Differential effects of epidural morphine in the treatment of cancer-related pain.

Fifty-five patients with pain associated with cancer were selected for long-term treatment with epidural morphine. Patients who had more than one type of pain within the same region were specially analysed concerning differential analgesic effects of the treatment, i.e. the patients served as their own control. Twenty-eight of the 55 patients became pain free. In 21 patients alleviation of pain was complete only for one or two of several types of pain within the same area with a certain dose of epidural morphine. In six patients the treatment failed. An analysis revealed that the best response was obtained when the pain was continuous and originated from deep somatic structures. In co-existing continuous visceral pain or intermittent somatic pain originating e.g. from a pathological fracture, the outcome of the treatment was variable. Cutaneous pain, pain classified as neurogenic, and intermittent pain due to intestinal obstruction was only occasionally relieved. Ten of the patients had co-existing pain of non-malignant origin and none of them was helped for that pain. The variable response to epidural morphine may indicate that different types of pain-producing stimuli engage different kinds of receptors which differ in affinity to morphine in the spinal fluid; it is also possible that some pain-mediating systems are non-responsive to opiates.

Desensitisation as a means of preventing untoward reactions to ionic contrast media.

Patients with a previous history of anaphylactic reactions to ionic iodinated contrast media were desensitised before a second radiologic examination was performed. The tolerance to the contrast medium was raised by repeated intravenous injections in increasing doses and concentrations. No serious side effects were noted when the examinations with contrast medium was repeated within a few days after the desensitisation. The positive effect of the desensitisation may depend on a successive consumption of complement proteins, probably responsible for the allergic reactions. Therefore, the available amount of complement for some days may be too low for the occurrence of a complement reaction.

Evaluation of the inhibition of allergen-induced intracutaneous reactions by a new beta-agonist, KWD 2131, and by terbutaline.

In a double-blind crossover study, the wheal inhibiting effect of a new beta-agonist, KWD 2131, and terbutaline was evaluated. The substances were given intracutaneously in five different concentrations, each together with specific allergen or with histamine. During the 2 days' study, 10 patients with known type I-allergy in the skin were randomly assigned to the KWD 2131 or terbutaline group. Both substances gave a dose-dependent inhibition of the allergen-induced wheals. They were, in this respect, equipotent. The greatest protective effect was obtained with the highest doses of both substances (250 micrograms KWD 2131; 25 micrograms terbutaline). In these doses, the inhibition with KWD 2131 and terbutaline was 55 and 45%, respectively (P less than 0.001). Significant inhibition was also seen with the two following lower doses of both substances i.e. 100 and 25 micrograms KWD 2131 and 10 and 2.5 micrograms terbutaline (P less than 0.001-0.01). KWD 2131 and terbutaline did not show any dose-dependent inhibition of histamine-induced wheals. Statistically significant protection against histamine was only reached with the highest dose KWD 2131 (250 micrograms) (P less than 0.05). We conclude that the inhibitory effect of KWD 2131 and of terbutaline on allergen-induced wheal formation in the dose-range tested, is of a selected anti-allergic quality.

Rape pollen allergy.

Rape plants are cultivated in southern and central Sweden. These partly wind pollinated plants have an exceedingly rich blooming period with pollinating times (for rape and turnip rape) from 10 May to 24 June (+/- 1--2 weeks). In a patient material from southern Sweden with bronchial asthma and other allergic manifestations, rape pollen allergy was found to occur quite frequently. In 366 consecutive patients positive intracutaneous skin tests to rape pollen extracts were found in 85 patients (23%). 54 patients with positive i.c. skin tests for rape pollen were provocated: 81% of them had positive provocation tests. Patients with symptoms of hay fever and/or bronchial asthma during the pollinating season in regions where rape and related species are cultivated should be examined for rape pollen allergy with i.c. skin tests or RAST.

Comparison between ibuterol hydrochloride and terbutaline in asthma.

The bronchodilating effect, circulatory effects, and subjective side effects of ibuterol hydrochloride, the di-isobutyric acid ester of terbutaline, at two dose levels (2 and 4 mg) were compared with those of 5 mg terbutaline sulphate in a double-blind cross-over study on 12 patients with asthma. Both drugs were given by mouth. The 2-mg dose of ibuterol had the same bronchodilating effect during the first three hours as 5 mg terbutaline. The 4-mg dose, however, produced a significantly greater increase in the peak expiratory flow rate between the 30th and 120th minutes than terbutaline. No significant changes in heart rate or pulse amplitude were noted, and there was no difference in the incidence of subjective side effects between ibuterol at either dose level and terbutaline.