[Statistical observations on patients with herpes zoster and postherpetic neuralgia (author's transl)].
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From 1969 to 1980, 83 patients with herpes zoster and postherpetic neuralgia were referred to our clinic. They consisted of 36 male and 47 female, whose ages ranged from 18 to 91 years. They were tested mainly with stellate ganglion block or epidural block. Patients with postherpetic neuralgia received imipramine 60 mg per day in addition. About half of the patients were relieved of pain or considerably improved after treatment. Other half of the patients somewhat improved excluding those patients whose therapeutic effect could not be assessed. More favourable results were obtained in patients whose treatment was instituted within 2 weeks from onset of herpes zoster than patients over 2 weeks from onset. Duration of treatment was shorter in younger patients (approximately 59 years) than older patients (60 years approximately), but results were same in both age groups. About 10% of the patients had concomitant malignant disease or autoimmune disease. No relationship between the localization of herpes zoster and the site of malignant disease was found.Keywords:
Postherpetic Neuralgia
Concomitant
Epidural block
Shingles
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From 1969 to 1980, 83 patients with herpes zoster and postherpetic neuralgia were referred to our clinic. They consisted of 36 male and 47 female, whose ages ranged from 18 to 91 years. They were tested mainly with stellate ganglion block or epidural block. Patients with postherpetic neuralgia received imipramine 60 mg per day in addition. About half of the patients were relieved of pain or considerably improved after treatment. Other half of the patients somewhat improved excluding those patients whose therapeutic effect could not be assessed. More favourable results were obtained in patients whose treatment was instituted within 2 weeks from onset of herpes zoster than patients over 2 weeks from onset. Duration of treatment was shorter in younger patients (approximately 59 years) than older patients (60 years approximately), but results were same in both age groups. About 10% of the patients had concomitant malignant disease or autoimmune disease. No relationship between the localization of herpes zoster and the site of malignant disease was found.
Postherpetic Neuralgia
Concomitant
Epidural block
Shingles
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Postherpetic Neuralgia
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Postherpetic Neuralgia
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Summary Postherpetic neuralgia is defined as pain persisting, or recurring, at the site of shingles at least three months after the onset of the acute rash. Thus defined, at least half of shingles sufferers over the age of 65 years develop postherpetic neuralgia. In addition to increasing age, less important risk factors for postherpetic neuralgia are pain severity of acute shingles and trigeminal distribution. Postherpetic neuralgia accounts for 11–15% of all referrals to pain clinics and would, in fact, be far more effectively dealt with in primary care. Effective treatment of acute shingles by systemic antivirals at the appropriate time may have some effect in reducing the incidence of postherpetic neuralgia, making it easier to treat with tricyclics and greatly reducing scarring (25% of all cases affect the face). Pre-emptive treatment with low-dose tricyclics (ami- or nor-triptyline 10–25 mg nocte) from the time of diagnosis of acute shingles reduces the incidence of postherpetic neuralgia by about 50%. Established postherpetic neuralgia should be vigorously treated with adrenergically active tricyclics in a dose rising over two or three weeks from 10–25 mg to 50–75 mg. Positive relaxation should also be used. Carbamazepine, like conventional analgesics, is of little or no value. Failure of tricyclics to effect relief within eight weeks calls for specialist treatment. North American practitioners in particular believe that some opioids (e.g., oxycodone) may be helpful in otherwise intractable cases.
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Shingles (herpes zoster) and postherpetic neuralgia, a chronic neuropathic pain syndrome that can persist after the shingles lesions heal, were studied by eminent neurologists of the 19th century. Autopsy studies were used to establish sensory neural pathways in the peripheral and central nervous systems. More recently, zoster and postherpetic neuralgia have served as models for the study of the pathogenesis and treatment of neuropathic pain. Postherpetic neuralgia has the cardinal clinical features of all neuropathic pain syndromes, including sensory abnormalities, ongoing pain, and allodynia (touch-induced pain). Unlike most other neuropathic pain syndromes, such as trigeminal neuralgia or nerve root compressions, shingles has a well-defined pathogenesis and onset, as well as visible lesions, and is therefore uniquely suitable for study.
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Herpes zoster (shingles) is a viral infection that results from a reactivation of a dormant varicella zoster virus. It has been estimated that more than 300,000 new cases are seen in the United States each year. Several factors influence the incidence of infection, with increasing age being the most consistent. Postherpetic neuralgia is the No. 1 cause of intractable, debilitating pain in the elderly and is the leading cause of suicide in chronic pain patients over the age of 70.
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Abstract Aim The worldwide increase in morbid obese patients raises controverises regarding the best timing of treatment for concomitant ventral hernias (VH). We present the preliminary experience at a referral center for bariatric surgery (BS): synchronous versus delayed ventral hernia repair (S-VHR, D-VHR) have been compared. Material and Methods From 2009, 40 consecutive morbid obese patients eligible for BS presented with concomitant VH. Symptoms and characteristics of the VH were evaluated to choose between S-VHR (28 patients), primary (n = 12) or mesh augmented (n = 16), and D-VHR (12 patients). 90-day postoperative complications and hernia recurrence were evaluated. Results 3 patients out of 16 in the mesh group experienced superficial surgical site infections. 4 patients in the D-VHR had a bowel incarceration within 20 days after BS and required emergency surgery with mesh implantation. No complications occurred in the primary repair group. The recurrence rate was around 19% in both groups of the S-VHR. Nonetheless the group that received mesh repair had a significant higher mean value of the defect. In the D-VHR cohort 1 patient was lost at follow up while 3 patients were not operated on due to inadequate weight loss. No recurrences occurred in the 4 patients requiring emergency surgery. Conclusions: D-VHR is associated with worse early postoperative outcomes; primary suture repair should be considered in preventing bowel incarceration but synchronous mesh repair is preferred in large symptomatic hernias for its acceptable postoperative morbidity and hernia recurrence at 1 year.
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Herpes zoster (HZ) or 'shingles' is a painful vesicular rash resulting from reactivation of the varicella-zoster virus that also causes chickenpox. The incidence of HZ infection (HZI) increases with age and the degree of immunosuppresssion. Post herpetic neuralgia, the most common complication of HZ, occurs after the zoster rash has resolved. Conventional therapies include antivirals, corticosteroids and analgesics, both oral and topical. Here we report a case of HZ in an 80-year-old woman involving maxillary nerve and the article also reviews various treatment modalities available for the management of HZI.
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Chicken Pox
Varicella zoster virus
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Initiate antiviral treatment as soon as possible; rapid resolution of acute pain and reduction in the development of postherpetic neuralgia (PHN) are most likely when therapy is started within 72 hours of the outbreak. Discuss herpes zoster (HZ) vaccination with healthy patients 60 years of age and older during their first office visit; the vaccine markedly reduces the incidence of HZ and PHN. Do not prescribe tricyclic antidepressants or corticosteroids in the acute phase of HZ.
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