bluuebunny/crossref_metadata_2025 huggingface dataset:
Anabolisants et bovins de boucherie : II. Bœufs à l'auge
Authors: Willemart Jean-Pierre , Bouffault Jean-Claude , Egron L.
Published: February 2018

Anabolics and meat cattle - steers fed in stable

A trial was done with 80 steers (mean live weight 680 kg at the first treatment). They were prepared for slaughter, first at grass and there in stable.

In stable five groups were done :

— controls (16 steers)

— E2 (40 mg) + TBA (200 mg) (16 4-16 steers)

— Z (72 mg) + TBA (280 mg) (16 steers)

— E2 (20 mg) + TBA (140 mg) (16 steers)

During the stable period, there were : Increase in : — live weight (DWG) ;

— carcasse weight ;

— slaughter yield.

Decrease in : — FCI.

Group n. 1 Group n. 2 and 5 Group n. 3 Group n. 4

For the total period (grass + stable) of 70 d. 4-70 d. the DWG were better in treated animals from 203 to 520 g/day.

Repeated anabolic treatment gave a better result than a single one. The results of stable period were good. The feeding on grass require a supplementary feeding to give optimum results.
Une banque de données sur la composition des aliments : un enjeu économique et technique pour l'industrie agro-alimentaire
Authors: Feinberg M. , Ireland-Ripert Jayne
Published: February 2018

Les auteurs décrivent les objectifs et la structure du Répertoire Général des Aliments (R.E.GA.L.), banque de données sur la composition des aliments actuellement en développement au Centre Informatique sur la Qualité des Aliments (C.I.Q.U.A.L.). Ils précisent ensuite son contenu, les modes de distribution possibles et la méthodologie de mise à jour de cette banque. En particulier, ils insistent sur le principe de codification des aliments et des constituants ainsi que sur le mode de validation des données. A titre d’illustration intéressant les industries agro-alimentaires, quelques exemples d'utilisation de la banque sont donnés.
Un cas d’ehrlichiose probable chez le chat
Authors: Charpentier F. , Groulade Paul
Published: February 2018

Report of one case of probable feline ehrlichiosis

The authors observed in one cat : anemia, fever, anorexia, weight loss, a Morula of erhlichia canis in the cytoplasma of feline monocytes.
La métrite contagieuse équine à Haemophilus equigenitalis. Situation en France
Authors: Vaissaire Josée , Plateau Éric , Laugier Claire , Tainturier Daniel
Published: February 2018

Contagious equine metritis in France

The authors describe the situation of the contagious equine metritis during the breeding season in 1986. The isolation of the germ was sometimes difficult ; this was due to different reasons : quality of the samples, presence of other pathogenic germs such as Klebsiella, streptococci, staphylococci and physiologic status of the reproductive tractus of the animals at the moment of the breeding.
Recherche en homéopathie. La rigueur : toujours plus
Authors: Belon Ph.
Published: February 2018

Présentation critique des buts, des méthodes et des résultats obtenus pendant les 40 dernières années par la recherche en homéopathie.

On s’appuie sur deux séries d'expérimentations pour souligner la recherche constante d’une plus grande fiabilité des résultats obtenus et une modification des questions soulevées par ces travaux.
Etude de colibacilles isolés lors de septicémies bovines : 1. Avec symptômes méningés. 2. Avec syndrome immunodépressif et purpura hémorragique
Authors: Contrepois Michel , Ribot Y.
Published: February 2018

Study of colon bacilli isolated from bovine septicaemia :

1. associated with meningeal symptoms

2. associated with immune depressive syndrome and haemorrhagic purpura

We have studied virulence factors of colon bacilli isolated from bovine septicaemia. In the first case of septicaemia with meningeal symptoms a same pathogenic E. coli (LD 50 % in mice about 2 X 107) non hemolytic, ColV+, producing hydroxamate siderophore and surface antigen 31 a was isolated. In a second case of septicaemia among young cattle with immune depressive syndrome and haemorrhagic purpura, were isolated highly pathogenic E. coli (LD 50 % in mice about 106) which produced hemolysin, hydroxamate siderophore but no V colicine nor surface antigen 31 a.
Parvovirose canine expérimentale. Recherche directe du virus dans les selles avec des anticorps monoclonaux, comparée aux techniques d'hémagglutination et d’isolement en culture cellulaire
Authors: Aubert A.
Published: February 2018

Les auteurs étudient les avantages et les inconvénients de la technique de recherche du parvovirus canin dans les selles au moyen de billes de latex sensibilisées par des anticorps monoclonaux, après infection expérimentale. Ils les comparent à ceux des méthodes classiques en culture cellulaire. La technique des billes de latex s’avère facile, sensible et spécifique, mais plus tardive et de plus courte durée que les techniques classiques.

L’étude de la cinétique des anticorps inhibant l’hémagglutination permet de constater qu’ils apparaissent très nettement après l’infection et persistent au-delà de 30 jours, longtemps après la disparition du virus.
Précautions préopératoires et généralités sur la chirurgie osseuse des ailes d'oiseaux
Authors: Wailly Philippe de
Published: February 2018

Après avoir énuméré les précautions préopératoires et les particularités anatomiques et physiologiques propres aux os des oiseaux, l’auteur évoque les généralités concernant le traitement des fractures des ailes, les précautions chirurgicales et les principes de l’orthopédie aviaire. Vous trouverez la description des méthodes d’immobilisation par bandage chez les oiseaux de petite taille ainsi que les techniques de mise en place des fixateurs internes et externes au niveau des os de l’aile.
L'arthrite encéphalite caprine (A.E.C.). Etude sérologique, anatomo-clinique. Procédures d’assainissement
Authors: Perrin Gérard , Polack Bruno
Published: February 2018

Caprine arthritis encephalitis (c.a.e.) serological survey -heat treatment.

Recording the main anatomic and clinic aspects of Caprine Arthritis Encephalitis, the autors show the status of 22 flocks of Poitou-Charentes area. Pourcentages of sero-positive animals in one year age and second year age classes are a very significant test to assess clinical incidence of the disease. Heat-treatment of colostrum reducing such pourcentage allows to reduce consequently clinical incidence.
La vaccination périfocale de nécessité des espèces sensibles à la fièvre aphteuse et son application dans le contexte du système français de lutte contre cette épizootie
Authors: Fleckinger Robert
Published: February 2018

Dans la lutte contre la fièvre aphteuse, associée aux mesures sanitaires classiques, la vaccination «périfocale», dite «en anneau», des espèces sensibles, s’était révélée efficace pour éviter l’extension de la maladie à partir d’un premier foyer.

Dans le contexte nouveau de la vaccination générale obligatoire annuelle des bovins, la vaccination ou revaccination périfocale complémentaire, sitôt l’apparition d’un cas de fièvre aphteuse, complète les mesures d’abattage et de désinfection, en opposant un manteau généralisé et renforcé d’animaux immunisés à la multiplication du virus sauvage.

Une analyse des lois, règlements, instructions y relatifs, met en évidence la faiblesse des bases juridiques actuelles qui pourraient permettre aux préfets de rendre obligatoire la vaccination ou revaccination complémentaire en anneau dans le < système de lutte français ». Cette situation conduit à appeler l’attention du Ministre de l’Agriculture sur la nécessité de préciser par arrêté :

1. Le caractère obligatoire de la vaccination ou revaccination périfocale complémentaire de nécessité des espèces sensibles à la fièvre aphteuse en cas d’apparition de la maladie.

2. Les conditions techniques de son application dans le contexte de la vaccination générale annuelle obligatoire des bovins.

3. Les modalités de la fourniture du vaccin.

4. Les modalités d’exécution.
Un nouvel antiparasitaire synthétique polyvalent : le thiophanate
Authors: Guilhon Jean
Published: February 2018

A new polyvalent synthetical antiparasitic.

Thiophonate reveals as a new synthetical antiparasitic drug, non embryo-toxic, with fungicid, nematodicid and dicrocoelicid properties.
Modèles animaux et études des effets de la microgravité. II. Programmes de recherche
Authors: Milhaud Claude
Published: February 2018

Animal models and study of effects of microgravity ii. research programmes.

Research programmes in space physiology involving the animal model are essentially initiated by the USA and die USSR. From 1973 to 1987 the Soviet Union orbited 8 biological satellites payloads including rats and rhesus monkeys.

Experiments carried out with international cooperation significantly contributed to the knowledge of the physiological effects of microgravity. The research programme proposed by NASA for the period 1990-1995 will use rats, squirrel monkeys and rhesus monkeys. French research teams participate in these various projects.
Utilité du milieu au tétrathionate (T.N.B.) pour la recherche des Salmonella par la méthode immuno-enzymatique des anticorps monoclonaux
Authors: Catsaras Marc , Mollard M. , Duée J. P.
Published: February 2018

Au cours de la présente expérimentation, 40 séries de viande hachée sont inoculées, soit avec Salmonella typhimurium (30 séries), soit avec des Citro-bacter (10 séries) à un taux de 106 par gramme.

Les Salmonella sont recherchées sur Tétrathionate + novobiocine de Jeffries (TNB) et sur Sélénite, isolés respectivement sur Desoxycholate et sur gélose S.S., et avec la méthode immunoenzymatique des anticorps monoclonaux.

La possibilité d’éliminer les faux positifs dus à Citrobacter (Bethesda ) par inhibition de leur culture sur TNB est mise en évidence.
Implementation of multiple interpretation data model concepts in CIDOC CRM and compatible models
Authors: Van Ruymbeke Muriel , Hallot Pierre , Nys Gilles-Antoine , Billen Roland
Published: February 2018

Modelling cultural heritage is a research topic shared by a broad scientific community.  Although  this subject has been widely studied, it  seems that  some  aspects  still  have  to  be  tackled.  This paper describes two CIDOC (ICOM’s International Committee for Documentation) Conceptual Reference Model (CRM) extension proposals (A & B) dedicated to structuring knowledge concerning historical objects and historical events.  It  focuses  on  multiple  interpretations and sequential reality, this last being a concept which does not exist in CIDOC CRM but was originally developed in another conceptual model, the Multiple Interpretation Data Model (MIDM). To begin, an extensive description of MIDM concepts is given as well as a recall of its main peculiarities. It is followed by a mapping proposed to translate MIDM concepts into ontologies  devoted to describing cultural  heritage  entities  and  activities,  the CIDOC CRM  and  compatible  models. Unfortunately,  some MIDM  concepts  are  not  covered  by this  mapping  because  they  do  not  match  with existing  CRM entities and properties, and this paper explains why an extension is necessary. It describes how the two versions of the extension proposal cover the missing MIDM concepts. One of these two versions, the proposal A, has been implemented as ontology in Protégé and has been tested through an instantiation phase using a real example. This instantiation phase is fully detailed. It shows that proposal A works coherently with CRM ontologies. On another hand, instantiation phase highlights improvements needs such as recording chronology in a structured way.

Highlights:

Cultural Heritage modelling involves two different ontological concepts: reality and information held about it.

Historical Objects existence is a sequence made by events, stability periods and changes affecting it.

Multiple Interpretation Data Model mapping to CIDOC CRM and its extension proposal take into account difference between reality and information. They also manage sequence concept.
Management of Burns
Authors: Dhanraj Prema
Published: February 2018

Skin is an essential organ of our body & performs many vital functions. It consists of epidermis & Dermis. Epidermal and burns to superficial part of dermis heal very well with no or minimal scarring. Burns to deep dermis usually heal with hypertrophy and contractures. When skin is burnt, all vital functions of skin are lost. Burns of the face usually heal well due to presence of high proportion of papillary dermis. They should be protected from sunlight. It is known that reticular layer of dermis comes to the defense and protects against formation of contractures. It is also proved that thin layer over eyelids, face and neck is responsible for development of contractures. Thick layer of skin over buttocks & back protects against developing contractures. We should remember that once a scar, it is always a scar. It may not be possible to remove the scars completely, but we can minimize the burn scar. Management of burns includes, management at the site of injury, management in emergency room, management in ICU (intensive care unit), HDU (High dependency unit) and also wards. Meticulous dressings to be done as and when required. When all the wounds have healed advice for massage with oil or moisturizer, active physiotherapy, provision of cervical collar, splints and pressure garments. We should check for compliance of the treatment at regular intervals. Counselling of the patients requires utmost attention. Psychological support and rehabilitation is very essential as many patients may go for psychiatric illnesses. Secondary surgery for correction of deformities after 6 months or as per indication is mandatory.

How to cite this article

Dhanraj P. Management of Burns. J Med Sci 2017;3(4):102-110.
Management of a Fractured Anterior Tooth by Reattachment using Fiber-reinforced Post
Authors: John Nino , Raj Aparna , Radhakrishnan Nair K , Kumar Meenu M , Alexander Rinsu N
Published: February 2018

Reattachment is an effective, economical, and conservative procedure to restore the natural shape, contour, translucency, surface texture, occlusal alignment, and color of the fractured tooth that results in positive emotional and social response in a patient. This case report details the multidisciplinary management of a fractured central incisor with fracture line extending subgingivally in the palatal region. Access opening was done through the fractured segment of 21 and it was detached and stored in saline. After completion of endodontic therapy, crown lengthening procedure was done. Fiber post was placed for added reinforcement and the fragment reattached. A new trauma occurred after 4 months, but the reattached fragment did not get detached.

How to cite this article

Alexander RN, Nair KR, Geetha P, John N, Raj A, Kumar MM. Management of a Fractured Anterior Tooth by Reattachment using Fiber-reinforced Post. Cons Dent Endod J 2017;2(2):56-59.
Tolerability and efficacy of two synergistic ratios of oral morphine and oxycodone combinations versus morphine in patients with chronic noncancer pain
Authors: De la Iglesia, MD Felix A. , Pace, PhD Gary W. , Robinson, PhD Gary L. W. G. , Huang, MD, PhD Nuo-Yu , Stern, PhD Warren , Richards, MD, PhD Patricia
Published: February 2018

Objectives: Analgesic synergy and improved tolerability have been reported for flexible dose morphine and oxycodone combinations. This report describes two studies with similar double-blind, randomized, 7-day crossover designs (up to 7 days per arm) conducted to 1) explore the analgesic and safety benefit of fixed ratio of morphine (M) and oxycodone (O) combinations (MOX) and 2) define the optimal ratio for morphine and oxycodone combination.Setting: Clinical study centers in Australia.Patients: Patients with chronic noncancer pain.Intervention: Eligible patients were randomly assigned to receive flexible doses of either M or fixed ratio of MOX (M3:O2 in study A; M1:O2 in study B). The starting doses of M or MOX were the morphine equivalent doses (MEDs) converted from the analgesics received before entering double-blind treatment. At each crossover period, the doses were titrated to achieve analgesia at steady state, which was defined as when the same total daily dose (±10 percent) had been given consecutively for 3 days.Main outcome measure: The primary endpoint was the study medication dose (MED), which produced adequate pain control at steady state.Results: Analgesic synergy in MOX was observed in both studies. On an MED basis, 61.6 percent (study A, M:O = 3:2) or 46.8 percent (study B, M:O = 1:2) more MED were needed for M monotherapy to achieve steady-state pain control when compared with MOX. Patient tolerability profiles were also generally better in the MOX groups.Conclusion: A 3:2 or1:2 fixed ratio combination of morphine and oxycodone (MOX) produced analgesic synergy and a tolerability profile improvement in patients with chronic noncancer pain.
Establishing the safety and efficacy of an opioid titration protocol
Authors: Wells, DNSc, RN Nancy , Murphy, MD Barbara , Douglas, MSN, RN Stacey , Yelton, MSN, RN Nancy
Published: February 2018

The primary goal of this single-group study was to determine the safety of a standard opioid titration order sheet to manage pain in ambulatory cancer patients. Secondary goals were to examine opioid toxicity and efficacy of this pain protocol.Twenty-seven patients who required fixed-dose opioids and who had uncontrolled pain were enrolled. All patients had their initial opioid dose titrated by the study physician using the opioid titration order sheet. Data were obtained by the study nurse during a weekly telephone interview and used to determine if pain was controlled. After initial titration, a trained study nurse titrated opioid doses based upon the standing order sheet. At each contact, patients were assessed for adverse effects, pain intensity, and analgesics used.Patients who completed the four-week trial (n = 17) did not differ from patients who did not complete the trial. No adverse effects were observed in 39 opioid titrations com-pleted by the study nurse. Opioid toxicities, worst pain, usual pain, and pain-related distress declined from baseline to week four. Patients who were adherent to their prescribed medications reported significantly lower pain intensity and distress (ps < 0.06).The opioid titration order sheet, used by a trained nurse, is safe to use in ambulatory cancer patients who have moderate to severe pain. Common opioid toxicities were reduced. The protocol also demonstrated initial efficacy in improving worst and usual pain and pain-related distress. Further research to establish efficacy of theprotocol is recommended.
Extended-release lipid-foam encapsulated epidural morphine: Clinical efficacy and safety precautions
Authors: Hutchison, PharmD Rob
Published: February 2018

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Fluctuating QTc interval in an asymptomatic patient treated with methadone for chronic pain
Authors: Ower, MD, FRCPC Katherine , Morley-Forster, MD, FRCPC Patricia , Moulin, MD, FRCPC Dwight
Published: February 2018

Prolongation of the QT interval associated with ventricular arrhythmias has been the most common cause of the restriction or withdrawal of drugs from the market in the past 10 years. Methadone, a synthetic opioid that is increasingly used for the management of chronic pain, has recently been implicated in the development of the prolonged QT syndrome. We present a case report of a patient who developed a prolonged QT while being treated with oral methadone for a chronic pain syndrome. Of particular interest in this patient is the fluctuation of the QT interval at a stable dose of methadone, suggesting that a single normal electrocardiogram (ECG) does not guarantee that the patient is not at risk of ventricular arrhythmias. After reviewing the current literature, we suggest that there is no dose of methadone that may be considered to be completely safe. Other risk factors for prolonged QT interval such as underlying cardiac abnormalities, electrolyte disturbances, and concurrent medications should be sought, and all patients should be monitored with serial ECGs even when methadone doses remain stable.
Prescription opioid dependence and treatment with methadone in pregnancy
Authors: Eken Sander, MD Stephanie C. , Hays, MD, MBA Lon R.
Published: February 2018

Prescription opioids are used medically to treat pain, but their diversion and abuse continues to escalate in the United States.1 Abuse of OxyContin (Purdue Pharma LP, Stamford, CT), a timed-release form of oxycodone, is a major focus of public health and law enforcement agencies. 2 The rise in opioid abuse may lead to an increase in opioid dependence in pregnancy, which was a focus of this study. Our retrospective chart review examined the demographics and patterns of opioid addiction of pregnant women admitted to an inpatient psychiatric unit in an academic medical center in central Kentucky. Charts of 94 women admitted from January 2001 to May 2004 were reviewed. Information obtained included demographics and details of their opioid use, including the specific opioid( s) used, route of administration, and duration of use. Treatment information included length of hospital stay, stabilizing dose of methadone, comorbid drug use, and concomitant Axis I diagnoses. Most women were in their mid-twenties and in the second trimester of pregnancy when they sought treatment. Benzodiazepines were the most common comorbid drugs of abuse and the most frequent medical complication of their drug use was hepatitis C, newly diagnosed in 11 patients. This study demonstrates the need for further research in prescription opioid dependency in pregnancy, methadone maintenance therapy, the safety of detoxification, and neonatal outcomes.
Use of a comprehensive survey as a first step in addressing clinical competence of physicians-in-training in the management of pain
Authors: Chaitowitz, MBBCh Mark , Tester, MD William , Eiger, MD Glenn
Published: February 2018

Deficiencies in practice, knowledge, and competence among physicians are important contributing factors to the unsatisfactory level of analgesic care in hospitalized patients. By way of a comprehensive survey, we characterized these deficiencies within an internal medicine residency program as an initial step in designing remedial educational strategies. To do so, an anonymous 43-item survey was administered to residents in an internal medicine program. A total of 61 residents (69 percent) responded.The results indicated that patient-controlled analgesia (PCA), a standardized pain scale, and an opioid equivalence table were underused. Competence in opioid conversion was suboptimal, but completion of an oncology rotation and familiarity with the opioid equivalence table predicted greater competence in this area (p = 0.007 and p = 0.001, respectively).Self-perceptions of adequacy of training and painmanagement competence were predictors of knowledge (p = 0.026 and p = 0.038, respectively). Attitudes regarding opioid analgesia were generally satisfactory (i.e., low “opiophobia” score), although the risk of addiction was still overestimated.The characterization of deficiencies in pain management in a residency program is an essential step in the design and implementation of educational interventions. Administration of a comprehensive survey is a simple and effective method of gathering this data and has the additional benefit of promoting awareness of pain management issues. Our experience served to establish, among other findings, the didactic value of experience on an oncology floor; this result substantiates the value of practical experience in the gaining of clinical competence in pain management. Interventions that capitalize on the findings of the survey and the interest in pain management generated by its administration are currently ongoing at our institution.
Taking back your turf: Understanding the role of law in medical decision making in opioid management (Part I—Overview)
Authors: Bolen, JD Jennifer
Published: February 2018

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Tramadol: Does it have a role in cancer pain management?
Authors: Prommer, MD Eric E.
Published: February 2018

Tramadol (Ultram, Ortho-McNeil Pharmaceutical, Inc., Raritan, NJ) is considered a Step 2 analgesic under the World Health Organization’s guidelines for the treatment of patients with cancer pain. It is a centrally acting analgesic that has affinity for opioid receptors and influences the action of norepinephrine and serotonin at the synapse. This dual mechanism of analgesia makes it unique among Step 2 agents. It is metabolized by CYP2D6, which increases the potential for drug interactions. Unlike other opioids, it does not cause respiratory depression. Tramadol has been studied in cancer pain and neuropathic pain. It compares well with low-dose morphine as an analgesic. The purpose of this review is to critically examine the pharmacodynamics, pharmacology, drug interactions, and adverse effects of the drug, and, based on the data presented, discuss the drug’s role in cancer care.
The opioid bowel syndrome: A review of pathophysiology and treatment
Authors: Davis, MD, FCCP Mellar P.
Published: February 2018

Opioids are responsible for 25 percent of constipation in terminally ill patients. Patients in pain require prophylaxis to prevent opioid bowel syndrome (OBS). Laxatives are the treatment of choice, but are marginally effective. The development of quaternary opioid receptor antagonists is a step toward target-specific therapy for opioidinduced bowel dysfunction. This review will discuss the pathophysiology and management of OBS.
No potentiation of fentanyl by use of transdermal buprenorphine in patients undergoing fast-track anesthesia for open-heart surgery
Authors: Freye, MD, PhD Enno , Hartung, MD Erhard , Levy, PhD Joseph Victor
Published: February 2018

Simultaneous use of opioids with a different pharmacological profile during anesthesia may lead to unexpected prolongation of effects. In addition, long-term use of transdermal buprenorphine may result in a reduced sensitivity to opioid anesthesia. In a prospective study, possible overlap of opioid effects and vigilance was determined in a group of patients (n = 22) using a buprenorphine patch for at least two months for treatment of chronic pain, and undergoing fentanyl-based fast-track enflurane anesthesia for open-heart surgery. The patients using buprenorphine were compared with a control group (n = 21) undergoing similar open-heart procedures with no opioid other than fentanyl on board. Aside from time to extubation, total dose of fentanyl, postoperative blood gases, and vigilance assessment score were used to determine possible overlap of opioid effects and/or development of opioid tolerance in the buprenorphine group compared to the control group. Both groups had similar operation and anesthesia times and comparable doses of fentanyl (0.69 mg ± 0.23 vs. 0.67 mg ± 0.16 SD). There was no significant difference in postoperative arterial blood gases (PaO2 136 ± 48 torr vs. 128 ± 35 torr SD; PCO2 43.3 ± 3.3 torr vs. 41.9 ± 1.2 torr SD), time until extubation (27 ± 22 min vs. 33 ± 24 min), and postanesthetic vigilance and recovery score (6.8 ± 1.0 vs. 7.5 ± 0.8, arbitrary units) between the two groups. Because of adaptive mechanisms and the development of tolerance in patients using buprenorphine, respiratory depression or sedation does not project into the postoperative period. The significant (p < 0.05) lower incidence of nausea and emesis in patients with transdermal buprenorphine owes to the development of tolerance to these opioid-related side effects.
Role of gabapentin in postoperative pain
Authors: Turan, MD Alparslan
Published: February 2018

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What can we learn from baseball’s steroid scandal?
Authors: Reisfield, MD Gary M. , Wilson, MD George R.
Published: February 2018

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A comparison of oral and implant naltrexone outcomes at 12 months
Authors: Colquhoun, BPsych(Hons) Ross , Tan, MBBS Donald Y-K. , Hull, BPsych(Hons) Samantha
Published: February 2018

Naltrexone’s current use has been limited by compliance. Subcutaneous implants would seem to offer a solution to this problem and improve long-term outcomes. The aim of the present study was to compare groups of patients who had received oral naltrexone or a naltrexone implant after detoxification and to follow their progress. Forty-one patients received an implant, and 42 patients received oral naltrexone. They were surveyed at one, three, six, and 12 months after detoxification. Their designated support person was also contacted to confirm the self-reports of the participants. Patients were compared on gender, age, and length of time since detoxification. Implant patients showed much higher abstinence rates, while those in both groups who were abstinent showed greater compliance to naltrexone (time spent in treatment) and attended more counseling sessions. Although the participants were not randomly allocated to each treatment condition, the preliminary evidence indicates that implants can improve compliance rates and outcomes.
Cholecystokinin antagonists: Can they augment opioid-derived analgesia?
Authors: McCleane, MD Gary
Published: February 2018

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Iatrogenic addiction in patients treated for acute or subacute pain: A systematic review
Authors: Wasan, MD, MSc Ajay D. , Correll, MD Darin J. , Kissin, MD, PhD Igor , O’Shea, BA Sarah , Jamison, PhD Robert N.
Published: February 2018

We conducted a systematic review of the literature on the evidence for iatrogenic addiction in patients treated for acute and subacute pain. Literature searches yielded 1,943 articles, 53 of which were reviewed in detail, and 41 of which met criteria for inclusion in the review of iatrogenic addiction. Two authors independently reviewed and summarized the findings of each article. Discrepancies of ratings were resolved by discussion. We identified no randomized trials or comparative longitudinal studies. The results of nine studies of low methodological quality suggest conflicting findings. This manuscript discusses some possible mechanisms of iatrogenic addiction and concludes with suggestions for methodologically stronger studies to provide more definitive data regarding the evidence for or against iatrogenic addiction in patients treated for acute and subacute pain. The systematic review of the literature could not adequately answer the study questions; thus, it is not known whether the risk for iatrogenic addiction among patients treated with opioids for acute or subacute pain is relatively high (> 10 percent) or low (< 0.1 percent).
Poor pain relief and possible toxicity from high-dose intrathecal opioid treatment: Report of two cases
Authors: Popescu, MD Anca , Mitra, MD Rajorshi , Ballantyne, MD, FRCA Jane
Published: February 2018

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A descriptive case series: Oral transmucosal fentanyl use in patients with noncancerous pain
Authors: Guarino, MD Anthony H. , Myers, RN, MSN, ANP Jennifer , Cornell, RN, BSN Martha E.
Published: February 2018

Transmucosal fentanyl is indicated for patients with cancer who are opioid tolerant, but it is also used for the treatment of noncancerous pain. The following is a survey study of the use of transmucosal fentanyl in 29 patients with noncancerous pain in an academic, communitybased pain management practice. Trans mucosal fentanyl was found to be safe and efficacious in the patients studied.
Early administration of oral morphine to orthopedic patients after surgery
Authors: Zaslansky, DSc Ruth , Eisenberg, MD Elon , Peskin, MD Bezalel , Sprecher, PhD Elliot , Reis, MD Daniel N. , Zinman, MD Chaim , Brill, MD Silviu
Published: February 2018

Current pain treatment guidelines advise against providing analgesics for postoperative pain using intramuscular injections, as this generally provides poor pain relief. However, this route remains the most prevalent treatment method. Intravenous or epidural patient-controlled-analgesia methods reduce pain effectively but are expensive, labor intensive, and available to only a limited number of patients. We propose administering the analgesics using oral analgesics and have developed a simple protocol for treating postoperative pain by use of oral morphine. After a variety of orthopedic surgeries, patients were given “around-the-clock,” oral, immediate-release morphine. Efficacy of the treatment (pain scores and adverse effects) was assessed 24 ± 2 hours after surgery. Data were collected prospectively from 95 patients, who received an average of 61 ± 30 (SD) mg morphine. Average pain scores were 2.4/10 (± 1.4) at rest and 4.0/10 (± 1.4) during movement in bed. Nausea and vomiting, the most common adverse effects, were reported by 22 (23 percent) patients. Naloxone was not administered to any of the patients. Oral morphine given in the early postoperative time to patients after a variety of orthopedic surgeries was effective and safe.
Pain control for dying patients: Hastening death or ensuring comfort?
Authors: Kapp, JD, MPH Marshall B.
Published: February 2018

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A Phase II, multicenter, randomized, double-blind, placebo-controlled crossover study of CJC-1008—a long-acting, parenteral opioid analgesic—in the treatment of postherpetic neuralgia
Authors: Wallace, MD Mark S. , Moulin, MD Dwight , Clark, FRCPC A. J. M. , Wasserman, MD Ronald , Neale Ann , Morley-Forster, MD Patricia , Castaigne, MD Jean-Paul , Teichman, MD Sam
Published: February 2018

Introduction: CJC-1008 is a chemical modification of the opioid peptide dynorphin A (1-13) (Dyn A) that promotes dynorphin’s covalent attachment to human serum albumin in vivo after administration, thus prolonging its duration of action. The primary objective of this study was to evaluate the preliminary efficacy and safety of CJC-1008 as compared with placebo in patients with postherpetic neuralgia (PHN).Methods: Patients with PHN were assigned 1:1 to receive active study medication or placebo. After dosing, measurements were made every 15 minutes for the first hour; at two, three, four, six, and eight hours postdose; and during return visits to the study site after two, seven, and 28 days (as necessary), as well as during precrossover and exit visits. These measurements examined: 1) overall pain intensity, 2) pain intensity for each individual PHN type, 3) categorical overall pain intensity, 4) categorical pain relief, and 5) adverse events (AEs). When PHN pain intensity returned to baseline and/or at patients’ first request for rescue analgesia other than acetaminophen (typically around 28 days after dosing but sometimes as soon as two days postdose), patients were to cross over to the alternative treatment and be monitored on the same schedule.Results: A substantial placebo response was observed, but the analgesic effect observed in the active group was greater than that in the placebo group for the first eight hours. By 24 hours, the difference was not significant. A total of 29 out of 30 patients (96 percent) experienced at least one treatment-emergent AE during active drug treatment, while 14 of 27 patients (52 percent) reported such AEs during placebo treatment. Of the AEs occurring within the first eight hours after dosing, 97 percent were reported during treatment with active drug and 3 percent were reported during treatment with placebo. The majority of these AEs were mild in intensity.Discussion: This study provides evidence of a greater analgesic effect when using CJC-1008 compared to placebo in patients with PHN. However, the effect only lasted through eight hours postdose and diminished by 24 hours. This study provides evidence of a peripheral action of dynorphin, since CJC-1008 does not cross the blood-brain barrier.
Opioid safety
Authors: Enck, MD Robert E.
Published: February 2018

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Getting Informed Consent and Agreement for Treatment right: A legal perspective on key obligations for practitioners who use controlled substances to treat chronic pain
Authors: Bolen, JD Jennifer
Published: February 2018

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Capnography monitoring during opioid PCA administration
Authors: Hutchison, PharmD Rob
Published: February 2018

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Renal effects of opioid exposure: Considerations for therapeutic use
Authors: Gupta, PhD Kalpna , Weber, MD Marc L.
Published: February 2018

In recent years, the discovery of peripheral opioid receptors has challenged the dogma of opioids interacting exclusively with the central nervous system. In this article, we describe the current understanding of the roles of opioids and opioid receptors in renal physiology and pathophysiology. The renal response to opioid exposure varies depending upon the specific opioid agonist, dose, and duration of exposure. The known acute effects of opioids on the kidney impact salt and water balance. The chronic effects of opioid exposure on kidney function are largely unknown, but collapsing glomerulopathy has been associated with chronic heroin abuse. Opioid exposure can lead to both physiological and architectural renal changes, and this may have important clinical implications. Since opioids are often used for pain management in patients with existing kidney disease, their role in kidney function warrants attention.
Malignant pain or malignant patients?
Authors: Weaver, MD Michael
Published: February 2018

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Significant pain reduction in chronic pain patients after detoxification from high-dose opioids
Authors: Baron, MD, MPH Michael J. , McDonald, PhD Paul W.
Published: February 2018

Opioid tolerance is a well-established phenomenon that often occurs in patients taking opioids for the treatment of chronic pain. Typically, doctors need to periodically elevate patients’ opioid doses in an attempt to manage their underlying pain conditions, resulting in escalating opioid levels with only moderate to negligible improvement in pain relief. Recently, opioid-induced hyperalgesia has been recognized as a potential form of central sensitization in which a patient’s pain level increases in parallel with elevation of his or her opioid dose. Here, we report a retrospective study of patients undergoing detoxification from high-dose opioids prescribed to treat an underlying chronic pain condition which had not resolved in the year prior. All patients were converted to ibuprofen to manage pain, with a subgroup treated with buprenorphine during detoxification. Selfreports for pain scores were taken at first evaluation, follow-up visits, and termination. Twenty-one of 23 patients reported a significant decrease in pain after detoxification, suggesting that high-dose opioids may contribute to pain sensitization via opioid-induced hyperalgesia, decreasing patient pain threshold and potentially masking resolution of the preexisting pain condition.
Healthcare professionals and the DEA: Restoring the balance
Authors: Heit, MD, FACP, FASAM Howard A.
Published: February 2018

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Science at the mercy of the mob: Dr. Hurwitz’s legal problems in perspective
Authors: Reynolds, MA, MFA Siobhan
Published: February 2018

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A patient-activated iontophoretic transdermal system for acute pain management with fentanyl hydrochloride: Overview and applications
Authors: Bain, PharmD, BCPS, CGP, FASCP Kevin T.
Published: February 2018

Opioid administration by patient-controlled analgesia (PCA) is the standard therapy for acute postoperative pain. Despite its utility in this setting, limitations of this modality do exist. Consequently, noninvasive PCA systems, including an iontophoretic transdermal system (ITS) with fentanyl hydrochloride, are under development to circumvent many of these limitations. This preprogram med, self-contained, compact, needle-free system provides pain con trol superior to that of placebo and comparable to morphine PCA in the first 24 hours after major surgical procedures. The objectives of this article are to describe the method of transdermal iontophoretic medication administration and to review the literature pertaining to the fentanyl ITS.
Perioperative management of opioid-tolerant chronic pain patients
Authors: Rozen, MD Dima , DeGaetano, MD Noah P.
Published: February 2018

Opioids occupy a position of unsurpassed clinical utility in the treatment of many types of painful conditions. In recent years there has been a noticeable shift regarding the use of opioids for the treatment of both benign and malignancy-related pain. As acceptance of the prescribing of opioids for chronically painful conditions has grown, many more opioid-tolerant patients are presenting for surgical procedures. It is therefore imperative that practicing anesthesiologists become familiar with currently available opioid formulations, including data regarding drug interactions and side effects, in order to better plan for patients’ perioperative anesthetic needs and management. Unfortunately, there is a lack of scientifically rigorous studies in this important area, and most information must be derived from anecdotal reports and the personal experience of anesthesiologists working in this field. In this review, we shall discuss current chronic pain management and the impact of opioid use and tolerance on perioperative anesthetic management.
A new type of harm reduction: Creating an arteriovenous fistula for a compulsively injecting opiate user
Authors: Brewer, MB Colin , Sobeh, FRCS Mohammed
Published: February 2018

Compulsive intravenous opiate injectors often cause themselves recurrent physical damage, which sometimes threatens life or limb. Unsuccessful attempts to find a vein can occupy several hours of each day, during which blood may clot in the syringe, making injection even more difficult. Adding small amounts of heparin to the opiate in the syringe before injecting prevents clotting but may be only partially helpful. The authors describe the first reported case in which an arteriovenous fistula was created specifically to enable a compulsive injector to inject quickly, easily, and safely.
Medication errors with opioids: Results from a national reporting system
Authors: Dy, MD, MSc Sydney Morss , Shore, PhD Andrew D. , Hicks, PhD, ARNP Rodney W. , Morlock, PhD Laura L.
Published: February 2018

Background: Errors may be more common and more likely to be harmful with opioids than with other medications, but little research has been conducted on these errors.Methods: The authors retrospectively analyzed MEDMARX®, an anonymous national medication error reporting database, and quantitatively described harmful opioid errors on inpatient units that did not involve devices such as patient-controlled analgesia. The authors compared patterns among opioids and qualitatively analyzed error descriptions to help explain the quantitative results.Results: The authors included 644 harmful errors from 222 facilities. Eighty-three percent caused only temporary harm; 60 percent were administration errors and 21 percent prescribing errors; and 23 percent caused underdosing and 52 percent overdosing. Morphine and hydromorphone had a significantly higher proportion of improper dose errors than other opioids (40 percent and 41 percent compared with 22 percent with meperidine). Hydromorphone errors were significantly more likely to be overdoses (78 percent vs 47 percent with other opioids). Omission errors were significantly more common with fentanyl patches (36 percent compared with 12 percent for other opioids). Wrong route errors were significantly more common with meperidine (given intravenously when prescribed as intramuscular, 34 percent vs 3 percent for morphine). Oxycodone errors were significantly more likely to be wrong drug errors (24 percent vs 11 percent for other opioids), often because of confusion between immediate- and sustained-release formulations.Conclusions: Reported opioid errors are usually associated with administration and prescribing and frequently cause uncontrolled pain as well as overdoses. These patterns of errors should be considered when using opioids and incorporated into pain guidelines, education, and quality improvement programs.
Trends in nonheroin opioid abuse admissions: 1992-2004
Authors: Peindl, PhD Kathleen S. , Mannelli, MD Paolo , Wu, ScD Li-Tzy , Patkar, MD Ashwin A.
Published: February 2018

Aims: This study examines trends for treatment admissions for nonheroin opioid abuse from 1992 to 2004.Methods: Databases from the Substance Abuse Mental Health Services Administration (SAMHSA, USA): Treatment Episode Data Set (TEDS) were used to examine the changing characteristics of admissions to treatment for nonheroin opioid abuse. Data are collected annually from each state on characteristics of admissions to treatment for all substances abused in the United States. Using the Mann-Kendall test for examining annual trends, we determined any significant trend changes by modeling data for every 2 years of TEDS information from 1992 to 2004.Results: We found significant changes for admissions to substance abuse treatment from 1992 to 2004. Overall, nonheroin opioid admissions to treatment have increased, specifically among adolescents. Other significant trends included an increase in the never-married group admitted, a higher rate of psychiatric problems for nonheroin opioid abuse admissions, changes in the treatment services and significant associations between age of first use of marijuana and methamphetamine, and subsequent nonheroin opioid abuse admissions.Conclusion: Characteristics of admissions to treatment are changing over time and identify an admitted treatment group that is historically different from heroin abusers. These findings will give providers information about who is seeking treatment for nonheroin opiate abuse. Altered treatment strategies that target the changing population who seek treatment for nonheroin opioid abuse need to be universally available.
Locally invasive and metastatic endometrial cancer: Multiple issues functioning in a multidirectional manner
Authors: Kaplan, MD Bruce Z. , Phillips, MD Reed , Ratner, BA Dan
Published: February 2018

A 32-year-old woman with locally invasive and metastatic endometrial cancer was admitted to the hospital for the treatment of crescendo pain. The effectiveness of her medical and psychosocial care was mitigated by four issues: (1) the intractable nature of her pain, (2) substance abuse, (3) mental illness, and (4) interorganizational conflict. This case report is both a chronicle and review of the literature of these multiple issues that converged together to adversely effect the patient’s overall care.
Use and misuse of buprenorphine in the management of opioid addiction
Authors: Cicero, PhD Theodore J. , Surratt, PhD Hilary L. , Inciardi, PhD James
Published: February 2018

Buprenorphine was approved in late 2004 for the treatment of opioid abuse and dependence in specially trained and certified physicians’ offices. At the time of the approval, there was a regulatory concern that given the anticipated wide exposure there would be unexpectedly high levels of abuse in the high-risk population for which it was intended. To assess its abuse potential, the authors recruited more than 1,000 individuals seeking treatment for prescription opioid abuse from 100 stand-alone (ie, self-pay or insurance) drug abuse treatment programs around the country to determine whether they misused buprenorphine in the past 30 days to get high. The results indicate that there was a time-related increase in the number of subjects who used burprenorphine to get high, reaching 30-35 percent of individuals completing a questionnaire in the second quarter of 2006. At this time, it was equivalent to the misuse of methadone, both of which, however, were considerably lower than hydrocodone and oxycodone. Thereafter, the number of individuals using buprenorphine to get high dropped in a near linear fashion to less than 20 percent of those completing a questionnaire in the second quarter of 2007, significantly lower than that for methadone, oxycodone, and hydrocodone. The most likely interpretation of these data is that the polysubstance- abusing population, for whom buprenorphine is intended, experimented with this medication for its mood-altering effects for a period of time, but presumably because of its lack of euphorogenic properties, its use has now dissipated. Additionally, support for this conclusion is the very rare endorsement of buprenorphine as a primary drug (<3 percent of the total sample). Thus, the results indicate that it is unlikely that buprenorphine abuse will ever reach the epidemic that was feared by some regulatory groups and that its use in opioid detoxification and maintenance should continue.