bluuebunny/crossref_metadata_2025 huggingface dataset:
Chronic pain management in older people
Authors: Helme Robert D.
Published: September 2002

Successful management of chronic pain in older people is dependent on a careful history and physical examination as it is in young adults. However, detailed attention must also be paid to the effects of co‐morbidity on the pain and its treatment, on communication strategies with patients who often have sight and hearing impediments, and on the feasible range of functional outcomes for each patient. Drug interactions are common in older people as they take more medications and have reduced ability to clear most analgesic and adjuvant medications. This suggests a larger than usual role for non‐pharmacological management strategies. However, simple analgesics and narcotics are safe to use in older people without overt liver and renal disease, providing the lowest dose compatible with functional improvement is sought; the goal of therapy is to maintain optimum function rather than cure the pain. In general the outcome is positive for both the patient and the practitioner as patients usually respond to medical, physical, psychosocial and cognitive behavioural programmes as well as young adults if given an appropriate milieu, adequate time and empathy.
Opioids in cancer and non‐cancer pain management in Korea: the past, present and future
Authors: Han TaeHyung
Published: September 2002

Opiate consumption in Korea has risen exponentially, mainly due to the improved awareness of patients as well as the medical community of the need for pain control. As education grows and the numbers of oncology patients increase, this trend is expected to continue in the area of cancer pain management. It will, however, take some time before it reaches further into the chronic non‐cancer population.

The current situation and problems of analgesic use in Korea are discussed in detail in this article. For the medical community, a lack of proper education appears to be the main issue. The stigma attached when using narcotic medication seems to be a psychological burden for patients. Bureaucracy in the legal and administrative systems hampers the adequate supply of drugs. The importance of proper education for everyone in these areas cannot be overemphasized. As many new health care systems are introduced in the future, change will be imposed upon the medical field.
Control of non‐malignant chronic pain conditions in Japan and the possible future role of tramadol
Authors: Itoh Tatsuo
Published: September 2002

Pharmacological treatment is the most common treatment for non‐malignant chronic pain diseases such as lumbar and/or cervical spondylosis and osteoarthritis of the knee or hip joint. In Japan, opioid analgesics cannot be used for non‐malignant chronic pain syndromes because of the strict regulations for opioid use by the Ministry of Health and Welfare. Non‐steroidal anti‐inflammatory drugs (NSAIDs) do not have sufficient effect as analgesics for some painful conditions as well as having possible serious side‐effects on the gastrointestinal tract and kidneys. According to the Japanese Rheumatism Foundation report on NSAID‐induced gastrointestinal lesions in 1991, gastric ulcers were found in 15.5% of 1008 patients who underwent endoscopic examinations. In multicentric questionnaire research, it was discovered that 63% received NSAIDs for longer than 3 months.

New drugs having stronger effects for chronic pain and less severe adverse side‐effects are expected within the decade. Tramadol hydrochloride controlled‐release is a long‐ and centrally‐acting analgesic without serious side‐effects for which we are currently going on to the phase II trial in collaborative studies between Japan and the United States for non‐malignant chronic pain diseases.
Calculation methods for the continuous intrathecal infusion of a solution containing two or three drugs
Authors: Nubourgh Yves , Moore John
Published: September 2002

The continuous intrathecal infusion of drugs with implantable and programmable pumps is commonly used for the treatment of otherwise intractable pain and spasticity. There is now a consensus that it is possible to use mixtures of two or even three drugs in selected cases. The calculation of the parameters of the pump is easy for a single drug, but it becomes more complicated for a combination of two or three drugs. This paper offers some algebraic formulae that make easier and faster the calculation of the following values: the flow of the pump, the volume of each drug solution to be added to the final mixture, the concentration of each drug in the mixture and the duration of the infusion. These values are determined from the desired quantity of each drug to be infused in 24 h, the concentration of each drug solution and the volume of the reservoir. It is essential that the drugs do not react with one another, that they will remain stable in the reservoir at body temperature and that they are safe for a long‐term infusion. © 2002 European Federation of Chapters of the International Association for the Study of Pain
Channelopathies can cause epilepsy in man
Authors: Steinlein Ortrud K.
Published: September 2002

Idiopathic epilepsies, which account for up to 40% of all epilepsies, are mainly caused by genetic factors. Most idiopathic epilepsies are due to oligogenic or multifactorial rather than monogenetic inheritance. Nevertheless, most of what is known today about the molecular genetics of idiopathic epilepsies has been found by analysing large families with rare monogenetic forms of the disease. For the first time, gene defects can be linked to certain epilepsies. Mutations in the CHRNA4 or CHRNB subunits of the neuronal nicotinic acetylcholine receptor lead to familial nocturnal frontal lobe epilepsy, while defects in the voltage‐gated potassium channels KCNQ2 and KCNQ3 have recently been found to cause benign familial neonatal convulsions. The voltage‐gated sodium channel subunits SCN1B, SCN1A and SCN2A as well as the GABRG2 subunit of the GABAA receptor are involved in the pathology of the newly described syndrome generalized epilepsy with febrile seizures plus. These rare monogenetic epilepsies can serve as models for further genetic analysis of the common forms of idiopathic epilepsies. © 2002 European Federation of Chapters of the International Association for the Study of Pain
What can we learn from clinical trials of anticonvulsant drugs in epilepsy?
Authors: Perucca Emilio
Published: September 2002

Any physician who intends to utilize the available antiepileptic drags (AEDs) judiciously, cannot do so without being well versed on their pharmacological properties and the large body of evidence that is continuously accumulating on their relative efficacy and tolerability in different types of epilepsy. While informal observations such as retrospective surveys and case reports can be useful under special circumstances, prospective randomized clinical studies represent by far the most important tool by which objective information can be obtained about the clinical value of existing drags. Even randomized trials, however, can produce misleading conclusions because of inherent weaknesses or bias in study design, analysis, and interpretation. Common deficiencies identified in some of the most recent drag trials in epilepsy include 1) inclusion of inappropriately heterogeneous patient groups (for example, patients with partial and primarily generalized seizures); 2) low statistical power due to insufficient sample size (for trials designed to show therapeutic equivalence); 3) inappropriate titration rates or suboptimal dosages or dosing schedules (often favouring the sponsor's product over the comparator); 4) insufficient duration of treatment; and 5) utilization of endpoints of questionable clinical significance. In part, some of the above shortcomings can be ascribed to the fact that most clinical drag trials are designed to address regulatory needs rather than to provide the type of information required for rational prescribing. Physicians need to be alerted about the importance of these issues, and they should make every possible effort to interpret critically the medical literature on which they rely to guide and support their therapeutic decisions. © 2002 European Federation of Chapters of the International Association for the Study of Pain
Neuropathic pain: clinical characteristics and diagnostic workup
Authors: Hansson Per
Published: September 2002

Neuropathic pain is part of the neurological disease spectrum and may be an expression of severe medical pathology. Painful neuropathies have multiple disguises and may to a certain extent be mimicked by non‐neurological pain conditions. Painful neuropathic conditions express themselves with spontaneous and/or abnormal stimulus‐evoked pain. The diagnosis of peripheral or central neuropathic pain should be made only when the history and signs are indicative of neuropathy in conjunction with neuroanatomically correlated pain distribution and sensory abnormalities within the area of pain. A future mechanism‐based classification of pain has recently been suggested to facilitate the development of mechanism‐tailored treatment strategies. This is a sound approach and should be pursued. It is mandatory, however, to retain the traditional organ‐based diagnostic workup, which should precede further in‐depth characterization of specific pain mechanisms. Extensive preparatory work is needed on how to link certain symptoms and signs to specific mechanisms, as elucidated from animal studies, before we can introduce mechanism‐coupled treatment strategies. © 2002 European Federation of Chapters of the International Association for the Study of Pain
Neurobiology of neuropathic pain: mode of action of anticonvulsants
Authors: Dickenson Anthony H. , Matthews Elizabeth A. , Suzuki Rie
Published: September 2002

Anticonvulsants are widely used for the treatment of neuropathic pain. Here we review the evidence for a number of peripheral and central changes after nerve injury that may provide a basis for the mechanisms of action of anticonvulsant therapies. The roles of sodium channels, calcium channels, and central glutamate mechanisms are emphasized as the main targets for anticonvulsant drugs in neuropathic pain states. The focus of this article is on anticonvulsants; however, opioids and antidepressants can also be effective in increasing inhibitions to control of pain in a manner similar to that of the enhancement of γ‐aminobutyric acid (GABA) function by antiepileptic drugs. A brief account of these approaches to neuropathic pain is also given. © 2002 European Federation of Chapters of the International Association for the Study of Pain
Children's pain at home following (adeno)tonsillectomy
Authors: Hamers Jan P. H. , Abu‐Saad Huda Huijer
Published: September 2002

The aim of this study was to evaluate the prevalence and severity of children's pain at home following (adeno)tonsillectomies. The subjects were parents of 161 children (86 boys, 75 girls) undergoing myringotomies, adenoidectomies and (adeno)tonsillectomies. The mean age of the children was 5.5 years (SD = 2.4; range 1–14). Parents were asked to assess the child's average pain on the day of operation and 7 days after the operation, using a 100 mm Visual Analogue Scale (VAS). Parents from (adeno)tonsillectomy patients were also interviewed by phone on day 7.

The mean VAS pain intensity scores by period (day of operation until 7th day after operation) differed between the myringotomy (3.2), adenoidectomy (10.6), and (adeno)tonsillectomy (22.1) group (F2,133 = 31.65; p < 0.001). The VAS ratings were highest for the tonsillectomy group (p < 0.001). There was a trend that pain intensity scores for adenoidectomies were significantly higher than scores for myringotomies (p = 0.07). In the interviews, 81% of the parents stated that their child suffered pain at home. However, this was not necessarily a reason to administer an analgesic. Furthermore, parents reported pain‐related problems like problems regarding eating, fluid intake, vomiting and sleep disturbance. Finally, 67% of the children at home recalled severe pain experience in the hospital.

It was concluded that especially following (adeno)tonsillectomies children suffer clinically significant pain at home and that the management of pain and related problems needs to be clearly improved. © 2002 European Federation of Chapters of the International Association for the Study of Pain. Published by Elsevier Science Ltd. All rights reserved.
Unexplained severe chronic pain in general practice
Authors: Kerssens J. J. , Verhaak P. F. M. , Bartelds A. I. M. , Sorbi M. J. , Bensing J. M.
Published: September 2002

The aim of this study was to estimate the prevalence of unexplained severe chronic pain (USCP) in general practice and to report medical as well as psychological descriptions of patients suffering from this condition.

A total of 45 GPs in 35 different practices included patients throughout the year 1996. Patients were included according to the following criteria: between 18 and 75 years of age; pain which had lasted at least 6 months; pain is the most prominent aspect in the clinical presentation; pain is serious enough to justify clinical attention; pain has led to obvious discomfort and disability in daily life for at least for 1 month. Medical aspects were measured with the IASP taxonomy while psychological aspects were derived from the MPI.

The overall prevalence of USCP was 7.91 per 1000 enlisted patients. Estimates ranged between 1.87 in the youngest age group and 13.50 in the 55–59 age category. The lower back and lower limbs were most frequently affected and 31% of the patients had pain in more than three major body sites. Pain was most frequently associated by the musculoskeletal system and most often (nearly) continuous. Mean severity of current pain was 3.7 on a scale from 0 (indicating no pain) to 6 (indicating a lot of pain). Mean rating of ‘average pain in the last week’ was 4.1. Regarding the psychosocial and behavioural aspects of pain, 27% of the patients could be described as perceiving severe pain while gaining social support for it. Fourteen per cent felt in the category ‘pain combined with affective and relational distress’ and 10% was classified as ‘coping well with pain intensities lower than those of the other groups’. The other half of the patients were on average or not classifiable on these aspects.

Unexplained severe chronic pain lasting more than 6 months had on overall prevalence of 7.91 per 1000 enlisted patients, ranging from 1.87 in the youngest to 13.50 in the oldest patients in these 35 general practices in The Netherlands. Our prevalence estimate of USCP is low compared to other studies on chronic pain. Probably for three reasons: Firstly, our study was confined to unexplained pain and not all chronic pain. Secondly, our inclusion criteria focused the attention of very severe chronic pain patients, and thirdly, we have defined ‘chronic’ as more than 6 months, while others have been using shorter time spans. © 2002 European Federation of Chapters of the International Association for the Study of Pain. Published by Elsevier Science Ltd. All rights reserved.
Stimulation of the left ventricle through the coronary sinus with a newly developed ‘over the wire’ lead system — early experiences with lead handling and positioning
Authors: Sack S. , Heinzel F. , Dagres N. , Enger S. , Auricchio A. , Stellbrink C. , Neuzner J. , Potty P. , Maarse A. , Tockman B. , Michel U. , Erbel R.
Published: September 2002

Aims

This report describes the initial clinical results with a newly designed guiding catheter and an ‘over the wire’ pacing lead based on angiolasty technology to stimulate the left ventricle using the transvenous route via the coronary sinus (OTW-CV lead).

Methods and Results

In 75% of the 15 patients (6 males, 9 females, mean age of 53±9 years) with congestive heart failure, access to coronary sinus required less than 2 min; in one patient, the attempt failed. Mean R wave amplitudes plus or minus the standard deviation, measured at apical, mid-ventricular and basal positions in the anterior (11·4±9·2, 10·8±6·2, 9·3±6·3 mV) and lateral or posterior veins (10·1±10·7, 8·6±6·4, 7·7±4·3 mV) showed a trend favouring the apex without statistical significance. Pacing impedance, measured at the same sites and vein tributaries, ranged from 670±191 to 915±145 ohms. Pacing thresholds measured at apical and mid ventricular sites were significantly lower than at the base in the anterior vein 2·5±2·8 and 2·8±1·8 vs 5·6±2·7 V at 0·5 ms, P< 0·001). Thresholds in the lateral/posterior veins showed a similar trend but did not reach statistical significance (3·0±1·7, 3·6±1·4±1·8 V at 0·5 ms). In patients, in whom thresholds were determined in more than one vein, the ‘best’ mean threshold was 1·6±0·7 V.

Conclusion

The new ‘over the wire’ lead and guiding catheter system allows uncomplicated access to the coronary sinus and the depth of the coronary vein tributaries. Left ventricular sensing and pacing thresholds are acceptable for chronic use in implanted cardiac rhythm management systems.
Radiation Therapy for Long-Term Control of Odontogenic Tumours and Epulis in Three Cats
Authors: Moore A S , Wood C A , Engler S J , Bengtson A E
Published: September 2002

Orthovoltage radiation was used to treat odontogenic tumours in three cats following incomplete surgical resection. Cats received a total radiation dose of 48–52 Gy over a period of 26–29 days. Acute toxicities were mild, consisting of hair loss within the radiation field in all cats, and mild mucositis in one cat. All cats had long-term (>35 months) control of their tumour, and two cats are still alive without recurrence of tumour 60 and 39 months, respectively, after completing treatment. Radiation therapy should be considered to be an adjuvant to incomplete surgery in cats with odontogenic neoplasms or epulides.
Back-Scattered Electron Imaging of a Non-Vertebral Case of Hypervitaminosis a in a Cat
Authors: Franch J , Pastor J , Franch B , Durall I , Manzanares M C
Published: September 2002

We describe a clinical case of hypervitaminosis A in a cat. The main lesions were bony fusions of both the hip and stifle joints, without spinal involvement. A post-mortem study using back-scattered scanning electron microscopy (BEI-SEM) revealed that exostoses had formed around the joints without articular surface involvement. The more recently formed areas of bony proliferation were composed mainly of chondroid tissue surrounded by different degrees of woven bone. As the bony reaction occurred, remodelling of the trabeculae was observed which lead to progressive substitution of chondroid tissue by woven bone surrounded by apposition of lamellar bone. No traces of calcified cartilage were observed in any of the bone sections evaluated.
Successful Treatment of Uterine Torsion in a Cat with Severe Metabolic and Haemostatic Complications
Authors: Ridyard A E , Welsh E A , Gunn-Moore D A
Published: September 2002

A peri-parturient fifteen-month-old female Maine Coon cat was presented with extreme weakness and depression, profound hypovolaemia and hypothermia. Severe hyperkalaemia, hyponatraemia and anaemia were detected. Disseminated intravascular coagulation was suspected due to marked prolongation of activated partial thromboplastin time. Uterine torsion was diagnosed at exploratory laparotomy. The cat made a full recovery following ovariohysterectomy and intensive supportive therapy.
Chylothorax in Cats: Is There a Role for Surgery?
Authors: Fossum TW
Published: September 2002

Chylothorax is a complex disease with many identified underlying causes including cardiac disease, mediastinal masses, heartworm disease and trauma. Management of this disease should be directed at identifying the cause, if possible, and treating the underlying disorder. In cats with idiopathic chylothorax, medical management is recommended initially because the condition may resolve spontaneously. Owners should be made aware of the potential development of fibrosing pleuritis in affected cats. When medical management is impractical or unsuccessful, surgical intervention should be considered. Surgical options include mesenteric lymphangiography and thoracic duct ligation, pericardiectomy, omentalisation, passive pleuroperitoneal shunting, active pleuroperitoneal or pleurovenous shunting, and pleurodesis. Of these, only thoracic duct ligation and pericardiectomy are preferred by the author because, if successful, the result is complete resolution of the chylothorax, thereby reducing the risk of developing fibrosing pleuritis. Omentalisation may be beneficial in some animals as adjuvant therapy, but this procedure may still allow fibrosing pleuritis to occur. Until the aetiology of the effusion in cats with idiopathic chylothorax is understood, the treatment success rate will be less than ideal. Future research needs to be directed at determining the pathophysiologic mechanisms underlying this disease in cats.
Clinical Application of Plasma Clearance of Iohexol on Feline Patients
Authors: Miyamoto K
Published: September 2002

Glomerular filtration rate (GFR) was estimated by plasma clearance of iohexol (PCio) in 52 conscious cats presented for a variety of reasons to Angel Animal Hospital over a 2-year period. Cats were divided into four groups according to their clinical conditions and reasons for measuring PCio. The median PCio (ml/min/kg) was 3.68 in normal cats (NM), 2.39 in cats with suspected renal disease (SP), 1.35 in cats referred to confirm renal dysfunction (RD), and 0.84 in cats with apparent clinical signs of renal failure (RF). There was a significant difference between the results for each group. The respective medians of blood urea nitrogen (BUN) and plasma creatinine concentration (Pcr) (mg/dl) were 15 and 1.40 in NM cats, 21 and 1.71 in SP cats, 30 and 2.20 in RD cats, and 48 and 3.30 in RF cats. The reference values of BUN and Pcr were 21 ± 7 mg/dl and 1.5 ± 0.4 mg/dl (mean ± SD). Diminished renal function could not be detected in SP cats by either BUN or Pcr, while a marked decrease of GFR was demonstrated before BUN and Pcr increased, indicating the insensitivity of BUN and Pcr in detecting renal dysfunction in cats. PCio can be performed non-invasively in conscious cats, which improves the veterinarian's ability to detect early stages of chronic renal disease.
Cholelithiasis and Hyperthyroidism in a Cat
Authors: Elwood CM , White RN , Freeman K , White M
Published: September 2002

A 14-year-old domestic short-hair cat presented with a history of intermittent malaise and increased drinking. A diagnosis of hyperthyroidism and cholelithiasis was made by a combination of blood testing, radiography and ultrasonography. After medical management of hyperthyroidism, thyroidectomy and cholecystectomy were successfully performed. Removed choleliths were comprised of calcium carbonate and bilirubinate. Histopathological analysis of tissue suggested low grade pancreatic and hepatobiliary disease, as well as hyperthyroidism, might have contributed to stone formation.
Primary Right Atrium Haemangiosarcoma in a Cat
Authors: Merlo M , Bo S , Ratto A
Published: September 2002

Primary cardiac neoplasms are rare in animals. Hemangiosarcoma is the most common primary cardiac tumour in the dog, but has not been reported in the cat.

We describe the clinical signs, the gross examination, and the morphological and immunohistochemical features of a haemangiosarcoma in the right atrium of a 13-year-old domestic shorthair cat. In addition, a distant metastasis was found in the liver.
Ultrasound Aspects of Fetal and Extrafetal Structures in Pregnant Cats
Authors: Zambelli D , Caneppele B , Bassi S , Paladini C
Published: September 2002

Prenatal feline fetal growth and utero-placental development were ultrasonographically evaluated using an ultrasound scanner with a 10 MHz sector probe. Uterus, placenta, embryo, fetus and fetal membranes in 16 pregnant cats were monitored during the course of pregnancy; 13 subjects underwent an ovariectomy on specific days while three subjects went to term. Various anatomic structures, fixed in Carson-buffered formalin, were sectioned and then compared to ultrasound images.

By ultrasound examination it is possible to evaluate every stage of the fetal development; the gestational chamber can be seen on the 10th and the embryo inside the chamber on the 14th day. By the 20th day it is possible to evaluate all the fetal membranes, and later it is possible to appreciate organs and structures such as the stomach, intestine, eyes (crystalline lens), kidneys and the cerebral choroid plexi, on the 30th, 40th, 50th, 39th and 40th day respectively.

Based on our observations, it will be simpler to locate anomalies of development or pathologies during ultrasound examination of pregnant queens.
Dietary Chromium Tripicolinate Supplementation Reduces Glucose Concentrations and Improves Glucose Tolerance in Normal-weight Cats
Authors: Appleton DJ , Rand JS , Sunvold GD , Priest J
Published: September 2002

The effect of dietary chromium supplementation on glucose and insulin metabolism in healthy, non-obese cats was evaluated. Thirty-two cats were randomly divided into four groups and fed experimental diets consisting of a standard diet with 0 ppb (control), 150 ppb, 300 ppb, or 600 ppb added chromium as chromium tripicolinate. Intravenous glucose tolerance, insulin tolerance and insulin sensitivity tests with minimal model analysis were performed before and after 6 weeks of feeding the test diets.

During the glucose tolerance test, glucose concentrations, area under the glucose concentration-time curve, and glucose half-life (300 ppb only), were significantly lower after the trial in cats supplemented with 300 ppb and 600 ppb chromium, compared with values before the trial. Fasting glucose concentrations measured on a different day in the biochemistry profile were also significantly lower after supplementation with 600 ppb chromium. There were no significant differences in insulin concentrations or indices in either the glucose or insulin tolerance tests following chromium supplementation, nor were there any differences between groups before or after the dietary trial.

Importantly, this study has shown a small but significant, dose-dependent improvement in glucose tolerance in healthy, non-obese cats supplemented with dietary chromium. Further long-term studies are warranted to determine if the addition of chromium to feline diets is advantageous. Cats most likely to benefit are those with glucose intolerance and insulin resistance from lack of exercise, obesity and old age. Healthy cats at risk of glucose intolerance and diabetes from underlying low insulin sensitivity or genetic factors may also benefit from long-term chromium supplementation.
Review of experimental studies in allergy: 1) Clinical studies
Authors: Poitevin Bernard
Published: September 2002

The incidence of allergic conditions is increasing. The treatment of allergic conditions by homoeopathy is one of the most extensively investigated aspects of clinical homoeopathy. The author reviews the use of isotherapy and other homoeopathic therapeutic strategies in homoeopathy. Open studies of homoeopathic treatment of allergic conjunctivitis, rhinitis, asthma and sensitivity to Cotrimoxazole are discussed. Controlled clinical trials of Galphimia glanca in hayfever and specific isotherapy in hayfever and asthma are discussed and criticised.
Preliminary research for testing Baptisia tinctoria 30c effectiveness against salmonellosis in first and second quality broiler chickens
Authors: Sandoval CH , Morfin LL , Lopez BB
Published: September 2002

The aim of this research was to compare the effectiveness of Baptisia tinctoria 30c and Ciprofloxacin against salmonellosis in fowl. Eight hundred (400 first quality and 400 second quality) poultry birds were used. All were the same commercial brand. There were two treatments, both with four repetitions. Treatment began when chickens were eight days old; two drops/kg live weight/d Baptisia tinctoria or 15 mg/kg live weight/d of Ciprofloxacin. Both treatments lasted ten days and were given in the drinking water. Salmonella diagnostic tests were made on day 0, day 8 and day 49 of age and death rate was when treatments had finished. Death rate values were applied a square root transformation and a 2×2 factorial analysis was made.

The mortality for first and second quality fowl in the Baptisia tinctoria group were 0.7125 and 2.037, respectively, and in the Ciprofloxacin group, 0.7245 and 2.1848, respectively. No significant statistical difference was observed (P>0.1) regarding treatments, only regarding different quality fowl (P<0.01). After comparing, Baptisia tinctoria 30c and Ciprofloxacin treatments against salmonellosis, it was concluded that there were no meaningful differences between outcomes.
The ammonia remedies: their homoeopathic use in head injuries and other head conditions
Authors: Richardson-Boedler Cornelia
Published: September 2002

The ammonia remedies, deriving from a gas, show distinct head symptoms, generally characterized by a cerebral congestion, heaviness and confusion. Case experiences, presenting with a similar symptomatology after a traumatic impact to the head, alerted to the remedies’ use in head injuries. Ammonium carbonicum and Ammonium muriaticum were found curative. Unlike the Natrum remedies, the ammonia remedies have not been specifically linked with this particular effect, although Clarke’s Dictionary of Practical Materia Medica describes the successful use of Ammonium picricum in the head injury.

The two cases are described and an overview of the materia medica of Ammonia remedies is given, with special attention to head and face symptoms. Nerve-related head symptoms are also apparent in the materia medica.

Respiratory illness, often with a suffocative character, a diminished vitality, and impeded circulatory functions are further typical manifestations of the ammonia compounds.
Homoeopathic medicine test according to the crossover design: from theory to practice
Authors: Koster Dick , Van Haselen Robbert , Jansen Gerard , Dicke Martin
Published: September 2002

An homoeopathic pathogenic trial (HPT, proving) was carried out using a double-blind, placebo-controlled crossover method. The name of the medicine was also unknown to the volunteers. A number of subjects withdrew at the last minute, leading to an unbalanced randomisation. A strong period effect was observed, which makes results difficult to interpret. Most subjects were able to guess correctly which treatment was active and which placebo.
Reduction of alcohol induced sleep time in albino mice by potentized Nux vomica prepared with 90% ethanol
Authors: Sukul A , Sinhabau SP , Sukul NC
Published: September 2002

Male adult albino mice were administered potentized Nux vomica 30 c (Nux v). The drug was mixed with sterile distilled water at 0.05 ml/2 ml water and given at 0.05 ml/individual. Control consisted of blank ethanol solution. Ethanolic extract from the seeds of
Strychnos nuxvomica
L was mixed with 90% ethanol 1:100 and sonicated for 30 s at 20 KHz. This was further diluted and sonicated in 30 steps to produce Nux v 30 c. Six hours after treatment, mice were given 25% ethanol i.p. at 4 g/kg body wt. The duration of sleep time starting from the loss of righting reflex until its restoration was recorded for each mouse. The duration of sleep time with ethanol was recorded in four sessions for the same group of mice with an interval of 10 d between sessions. Treatments: session 1 with control solution, 2 with
Nux v
(oral), 3 with control solution and 4 with
Nux v
(i.p.).
Nux v
(oral) produced the shortest sleep time as compared to other treatments which did not differ from each other significantly with respect to sleep time.

In another experiment Nux v 30 c was prepared with distilled water and pure absolute ethanol by the above process of successive dilution and sonication. These two preparations together with
Nux v
30 c, prepared with 90% ethanol, were tested on mice for their effect on alcohol-induced sleep time. Only
Nux v
30 c prepared with 90% ethanol was effective in reducing the sleep time in mice. It is concluded that the solution structure of ethanol/water mixture carries the specificity of the
Nux v
at ultra high dilution. It is further concluded that the effect is mediated through oral receptors.
Homeopathy in HIV infection: a trial report of double-blind placebo controlled study
Authors: Rastogi DP , Singh VP , Singh V , Dey SK , Rao K
Published: September 2002

Objective: This study was aimed to evaluate the immuno-modulator role of homeopathic remedies in Human Immunodeficiency Virus (HIV) infection.

Methodology: A randomised double blind clinical trial was conducted to compare the effect of homeopathic remedies with placebo, on CD4+ve T-lymphocytes in HIV infected individuals, conforming to Centres for Disease Control (CDC) stage II & III. 100 HIV+ve individuals between 18–50 y (71% males) were included in the study. 50 cases conformed to CDC stage II—Asymptomatic HIV infection, and 50 cases to CDC stage III—Persistent Generalised Lymphadenopathy (PGL). Cases were stratified according to their clinical status and CD4+ve lymphocyte counts. The randomisation charts were prepared much before the start of the trial by randomly assigning placebo and verum codes to registration numbers from 1 to 50. A single individualised homeopathic remedy was prescribed in each case and was followed up at intervals of 15 d to one month. A six months study was performed for each registered case. Assessment of progress was made by evaluation of CD4+ve lymphocyte counts, which was the prospectively-defined main outcome measure of the study; the results were compared with the base line immune status.

Results: In PGL, a statistically significant difference was observed in CD4+ve T-lymphocyte counts between pre and post trial levels in verum group (P<0.01). In the placebo group a similar comparison yielded non-significant results. (P=0.91). Analysis of change in the pre and post trial counts of CD4+ve cells between groups was also statistically significant (P=0.04).

In asymptomatic HIV infection, differences in absolute CD4+ve lymphocyte counts between pre and post trial levels were not significant. Analysis of changes in pre and post trial CD4 levels of placebo and verum groups for combined strata of asymptomatic and PGL groups was also not significant.

Conclusion: The study suggests a possible role of homeopathic treatment in HIV infection in symptomatic phase, as evidenced by a statistically significant elevation of base line immune status in persistent generalised lymphadenopathy.
Homeopathy and general practice: an urban perspective
Authors: Perry R , Dowrick C
Published: September 2002

Complementary medicine appears to be an increasingly popular option amongst both doctors and patients. General practitioners (GPs) in more affluent parts of Britain have showed considerable interest in its use. Our objectives were to ascertain the use of and attitudes towards homeopathy amongst GPs working in a socio-economically deprived urban area such as Liverpool.

A postal questionnaire survey was carried out of all general practice principals in Liverpool, using freepost envelopes and one reminder after three weeks. With respect to eight common complementary therapies in general and homeopathy in particular, respondents were asked whether they treat with, refer to or endorse each therapy; and their views were questioned on NHS funding, effectiveness, adverse reactions, training needs and theoretical validity, for each therapy.

The response rate was 131/252 (52%), and was higher amongst women and doctors aged under 40 y. During the previous week 37 (28%) GPs had been involved in homeopathy with their patients: 6.5% had treated directly, 18.5% had referred to, and 7% had endorsed homeopathy. 31% of GPs reported successful outcomes by homeopathic treatment compared with 14% reporting adverse effects. Respondents were generally uncertain about the validity of the theoretical basis of homeopathy; only 23% considered it to have a valid basis.
Madingley, Madding, Mad scenarios: an exercise in futurology
Authors: Eskinazi D
Published: September 2002

The Madingley scenarios were created to suggest potential contrasting futures (around year 2020) that could develop from the same driving forces. Those contrasting futures are named ‘Trust their Guidance’ and ‘Find my Way’, respectively. Trust their Guidance depicts a world where institutions have succeeded in adapting to the changing world and have strengthened their power and control on nations. Find my Way depicts a world where empowered individuals have taken responsibility for optimising their own lives. The discussion of these scenarios raised a number of questions including the purpose and role of governments, differences between societies, fundamental vs superficial change and, applied to the area of homeopathy, the role and responsibility of the homeopathic community in shaping the future of this medical approach.
Using a computer-based clinical management system to improve effectiveness of a homeopathic service in a fundholding general practice
Authors: Peters D , Pinto GJ , Harris G
Published: September 2002

Problems which the development attempts to address.

This study’s overall objectives were to determine whether:

Method: The primary care team (PCT) explored the problems of developing a rational and quality assured complementary therapy service in a series of meetings in an NHS practice where complementary therapists are members of the PCT. This led to the defining of data-collection structures and processes needed. The researchers designed and supervised their implementation and evaluation through a series of action research cycles.

A database was designed which allowed the clinicians to track interventions and outcomes using the Measure Your Own Medical Outcome Profile (MYMOP). Critical incidents were brought to fortnightly clinical meetings and methods were continually adapted as problems arose and new options emerged at six-weekly audit meetings.

Results: GPs tended to refer patients who do not fit easily into biomedical disease categories. Patients referred tend to self-rate themselves as experiencing notably poor wellbeing. MYMOP has to be used skillfully with homeopathic patients, especially where psychological distress is identified as one of their main complaints.

Conclusions: It is possible to introduce rigour and reflectiveness when providing a homeopathic service in general practice by assessing the needs of patient and practitioners, agreeing intake guidelines, developing referral processes, implementing audit cycles. Clear lines of communication can be established and a patient-centred outcome measure can be introduced into the treatment cycle.
Effects of acupuncture and homeopathy: prospective documentation. Interim results
Authors: Walach H , Güthlin C
Published: September 2002

Objective: To evaluate the overall effectiveness in general practice of homeopathy and acupuncture, and to estimate costs.

Method: Prospective documentation of all patients insured with an insurance company who are provided with free treatment of acupuncture and homeopathy. 4000 patients treated by acupuncture and 1000 patients by homeopathy will be enrolled. All patients will be followed up from the beginning of treatment for another 4 years. Doctors will provide data on each visit (diagnosis, treatment, change of symptoms, etc.), patients will fill in questionnaires at the beginning and at the end of treatment, as well as each year after the end of treatment (complaints, current treatment, general health status as measured by the MOS-SF 36). Insurance data on workdays lost will be provided by the insurance company.

Results: Data acquisition and entry is continuing. Up to now data from the first questionnaire of 1453 patients have been entered and 951 patients have returned the follow-up questionnaire. Doctors’ ratings of the change of the main diagnosis shows improvement of around 80% with only 2% deteriorated. This impression is vindicated by the patients’ follow-up questionnaire. 36% patients rated the therapy as efficacious, 47% as partially efficacious. Quality of life as measured by the SF 36 questionnaire improved significantly in all dimensions. Data on workdays off will be presented.

Conclusion: Homeopathy and acupuncture are clinically effective in a variety of medical problems.
Immunologic changes in healthy probands and HIV infected patients after oral administration of Staphylococcus aureus 12c: a pilot study
Authors: Danninger T , Gallenberger K , Kraeling J
Published: September 2002

The tumoricidal and antiviral effects of Staphylococcal toxins are well documented. In a preliminary study we investigated the immune modulating properties of these toxins by administering single oral doses of a 12c potency of a lysate of Staphylococcus aureus Cowan I, to 4 healthy probands and 12 HIV infected patients with clinical symptoms. We observed a decrease of circulating immune complexes in the healthy probands as well as in the HIV positive patients, accompanied in the latter by a significant increase of CD4 lymphocytes, CD4/CD8-ratio and an improvement of the HIV related symptoms. None of the dose dependent toxic effects commonly found in Staphylococcal sepsis were noticed. Further research on the immune modulating effects of potencies of bacterial superantigens is suggested, especially in view of a possible treatment for HIV infected and other immune compromised patients.
An evaluation of Coffea cruda effect on rats
Authors: Ruiz-Vega G , Pérez-Ordaz L , Proa-Flores P , Aguilar-Díaz Y
Published: September 2002

To investigate the effect of the homeopathic medicine Coffea cruda on sleep pattern, it was orally administered to rats at the beginning of their waking period. EEG from the parietal region was recorded during their next sleep cycle. Applying an FFT algorithm, spectral in the band, 0.5–2.5 Hz, was chosen as a marker parameter, evaluated for control and verum groups using a double-blind protocol. Power in the verum group was statistically higher than baseline value, it was not statistically different in the control group. The results indicate that an enhancement in EEG slow delta activity is associated with Coffea cruda.
The widow spider Latrodectus tredecimguttatus: source of the remedy Tarentula hispanica?
Authors: Richardson-Boedler C
Published: September 2002

The European wolf spider, Lycosa tarentula, said to have caused the historical phenomenon of ‘tarantism’, is the official medicinal source of the homeopathic remedy Tarentula hispanica. Yet, scientific evidence links the spider's venomous effects with mild necrotic and minor systemic effects that contrast with the proving symptoms of Tarentula hispanica which show a cerebral and neural component. A comparative investigation by use of toxicological, clinical findings, supported by modern and antique biological texts, as well as homeopathic materia medica, traces the source of the remedy Tarentula hispanica to the Mediterranean widow spider Latrodectus tredecimguttatus, thus warranting a re-evaluation of pharmacological preparation.
The efficacy and safety of a homeopathic gel in the treatment of acute low back pain: a multi-centre, randomised, double-blind comparative clinical trial
Authors: Stam C , Bonnet MS , van Haselen RA
Published: September 2002

Acute low back pain is a very common condition in Western industrialised countries. In most cases analgesics or topical medications are prescribed at first encounter with the general practitioner (GP).

The aim of this study was to investigate whether the homeopathic gel Spiroflor SRL® gel (SRL) is equally effective and better tolerated than Cremor Capsici Compositus FNA (CCC) in patients with acute low back pain.

A multi-centre, randomised, double-blind, controlled clinical trial was conducted in the practices of 19 GPs in the districts of Bristol and Manchester, UK. One hundred and sixty-one subjects suffering from acute low back pain were treated for one week either with SRL or with CCC. Pain was scored on a 100 mm visual analogue scale (VAS). Main efficacy parameter VAS reduction was compared between treatments. Evaluation of safety was primarily based on the number of subjects with adverse events (AEs), withdrawals due to an AE and adverse drug reactions (ADRs).

The mean difference between the VAS reduction in the SRL group and the CCC group adjusted for VAS at baseline and age was −0.6 mm (90%CI=−6.5–5.3 mm). Fewer subjects in the SRL group (11%) experienced an AE than in the CCC group (26%). The same applies to the number of subjects with an ADR (3/81=4% vs 18/74=24%) and the number of subjects withdrawn due to an ADR (0/81=0% vs 8/74=11%).

In conclusion, SRL and CCC are equally effective in the treatment of acute low back pain, however, SRL has a better safety profile. Spiroflor SRL® gel is preferable to Capsicum-based products for the topical treatment of low back pain, because of the lower risk of adverse effects.
Homeopathy in Cuban epidemic neuropathy: an open clinical trial
Authors: Cairo J , Elliot BE , Barnouin J , Fleites P , Araoz A , Morales M , Verdura T , Sanchez M , Serrano C , Alvarez JL , Veillard J-J
Published: September 2002

In an outbreak of epidemic neuropathy (EN) in Cuba (1992–1993), most patients were improved by vitamin therapy. In subjects with residual symptoms, alternative treatments including homeopathy were suggested to ameliorate optic and peripheral signs of the disease. An open clinical pilot trial was conducted on 31 patients with long standing symptoms of optic (OPTI group, n=15) or peripheral EN (PERI group, n=16). During the trial, OPTI and PERI patients continued the same treatment that they received before. Carboneum sulphuratum and Tabacum in homeopathic dilutions were administered for 30 days. These medicines are specific to optic EN, but not closely linked with peripheral EN. Clinical status was evaluated by neurological and ophthalmologic tests at diagnosis (Ddiag), 7 days before homeopathic treatment (D0) and 90 days after (D90). From D0 to D90, the percentages of improvement were 73.3% for the OPTI form and 12.5% for the PERI form. The percentage of improved OPTI patients was significantly higher after the homeopathic treatment vs the period between Ddiag and D0 for optical EN (P<0.01), but not for PERI subjects (P>0.05). In the OPTI group, colour vision, visual acuity and visual field improved after homeopathic treatment (P<0.001), these parameters did not change between Ddiag and D90 (P>0.05). Carboneum sulphuratum and Tabacum showed a reasonable effectiveness in optical EN, but were not effective in PERI EN.
Do constitutional types really exist? A further study using grade of membership analysis
Authors: Davidson J , Fisher P , van Haselen R , Woodbury M , Connor K
Published: September 2002

‘Constitutional types’ are a feature of homeopathy. Constitutions are constellations of mental, physical and general features. We present results of a 152-item ‘Constitutional Type Questionnaire’ (CTQ), relating to 19 major constitutional remedies. Patients referred to the Royal London Homoeopathic Hospital (RLHH) were recruited from outpatient clinics. Each remedy was assigned eight associated features. Each item is rated as it applies to the subject most of the time on a five-point scale. Grade of Membership analysis (GOM) was used for evaluation of remedy profiles. Four hundred and forty-seven individuals provided useable data. Demographic data were collected. A nine pure type solution provided the best fit to the data. Few subjects had exclusive ‘membership’ of one pure type. There are some difficulties in interpretation; for instance some groups were characterised by the absence of ‘constitutional’ features. Some pure types are coherent, recognisable types.

The results give some support to the homeopathic concept of constitution. CTQ results correlate quite well with the actual prescribing of homeopaths. Further validation with other cohorts is required and with refinement it might become a useful screening method. It cannot simulate complex information processing performed by homeopathic practitioners.