Thalamic stimulation for neuropathic pain

1980 ◽  
Vol 52 (4) ◽  
pp. 486-493 ◽  
Author(s):  
Ian M. Turnbull ◽  
Ralph Shulman ◽  
W. Barrie Woodhurst
Keyword(s):  
Neuropathic Pain ◽  
Pain Relief ◽  
The Body ◽  
The Other ◽  
Technical Problems ◽  
Content Type ◽  
Thalamic Stimulation ◽  
Sensory Nucleus ◽  
Electrode Systems

✓ Eighteen patients with neuropathic pain underwent thalamic electrode implantation. Satisfactory initial pain relief ensued in 14, and their electrode systems were internalized for long-term use. Twelve of the 14 continue to obtain either complete or partial pain relief by regular stimulation. One of the other two patients has had a complete remission of pain, apparently spontaneously, and the other had to have the electrode removed after it retracted from his thalamus on two occasions. The electrodes have been placed in the sensory nucleus of the thalamus where stimulation evokes paresthesias in the painful part of the body. Technical problems consisting of our inability to locate the target in two patients and our failure to fix the electrode adequately in one prevented us from employing the treatment in three patients. The fourth patient had temperature dysesthesia which was not altered during 2 weeks of stimulation.

Are jacks-of-all-trades successful entrepreneurs? Revisiting Lazear's theory of entrepreneurship

2020 ◽  
Vol 15 (3) ◽  
pp. 411-430
Author(s):  
Agnieszka Kurczewska ◽  
Michał Mackiewicz
Keyword(s):  
Design Methodology ◽  
Success Factors ◽  
Negative Influence ◽  
The Body ◽  
Entrepreneurial Success ◽  
Content Type ◽  
Logit Regression ◽  
Managerial Experience ◽  
A Company

PurposeThe purpose of this paper is to identify human capital factors that pertain both to setting up and successfully running a business. To achieve this objective, the authors apply and extend the theory of career choice offered by Lazear (2005) that explains individual selection into entrepreneurship.Design/methodology/approachThe authors hypothesise that individuals with broader educational and professional backgrounds are more likely to start a business and are more likely to run a business in the long term. The authors tested the hypotheses using unique data from 800 current entrepreneurs, 800 employees who were previously entrepreneurs and 842 employees with no entrepreneurial experience, by means of a logit regression with robust standard errors and extensive robustness checks.FindingsThe authors empirically show that individuals with more diverse educational and professional backgrounds tend to have both greater chances of starting a company, as well as a higher probability of entrepreneurial success. Surprisingly, having managerial experience proved to exert a negative influence on the likelihood of starting a business while having an insignificant impact on the odds of entrepreneurial success.Research limitations/implicationsThe findings are informative for those planning or pursuing an entrepreneurial career, but they are also relevant for the purpose of entrepreneurship education.Originality/valueThe author's extend the body of research supporting Lazear's (2005) theory by showing that broad education and professional experience not only contribute to a higher propensity to start a company but they are also success factors in business per se.

The use of stereotaxic chemical hypophysectomy in the treatment of thalamic pain syndrome

1983 ◽  
Vol 59 (6) ◽  
pp. 1002-1006 ◽  
Author(s):  
Allan B. Levin ◽  
Lincoln F. Ramirez ◽  
Jordan Katz
Keyword(s):  
Pain Relief ◽  
Diabetes Insipidus ◽  
Pain Syndrome ◽  
Pituitary Hormones ◽  
The Body ◽  
Cerebral Stroke ◽  
Preoperative Pain ◽  
Content Type ◽  
Third Nerve Palsy ◽  
Thalamic Pain Syndrome

✓ Three patients with neurological injuries consistent with cerebral stroke subsequently developed pain over portions of the body contralateral to the injured hemisphere. Stereotaxic chemical hypophysectomy was used in the management of this pain after other surgical procedures and medical management had failed to provide relief. Postoperatively, all patients were treated for hypopituitarism. All developed transient diabetes insipidus, and one patient developed transient right third nerve palsy. No other complications were encountered. All three patients experienced significant pain relief within 48 hours of the procedure. By the date of discharge, two of the three patients reported complete, and the third greater than 80% pain relief. At the initial follow-up visit all patients were essentially pain-free. These patients have now been followed for 58, 39 and 19 months, and remain free of their original pain. During this time the intravenous administration of naloxone has failed to reproduce the preoperative pain. Pituitary function testing 1 year or more following operation demonstrated that none of the patients had an endocrinologically complete hypophysectomy. Recovery from transient diabetes insipidus was not associated with return of the original pain. The mechanism of action of stereotaxic chemical hypophysectomy in the relief of pain related to thalamic lesions remains unknown. The observation that naloxone failed to reproduce the preoperative pain casts doubt on the theory that augmentation of endogenous opiate release is the primary mechanism. Additional observations suggest that pain relief after hypophysectomy may be more directly the result of stimulation of a hypothalamic pain-suppressing mechanism than due to the elimination of pituitary hormones.

Economic complexity and price competitiveness dependence: empirical evidence using panel models

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Guilherme Magacho ◽  
Rafael Ribeiro ◽  
Igor Rocha
Keyword(s):  
Exchange Rate ◽  
Generalized Method Of Moments ◽  
Output Growth ◽  
The Other ◽  
Content Type ◽  
Price Competitiveness ◽  
Economic Complexity ◽  
Other Hand ◽  
The Impact

Purpose As economies with high economic complexity and productive capabilities may easily adapt their productive structure due to product differentiation and innovation, the central variable of competitiveness for these countries is the product quality, not price. On the other hand, the price can be an important determinant of less complex countries, and hence, real exchange rate (RER) misalignments may have long-term impacts. This paper aims to empirically assess variations in the magnitude of the impact in RER misalignments on output growth subject to countries’ economic complexity. Design/methodology/approach The estimation technique used is the generalized method of moments-System estimator as this method is robust to reverse causality. Heterogeneous regressions using interaction models are undertaken to analyze to what extend promoting economic complexity can reduce price competitiveness dependence and allow countries to grow faster without relying on cost competitiveness. Findings Estimates show that economic complexity (which measures technological and productive capabilities) determines cross-country differences regarding the effects of RER misalignments on countries’ long-term growth rates. The results suggest that exchange rate devaluations may not be effective for countries at the top end of the technological ladder while an overvalued RER may damage the long-term growth rate of countries with low levels of economic complexity. Originality/value This paper contributes to the literature by empirically investigating the impact of RER misalignments in countries with distinct technological and productive capabilities based on the recent developments of countries’ economic complexity analysis. It investigates whether more diversified and complex economies are less sensitive to RER misalignments as they can adapt their production, undertake other tasks, create new products and increase the quality of products they produce. Less complex economies, on the other hand, are less capable of innovating because it demands productive capabilities they do not have, and hence, they are more dependent on their current export basket.

Percutaneous endoscopic treatment of suprasellar arachnoid cysts: ventriculocystostomy or ventriculocystocisternostomy?

1996 ◽  
Vol 84 (4) ◽  
pp. 696-701 ◽  
Author(s):  
Philippe Decq ◽  
Pierre Brugières ◽  
Caroline Le Guerinel ◽  
Michel Djindjian ◽  
Yves Kéravel ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Flow Dynamics ◽  
The Other ◽  
Arachnoid Cysts ◽  
Csf Flow ◽  
Content Type ◽  
Secondary Closure ◽  
Fine Print

✓ The use of an endoscope in the treatment of suprasellar arachnoid cysts provides an opening of the upper and lower cyst walls, thereby allowing the surgeon to perform a ventriculocystostomy (VC) or a ventriculocystocysternostomy (VCC). To discover which procedure is appropriate, magnetic resonance (MR)—imaged cerebrospinal fluid (CSF) flow dynamics in two patients were analyzed, one having undergone a VC and the other a VCC using a rigid endoscope. Magnetic resonance imaging studies were performed before and after treatment, with long-term follow-up periods (18 months and 2 years). The two patients were reoperated on during the follow-up period because of slight headache recurrence in one case and MR—imaged CSF flow dynamics modifications in the other. In each case surgery confirmed the CSF flow dynamics modifications appearing on MR imaging. In both cases, long-term MR imaging follow-up studies showed a secondary closing of the upper wall orifice. After VCC, however, the lower communication between the cyst and the cisterns remained functional. The secondary closure of the upper orifice may be explained as follows: when opened, the upper wall becomes unnecessary and tends to return to a normal shape, leading to a secondary closure. The patent sylvian aqueduct aids this phenomenon, as observed after ventriculostomy when the aqueduct is secondarily functional. The simplicity of the VCC performed using endoscopic control, which is the only procedure to allow the opening in the cyst's lower wall to remain patent, leads the authors to advocate this technique in the treatment of suprasellar arachnoid cysts.

scholarly journals Long-Term Results of a Simultaneous Trial of Deep Brain and Motor Cortex Stimulation in Refractory Neuropathic Pain

2017 ◽  
Vol 3 (1) ◽  
pp. 4-15
Author(s):  
Byung-chul Son ◽  
Jin-gyu Choi ◽  
Sang-woo Ha ◽  
Deog-ryeong Kim
Keyword(s):  
Neuropathic Pain ◽  
Pain Relief ◽  
Motor Cortex ◽  
Success Rate ◽  
Rating Scale ◽  
Long Term Results ◽  
Motor Cortex Stimulation ◽  
Significant Difference ◽  
Deep Brain

Objective Although deep brain stimulation (DBS) and motor cortex stimulation (MCS) are effective in patients with refractory neuropathic pain, their application is still empirical; there is no consensus on which technique is better. Methods To enhance the success rate of trial stimulation of invasive neuromodulation techniques and identify approapriate stimulation targets in individual patients, we performed a simultaneous trial of thalamic ventralis caudalis (Vc) DBS and MCS in 11 patients with chronic neuropathic pain and assessed the results of the trial stimulation and long-term analgesia. Results Of the 11 patients implanted with both DBS and MCS electrodes, nine (81.8%) had successful trials. Seven of these nine patients (77.8%) responded to MCS, and two (18.2%) responded to Vc DBS. With long-term follow-up (56 ± 27.5 months), the mean numerical rating scale decreased significantly (P < 0.05). The degree of percentage pain relief in the chronic MCS (n = 7) and chronic DBS (n = 2) groups were 34.1% ± 18.2% and 37.5%, respectively, and there was no significant difference (P = 0.807). Five out of the seven MCS patients (71%) and both DBS patients had long-term success with the treatments, defined as >30% pain relief compared with baseline. Conclusions With simultaneous trial of DBS and MCS, we could enhance the success rate of invasive trials. Considering the initial success rate and the less invasive nature of epidural MCS over DBS, we suggest that MCS may be a better, initial means of treatment in chronic intractable neuropathic pain. Further investigations including other subcortical target-associated medial pain pathways are warranted.

Multiple meningiomas: a long-term review

1983 ◽  
Vol 59 (1) ◽  
pp. 1-5 ◽  
Author(s):  
John P. Sheehy ◽  
H. Alan Crockard
Keyword(s):  
Tumor Recurrence ◽  
The Other ◽  
Von Recklinghausen’S Disease ◽  
Von Recklinghausen's Disease ◽  
Content Type ◽  
Multiple Meningiomas ◽  
Recklinghausen's Disease ◽  
Fine Print ◽  
Recklinghausen’S Disease

✓ Ten cases of multiple meningiomas seen over a 34-year period have been reviewed. The total case load from which these cases were selected was 566. The incidence of multiple meningiomas found prior to the introduction of computerized tomography (CT) in this series was 1.1%. The incidence since the introduction of CT was 8%. In eight cases all the tumors were found at the initial presentation and surgery; in the other two cases new tumors were discovered 1 and 4 years later. In only one case was von Recklinghausen's disease known to be present, and this patient developed new tumors. Six cases have been followed for 5 or more years, two for 16 years. Tumor recurrence has not been seen. All the patients were females. There was a higher proportion than usual of the whorling psammomatous type of tumor; papillary, angioblastic or malignant forms were not noted. The possibility of multiple meningiomas being a forme fruste of von Recklinghausen's disease is considered.

Endoscopic third ventriculostomy for shunt dysfunction in occlusive hydrocephalus: long-term follow up and review

2003 ◽  
Vol 98 (5) ◽  
pp. 1032-1039 ◽  
Author(s):  
Jürgen Boschert ◽  
Dieter Hellwig ◽  
Joachim K. Krauss
Keyword(s):  
Endoscopic Third Ventriculostomy ◽  
Obstructive Hydrocephalus ◽  
The Other ◽  
Third Ventriculostomy ◽  
Content Type ◽  
Shunt Placement ◽  
Occlusive Hydrocephalus ◽  
Shunt Dysfunction ◽  
Fine Print

Object. Endoscopic third ventriculostomy (ETV) is the treatment of choice for occlusive (noncommunicating) hydrocephalus. Nevertheless, its routine use in patients who have previously undergone shunt placement is still not generally accepted. The authors' aim was to investigate the long-term effects of ETV in a group of prospectively chosen patients. Methods. Patients who underwent ETV and had previously undergone shunt placement for occlusive hydrocephalus were followed prospectively for at least 3 years (range 36–103 months, mean 63.6 months). Nine female and eight male patients ranging from 8 to 54 years of age (mean 32 years) had undergone shunt placement 0.7 to 23.5 years (mean 8.1 years) before ETV. Fifteen patients were admitted with underdrainage and two with overdrainage. In six cases, ETV was performed as an emergency operation. The origin of hydrocephalus was aqueductal stenosis in 12 cases and aqueductal compression by a tumor in two cases. Three patients suffered from a fourth ventricle outlet syndrome, and in two patients an additional malresorptive component was suspected. Thirteen patients underwent ETV with shunt removal and insertion of an external drain in one session. The drain served as a safety measure; it could be opened if raised intracranial pressure or ventricular dilation was observed on postoperative imaging studies. In the other four patients the shunt was initially ligated and then removed during a second operation. Fourteen patients (82%) have remained shunt free. The other three patients, including the two with an additional malresorptive component, needed shunt reimplantation 3 days, 2 weeks, or 7 months after ETV. Conclusions. Use of ETV is safe and effective for the treatment for shunt dysfunction in patients with obstructive hydrocephalus.

Long-term follow-up results of selective VIM-thalamotomy

1986 ◽  
Vol 65 (3) ◽  
pp. 296-302 ◽  
Author(s):  
Yoshishige Nagaseki ◽  
Tohru Shibazaki ◽  
Tatsuo Hirai ◽  
Yasuhiro Kawashima ◽  
Masafumi Hirato ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Essential Tremor ◽  
The Other ◽  
Content Type ◽  
Early Results ◽  
Initial Surgery ◽  
Long Term Follow Up

✓ The authors report the results of a long-term follow-up study of the effects of the physiologically defined selective VIM (nucleus ventralis intermedius)-thalamotomy on tremor of Parkinson's disease in 27 patients and essential tremor in 16 patients. The follow-up period ranged from 3.25 to 10 years (mean 6.58 years). In 43 patients a total of 50 operations (including four bilateral operations and three reoperations) were carried out. The early (2 to 4 weeks after surgery) and late effects on the tremors were determined clinically and electromyographically. Fourteen parkinsonian cases were treated with minimal lesions (about 40 cu mm). Their late results were very similar to the early results: in 10, the tremors were completely abolished, three had a slight residual tremor, and one underwent reoperation 3 months after the first surgery. Eleven essential tremor cases were treated with minimal lesions. Six of these tremors were completely abolished, four patients had slight residual tremors, and one patient with a recurrence underwent reoperation 2 years after the initial surgery. In these 23 successful operations with minimal lesions (excluding two cases with reoperation), the tremor was abolished without discernible long-lasting side effects. The other 23 operations on 16 patients with Parkinson's disease (including one reoperation) and on seven with essential tremor (one of whom also had a minimal lesion on the other side) involved relatively large lesions. In this group, the surgery was successful in almost every case. It was concluded that radiographically and physiologically monitored selective VIM-thalamotomy for parkinsonian and essential tremor is effective even when lesioning is minimal. Moreover, the beneficial effect is maintained over a long period of time.

The antecedents of relational capital in key exporter-importer relationships

2016 ◽  
Vol 33 (2) ◽  
pp. 196-218 ◽  
Author(s):  
Dario Miocevic
Keyword(s):  
Survey Methodology ◽  
Value Added ◽  
Ordinary Least Squares ◽  
The Body ◽  
Institutional Distance ◽  
Relational Capital ◽  
Relational Exchange ◽  
Content Type ◽  
Relational Norms

Purpose – During their process of going international, small and medium-sized manufacturing firms seek to establish long-term relationships with key importers in order to minimize the risks of doing business in a foreign market. In the process of establishing long-term relationships, exporters aim to create relational capital with key importers. Yet, the body of international marketing literature that addresses the importance of relational capital in exporter-importer (E-I) relationships is still underdeveloped. The purpose of this paper is to examine the influence of relational norms on relational capital in key E-I relationships under the moderating influence of formal and informal institutional distance. The study’s conceptual framework was developed by integrating relational exchange and institutional theories. Design/methodology/approach – The study was carried out by using a survey methodology. Data were obtained by questionnaire from a sample of 122 small and medium-sized exporters from the manufacturing industry in Croatia. In order to test the hypotheses, the ordinary least squares technique was employed. Findings – The findings support the hypotheses, implying that the development of relational capital requires relational efforts in terms of reliance and relational bonding norms. Additionally, the empirical data suggest that the dimensions of formal and informal institutional distance significantly moderate the relationships between relational norms and relational capital. Originality/value – The value-added of this study is embedded within the theoretical framing and empirical testing of the antecedents of relational capital in key E-I relationships in the context of the institutional distance between partners, which has been neglected by previous studies in the field.

Conceptualizing the body and the logics of performing

2015 ◽  
Vol 21 (3) ◽  
pp. 345-371
Author(s):  
Deryk Stec
Keyword(s):  
Design Methodology ◽  
Physical Space ◽  
Art Music ◽  
The Body ◽  
Content Type ◽  
Excessive Heat ◽  
The Past ◽  
The Social ◽  
Performance Teams

Purpose This paper aims to examine how residues of ancient images have influenced one’s perspectives on management. Increased attention has been given to the absence of bodies within discussions of organisations; however, far less attention has been given to the interplay between organisations and images of one’s body. Design/methodology/approach By comparing the perceived benefits of studying sport (e.g. passion, embodiment and action) with the tensions that existed between athletic performances and an ancient image of the body, this paper draws attention to residuals that exist within discussions of organisations. Findings In a context where an image of the body encouraged moderation, the appropriate levels of heat, and the development of an immaterial and eternal soul, athletic performances, which were physical, extreme, focused on the body and generated excessive heat, were often problematic. These problems are then examined within the literature discussing current issues in management. Research limitations/implications Sport has the potential to facilitate one’s understanding of issues that management, consistent with ancient images of the body, has traditionally neglected (i.e. extremes, passion) and the possibilities of using embodied cognition to enhance our understandings of performance, teams and leading are discussed. Social implications As scientists become increasingly concerned about the long-term consequences of the reduced opportunities for cultural programs (sport, art, music, etc.), revisiting one’s assumptions is increasingly important, especially as athletics and philosophy once shared the same physical space. Originality/value By describing how residues from historical images of the body have influenced the thinking about organizing, this paper highlights the connection between the social and the biological and demonstrates how vestiges from the past influence contemporary discussions.

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