Percutaneous electrical nerve stimulation for low back pain: a randomized crossover study

CONTEXT: Low back pain (LBP) contributes to considerable disability and lost wages in the United States. Commonly used opioid and nonopioid analgesic drugs produce adverse effects and are of limited long-term benefit in the management of this patient population. OBJECTIVE: To compare the effectiveness of a novel nonpharmacologic pain therapy, percutaneous electrical nerve stimulation (PENS), with transcutaneous electrical nerve stimulation (TENS) and flexion-extension exercise therapies in patients with long-term LBP. DESIGN: A randomized, single-blinded, sham-controlled, crossover study from March 1997 to December 1997. SETTING: An ambulatory pain management center at a university medical center. PATIENTS: Twenty-nine men and 31 women with LBP secondary to degenerative disk disease. INTERVENTIONS: Four therapeutic modalities (sham-PENS, PENS, TENS, and exercise therapies) were each administered for a period of 30 minutes 3 times a week for 3 weeks. MAIN OUTCOME MEASURES: Pretreatment and posttreatment visual analog scale (VAS) scores for pain, physical activity, and quality of sleep; daily analgesic medication usage; a global patient assessment questionnaire; and Health Status Survey Short Form (SF-36). RESULTS: PENS was significantly more effective in decreasing VAS pain scores after each treatment than sham-PENS, TENS, and exercise therapies (after-treatment mean +/- SD VAS for pain, 3.4+/-1.4 cm, 5.5+/-1.9 cm, 5.6+/-1.9 cm, and 6.4+/-1.9 cm, respectively). The average +/- SD daily oral intake of nonopioid analgesics (2.6+/-1.4 pills per day) was decreased to 1.3+/-1.0 pills per day with PENS (P<.008) compared with 2.5+/-1.1, 2.2+/-1.0, and 2.6+/-1.2 pills per day with sham-PENS, TENS, and exercise, respectively. Compared with the other 3 modalities, 91 % of the patients reported that PENS was the most effective in decreasing their LBP. The PENS therapy was also significantly more effective in improving physical activity, quality of sleep, and sense of well-being (P<.05 for each). The SF-36 survey confirmed that PENS improved posttreatment function more than sham-PENS, TENS, and exercise. CONCLUSIONS: In this sham-controlled study, PENS was more effective than TENS or exercise therapy in providing short-term pain relief and improved physical function in patients with long-term LBP.     

Changes in glutathione levels in the renal cortex of dogs during preservation by continuous hypothermic pulsatile perfusion]

A loss of glutathione (GT) from the kidney can cause increased sensitivity to oxygen free radical-induced injury. In this study we investigated the effects of kidney preservation on GT concentration in the cortex tissue, and how various GT precursors affect GT concentration in the dog kidney. During five day continuous machine perfusion of the kidney at 5 degrees C, there was a loss of GT from the cortex tissue (524 +/- 1% GT remained after 5 days). Perfusion with reduced glutathione (GSH, 3 mM) suppressed this loss (77 +/- 11% of GT remained after 5 days). Oxidized glutathione (GSSG) did not prevent the loss of GT. The addition of the three amino acids that make up GT (glycine, glutamic acid, and cysteine, 3 mM each) stimulated the synthesis of GT in the kidney during hypothermic perfusion (137 +/- 23% of control values at 5 days). The increase in tissue GT stimulated by GSH or other precursors was sensitive to the GT synthetase inhibitor, buthionine sulfoximine. This indicated active GT metabolism even at 5 degrees C in perfused kidneys. This study showed that in kidney preservation there was a loss of GT that could be suppressed by the addition of various precursors for GT synthesis. The loss of GT from preserved kidneys may be one cause of post-transplant renal injury which could be prevented by utilization of the appropriate GT precursors.     

Immunocytochemical expression of E-cadherin on fine-needle aspirates from breast carcinomas correlate with the cell dissociation pattern seen on smears.

Altered E-cadherin expression has been suggested to be of prognostic significance in breast cancers and to correlate with tumor subtype and grade. A dysfunctional, intercellular adhesion system may be responsible for the tumor cell dissociation pattern seen on fine-needle aspirate cytology (FNAC). The aim of our study was to determine E-cadherin expression on direct FNAC smears from breast carcinomas and compare the results with the dyscohesion grade of the tumor cells and the cytological grading. The material consisted of FNAs from 56 breast carcinomas. The degree of cellular cohesion was estimated semiquantitatively. Full expression of E-cadherin was defined as a complete and strong membrane staining of virtually all tumor cells. All nonductal as well as 85% of the invasive ductal carcinomas revealed reduced expression or negativity for E-cadherin. In all, 25% of carcinomas with dyscohesion Grade 1 (mainly in groups) revealed full expression of E-cadherin, in contrast to 12.5% of tumors with dyscohesion Grade 3 (mainly dispersed cells). Nuclear positivity was seen in 21% of the tumors (12 cases) and seven of these were G3 ductal carcinomas. In conclusion, E-cadherin expression correlated with the cell dissociation pattern seen on direct smears from FNAC of breast carcinomas, but is only one of several markers that modulate this pattern. High-grade carcinomas rarely revealed full expression and had a high incidence of aberrant nuclear localization of E-cadherin.     

Tuberculosis of the posterior vertebral arch. Apropos of 2 cases

Spinal tuberculosis involving vertebral arc occurred in two patients. The first case had a single lesion presenting as a pseudo-tumoral feature. The second one had plurifocal tuberculosis peripheral and spinal one. The needle biopsy permitted the diagnosis in the two cases. Computed tomography showed the vertebral arch lesions with details and contiguous corporeal involvement. Clinical and radiological improvement was obtained after medical treatment.     

Investigation of natural radioactivity levels in water around Kadugli, Sudan.

Surface water from Miri Lake and groundwater from around Kadugli (West-Central Sudan) obtained by means of hand-pumps was analysed for (238)U, (226)Ra, (222)Rn, and (232)Th activity concentrations. The surface water showed very low levels of radionuclide concentrations: <1.0-7.5, 8.5-16.5, <1.6, and <0.1-0.39mBqL(-1) for (238)U, (226)Ra, (222)Rn, and (232)Th, respectively. Groundwater revealed a significant amount of natural radioactivity (16.1-1720, 7.7-14.3, 3000-139,000, <0.1-39mBqL(-1)) respectively. The overall annual effective dose was below the WHO reference dose level of 0.1mSvyr(-1) except in one groundwater sample with an associated dose of 0.7mSvyr(-1).     

Prolonged disease-free survival in pediatric non-Hodgkin's lymphoma using ifosfamide-containing combination chemotherapy.

Pediatric non-Hodgkin's lymphoma (NHL) constitutes 16 per cent of pediatric malignancies reported to the National Cancer Institute (NCI) in Cairo. The adopted treatment for these cases was, from 1982 to July 1985, a modified St Jude's regimen consisting of: vincristine, cyclophosphamide, adriamycin, prednisone and intrathecal methotrexate for the first 6 weeks for induction, followed by cranial irradiation for cranial prophylaxis. Patients in remission received maintenance therapy for 18 months. Of 32 patients complete remission (CR) was achieved in 24 patients (75 per cent); partial remission (PR) in one patient (3 per cent); five patients showed no response (15 per cent) while two patients died during the induction phase. At 60+ months follow-up, 60 per cent of cases are still alive, disease-free, and overall survival is 66 per cent. A new protocol was adopted in 1985, consisting of alternating cycles: A and B, for 4-8 cycles. Cycle A: cyclophosphamide, high dose ara-C, adriamycin, and vincristine. Cycle B: ifosfamide, methotrexate, VP 16, with intrathecal methotrexate. The response in 39 cases is: CR in 31 cases (82 per cent); PR in four cases (10 per cent); no response in three cases (8 per cent). At 60+ months, the disease-free survival is 60 per cent, and overall survival 80 per cent. This new protocol has the advantage of: short duration of therapy and so better patient compliance, no maintenance therapy or cranial irradiation with its sequelae in the future. Moreover, it has a better overall survival.     

VEGF and mRNA VEGF expression in CSF from Behçet's disease with neurological involvement

Vascular endothelial growth factor (VEGF) stimulates angiogenesis, but is also pro-inflammatory and plays an important role in the development of neurological disease, where it can have both attenuating and exacerbating effects. Several studies have indicated that VEGF-A (VEGF) may play a role in the pathogenesis of neurological inflammatory diseases.To assess the role of VEGF in patients with Behçet's disease with neurological involvement, VEGF was measured in the cerebrospinal fluid (CSF) of 32 patients compared to a group of 12 patients with noninflammatory neurological diseases (NIND) and 14 patients with multiple sclerosis (MS). We have also studied the expression of mRNA-VEGF (VEGF-A) in CSF and in peripheral blood mononuclear cells.The mean VEGF_CSF was significantly increased in neuro-BD and MS patients compared to NIND patients. There was an association between neuro-BD-VEGF_CSF, and leukocyte count. A significant correlation was also observed between neuro-BD-VEGF_CSF and CSF_%CD4 cells. As a measure of the integrity of the blood-brain barrier Q_albumin was found correlated to VEGF_CSF. VEGF mRNA was significantly increased in neuro-BD patients compared to NIND patients.These results indicate that, VEGF may be associated with the increased percentages of CD4 cell subpopulation. The role of VEGF is within the inflammatory cascade in the mediation of blood-brain barrier disruption and not specific to Behçet's.