[Pain experience and pain therapy of tumor patients in the view of general practitioners]. / Schmerzerleben und Schmerzbehandlung von Tumorpatienten aus der Sicht von Allgemeinmedizinern.

AIM: The aim of the study presented in this paper is to find out how general practitioners evaluate their cancer patients' health, quality of life and type and extent of pain. In addition the study aims to get information about the training in pain therapy and palliative medicine. METHODS: A representative sample of 440 of all Austrian general practitioners was interviewed via a standardized questionnaire. The consent for the questioning had been obtained by telephone. RESULTS: The state of health and quality of life of the treated cancer patients are described as little satisfying and most unfavourably affected by the disease. The physicians suppose that the patients experience pain more intense than could be expected of them as endurable. Nevertheless the cancer patients appreciate pain therapy. CONCLUSION: As a result the medical training in pain therapy and palliative medicine should be improved. At the same time the future general practitioners should gain psychological competences, which would consequently provide them with a broad spectrum of treatment needed when dealing with pain patients (suffering from cancer).

[Results of a poll of cancer patients with respect to pain and quality of life]. / Ergebnisse einer Umfrage zu Schmerzen und Lebensqualität bei Tumorpatienten.

AIM: Bernatzky et al. recently published a study on the prescribing practices of general practitioners in Austria with respect to the prescribing of opioids in cancer patients. The aim of the study was to assess the adequately of pain therapy and the resulting quality of life in chronic cancer patients. METHODS: A representative sample of patients was taken from the Carinthian tumor register. These patient were sent a questionnaire alone with an explanatory letter and at a later date a reminder letter by mail. RESULTS: Of the 1.895 returned questionnaires 665 (35%) were completed. In this study only the data of the 429 patients who indicated that they experienced pain were processed. More than one fifth of the patients complained of a poor or a very poor quality of life and 80% of the patients were limited in their activities of daily living by pain. There are still many prejudices and informational gaps with respect to the effects of morphine. The main focus of treatment was medication therapy and was generally carried out by the family physician. The satisfaction with pain therapy was at best moderate. This is insofar of importance, as the satisfaction with pain therapy has a massive impact on the quality of life. CONCLUSIONS: More extensive information and education are required with respect to the various options and possibilities of pain control. Explanations of the mode of action and side-effects of pain medication in order to deal with the prejudices. Earlier and more focused use of pain therapy (long duration of pain), and use of coping aids for activities of daily living (limited through pain) and a broadening of the spectrum of treatment are all necessary. Patient satisfaction with pain therapy should be the main focus, as this is the deciding factor in terms of the quality of life.

Glass-ionomer cement: evaluation as an orbital implant.

BACKGROUND: To assess the potential of a porous glass-ionomer cement (GIC) as an alternative material for spherical orbital implants, the handling, side effects and rates of fibrovascular ingrowth of this material were compared with those of a synthetic hydroxyapatite (HA) implant. METHOD: Twenty-one GIC and 8 HA uncovered 14-mm spheres were implanted into the orbits of New Zealand albino rabbits. Postoperative reactions, animal's behaviour, weight increase and socket conditions were monitored. Light and electron microscopy of the exenterated orbits were performed 2, 3 and 6 months after primary insertion. RESULTS: Implanting of GIC was easier than HA. Postoperatively all animals did well. Three HA and 1 GIC implant caused conjunctival dehiscences, but no implant extrusion was observed. Histologically, both materials caused mild inflammation in the surrounding connective tissue capsule, decreasing with time. GIC implants proved to be not truly porous, with only peripheral pores partly occupied by relatively acellular collagenous connective tissue. Free glass particles were observed in both the connective tissue and giant cells, occupying the partly filled pore spaces. HA implants showed extensive ingrowth of vital host tissue from the beginning. CONCLUSIONS: Considering the clinical findings and the mild inflammation in the connective tissue capsule surrounding both materials, they would appear to be equally well tolerated at the implant site. The significantly different microstructure and the histological results make GIC, despite better handling, less suitable as an orbital implant.

[Opioid therapy in Austria: results and analysis of a survey]. / Opioidtherapie bei Arzten für Allgemeinmedizin in Osterreich: Ergebnisse und Analyse einer Umfrage.

INTRODUCTION: Many causes are given as the main reason for inadequate pain therapy. The objective of our study was to demonstrate the current position of doctors in general practice all over Austria who prescribe prescriptions. METHODS: A total of 5,359 questionnaires were sent out to general practitioners in all federal states of Austria. These questionnaires contained 21 main questions on subjects relevant to pain therapy. RESULTS: On average, 16% of all general practitioners returned the questionnaires; 89.3% of these are acquainted with the WHO graduated scale, 87% have prescribed strong opioids. Old prejudices such as concerns about the side effects are hardly to be found now. Modern therapy strategies are used. CONCLUSION: Based on the data at hand, pain therapy for patients should be excellent. The reality, however, is somewhat different. The large number of doctors who did not reply makes it enormously difficult to make a statement about the position of pain therapy in Austria.

[Randomized, double-blind study with ketoprofen in gynecologic patients. Preemptive analgesia study following the Brevik-Stubhaug design]. / Randomisierte, doppelblinde Studie mit Ketoprofen bei gynäkologischen Eingriffen. Präemptive Analgesiestudie nach dem Design Breivik/Stubhaug.

STUDY OBJECTIVE: The clinical effect of ketoprofen is based not only on the inhibition of prostaglandin synthesis. Ketoprofen also acts through kynurenic acid as a central antagonist on the NMDA receptor. Due to this central analgesic mechanism of ketoprofen, we expected an analgesic preemptive effect. This study was carried out following the Breivik/Stubhaug preemptive effect study design. METHODS: In 81 patients scheduled for gynaecological surgery a randomized double-blind study was performed. Three groups were studied: Group I received preoperative ketoprofen 100 mg i.v., 12 mg/h during surgery and for 48 hours afterwards. Group II received 100 mg ketoprofen as a bolus injection before the end of surgery, thereafter 12 mg/h ketoprofen continuously for 48 hours. Group III received a placebo during surgery and for 48 hours after surgery. The effects were measured postoperatively using a visual analog scale (VAS; at rest and on exertion) and the total analgesic consumption (PCA piritramide) within the first 48 hours after surgery. Furthermore, the time to first analgesic request was recorded. The vital signs and side effects were documented. RESULTS: The time to first analgesic request in group I was significantly longer than in groups II and III. In addition, the cumulative postoperative analgesic consumption during the first 24 hours after surgery was significantly lower in group I than in group III. Furthermore, the combination of an opioid with a non-opioid led to a lower pain score (VAS) at rest and on exertion. CONCLUSIONS: We showed a preemptive effect with ketoprofen, which was expressed significantly both in terms of the time to first analgesic request and by the lower analgesic consumption in the first 24 hours after surgery.

[Frequency and treatment success of pain in childhood--a survey of parents]. / Häufigkeit und Behandlungserfolg von Schmerzen im Kindesalter. Eine Umfrage aus der Sicht der Eltern.

INTRODUCTION: Pain in childhood still seems to be a major problem. In this study we investigated parents' opinion about the frequency of pain in their children and the efficacy of pain treatment. METHOD: Parents of 93 children (average age: 11-14 years) answered a questionnaire. The participants were asked to evaluate the frequency of pain and the success of pain treatment in their children. They were also asked about their family structure. RESULTS: The result confirmed that perioperative pain therapy in children was not satisfactory. However, the majority of parents were satisfied with the outpatient pain therapy. CONCLUSION: In order to achieve adequate and successful pain therapy in childhood, better information of the parents and better medical education of doctors is mandatory.

Intraarticular morphine analgesia in chronic pain patients with osteoarthritis.

Controlled clinical studies have shown that local administration of morphine can significantly relieve acute postoperative pain. This analgesic effect is long-lasting (up to 48 h) and is mediated by peripheral opioid receptors. Experimental evidence shows that analgesic effects of peripheral opioids and the density of opioid receptors on peripheral sensory nerves increase with the duration of painful inflammatory processes. This study examines the analgesic effects of 1 mg of morphine injected into the arthritic knee joints of two groups of chronic pain patients (n = 23) suffering from osteoarthritis. Using a randomized, double-blind cross-over design, patients received either an intraarticular injection of morphine and intravenous saline (Group A, n = 13) or an intraarticular injection of saline and intravenous morphine (Group B, n = 10) during Phase I. Seven days later, patients crossed over to the opposite treatment (Phase II). During Phase I, intraarticular morphine resulted in significantly greater pain relief than intraarticular saline, and this effect was present at rest as well as during movement. The analgesic effect was surprisingly long-lasting and extended into Phase II, a carry-over effect that prevented the analysis of Phase II. No side effects were reported. The treatment of arthritic pain by peripherally acting opioids may be a promising alternative to currently available medications that have serious side effects.

[The preemptive action of ketoprofen. Randomized, double-blind study with gynecologic operations]. / Zur präemptiven Wirkung von Ketoprofen. Randomisierte, doppelblinde Studie bei gynäkologischen Operationen.

STUDY OBJECTIVE: Ketoprofen exerts its clinical effect by inhibition of prostaglandin synthesis, but also acts as an NMDA-receptor antagonist by means of the kynurenic acid. Based on ketoprofen's supposed central mechanism of analgesia, we expected a preemptive effect, which was assessed by the present study. METHODS: In a prospective, randomised, double-blind investigation of 48 patients undergoing gynaecological procedures (laparotomy, pelvioscopy), the first group received ketoprofen 2 mg/kg body weight i.v. 20 min before the beginning of surgery and placebo i.v. at the end of surgery. In the second group, placebo was administered first and ketoprofen at the end of surgery. Premedication and anaesthesia were standardised by protocol. The postoperative analgesic patient-controlled analgesia consumption by was also standardised (piritramide). Efficacy was assessed by visual analogue scale (VAS) and total requirement of analgesics within the first 24 postoperative hours. The time to the first request for postoperative analgesics was also recorded. Safety was assessed by continuous monitoring of vital parameters such as respiratory rate, heart rate, blood pressure, and oxygen saturation. The incidence and severity of adverse events was documented. RESULTS: There were no significant differences between the groups in demographic data or type or duration of surgery. The time to the first request for analgesic, VAS pain intensity, and analgesic consumption in the first 24 h post-surgery were not significantly different between the groups (t-test). CONCLUSION: Ketoprofen is an effective post-operative analgesic in combination with an opioid, but has no preemptive effect according to the results of this study.

Application of silver acetate autometallography and gold-silver staining methods for in situ DNA hybridization.

In situ hybridization using biotinylated DNA probes has become an important tool in histopathology. It is well known that the sensitivity of the methods used to demonstrate viral DNA in formalin-fixed and paraffin-embedded specimen depends strongly on the detection system used. In the present study, an optimized in situ DNA hybridization protocol was combined with four different approaches of gold-silver staining methods. For silver enhancement, the recently described method of silver acetate autometallography, a technique allowing highly efficient development without the necessity of dark room illumination has been used. The most efficient detection method found in our experiments was the use of gold-adsorbed anti-biotin antibodies with subsequent silver enhancement. This staining procedure can be completed in 5 hours including hybridization and is a highly sensitive alternative to peroxidase and alkaline phosphatase detection systems.

Calcitonin gene-related peptide in the brain. Neurochemical and behavioral investigations.

CGRP in the amygdala is concentrated in an area close to the central nucleus. High potassium releases CGRP, and this release, as well as the tissue concentration of CGRP in the amygdala, can be influenced by neuroleptic drugs. Both molecular forms, alpha- and beta-CGRP, are present in the amygdala in a ratio of approximately 3:1. CGRP influences social behavior in chicken. Therefore, CGRP may have a prominent role in psycho-behavioral function and may be a target for action and/or side effects of antipsychotic drugs.

Regulatory peptides and general neuroendocrine markers in human nasal mucosa, soft palate and larynx.

Various peptide immunoreactivities in the respiratory system have been reported, indicating complex physiological mechanisms. There is only little information on the upper respiratory system of man. The present study was carried out to demonstrate regulatory peptides in the nasal mucosa, larynx (vocal cords and ventricular folds) and soft palate of man using highly efficient immunocytochemical methods. In addition, some peptide immunoreactivities were measured by use of radioimmunoassay (RIA). Using indirect immunofluorescence and immunogold-silver staining (IGSS) with silver acetate autometallography, a series of peptides could be detected, including vasoactive intestinal polypeptide (VIP), peptide histidine methionine (PHM), galanin, calcitonin gene-related peptide (CGRP), substance P, neuropeptide tyrosine (NPY), C-flanking peptide of NPY (CPON) and somatostatin. In addition, antibodies to protein gene-product (PGP) 9.5, neuron-specific enolase (NSE), S-100, PHE-5 and neurofilament proteins gave positive reactions in tissue sections. Using RIA, CGRP, substance P, and neurokinin A were measured. Our results demonstrate a complex network of regulatory peptide-containing nerve fibers and the possible existence of endocrine cells regulating various functions of the upper respiratory system, which need to be further investigated.

Gastrin- and somatostatin-immunoreactive cells of the antral mucosa in patients with duodenal or gastric ulcers. An immunocytochemical study.

Gastrin- and somatostatin-immunoreactive cells in biopsies taken from the prepyloric portion of the antrum from 15 patients with duodenal ulcer, 16 patients with gastric ulcer, and a control group of 19 patients without histopathological alterations of the antral mucosa were studied using peroxidase anti-peroxidase and immunogold-silver staining methods in combination with morphometry. Numerical densities and sizes (immunoreactive areas) of the cells demonstrated were measured and compared between all three groups. Gastrin- and somatostatin-immunoreactive cells were located most frequently in the lower midzone of the gastric crypts. None of the parameters measured showed a correlation with age or sex. The group with duodenal ulcer tended to exhibit gastrin- and somatostatin-cell-hyperplasia whereas the size of both cell types remained unchanged. In comparison with the control group, the numerical density of gastrin-immunoreactive cells was significantly increased in gastric ulcer patients, whereas the numerical density of somatostatin-immunoreactive cells was decreased in this group. Immunoreactive areas of both cell types were significantly increased in patients with gastric ulcer.

Intrathecal injection of codeine, buprenorphine, tilidine, tramadol and nefopam depresses the tail-flick response in rats.

The effect of intrathecal (i.t.) injection of the analgesic agents, codeine, buprenorphine, tilidine and one of its metabolites, nortilidine, tramadol and nefopam, was determined in the tail-flick test performed on rats. ED50 values were derived from the dose-response lines. The relative potency ranking established from the ED50 values is buprenorphine (0.4 nM) greater than nortilidine (29 nM) = tramadol (26 nM) = nefopam (34 nM) greater than codeine (42 nM) greater than tilidine (118 nM). An i.t. injection of the opiate antagonist, naloxone (5 micrograms), prevented the antinociceptive effect of all analgesic agents administered at the highest dose tested. It is concluded that these analgesic agents, like morphine, exert their effect at least in part through a spinal site of action.

Characterization of substance P-like immunoreactivity in submammalian species by high performance liquid chromatography.

Substance P-like immunoreactivity (SP-LI) as measured by RIA was found to be present in a variety of submammalian species and invertebrates. We analyzed this SP-LI in extracts from submammalian species by high performance liquid chromatography. The following species were investigated for the presence of SP-LI (RIA) which was further characterized by subsequent HPLC (investigated areas in parentheses): Hagfish (brain plus spinal cord), (brain, intestine, skin), frog (brain, intestine), turtle (brain, intestine), lizard (brain, intestine, skin) and mouse (spinal cord). RIA alone was performed in extracts from branchiostoma and cricket. The concentrations of SP-LI in brain, spinal cord and intestine of different submammalian species except branchiostoma brain and intestine and turtle brain, were in a similar range (2.1-5.3 fmol/mg in the brain, 0.2-2.0 fmol/mg in the spinal cord, 0.3-4.2 fmol/mg in the intestine). In the turtle brain, extremely high SP-LI concentrations (210 fmol/mg) were found, whereas brain and intestine of branchiostoma contained very little SP-LI (0.1 fmol/mg). In the skin of different species, SP-LI concentrations varied from 0.04 fmol/mg (trout) to 2.0 fmol/mg (lizard). In the cricket, high SP-LI concentrations were found in the cerebral ganglion (15 fmol/mg protein) and in the subesophageal ganglion (27 fmol/mg protein). HPLC analysis of extracts showed that all tissues investigated contained a substance which co-eluted with synthetic SP, and in most tissues a peak was present which co-eluted with SP sulfoxide. Only in mouse spinal cord, trout brain and hagfish brain were these the only peaks.(ABSTRACT TRUNCATED AT 250 WORDS)

Effects of intrathecally administered pentobarbital and naloxone on the activity evoked in ascending axons of the rat spinal cord by stimulation of afferent A and C fibres. Further evidence for a tonic endorphinergic inhibition in nociception.

The effects of intrathecally administered pentobarbital and naloxone on activity in ascending axons were determined in decerebrate rats with the spinal cord transected at the lower thoracic level. Activity in ascending axons of the spinal cord was recorded below the site of transection and evoked by electrical stimulation of afferent A beta, A delta or C fibres in the sural nerve. Pentobarbital 250 micrograms depressed activity evoked by stimulation of non-nociceptive A beta and nociceptive C fibres; it did not change activity in response to stimulation of A delta fibres. A low dose (100 micrograms) had no effect of A beta and C fibre-evoked activity but depressed spontaneous activity in the ascending axons. Naloxone 5 micrograms enhanced the spontaneous and evoked activities only in those ascending axons which responded to C fibre stimulation. Pretreatment with pentobarbital 250 micrograms prevented the facilitation by naloxone of C fibre-evoked activity. Naloxone was ineffective even when it was administered in a dose of 100 micrograms simultaneously with pentobarbital. Intrathecal injections of magnesium chloride depressed spontaneous and C fibre-evoked activities and markedly reduced the facilitatory effect of naloxone. It is concluded that nociceptive C fibre-evoked activity is subject to the inhibitory control of endorphinergic neurones and that naloxone facilitates this activity by producing release from inhibition.