Linear Visual Analogue Scale Research Articles

Efficacy of a Spray Compound Containing a Pool of Collagen Precursor Synthetic Amino Acids (L-Proline, L-Leucine, L-Lysine and Glycine) Combined with Sodium Hyaluronate to Manage Chemo/Radiotherapy-Induced Oral Mucositis: Preliminary Data of an Open Clinical Trial

Oral mucositis (OM) is a very frequent and potentially severe complication experienced by patients receiving chemotherapy and/or radiotherapy, which often leads to significant morbidity and mortality, and decreased quality of life, and is very costly. Despite its severity and prevalence, there is no standard recognised management today. The aim of this open clinical trial is to evaluate the efficacy and compliance of a new spray compound containing sodium hyaluronate (SH) and a pool of collagen precursor amino acids (AAs) combined with sodium hyaluronate (SH) to manage radio/chemotherapy-induced OM. Twenty-seven consecutive patients with OM were treated according to the manufacturers instructions. At time T0 (baseline before intervention), we evaluated the following parameters: (i) pain score (by linear visual analogue scale; 0100) and (ii) severity of OM scored according to WHO Mucositis scale. The treatment efficacy was evaluated on i) pain score, ii) clinical resolution index (CRI) and iii) patient compliance at times T01 (after 2 hours), T1 (after 24 hours), T2 (after 72 hours), T3 (after 7 days) and T4 (after 14 days). Results showed that painful symptoms were significantly reduced after only 2 hours of spray administration compared with baseline measurements (p less than 0.0001; z=-4.541). A progressive reduction of pain through the 2 weeks was also noted (p less than 0.0001). Patient lesions treated with SH-Asbased spray also significantly improved after 72 hours of treatment (p=0.0051; z=-2.803). During the two-week observation, all patients significantly improved from the baseline (p less than 0.0001) and progressively ameliorated their ability to swallow foods and liquids. The compliance of all patients to the product was very good, and at the end of the study there were no adverse effects. The results suggest that the SHAAs-based spray accelerates lesion healing and above all helps to manage mucositis pain, especially in terms of immediate pain relief (after 2 hours from application). Although further randomized controlled studies are recommended, our findings suggest that frequent applications of this spray may offer rapid and effective pain management, aiding faster mucosal wound healing.

Thoracoscopic approaches for treating various spinal diseases

Minimally invasive surgery is currently a goal for surgical intervention in the spine. The effectiveness of endoscopic thoracic spine surgery and technological improvements are two factors that are always under consideration in the practice of spinal surgery. We present twenty-five patients whose thoracoscopic spinal surgeries were performed between 2002 and 2008 for the treatment of various spinal diseases. Eleven patients with thoracic disc herniation, five patients with traumatic thoracic spinal compressive fracture, six patients with metastatic thoracic spinal tumors and three patients with tubercular spondylitis underwent thoracoscopic spine surgery. Clinical evaluations were performed at 3, 6,12 and 24 months post-surgery. The Oswestry disability questionnaire and linear visual analog scale (VAS) were used for the evaluation of pain. Postoperatively, two patients had lung contusions, one patient had pneumonia and one patient had instability. There were significant initial improvements in both the Oswestry score and the VAS pain score up to 6 months (p<0.05). The average relative difference in pain scores in all groups was not significant at 12 and 24 months (p>0.05). The favorable results of thoracoscopic spinal surgery encourage its application to situations in which a conventional thoracic approach is indicated. Thoracoscopic spine surgery is applicable to all patients with various spinal diseases.

Changes in Urinary Symptoms and Tolerance due to Long-term Ureteral Double-J Stenting

Most studies have reported the effects of short-term double-J ureteral stenting on patient symptoms. We reviewed the changes in symptoms and the factors associated with tolerance due to long-term stenting. We investigated 20 patients (mean age±SD, 58.3±11.8 years). The patients consisted of those with cervical cancer (n=12), retroperitoneal fibrosis (n=5), colon cancer (n=1), rectal cancer (n=1), and endometrial cancer (n=1). A questionnaire that included domains for urinary symptoms and quality of life (QoL) scores for evaluation of urinary symptoms (International Prostate Symptom Score, or IPSS), a 10-cm linear visual analogue scale (VAS) score rated from 0 (no pain) to 10 (unendurable pain) for tolerance, and uroflowmetry were performed at every replacement. Frequency and urgency on the storage symptom score, residual urine sensations, and intermittency on the voiding symptom score were significantly aggravated at the initial stenting (p<0.05), but the sum of the storage symptom score and urgency improved with time (p<0.05). The quality of life score and total IPSS score also changed significantly (p<0.05). However, although the QoL score and the total IPSS score after stenting were not decreased to less than before stenting, the QoL score was significantly decreased at 9 months (p<0.05), and the total IPSS score was significantly decreased at 12 months (p<0.05). The symptoms were acutely aggravated at first, but the results showed increased tolerance with time. Adaptation of the bladder and desensitization of the patients may be important factors in the increased tolerance.

Oncological Outcome and Patient's Satisfaction of Skin-Sparing Mastectomy and Immediate Breast Reconstruction: A Prospective Observational Study.

Abstract INTRODUCTION: The management of early breast cancer with skin-sparing mastectomy (SSM) and immediate breast reconstruction (IBR) is not based on evidence from randomised controlled trials. The purpose of this study is to evaluate the oncological safety, post-operative morbidity and patients' satisfaction with SSM and IBR using the latissimus dorsi (LD) myocutaneous flap and/or breast prosthesis. METHODS: One hundred and twenty five consecutive women underwent 137 SSMs with IBR (12 bilateral), using the LD flap plus implant (n=85) or implant alone (n=42), indications included breast cancer (n=130)and prophylaxis (n=7). Most tumours (99.2%) were Tis, T1, or T2 and only one tumour was T3 stage. Nipple reconstruction was performed in 69 patients, using a small local flap technique (n=61), nipple sharing (n=6), free skin graft (n=1) or Monocryl mesh (n=1). Thirty patients underwent contra-lateral surgery in order to optimise symmetry, including 19 augmentations and 11 mastopexy/reduction mammoplasties. Patient satisfaction with the outcome of surgery was assessed on a linear visual analogue scale ranging from 0 (not satisfied) to 10 (most satisfied). RESULTS: There was no local recurrence (LR) after a mean follow-up of 33.2 months (range=3-98 months). Overall survival was 99.2%, seven patients developed distant disease and one patient died of metastatic breast cancer. No case of partial or total LD flap loss was observed. Morbidities included infection, requiring implant removal in two patients and one patient developed marginal ischaemia of the skin envelope. Significant capsule formation, requiring capsulotomy, was observed in 87% of patients who had either PMR or prior RT compared with 13% for those who did not have RT. Eighty two (65.6%) of 125 patients completed the questionnaire with a median satisfaction scores of 9 (range=5-10). CONCLUSION: SSM with IBR is associated with low morbidity, high levels of patient satisfaction and is oncologically safe for T(is), T1 and T2 tumours without extensive skin involvement. Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 3113.

Diminished Neural and Cognitive Responses to Facial Expressions of Disgust in Patients with Psoriasis: A Functional Magnetic Resonance Imaging Study

Psoriasis produces significant psychosocial disability; however, little is understood about the neurocognitive mechanisms that mediate the adverse consequences of the social stigma associated with visible skin lesions, such as disgusted facial expressions of others. Both the feeling of disgust and the observation of disgust in others are known to activate the insula cortex. We investigated whether the social impact of psoriasis is associated with altered cognitive processing of disgust using (i) a covert recognition of faces task conducted using functional magnetic resonance imaging (fMRI) and (ii) the facial expression recognition task (FERT), a decision-making task, conducted outside the scanner to assess the ability to recognize overtly different intensities of disgust. Thirteen right-handed male patients with psoriasis and 13 age-matched male controls were included. In the fMRI study, psoriasis patients had significantly (P<0.005) smaller signal responses to disgusted faces in the bilateral insular cortex compared with healthy controls. These data were corroborated by FERT, in that patients were less able than controls to identify all intensities of disgust tested. We hypothesize that patients with psoriasis, in this case male patients, develop a coping mechanism to protect them from stressful emotional responses by blocking the processing of disgusted facial expressions.

Topical and Long-Acting Local Anesthetic for Prostate Biopsy: A Prospective Randomized Placebo-Controlled Study

Objective: To determine the efficacy of intrarectal lidocaine gel alone and a combination of lidocaine gel with 2 different longer-acting local anesthetic (LA) agents that were injected into the periprostatic area before transrectal ultrasound-guided prostate biopsy. Patients and Methods: One hundred patients undergoing transrectal prostate biopsy were randomized into 4 groups of 25 patients each. Before the biopsy, group 1 received no local anesthesia, group 2 received 2% lidocaine gel intrarectally, group 3 received intrarectal lidocaine gel and 5 ml bupivacaine (0.25%) injected into periprostatic area, and group 4 received lidocaine gel intrarectally and a 5-ml ropivacaine injection (0.25%) in the same location as group 3. Pain levels during and after the biopsy were assessed by using a 10-point linear visual analog scale (VAS). Results: Patients in groups 3 and 4 had significantly lower VAS scores than those in groups 1 and 2, both during and 1 h after biopsy. There were no differences in the pain scores between groups 1 and 2. Conclusion: The combination of intrarectal lidocaine gel and periprostatic longer-acting LA agents significantly reduces the pain related to prostate biopsy, whereas intrarectal lidocaine gel administration alone does not reduce pain. Thus, administration of the periprostatic longer-acting LA agents alone is adequate.

Effects of Tamsulosin on Lower Urinary Tract Symptoms due to Double-J Stent: A Prospective Study

Objective: To evaluate the effect of tamsulosin in improving symptoms in, and quality of life of, patients with indwelling double-J ureteral stents. Patients and Methods: This prospective study lasted from January 2005 to February 2007. All the patients with symptomatic lower ureteral stones with <15 mm diameter were enrolled in this prospective study, and were prospectively randomized (programs Plus 1.0 and Plus 2.10; S-Plus, Taiwan) into two groups. There was a total of 146 patients with insertion of a double-J ureteral stent after ureteroscopic stone removal. In group 1, 71 patients were enrolled and they received placebo for 2 weeks. Group 2 included 75 patients who received 0.4 mg of tamsulosin, once daily for 2 weeks. All patients completed a 10-cm linear visual analogue scale (VAS) for evaluating pain and voiding flank pain, and irritative domain of the International Prostate Symptom Scale (IPSS) before double-J stent removal 2 weeks later. Results: The mean VAS for pain was 4.01 in group 1, 1.52 in group 2, and for voiding flank pain it was 3.3 in group 1 and 1.93 in group 2. The mean score of frequency in IPSS was 3.7 in group 1 and 1.55 in group 2. The mean score of urgency in IPSS was 3.82 in group 1 and 1.43 in group 2. The mean score of nocturia in IPSS was 2.01 in group 1 and 0.65 in group 2. The mean score of quality of life in IPSS was 4.21 in group 1 and 1.6 in group 2. All p values are <0.0001 with statistical significances. Conclusions: Tamsulosin improved a subset of stent-related urinary symptoms, pain, voiding flank pain and quality of life.

Topical Bromfenac 0.09% vs Ketorolac 0.4% for the Control of Pain, Photophobia, and Discomfort Following PRK

To compare the efficacy of two topical nonsteroidal anti-inflammatory drugs with regards to the control of pain, burning, photophobia, foreign body sensation, and epithelial healing rates in patients who underwent photorefractive keratectomy (PRK). Two hundred twelve eyes were randomized to receive topical postoperative ketorolac 0.4% four times daily (Acular LS, Allergan) or bromfenac 0.09% twice daily (Xibrom, ISTA Pharmaceuticals) in an open label trial. Patients having both eyes treated received ketorolac in one eye and bromfenac in the other. The epithelium was removed using the 8.4-mm Amoils brush (Innovative Excimer Solutions), and various laser beam platforms were permitted for the surgery. Investigated drugs were applied after a bandage contact lens (Acuvue Oasys, Johnson & Johnson Vision Care) was fitted. All patients received postoperative cold saline (balanced saline solution [BSS]), prednisolone acetate 1.0% (Pred Forte, Allergan), gatifloxacin ophthalmic solution 0.3% (Zymar, Allergan), and in some cases, mitomycin C 0.02% (MMC). Patients recorded postoperative results for pain, photophobia, burning, and foreign-body sensation on a visual linear analog scale. During postoperative follow-up, the corneal epithelial defect was measured. Two hundred twelve eyes from 149 patients were enrolled in the study. Of these eyes, 105 received bromfenac and 107 received ketorolac. No significant differences were noted in postoperative pain, burning, foreign-body sensation, and photophobia between the two drug populations at any time during the study or overall. There were no drug-related adverse events or differences in epithelial healing rates for either drug. No significant differences were observed between the use of bromfenac (twice daily) and ketorolac (four times daily) with regard to postoperative PRK discomfort and safety when combined with postoperative measures such as cold BSS and a bandage contact lens.

Pain and efficacy of local anesthetics for central venous access

To compare pain during injection and efficacy of analgesia of local anesthetics during central venous line placement. Sixty-two patients were studied in a randomized, double-blinded prospective fashion. Patients received 1% lidocaine (L), buffered 1% lidocaine (LB), or 2% chloroprocaine (CP) injected around the internal jugular vein for procedural analgesia for central venous access. Patients reported pain via a standard linear visual analog scale, with 0 representing no pain and 10 being the worst pain imaginable. Overall patient perception of pain was better with CP and L than LB with mean scores of CP 2.4, L 2.6, LB 4.2. Pain with injection mean scores were CP 2.1, L 2.5, LB 3.2. Pain with catheter placement scores were CP 2.5, L 1.7, LB 3.4. Operator assessment of overall pain values were CP 1.9, L 2.2, LB 3.4. LB consistently scored the worst, though compared with CP, this only reached statistical significance in overall patient pain and pain at catheter insertion compared with L. Though chloroprocaine scored better than lidocaine in 3 of 4 parameters, this trend did not achieve statistical significance. Adding sodium bicarbonate to lidocaine isn't justified in routine practice, nor is routine replacement of lidocaine with chloroprocaine.

The effect of FloSeal on post‐tonsillectomy pain: a randomised controlled pilot study

To determine whether FloSeal as a haemostatic agent in tonsillectomy is associated with less postoperative pain than conventional haemostasis with ligatures. Randomised, controlled, single-blinded pilot study. James Cook University Hospital, Middlesbrough, Cleveland, UK. Thirty patients over 16 years of age undergoing tonsillectomy for recurrent tonsillitis were recruited for the study. At surgery both tonsils were removed by cold steel dissection. Following randomisation one tonsil fossa had FloSeal applied and the other ligatures for haemostasis. The primary outcome measure was postoperative pain following tonsillectomy measured on a visual analogue scale. Pain was recorded three times a day for the first 10 days following surgery. Haemorrhage rates were also recorded as a secondary outcome. Complete data was analysed for 26 patients (87%). The data was grouped into distinct time periods: 0-2, 3-6 and 7-10 days. The sum of the visual linear analogue scale over the time periods for each patient was calculated. Using Wilcoxon Signed Ranks Test, the data was analysed and it was found that there was no statistically significant difference in postoperative pain scores between the control and treatment side at any time. There was a postoperative reactionary haemorrhage rate of 6.7% on the FloSeal side. In our pilot study there was no reduction in pain on the FloSeal side in the first 10 days following tonsillectomy which contrasts with previous findings in the literature.

Simplified axillary lymphadenectomy without suction drain and without padding in breast cancer: a prospective and comparative cohort of 100 patients with early and locally advanced breast cancer

The management of early breast cancer with skin-sparing mastectomy (SSM) and immediate breast reconstruction (IBR) is not based on evidence from randomised controlled trials. The purpose of this study is to evaluate the oncological safety, post-operative morbidity and patients’ satisfaction with SSM and IBR using the latissimus dorsi (LD) myocutaneous flap and/or breast prosthesis.Eighty-three consecutive women underwent 93 SSMs with IBR (10 bilateral), using the LD flap plus implant (n=55) or implant alone (n=38), indications included early breast cancer and prophylaxis due to BRCA-1 gene mutation. Nipple reconstruction was performed in 38 patients, using the trefoil local flap technique, nipple sharing or Monocryl mesh. Twenty-three underwent contra-lateral surgery in order to optimise symmetry, including 15 augmentations and eight mastopexy/reduction mammoplasties. Patient satisfaction with the outcome of surgery was assessed on a linear visual analogue scale ranging from 0 (not satisfied) to 10 (most satisfied).There was no local recurrence (LR) after a median follow-up of 34 months (range=3–79 months). Overall survival was 98.8%, three patients developed distant disease and one patient died of metastatic breast cancer. No case of partial or total LD flap loss was observed. Morbidities included infection, requiring implant removal in two patients and one patient developed marginal ischaemia of the skin envelope. Significant capsule formation, requiring capsulotomy, was observed in 87% of patients who had either PMR or prior RT compared with 13% for those who did not have RT. Sixty-one (73.5%) of 83 patients completed the questionnaire with a median and mean satisfaction scores of 10.0 and 9.3, respectively (range=6–10).SSM with IBR is associated with low morbidity, high levels of patient satisfaction and is oncologically adequate for Tis, T1 and T2 tumours without extensive skin involvement.

A Randomized Double-Blind Placebo-Controlled Study of Low-Dose Intravenous Lorazepam to Reduce Procedural Pain During Bone Marrow Aspiration and Biopsy

To evaluate the efficacy of intravenous lorazepam as premedication for bone marrow aspiration and biopsy (BMAB). Randomized, double-blind, placebo-controlled. One hundred and thirty-eight consenting patients planned to receive BMAB. Patients were randomly assigned to receive either intravenous lorazepam 1 mg or placebo just prior to BMAB. Tertiary referral center, inpatient setting. A questionnaire was used to determine the patient perception about the procedure and pain at baseline, which was completed just after the procedure, and the next day after the BMAB. Pain was rated using a 10-cm linear visual analog scale (VAS). The mean VAS scores measured during the BMAB examination were 6.0 for lorazepam vs 6.2 for placebo. Few adverse events were noted during intravenous lorazepam administration. The patients in the lorazepam group were more likely to accept the next BMAB (P = 0.044). Intravenous lorazepam was safe in patients undergoing BMAB and was more effective than placebo in enhancing cooperation during BMAB and willingness to undergo another procedure. However, use of lorazepam 1 mg provided no reduction in the pain associated with BMAB. Further studies should focus on providing appropriate analgesia for this potentially painful procedure.

Oncological safety and patient satisfaction with skin-sparing mastectomy and immediate breast reconstruction

The management of early breast cancer with skin-sparing mastectomy (SSM) and immediate breast reconstruction (IBR) is not based on evidence from randomised controlled trials. The purpose of this study is to evaluate the oncological safety, post-operative morbidity and patients' satisfaction with SSM and IBR using the latissimus dorsi (LD) myocutaneous flap and/or breast prosthesis. Eighty-three consecutive women underwent 93 SSMs with IBR (10 bilateral), using the LD flap plus implant (n=55) or implant alone (n=38), indications included early breast cancer and prophylaxis due to BRCA-1 gene mutation. Nipple reconstruction was performed in 38 patients, using the trefoil local flap technique, nipple sharing or Monocryl mesh. Twenty-three underwent contra-lateral surgery in order to optimise symmetry, including 15 augmentations and eight mastopexy/reduction mammoplasties. Patient satisfaction with the outcome of surgery was assessed on a linear visual analogue scale ranging from 0 (not satisfied) to 10 (most satisfied). There was no local recurrence (LR) after a median follow-up of 34 months (range=3-79 months). Overall survival was 98.8%, three patients developed distant disease and one patient died of metastatic breast cancer. No case of partial or total LD flap loss was observed. Morbidities included infection, requiring implant removal in two patients and one patient developed marginal ischaemia of the skin envelope. Significant capsule formation, requiring capsulotomy, was observed in 87% of patients who had either PMR or prior RT compared with 13% for those who did not have RT. Sixty-one (73.5%) of 83 patients completed the questionnaire with a median and mean satisfaction scores of 10.0 and 9.3, respectively (range=6-10). SSM with IBR is associated with low morbidity, high levels of patient satisfaction and is oncologically adequate for T(is), T1 and T2 tumours without extensive skin involvement.

Sequential Combined Spinal Epidural Block Superior To Epidural Block For Total Abdominal Hysterectomy In Patient And Surgeons Perspective: Double Blind Randomized Control Trial

Introduction: The aim of this study was to compare sequential combined spinal epidural with epidural block for total abdominal hysterectomy to assess quality of block in terms of surgeon and patient's satisfaction. Methods: 100 patients of ASA grade I & II were randomly divided into 2 groups. Group A patients received CSE using “needle through needle technique” and were given 2.5 ml of 0.5% hyperbaric bupivacaine for spinal block. Group B patients received epidural block through catheter using 15 ml of 0.5% plain bupivacaine. In all patients, subsequent dosage of 0.5% plain bupivacaine (1.5 ml per unblocked segment) was administered to achieve a block up to T4-5. The quality of block was rated from excellent to poor by surgeon and anesthetist. Patient satisfaction was rated on 0 to 100 linear visual analog scale. Results: The surgical analgesia and motor blockade occurred significantly early in CSE group. The quality of analgesia as assessed by anesthetist was excellent in 92% of patients in group A as compared to 30% in group B (p=0.000). In 88% cases in CSE group surgical conditions were reported as excellent by surgeons as compared to only 36% in epidural group. VAS scores for patient satisfaction were also much lower in CSE group (11.2±7.304 versus 26.4±22.94 in epidural group) (p=0.000). Conclusion: The quality of block is superior in CSE as compared to epidural block and associated with greater degree of patient and surgeon satisfaction.

A controlled release buccal insert

Objectives To assess the efficacy of a novel hydrogel polymer buccal insert containing 5 mg pilocarpine in releasing the pilocarpine in a controlled fashion over a three hour period, and to assess the effects of this on quantitative tear and saliva production and the acceptability of the insert to the patient. Design This was an open, uncontrolled pilot study for which Ethics Committee approval was obtained prior to starting. Hydrogel buccal inserts containing 5 mg pilocarpine were used three times a day for seven days. Setting The Department of Oral Medicine, Glasgow Dental Hospital & School. Subjects Eight patients with Sjogren's syndrome. Main outcome measures Changes over baseline in (1) Schirmer test, (2) whole saliva flow rate, (3) oral comfort score (VAS), (4) ocular comfort score (VAS), (5) patient acceptability. Results The buccal inserts successfully released in excess of 85% of their 5 mg pilocarpine load over three hours. There was a general improvement in oral and ocular comfort scores assessed by visual linear analogue scale, and saliva and tear production generally increased. The inserts were well tolerated by all patients except one (who wore dentures). Adverse events were few and none was serious. Conclusion This novel form of buccal pilocarpine delivery demonstrated potential for use in treating patients with Sjogren's syndrome.

Importance of components of the curriculum vitae in determining appointment to senior registrar posts.

To evaluate the opinions of regional education advisers, academics and other consultants about features of the curriculum vitae, we undertook a small attitude survey. The response rate was 73%, which provided data from a total of 78 influential anaesthetists. The respondents' attitude to each feature of the curriculum vitae was reported using a linear visual analogue scale. The three groups had similar attitude scores to most features, but not to research time, training time, higher degrees and abstracts of papers presented to the Anaesthetic Research Society. Publications in the main anaesthesia journals, time in other major medical specialties, research and the possession of a higher degree were scored highly by all respondents. Papers in non-peer-reviewed journals, letters, unsubmitted papers, and time in training for general practice attracted lower scores. The free text comments of many respondents indicated a considerable disillusionment about the whole appointments process.

A randomized‐controlled trial to compare topical cyclosporin with triamcinolone acetonide for the treatment of oral lichen planus

Various treatments have been employed to treat symptomatic oral lichen planus (OLP), but a complete cure is very difficult to achieve because of its recalcitrant nature. Topical cyclosporin therapy of OLP has shown conflicting results in many reports. The purpose of this study was to compare the effectiveness of cyclosporin solution with triamcinolone acetonide 0.1% in orabase in the treatment of Thai patients with OLP. Thirteen Thai patients with symptomatic OLP and proven by biopsy were randomly assigned treatment with cyclosporin (six) or triamcinolone acetonide 0.1% (seven). The patients were instructed to apply cyclosporin or triamcinolone acetonide 0.1% three times daily at the marker lesions and affected areas. The assessments were at weeks 0, 2, 4, 8 by clinical scoring and grid measurement of the target lesions. Cyclosporin levels were assessed at weeks 2 and 8 of treatment. Pain and burning sensation were evaluated by linear visual analogue scale (0-10). OLP patients in the triamcinolone acetonide group showed equal cases of clinical complete and partial remission (50%). Whereas, in the cyclosporin group, there was partial remission in only two cases (33.5%) and no response in four cases (66.7%). However, our study showed that there were no statistical differences in pain, burning sensation and clinical response in OLP patients between the two groups (P > 0.01). Moreover, five of six cases in the cyclosporin group developed side-effects such as transient burning sensation, itching, swelling lips, petechial haemorrhages and others. Our results indicated that topical cyclosporin did not provide any beneficial effect and was not more effective than triamcinolone acetonide 0.1% in the treatment of Thai patients with symptomatic OLP.

A controlled release pilocarpine buccal insert in the treatment of Sjögren's syndrome

To assess the efficacy of a novel hydrogel polymer buccal insert containing 5 mg pilocarpine in releasing the pilocarpine in a controlled fashion over a three hour period, and to assess the effects of this on quantitative tear and saliva production and the acceptability of the insert to the patient. This was an open, uncontrolled pilot study for which Ethics Committee approval was obtained prior to starting. Hydrogel buccal inserts containing 5 mg pilocarpine were used three times a day for seven days. The Department of Oral Medicine, Glasgow Dental Hospital & School. Eight patients with Sjögren's syndrome. Changes over baseline in (1) Schirmer test, (2) whole saliva flow rate, (3) oral comfort score (VAS), (4) ocular comfort score (VAS), (5) patient acceptability. The buccal inserts successfully released in excess of 85% of their 5 mg pilocarpine load over three hours. There was a general improvement in oral and ocular comfort scores assessed by visual linear analogue scale, and saliva and tear production generally increased. The inserts were well tolerated by all patients except one (who wore dentures). Adverse events were few and none was serious. This novel form of buccal pilocarpine delivery demonstrated potential for use in treating patients with Sjögren's syndrome.

Is There Still a Role for the Uniscale Assessment of Quality of Life?

To obtain proof of external validity of the visual analogue scale and re-evaluate the use of this instrument in assessing cancer patients' quality of life. Consecutive patients attending 79 Italian medical oncology and radiotherapy centers over a period of 1 week were asked to fill out both a questionnaire concerning the presence of 19 problems and a 100-mm linear visual analogue scale evaluating their quality of life. Quality of life was rated as "good" and "bad" when given a score of 70-100 and 0-30, respectively. Multifactorial logistic models were used where good and bad quality of life were correlated with explanatory variables including patient and disease characteristics and the presence or absence of the 19 problems. Gender, level of education, treatment setting, Karnofsky performance status, disease extent, and the presence of 12 out of 19 problems were found to be correlated with good quality of life. A similar pattern of correlations was found with bad quality of life. Due to the difficulties in attaining reliable assessment of quality of life using psychometric questionnaires, the further proof of validity obtained in this study allows us to propose the re-evaluation of the role of the uniscale in measuring the quality of life of cancer patients.

Pain Relief after Pterygium Surgery with Viscous Lidocaine

Purpose:The aim of the current study is to investigate the efficacy of lidocaine 2% gel for the control of pain experienced after pterygium surgery. Methods: We conducted a prospective, randomized clinical trial on 45 eyes of 45 patients who underwent pterygium surgery. The patients were randomized into 2 groups. Group 1 was provided with topical 2% lidocaine gel and group 2 with artificial tear gel. The primary outcome of interest was the pain experienced at the 4th, 7th and 10th postoperative hours. Corneal reepithelization was evaluated by slitlamp biomicroscopy. Pain was determined using a 10-point linear visual analogue scale. No systemic analgesic or topical nonsteroidal anti-inflammatory drop was administered. Results: The groups had similar demographic data. The mean pain scores of the study and the control groups according to the visual analogue scale were: 4.13 ± 1.86 and 6.50 ± 1.47 (p = 0.001) at the 4th postoperative hour, 4.00 ± 1.16 and 4.00 ± 1.16 (p = 0.001) at the 7th , and 2.39 ± 0.89 and 3.63 ± 1.00 (p = 0.001) at the 10th postoperative hour, respectively. The mean area of the corneal epithelial defect in the lidocaine gel group was 4.78 ± 1.04 mm² and 4.68 ± 0.89 in the artificial tear gel group (p = 0.42). The mean corneal reepithelization time was 37.56 ± 10.42 h in the lidocaine gel group and 34.36 ± 10.00 h in the artificial tear gel group (p = 0.26). There were no side effects related to the drugs observed in either of the 2 treatment groups. Conclusion: We conclude that topical lidocaine gel is an effective and safe anesthetic agent for the control of pain experienced shortly after pterygium surgery.