bluuebunny/crossref_metadata_2025 huggingface dataset:
Leg Muscle Mass and Composition in Relation to Lower Extremity Performance in Men and Women Aged 70 to 79: The Health, Aging and Body Composition Study
Authors: Visser Marjolein , Kritchevsky Stephen B. , Goodpaster Bret H. , Newman Anne B. , Nevitt Michael , Stamm Elizabeth , Harris Tamara B.
Published: March 2003

OBJECTIVES: The loss of muscle mass with aging, or sarcopenia, is hypothesized to be associated with the deterioration of physical function. Our aim was to determine whether low leg muscle mass and greater fat infiltration in the muscle were associated with poor lower extremity performance (LEP).

DESIGN: A cross‐sectional study, using baseline data of the Health, Aging and Body Composition study (1997/98).

SETTING: Medicare beneficiaries residing in ZIP codes from the metropolitan areas surrounding Pittsburgh, Pennsylvania, and Memphis, Tennessee.

PARTICIPANTS: Three thousand seventy‐five well‐functioning black and white men and women aged 70 to 79.

MEASUREMENTS: Two timed tests (6‐meter walk and repeated chair stands) were used to measure LEP. Muscle cross‐sectional area and muscle tissue attenuation (indicative of fat infiltration) were obtained from computed tomography scans at the midthigh. Body fat was assessed using dual‐energy x‐ray absorptiometry.

RESULTS: Blacks had greater muscle mass and poorer LEP than whites. Black women had greater fat infiltration into the muscle than white women. After adjustment for clinic site, age, height, and total body fat, smaller muscle area was associated with poorer LEP in all four race‐gender groups. (Regression coefficients, expressed per standard deviation (±55 cm2) of muscle area, were 0.658 and 0.519 in white and black men and 0.547 and 0.435 in white and black women, respectively, P < .01.) In addition, reduced muscle attenuation—indicative of greater fat infiltration into the muscle—was associated with poorer LEP, independent of total body fat and muscle area. (Regression coefficients per standard deviation (= 7 Hounsfield Units) of muscle attenuation were 0.292 and 0.224 in white and black men, and 0.193 and 0.159 in white and black women, respectively, P < .05). The most important body composition components related to LEP were muscle area in men and total body fat in women. Results were similar after additional adjustment for lifestyle factors and health status. No interactions between race and muscle area (P> .7) or between race and muscle attenuation (P> .2) were observed.

CONCLUSION: Smaller midthigh muscle area and greater fat infiltration in the muscle are associated with poorer LEP in well‐functioning older men and women.
Looking at the Relationship Between Hemoglobin Concentration and Prevalent Mobility Difficulty in Older Women. Should the Criteria Currently Used to Define Anemia in Older People be Reevaluated?
Authors: Chaves Paulo H. M. , Ashar Bimal , Guralnik Jack M. , Fried Linda P.
Published: March 2003

OBJECTIVES: The World Health Organization (WHO) and other currently used criteria for defining anemia in older women are mainly based on statistical distribution considerations. To explore their clinical appropriateness, we evaluated the relationship between hemoglobin (Hb) concentration, prevalent mobility difficulty, and the Summary Performance Score (SPS).

DESIGN: Cross‐sectional study.

SETTING: Two population‐based studies, the Women's Health and Aging Studies I and II, Baltimore, Maryland.

PARTICIPANTS: Six hundred thirty‐three community‐dwelling women aged 70 to 80 with Hb levels obtained within 90 days from baseline assessment.

MEASUREMENTS: Mobility difficulty (self‐reported difficulty walking one‐quarter of a mile or climbing 10 steps (primary outcome)). SPS, a performance‐based summary measure of lower extremity function that combines the results of walking, chair stands, and balance tests (secondary outcome).

RESULTS: Mobility difficulty prevalence was not constant within the WHO “normal” Hb range (12.0–16.0 g/dL). For example, a Hb of 13.5 g/dL was associated with a significantly lower mobility difficulty prevalence than a Hb of 12.0 g/dL (OR = 0.68, 95% CI = 0.47–0.93), even after adjustment for chronic diseases and other relevant health indicators. A consistent trend of improvement in performance‐based scores with increasing Hb categories less than 12.0 g/dL, 12.0 to 13.0g/dL, and 13.0–14.0 g/dL was observed.

CONCLUSION: Our findings raise two hypotheses: (1) Hb currently perceived as “mildly‐low” and even “low‐normal” might have an independent, adverse effect on mobility function, and (2) Hb of 12.0 g/dL might be a suboptimal criterion for defining anemia in older women. Formal testing of these hypotheses might prove relevant for anemia‐ and mobility disability–related clinical decision‐making.
Age‐Related Differences in Lower Extremity Power After Support Surface Perturbations
Authors: Hall Courtney D. , Jensen Jody L.
Published: March 2003

OBJECTIVES: The purpose of this study was to examine a comprehensive measure relating to the ability to generate, absorb, and transfer mechanical energy introduced by a perturbation. It was hypothesized that this measure would reveal age‐related differences leading to different balance recovery responses (i.e., feet‐in‐place and compensatory step).

DESIGN: Cross‐sectional, descriptive study.

SETTING: The Motor Control Laboratory at the University of Oregon.

PARTICIPANTS: Eighteen younger (aged 18–35) and 21 older (aged 65–85) women received forward and backward support surface translations of varying amplitudes and velocities.

MEASUREMENTS: Lower extremity peak positive joint power and peak negative muscle power were examined at the largest perturbation in which a feet‐in‐place response was used and the subsequent perturbation where a step occurred. Peak positive joint power depicts the maximum rate of passive transfer of energy into a segment and is indicative of the maximum destabilization of that segment. Peak negative muscle power is the maximum rate of energy absorption by muscle, which reduces the effect of the perturbation on the segment.

RESULTS: After a backward perturbation, there was a significant main effect of age for muscle power and a significant main effect of response type for joint power. For the forward condition, there was a significant main effect of response type for muscle power only.

CONCLUSIONS: The mechanical reason for the emergence of the compensatory step after support‐surface perturbations is clear; the feet‐in‐place response is energetically more demanding than the compensatory step. The energy analysis suggests a mechanical basis as one reason for older adults' reliance on the compensatory step: older adult muscles absorb less energy. The results of this study also highlight the importance of the proximal knee and hip musculature versus the distal ankle musculature.
Do Older Adults Expect to Age Successfully? The Association Between Expectations Regarding Aging and Beliefs Regarding Healthcare Seeking Among Older Adults
Authors: Sarkisian Catherine A. , Hays Ron D. , Mangione Carol M.
Published: March 2003

OBJECTIVES: To measure expectations regarding aging among community‐residing‐older adults, identify characteristics associated with having low expectations regarding aging, and examine whether expectations regarding aging are associated with healthcare‐seeking beliefs for age‐associated conditions.

DESIGN: Self‐administered mail survey.

SETTING: Greater Los Angeles.

PARTICIPANTS: Four hundred twenty‐nine of 588 (73%) randomly selected community‐residing adults aged 65 to 100 (mean age 76) cared for by 20 primary care physicians; 54% were women, and 76% were white.

MEASUREMENTS: The Expectations Regarding Aging Survey, a validated survey measuring expectations regarding aging; 13 items measuring care seeking beliefs; and validated measures of health status.

RESULTS: More than 50% of participants felt it was an expected part of aging to become depressed, to become more dependent, to have more aches and pains, to have less ability to have sex, and to have less energy. After adjusting for sociodemographic and health characteristics using multivariate regression, older age was independently associated with lower expectations regarding aging (P < .001), as was having lower physical and mental health‐related quality of life. Having lower expectations regarding aging was independently associated with placing less importance on seeking health care (P = .049).

CONCLUSIONS: Most older adults in this sample did not expect to achieve the model of successful aging in which high cognitive and physical functioning is maintained. Older age was independently associated with lower expectations regarding aging. Furthermore, having low expectations regarding aging was independently associated with not believing it important to seek health care.
Outcomes of Pain in Frail Older Adults With Dementia
Authors: Brummel‐Smith Kenneth , London Marla R. , Drew Nicholas , Krulewitch Harry , Singer Clifford , Hanson Lynn
Published: March 2003

OBJECTIVES: To describe the outcomes of pain in cognitively impaired older adults in a Program of All‐inclusive Care for older people (PACE) setting and to determine whether pain and psychotropic drug use, behavioral disturbances, hospital, nursing facility, and emergency department use, or mortality increases with the level of pain reported.

DESIGN: Retrospective review of an observational cohort of patients with dementia.

SETTING: A first‐generation PACE program located in Portland, Oregon. Patients with the diagnosis of dementia had been assessed for pain in a prior study.

PARTICIPANTS: One hundred fifty‐four cognitively impaired subjects.

MEASUREMENTS: Standardized pain assessments were administered to cognitively impaired subjects between June and October 1998. After the pain assessment, information about mortality and healthcare use, including use of medication, was collected and analyzed. Subjects who reported moderate to severe pain were compared with demented subjects who reported no or mild pain.

RESULTS: There were no differences in patient characteristics (age, sex, functional limitations, disruptive behaviors, and incontinence), medications (pain and psychotropic), use (hospital, nursing home, or emergency department visit), or mortality by level of pain alone or by levels of pain and dementia together.

CONCLUSIONS: The study did not demonstrate that a single point‐in‐time measurement of pain in demented persons was associated with an increased rate of behavioral problems, narcotic use, or hospital or emergency department use over the following year. Prospective studies are needed that measure pain over time to determine more accurately the relationship between pain and negative outcomes in dementia.
Outcome of West Nile Fever in Older Adults
Authors: Berner Yitshal N. , Lang Ruth , Chowers Michal Y.
Published: March 2003

OBJECTIVES: To determine the effect of clinical presentation and cognitive changes on the postdischarge outcome in older adult patients with West Nile fever (WNF).

DESIGN: Retrospective, cohort analysis.

SETTING: Meir Hospital located in the center of Israel in the Sharon region.

PARTICIPANTS: Thirty‐two patients aged 65 and older hospitalized during a WNF outbreak.

MEASUREMENTS: All patients' charts were analyzed retrospectively with special emphasis on their cognitive and functional state. A follow‐up examination of patients with functional decline at discharge was performed after 3 months.

RESULTS: A change in consciousness, rather than in cognition, predicted the outcome. The death rate was 22% (7/32); all fatal cases were aged 78 and older. Similarly, the functional decline and residual damage appeared only in the older age group (≥75). Eighty‐eight percent of the survivors returned to their premorbid function. In contrast to other viral infections, chronic conditions in the subjects had no effect on the outcome.

CONCLUSIONS: In older adults, WNF carries a high death rate, but the outcome is favorable for the survivors.
Sex Differences in Peripheral Arterial Disease: Leg Symptoms and Physical Functioning
Authors: McDermott Mary McGrae , Greenland Philip , Liu Kiang , Criqui Michael H. , Guralnik Jack M. , Celic Lillian , Chan Cheeling
Published: March 2003

OBJECTIVES:LTo compare lower extremity functioning and leg symptoms between women and men with peripheral arterial disease (PAD).

DESIGN:Cross‐sectional.

SETTING:Three Chicago‐area medical centers.

PARTICIPANTS:One hundred eighty‐seven women and 273 men with PAD identified consecutively in patients in the noninvasive vascular laboratories and a general medicine practice at the three medical centers.

MEASUREMENTS:Walking speed, 6‐minute walk, accelerometer‐measured 7‐day physical activity, and a summary performance score. The summary performance score combines data on walking velocity, time for five repeated chair rises, and standing balance to achieve a score on a 0 to 12 scale (12 = best).

RESULTS:Women with PAD were older and had a lower prevalence of prior leg revascularization, a higher prevalence of spinal stenosis, and a lower prevalence of other cardiovascular disease than men with PAD. Mean ankle brachial index (ABI) values ± standard deviation were similar in women and men with PAD (0.64 ± 0.15 vs 0.66 ± 0.14, P = .15). Women with PAD were significantly more likely than men with PAD to have exertional leg pain that sometimes begins at rest (27.8% vs 13.2%, P < .001). Women with PAD had slower walking speed (0.81 vs 0.92 m/s, P < .001), shorter 6‐minute walk distance (1,047 vs 1,182 feet, P < .001), and a poorer summary performance score (8.9 vs 9.8, P < .001) than men with PAD, adjusting for age, race, height, comorbid disease, and leg symptoms. After adjusting for leg strength, sex differences in 6‐minute walk performance and summary performance score were attenuated modestly (1,089 vs 1,177 feet for 6‐minute walk, P = .022 and 9.2 vs 9.8 for summary performance score, P = .027).

CONCLUSION:Women with PAD had a higher prevalence of leg pain on exertion and rest, poorer functioning, and greater walking impairment from leg symptoms than men with PAD. A higher prevalence of spinal stenosis in women may explain the observed sex differences in leg symptoms. Poorer leg strength in women may contribute to poorer lower extremity functioning in women with PAD than in men with PAD. J Am Geriatr Soc 51:222–228, 2003.
Effect of End‐Stage Renal Disease on the Quality of Life of Older Patients
Authors: Loos Carole , Briançon Serge , Frimat Luc , Hanesse Bernadette , Kessler Michèle
Published: March 2003

OBJECTIVES: To assess the effect of chronic renal failure (CRF) on quality of life (QOL).

DESIGN: Controlled cross‐sectional study.

SETTING: All 13 dialysis units in the French Lorraine region and six departments of a Nancy hospital.

PARTICIPANTS: One hundred sixty‐nine older patients with end‐stage renal disease (ESRD) who were starting first dialysis (mean age ± standard deviation = 76.2 ± 5.1) and 169 age‐ and sex‐matched non‐CRF controls.

MEASUREMENTS: QOL was assessed using the short‐form health survey 36‐item (SF‐36) self‐administered questionnaire. Information on comorbid conditions, clinical symptoms and laboratory findings was obtained from medical records.

RESULTS: Mean QOL scores ranged from 11.2 (role limitation due to physical function (RP) dimension) to 55.5 (social function) in the ESRD group, and from 22.0 (RP) to 54.3 (mental health) in the non‐CRF group. Among ESRD patients, factors related to QOL scores (physical function (PF) and vitality dimensions) were the conditions under which dialysis was initiated and comorbidity. Patients whose first dialysis was unplanned had 10.4 fewer points in the PF dimension than those in whom it was planned (P = .014).

CONCLUSIONS: If dialysis initiation is planned, ESRD in older patients has no more effect on QOL than others diseases. However, patients whose dialysis is unplanned have severely impaired QOL. These results represent an argument for improving the predialysis care of older renal failure patients to optimize conditions at first dialysis.
Antinoceptive and motor‐blocking action of epidurally administered IQB‐9302 and bupivacaine in the dog. (La Paz University Hospital, Madrid, Spain) Reg Anesth Pain Med 2000;25:522–528.
Authors: De Segura Ignacio A. Gómez , Vazquez Isabel , De Miguel: Enrique
Published: March 2003

This study aimed to compare the antinociceptive and motor‐blocking effects of epidurally administered IQB‐9302 and bupivacaine in the dog. Twelve adult female Beagle dogs were used. Each animal received 3 concentrations of either IQB‐9302 or bupivacaine by means of chronic epidural catheter. Epidurally administered IQB‐9302 caused a more potent nocifensive and motor‐blocking action than bupivacaine. The duration of complete nocifensive block was the longest with IQB‐9302, whereas the duration of dermatome nocifensive block was similar for both drugs. The nocifensive to motor block ratio was significantly higher with IQB‐9302. Conclude that IQB‐9302 produced an anesthetic action similar to that of bupivacaine, although the former drug induced slightly more potent nocifensive block. Nocifensive and motor block duration are very similar with IQB‐9302, whereas bupivacaine induces a more prolonged motor block without nocifensive block.

Comment by James E. Heavner, D.V.M., Ph.D. IQB‐9302 (1‐methylcycloprophyl‐N‐(2,6‐dymethylphenyl)‐2 piperidinecarboxyamide) is a recently developed local anesthetic with physiochemical properties similar to those of bupivacaine. Therefore, it is not surprising that the two compounds produce very similar outcomes when motor and sensory block is evaluated following epidural administration to dogs. What distinguishes results from the two compounds is that the motor blocking and nociceptive blocking actions of IQB apparently are better matched than are the blocking actions of bupivacaine. Whether this compound will eventually reach clinical use will depend on at least two things: 1) if IQB offers advantage in terms of systemic toxicity relative to the systemic toxicity of bupivacaine; and 2) whether the relatively small difference between bupivacaine and IQB when used for epidural anesthesia exists in humans as it does in animals and the differences are considered to be clinically meaningful. The Holy Grail sought by developers of new local anesthetics is a local anesthetic that produces sensory, but no motor block. IQB clearly is not that Holy Grail.
Psychological principles of burn wound pain in children. II: Treatment applications. (University of Washington School of Medicine, Seattle, WA) J Burn Care Rehabil 2000;21:458–472.
Authors: Martin‐Herz Susanne Pelley , Thurber Christopher A. , Patterson: David R.
Published: March 2003

The pain involved in acute burn care can be excruciating and intractable. Even the best pharmacologic pain control efforts often fail to adequately control pain, especially procedure‐related pain, in pediatric patients with burn injuries. Nonpharmacologic interventions have been found to be effective in reducing pain in both children and adults and can be extremely important adjuvant to standard pharmacologic analgesia in the burn care setting. This article presented a detailed discussion of the implementation of nonpharmacologic intervention strategies in the burn care setting. Because accurate measurement of discomfort is imperative for the development of interventions and for the evaluation of their efficacy, this article began with a brief review of pain measurement techniques. Suggestions for tailoring interventions to meet specific patient needs were provided. This article also included a detailed and practical discussion of specific intervention techniques and the implementation of those techniques.
Morphine tolerance increases [3H]MK‐801 binding affinity and constitutive neuronal nitric oxide synthase expression in rat spinal cord. (National Medical Defense Center, Taipei, Taiwan) Br J Anaesth 2000;85:587–591.
Authors: Wong Chih‐Shung , Hsu Ming‐Man , Chou Yen‐Yen , Tao Pao‐Luh , Tung: Che‐Se
Published: March 2003

N‐Methyl‐D‐aspartate (NMDA) receptor antagonists and nitric oxide synthase (NOS) inhibitors inhibit morphine tolerance. In the present study, a lumbar subarachnoid polyethylene (PE10) catheter was implanted for drug administration to study alterations in NMDA receptor activity and NOS protein expression in a morphine‐tolerant rat spinal model. Antinociceptive tolerance induced by intrathecal morphine infusion (10 μg h−1) for 5 days. Co‐administered MK801 with morphine was used to inhibit the development of morphine tolerance. Lumbar spinal cord segments were removed and prepared for [3H]MK‐801 binding assays and NOS western blotting. The binding affinity of [3H]MK‐801 was higher in spinal cords of morphine‐related rats than in control rats. There was no difference in Bmax. Western blot analysis showed that constitutive expression of neuronal NOS protein in the morphine‐tolerant group was twice that in the control group. This up‐regulation was partially prevented by MK‐801. The results suggest that morphine tolerance affects NMDA receptor binding activity and increases nNOS expression in the rat spinal cord.

Comment by Octavio Calvillo, M.D., Ph.D. Morphine tolerance may be due to receptor down‐regulation or receptor uncoupling; activation of the NMDA‐dependent pain‐facilitatory system may also play a role. It has been proposed that NMDA receptor activation may play a role in morphine tolerance. NMDA receptor antagonists and nitric oxide synthase [NOS] inhibitors may prevent morphine tolerance. Tolerance was induced in rats by intrathecal injection of morphine [10 ug/h] for 5 days, co‐administration of MK801 [NMDA antagonist] with morphine was used to prevent morphine tolerance. Lumbar spinal cord segments were removed and prepared for [H3]MK801 binding assays and NOS western blotting. The binding affinity of labeled MK801 was higher in spinal cords of morphine tolerant rats than in control rats. Western blot analysis showed that constitutive expression of neuronal NOS protein in the morphine tolerant rats was twice that in the control group, thus, up‐regulation was prevented by MK801. The results suggest that morphine tolerance affect NMDA receptor binding activity and increase neuronal protein expression in rat the spinal cord.
Neuropathic pain. (Kings College Hospital, London, United Kingdom) Hospital Med 2000;61:760–766.
Authors: Smith T. E. , Chang: M. S.
Published: March 2003

Neuropathic pain is often a distressing and undertreated condition. This review examined the definition and classification of neuropathic pain. It also summarized clinically important underlying mechanisms and outlined current management strategies. Future directions for research and therapy were also discussed.
Computed tomography‐guided neurolytic celiac plexus block with alcohol complicated by superior mesenteric venous thrombosis. (University of Washington, Seattle, WA) Pain. 2001;92:307–310.
Authors: Grant Stuart A. , Nielsen Karen C. , Greengrass Roy A. , Steele Susan M. , Klein Stephen M.
Published: March 2003

This case report discussed a 62‐year‐old woman who suffered from intractable, tumor‐associated pain. Neurolytic celiac plexus block (CPB) under radiological guidance is often performed to manage pain associated with pancreatic cancer. Serious complications related to the block are rare. Computed tomography (CT)‐guided neurolytic CPB is advocated to improve the efficacy of the block and to reduce the incidence of associated complications.
The role of central and peripheral Cannabinoid1 receptors in the antihyperalgesic activity of cannabinoids in a model of neuropathic pain. (Novartic Institute for Medical Sciences, London, United Kingdom) Pain. 2001;92:91–100.
Authors: Fox Alyson , Kesingland Adam , Gentry Clive , McNair Kara , Patel Sadhana , Urban Laszlo , James Iain
Published: March 2003

This study examined the effects of cannabinoid agonists on hyperalgesia in a model of neuropathic pain in the rat and investigated the possible sites of action. The antihyperalgesic activity of the cannabinoids was compared with their ability to elicit behavioral effects characteristic of central cannabinoid activity. WIN55, 212‐2 (0.3–10 mg/kg−1), CP‐55, 940 (0.03–1 mg/kg−1), and HU‐210 (0.001–0.03 mg/kg−1) were all active in a “tetrad” of tests consisting of tail‐flick, catalepsy, rotarod, and hypothermia following subcutaneous administration, with a rank order of potency in each of HU‐210> CP‐55, 940> WIN55, 212‐2. The effects of WIN55, 212‐2 in each assay were blocked by the Cannabinoid1 (CB1) antagonist SR141716A. In the partial sciatic ligation model if neuropathic pain WIN55, 212‐2, CP‐55, 940, and HU‐210 produced complete reversal of mechanical hyperalgesia within 3 hours of subcutaneous administration with D50 values of 0.52, 0.08, and 0.005 mg/kg−1, respectively. In this model WIN55, 212‐2 was also effective against thermal hyperalgesia and mechanical allodynia. WIN55, 212‐2 produced pronounced reversal of mechanical hyperalgesia following intrathecal administration that was blocked by the CB1 antagonist SR141716A. Following intraplantar administration into the ipsilateral hindpaw, WIN55, 212‐2 produced up to 70% reversal of mechanical hyperalgesia, although activity was also observed at high doses following injection into contralateral paw. The antihyperalgesic effect of WIN55, 212‐2 injected into the ipsilateral paw was blocked by subcutaneously administered SR141716A, but was not affected by intrathecally administered SR141716A. Conclude that cannabinoids are highly potent and efficacious antihyperalgesic agents in a model of neuropathic pain. This activity is likely to be mediated via action in both the CNS and in the periphery.

Comment by Leland Lou, M.D. Rat study that looked at the potential of cannabinoids in the management of neuropathic pain. The data seem to indicate the presence of peripheral cannabinoid receptors for suppression of neuropathic pain. Historically, a central mechanism of action for cannabinoid's analgesic and antihyperalgesic properties is thought to be responsible. Unfortunately, this report only confirms previous studies finding a peripheral mechanism of action.
Herpes zoster in older adults. (Duke University Medical Center, Durham, NC) Clinical Infectious Diseases. 2001;32:1481–1486.
Authors: Schmader Kenneth
Published: March 2003

Herpes zoster (HZ) strikes millions of older adults annually worldwide and disables a substantial number of them via postherpetic neuralgia (PHN). Key aged‐related clinical, epidemiological, and treatment features of zoster and PHN are reviewed in this article. HZ is caused by renewed replication and spread of the varicella‐zoster virus (VZV) in sensory ganglia and afferent peripheral nerves in the setting of age‐related, disease‐related, and drug‐related decline in cellular immunity to VZV. VZV‐induced neuronal destruction and inflammation causes the principal problems of pain, interference with activities in daily living, and reduced quality of life in elderly patients. Recently, attempts to reduce or eliminate HZ pain have been bolstered by the findings of clinical trials that antiviral agents and corticosteroids are effective treatment for HZ and that tricyclic antidepressants, topical lidocaine, gabapentin, and opiates are effective treatment for PHN. Although these advances have helped, PHN remains a difficult condition to prevent and treat in many elderly patients.

Comment by Miles Day, M.D. This article reviews the epidemiology clinical features diagnosis and treatment of acute herpes zoster. It also describes the treatment of postherpetic neuralgia. While this is a good review for the primary care physician, the discussion for the treatment for both acute herpes zoster and postherpetic neuralgia do not mention invasive therapy. It is well documented in pain literature that sympathetic blocks with local anesthetic and steroid as well as subcutaneous infiltration of active zoster lesions not only facilitate the healing of acute herpes zoster but also prevents or helps decrease the incidence of postherpetic neuralgia. All patients who present to the primary care physician with acute herpes zoster should have an immediate referral to a pain management physician for invasive therapy.

The treatment of postherpetic neuralgia is a challenging experience both for the patient and the physician. While the treatments that have been discussed in this article are important, other treatments are also available. Regional nerve blocks including intercostal nerve blocks, root sleeve injections, and sympathetic blocks have been used in the past to treat postherpetic neuralgia. If these blocks are helpful, one can proceed with doing crynourlysis of the affected nerves or also radio‐frequency lesioning. Spinal cord stimulation has also been used for those patients who are refractory to noninvasive and invasive therapy. While intrathecal methylprednisolone was shown to be effective in the study quoted in this article one must be cautious not to do multiple intrathecal steroid injections in these patients. Multilple intrathecal steroid injections can lead to archnoiditis secondary to the accumulation of the steroid on the nerve roots and in turn causing worsening pain.
TNF‐alpha expression in painful and nonpainful neuropathies. (University Hospital, Basel, Switzerland) Neurology. 2001;56:1371–1377.
Authors: Empl M. , Renaud S. , Erne B. , Fuhr P. , Straube A. , Schaeren‐Wiemers N. , Steck A. J.
Published: March 2003

The objective of this study was to determine whether the cytokine tumor necrosis factor α (TNF‐α) acts as a pain mediator in neuropathic pain in humans. Patients with painful neuropathies showed a stronger TNF‐α immunoreactivity in myelinating Schwann cells relative to the epineurial background staining compared with patients with nonpainful neuropathy. Although there was no difference in sTNF‐RI levels between painful and nonpainful neuropathies, patients with a mechanical allodynia had elevated serums sTNF‐RI as compared to patients without allodynia. Conclude that TNF‐α expression of human Schwann cells may be up‐regulated in painful neuropathies. The elevation of sTNF‐RI in patients with centrally mediated mechanical allodynia suggests that systemic sTNF‐RI levels may influence central pain processing mechanisms.
Herpes zoster as an immune reconstitution disease after initiation of combination antiretroviral therapy in patients with human immunodeficiency virus type‐1 infection. (Hospital de la Santa Creu I Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain) Am J Med. 2001;110:605–609.
Authors: Domingo Pere , Torres Olga H. , Ris Josep , Vazquez Guillermo
Published: March 2003

Of the 316 patients who initiated combination antiretroviral therapy, 24 were treated for herpes zoster within 17 weeks of starting therapy. The characteristics of these cases were compared with those of a control group of 96 human immunodeficiency virus type‐1 (HIV‐1) infected patients, who were matched by age, sex, plasma, HIV‐1 RNA concentration and CD4 cell counts, and length of follow‐up. The incidence of herpes zoster associated with combination antiretroviral therapy was 9 episodes per 100 patient years. There were no significant differences between cases and controls in age, sex, years of HIV infection, history of herpes zoster, previous acquired immune deficiency syndrome, or baseline mean CD4 and CD8 cell counts before beginning combination antiretroviral therapy. However, patients who developed herpes zoster had a significantly greater mean increase in the number of CD8 cells than did controls. Conclude that the initiation of combination antiretroviral therapy in HIV‐1 infected patients was often associated with the development of herpes zoster especially in those whom the number of CD8 cells increased after therapy.
Activation of brainstem N‐methyl‐D‐aspartate receptors is required for the analgesic actions of morphine given systemically. (Oregon Health Sciences University, Portland, OR) Pain. 2001;92:129–138.
Authors: Heinricher M. M. , Schouten J. C. , Jobst E. E.
Published: March 2003

This study was designed to characterize the contribution of N‐methyl‐D‐aspartate (NMDA) and non‐NMDA‐mediated excitatory transmission within the rostral ventromedial medulla (RVM) to activation of brainstem inhibitory output neurons and analgesia produced by systemic morphine administration. The results highlight 2 important aspects of RVM pain modulatory circuits. First, morphine given systemically produces it analgesic effect at least in part by recruiting an NMDA‐mediated excitatory process to activate off‐cells within the RVM. This excitatory process plays a role in the analgesic synergy produced by simultaneous μ‐opioid activation at different levels of the neuraxis. Second, reflex‐related activation of on‐cells is medicated by a non‐NMDA receptor, and this activation does not appear to play a significant role in regulating reflex responses to acute noxious stimuli. Excitatory amino acid‐mediated excitation, thus, has 2 distinct roles within the RVM, activating off‐cells and on‐cells under different conditions.
Using gabapentin to treat failed back surgery syndrome caused by epidural fibrosis: A report of 2 cases. (University of Pennsylvania Health System, School of Medicine, Pennsylvania, PA). Arch Phys Med Rehabil. 2001;82:691–693.
Authors: Braverman Debra L. , Slipman Curtis W. , Lenrow David A.
Published: March 2003

Failed back surgery syndrome (FBSS) is a long‐lasting often disabling, and relatively frequent (5% to 10%) complication of lumdosacral spine surgery. Epidural fibrosis is among the most common causes of FBSS, and it is often recalcitrant to treatment. Repeated surgery for fibrosis has only a 30% to 35% success rate, whereas 15% to 20% of patients report worsening of their symptoms. Long‐term outcome studies focusing on pharmacologic management of chronic back pain secondary to epidural fibrosis are lacking in the literature. This report presented 2 cases of severe epidural fibrosis managed successfully with gabapentin monotherapy. In both cases, functional status improved markedly and pain was significantly diminished. Gabapentin has an established, favorable safety profile and has been shown to be effective in various animal models and human studies of chronic neuropathic pain. Conclude clinicians should consider gabapentin as a pharmacological treatment alternative in the management of FBSS caused by epidural fibrosis.
Lumbar sympathetic block for pain relief in two patients with interstitial cystitis. (Shimane Medical University, Izumo, Japan) Reg Anesth Pain Med 2001;26:271–273.
Authors: Doi Katsushi , Saito Yoji , Nikai Tetsuro , Morimoto Noriko , Nakatani Toshihiko , Sakura Shinichi
Published: March 2003

This case report discussed the effective treatment of interstitial cystitis (IC) with regard to a 63‐year‐old woman and a 78‐year‐old woman. Medical therapy with nonsteroidal anti‐inflammatory drugs, anticholinergics, and hydrodistention of the bladder failed to improve their symptoms. Subsequently, a continuous lumbar epidural block using 1% mepivacaine was used in these patients. A transient reduction of the symptoms in both patients was achieved. A lumbar sympathetic block with a neurolytic agent produced almost complete and long‐lasting relief of their symptoms. Conclude that lumbar sympathetic block using a neurolytic agent produced long‐lasting pain relief in 2 patients with IC.

Comment by Pedro F. Bejarano, M.D. Chronic visceral pain association to the neurovegetative system and to sympathetically‐maintained mechanisms has been well documented nowadays. The multiple neural connections among different abdominal nerve plexus has also been described, and this anastomoses may account for the observed analgesic effects in this case obtained without specific blockade of the superior hypogastric plexus. Despite the reported good results, the use of the lumbar approach may be controversial in this cases, as the uncomfortable peripheral effects of a permanent lumbar sympathetic neurolytic block (i.e.: lower limb vasodilation) favors a more anatomically restricted (visceral) area like that obtained with a superior hypogastric approach.

We must remark that the existence of Sympathetically mediated and/or maintained pain is not enough phenomenae to fit the diagnostic criteria of a RCPS, as suggested by the authors, but it is less so in the case of an evidently persistent, organic source of visceral nociception like in the Intersticial Cystitis disease.
Preservation of antithrombin 111 activity in stored whole blood
Authors: INKSTER M. , SHEKMAN L. A. , AHMED P. , BENTON M. B. , GASTON L. W.
Published: March 2003

Antithrombin III (AT‐III) is the major inhibitor of thrombin, Factor Xa, and other coagulation enzymes. Congenital and acquired deficiencies of AT‐III are thought to contribute to thrombosis and disseminated intravascular coagulation. Because a recent report suggested reduced AT III in stored blood, we evaluated blood bank storage effects. Serial samples were taken from 6 units of whole blood drawn into citrate‐ phosphate‐dextrose‐adenine over 42 days, and assays for AT‐III functional activity were performed on the same day. The values (mean +/− SD) were as follows: day 0,91.8 +/− 10.7 percent; day 2, 101.9 +/− 10.7 percent; day 8, 107.3 +/− 7.4 percent; day 15, 118.9 +/− 11.1 percent; day 22, 105.4 +/− 9.8 percent; day 35, 93.4 +/− 8.8 percent; and day 42, 97.4 +/− 7.5 percent. The rise from day 0 to day 15 was significant but presumably secondary to interassay variation because analysis of frozen aliquots showed no significant change when all samples from each unit were assayed in one batch. Immunoassay of AT‐III also showed no change with storage. The results indicate AT‐III retains functional activity in whole blood stored at 2 to 6 degrees C for 42 days, and AT‐ III replacement does not require fresh blood or fresh‐frozen plasma. Low values may reflect individual donor differences or dilution of plasma by anticoagulant.
Anti‐D prozone and membrane sulfhydryl modification
Authors: Jameson J.T. , Kleeman J.E. , Masouredis S.P. , Victoria E.J.
Published: March 2003

An IgG anti‐D prozone is produced by progressive inactivation of the D antigen following red cell exposure to increasing concentrations of thimerosal and phenol present as antibody excess is achieved. Partial inactivation of the D antigen by routinely added thimerosal, an organic mercurial, and phenol is associated with an unstable D antigen‐antibody complex resulting in an increased rate of dissociation of anti‐D and with a decreased reactivity of the cell‐bound anti‐D in the antiglobulin reaction. Complete D inactivation occurs with concentrations in excess of 0.43 microM thimerosal. If attributable to inactivation of a surface‐exposed sulfhydryl group, it suggests that less than 5 percent of these are involved in D‐antigen activity. The data do not exclude the possibility that D inactivation may result from alteration of sulfhydryl groups other than those exposed at the surface.
Delayed hemolytic transfusion reactions. Evidence for complement activation involving allogeneic and autologous red cells
Authors: Salama A. , Mueller‐Eckhardt C.
Published: March 2003

Twenty‐six patients with delayed hemolytic transfusion reactions (DHTR) were investigated. The reaction of hemolysis often was concealed by other disorders that were usually associated with signs of hemolysis or blood loss. Coating of red cells was analyzed with regard to IgG and/or complement bound in vivo. Although many of the alloantibodies involved (K [8]; E [5]; Fya [2]; Fyb [2]; D [1]; c [1]; multiple [7]) are usually thought to be incapable of complement activation, a strongly positive direct antiglobulin test (DAT) due to C3d was found in all cases. On first examination after transfusion, C3d was present on circulating red cells in large amounts and remained discernible for weeks and even months. IgG on red cells was detected by the DAT in only 10 out of 26 cases. By means of a sensitive radioimmunoassay, IgG was demonstrated in 16 out of 17 cases, but usually in small quantities. Despite the low IgG concentrations, the causative alloantibodies could be eluted in 25 of 26 cases, and, as shown by sequential investigations, in six cases were recoverable from circulating red cells for over 100 days posttransfusion. Since the antiglobulin reactions due to anti‐complement were usually strong, not of the “mixed‐ field” type, and in some cases remained detectable on circulating red cells for months, we conclude that complement is regularly activated in DHTR and binds not only to donated but probably also to autologous red cells.
Acquired hemolytic anemia due to “auto”‐anti‐A or “auto”‐anti‐B induced by group O homograft in renal transplant recipients
Authors: Mangal A.K. , Growe G.H. , Sinclair M. , Stillwell G.F. , Reeve C.E. , Naiman S.C.
Published: March 2003

Three patients developed severe but self‐limited hemolytic anemia within 2 weeks of renal transplantation. All three had received kidneys from cadaver donors who were blood group O. Two of the recipients were blood group B while the third was blood group A. There was no pretransplant preparation of the donors or the recipients. Preoperative crossmatch and antibody screen were negative; however, subsequent to the hemolytic episodes, group‐specific blood was incompatible and the patients were transfused with group O crossmatch‐compatible blood. Blood bank serological tests showed a positive direct antiglobulin test (DAT), and anti‐A and anti‐B were eluted from group A and B patients, respectively. There was no evidence of hemolysis despite the positive DAT at 37 days following transplantation in two of the three patients who were maintained on cyclosporine immunosuppression. Retrospective analysis of renal transplant records showed that these “autoantibodies” appeared in three of the four renal transplant recipients who were on an immunosuppressive regimen of cyclosporine, with or without prednisone, but not in the 21 recipients who received radiotherapy to the donor kidney in addition to cyclosporine or azathioprine (p = less than 0.001). The possible pathogenetic mechanism for “autoantibody” formation by donor kidney and the role of immunosuppressive agents are discussed.
The importance of warming at 37 degrees C for removal of leukocytes and platelets from reconstituted red cells
Authors: Shimizu T , Noda Y , Furuta A , Morishima Y , Goto S , Hasegawa I , Fukuda T
Published: March 2003

Red cells suspended in sodium phosphate buffer (R‐RBC) were incubated at 37 degrees C, and the distribution of the leukocytes and platelets in the suspension was compared to a similar suspension incubated at 22 degrees C. Following centrifugation, a more dense packing of the red cells was observed in warm R‐RBC, and less leukocytes and platelets remained in the red cells below the buffy coat, than was observed in R‐ RBC packed at room temperature. These experiments indicate that incubation at 37 degrees C prior to separation improves the quality of leukocyte‐ and platelet‐depleted red cells.
Prevention of transfusion‐associated cytomegalovirus infection in very low‐birthweight infants using frozen blood and donors seronegative for cytomegalovirus
Authors: Adler SP , Lawrence LT , Baggett J , Biro V , Sharp DE
Published: March 2003

During a 15‐month period, 34 low birthweight infants (less than 1300 g) lacking maternal antibody to cytomegalovirus (CMV) received transfusions from an average of 10 donors per infant. Blood products consisted of predominantly washed deglycerolized frozen red cells from donors lacking antibody to CMV (an average of nine seronegative donors per infant). None of these infants acquired CMV infection while hospitalized. The absence of acquired CMV infections in these infants was in marked contrast (p less than 0.001) to the incidence of CMV infections in seronegative low‐birthweight infants during the previous 21‐month period when 28 percent acquired CMV (7 of 25 infants). The infants in this previous group received transfusions from an average of 11 donors per infant with an average of four seropositive donors per infant. These results confirm that hospital‐acquired CMV infections can be prevented for very low‐birthweight infants by donor selection and/or blood processing.
Preservation of red cell antigens during storage of blood with different anticoagulants
Authors: Myhre B. A. , Demaniew S. , Nelson E. J.
Published: March 2003

A major concern when storing blood is that the antigens of the red cells will lose some of their reactivity in vitro. As part of a study of blood stored in newer anticoagulants, we tested the persistence of the ABO, Rh, Lewis, and P antigens. Blood was stored for 21 to 35 days in several anticoagulant‐preservative systems, such as citrate‐ phosphate‐dextrose and several additive solutions, while using bags of polyvinyl chloride plasticized with di(2‐ethyl hexyl) phthalate or tri (2‐ethyl hexyl) trimellitate. No significant loss of antigenicity occurred in the ABO and Rh systems, but antigens in the Lewis and P systems lost some reactivity during storage.
Cryoprecipitated antihemophilic factor production from blood collected in quad packs or from blood with delayed processing. The importance of plasma thawing method
Authors: Orthner C. L. , MacPherson J. L.
Published: March 2003

Two alternate approaches to increasing the supply of plasma suitable for the production of cryoprecipitated AHF (cryo) were evaluated. In the first, cryo was prepared from blood collected in quadruple packs from which red cells and platelets also were made. This procedure resulted in a mean reduction of starting plasma volume of about 25 percent with a concomitant decrease in factor VIII coagulant activity (FVIII:C) of cryo when compared to approximately 2000 cryos made in triple packs assayed in our laboratory during the past year. However, American Red Cross (ARC) regions using a higher yield waterbath method of thawing plasma successfully produced quadruple pack cryos with a mean potency of 109 international units per container and about 90 percent of them met federal potency requirements. This was not the case for ARC regions using the lower yield method of thawing plasma in a refrigerator. The second approach involved cryo production from plasma frozen following 15 hours of cold storage of either the separated plasma or whole blood. Cold storage of plasma resulted in small but insignificant decreases in FVIII:C potency and yield in the cryo. However, there was a 20 percent decrease in FVIII:C yield in cryo produced from frozen plasma following 15 hours of cold storage of whole blood. Again, the decrease in FVIII:C yield resulting from interim blood storage was compensated for by the use of the higher yield waterbath method.
Preparation of pooled cryoprecipitate for treatment of hemophilia A in a home care program
Authors: Smith K. J. , Hodges P. A.
Published: March 2003

Cryoprecipitate is used infrequently in home therapy for patients with hemophilia A since freezer storage is required and resuspension and pooling of thawed cryoprecipitate is cumbersome. We evaluated procedures for preparation of cryoprecipitate in an “open system” so that four to six bags of cryoprecipitate could be pooled after production and refrozen for home therapy. Factor VIII activity for pooled cryoprecipitate was 132 +/− 30 (mean +/− SD), 125 +/− 45, and 145 +/− 47 units per bag pooled in three separate studies. Cultures from cryoprecipitate pools and individual cryoprecipitate bags did not show contamination in the “open system” or with the water bath thawing procedure. The mean increment in factor VIII activity per unit per kg infused was 0.02 units per ml and the mean half‐life was 10.5 hours in three patients with hemophilia A. Pooled cryoprecipitate was shown to be clinically efficacious and acceptable for use in home care programs for hemophilia A.
The effect of dithiothreitol on the LW antigen
Authors: Konigshaus G. J. , Holland T. I.
Published: March 2003

Dithiothreitol (DTT) has been found to destroy the integrity of the LW antigen. This may pose a problem when DTT is used to differentiate IgM from IgG anti‐LW, or may be used as an aid in the identification of anti‐LW.