Repair of patellar tendon rupture using suture anchors

Acute isolated rupture of the patellar tendon traditionally has been repaired via transpatellar suture tunnels. This retrospective study evaluated the demographics and epidemiology of this injury as well as the effectiveness and complication rates of our suture anchor technique. Between 1993 and 2005, a total of 82 cases of patellar tendon disruption in 71 patients were repaired. Fourteen cases involved basic primary repair with suture anchors of an acute isolated rupture of the patellar tendon and had an average follow-up of 29 months (range: 3-112 months). There were 3 (21%) failures of repair. The remaining 11 patients had excellent range of motion and strength and returned to their preoperative level of function. These results are comparable with other reports in the literature. The suture anchor technique thus represents a viable option for repair of patellar tendon ruptures and should be investigated further with a randomized, controlled trial.     

Experimentally Induced Mood Changes Preferentially Affect Pain Unpleasantness

Our group previously demonstrated that changes in mood induced by pleasant or unpleasant odors affect the perceived unpleasantness of painful heat stimuli, without significantly altering perceived pain intensity. In the present study, we examined whether changing mood by viewing emotionally laden visual stimuli also preferentially alters pain unpleasantness. Twelve female subjects immersed their right hand in hot water while observing a video showing a person experiencing the same type of pain (ie, model condition), unpleasant scenes not involving people (ie, disasters condition), or a cityscape video (ie, cityscape condition). Subjects were asked to rate pain intensity, pain unpleasantness, mood, anxiety/calmness, and video unpleasantness, and their skin conductance was measured throughout the experiment. Pain unpleasantness (but not intensity) ratings were higher during the disasters condition, which was associated with the worst mood, than during the cityscape condition; neither mood nor pain unpleasantness was altered in the model video compared with the cityscape video. Moreover, mood was significantly correlated with pain unpleasantness but not with pain intensity. Because these results are similar to those observed when odors were used to alter mood, we conclude that the effects of mood on the affective components of pain are independent of mood induction technique used.

Perspective

This article provides new evidence that changes in mood affect the pain experience by preferentially modulating pain unpleasantness. This finding could potentially help health professionals to treat pain symptoms in patients with altered mood, suggesting methods of pain management aimed at easing the affective, along with the sensory, components of pain.     

Unmyelinated tactile afferents underpin detection of low-force monofilaments

Human hairy but not glabrous skin has unmyelinated (C) tactile (CT) afferents that project to insular cortex. We studied two subjects with the rare sensory neuronopathy syndrome who lack A-beta fibers but have relatively preserved C-fiber function. Weak monofilaments were detected on hairy skin alone. Hence, the ability to detect light touch does not depend entirely on the A-beta somatosensory system; CT afferents may contribute to the detection of weak monofilaments.     

Safety and efficacy of repeat administration of samarium Sm-153 lexidronam to patients with metastatic bone pain

BACKGROUND: Samarium Sm 153 lexidronam (Sm-153) is an effective and well-tolerated treatment for painful bone metastases. The purpose of the analysis was to assess the safety and efficacy of repeated doses of Sm-153 in patients with metastatic bone pain. METHODS: Data were collected prospectively for 202 patients administered 1.0 mCi/kg of Sm-153. Particular emphasis was placed on analysis of data from 55 patients receiving > or = 2 doses. Pain scores, adverse events, and hematologic parameters were assessed after each dose. RESULTS: Mild, transient suppression of platelets and white blood cell counts was the most common adverse event after treatment. Nadirs were approximately half of baseline at 4 weeks after dosing with recovery by Week 8 in 90% of patients. Temporary grade 3 thrombocytopenia occurred in 11%, 12%, and 17% of patients after the first, second, and third drug administration, respectively. Grade 3 leukopenia occurred in less than 7% of patients independent of the number of administrations. Significant decreases in pain scores (P < .001) were observed at Week 4 after each of the first 3 doses and maintained at Week 8 after the first 2 doses (P < .003) but not the third. Decreases in pain scores were observed in 70%, 63%, and 80% of patients, respectively, at Week 4 after the first 3 administrations. CONCLUSIONS: Repeated dosing of 1.0 mCi/kg of Sm-153 was both safe and effective and is a reasonable treatment option in patients whose bone pain responds and then recurs after an initial dose provided that adequate hematologic function is present at the time of drug administration.     

Thermal and tactile sensory deficits and allodynia in a nerve-injured patient: a multimodal psychophysical and functional magnetic resonance imaging study

OBJECTIVE: A case study was conducted to examine a patient with chronic neuropathic pain of the right foot following peripheral nerve injury and characterize associated sensory abnormalities. METHODS: Multimodal psychophysical examination of the patient's affected and nonaffected foot included thermal sensibility, dynamic touch, and directional sensibility. In addition, we used functional magnetic resonance imaging to study cortical representation of brush-evoked allodynia. RESULTS: Detailed psychophysical examination revealed substantial deficits in warm, cool, and tactile perception on the injured foot. These findings indicated severe dysfunction of perceptual processes mediated by A beta, A delta, and C fibers. Despite reduced tactile perception, light touch evoked a deep burning pain in the foot. Functional magnetic resonance imaging during brushing of the patient's injured foot showed that tactile allodynia led to activation of several cortical regions including secondary somatosensory cortex, anterior and posterior insular cortex, and anterior cingulate cortex. Brushing of the patient's nonaffected foot led to fewer activated regions. DISCUSSION: The profound sensory disturbances suggest a possible deafferentation type of tactile allodynia mediated by changes within the central nervous system, such as a disruption of normal tactile or thermal inhibition of nociception. The functional magnetic resonance imaging data suggest that tactile allodynia is represented in similar brain regions as experimental pain.     

Persistence of impaired reversal learning in young monkeys exposed to low levels of dietary lead.

Lead acetate in milk was fed daily to infant rhesus monkeys at doses averaging 0 (control), 0.287 (low-Pb), or 0.880 (high-Pb) mg/kgd for the first year of life. Pb concentrations in whole blood (PbB) averaged 4.15, 31.71, and 65.17 microgram/dl for the control, low-Pb, and high-Pb groups, respectively, during the year of treatment and declined toward control levels when Pb dosing was stopped. Behavioral observations during the year of treatment had shown that both experimental groups were retarded in their acquisition of object-cue discrimination reversal learning sets. At 4 yr of age, when PbB levels in all animals were normal, the ability of the same monkeys to acquire a series of 3 spatial-cue reversal learning sets was examined; these data form the basis for this report. In the first problem, the high-Pb group was significantly retarded in acquisition of the original discrimination and of most reversals, and the low-Pb group was retarded on reversal 1 only. These deficits declined in severity across the three problems administered, in a manner similar to that seen in the tests given during the first year of life. These data demonstrate that reversal learning retardation, observed early in life, can recur in postadolescent primates with a history of chronic, low-level Pb intoxication during infancy.     

Performance of two self-report measures for evaluating obesity and weight loss

OBJECTIVES: To evaluate performance of the Obesity and Weight-Loss Quality-of-Life (OWLQOL) and Weight-Related Symptoms (WRSM) measures. RESEARCH METHODS AND PROCEDURES: Four studies of obese persons 18 to 75 years of age were analyzed: a 12-week initial validation study, a clinical trial using blinded endpoint data at 50 to 83 weeks, and community studies conducted in the U.S. and Europe. Fifty-six initial validation study subjects visited 1 week after screening to evaluate reproducibility. RESULTS: Overall, 6107 obese persons completed one assessment, 291 completed follow-up at 12 weeks, and 642 at >50 weeks. Psychometric analyses resulted in a 17-item OWLQOL with a single score tested on five samples that was internally consistent (alpha values > 0.90) and reproducible (intraclass correlation coefficient > 0.95). The OWLQOL score (higher is better) was associated, as expected, with the symptom measure (lower is better, -0.54), generic quality of life measure (0.53), and measures of physical (0.40) and mental functioning (0.47). The 20-item WRSM was internally consistent (alpha = 0.87) and reproducible (intraclass correlation coefficient = 0.83). The OWLQOL discriminated between genders (p < 0.001), presence of disability days (p < 0.05), levels of BMI (p < 0.05), and levels of symptom bothersomeness (p < 0.001). Evaluation at 12 weeks yielded an effect size for > or = 2.5% weight loss of 0.77 for the OWLQOL and -0.54 for the WRSM. At > or = 50 weeks for > or = 10% weight change, effect sizes were 1.63 and -0.73, respectively. DISCUSSION: The OWLQOL and WRSM are brief, valid, reproducible, and responsive self-reported outcomes for evaluating obesity and weight loss.