[Clinical observation on fire needles at bones combined with cupping and Tuina for knee osteoarthritistis]

OBJECTIVE

To explore a better therapy for knee osteoarthritis.

METHODS

One hundred cases were randomly divided into a comprehensive group and an acupuncture group, 50 cases in each one. The comprehensive treatment of fire needles at bones combined with cupping and Tuina on local area of affected knee was applied in the comprehensive group. The Ashi points were mainly selected in the fire needles at bones therapy, once every other day. The cupping and Tuina therapy was adopted once a day. The conventional acupuncture was applied in the acupuncture group, in which Dubi (ST 35), Neixiyan (EX-LE 4), Xuehai (SP 10), Liangqiu (ST 34) and so on were selected, once a day. Ten days of treatment were taken as a treatment course in both two groups, and totally 1 to 2 courses was required. The pain score of joint before and after the treatment was observed and efficacy was assessed in two groups.

RESULTS

Compared before the treatment, the pain score of joint after the treatment was obviously improved in two groups (both P<0.05), and the score in the comprehensive group was lower than that in the acupuncture group (P<0.05). The clinical cured rate was 38.0% (19/50), which was superior to 20.0% (10/50) in the acupuncture group.

CONCLUSION

The comprehensive treatment of fire needles at bones combined with cupping and Tuina, considered as a better therapy for knee osteoarthritis, could improve joint pain, swelling and action function, which is superior to the conventional acupuncture.

Barbiturates inhibit progesterone synthesis in cultured Leydig tumor cells and human granulosa cells

Screening drugs used in obstetrical practice for effects on steroid hormone synthesis revealed that phenobarbital inhibited progesterone synthesis in MA-10 Leydig tumor cells. The inhibition was apparently a drug class effect since it could be reproduced by other barbiturates. Barbiturate blockade was reversible and could be bypassed in the MA-10 cells by using 22-hydroxycholesterol. Human granulosa cell progesterone synthesis was also inhibited in a dose dependent fashion by phenobarbital, secobarbital and barbituric acid. Significant inhibition occurred in dose ranges that would be therapeutic for treating epilepsy. From these data we conclude that barbiturates block steroidogenesis by inhibiting cholesterol transport to the cholesterol side chain cleavage enzyme.

Analgesia versus sedation during Broviac catheter placement

Premature infants are capable of mounting physiologic and metabolic responses to pain. Systemic and local anesthesia reduce stress responses to major and minor surgical procedures. We evaluated the effects of local anesthesia (5 mg/kg lidocaine) preceded by either 1 mg/kg secobarbital (S) intravenously or by 2 micrograms/kg fentanyl (F) intravenously on the stress response to Broviac catheter placement. Twenty-nine premature infants ages 5 to 30 days, weighing between 650 and 1350 gm, were randomly assigned to either S or F groups. Age, birthweight, sex, race, and severity of illness were similar among S and F groups. Heart rate and blood pressure remained unchanged throughout the procedure. Oxygen saturation (O2sat) declined significantly in both groups during skin preparation and wound closure, but not during incision, dissection, or tunneling. In spite of fractional inspired oxygen adjustments made in 13 of 14 S- and 3 of 15 F-treated patients, decline in O2sat was more common and more pronounced (p less than 0.01) in S-treated babies. Hyperglycemic responses occurred in all S- and in none of the F-treated patients (p less than 0.001). Norepinephrine plasma concentrations did not change during Broviac catheter placement in either F or S group. Epinephrine concentrations were more elevated in S- than in F-treated patients, although these differences were not statistically significant. Low-dose fentanyl analgesia effectively complements local lidocaine anesthesia during Broviac catheter placement. Sedatives neither abolish metabolic responses to surgical stress nor prevent profound and persistent oxygen desaturation.

Effect of premedication on arterial oxygen saturation in children with congenital heart disease

The effect of a standardized intramuscular premedication (morphine, 0.1 mg/kg, scopolamine, 13 micrograms/kg, and secobarbital, 2.5 mg/kg) on the arterial oxygen saturation of hemoglobin was evaluated in 33 patients with congenital heart disease by use of the Nellcor pulse oximeter. Sixteen patients had noncyanotic congenital heart disease and 17 patients had cyanotic congenital heart disease. In the noncyanotic congenital heart disease group, pulse oximeter saturations decreased from 98.1% +/- 1.5% (mean +/- SD), before premedication, to 96.5% +/- 1.5% following premedication. Although this decrease was statistically significant (P less than 0.05), it was determined to not be clinically meaningful. In the patients with cyanotic congenital heart disease, oxygen saturation increased from 73.5% +/- 11.8 to 74.7% +/- 10.2 following premedication, but this change was not statistically significant. The effect of premedication on SaO2 was highly variable in patients with cyanotic heart disease; although the group mean appeared to increase, 6 of the 17 patients had decreases in saturation and the decrease exceeded 10% in saturation in 3 of them. Therefore, oxygen saturation should be monitored following premedication in patients with cyanotic heart disease and oxygen administered as needed.

Flight surgeon support of combat operations at RAF Upper Heyford

Flight surgeon support of the Libyan Air Strike on April 14-15, 1986 is reviewed. Problems encountered included lack of time for adequate briefings, aircrew member fatigue, family stress, and lack of confidence in medication. In spite of problems, the mission was performed in an outstanding manner. Recommendations for future combat operation flight surgeon support are given.

The antiemetic efficacy of secobarbital and chlorpromazine compared to metoclopramide, diphenhydramine, and dexamethasone. A randomized trial

The efficacy of secobarbital sodium plus chlorpromazine (SC) in the prevention of cisplatin induced emesis was compared to the combination of metoclopramide, diphenhydramine, and dexamethasone (MDD). Twenty-three patients were entered onto protocol. Eighteen were evaluable. Good to excellent antiemetic prophylaxis was obtained in 72% with MDD versus 17% with SC (P less than 0.01). Sedation and anticholinergic side effects were more common with SC. Extrapyramidal reactions were more commonly seen with MDD. Significantly more patients preferred the combination of metoclopramide, diphenhydramine, and dexamethasone (P less than 0.05).

Stimulant medications in adults with attention deficit disorder

The long-term prospective studies done in the last two decades on children suffering from attention deficit disorder with hyperactivity (ADD-H) give evidence of persistent disability in a majority of them when they reach adulthood. The literature on the use of stimulant medication in adults suffering from attention deficit disorder, residual type (ADD-R), is critically reviewed. After optimistic case reports two controlled double-blind studies have recently showed contradictory results. Some adults appear clearly to be helped by stimulant medication, but more investigations, especially with children diagnosed in childhood and followed-up, are needed before any firm conclusion can be made about the usefulness or non-usefulness of stimulants in ADD-R. There, as it is the case in childhood, medication might be insufficient by itself and might have to be associated with other forms of treatment.

Selectivity in response to L-tryptophan among insomniac subjects: a preliminary report

The hypnotic effects of l-tryptophan (1 g), secobarbital (100 mg), and flurazepam (30 mg), relative to placebo, were evaluated in a sample of 54 outpatient chronic insomniacs with a major complaint of sleep maintenance insomnia. Three mutually exclusive complaints about sleep maintenance were identified. Analysis of the data from the tryptophan condition indicated that the single factor type of sleep maintenance complaint accounted for 100% of the variance in a measure reflecting a single overall assessment of tryptophan's hypnotic effect, and 52% of variance in a second, repeated measure assessing subjects' day-to-day experience with the treatment. It is concluded that the distinctions in sleep maintenance insomnia identified are likely to be clinically meaningful. The distinct profiles of the tryptophan responders and nonresponders are described, and the utility of the distinctions in understanding the differential effects of flurazepam and secobarbital discussed. The implications of the finding for a number of sleep disorder-related issues were addressed.

Chronic insomnia: effects of tryptophan, flurazepam, secobarbital, and placebo

This study compared the effects of l-tryptophan (1 g), secobarbital (100 mg), flurazepam (30 mg), and placebo on sleep in 96 serious insomniacs. Each treatment was given nightly for 7 nights in a separate-group design. Outcome measures were subjective estimates by subjects of a number of sleep parameters during the week of treatment and for 1 week after, and an overall evaluation made by subjects and investigators at the end of the 2 weeks. During the treatment week, flurazepam produced significant improvement on several sleep measures compared to placebo, while tryptophan and secobarbital did not. Flurazepam and secobarbital produced withdrawal symptoms during the post-treatment week, while tryptophan and placebo did not. Sleep latency was not significantly improved by tryptophan during the treatment week, but continued to improve during the post-treatment week, resulting in a significant difference between tryptophan and baseline in week 2.

Comparative study of midazolam and vesparax in moderate or severe insomnia in female surgical patients

A double-blind study was conducted in 60 female patients with moderate or severe insomnia, hospitalized for gynaecological surgery. After an initial 2-day placebo selection phase, 30 subjects received 15 mg midazolam and the remaining 30 received 1 tablet Vesparax (= 50 mg hydroxyzine, 150 mg secobarbital, 50 mg brallobarbital) for 5 nights. This verum phase was immediately followed by a 2-day placebo withdrawal phase in order to study the occurrence of rebound phenomena. Both verum compounds were effective in hastening sleep onset, increasing sleep duration, and improving sleep quality, without causing residual effects on the following day. There was no difference in effect between the two agents. Neither active drug caused rebound effects on withdrawal.

Efficacy and safety of midazolam and vesparax in treatment of sleep disorders

In a double-blind parallel study in which a placebo phase preceded and followed the double-blind verum phase, midazolam 15 mg and Vesparax (150 mg secobarbital, 50 mg brallobarbital, 50 mg hydroxyzine) were administered to 30 female patients aged 20-76 years, suffering from insomnia secondary to neuromuscular disease. Both products were shown to be efficient hypnotics maintaining a constant level of effect. Midazolam proved to be better tolerated and, in contrast to Vesparax, did not cause hangover, nor did rebound phenomena ensue after its withdrawal.

Midazolam in the treatment of sleep disorders in geriatric patients

The use of hypnotics in the elderly must be approached with special care in view of possible changes in pharmacokinetic behaviour and drug interactions in older patients. In a randomized, double-blind study in a large geriatric department, midazolam was compared with the barbiturate combination Vesparax with regard to efficacy and safety. The comparison of the efficacy of the 2 hypnotics showed them to be almost identical in this respect. Side-effects, however, were more frequent with Vesparax. Furthermore, in the Vesparax group, unlike in the midazolam group, a troublesome cumulation of effect was observed, together with relatively frequent signs of hangover. It is concluded that, in appropriately titrated dosage, midazolam is an effective and well-tolerated hypnotic for use in the elderly.

Efficacy and side effects of flurazepam and a combination of amobarbital and secobarbital in insomniac patients

Flurazepam, 30 mg, was not more effective in inducing sleep than placebo. Barbiturates (100 mg amobarbital plus 100 mg secobarbital) were more effective in inducing and maintaining sleep than flurazepam or placebo. Contrary to work conducted in the sleep laboratory, the barbiturate hypnotics were still effective on the 14th night. Insomniacs performed poorly on psychomotor tests, but as a group they did not show statistically significant psychomotor impairment after the use of the hypnotics.

A clinical comparison of triazolam with placebo and with secobarbital in insomniac patients

Seventy-six out-patient insomniacs participated in three different two-night, double-blind crossover trials investigating the hypnotic efficacy andsafety of triazolam. Triazolam 0.5 mg was compared to placebo in one trial conducted K Kay Okawa, MD, and triazolam 0.5 mg was compared to secobarbital 100 mg in trials conducted by K Kay Okawa, MD and George S Allen, MD. The results of the later two studies were combined and the data analyzed jointly. Triazolam 0.5 mg was found to be preferred and to be significantly better than both placebo and secobarbital 100 mg in the treatment of insomnia. Analysis of sleep questionnaire data showed triazolam to be superior to either placebo or secobarbital on the following parameters: how much the medication helped the patients sleep; onset of sleep; duration of sleep; and number of nocturnal awakenings. No differences were observed between treatments in any trial with regard to the patient's feeling of alertness the next morning. The side-effects reported for all treatments did not significantly interfere with the patient's ability to function.

Effectiveness of intermediate-term use of secobarbital

Secobarbital, 100 mg, was evaluated in two separate sleep laboratory drug evaluation studies, each with 4 insomniac patients. In both studies, the effect of secobarbital in inducing and maintaining sleep was evaluated, as well as the effects of the drug on sleep stages. Statistical analysis demonstrated that the results of the two studies could be combined. With short-term drug administration of secobarbital (up to 3 nights), there was an improvement in both sleep induction and sleep maintenance. Total wake time was decreased 43% below baseline and was consistently decreased in each third of the night. With intermediate-term drug administration (2 wk), total wake time was decreased only 14% (not statistically significant). Following drug withdrawal, the degree of sleep difficulty returned to baseline levels. The results indicate that secobarbital 100 mg is effective for short-term use but loses much of its effectiveness with intermediate use and suggest that the drug is of limited value for insomniac patients who require nightly medication beyond a period of 1 wk. With short-term administration, secobarbital induced a slight decrease in rapid eye movement (REM) and slow-wave sleep and a significant increase in stage 2 sleep. With intermediate administration, sleep stage values were similar to baseline levels. Following withdrawal, there was only a minimal increase in REM sleep above baseline levels, a significant increase in stage 3 sleep, and a significant decrease in stage 2 sleep. The rebound increase in stage 3 sleep is similar to that reported following withdrawal of pentobarbital.

Triazolam in insomniac family practice patients

Triazolam, 0.5 mg, a benzodiazepine with hypnotic properties, was compared to secobarbital, 100 mg, and placebo in a 1-wk study conducted with 100 insomniac family practice patients. Considerable sensitivity to differential treatment effects was demonstrated for these family practice patients as well as for a research methodology that combines a crossover design, permitting preference ratings, with a between-patient design. In almost all sleep parameters, assessed with a variety of subjective techniques, triazolam and secobarbital were shown to be significantly more effective than placebo. Triazolam was consistently and often significantly indicated to be a more effective hypnotic, particularly for reducing nocturnal awakening, than secobarbital. Analysis of self-report emotional distress data revealed that present insomniac patients were slightly more emotionally symptomatic than other nonpsychiatric populations. Triazolam was followed by the greatest and secobarbital the least relief of emotional symptoms and triazolam emerged as an especially effective hypnotic for initially more depressed insomniac patients. Present findings suggest that type and degree of emotional symptomatology may affect the response of insomniac patients to hypnotics.

Focal reflex myoclonus

In a patient with reflex myoclonus limited to the right side of the body, stimulation of the right median nerve in the index finger or wrist elicited a very large somatosensory evoked response (SER) and a long loop C reflex which represents an electrically evoked myoclonic response. It is suggested that the pathway for the C reflex is through peripheral nerve, dorsal funiculus of spinal cord, contralateral VP nucleus of thalamus, sensorimotor cortex, corticospinal tract, and anterior horn cell. The large SER, C reflex, and myoclonic jerks are presumed to result from a release effect causing increased excitability at central synapses along this pathway. The patient presented has a large atrophic vascular lesion involving the left frontotemporoparietal region and involvement of pathways through the right superior cerebellar peduncle to account for the neural dysfunction.