Faculty Bibliography

Autotomy in nerve injured rats has been put forward as an animal model in a broad range of chronic neuralgic pain. We have examined the effect of glycerol, a new and promising therapeutic agent for trigeminal neuralgia, on this animal model. A single dose of glycerol, alcohol or saline was injected directly into experimental sciatic nerve neuromas in rats via a chronically implanted cannula. Injections were made either at the time of nerve injury or 2 weeks afterwards. Both forms of glycerol treatment caused a significant reduction in autotomy behavior relative to saline. Alcohol also suppressed autotomy, but it was less effective than glycerol.

Percutaneous chemical lumbar sympathectomy with alcohol (PCLSA) using computed tomography (CT) control was performed in 8 patients suffering from advanced peripheral arterial occlusive disease. PCLSA under CT guidance was found to be a simple and safe procedure. The use of CT control added precision in the guidance of needle placement. Positive results were obtained in all patients, without significant morbidity. PCLSA may be an alternative to surgical sympathectomy.

The case of an asymptomatic 7-year-old girl with a hard bulge in the left forehead is presented. The radiological evaluation disclosed a hyperostotic mass with a large intracranial extension. A surgical specimen revealed a meningioma. The presence of a localized cranial bulge as the only sign of an intracranial tumor and the diagnostic value of computerized tomography (CT) are discussed.

Autotomy has been suggested as an animal model of chronic pain. It starts about a week or two postoperatively and develops until 10 weeks after nerve section. This behaviour is thought to be triggered by activity of sensory fibres ending in a neuroma. Here we suggest to utilize it in combination with a novel drug delivery system which enables a direct and exclusive access of the drug to the neuroma. Alteration in the autotomy behaviour can then be related to the exclusive topical action on the sensory fibres within the neuroma. The sciatic nerve is transsected and its proximal end inserted into a PE tube sealed distally. A second, smaller tube originates in a wound exit in the back of the animal and subcutaneously leads into the large tube, where it is fixed by glue to the inner wall. Thus, the end of the smaller tube is juxtaposed to the nerve end. During the following weeks a neuroma develops within the tube. The resulting autotomy scores are then examined weekly. At various times after the operation, under light anaesthesia, drugs can be injected into the tube and the effect on the autotomy behaviour is monitored. An example is given, describing the autotomy suppressive effects of glycerol and alcohol, injected to different groups of rats immediately after the operation and compared to an injection 14 days postoperatively. This method is suggested as a pharmaco-behavioural assay for the assessment of the analgetic efficacy of drugs for chronic pain.

A vertex epidural hematoma of a 21-year-old man was diagnosed by angiography 1 month after head trauma. Two axial computed tomography scans did not reveal the lesion, whereas a coronal computed tomography scan demonstrated the hyperdense hematoma. The problems of detecting vertex lesions with axial computed tomography scans are discussed.