Randomized trial of Codetron for pain control in osteoarthritis of the hip/knee

Patients suffering from pain due to osteoarthritis of the hip and knee participated in a double-blind placebo controlled trial using daily Codetron home care units for 6 weeks over the tibial, saphenous, popliteal and sciatic nerves, and tender points. Seventy-four percent of patients in the real Codetron (Group A) and 28% of the patients in sham Codetron (Group B) improved their pain level more than 25% as measured by visual analogue scale. The difference in pain improvement in the two groups was statistically significant (p less than 0.02 using Fisher's exact probability ratio). Other functional parameters proved to be insensitive to change in this study. This is highly suggestive of beneficial effect of nonhabituating Codetron as a complementary modality in the therapy of chronic pain conditions such as osteoarthritis.     

Curcumin Reduces Burn Progression in Rats

Objectives Cutaneous burns are dynamic injuries with a central zone of necrosis surrounded by a zone of ischemia. Conversion of this ischemic zone to full necrosis over the days following injury is due in part to highly reactive oxygen radicals. Curcumin is a component of the Oriental spice turmeric that has been shown to have antioxidant and antiapoptotic properties. The authors hypothesized that treatment of burns with curcumin would reduce the conversion of the ischemic zone to full necrosis. Methods This was a randomized controlled experiment. Twenty Sprague‐Dawley rats were used. Two burns were created on each animal's dorsum using a brass comb with four rectangular prongs preheated in boiling water and applied for 30 seconds, resulting in four rectangular 10 × 20–mm full‐thickness burns separated by three 5 × 20–mm unburned interspaces (zone of ischemia). Animals were randomized to curcumin or vehicle by oral gavage 30 minutes before injury and at 24, 48, and 72 hours after injury. Wounds were observed at one, two, and three days after injury for visual evidence of necrosis in the unburned interspaces. Full‐thickness biopsy specimens from the interspaces were evaluated with hematoxylin and eosin staining seven days after injury for evidence of necrosis. The percentage of interspaces that progressed to necrosis was compared with chi‐square tests. Results Forty comb burns with 120 unburned interspaces were created, evenly distributed between curcumin and vehicle alone. The percentage of interspaces that progressed to full‐thickness necrosis at one, two, three, and seven days after injury in the curcumin and vehicle groups were 30% versus 63% (p = 0.003), 30% versus 70% (p < 0.001), 63% versus 95% (p = 0.02), and 63% versus 95% (p = 0.02), respectively. Conclusions Pretreatment of rats with oral curcumin followed by once‐daily oral treatment for three days reduced the percentage of unburned skin interspaces that progressed to full necrosis.     

Evaluation of selective actions of dopamine D-1 and D-2 receptor agonists and antagonists on opioid antinociception

The effect of the selective dopamine receptor agonists SKF 38393 (D-1) and quinpirole (D-2) on nociception was studied in the mouse tail immersion test. The D-1 receptor agonist induced mild hyperalgesia whereas the D-2 agonist produced antinociception. Pretreatment with either the selective D-1 receptor antagonist SCH 23390 or the D-2 receptor antagonist (-)-sulpiride converted the hyperalgesia produced by the D-1 agonist into an antinociceptive response whereas the effect of the D-2 receptor agonist was significantly antagonised. The antinociceptive response of selective opioid agonists was also studied in combination with selective dopamine receptor agonists and antagonists. Sufentanil (mu-opioid) antinociception was enhanced in animals pretreated with (-)-sulpiride but not SCH 23390. In animals co-administered sufentanil with SKF 38393 there was a reduced antinociceptive effect whilst quinpirole enhanced the action of sufentanil. Likewise, antinociception induced by the kappa-opioid agonist U50,488H was unaltered in animals pretreated with SCH 23390, increased by (-)-sulpiride, and reduced by SKF 38393. delta-Opioid antinociception induced by [D-Ala2,D-Leu5]enkephaline remained unmodified following pretreatment with either (-)-sulpiride or SCH 23390 but was potentiated in animals which received both the delta-agonist and the D-2 receptor agonist. It is concluded that D-2 receptor agonists not only have intrinsic antinociceptive activity, but can also potentiate opioid-induced antinociception. Similarly, dopamine D-2 receptor antagonists appear to potentiate opioid-induced antinociception in this nociceptive model.     

Post-traumatic squamous-cell carcinoma

Between January 1, 1976, and January 1, 1986, we treated sixty-three patients who had histologically proved squamous-cell carcinoma that originated in a pre-existing scar or sinus of an extremity. In 49 per cent of the patients, metastases to regional lymph nodes either were present when the patient was first seen or subsequently developed. The age and sex of the patient, the etiology of the original scar, and the duration of illness bore no relationship to the result. The most significant factor in predicting the outcome was the grade of the tumor: for grade-I (low-grade) lesions, the incidence of metastasis was 10 per cent; for grade-II (moderately well differentiated) lesions, 59 per cent; and for grade-III (poorly differentiated) lesions, 86 per cent. Eleven patients had wide local excision of the lesion, which resulted in local recurrence in four patients and metastasis in three. Thirty patients had therapeutic amputation: one patient had recurrent disease and five patients had metastasis. Radical resection of lymph nodes after metastasis was uniformly unsuccessful in preventing additional metastasis. Ten patients who had a grade-II or grade-III tumor had prophylactic irradiation of the regional lymph nodes after the definitive operative treatment. At an average of thirty-seven months of follow-up, only one of them had metastasis. We recommend that well differentiated squamous-cell carcinoma be considered a low-grade tumor, according to the staging system for musculoskeletal neoplasms, and that more poorly differentiated squamous-cell carcinoma (grades II and III) be considered a high-grade lesion.(ABSTRACT TRUNCATED AT 250 WORDS)     

Coronary thrombosis and platelet/fibrin microemboli in death associated with acute myocardial infarction.

The frequency and clinical significance of platelet/fibrin microemboli in the microcirculation were investigated in 24 patients whose deaths (before and during hospital admission) were associated with acute myocardial infarction. An acute coronary thrombus was present in all the hearts. In nine hearts an acute thrombus was found in more than one major epicardial coronary artery. A total of 35 acute thrombi were found in the 24 hearts. Platelet/fibrin microemboli were found in 19 (79%) hearts. Eighteen patients died in hospital. The hearts of 16 of these cases showed microemboli; 16 had important arrhythmias or various forms of heart block; 13 showed acute pathological changes in the conduction system. Fourteen of the deaths in hospital were primarily the result of cardiogenic shock and four were primarily caused by arrhythmia. Six of the deaths that occurred before admission to hospital were regarded as being arrhythmic in origin. Three of these showed microemboli and the other three had acute pathological changes in the conduction system. Microemboli were found in two (24%) of 12 control hearts. Coronary thrombosis was found in most deaths caused by acute myocardial infarction and platelet/fibrin microemboli were present in the majority of such hearts. These may arise from the coronary thrombus in the larger upstream vessel supplying the microcirculation.     

Cibacron blue stimulation of surfactant secretion in rat type II pneumocytes.

1. The effect of cibacron blue, a selective P2y-purinoceptor antagonist in some systems, on the stimulatory effect of adenosine 5'-triphosphate (ATP) on [3H]-phosphatidylcholine secretion was examined in primary cultures of rat type II pneumocytes prelabelled by overnight culture with [3H]-choline. 2. Cibacron blue alone stimulated phosphatidylcholine secretion in a concentration-dependent manner in the range 10(-4)-10(-3) M. At a concentration of 10(-4) or lower, cibacron blue had no effect on ATP-induced phosphatidylcholine secretion but at 10(-4)-10(-3) M it increased the effect of ATP. Enhancement of the ATP effect was apparent whether cibacron blue was added before or together with ATP. Cibacron blue also increased ATP-induced secretion in the presence of the P1-purinoceptor antagonist, xanthine amine congener (10(-5) M). 3. The stimulatory effect of cibacron blue on phosphatidylcholine secretion was additive to those of 5' (N-ethylcarboxyamido) adenosine (NECA) and terbutaline but less than additive to that of ATP. 4. Cibacron blue alone had no effect on formation of cyclic AMP or inositol phosphate and when added simultaneously with ATP it did not affect the ATP-induced increase in these second messengers. Preincubation of the cells with cibacron blue before addition of ATP, however, resulted in antagonism of the ATP-induced increase in cyclic AMP and inositol phosphates. Preincubation with ATP had the same effect. The stimulatory effects of NECA and terbutaline on cyclic AMP formation were enhanced by preincubation with cibacron blue. 5. Thus, ATP-induced phosphatidylcholine secretion in type II cells is not diminished by the P2y-antagonist, cibacron blue.(ABSTRACT TRUNCATED AT 250 WORDS)     

Gliadin antibody detection in gluten enteropathy

Circulating antigliadin antibody has been described in patients with gluten enteropathy although the prevalence varies in different studies. It has been suggested that the investigation for antigliadin antibody might be useful as a screening test. The object of the present study was to evaluate two different techniques for assaying these antibodies — an indirect immunofluorescent method and an enzyme-linked immunosorbent assay (ELISA). Antibodies were assayed in the sera of 102 patients in whom jejunal biopsies were also obtained. The specificity of both tests was greater than 95%, and the correlation between the presence of antibody and histology was significant (p < 0.005), though the sensitivity of each test was less than 70%.