Search

Background: Inflammatory and mechanical stimuli in tooth/jaw pathologies can have far-reaching consequences via trigeminal and autonomic circuitry and can cause systemic (e. g. autoimmune) diseases and pain conditions outside the tooth/jaw region. In addition to a case report, we also describe new pathophysiological findings. Case Report: We report on a patient with chronic, therapy-resistant neck pain whose cause lied in the tooth/jaw region, specifically, in wisdom teeth with room problems, and partially impacted. The tooth/jaw area itself was not painful; however, neck pain developed via the nucleus spinalis n. trigemini which extends into the cervical medulla. Surgical restoration of the wisdom teeth and subsequent neural therapy treatment of the extraction scars provided permanent pain relief. Conclusion: In case of therapy-resistant neck pain (among others), it is worthwhile to look for pathologies in the dental/jaw area, possibly allowing for a causal therapy.

Die zunehmend sowohl in Grundversorger- als auch in spezialisierten Praxen angewandte Neuraltherapie (als diagnostische und therapeutische Lokalanasthesie) ist auch aus keiner Schmerzklinik mehr wegzudenken. So wird sie in der Schweiz seit 2011 zur Schulmedizin gerechnet und ist Bestandteil der Grundversicherung.

Whereas the autonomic nervous system (ANS) and the immune system used to be assigned separate functions, it has now become clear that the ANS and the immune system (and thereby inflammatory cascades) work closely together. During an acute immune response (e. g., in viral infection like Covid-19) the ANS and the immune system establish a fast interaction resulting in “physiological” inflammation. Based on our knowledge of the modulation of inflammation by the ANS we propose that a reflectory malfunction of the ANS with hyperactivity of the sympathetic nervous system (SNS) may be involved in the generation of acute hyperinflammation. We believe that sympathetic hyperactivity triggers a hyperresponsiveness of the immune system (“cytokine storm”) with consecutive tissue damage. These reflectory neuroimmunological and inflammatory cascades constitute a general reaction principle of the organism under the leadership of the ANS and does not only occur in viral infections, although Covid-19 is a typical current example therefore. Within the overreaction several interdependent pathological positive feedback loops can be detected in which the SNS plays an important part. Consequently, there is a chance to regulate the hyperinflammation by influencing the SNS. This can be achieved by a stellate ganglion block (SGB) with local anesthetics, temporarily disrupting the pathological positive feedback loops. Thereafter, the complex neuroimmune system has the chance to reorganize itself. Previous clinical and experimental data have confirmed a favorable outcome in hyperinflammation (including pneumonia) after SGB (measurable e. g. by a reduction in proinflammatory cytokines).

We describe a patient with a 35-year history of a severe chronic pelvic pain syndrome (CPPS) that failed to adequately respond to various drug therapies and other treatments by different specialists. In addition to the ongoing chronic pain, he suffered from week-long episodes of increased pain with no discernible trigger. At the first consultation with us the patient was in a particularly severe pain phase. He was taking four different analgesically effective drugs. In terms of therapeutic local anesthesia (neural therapy), we performed suprapubic injection of procaine 1% with infiltration of the vesicoprostatic plexus. Just a few minutes later, the pain decreased significantly. To maintain and further increase the effect, we performed the injection six more times. The patient gradually reduced and stopped all drugs and remained free of pain and discomfort ever since. This is the first report of a successful therapeutic infiltration of the vesicoprostatic plexus using a local anesthetic (LA) in a patient with CPPS that has been refractory to different treatments for many years. A possible explanation may be that the positive feedback loops maintaining pain and neurogenic inflammation are disrupted by LA infiltration. This can lead to a new organisation (self-organisation) of the pain-processing systems.

Im Bereich der Palliativmedizin stellt die Tracheotomie zumeist eine permanente Losung zur Gewahrleistung sicherer oberer Atemwege, aber auch eine Option zur Aspirationsvermeidung im Falle von z. B. Tumorblutungen dar. Mittlerweile erweitert auch die Palliativmedizin ihr therapeutisches Spektrum mit interventionellen Verfahren, immer unter Berucksichtigung medizinethischer Aspekte, der Therapieziele und des Patientenwillens. Da bei den progredienten Krankheitsverlaufen in der Palliativmedizin nur ein langerfristiger, dauerhafter Zugang die Atemwege sichern kann, kommen plastische Verfahren zur Anwendung, die ein stabiles epithelisiertes Tracheostoma herstellen. Zum Tracheostomaverschluss oder langfristigen Komplikationen kommt es in der Regel nicht. Der Leser erhalt in diesem Kapitel Einblick in die Prinzipien der Palliativbehandlung und insbesondere die abwagende Beurteilung der Tracheotomie im Kontext von Lebensdauer und Lebensqualitat.

Eine Dysfunktion (Reizzustand) des Ganglion stellatum kann sich – aufgrund der von ihm ausgehenden Versorgung des oberen Korperviertels mit sympathischen Fasern – klinisch auserst vielfaltig zeigen. Die Injektion mit Lokalanasthetika an dieses Ganglion ist diagnostisch und therapeutisch immer besser etabliert.

Background The sympathetic nervous system has an important role in generating pain. Various pathomechanisms are involved that respond well to the application of local anesthetics (LA), for example to the stellate ganglion block (SGB). Objectives We wanted to know more about the effects of SGB on cardiovascular parameters. Methods We included 15 healthy volunteers; another 15 healthy volunteers as a control group (sham injection of LA). In order to produce a more precise SGB, we employed only a small volume of LA (3 mL), a LA with a lower permeability (procaine 1%), and a modified injection technique. Systolic and diastolic blood pressure (SBP, DBP), heart rate (HR), and echocardiographic parameters were recorded before and after SGB. We also investigated whether there are side differences (left and right SBG). Results At baseline all parameters were within the normal range. After performing right and left SGB DBP significantly increased (on the right side from 68.73 ± 8.61 to 73.53 ± 11.10, p = 0.015; on the left side from 70.66 ± 13.01 to 77.93 ± 10.40, p = 0.003). In the control group no increase in DBP was observed. No side-specific differences were found, except a significant reduction in the maximum velocity of myocardial contraction during the systole with left-sided SGB. Conclusions Even with our methods we could not prevent the simultaneous occurrence of a partial parasympatholytic effect. For this reason, the SGB has only minor hemodynamic effects, which is desirable as it enhances the safety of the SGB.

Hintergrund: Die Arztlichen Zuweisungen therapieresistenter chronischer Schmerzpatienten zur Neuraltherapie sind ansteigend. Therapeutisch werden gezielt neurophysiologische Reiz- und Hemm-Mechanismen angesprochen. Studienziel: Ziel der Studie ist es, die Wirkung der Neuraltherapie nach Huneke bei therapieresistenten chronischen Schmerzpatienten zu dokumentieren. Studiendesign: Offene Studie in einer neuraltherapeutischen Praxis. Methoden: In die Studie aufgenommen wurden alle Patienten mit therapieresistenten chronischen Schmerzen (n=72), welche in einem Zeitraum von drei Jahren zur Neuraltherapie zugewiesen wurden. Bei allen Patienten lagen schwere, chronische SchmerzzustAnde vor (am hAufigsten RUckenleiden), welche auf konventionelle (Medikamente, physikalische Therapien, Operationen usw.) und auf komplementAre Therapien (z.B. Akupunktur) resistent waren. Der Behandlungserfolg der Neuraltherapie wurde nach einer Langzeitbeobachtung mit den ZielgrOssen Schmerz und Medikamentenverbrauch erfasst. Ergebnisse: Durchschnittlich waren 8.2 (± 7.7) neuraltherapeutische Konsultationen notwendig. Die deutlichste Verbesserung ergab sich nach durchschnittlich 3.7 (± 4.0) Konsultationen. Ein FUnftel der Patienten blieb therapieresistent, ein Drittel erlebte eine deutliche Verbesserung und ein Viertel blieb auch nach mehreren Monaten beschwerdefrei. Bei knapp 60% der Patienten konnte der Schmerzmittelverbrauch gesenkt werden (mehrmonatige Beobachtungszeit). Schlussfolgerung: Bei chronischen Schmerzpatienten mit Resistenz auf konventionelle und komplementAre Behandlungen liefert die Neuraltherapie bei einer Mehrheit der Patienten gute Langzeitergebnisse.

In recent years, search engines have started presenting semantically relevant entity information together with document search results. Entity ranking systems are used to compute recommendations for related entities that a user might also be interested to explore. Typically, this is done by ranking relationships between entities in a semantic knowledge graph using signals found in a data source as well as type annotations on the nodes and links of the graph. However, the process of producing these rankings can take a substantial amount of time. As a result, entity ranking systems typically lag behind real-world events and present relevant entities with outdated relationships to the search term or even outdated entities that should be replaced with more recent relations or entities. This paper presents a study using a real-world stream-processing based implementation of an entity ranking system, to understand the effect of data timeliness on entity rankings. We describe the system and the data it processes in detail. Using a longitudinal case-study, we demonstrate i that low-latency, large-scale entity relationship ranking is feasible using moderate resources and ii that stream-based entity ranking improves the freshness of related entities while maintaining relevance.

Die Neuraltherapie nach Huneke ist eine Injektionsbehandlung, welche Lokalanästhetika zur Diagnostik und Therapie einsetzt. Je nach Situation erfolgt der Reiz (und/oder die Unterbrechung einer pathologischen Belastung) im Bereiche der Segmentreflektorik oder über das sogenannte Störfeld. Dieses kann ausserhalb jeder segmentalen Ordnung eine Erkrankung oder ein Schmerzbild auslösen und unterhalten. Mit der Neuraltherapie werden gezielt autoregulatorische Mechanismen des Vegetativums (insbesondere des Sympathikus) angesprochen. Theoretische Grundlagen hierzu sind Erkenntnisse aus der Neurophysiologie und der Modernen Physik.

We describe a patient with a three-year history of severe progressive left-sided glossopharyngeal neuralgia (GPN) that failed to adequately respond to various drug therapies. The application of lidocaine spray to the posterior pharyngeal wall provided no more than short-term relief. Apart from a large hypertrophic tonsillectomy scar on the left side all clinical and radiologic findings were normal. In terms of therapeutic local anaesthesia, the hypertrophic tonsillectomy scar tissue was completely infiltrated with the local anaesthetic (LA) procaine 1%. The patient has been almost completely pain-free ever since, and the lidocaine spray is no longer needed. Six weeks after the first treatment a repeat infiltration of the tonsillectomy scar led to the complete resolution of all symptoms. The patient has become totally symptom-free without the need to take any medication now for two and a half years. This is the first report of a successful therapeutic infiltration of a tonsillectomy scar using an LA in a patient with GPN that has been refractory to medical treatment for several years. A possible explanation may be that the positive feedback loop maintaining neurogenic inflammation is disrupted and “sympathetically maintained pain” resolved by LA infiltration.

Das Spektrum der kardiologischen Krankheitsbilder war sehr breit, und die zusatzliche konsiliarische Tatigkeit im Hopital du Jura bot Abwechslung im Praxisalltag.