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Am J Emerg Med 2002 Nov;20(7):624-6
Emergency Department, Kapiolani Medical Center For Women And Children, University of Hawaii John A. Burns School of Medicine, Honolulu, HI, USA.
The objective of the study was to compare cutaneous treatments (heat, papain and vinegar) for acute jellyfish (Carybdea alata) stings. Healthy adult volunteer subjects received a single-tentacle jellyfish sting on each forearm. One forearm was treated with hot-water immersion (40-41 degrees C). This was compared with the other forearm, which was randomized to a comparison treatment of papain meat tenderizer or vinegar. Pain was measured at 0, 2, 4, 6, 8, 10, 15, and 20 minutes using a 10-cm visual analog scale (VAS). For 25 subject runs, the average VAS scores at t = 0 were 3.6 cm (hot water) and 3.7 cm (comparison treatment). At t = 4 minutes (2 minutes after treatment had started), the differences between hot-water and comparison group VAS scores were 2.1 cm versus 3.2 cm, respectively. The mean difference between hot-water and comparison treatments was 1.1 cm (95% confidence interval, 0.6 to 1.6). At t = 20 minutes (the end of the study period), the differences between hot-water and comparison group VAS scores were 0.2 cm versus 1.8 cm, respectively. The mean difference between hot-water and comparison treatments was 1.6 cm (95% confidence interval, 0.9 to 2.3). This study suggests that the most efficacious initial treatment for C alata jellyfish envenomation is hot-water immersion to the afflicted site. Copyright 2002, Elsevier Science (USA). All rights reserved.)
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PMID: 12442242, UI: 22328506
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BMJ 2002 Nov 30;325(7375):1287-9
The Haemostasis Thrombosis and Vascular Biology Unit, University Department of Medicine, City Hospital, Birmingham, UK.
PMID: 12458252, UI: 22345421
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Br J Anaesth 2003 Jan;90(1):108-9
Rouen, France.
[Medline record in process]
PMID: 12488397, UI: 22375937
Eur J Anaesthesiol 2002 Apr;19(4):295-7
Universitatsklinikum Munster, Klinik und Poliklinik fur Anasthesiologie und operative Intensivmedizin, Germany.
BACKGROUND AND OBJECTIVE: Drug mixtures containing sufentanil may be unstable owing to absorption into the drug reservoirs of patient-controlled epidural analgesia systems that contain polyvinylchloride. The stability of sufentanil in a mixture of ropivacaine 0.2% in a 750 mL reservoir was therefore investigated. METHODS: During simulated epidural infusions of 5 mLh(-1) at 25 degrees C, sufentanil concentrations were measured for 96 h. Samples were taken from the reservoir and from the end of the epidural catheter under the following conditions: into glass or polyvinylchloride reservoirs containing ropivacaine 0.2% with sufentanil 1, 0.75 or 0.5 microg mL(-1); and into polyvinylchloride reservoirs with ropivacaine 0.2% and sufentanil 1 microg mL(-1) which were stored for 4 weeks at 8 degrees C. RESULTS: The different solutions remained stable over the observation period of 96 h. Using the same solutions, independent samples' ANOVA showed no difference in the sufentanil concentrations between the glass and polyvinylchloride reservoirs, or between the polyvinylchloride reservoirs when stored for 4 weeks. Correlations between the concentrations at the different measurement times were extremely high for the reservoir (r(min) = 0.98, r(max) = 1.00) and the catheter end (rmin = 0.86, r(max) = 1.00). CONCLUSIONS: Sufentanil citrate at 0.5-1.0 microg mL(-1) in an admixture of ropivacaine 0.29 for 5 days, which is the usual period for postoperative epidural analgesia, remains stable in a polyvinylchloride reservoir. There is no change in the drug concentration even if the reservoir is stored for 4 weeks at 8 degrees C.
PMID: 12074420, UI: 22068944
J Pain Symptom Manage 2002 Sep;24(3):279; author reply 279-80
PMID: 12458102, UI: 22345932
Neurology 2002 Nov 26;59(10):1573-9
Department of Neurology, Fundacion Jimenez Diaz, Madrid, Spain. dgarciaborreguero@fjd.es
OBJECTIVE: To assess the effects of gabapentin on sensory and motor symptoms in patients with restless legs syndrome (RLS). METHODS: Patients with RLS (22 idiopathic, 2 secondary to iron deficiency) were randomized and treated for 6 weeks with either gabapentin or placebo. After a 1-week washout they crossed over to the alternative treatment for 6 weeks. Patients were rated at baseline and at scheduled intervals by the RLS Rating Scale, Clinical Global Impression, pain analogue scale, and Pittsburgh Sleep Quality Index. At the end of each treatment period, all-night polysomnography was performed. RESULTS: Compared to placebo, gabapentin was associated with reduced symptoms on all rating scales. In addition, sleep studies showed a significantly reduced periodic leg movements during sleep (PLMS) index and improved sleep architecture (increased total sleep time, sleep efficiency, and slow wave sleep, and decreased stage 1 sleep). Patients whose symptoms included pain benefited most from gabapentin. The mean effective dosage at the end of the 6-week treatment period was 1,855 mg, although therapeutic effects were already observed at the end of week 4 (1,391 mg). CONCLUSIONS: Gabapentin improves sensory and motor symptoms in RLS and also improves sleep architecture and PLMS.
PMID: 12451200, UI: 22339024
Spine 2002 Dec 15;27(24):2835-43
*U.S. Army-Baylor University Graduate Program in Physical Therapy, San Antonio, Texas, and the double dagger U.S. Army-Baylor University, Postprofessional Doctoral Program in Orthopaedic & Manual Physical Therapy, Fort Sam Houston, Texas.
STUDY DESIGN A prospective, cohort study of patients with nonradicular low back pain referred to physical therapy.OBJECTIVE Develop a clinical prediction rule for identifying patients with low back pain who improve with spinal manipulation.SUMMARY OF BACKGROUND DATA Development of clinical prediction rules for classifying patients with low back pain who are likely to respond to a particular intervention, such as manipulation, would improve clinical decision-making and research.METHODS Patients with nonradicular low back pain underwent a standardized examination and then underwent a standardized spinal manipulation treatment program. Success with treatment was determined using percent change in disability scores over three sessions and served as the reference standard for determining the accuracy of examination variables. Examination variables were first analyzed for univariate accuracy in predicting success and then combined into a multivariate clinical prediction rule.RESULTS Seventy-one patients participated. Thirty-two had success with the manipulation intervention. A clinical prediction rule with five variables (symptom duration, fear-avoidance beliefs, lumbar hypomobility, hip internal rotation range of motion, and no symptoms distal to the knee) was identified. The presence of four of five of these variables (positive likelihood ratio = 24.38) increased the probability of success with manipulation from 45% to 95%.CONCLUSION It appears that patients with low back pain likely to respond to manipulation can be accurately identified before treatment.
PMID: 12486357, UI: 22374682
Spine 2002 Dec 15;27(24):2831-4
Departments of *Physiotherapy.
STUDY DESIGN A prospective epidemiologic cohort study.OBJECTIVE To determine the incidence of clearly defined pelvic joint pain in pregnancy based on both history and objective confirmation and to classify pelvic joint pain into four groups and determine their incidence.SUMMARY AND BACKGROUND DATA Pelvic and low back pain in pregnancy is a substantial problem, and the correct treatment is hampered by several factors, such as the lack of clearly defined clinical conditions, variety of nomenclature, and great variance in reported incidence (range 4-76.4%). This variation in incidence is a problem that calls for a clearly defined criteria and a study design aimed at resolving such varying incidence rates.METHODS All pregnant women booked for delivery at two Danish hospitals over a 1-year period were offered to participate in the study in week 33 of gestation. Women who reported daily pain from pelvic joints, which could be objectively confirmed, were divided, according to symptoms, into five subgroups: four classification groups (pelvic girdle syndrome, symphysiolysis, one-sided sacroiliac syndrome, and double-sided sacroiliac syndrome) and one miscellaneous. A total of 1460 women formed the incidence cohort based on geographic criteria.RESULTS A total of 293 women (20.1%) were found to have pelvic joint pain divided in one of the four classification groups: pelvic girdle syndrome 6.0%, symphysiolysis 2.3%, one-sided sacroiliac syndrome 5.5%, and double-sided sacroiliac syndrome 6.3%.CONCLUSION This study proposes new, more precise procedures for the identification and classification of pregnancy-related pelvic joint pain based on both reports from the women and a physical examination. Presumably, the 20.1% incidence rate, identified in the present study, represents the most precise and reliable information available hitherto, regarding the incidence of pregnancy-related pelvic joint pain.
PMID: 12486356, UI: 22374681
Spine 2002 Dec 15;27(24):2820-4
*Institute of Rehabilitation Medicine, dagger Department of Biomedical Physics and Technology.
STUDY DESIGN Prospective cohort study.OBJECTIVE To determine the prognostic value of asymmetric laxity of the sacroiliac joints during pregnancy on pregnancy-related pelvic pain postpartum.SUMMARY OF BACKGROUND DATA In a previous study, we observed a significant relation between asymmetric laxity of the sacroiliac joints and moderate to severe pregnancy-related pelvic pain during pregnancy.METHODS A group of 123 women were prospectively questioned and examined, and sacroiliac joint laxity was measured by means of Doppler imaging of vibrations at 36 weeks' gestation and at 8 weeks' postpartum. A left to right difference in sacroiliac joint laxity >/=3 threshold units was considered to indicate asymmetric laxity of the sacroiliac joints.RESULTS In subjects with moderate to severe pregnancy-related pelvic pain during pregnancy, sacroiliac joint asymmetric laxity was predictive of moderate to severe pregnancy-related pelvic pain persisting into the postpartum period in 77% of the subjects. The sensitivity, specificity, and positive predictive value of sacroiliac joint asymmetric laxity during pregnancy for pregnancy-related pelvic pain persisting postpartum were 65%, 83%, and 77%, respectively. Subjects with moderate to severe pregnancy-related pelvic pain and asymmetric laxity of the sacroiliac joints during pregnancy have a threefold higher risk of moderate to severe pregnancy-related pelvic pain postpartum than subjects with symmetric laxity.CONCLUSION These data indicate that in women with moderate to severe complaints of pelvic pain during pregnancy, sacroiliac joint asymmetric laxity measured during pregnancy is predictive of the persistence of moderate to severe pregnancy-related pelvic pain into the postpartum period.
PMID: 12486354, UI: 22374679
Spine 2002 Dec 15;27(24):2776-81
STUDY DESIGN Prospective, within-subjects, observational experimental design.OBJECTIVES To determine the pattern of pain response to noxious stimulation of the intervertebral disc.SUMMARY OF BACKGROUND DATA Experimental studies have demonstrated that noxious stimulation of interspinous ligaments, facet joints, and paravertebral muscles causes referred pain into the extremity, with the distal extent of radiation dependent on the intensity of stimulation. Analogous studies have not been performed on the lumbar intervertebral disc.METHODS A total of 25 consecutive patients meeting inclusion criteria completed a pain diagram before undergoing the intradiscal electrothermal annuloplasty procedure. The location, intensity, and familiarity of any pain provoked during disc heating were correlated with presenting symptoms and duration of heating.RESULTS During disc heating, 68% of patients reported exact reproduction of their presenting pain, in both pain quality and location. None of the patients experienced unfamiliar pain during the procedure. The pattern of pain reproduction was consistent; pain originated proximally and progressed distally as stimulus intensity increased.CONCLUSION Noxious stimulation of the intervertebral disc may result in low back and referred extremity in patients presenting with these symptoms. The distal extent of pain produced depends on the intensity of stimulation. Disc stimulation may reproduce pain that extends to below the knee.
PMID: 12486346, UI: 22374671