ABSTRACT
The aim of the study was to determine the efficacy of a combined treatment - intra-articular injections of sodium hyaluronate [HA] plus suprascapular nerve block [SSNB] - of established idiopathic frozen shoulder. The study consisted of a randomized trial of 30 patients with frozen shoulder to compare a combination therapy consisting of intra-articular injection of HA and SSNB, with a course of either one of these therapies alone. Patients' pain levels and range of movement were assessed over a 4-week period. Combination therapy produced a faster and more complete resolution of pain than a series of either therapy alone. After 4 weeks of treatment there was a 78.3% reduction in pain, as measured by the visual analog scale [p = 0.0037], in the combination therapy group versus 60.5% and 48.8% respectively in the groups that were given intra-articular injections of HA or SSNB alone. However, no statistical significance was found for the improvement in shoulder range of motion in the combined therapy as compared with either therapy alone. This study suggests that combination therapy with intra-articular injections of HA and SSNB can improve the clinical condition in patients with frozen shoulder
Subject(s)
Humans , Male , Female , Injections, Intra-Articular , Hyaluronic Acid , Nerve Block , Combined Modality Therapy , Treatment OutcomeABSTRACT
An organophosphorus insecticide EPN, O-ethyl-O, 4-nitrophenyl phenylphosphonothioate, is a stronger inhibitor of ChE activity than leptophos or cyanofenphos which are delayed neurotoxic organophosphorus insecticides, and it is usually difficult to demonstrate its delayed neurotoxicity with a single oral dose without atropinization. In this study, delayed neurotoxic effect of EPN was observed in non-atropinized hens by using the repeated pretreatment method.<BR>1) Three groups of hens were given preliminarily small dose of EPN such as 10mg/kg/day for 10 days, 5 mg/kg/day for 20 days and 10mg/kg/day for 20 days. Another group was not given any preliminary dose. After each pretreatment, these groups received a large amount of dose called ‘challenge dese’, 150mg/kg, 200mg/kg or 300mg/kg of EPN. During the pretreatmental period, only 2 out of 60 hens which received the pretreatment died.<BR>2) The mortality rate due to the acute toxicity after the challenge does in the group pretreated by 10 mg/kg/day for 20 days was significantly lower than in the non-pretreated group.<BR>3) It is clear that EPN shows delayed neurotoxicity in hens. Delayed neurotoxic effect was observed in all groups which were given repeatedly the pretreatment of EPN prior to each challenge dose. While the survived hens from the acute death in the non-pretreated group did not show any sign of delayed neurotoxicity. The specific relationship, however, was not observed between the anount and times of pretreatment and the incidence of delayed neurotoxicity.<BR>4) Delayed neurotoxic effects of EPN such as clinical symptomes, the cource of body-weight change and the findings of histopathological changes were just similar to those of leptophos and cyanofenphos.<BR>5) The results of this study suggest that the using of the repeated pretreatment method allows to give high concentrated organophosphorus compound without atropinization and to accurate assessment of delayed neurotoxicity of some organophosphates; these effects would otherwise not be detected using a single dose of LD<SUB>50</SUB>.
ABSTRACT
Phosvel is an organophosphorus pesticide known to produce delayed neurotoxicity. In our earlier investigation, the neurotoxicity was greater in hens which fasted for two weeks than in those which were normally or force fed for some weeks. This suggested a relationship between the sensitivity to the neurotoxicity of phosvel and the amount of adipose tissue of animals receiving this compound.<BR>In this study, neurotoxicity levels in five groups of hens, each fasted for different duration (3, 6, 9, 12 and 15 days) before administration of phosvel, were compared with normally fed hens. The results are as follows;<BR>1. A single oral dose of phosvel was administered to each hen at the rate of 250 mg/kg body weight.<BR>2. There were no abnormal hens in the fed group or the ‘3 days fasting’ group.<BR>3. In the ‘6 days fasting’ group, 2 out of 5 hens showed ataxia and one of them developed mild paralysis. But no hens died in this group.<BR>4. However, in both groups of ‘9’ and ‘15 days fasting’, all hens were attacked by delayed neurotoxic effect. Three out of five in each group died after developing severe paralysis.<BR>5. One bird in the ‘12 days fasting’ group died due to the acute poisoning of phosvel on day 3 after administration. This was a very rare case in the series of studies of the compound. Three out of 4 remaining hens developed severe paralysis and one of these affected hens died.<BR>6. In general, the longer the animals fasted the greater was the delayed neurotoxic effect, however, if the adipose tissue of the animals was cosumed more than a certain level by enforced fasting, the neurotoxicity tended to be markedly increased.