Improvement In Pain Symptoms Research Articles

Efficacy of stabilization splints for the management of patients with masticatory muscle pain: a qualitative systematic review.

This study aimed at providing an answer to two clinical questions related to patients with masticatory muscle pain: 1) Does the use of a full-coverage hard acrylic occlusal appliance (stabilization splint) lead to a significant decrease of symptoms? and 2) Is the treatment success achieved with a stabilization splint more pronounced than the success attained with other forms of treatment (including placebo treatment) or no treatment? A systematic search was carried out in different electronic databases, supplemented by handsearch in four selected dental journals and by examination of the bibliographies of the retrieved articles. Thirteen publications, representing nine controlled clinical studies, could be identified. Reporting quality of most studies as assessed with the Jadad score ranged from 1 to 5. Based on the currently best available evidence it appears that most patients with masticatory muscle pain are helped by the incorporation of a stabilization splint. Nevertheless, evidence is equivocal if improvement of pain symptoms after incorporation of the intraoral appliance is caused by a specific effect of the appliance. A stabilization splint does not appear to yield a better clinical outcome than a soft splint, a non-occluding palatal splint, physical therapy, or body acupuncture. The scarcity of current external evidence emphasizes the need for more and better clinical research.

Clinical open‐label study for evaluation of efficacy and tolerability of oxcarbazepine in the treatment of neuropathic pain

Oxcarbazepine (OXC) is a keto‐10‐analogue of carbamazepine (CBZ) with linear pharmacokinetics and a better tolerability profile compared to CBZ. For this reason, OXC has been used in some studies in the treatment of neuropathic pain of various genesis, with administration doses ranging from 300 to 2400 mg/day. In this study we have assessed the efficacy and tolerability of OXC 600 mg/day, a dose considered, based on previous data, the minimal therapeutic dose in the treatment of neuropathic pain in some neuropathies, such as diabetic neuropathy. We have studied 11 patients affected by predominant sensitive painful neuropathy, of metabolic, compressive, inflammatory or dysimmune genesis, clinically characterized by paresthesias, dysesthesias and neuralgic pain not responding to other pharmacologic therapies. At the follow‐up analysis, 7 patients have referred an improvement of painful symptoms, as evidenced by Visual Analogue Scale score, the reduction of which ranged from 20 to 60% compared to baseline values. One patient interrupted the trial for incompliance, two patients for collateral events (excessive sleepiness) and another one for a worsening of clinical picture. In conclusion, our study suggests that OXC can be considered as a valid alternative in the treatment of painful neuropathies owing to its characteristics of tolerability and efficacy in such conditions.

Abdominal Myomectomy versus Uterine Fibroid Embolization in the Treatment of Symptomatic Uterine Leiomyomas

Obstetrical & Gynecological Survey 59(3):p 190-191, March 2004. | DOI: 10.1097/01.OGX.0000116048.77359.99

Prise en charge chirurgicale des endométrioses de la cloison rectovaginale. À propos d’une série continue de 50 cas

Objectives. – To assess the value of MRI and ano-rectal endosonography (ARES) for the diagnosis and surgical prognosis of rectovaginal septum endometriosis and to analyse the surgical management in order to evaluate its functional results and complications. Patients and methods. – Retrospective study of 50 consecutive patients operated for a clinical presumption of endometriosis nodule of the recto vaginal septum. Thirty-nine patients had a MRI, 31 an ARES and 28 both exams. All the patients had a complete dissection of the rectovaginal septum and all lesions were excised. Results. – For the diagnosis of rectovaginal septum endometriosis nodule, MRI results are: sensitivity 73%, specificity 50%, positive predictive value (PPV) 89%, negative predictive value (NPV) 25%; for uterosacral ligaments involvement: sensitivity 84%, specificity 95%, PPV 94%, NPV 86% and for rectal wall infiltration: sensitivity 53%, specificity 82%, PPV 69%, NPV 69%. The ARES results for diagnosis of rectovaginal septum endometriosis nodule are: sensitivity 93%, specificity 100%, PPV 100%, NPV 50% and for rectal wall infiltration: sensitivity 100%, specificity 71%, PPV 81%, NPV 100%. ARES appeared more sensitive than MRI for the detection of rectal wall infiltration ( P = 0.002) and for rectovaginal septum endometriosis nodule diagnosis ( P = 0.03). Eighty-nine percent of the patients had a coelioscopy in first intention and 15 laparoconversions were performed, 11 in order to perform a digestive resection: 45 nodules were found. In 43cases the nodule was excised, associated to 19 digestive resections, 30 colpectomys, and 22 uterosacral ligaments resections. Three patients required an additional surgical treatment by Hartman’s procedure with Mickulicz’s drainage for peritonitis. Forty-one nodules were endometriosis nodules: the two other cases were fibrosis nodules. Thirty-three patients were interviewed about the evolution of their pains over a mean history of 20 months: 90% of the patients were satisfied with the management results. Discussion and conclusions. – Our data support the efficiency of MRI for rectovaginal septum endometriosis nodule and uterosacral ligaments involvement diagnosis; accord ARES to rectovaginal septum endometriosis nodule diagnosis and its reliability in establishing a diagnosis of rectal wall involvement. The surgical cure of rectovaginal septum nodules without digestive infiltration is performed by coelioscopic or coelio-vaginal procedure, but in case of associated digestive affliction, laparotomy is actually the standard procedure in order to achieve a complete cure of the lesions. Complications, in particular peritonitis, are not frequent. Our data support the efficiency of radical surgical treatment for the improvement of pain symptoms. Results on fertility seem to be satisfactory, but complication risks suggest being careful in this indication. Clinical examination during a catamenial period is essential in order to evoke the diagnosis. MRI yields a complete map of the sub-peritoneal and peritoneal lesions and ARES allows for the diagnosis of an infiltration of the rectal wall. Pre-operative association of those two exams is actually indispensable for the surgical management of those patients, which consists of complete excision of endometriosical lesions and is efficient at treating pain symptoms and fertility. Complications are rare but severe, therefore, justifying a cure in specialised centres.

What's new in the therapy of fibromyalgia?

Modern management of fibromyalgia (FM) requires a holistic approach, which includes nonpharmacologic strategies (both exercise and behavioral strategies) and pharmacologic treatment. Despite only partial effects in some patients, tricyclic antidepressants, selective serotonin reuptake inhibitors, nonsteroidal antiinflammatory drugs, analgesics and opioids are in use. The use of antiepileptic drugs and antispasticity agents is mainly supported by anecdotal data. Three other classes of agents are currently thought to have useful potentials. N-methyl-D-aspartate-(NMDA-)mediated neurotransmission may play an important role in mediating wind-up and related phenomena in pain pathways. Recent studies have demonstrated that NMDA receptor antagonists improve pain symptoms in FM. But a poor side effect profile represents a significant problem. Cerebrospinal fluid substance P concentrations are significantly elevated in FM patients, but the analgesic potential of neurokinin-1 (NK1) receptor antagonists did not meet early expectations. Tropisetron, a 5-HT3 receptor antagonist, was tested in a multicenter, double-blind, randomized, placebo-controlled trial including 403 patients. In those receiving 5 mg tropisetron, 39.2% fulfilled the response criterion (pain reduction 35%) as compared to 26.2% in the placebo group (p=0.033). On 10 and 15 mg, the responder rates were smaller and statistically not significant. A total of 78 responders to therapy were followed up for 12 months. After the end of treatment, pain intensity rose within one month in all 4 groups. Patients having received 5 or 10 mg showed a less pronounced increase in pain. In addition, even 12 months after stopping treatment, pain was still markedly below baseline levels in the 5 and 10 mg groups.

Vulvar Dysesthesia (Vulvodynia): A Follow-Up Study

To evaluate the long-term results of treatment and the outlook for women with vulvar dysesthesia (vulvodynia) or vulvar vestibulodynia (vulvar vestibulitis), a follow-up questionnaire was mailed to 234 patients with this diagnosis at least 6 months after they had undergone treatment. Return questionnaires were received from 104 patients. Forty percent of participants had been diagnosed with vulvar dysesthesia and 60% with vulvar vestibulodynia. The 2 groups were similar except that those with dysesthesia were older (mean age, 47.5 years vs. 37 years for patients with vestibulodynia, P = 0.001). On average, women had experienced vulvar pain for a total of 7.1 years and for 2.7 years before diagnosis. Over half of the respondents (52%) associated the onset of their pain, whether sudden (23.9%) or gradual (76.1%), with a specific incident. Yeast infection and intercourse were most commonly cited (19% and 17%, respectively), allowed by surgery (11%), menopause (7%), childbirth (7%), and stress (7%). For 44% of women, vulvar pain was present with their first sexual intercourse, and 25% had pain with their first tampon insertion. Most women had tried a variety of treatments for vulvar pain. Treatment outcomes are listed in Table 1. In all, 11 patients felt they had a complete resolution of symptoms, and 60 said that their pain was under control but not cured. One third of the women reported a greater than 75% diminution of pain levels, and 21% noted a 50% to 75% reduction. The level of pain that was currently experienced was significantly lower than the level reported at diagnosis (on a scale of 0-6, the average pain level had dropped from 4.5 at diagnosis to a current level of 1.5, P = 0.0000). When women taking antidepressants or anticonvulsant medications alone or together were considered, over half (36 of 63) of those who had ever used antidepressants alone and 2 of 6 who had ever taken anticonvulsants alone reported a greater than 50% improvement in symptoms. More than 50% improvement was noted in 6 of 22 patients who had ever taken both drugs in combination. Nine of 14 patients who had never used either medication reported a greater than 50% improvement, including 3 women who felt their condition was resolved. In general, there was no difference in response to treatments between women with vulvar dysesthesia and those with vulvar vestibulodynia. However, those with vestibulodynia had a greater response to topical steroid cream and derived greater benefit from biofeedback. Patients with vulvar pain reported a drop in the quality and quantity of sexual activity (3 points and 2.7 points, respectively, on a 7-point scale; P <0.0001 for both) compared with pre-onset levels. However, the range of sexual activities was not affected and was similar for those with greater than 50% or less than 50% improvement in pain symptoms. Seventeen women became pregnant with vulvar pain. Seven of them (41%) said that the pregnancy did not affect their pain levels, and 5 each (29%) reported improved or worsened symptoms. Other pain syndromes reported by the 104 patients included headaches (32%), irritable bowel syndrome (25%), low back pain (27%), pelvic pain (12%), and interstitial cystitis (9.8%). Pelvic pain was associated with more severe recent vulvar pain (on a 7-point scale, 2.6 in the past week vs. 1.5, P = 0.001) and a lesser degree of improvement of vulvar pain symptoms (P = 0.006).

Poster 142: Repeat post-intradiskal electrothermal annuloplasty (IDET) diskography: an analysis of failed IDET cases.

Objectives: To evaluate failure of intradiskal electrothermal annuloplasty (IDET) in patients with repeat diskography and to report their findings. Design: Retrospective chart review. Setting: Academic physiatric outpatient private practice. Participants: Of 150 patients who underwent IDET, 8 patients who failed after 1, 2, or 3 level IDET and underwent repeat provocative, pressure-controlled lumbar diskography were analyzed. Interventions: Repeat diskography was performed in patients for whom IDET failed. Main Outcome Measures: Comparison of pre- and post-IDET diskograms. Results: 8 patients (4 men, 4 women) with a total of 11 treated disk levels were evaluated. Patients’ mean age was 44.00±9.35 years. All patients underwent repeat provocative, pressure-controlled lumbar diskography to evaluate new or continued symptoms. Average time interval between pre- and post-IDET second-look diskography was 21.38±10.21 months (range, 6–33mo). Pre-IDET diskography demonstrated 11 disk levels with moderately severe to severe concordant pain. Post-IDET diskography demonstrated persistent concordant pain in the treated levels in 6 of 8 (75%) patients. Of these, 1 patient with a radial tear pre-IDET demonstrated morphologic improvement with partial improvement in pain symptoms. Of the remaining 2 patients (25%), 1 patient had pain at a different disk level and 1 patient had pain from an extraspinal source (sacroiliac joint). Conclusions: Repeat diskography in patients with failed IDET is helpful to distinguish recurrent pain generators. Based on limited numbers of patients, repeat diskography showed persistent problems in 75% of treated IDET levels in patients with continued pain after IDET. 25% of patients have pain from other sources, including different disk levels and extraspinal sources. Further prospective studies involving larger numbers of patients are needed to evaluate the value of diskography in post-IDET patients with successful and failed outcomes.

Stabilization of the ulna stump after Darrach's procedure at the wrist.

We studied the outcome of patients with chronic distal radioulnar joint symptoms who were treated with excision of the distal ulna and reconstruction using the flexor carpi ulnaris tendon. Twelve patients with 14 wrists were assessed. Ten patients were posttraumatic, and two had bilateral surgery for rheumatoid arthritis. Average age was 37 years at time of operation. Follow-up averaged 20 months (9 months to 4 years). All patients except one reported improvement in pain symptoms. Grip strength of the operated hand as measured by dynamometer readings was 67% of the strength of the normal hand with five wrists achieving an excellent result in grip strength. Eleven patients reported a subjective improvement in functional activities. An improved range of motion was obtained in all patients. We discuss the importance and basis for ligamentous reconstruction following excision of the distal ulna and review the literature for other previously described procedures.

Chronic pelvic pain as a form of complex regional pain syndrome. Role of autonomic nervous system in chronic pelvic pain

Objective: Some of the patients suffering from Chronic Pelvic Pain display variety of symptoms and co-morbidities indicating dysfunction within autonomic nervous system. Model of Chronic Pelvic Pain as a form of Complex Regional Pain Syndrome will be presented. Concept of maladaptive program initiated and maintained by autonomic nervous system, which uses pain impulses and pain equivalents will be explored. The notion that within the framework of Complex Regional Pain Syndrome laparoscopic findings of minimal endometriosis, adhesions and occult hernias, represent pain triggers, rather than sole sources of the pain, and their removal may not be associated with permanent improvement of pain symptoms, will be discussed. Characterization of the autonomic nervous system as our operating system and the bridge between conscious thought, emotions and the body will be explored. Necessity of multidisciplinary approach including surgical and pharmacologic treatment as well as, stress reduction measures and psychotherapy will be emphasized.

The role of the microfracturetechnique in the treatment of full-thickness chondral injuries

Microfracture is indicated for both traumatic and degenerative full-thickness chondral defects. The technique isuseful for both unipolar and “kissing” (bipolar) lesions in both the primary treatment and revision settings. There are no contraindications to the technique based on the size or location of the lesion, although smaller (<400 mm 2), acute (<12 weeks from injury) femoral and trochlear lesions have the most predictable results. Relative contraindications to microfracture include chondral defects greater than 5 to 10 mm deep and the presence of a malaligned limb. Clinical studies have shown significant ( P < .05) improvement in all functional parameters studied following the use of microfracture for the treatment of full-thickness, traumatic chondral defects. Of note, improvement in symptoms of pain and swelling continue to be seen until 2 years after surgery following microfracture. The microfacture technique is a cost-effective, technically feasible, highly efficacious procedure available to all surgeons who perform arthroscopy of the knee. It is a reasonable first approach to the treatment of chondral defects, because it does not burn any bridges with regard to future procedures such as a mosaic-plasty or autologous chondrocyte transplantation if the microfracture should fail.

Holmium

Although surgical lasers were introduced to the field of otolaryngology more than 20 years ago, their use in rhinologic surgery has remained relatively limited. With the development of the holmium:yttrium-aluminum-garnet (YAG) laser, a device is now available that offers those features necessary for effective sinus surgery:precise bone ablation, efficient soft tissue coagulation, and fiberoptic transmission. This solid-state laser of 2.1-microns wavelength can be coupled with endoscopic instrumentation for the surgical treatment of sinus disease. This study was conducted to determine the clinical efficacy of the holmium:YAG laser for endoscopic sinus surgery. A microscopic analysis of laser-treated sinus tissue was also performed in an attempt to determine the histologic basis of the observed clinical findings. In a prospective, randomized, controlled, single-blinded study, 32 consecutive patients underwent endoscopic sinus surgery using the holmium:YAG laser on one side of the nose and conventional endoscopic instrumentation on the other side. Patients rated symptoms for each side of the nose at 1 week, 1 month, 3 months, 6 months, and 2 years after surgery. Healing parameters were similarly rated by the surgeon. Until the study was completed, patients were not told which side of the nose had been treated with laser surgery. No intraoperative complications occurred. The mean intraoperative blood loss was 24.6 mL less on the laser-treated side of the nose than on conventionally treated side (P < .001). At 1 week after surgery, there was increased mucosal edema on the laser-treated side (P < .01). Crust formation was greater on the conventionally treated side at 1 week and was greater on the laser-treated side at 1 mouth (P < .01). Improvements in symptoms of pain, congestion, and drainage were equivalent for both treatment modalities (P < .001). Microscopic analysis demonstrated the ability of the holmium:YAG laser to remove tissue in relatively thin layers with ablation depths of 260 +/- 8.2 microns, 286 +/- 9.4 microns, and 341 +/- 20.4 microns per pulse at energy levels of 0.5, 1.0, and 1.5 J, respectively. A zone of thermal necrosis extending up to 1 mm beyond the site of laser impact was thought to correlate with the increased postoperative edema observed on the laser-treated side. Endoscopic sinus surgery with the holmium:YAG laser is as effective as nonlaser techniques in relieving the symptoms of chronic sinusitis. Laser surgery offers improved intraoperative hemostasis, but it causes increased postoperative tissue edema. The holmium:YAG laser provides the surgeon with an additional tool for the performance of safe, effective sinus surgery.

The Efficacy of Aldose Reductase Inhibitors in the Management of Diabetic Complications

Recently, aldose reductase inhibitors (ARIs) have been registered in several countries for the improvement of glycaemic control. However, their efficacy is still controversial. ARIs inhibit the enhanced flux of glucose through the polyol pathway. As such, they can never be more effective than normoglycaemia, and so their potential benefits and limitations should be considered relative to the effects of prolonged euglycaemia. The clinical effects of ARIs can be put into perspective by assessing the effects of improved glycaemic control attained in randomised trials of intensive insulin treatment [such as the Diabetes Control and Complications Trial (DCCT)] and after pancreatic transplantation. Although direct comparison of these 3 interventions is hampered by differences in patient populations, duration and methods of follow-up and in the potency of ARIs, the effects of these 3 metabolic interventions and their course in time appear remarkably similar. For neuropathy, all 3 interventions induce an increase in average motor nerve conduction velocity of approximately 1 m/sec during the first months of treatment. At the same time, improvement of painful symptoms may occur. These changes probably largely represent a metabolic amelioration of the condition of the nerves. Around the second year of treatment with all 3 forms of metabolic improvement, an acceleration of nerve conduction of a similar magnitude occurs, with signs of structural nerve regeneration and some sensory recuperation. Experience with ARIs in nephropathy is still limited, but similar improvements in glomerular filtration rate and, less consistently, in urinary albumin excretion were found during short term normoglycaemia produced by all 3 forms of treatment. Comparison of a small number of studies, however, shows differences between intensive insulin regimens, pancreatic transplantation and ARIs in effects on retinopathy. Retinopathy often temporarily deteriorates in the early phases of improved glycaemic control, but this is not noted with ARIs. New microaneurysm formation was slightly reduced in a single long term study with the ARI sorbinil, but the preventive effects on the overall levels of retinopathy seemed less strong than in normoglycaemia trials of similar duration. However, the pharmacodynamic effects on inhibiting the polyol pathway differ among ARIs, and the half-life of the inhibiting effect of sorbinil may have been too short for a complete reduction of polyol pathway activity. The trials of prolonged intensive insulin therapy and pancreatic transplantation have demonstrated that very strict metabolic control must be maintained continuously for many years before a significant reduction of complications can be demonstrated.(ABSTRACT TRUNCATED AT 400 WORDS)

Laparoscopic adnexectomy: A comparison with laparotomy

Our purpose was to compare the newer technique of laparoscopic adnexal excision with conventional laparotomy. With the same entry criteria, a retrospective, consecutive series of 26 women who underwent adnexectomy by laparotomy was compared with a later prospective consecutive series of 64 women who had laparoscopic adnexectomy in a university referral practice. The two groups were similar in all characteristics examined. The ages of the women ranged from 18 to 70 years, but only two women were postmenopausal. Pelvic pain with or without an ovarian cystic mass was the surgical indication in 91% to 92% of the women. Seven women had a persistent adnexal cystic mass and one woman had a unilateral androgen-secreting ovary. Bipolar coagulation was the laparoscopic method used. Median operating time (88 vs 107 minutes), blood loss (72 vs 222 ml), days in the hospital (1 day vs 3 days), total costs ($4573 vs $6044), and recovery time (1 week vs 4 weeks) were significantly less with laparoscopic adnexectomy. There were no differences between the two techniques in major complications (one in each group), blood transfusions, adhesion formation, or the proportion of women noting improvement of pain symptoms. In this preliminary assessment of laparoscopic adnexectomy, this surgical procedure offers significant advantages to laparotomy in selected patients when performed by a laparoscopist experienced in advanced techniques.

Buserelin acetate in the treatment of pelvic pain associated with minimal and mild endometriosis: a controlled study

To evaluate the changes of pain symptoms induced by buserelin acetate, a gonadotropin-releasing hormone agonist, in a group of patients with endometriosis. Thirty-five infertile patients with one or more of the following symptoms (dysmenorrhea, pelvic pain, deep dyspareunia, and endometriosis stage I or II) were allocated randomly to treatment with buserelin acetate 1,200 micrograms/d IN for 6 months (n = 19) or expectant management (n = 16). Pain symptoms were recorded by the women themselves using a questionnaire that included two scales for pain evaluation: one analogue and one multidimensional. The treated and untreated patients were followed for a minimum of 18 and 12 months from the time of randomization, respectively. Buserelin acetate markedly reduced dysmenorrhea, pelvic pain, and dyspareunia during the treatment and also for the 12 subsequent months. During follow-up of the expectant management group, dysmenorrhea resolved in 19% (3/16) of the cases, and pelvic pain did not recur after diagnostic laparoscopy in one of the three women affected nor did deep dyspareunia in two of the five who reported the symptom before laparoscopy. Buserelin acetate induced a significant improvement of pain symptoms that persisted in approximately half of the patients even after withdrawal of the drug. However, symptoms associated with endometriosis showed a spontaneous remission in approximately one fifth of the untreated patients.

Atraumatic CT-controlled percutaneous laser nucleotomy

The main aim of percutaneous nucleotomy techniques is to reduce the volume and pressure of the affected disc while leaving all other structures unaffected. Previously percutaneous discectomies were performed under fluoroscopic guidance with or without endoscopy. In this paper we describe the combination of CT-scanning and fluoroscopy for guidance of nucleo-tomes, lasers, microendoscopes and other microinstmments. The results of percutaneous laser nucleotomy performed on 116 out-patients with chronic back pain are reported. Immediate pain relief was obtained in 92% of the patients, and improvement of neurological deficits in 59%. After 6 weeks, 87% of patients were back at work. At follow-up, 1–17 months later, overall improvement of pain symptoms of 50–100% was present in 81% of the patients; the results were better in patients with longer follow-up times. Spon-dylodiscitis occurred in one patient and a second herniation with re-operation in five patients. These results show that effective treatment of di...

Gestrinone versus danazol in the treatment of endometriosis

Thirty-nine infertile patients with laparoscopic diagnosis of endometriosis were allocated randomly to treatment with gestrinone 2.5 mg twice weekly (20 patients) or danazol 600 mg/day (19 patients) for 6 months. If amenorrhea was not obtained after 1 month of treatment, the gestrinone dose was increased to 2.5 mg three times a week (7 patients) and the danazol dose to 800 mg/day (2 patients). One month after the end of the treatment, a repeat laparoscopy was performed only in the women who agreed (7 of the gestrinone treated group, 9 of the danazol group). All of the patients were followed for at least 12 months after the end of the treatment, during which time they attempted to conceive. There was a marked improvement of pain symptoms during the treatment in the patients of both groups. The repeat laparoscopy did not reveal significant differences between the two groups in the reduction of the disease extent. Eighteen months after treatment suspension, the cumulative pregnancy rate was 33% in the patients treated with gestrinone and 40% in those treated with danazol. Pain symptoms recurred during the follow-up in 57% of the gestrinone and 53% of the danazol group. The side effects were more frequent and severe with the danazol treatment, whereas those caused by gestrinone were mostly weight gain and acne. The results of this study suggest that gestrinone is as effective as danazol in the treatment of infertility associated with endometriosis and is better tolerated.

Nitrous Oxide Analgesia for Refractory Pain in the Terminally III

Nitrous oxide analgesia was used in the management of the terminal hospitalization of four adolescents and one child with disseminated cancer. All patients had severe pain that was unresponsive to standard regimens of narcotics and various narcotic analgesia-stimulant combinations. In each case, the addition of nitrous oxide led to an obvious improvement in symptoms of pain, anxiety, and agitation, while simultaneously improving appetite, mood, and the capacity to communicate. There were no side effects except those related to the discomfort of wearing a mask. Acceptance of the procedure by patient, family, and staff was universal and enthusiastic. The procedure is safe, easily administered, and noninvasive. Nitrous oxide can be useful in managing terminal illness refractory to standard pain control measures.

急性上気道炎に対するクリノリル錠の臨床治験

The therapeutic effectiveness, safety and usefulness of CLINORIL (generic name: sulindac), a nonsteroidal anti inflammatory/analgesic agent, were evaluated in 72 patients with acute upper respiratory tract infections by an open trial.The patients were administered of CLINORIL in a daily dose of 300mg given in b.i.d. for 4 days. The study period was from November, 1981 to January, 1982. As for the effectiveness a slight to marked improvement in pain symptoms (pharynx, swallowing, joint and muscle pain and headache) was attained in 62.2-75.0% on the 3rd day and in 69.2-92.5% on the 5th day. Antipyretic effect was showen in all the 25 patients with fever on the 3rd day. On the other hand, the improvement of fatigue and respiratory symptoms was poor being 29.4-55.6% throughout an observation period of 5 days. Symptoms of local inflammation, namely, redness and swelling of the pharynx, and the tonsil were improved in 52.8-65.0% on the 3rd day, likewise in 72.4-100% on the 5the day. Only 2 patients experienced adverse reactions of stomach discomfort.Doctor's overall evalution on the usefulness of CLINORIL revealed that the treatment was quite useful in 19 (26.4%) of the 72 patients, moderately useful in 26 (36.1%), slightly useful in 22 (30.6%), ambiguous in 5 (6.9%), namely, of the 72 patients received CLINORIL those rated as slightly to quite useful were 67 (93.1%).

Serum treatment of cerebrospinal meningitis in children. N. A. Euler (Pediatrics, 1928, No. 4)

According to observations of N.A. Euler, anti-meningococcal serum is a strictly specific, good, and often powerful tool in the fight against cerebrospinal meningitis. When it is used in successful cases there is a rapid improvement in painful symptoms and well-being, clarification of consciousness and a rapid return to normal cerebral fluid.