became a training ground for anatomic and clinical studies. It was only in 1929 that a Faculty of Medicine was set up at Ospedale Maggiore
Guidelines for medical and surgical management in head trauma patients in the United States and Europe
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A case of post-traumatic cervicogenic headache treated by cervical cord stimulation.
No full textThe case of a 26-year-old woman suffering from cervical trauma with disc herniation presenting with arm and neck pain is presented. She underwent cervical discectomy with fusion because the pain did not improve with medical therapies; as the neck pain resumed after surgery, a cervical cord neurostimulator was implanted, with improvement for cervicogenic headache. This report underlines the presence of two pathologies and the relationship between C2 and trigeminal pathways
The use of Gore Preclude to avoid scar round the nerve in the peripheral nerve electrodes
No full textPharmacological complications of the chronic baclofen infusion in the severe spinal spasticity. Personal experience and review of the literature
No full textAIM: To evaluate the pharmacological complications and side effects of the chronic intrathecal baclofen infusion in patients suffering from intractable spinal spasticity in our Department as well as in the literature. METHODS: The pharmacological complications and side effects observed at long-term follow-up in 25 patients with chronic intrathecal baclofen infusion are evaluated; the search of the literature complications was carried out in Medline and in Ingenta web sites. RESULTS: We have been able to observe in our series 3 (12%) patients with hypotonia, 2 with impairment on erection (8%) and 1 (4%) with constipation; 5 (20%) patients showed also tolerance but only 1 (4%) needed a ''drug holiday''. In the literature the side effects range from 4% to 16%. Moreover the tolerance is reported from 3% to 15%. The overdose has been reported from 0% to 14%, while the syndrome of withdrawal is reported in 16 patients with 6 fatalities. In our series these two last complications were not observed. CONCLUSIONS: Lethal pharmacological complications are rare and, if promptly diagnosed and treated, are reversible. Side effects of minor importance can impair the patient quality of live and needed to be adjusted to patient's requirements. This kind of therapy should be restricted to specialized centres
The microvasculature of the lateral choroid plexus in the rat: a scanning electron microscopy study of vascular corrosion casts.
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