Surgery versus chemonucleolysis for herniated lumbar discs. A prospective study with random assignment

The results of removal of a disc hernia at the L4/L5 level were compared with those obtained by the injection of 4000 IU (2 ml) of chymopapain (Discase) in 29 consecutive patients randomly selected for either treatment. All exhibited severe incapacitating sciatica, and all had a myelogram demonstrating a definite disc hernia. The two groups of patients did not differ significantly with regard to age, sex, or length of history. The total time of general anesthesia was significantly shorter for the injected patients by 20 minutes (p less than 0.01), as was the length of hospitalization, by three days (p less than 0.05). Within five months, eight of the patients receiving chymopapain injections had to be operated on because of unrelieved symptoms. All had definite disc herniae, and in four, a free fragment was found. All patients were seen at the time of dismissal from the hospital and at six and 12 months after operation by an independent observer. Comparisons made at these intervals, following either surgery or chymopapain injection with or without subsequent surgery, did not reveal any significant differences, but the short-term results following either treatment alone significantly (p less than 0.01) favored the surgical approach.

Estimation of time as a measure of pain magnitude

A new method of measuring pain is presented where the patient's estimation of time is used as a pain-related parameter. Pain patients experience a certain time period as increased when compared with pain free control subjects. The increase in time estimation correlates roughly with the clinical estimate of pain severity in different diagnostic groups. Successfully treated patients change their time estimation towards normal. It is considered that this method could be used to evaluate a certain patient's pain and the effectiveness of treatment in relation to the mean time estimate of other patients with the same diagnosis.

Pharmacodynamic and pharmacokinetic study of oral and intravenous penbutolol

The present study was done to establish the dose-response relationships for effects on heart rate and systolic and diastolic blood pressure, tolerance and plasma disappearance kinetics after large intravenous and oral doses of penbutolol. Twelve healthy volunteers were randomly allocated to receive penbutolol (n = 8) or placebo (n = 4) in this single blind, placebo-controlled investigation. The degree of beta-blockade was measured by standarized exercise tests at work loads selected to produce a heart rate of 150/min without treatment. Penbutolol was given as single i.v. doses of 3, 6 and 12 mg and as 40, 80 and 120 mg once daily for one week, measurements being made 2 and 24 h after the last dose. Penbutolol i.v. did not influence the resting heart rate but it did reduce resting systolic blood pressure in a non-dose dependent manner. Exercise heart rate and systolic pressure were lowered by all the intravenous doses. All oral doses of penbutolol lowered exercise heart rate and systolic blood pressure to the same extent. The reductions in exercise tachycardia was still present after 24 h. After i.v. administration t1/2 was approximately 1.2 h and the volume of distribution was 32-421. All doses were well tolerated.

Surgical treatment of carcinoma of the vulva

In a prospective study, 169 patients with invasive squamous cell carcinoma of the vulva were treated by radical surgery. One hundred patients, without palpable inguinal lymph nodes, had a vulvectomy only, and the remaining 69 underwent vulvectomy in combination with groin dissection. Different prognostic factors were analyzed, and the results of radical surgery were evaluated. It was found that a small, exophytic, microscopically well differentiated tumor confined to one anatomic area will carry the best prognosis. Conversely, a patient with a large, endophytic, poorly differentiated tumor with inguinal lymph node metastasis will have the least favorable outcome. If there is metastatic spread to the deep inguinal node, Rosenmüller, the prognosis is quite bad. The crude five year survival rate was 56 per cent and the corrected survival ate was 65 per cent. Eleven patients died of early complications, seven of pulmonary embolism. It was concluded that radical surgery gives the best cure rate. It is suggested that operation for invasive squamous cell carcinoma of the vulva in all patients should consist of vulvectomy with primary skin grafting and bilateral superficial inguinal gland excision en bloc.

Pain relief in labor by transcutaneous electrical nerve stimulation. Testing of a modified stimulation technique and evaluation of the neurological and biochemical condition of the newborn infant

In this prospective randomized study of pain relief in labor, the effect of transcutaneous electrical nerve stimulation (TNS) performed over both the low-back and suprapubic region was evaluated and compared with a control group not receiving TNS. Both high frequency and pulse train TNS were used. The study included 24 induced labors. In the TNS group, conventional methods were added when needed, while in the control group only conventional methods were used. Assessment of low-back and suprapubic pain was performed by the parturient each hour during the first stage. In the TNS group most of the parturients reported minimal or moderate low-back pain throughout labor, while parturients in the control group reported an increased intensity of low-back pain as labor progressed. The effect of suprapubic pain was insignificant in both groups. Neither TNS nor nitrous oxide-oxygen mixture and pethidine could reduce this pain component. Course of labor, uterine activity and fetal heart patterns were similar in the two groups. The neonates were evaluated with Apgar score, assays of blood samples from the umbilical vein including blood lactate, plasma hypoxanthine and blood gas, and neurobehavioral assessment on two occasions. All newborn infants were in good condition and no significant differences between the two groups could be demonstrated.

Pain relief in labor by transcutaneous electrical nerve stimulation. A prospective matched study

The study evaluated transcutaneous electrical nerve stimulation (TNS) for pain relief in labor, used in parallel with conventional methods. The investigation comprised 566 vaginally delivered women, 283 of whom were given TNS. Pain relief was evaluated with a questionnaire which the women answered shortly after delivery. With a statistical multivariate technique, it was concluded that TNS has a specific effect on pain localized to the back. Few women in either the TNS or the control group reported good relief of pain localized to the suprapubic region. Nitrous oxide-oxygen mixture was used less often in the TNS group than in the controls. Duration of labor and maternal blood loss were comparable in the two groups. The babies borne by primiparae in the TNS group tended to have better Apgar scores. Fewer babies of primiparae in the TNS group required observation for two days or more on the neonatal ward than was the case with the controls. However, the electrical stimulation could not be used optimally as it interfered with monitoring the fetal heart rate in half the cases. It is concluded that although TNS has a good effect on low-back pain and seems to have no negative effects on the mother or child, it is only a complement to conventional methods.

Periapical surgery

A retrospective study of 572 teeth treated with periapical surgery was undertaken in order to evaluate the influence of preoperative, operative and postoperative factors in the healing process as well as the operation method used. It was also the aim to assess whether the histophatological diagnosis of biopsies taken at the operation could be correlated to healing. Statistical analyses by the AID method and conventional cross-classification methods were performed. Factors of importance were found to be the extent of the destrucion, the operation method used, the bone surrounding the destruction, the quality of the orthograde root filling, the age of the patient, and the marginal bone buccally. The operation method was of importance in large destructions where root fillings were considered as not having properly sealed the canals, and when treating inflamed cysts. The histopathological diagnosis could not be ascribed any definite prognostic value.

Applied diagnostic techniques: a decisive factor in the long-term T-year survival rate in prostatic carcinoma

Ii is shown from statistical data reported to the Swedish Cancer Registry that in cases of prostatic carcinoma the long-term T-year survival rate is the final outcome of a complex interplay of multiple factors including diagnostic technology and techniques for staging and grading. Assessment of the value of specific therapy is not possible except in controlled clinical trials. The T-year survival rate per se does not give an accurate estimate of the effect of treatment.

Analgesic efficacy and safety of Fenbufen following surgical removal of a lower wisdom tooth: a comparison with acetylsalicylic acid and placebo

In a double-blind clinical trial a new, non-steroidal anti-inflammatory agent with analgesic properties, Fenbufen, was compared to acetylsalicylic acid (ASA) and placebo. Six hundred (600) out-patients, following surgical removal of an impacted lower wisdom tooth, were divided into three groups and randomly given either Fenbufen (500 mg capsules), ASA (750 mg capsules), or placebo. One capsule was taken immediately after the surgical procedure, followed by another capsule every 6 hours. The duration of treatment was 24 hours. Thus, a total of 4 capsules were taken. Self-evaluation forms were provided to the patients and were returned to the investigators the following day. The results were statistically analyzed. Both Fenbufen and ASA were statistically superior (p less than or equal to 0.01) to placebo in relieving pain. A comparison of the Fenbufen and ASA groups demonstrated a statistically significant (p less than or equal to 0.05) superiority for Fenbufen in relieving pain. Also sleep was less disturbed in the Fenbufen group. Side-effects reported were few, minor in character, and fewer in number in the Fenbufen group.

Prognostic factors in cutaneous malignant melanoma in stage I. A clinical, morphological and multivariate analysis

In a retrospective study of 324 cutaneous malignant melanomas in stage I, treated during the years 1959-74, the influence of different morphological and clinical factors on the prognosis was investigated. 223 patients with melanoma in levels II-V, observed for more than five years, were subjected to a multivariate analysis. 180/223 were in levels III-V. The age of the patient, the location of the tumour, its diameter, thickness, infiltration level, presence of ulceration and mitotic activity were shown to be of significant importance for the five-year survival of the 223 patients. Analysis limited to levels III-V disclosed that the diameter and the thickness of the tumour but not the infiltration level significantly influenced the prognosis. However, the sex of the patient, the histogenetic type of the tumour, the cross-sectional profile, vascular invasion and degree of lymphocytic infiltration did not correlate with survival.

Lunar Surface Radioactivity: Preliminary Results of the Apollo 15 and Apollo 16 Gamma-Ray Spectrometer Experiments

Gamma-ray spectrometers on the Apollo 15 and Apollo 16 missions have been used to map the moon's radioactivity over 20 percent of its surface. The highest levels of natural radioactivity are found in Mare Imbrium and Oceanus Procellarum with contrastingly lower enhancements in the eastern maria. The ratio of potassium to uranium is higher on the far side than on the near side, although it is everywhere lower than commonly found on the earth.