Chronic noncancer pain and the long term utility of opioids.

OBJECTIVE: To report on a long term experience in treating patients with chronic noncancer pain (CNCP). METHODS: One hundred two patients with CNCP were seen every three months and followed for one year or more (median eight years, range one to 22). Demographic data, diagnostic categories and response to therapies were recorded. The utility and safety of opioid therapy, adverse events, impact on disability and issues related to previous psychiatric or chemical dependency history were documented. RESULTS: Most patients reported a variety of neuropathic pain problems and most required chronic opioid therapy after the failure of other treatments. Although 44% reported being satisfied with pain relief despite adverse events, it is noteworthy that the remaining patients chose to continue therapy for the modest benefit of pain relief despite adverse events. Moreover, 54% were less disabled on opioid therapy. CONCLUSIONS: This is a large sample of CNCP patients, most taking opioids over a long period of time. CNCP can be treated by opioids safely and with a modest effect, with improvement in functioning in some patients who are refractory to other measures. If care is taken, opioids may even be used effectively for patients with a history of chemical dependency.

High purity, recovery, and selection of human blood cells with a novel high gradient magnetic separator.

The selective isolation of cell subpopulations from previously cryopreserved human blood mononuclear cells was achieved magnetically using a novel, well-characterized conical funnel filter containing a variety of ordered wire arrays. Tetrameric antibody complexes targeted against the CD8 antigen were used to bind colloidal superparamagnetic dextran-iron particles to the desired cells with very low nonspecific binding. The novel design of the filter was such that the retention of cells at zero magnetic field was on average 0.9%. After two successive magnetic separations, an average purity of 98% was obtained for the desired labeled cells. A third separation gave > 99% purity. Purity was affected by the unlabeled cells, which expressed high intercellular adhesion (0.5% of the total cells). The ultimate recovery of the labeled cells was limited by the degree of nonmagnetic labeling of the cells expressing very low levels of targeted antigen. Recoveries could be as low as 78%, depending on the donor. The separation system described was believed suitable for difficult large-scale separations, that is, cells expressing the CD34 antigen.

Positive selection of human blood cells using improved high gradient magnetic separation filters.

High gradient magnetic separators (HGMS) create magnetic field gradients that can be used to attract much smaller and less magnetic particles than those required for conventional magnetic separation techniques. As a result cells can be labeled with submicron magnetic particles and still be separated using an HGMS filter. Typically, HGMS filters consist of random arrays of wire such as stainless steel wool. Wire elements arranged regularly in a filter should allow more efficient separation of cells. Filters were constructed containing ordered wire arrays composed of 430 series stainless steel wire mesh with wire diameters of 50, 100, or 150 microns. The ability of these filters to separate T cells from peripheral blood mononuclear cell suspensions was tested and found superior to random arrays of 302 series stainless steel wire (Thomas et al, 1992). Target cells recognized by OKT5 monoclonal antibody were cross-linked to dextran-iron particles of approximately 20 nm in diameter. Separation conditions were optimized and after one passage through the filter 88% of the OKT5+ cells were recovered in the enriched fraction with 85% purity (%OKT5+). Multiple passages (3 times) could achieve 99% purity with 68% recovery. Variations in separation flow rate had a large effect on the balance between purity and recovery. Optimum separation efficiencies were achieved only when > 10(8) cells were processed. The primarily cause of nonspecific entrapment of CD8- cells was not nonspecific magnetic labeling of cells but the physical (nonmagnetic) characteristics of the filter/filter chamber.

Parents' perceptions of their child's acute pain experience.

Painful procedures, experienced by many pediatric patients early in their admission, have been identified by parents in our clinical practice as a source of stress. The purpose of this study was to examine parents' perceptions and concerns about their child's acute pain experience. A convenience sample of 71 parents of 62 children was given a questionnaire that focused on the child's pain intensity, the behaviors that indicated the child was in pain, and the parents' preparation for and involvement in the child's pain experience. The majority of parents were asking for more information about and greater participation in procedures that caused their child pain.

Sickness impact profile: a measure of dysfunction with chronic pain patients.

Although chronic pain may affect all facets of a patient's life, there is no generally accepted method of measuring the extent of the disability experienced. This component of a larger study examined changes in usual activities and relationships for patients experiencing chronic nonmalignant pain, in order to understand the impact of pain on an individual's life. The effect of pain intensity and depression on the performance of usual daily activities was assessed by the Sickness Impact Profile (SIP). The sample of 34 subjects, 17 women and 17 men, rated their pain as moderate to severe on a linear analogue scale (mean 64). Thirty percent of subjects were moderately to severely depressed as measured by the Beck Depression Inventory (mean 21). The SIP scores indicated severe disruption in daily activities and relationships for this sample. Significant correlations between the SIP and visual analogue scales measuring coping adequacy and activity levels were interesting and warrant further study.

Scanning electron microscopy of Legionella pneumophila in clinical tissue.

Scanning electron microscopy (SEM) is a valuable technique for rapid detection of the presence of microorganisms, for determination of their three-dimensional morphology and topology and for identification of their anatomical sites. It has been used for these purposes in Legionnaires' disease with three patients at autopsy in an investigation of Legionella pneumophila in situ. In two cases the study was restricted to lung, and in the third case tissues from extra-pulmonic sites were examined in addition to lung. Microorganisms in good condition of surface preservation were found in lung, tracheal lymph node and heart. The work has shown that the bacterium is pleomorphic, that it can be either rod or sausage-shaped and that it can possess a smooth, dimpled or wrinkled surface, with or without small terminal or lateral blebs. Binary fission was often seen and there was some minimal evidence of flagella in clinical specimens. Well preserved bacteria were found in lung both intra- and extracellularly.

Microorganisms seen by scanning and transmission electron microscopy in Legionnaires' disease from human lung.

In addition to several anomalous structures, other general forms of definitely rod-shaped microorganisms have been found by scanning and transmission electron microscopy in the lung tissue taken at autopsy from a patient who succumbed to confirmed Legionnaires' disease with extensive necrotizing lobar pneumonia. The microorganisms were greatly varied in size and shape. They were micrographed in the act of fission. These forms have been found to some extent throughout the tissue. No nickel was demonstrated, either in the lung tissue or in the microorganisms.

A survey of two cohorts of women who graduated from a Canadian medical school.

The careers of 71 women who graduated in medicine from the University of Western Ontario between 1961 and 1970 are compared with those of 84 women who graduated from the same university between 1924 and 1958. In both cohorts approximately 65% were working full time. Fewer members of the 1961-70 cohort were doing no medical work and more were working part time.

Scanning electron microscopy of human female reproductive tract and amniotic fluid cells.

Scanning electron microscopy was used to examine surface ultrastructural characteristics of cells of the epithelium of female reproductive tract, cervical mucus, and amniotic fluid cells. The female epithelium undergoes hormone-dependent cyclical morphological alterations in cell shape, apical microvilli, ciliation, and secretory patterns. The frequency distribution of ciliated cells varies in different parts of the female reproductive tract and different segments of the same organ. In the endocervix, a few ciliated cells are randomly distributed. The density of ciliated cells is variable in several areas of the endometrium. The sparse distribution of ciliated cells in the central portion of the uterine wall may indicate a possible implantation site. According to surface ultrastructure of cells, three segments are noted in the uterotubal junction: cornual endometrium, interstitial tubal epithelium, and transitional area. The vaginal epithelium is made of flat polygonal cells with interdigitating borders and a fine interlacing network of microridges. After the menopause, the microridge pattern and distinct cell borders are lost or severely modified. Two types of fibrous structures can be found in cervical mucus: a) microfibrils that vary in diameter from 500 to 1,500 A and from bundles or networks, and b) long, thick fibers that vary in diameter from 0.5 to 5 micrometer run parallel to each other, and appear to be made up of microfibrils. Amniotic fluid cells, derived from amniotic epithelium and fetal ectoderm, consist of non-nucleated and nucleated cells with extensive microplicae.