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zoster rash But practically no instances of Bell s palsy, tic douloureux, and intercostal neuralgia are associated with serologic evidence of activation of VZV (Bell s palsy has instead been associated with HSV, as indicated on page 1181) Treatment During the acute stage, analgesics and drying and soothing lotions, such as calamine, help to blunt the pain Nerve root blocks may provide very temporary relief After the lesions have dried, the repeated application of capsaicin ointment (derived from hot peppers) may relieve the pain in some cases by inducing a cutaneous anesthesia When applied too soon after the acute stage, capsaicin is highly irritating and should be used cautiously Acyclovir (800 mg orally ve times daily for 7 days) shortens the duration of acute pain and speeds the healing of vesicles, provided that treatment is begun within approximately 48 h (some authorities say 72 h) of the appearance of the rash (McKendrick et al) Famcyclovir (500 mg three times daily for 7 days) or the better absorbed valacyclovir (2 g orally four times daily) are alternatives It should be noted that several studies have suggested that the duration of postherpetic neuralgia is reduced by treatment during the acute phase with famcyclovir or valacyclovir, but the incidence of this complication is not markedly affected and a similar effect of shortening the illness has not been shown for acyclovir (see below) All patients with ophthalmic zoster should receive acyclovir orally; in addition, acyclovir applied topically to the eye, in either a 01% solution every hour or a 05% ointment four or ve times a day, is recommended by some ophthalmologists Patients who are immunocompromised or have disseminated zoster (lesions in more than three dermatomes) receive intravenous acyclovir for 10 days There is now available from state health agencies a VZV immune globulin (VZIG) that shortens the course of the cutaneous disease and may protect against its dissemination in immunosuppressed patients While it may reduce the incidence of post herpetic neuralgia (see Hugler et al), this is not its main purpose and it does not appear to prevent or ameliorate CNS complications Postherpetic Neuralgia This severely painful syndrome follows shingles in 5 to 10 percent of patients but occurs at almost three times that often among individuals over age 60 The possible effect of acute treatment on the severity of postherpectic neuralgia is mentioned above The management of postherpetic pain and dysesthesia can be a trying matter for both the patient and the physician It is likely that incomplete interruption of nerves results in a hyperpathic state, in which every stimulus excites pain In a number of controlled studies, amitriptyline proved to be an effective therapeutic measure Initially, it is given in doses of approximately 50 mg at bedtime; if needed, the dosage can be increased gradually to 125 mg daily The addition of carbamazepine, gabapentin, or valproate may further moderate the pain, particularly if it is of lancinating type Capsaicin ointment can be applied to painful skin, as noted above A salve of two aspirin tablets, crushed and mixed with cold cream or chloroform (15 mL) and spread on the painful skin, is reported to be successful in relieving the pain for several hours (King) The effect of nerve root blocks is not consistent but this procedure may afford temporary relief It should be emphasized that postherpetic neuralgia eventually subsides even in the most severe and persistent cases, but the short-term use of narcotics is appropriate when the pain is severe Until the pain subsides, the physician must exercise skill and patience in its medical management (see page 125) and avoid the temptation of subjecting the patient to one of the many.

the characteristic results in a detail object for the corresponding dimension objects in the universe

surgical measures that have been advocated for this disorder Many patients with the most persistent complaints, beyond a year, have all the major symptoms of a depressive state and will be helped by appropriate antidepressive medications

Retroviruses are a large group of RNA viruses, so called because they contain the enzyme reverse transcriptase, which permits the reverse ow of genetic information from RNA to DNA Two families of retroviruses are known to infect humans: (1) the lentiviruses, the most important of which is the human immunode ciency virus (HIV), the cause of AIDS, and (2) the oncornaviruses, which include the human T-cell lymphotropic viruses, ie, the agents that induce chronic T-cell leukemias and lymphomas (HTLV-II) and tropical spastic paraparesis (HTLV-I) In the following pages, we consider the major neurologic syndromes induced by the two main human retroviruses AIDS, a constellation of neurologic diseases caused by HIV, and tropical spastic paraparesis, caused by HTLV-I These diseases are now the subjects of great public interest and laboratory investigation A comprehensive account of the neurobiology, pathology, and clinical features of these infections can be found in the appropriate sections of Harrison s Principles of Internal Medicine

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