Intravenous chlorpromazine in the acute treatment of episodic tension-type headache: a randomized,placebo controlled,double-blind study

Acute headache is a very frequent symptom, responsible for a significant percentage of caseload at primary care units and emergency rooms. Chlorpromazine is easily available in such settings. The aim of this study is to conduct a randomized, placebo-controlled, double-blind study to assess the efficacy of chlorpromazine on the acute treatment of episodic tension-type headache. We randomized 30 patients to receive placebo (10 ml of saline intravenous injections) and 30 patients to receive 0.1 mg/Kg chlorpromazine intravenously. We used 7 parameters of analgesic evaluation. Patients receiving chlorpromazine showed a statistically significant improvement (p < 0.05 and p < 0.01) of pain compared to placebo, far up to 30 minutes after the drug administration. The therapeutic gain was 36.7% in 30 minutes and 56.6 % in 60 minutes. The number needed to treat (NNT, the reciprocal or the therapeutic gain) was 2.7 in 30 minutes and 1.8 in 60 minutes. There were reductions in the recurrence and in the use of rescue medication in the chlorpromazine group. We can conclude that intravenous chlorpromazine is an effective drug to relief the pain in tension-type headache.     

The anxiogenic video-recorded Stroop Color-Word Test: psychological and physiological alterations and effects of diazepam

From among the few human experimental models that can be used to predict the clinical activity of new anxiolytic drugs, the video-recorded Stroop Color-Word Test (VRSCWT), which uses subjective scales to evaluate anxious states, is notable for its simplicity. However, considering that the choice of treatment for anxiety disorders is heavily dependent on the level of somatic symptomatology, a quantitative evaluation of the physiological alterations elicited by the anxiogenic situation of the VRSCWT would also be of great interest. In the present study, 36 healthy male and female volunteers were submitted to either the VRSCWT or to a nonanxiogenic test. The results showed that, as well as a sensation of anxiety, the VRSCWT elicited increases in heart rate and gastrocnemius tension. Subsequently, a further 48 healthy men and women were randomly assigned to three treatments: placebo, 5 and 10 mg of diazepam, and were submitted to the VRSCWT. The results showed that in men, diazepam blocked the feeling of anxiety elicited by the test, although it did not prevent the physiological alterations, while in women, there was no response to the anxiolytic action of the drug. Taken as a whole, these results suggest that the VRSCWT is an efficient method of inducing anxiety experimentally. It is able to elicit observable psychological and physiological alterations and can detect the blocking, by an anxiolytic, of the feelings of anxiety in healthy men. Furthermore, the results suggest that the neural pathways for the control of the psychological and physiological manifestations of anxiety may be separate. This study also draws attention to the fact that gender is an important variable in the evaluation of anxiolytic drugs.     

Behavior of Hylamer polyethylene in hip arthroplasty: comparison of two gamma sterilization techniques

Hylamer polyethylene was introduced in the 1990s as an alternative to conventional polyethylene. Its chemical and physical properties, and especially its high crystallinity, were claimed to improve resistance to wear. Initially Hylamer devices were sterilized by gamma radiation in air, then the technique was changed and gamma radiation was performed in the absence of oxygen. Clinical experience has shown the early loosening of some devices made from Hylamer. The aim of this study was to ascertain whether early wear and consequent osteolysis was linked to the sterilization method. We retrospectively compared 31 patients with hip prostheses with Hylamer liners sterilized by gamma radiation in air (group 1) with 30 patients with the same prosthesis, but sterilized in the absence of oxygen (group 2). The groups were similar for sex, age, disease, head diameter and material. Mean follow-up was 84 months and no clinical signs of failure were present. Radiographic measurement revealed that wear of group 1 was significantly greater than that of group 2 (0.23 mm/year vs 0.09 mm/year, p=0.001). Periacetabular and femoral osteolysis in group 1 was significantly greater than group 2. In conclusion, the method of sterilization might have influenced the outcome of Hylamer polyethylene liners.

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Résumé Le polyéthylène Hylamer a été présenté dans les années 1990 comme une alternative au polyéthylène conventionnel. Ses caractéristiques chimiques et physiques, et surtout sa haute cristallinité, devaient améliorer la résistance à l'usure. Tout d'abord l'Hylamer a été stérilisé par rayonnement gamma dans l'air, puis la technique a été changée et le rayonnement gamma a été exécuté en l'absence d'oxygène. L'expérience clinique a montré des descellements précoces de composants en Hylamer. Le but de cette étude était de découvrir si l'usure précoce et l'ostéolyse résultante étaient liées à la méthode de stérilisation. Nous avons comparé rétrospectivement 31 malades avec une prothèse de la hanche avec liner en Hylamer stérilisé par rayonnement gamma dans l'air (groupe 1) avec 30 malades avec la même prothèse, mais stérilisée en l'absence d'oxygène (groupe 2). Les groupes n'étaient pas différents pour le sexe, l'age et la maladie, le diamètre de la tête et la matière. Le suivi moyen était de 84 mois et aucun signe clinique d'échec n'était présent. Les mesures radiographiques ont noté que l'usure du groupe 1 était notablement plus grande que celle du groupe 2 (0.23 mm/an contre 0.09 mm/an, p=0.001). L'ostéolyse périacétabulaire et fémorale dans le groupe 1 était nettement plus grande que dans le groupe 2. En conclusion, la méthode de stérilisation a pu influencer le devenir du liner en polyéthylène Hylamer.

     

Comparative Morphometric Analysis of 5 Interpositional Arterial Autograft Options for Adult Living Donor Liver Transplantation

In living donor liver transplantation, the right-sided graft presents thin and short vessels, bringing forward a more difficult anastomosis. In these cases, an interpositional arterial autograft can be used to favor the performance of the arterial anastomosis, making the procedure easier and avoiding surgical complications.     

Synovial fluid microanalysis allows early diagnosis of ceramic hip prosthesis damage

The first clinical sign of ceramic hip prosthesis failure is hip noise. We therefore investigated whether isolation, observation at scanning electron microscopy, and chemical identification with microanalysis of particles from synovial fluid of “noisy hip” could be predictive of ceramic damage. Firstly, the level of “physiological wear” of well functioning ceramic‐on‐ceramic hip prostheses was assessed with this method, then the test was validated as diagnostic method for liner fracture. Twelve asymptomatic patients were enrolled to demonstrate the first aim; 39 cases of noisy hip (GROUP 1), and 7 cases of pending failure not related to ceramic (GROUP 2) were enrolled for the second aim. The analysis of the synovial fluid of the 12 asymptomatic patients allowed to set the “physiological wear” threshold. The analysis of GROUP 1 hips demonstrated the presence of ceramic particles (2 physiological, 12 mild, and 25 strong). The analysis of GROUP 2 showed a physiological presence of ceramic particles in all cases. Revision surgery in GROUP 1 was performed in 16 hips out 25 with strong ceramic particle presence and 2 out of 12 with mild ceramic particle presence. Failure of the ceramic component was evident in all but one of these cases, while the integrity of components was demonstrated in all seven hips of GROUP 2. Synovial fluid microanalysis can be a useful surrogate in predicting ceramic failure particularly when a strong presence of ceramic particles is observed. On the contrary there is not enough evidence to predict ceramic failure in presence of mild positivity. © 2012 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 30:1312–1320, 2012