A 58-year-old woman, with recurrent headaches, exhibited cerebellar alaxic gait, anosmia, deafness and a pyramidal syndrome, with a progressive onset. In cerebrospinal fluid there was erythrocytes ...and siderophages. MRI on T2-weighted images revealed a marginal hypo-intensity, leading to the diagnostic of superficial siderosis of the central nervous system. None haemorragic lesion was found. The patient was given Trientine. Unfortunately she worsened on later examinations.
La pratique de la stomatologie et de la chirurgie maxillofaciale chez le sujet âgé est aujourd'hui en forte augmentation du fait de l'allongement de l'espérance de vie. Elle pose des problèmes de ...plus en plus fréquents et contraignants de prise en charge de ces patients. En effet, les retentissements du vieillissement sur les différents tissus buccofaciaux s'expriment par des pathologies très diverses, qui s'intriquent entre elles et plus ou moins directement à la pathologie générale. Par ailleurs, il est parfois difficile d'établir la distinction entre un état de « sénescence normale » et un état pathologique. La fragilité des patients, leur participation aléatoire, les contraintes et les risques de leur polymédication sont autant de problèmes dans la prise en charge thérapeutique des sujets âgés. La sous- ou la surmédicalisation sont également un écueil de la thérapeutique, tout particulièrement en cancérologie cutanée ou buccale. Enfin, il ne faut pas perdre de vue que dans la grande majorité des cas, les motifs de consultation sont liés aux conséquences fonctionnelles et esthétiques du vieillissement. Par conséquent, les différents praticiens (chirurgien maxillofacial et stomatologiste, odontologiste) vont être amenés à préserver ou à ménager la qualité de vie de ces patients.
The practice of stomatology and maxillo-facial surgery in the elderly has become more frequent, in relation with lengthened life expectancy. The management of older patients induces frequent and constraining problems due to the repercussions of ageing on orofacial tissues; these repercussions consist of various intricate diseases that more or less directly interfere with the general disease. Besides, “normal senescence” may not or hardly be distinguished from a pathological state. The frailty of older patients, their uncertain participation, the constraints and risks related to their poly-medication constitute a wide range of problems in their therapeutic management. The risk of under- or over-consumption of drugs is also to be considered, particularly in cutaneous or oral cancerology. Lastly, it should be reminded that in most cases, age-related functional and aesthetic disorders are the main reason for seeking treatment. Consequently, all concerned practitioners (maxillo-facial surgeon, stomatologist, odontologist) have to aim the preservation of these patient's quality of life.
Various clinical and experimental reports indicate that antidepressant drugs can have analgesic properties. The authors tested successively the anti-nociceptive activity of desipramine, clomipramine, ...maprotiline, viloxazine and nomifensine on the acute experimental pain model designed by Charpentier. At 25 mg/kg, desipramine showed a marked antalgic action. Clomipramine and maprotiline had a similar though much weaker action. On the other hand, nomifensine and viloxazine did not reduce pain perception; their effects on the parameters studied were variable. The usefulness of the test itself is discussed and suggestions are made regarding the relations between the analgesic potency of the drugs and the main neurotransmitter system they are assumed to act on.
Although tricyclic antidepressants have now been used for more than 20 years in the treatment of chronic pain, controlled studies of their effectiveness are quite recent. The best results are ...obtained in pain due to peripheral nerve lesions, and high doses are recommended. In contrast with the slow onset of their effect on depression, these drugs promptly relieve pain, which suggests two different mechanisms of action. The analgesic mechanism is unknown; some data indicate that serotonin is involved but an action on the adrenergic system cannot be ruled out. The arguments supporting the recent endorphin hypothesis are reviewed, ad a possible relationship between tricyclic antidepressants and endorphins is envisaged.
Contralateral hemiplegia may develop a few weeks after the onset of an ophthalmic herpes zoster. This complication, which is not part of the herpetic encephalopathy, generally coexists with lesions ...of arteritis demonstrable by arteriography, affecting in most cases the proximal segments of the middle and anterior cerebral arteries and resulting in infarcts. The pathophysiology of these lesions is uncertain, but the vessels appear to be invaded by contiguity.
The most frequent causes of trismus are tetanus and local lesions. This report discusses other etiologies. Trismus is usually only a secondary sign of a rich clinical picture, but may be of ...diagnostic value in some cases. Emphasis is placed on the frequency of involvement of neuroleptic intoxication, the early onset of trismus in the malignant hyperthermia syndrome, and on the useful role of trismus in the localization of neurological lesions.
