Atypical Facial Pain in the Elderly1

Atypical facial pain describes a chronic pain state but does not imply an etiology. One-hundred and two patients with atypical facial pain were evaluated. Patients were separated into two groups; 40 patients over age 60 and 62 patients under age 60. Comparisons between the two groups for sex, diagnostic classifications, location of symptoms, specific symptoms, and treatment results were performed. Medical/dental disorders (20%), psychiatric disorders (50%) and combinations of both (15%) were causes of atypical facial pain. Fifteen percent of patients had an indeterminate cause. Psychiatric treatment was effective in reducing psychopathology and pain when a psychiatric diagnosis was present. Burning of the oral mucosa as a specific symptom occurred more frequently in the elderly. No differences were noted between the two age groups in relation to sex, diagnostic classification, or treatment results. No particular psychiatric, medical or dental disorder predominated as a specific cause of atypical facial pain.     

Altered Pain Sensitivity in Elderly Women with Chronic Neck Pain

Background

Age-related changes occur in both the peripheral and central nervous system, yet little is known about the influence of chronic pain on pain sensitivity in older persons. The aim of this study was to investigate pain sensitivity in elders with chronic neck pain compared to healthy elders.

Methods

Thirty elderly women with chronic neck pain and 30 controls were recruited. Measures of pain sensitivity included pressure pain thresholds, heat/cold pain thresholds and suprathreshold heat pain responses. The pain measures were assessed over the cervical spine and at a remote site, the tibialis anterior muscle.

Results

Elders with chronic neck pain had lower pressure pain threshold over the articular pillar of C5-C6 and decreased cold pain thresholds over the cervical spine and tibialis anterior muscle when compared with controls (p < 0.05). There were no between group differences in heat pain thresholds and suprathreshold heat pain responses (p > 0.05).

Conclusion

The presence of pain hypersensitivity in elderly women with chronic neck pain appears to be dependent on types of painful stimuli. This may reflect changes in the peripheral and central nervous system with age.     

Some Aspects of Abdominal Surgery in the Elderly Patient

Most operations on elderly patients are of an urgent nature. If time permits, measures to improve cardiac, respiratory and renal functions in the appropriate ways should be undertaken. During recovery from anesthesia careful but adequate sedation will reduce the risk of myocardial ischemia. Throughout the postoperative period constant encouragement of the older patient is particularly helpful.Transverse abdominal incisions and the frequent use of temporary gastrostomy are advocated.External hernia, hiatus hernia, peptic ulcer, carcinoma of the stomach, biliary disease, appendicits, intestinal obstruction, and carcinoma of the large intestine are discussed specifically, with special reference to the practical details of management in the elderly patient.     

Facial Behaviors Related to Pain in the Elderly1

Clinicians currently rely almost exclusively on the patient's verbal report for assessing pain. Systematic measures of nonverbal behaviors related to pain could serve as useful adjuncts to verbal behavior in evaluating pain in clinical settings, and might be especially important for patients with communication deficits. A facial expression prototype for pain has been identified which differs from expressions of the negative emotions. This expression accompanies non-facial pain in infants and adults, and also occurs with naturally-arising and experimentally-induced dental pain in young and middle-aged adults. The facial expressions accompanying pain in the elderly may be the same as those occurring in younger adults or may vary because of neuromuscular or psychosocial differences between these groups. Adaptation of direct facial measurement systems for study of the facial expressions of the elderly is an essential step if research in this area is to progress.     

Hormones in the Lives of Crustaceans: An Overview

We present an overview of the isolation and characterizationof three hormones (or hormone families) important for the growthand development of decapod crustaceans. These hormones includethe ecdysteroids (steroid molting hormones), the hyperglycemichormone neuropeptide family, and the terpenoid methyl farnesoate.Using examples primarily from our laboratory, we describe workon these hormones using various life stages of the lobster (Homarusamericanus) as the principal model.     

Fungal Thyroiditis: An Overview

The authors review the epidemiology, clinical manifestations, diagnosis, and treatment of fungal thyroiditis cases previously reported in the medical literature. Aspergillus was by far the most common cause of fungal thyroiditis. Immunocompromised patients, such as those with leukemia, lymphoma, autoimmune diseases, and organ-transplant patients on pharmacological immunosuppression were particularly at risk. Fungal thyroiditis was diagnosed at autopsy as part of disseminated infection in a substantial number of patients without clinical manifestations and laboratory evidence of thyroid dysfunction. Local signs and symptoms of infection were indistinguishable from other infectious thyroiditis and included fever, anterior cervical pain, thyroid enlargement sometimes associated with dysphagia and dysphonia, and clinical and laboratory features of transient hyperthyroidism due to the release of thyroid hormone from follicular cell damage, followed by residual hypothyroidism. Antemortem diagnosis of fungal thyroiditis was made by direct microscopy and culture of a fine-needle aspirate, or/and biopsy in most cases. Since most patients with fungal thyroiditis had disseminated fungal infection with delay in diagnosis and treatment, the overall mortality was high.     

Pain Detection and Amelioration in Animals on the Farm: Issues and Options

Pain in nonhuman animals is a difficult concept to identify and measure. This article briefly describes the consequences of pain in animals on the farm and explains the reasons for the minimal use of analgesics in farmed animals. Pain can have implications for both animal welfare and economics. The reasons for a low use of analgesics in farmed animals include the lack of recognition of animal pain owing to the apparent lack of anthropomorphically identifiable behavioral changes, concern over human food safety, and lack of research efforts to develop safe analgesics for farm use. Treatment cost relative to the benefits expected is another hindering factor. Interventions to minimize pain must begin with developing objective and practical measures for pain identification and measurement at the farm level. A suggested use of a combination of different behavioral and physiological indicators would help to identify pain in animals. To facilitate continued usage of the methodologies on the farm it also is necessary to evaluate the economic implication of the pain alleviation intervention.     

Adhesion in Development: An Historical Overview

My purpose here is to provide brief historical overviews of three related subjects conceptually fundamental to the broader subject of “cell adhesion in development.” These subjects are (1) the evolution of our present understanding of how animal cells cohere; (2) the question of what principles underlie the ability of embryonic cell populations to organize themselves into anatomically correct structures; and (3) the ongoing effort to understand the origins of the “recognition specificity” evinced in the latter phenomenon. Because this review must be brief, it is not possible to mention all of the significant advances, many of which will be referenced in a recent more detailed review of this subject (Grunwald, 1991). For the same reason, the important work on cell adhesion in nonvertebrate systems is not included.     

Butyrylcholinesterase in Substance Abuse: An Overview

Neurophysiology - Substance abuse places a great burden on associated families, communities, and the health care sector. Drug addiction leads to physical traumas, psychiatric disorders, and other...     

Hallucinogenic Mushrooms in Mexico: An Overview

Hallucinogenic Mushrooms in Mexico: An Overview. Psilocybe, with 53 known hallucinogenic species in Mexico, is the most important and diverse group of sacred mushrooms used by Mexican indigenous cultures. Psilocybe caerulescens, known by the present-day Nahuatl Indians as teotlaquilnanácatl, is hypothesized to be the ceremonially-used teonanácatl mushroom cited by Sahagún in the 16th century, the true identity of which has remained obscure for centuries. Correcting a widely disseminated error derived from early published information on Mexican hallucinogenic mushrooms, emphasis is placed on the fact that Panaeolus species have never been used traditionally in Mexico. Reports of the use of species of Amanita, Clavaria, Conocybe, Cordyceps, Dictyophora, Elaphomyces, Gomphus, Lycoperdon, Psathyrella, and Stropharia as sacred or narcotic mushrooms are discussed. A brief history of the discovery of hallucinogenic mushrooms in Mexico is presented, as well as notes on their taxonomy, distribution, and traditional use in Mexico.

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Hongos Alucinógenos en México: Historia, Taxonomia, Distribución Geográfica y Uso Tradicional. Psilocybe, con 53 especies alucinógenas conocidas en México, es el grupo más importante y más diverso de hongos sagrados usados por las culturas indígenas mexicanas. Se propone aquí que Psilocybe caerulescens, nombrado por los nahuatls de hoy día teotlaquilnanácatl, es el hongo ceremonial teonanácatl citado por Sahagún en el siglo XVI, cuya identidad verdadera permanece oscura desde hace siglos. A fin de corregir un error muy diseminado derivado de los primeros datos publicados sobre los hongos alucinógenos mexicanos, se hará hincapié en el hecho de que las especies Paneolus nunca han sido usadas tradicionalmente en México. Se discutirán aquí informes sobre el uso de especies de Amanita, Clavaria, Conocybe, Cordyceps, Dictyophora, Elaphomyces, Gomphus, Lycoperdon, Psathyrella y Stropharia como hongos sagrados o narcóticos, y se presentará también una breve historia del descubrimiento de hongos alucinógenos en México, como también algunos datos sobre su taxonomía, su distribución, y su uso tradicional en México.

     

The Cardiac Mutant: An Overview

SYNOPSIS.The cardiac lethal mutation was discovered in a strainof axolotls (Ambysloma mexkanum) imported from Mexico. Embryoshomozygous recessive for the c gene develop in a normal fashionuntil the heartbeat stage of development. At this time, heartaction is observed in unaffected siblings, but in cardiac lethalembryos heart action is not apparent. Affected animals hatchand swim, but do not feed. Within a few days, ascites developsand the animals die within a short time afterward. The c geneis inherited as a simple recessive. The direct effect of gene c is unknown. Data has been presentedwhich suggests that gene c alters the anterior endoderm whichmay be a specific heart inductor in this species. Alternatively,the failure of heart action may result from an ionic imbalancein the immediate heart environment. This paper reviews the relevantexperiments and presents new data supporting each of these suggestionsfor the mechanism of action of the cardiac lethal gene.     

Fetal Pain: An Infantile Debate

The question of whether a fetus can experience pain is an immense challenge. The issue demands consideration of the physical and psychological basis of being and the relation between the two. At the center of this debate is the question of how it is that we are conscious, a question that has inspired the writing of some of our most brilliant contemporary philosophers and scientists, with one commentary suggesting surrender. In my earlier review I attempted to draw together the various strands of thinking that had attacked the question of fetal pain and relate them back to the bigger question of consciousness. In their vituperative response, Benatar and Benatar bite off my finger before looking to where I am pointing. I will examine each of their criticisms and attempt to redirect the readers' interest towards examining the subjectivity of pain and the mediating links between physiology and experience.     

Glial Cell Lines: An Overview

The importance and essential functions of glial cells in the nervous system are now beginning to be understood and appreciated. Glial cell lines have been instrumental in the elucidation of many of these properties. In this Overview, the origin and properties of most of the existing cell lines for the major glial types: oligodendroglia, astroglia, microglia and Schwann cells, are documented. Particular emphasis is given to the culture conditions for each cell line and the degree to which the line can differentiate in vitro and in vivo. The major molecular markers for each glial cell lines are indicated. Finally, methods by which the glial cell lines have been developed are noted and the future directions of glial cell line research are discussed.     

Seasonal Affective Disorder: An Overview

Seasonal Affective Disorder (SAD) is a condition of regularly occurring depressions in winter with a remission the following spring or summer. In addition to depressed mood, the patients tend to experience increased appetite and an increased duration of sleep during the winter. SAD is a relatively common condition, affecting 1–3% of adults in temperate climates, and it is more prevalent in women.

The pathological mechanisms underlying SAD are incompletely understood. Certain neurotransmitters have been implicated; a dysfunction in the serotonin system in particular has been demonstrated by a variety of approaches. The role of circadian rhythms in SAD needs to be clarified. The phase-delay hypothesis holds that SAD patients' circadian rhythms are delayed relative to the sleep/wake or rest/activity cycle. This hypothesis predicts that the symptoms of SAD will improve if the circadian rhythms can be phase-advanced. There is some experimental support for this.

SAD can be treated successfully with light therapy. In classical light therapy, the SAD sufferer sits in front of a light box, exposed to 2000–10,000 lux for 30–120min daily during the winter. Other forms of light treatments, pharmacotherapy, and other therapies are currently being tested for SAD.