Do Bach flower remedies have a role to play in pain control?: A critical analysis investigating therapeutic value beyond the placebo effect,and the potential of Bach flower remedies as a psychological method of pain relief

This paper explores the potentiality of Bach flower remedies as a means of pain relief through a retrospective case-study analysis to establish how clients suffering with painful conditions responded to the therapy. RESULTS: Of 384 subjects, 41 suffered pain. Of these, 46% felt treatment had relieved their pain; in 49% the physical outcome was unknown. About 88% of all subjects reported an improvement in their emotional outlook. DISCUSSION: The role of placebo and its influence on the study's key features: focus shift from physical pain to emotional outlook, and the importance of the client-practitioner relationship and belief in the therapy. CONCLUSION: The use of Bach flower remedies has brought about positive emotional changes in the majority of clients in this study. Whilst it is difficult to draw a definitive conclusion as to significance of the therapeutic value of these remedies in relation to pain above that of a placebo, the results are encouraging. In particular, relief of negative emotions and promotion of positive thought including how clients opened up about, and dealt with, emotional issues. The indication is that potential for Bach flower remedies as a therapeutic agent in the relief of pain does exist and is worthy of further qualitative and quantitative investigation through robust, purpose-designed studies to replicate and progress the results shown here.     

Loss of corticomedullary demarcation on magnetic resonance imaging: an index of biopsy-proven acute renal transplant dysfunction

A prospective study of 19 cadaveric renal allograft recipients with suspected graft rejection was undertaken to compare the histological findings of the renal transplant biopsy with the results of magnetic resonance imaging (MRI). All 19 patients underwent a biopsy of the transplant allograft. Biopsy results included acute cellular rejection, acute vascular rejection, chronic vascular rejection (CVR), and acute tubular necrosis (ATN). Recipients of cadaveric renal allografts with normal function served as controls. The control showed distinct corticomedullary demarcation (CMD) on T1-weighted imaging. In contrast, CMD was absent or diminished in all the patients with suspected allograft rejection. Unfortunately, the loss of CMD did not correlate with a specific biopsy diagnosis. Patients with biopsy evidence of acute and chronic rejection or ATN demonstrated loss of CMD with similar image patterns. In conclusion, MRI is capable of detecting renal allograft dysfunction, but does not permit the determination of a specific cause.     

Effect of iron and liver injury on the pathogenesis of Vibrio vulnificus

Noncholera vibrio species can cause necrotizing soft tissue infections and cellulitis in addition to gastroenteritis. Cellulitis and necrotizing soft tissue infections frequently occur in people with liver disease or in people who are in some way a compromised host. We studied the effect of Vibrio vulnificus on the mortality of mice treated with carbon tetrachloride, an agent that causes liver damage, Desferal, an iron-chelating agent, or iron. The LD50 of V. vulnificus is approximately 2.5 X 10(6) CFU. In mice, desferal lowered the LD50 to less than 100 CFU, and carbon tetrachloride lowered the LD50 to approximately 1000 CFU. Twenty percent of the mice that survived had necrosis of the skin overlying the injection site. These studies demonstrate that liver damage and iron chelating agents increase mortality and necrotizing soft tissue infections caused by V. vulnificus.     

A triple-blinded randomized trial comparing the hemostatic effects of large-dose 10% hydroxyethyl starch 264/0.45 versus 5% albumin during major reconstructive surgery

In Canada, hydroxyethyl starch 264/0.45 (HES 264/0.45; molar weight 264 kDa, molar substitution 0.45) has largely replaced albumin as the colloidal fluid of choice for perioperative intravascular volume expansion. The maximum recommended dose of HES 264/0.45 is 28 mL/kg; however, there are no clinical data supporting this limit. In this study we compared the hemostatic effects of HES 264/0.45 versus 5% albumin in doses up to 45 mL/kg over 24 h during major reconstructive head and neck surgery. Fifty patients were randomized to receive HES 264/0.45 or 5% human albumin from the induction of anesthesia until 24 h thereafter. Both albumin and HES 264/0.45 effectively maintained physiologic variables in the perioperative and postoperative periods. The partial thromboplastin time and international normalized ratio were significantly increased in the HES 264/0.45 group compared with the albumin group after infusion of 30 mL/kg and 45 mL/kg (P < 0.05). Factor VIII activity and von Willebrand factor level were significantly reduced in the HES 264/0.45 group compared with the albumin group after infusion of 15 mL/kg, 30 mL/kg, and 45 mL/kg (P < 0.05). Significantly more subjects in the HES 264/0.45 group received allogeneic red blood cell transfusions (P < 0.02). We conclude that HES 264/0.45 infusions >30 mL/kg over 24 h impair coagulation to a greater extent than albumin, possibly leading to more allogeneic transfusions.     

Does the Additional Articulation in Retrieved Bipolar Hemiarthroplasty Implants Decrease Trunnionosis Compared to Total Hip Arthroplasty?

Background

Trunnionosis at the modular head-neck taper interface in metal-on-polyethylene total hip arthroplasty (MoP THA) has been shown to occur, and represents a potential mode of MoP THA failure. The purpose of the present investigation is to elucidate differences in fretting and corrosion at the head-neck taper interface of prostheses retrieved from bipolar hemiarthroplasty (BH) and MoP THA.

Myoblast transplantation for heart repair: A review of the state of the field

Autologous immature myoblasts are obtained from biopsy of thigh muscle. These cells are cultured to a thera peutic dosage at a central Good Manufacture Practic (cGMP) facility. The cells are suspended in a special solu tion which preserves their shelf lif…     

Emergence of Imatinib Resistance Associated with Downregulation of C-Kit Expression in Recurrent Gastrointestinal Stromal Tumor (GIST): Optimal Timing of Resection

Introduction  

Gastrointestinal stromal tumors (GISTs) are the most common gastrointestinal mesenchymal tumors. The activating mutation in the KIT (c-kit; CD117) proto-oncogene with subsequent tyrosine kinase activation plays a central role in the pathogenesis of GIST. Tyrosine kinase inhibitors are an integral part of GIST therapy. Initial response to neoadjuvant imatinib can be expected in up to 70% of the patients, thus offering an opportunity to surgically treat those with locally advanced primary or recurrent GIST. This favorable response to imatinib, however, is plagued with development of secondary resistance during the course of therapy.     

Cell volume regulation: a review of cerebral adaptive mechanisms and implications for clinical treatment of osmolal disturbances. I

Control of cell size within defined limits is vital for maintenance of normal organ function. This important feature of cell physiology can be disturbed by changes in membrane transport in epithelial cells. In addition, fluctuations in the osmolality of the extracellular fluid, caused by an abnormal plasma concentration of sodium, glucose, or urea can lead to derangements in cell size. Cell volume regulation is especially important in the brain because the brain is confined within a non-compliant vault and cannot tolerate significant perturbations in cell size. Therefore, brain cells have developed a coordinated array of adaptive mechanisms designed to modulate the cytosolic content of osmotically active solutes in response to alterations in the osmolality of the extracellular fluid. This process is controlled by various hormones including arginine vasopressin, insulin, and estrogen, and is subject to changes during development. The bulk of the change in cell content of osmolytes involves inorganic electrolytes. However, excessive variation in the cytosolic ionic strength has deleterious effects on protein structure and enzyme function. Therefore, brain cells have developed the capacity to accumulate or extrude various organic osmolytes in order to adjust the cytosolic osmolality without adversely affecting cell function. These solutes are termed non-pertubing osmolytes and belong to one of three classes of molecules: amino acids, carbohydrates and polyhydric sugar alcohols, or methylamines. Cerebral cells regulate the cytosolic content of organic osmolytes primarily by altering the transmembrane flux of these solutes. There are features of the cell volume regulatory response that are shared by the brain and kidney cells. However, there are important interorgan differences including the speed of response, the exact identitiy of the organic osmolytes utilized by each organ, and the reliance upon de novo osmolyte synthesis rather than transport in modulating cytosolic content of these solutes. An improved understanding of the cerebral cell volume regulatory response has led to better treatment of clinical disorders of plasma osmolality.Part II of this survey will be published in Pediatr Nephrol (1992) Volume 6, Issue 1     

Small Pancreatic and Periampullary Neuroendocrine Tumors: Resect or Enucleate?

Objective  The aim of this study was to compare the outcomes of enucleation versus resection in patients with small pancreatic, ampullary, and duodenal neuroendocrine tumors (NETs). Methods  Multi-institutional retrospective review identified all patients with pancreatic and peri-pancreatic NETs who underwent surgery from January 1990 to October 2008. Patients with tumors ≤3 cm and without nodal or metastatic disease were included. Results  Of the 271 patients identified, 122 (45%) met the inclusion criteria and had either an enucleation (n = 37) and/or a resection (n = 87). Enucleated tumors were more likely to be in the pancreatic head (P = 0.003) or functioning (P < 0.0001) and, when applicable, less likely to result in splenectomy (P = 0.0003). The rate of pancreatic fistula formation was higher after enucleation (P < 0.01), but the fistula severity tended to be worse following resection (P = 0.07). The enucleation and resection patients had similar operative times, blood loss, overall morbidity, mortality, hospital stay, and 5-year survival. However, for pancreatic head tumors, enucleation resulted in decreased blood loss, operative time, and length of stay compared to pancreaticoduodenectomy (P < 0.05). Conclusion  These data suggest that most outcomes of enucleation and resection for small pancreatic and peri-pancreatic NETs are comparable. However, enucleation has better outcomes than pancreaticoduodenectomy for head lesions and the advantage of preserving splenic function for tail lesions. Presented at the 2009 American Hepatopancreaticobiliary Association, March 14, 2009, Miami, FL American College of Surgeons Resident Research Scholarship, NIH Grant T32 CA009614 Physician Scientist Training in Cancer Medicine.