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Aim: Arterial blood gas sampling provides useful information on respiratory parameters and acid-base balance. However, this procedure is painful and uncomfortable for the patient. Therefore, this study aimed to examine the analgesic efficacy of ethyl chloride spray compared to a placebo during radial artery blood gas sampling., Method: This randomized, double-blind, placebo-controlled study was conducted at the emergency department of a tertiary hospital. A total of 202 patients were randomly divided into two groups: ethyl chloride spray (n = 101) and placebo (n = 101). The analgesic efficacy of ethyl chloride spray was compared with the placebo using the Visual Analog Scale (VAS)., Results: The VAS score was determined to be 4 [interquartile range (IQR): 1.0] for the ethyl chloride spray group and 5 (IQR: 1.0) for the placebo group. The analgesic efficacy of ethyl chloride spray in reducing pain was statistically significantly higher compared to the placebo (p = 0.000)., Conclusion: Ethyl chloride spray has analgesic efficacy in arterial blood gas sampling. Therefore, the use of this spray provides an analgesic effect on patients during arterial blood gas sampling performed in the emergency department., Competing Interests: Declaration of Competing Interest The authors declare no conflicts of interest., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Ultrasound-guided injections such as steroid injections are common procedures involving the musculoskeletal system. They are usually performed after a subcutaneous injection of local anesthetic (LA), which can be painful. In 126 consecutive patients, local anesthesia was performed using ethyl chloride spray prior to a therapeutic ultrasound-guided injection in joints, tendons, or bursae. Ninety-nine (78.5%) patients found the use of ethyl chloride spray helpful. The use of ethyl chloride spray is an effective, patient-friendly alternative to the standard injection of local aesthetic for ultrasound-guided therapeutic musculoskeletal injections with the advantage of a lower cost of $0.18 per procedure., (© 2017 Wiley Periodicals, Inc.)

Background: Ethyl chloride spray as a common cooling modality has been widely used in acute sports injuries and joint injection procedures. Several clinical studies reported that use of ethyl chloride has positive effects on swelling, pain reduction and recovery from sports injuries. The main aim of present study was to analyze whether postoperative use of ethyl chloride spray benefits results after primary total knee arthroplasty (TKA)., Methods: Between April 1, 2014 and October 21, 2015, 306 subjects undergoing primary TKA used ethyl chloride spray for improving recovery from the damage from surgery. After exclusion of 31 subjects due to adverse events including periprosthetic joint infection (PJI), deep venous thrombosis (DVT), acute myocardial infarction, finally 275 subjects' data regarding pain score, knee range of motion (ROM), knee girth, time of being able to reach 90° knee flexion and analgesic consumption were analyzed., Results: Significant differences in pain score, knee ROM at each time point and knee girth at on 21st and 28th postoperatively were detected without increased incidence of adverse events. Besides, time of being able to reach 90° knee flexion and analgesic consumption in the treatment group were significantly decreased in comparison to the control group., Conclusion: Use of ethyl chloride spray can help patients recovery from the damage from TKA safely., (Copyright © 2016. Published by Elsevier B.V.)

Background: Unstructured data encountered during retrospective electronic medical record (EMR) abstraction has routinely been identified as challenging to reliably abstract, as these data are often recorded as free text, without limitations to format or structure. There is increased interest in reliably abstracting this type of data given its prominent role in care coordination and communication, yet limited methodological guidance exists., Objectives: As standard abstraction approaches resulted in substandard data reliability for unstructured data elements collected as part of a multisite, retrospective EMR study of hospital discharge communication quality, our goal was to develop, apply and examine the utility of a phase-based approach to reliably abstract unstructured data. This approach is examined using the specific example of discharge communication for warfarin management., Research Design: We adopted a "fit-for-use" framework to guide the development and evaluation of abstraction methods using a 4-step, phase-based approach including (1) team building; (2) identification of challenges; (3) adaptation of abstraction methods; and (4) systematic data quality monitoring., Measures: Unstructured data elements were the focus of this study, including elements communicating steps in warfarin management (eg, warfarin initiation) and medical follow-up (eg, timeframe for follow-up)., Results: After implementation of the phase-based approach, interrater reliability for all unstructured data elements demonstrated κ's of ≥0.89-an average increase of +0.25 for each unstructured data element., Conclusions: As compared with standard abstraction methodologies, this phase-based approach was more time intensive, but did markedly increase abstraction reliability for unstructured data elements within multisite EMR documentation.

How nurses make a difference and influence outcome has been the subject of much debate over many years and is perhaps more relevant now owing to healthcare funding being a scarce commodity. Nurses need justification and validation of what they do. Nursing therapeutics is a relatively new term that can help nurses and others to appreciate the multifariousness, complexity and value of what they do. It encapsulates the means by which a nurse delivers care that is both evidence based and beneficial to his or her patients. This article highlights how nurses can make use of common nursing interventions to ensure that the full impact of their skills is embedded in their care-using the administration of vapocoolants as the focus of the discussion. It will be illustrated that through each patient contact, a nurse can establish therapeutic principles that can positively influence health outcomes.

Objective: To compare pain associated with venous catheterization after administration of topical ethyl chloride vs placebo among emergency department health care providers., Methods: We conducted a randomized, double-blind, placebo-controlled, crossover trial among a convenience sample of health care provider volunteers in a tertiary care urban emergency department. We randomly allocated subjects to initial treatment (ethyl chloride vs sterile water aerosol spray) and catheterization site (left or right antecubital fossa). After venous catheterization placement and discontinuation, subjects underwent a 5-minute washout period. All subjects then underwent venous catheterization in the contralateral antecubital fossa after administration of the alternative agent. We measured all outcomes after discontinuation of the second catheter. The primary outcome was difference in pain verbal numeric rating scale score (0-10) between the 2 agents. Secondary outcomes included preferred agent (binary) and future willingness to use agent on patients (5-point Likert scale)., Results: Thirty-eight health care providers were recruited; all completed the study. Median pain verbal numeric rating scale scores were 4 (interquartile range, 2-5) for placebo vs 2 (1-4) for ethyl chloride. The effect size for pain reduction with ethyl chloride compared with placebo was 2 (95% confidence interval, 0.5-2; P = .001). Most subjects (68.4%) preferred ethyl chloride to placebo. Five-point Likert scale scores measuring willingness to use preferred product on future patients were higher by 2 (95% confidence interval, 1-3) among subjects preferring ethyl chloride vs placebo., Conclusions: We found that topical ethyl chloride yields a greater reduction in pain associated with venous catheterization compared with topical placebo., (Published by Elsevier Inc.)

Objectives: This study aims to analyze the efficiency of EMLA cream and ethyl chloride spray application for pain alleviation before botulinum toxin injection., Methods: Forty-five patients were divided into 3 treatment groups. Skin cooling with ethyl chloride spray (in group 1), topical anesthetic cream (EMLA) (in group 2), was used on the forehead area on one side previous to injection; the opposite side served as the control. In the third group (n = 15), cold was applied using ethyl chloride spray to one side, and to the other side topical anesthetic cream (EMLA) was applied. A visual analog scale was used for pain intensity., Results: In the first group, the average pain score was 3.20 ± 1.20 on the side where ethyl chloride spray was applied and 7.26 ± 1.94 on the control side (P < 0.05). It was 4.20 ± 1.37 on the side receiving EMLA and 7.66 ± 1.54 (P < 0.05) on the control side in the second group. In the third group, the average score was 6.80 ± 1.37 for the EMLA side and 2.93 ± 1.03 for the ethyl chloride sprayed side (P < 0.05)., Conclusions: Skin cooling with ethyl chloride spray significantly decreases the pain associated during forehead botulinum toxin injections.

Background: Baló's concentric sclerosis (BCS), a rare variant of multiple sclerosis (MS), as the initial presentation of antiphospholipid syndrome (APS) is unusual. The pathogenic role of antiphospholipid antibodies in the development of MS remains unknown. Anticoagulant therapy might be used in patients with MS and APS for prevention against the relapse of MS., Case Report: We present a 27-year-old man diagnosed as BCS with APS. Initially, after corticosteroid therapy, he exhibited a complete recovery. During follow-up, his Baló-like lesion dissolved over time but transformed into other asymptomatic MS-like lesions. He also had persistently elevated anticardiolipin IgG levels. The patient was, therefore, on a combined therapy of interferon β-1b and an anticoagulant agent. No new brain lesions were found on 2 occasional head magnetic resonance imaging studies at 1 year follow-up., Conclusions: To prevent further MS relapse and thrombotic complications of APS, a combined therapy of interferon β-1b and an anticoagulant agent can be an important strategy in treating patients with both BCS and APS.

The control of symptoms in general and pain in particular, remains a current topic in scientific conferences and meetings, and discussed the recommendations of the Scientific Societies. Do not suffer unnecessary pain because the treatment is a right of every patient and facilitating action to control it, by nurses, is an expression of respect for that right. A common procedure nursing care consists of venous and arterial puncture for blood samples or to place catheters for different purposes, these procedures are painful for the patient and sometimes unpleasant by the need to perform them repeatedly. There are different relaxation techniques that can help to reduce this effect in the body but also have pharmacological interventions to help decrease the pain associated with vascular punctures. One of them, easy to use, quick to act and no side effects is the use of topical anesthesia by cold ethyl chloride.

Background: Ethyl chloride (EC) is usually used as a topical anesthetic spray agent. However, its antipruritic effects have never been studied, to the best of our knowledge., Methods: A double-blind placebo-controlled prospective study. Overall, 51 healthy volunteers underwent a histamine skin prick test on both arms in order to trigger local pruritus. Thereafter, the affected areas were treated with an EC spray on one arm and a saline spray (placebo) on the other. Subjects as well as researchers were blind to which sprays were used. Subjects reported improvement in pruritus following EC/placebo and rated the intensity of pruritus by using a validated questionnaire and a visual analog scale. The flare and wheal reactions were measured in both arms before and following treatment with EC/placebo., Results: Significant improvement in pruritus was reported more frequently following treatment with EC compared with placebo (84 vs. 16%; p < 0.0001). Significant reduction in pruritus intensity was reported immediately and 15 min following treatment with EC compared with placebo (p < 0.05). There was no significant difference between EC and placebo in terms of the flare and wheal reactions., Conclusions: EC is an effective antipruritic agent, and it does not change the wheal and flare reactions, making it ideal for treating pruritus secondary to allergy skin tests without masking their results., (Copyright © 2010 S. Karger AG, Basel.)

Objectives: The purpose of this study was to evaluate the effectiveness of vapocoolant for preschoolers' immunization injection pain relief., Methods: Fifty-seven 4 to 6-year-old children were randomized into vapocoolant alone or typical care conditions. Pain was measured at the baseline and at injection via self-report, caregiver report, nurse report, and by an observational scale., Results: Self-report of pain suggested that children in the vapocoolant alone condition demonstrated stronger increases in pain from baseline to injection than children in the typical care condition. All other measures showed significant increases in pain from baseline to injection, but no other measures indicated treatment effects., Discussion: This study revealed that vapocoolant is not an effective pain management intervention for children's intramuscular injections.

Objective: To determine whether the use of ethyl chloride and subcutaneous lidocaine are associated with a reduction in pain during arterial blood sampling compared with using no local anaesthesia., Methods: Patients over the age of 16 years and who required arterial blood sampling as part of their on-going emergency department management were randomly allocated to one of three groups. Group A received routine skin preparation before arterial puncture (AP); group B received 0.5 ml of 2% lidocaine 2 min before AP; and group C received ethyl chloride immediately before AP. Pain was measured using 100-mm visual analogue scale., Setting: Two urban emergency departments., Results: Fifty-four patients were recruited. Those receiving lidocaine before AP had lower pain scores [10.2 mm, 95% confidence interval (CI): 4.8-16.3 mm] compared with the use of ethyl chloride (23.9 mm, 95% CI: 12.4-35.5 mm) and nothing (23.4 mm, 95% CI: 11.7-35.0 mm). Lidocaine was more painful to administer (22.0 mm, 95% CI: 10.9-33.7 mm) compared with ethyl chloride (12.9 mm, 95% CI: 5.5-20.3 mm)., Conclusion: Ethyl chloride is not an effective local anaesthetic agent for AP. When the pain of local anaesthetic administration is taken into account the benefit of subcutaneous lidocaine for single AP is limited.

Background: Peripheral intravenous (i.v.) cannulation is a painful, frequently performed ED procedure. It is common practice in other medical settings to offer analgesia prior to cannulation., Objective: The present trial aims to reproduce in the ED studies that found a reduction in the pain of i.v. cannulation after intradermal lignocaine, ethyl chloride topical spray and entonox (50:50 oxygen : nitrous oxide). It also intends to determine which is analgesic most effective and explore the role of entonox for cannulation analgesia., Methods: Three hundred subjects were randomized into four groups: i.v. cannula inserted with (i) no anaesthesia; (ii) entonox; (iii) ethyl chloride; and (iv) 0.1 mL intradermal 1% lignocaine. Pain was recorded on 100 mm visual analogue scales (VAS) after lignocaine injection or ethyl chloride spray and following i.v. cannulation. A clinically significant reduction in VAS pain score was determined to be 13 mm., Results: Patients cannulated without analgesia reported the most pain. Those cannulated after lignocaine had the least pain (median VAS 20 mm, 95% CI 15-25, vs 1 mm 95% CI 0-6, P < or = 0.001). Ethyl chloride (VAS 11 mm, 95% CI 7-15, P = 0.003) and entonox (VAS 13 mm, 95% CI 8-18, P = 0.047) reduced i.v. cannulation pain but did not reach clinical significance. Neither pain from presenting symptoms (P = 0.3), nor size of cannula (P = 0.8) affected pain scores. VAS scores were independent of sex and age (P = 0.1). Cannulation success was not affected by either the choice of analgesia or cannulation site., Conclusions: The present trial confirms the findings of Harris and colleagues that lignocaine reduces the pain of cannulation in the ED. Lignocaine reduced the pain of i.v. cannulation more effectively than entonox or ethyl chloride.

Introduction: Ethyl chloride can be used as a cryoanalgesic, but with the availability of alternative and relatively safer topical analgesics, its use has decreased. However, it still has the advantage of being quicker to apply compared with other topical analgesics, making it ideal for use in the outpatient departments. We wanted to compare the effectiveness of ethyl chloride as an analgesic during venipuncture in children., Methods: Venipuncture was carried out using either no analgesia (NO), ethyl chloride spray (EC), or application of the topical anesthetic Ametop (TA) on children attending the phlebotomy outpatient service by experienced pediatric phlebotomists. A pain score was recorded using either the Faces scoring system or the Faces, Legs, Activity, Cry Consolability scoring system., Results: A total of 55 patients were included in the study, 18 from group EC, 18 from group TA, and 19 from group NO. Thirteen patients from both groups EC and TA and 17 from group NO scored 2 or less on the pain scores., Discussion: The use of ethyl chloride was as effective as topical anesthetics in preventing distress to children in venipuncture. However, in the appropriate situations, the use of NO could also be comfortable to the child if venipuncture was done by specialist pediatric phlebotomists.

The purpose of the study was to determine the effect of ethyl vinyl chloride vapocoolant spray on pain reported by children undergoing intravenous cannulation. A randomized, double-blinded, placebo-controlled trial was conducted on eligible children between the ages of 9 and 18 years seen in a pediatric emergency department and requiring intravenous cannulation. Informed consent was obtained, and children were randomized to receive ethyl vinyl chloride spray, isopropyl alcohol spray, or no spray (control group). Patient demographics and information pertaining to each intravenous cannulation were recorded. Children indicated the degree of pain associated with intravenous cannulation on a 100-mm visual analog scale (VAS) compared to a baseline pain score of "zero." Statistical analysis was performed by using Stata version 7. One hundred twenty-seven subjects were enrolled: 37 received ethyl vinyl chloride vapocoolant spray, 48 received isopropyl alcohol spray (placebo), and 42 received no pretreatment. Mean VAS scores for pain experienced during cannulation were 34, 33, and 31 mL for each group, respectively. Ethyl vinyl chloride vapocoolant spray failed to measurably reduce pain associated with intravenous cannulation when compared to those pretreated with isopropyl alcohol spray or receiving no intervention.

Patient satisfaction with nursing care is the strongest predictor of overall satisfaction. Reducing discomfort of routine procedures, such as venipuncture for an intravenous insertion, can contribute to perceived satisfaction. This article reviews three common pharmacological interventions that can be used by perianesthesia nurses to reduce the pain of venipuncture.

A prospective, randomized and double blind study was undertaken to determine the incidence and a possible dose- or age-dependence of hiccups in children premedicated with rectal midazolam and to investigate the treatment of hiccups by intranasal ethyl chloride spray application. Two hundred ASA physical status 1 and 2 children, weighing 3.0 to 15.0 kg, scheduled for minor surgery, were randomly assigned to be given either 0.5 mg.kg-1 midazolam(n=100) or 1.0 mg. kg-1 midazolam (n=100) administered rectally. If hiccups were observed during a period of 20 min after premedication with midazolam, these children were treated after 3 min of hiccups with two short intranasal applications of ethyl chloride spray. Hiccups occurred in 22% of children in the 0.5 mg.kg-1 group and 26% in the 1.0 mg.kg-1 group (n.s.). The intranasal application with ethyl chloride was successful in 100% in both groups. The mean age levels between children with or without hiccups were 5+/-9 months vs 21+/-19 months (P<0.01) in the 0.5 mg.kg-1 group and 6+/-7 months vs 20+/-14 months (P<0.01) in the 1.0 mg.kg-1 group. Intranasal application of ethyl chloride spray seems to be an effective therapy for midazolam induced hiccups in paediatric anaesthesia. The incidence of these hiccups is highly age significant, but not dose dependent.

In vivo freezing of microarteries is known to relieve spasm without inducing thrombosis. In the present study the process of vascular freezing was investigated in veins using ethyl chloride in the rat model. Two separate experiments were performed. In experiment 1 the epigastric and femoral veins were frozen, and the immediate change in diameter was recorded. Patency rates were evaluated and specimens harvested at 2, 10, and 30 days. In experiment 2 the epigastric and femoral veins were frozen, divided, anastomosed, and examined for patency at 72 hours. Patency in frozen epigastric and femoral veins was 100%. Pathological findings were loss of intima and part of the media layers, and cellular depopulation of the media layer, with progressive regeneration. Increase in vein diameter was statistically significant. In experiment 2, patency rates were 5% at 72 hours for epigastric veins and 100% for the femoral vein. Microthrombi adherent to the wall were demonstrated in all specimens. In conclusion, the freezing of microveins relieves spasm without inducing thrombosis; the frozen veins can be reliably divided and anastomosed in the femoral vein but not in the epigastric vein, the difference being most likely due to the different diameter and flow.

Free flap transfer to the lower limb in chronic post-traumatic conditions is known to have a higher complication rate, with flap loss in up to 10% of cases, due mainly to the recipient vessels (Godina: Plast Reconstruct Surg 78:285-291, 1986]). The dissection of these vessels often leads to refractory spasm, due to the so-called perivascular post-traumatic disease (PVPTD) (Khouri [Clin Plast Surg 19:773-785, 1992]). A case is presented of the use of a fairly new spasmolytic maneuver, i.e., in vivo vascular freezing, in a patient who developed intractable spasm of the recipient artery.

Vascular spasm of recipient vessels can increase failure rates in free tissue transfer, especially in post-traumatic perivascular-injured vessels. To investigate the effect of freezing-induced spasmolysis of recipient vessels, an experimental model of perivascular injury was developed in the rat through previous dissection of the femoral artery and epigastric vein (6 weeks before). The contralateral epigastric flap was free-transferred to healthy recipient vessels in group I, to the previously dissected vessels in group II, and to frozen-dilated perivascular-injured vessels in group III. The injured artery showed the same degree of spasm as normal arteries, while the vein showed greater spasm. Ethyl chloride reverted spasm in the injured artery and vein to the same degree as in normal vessels. Flap viability rates were 73.3% in group I, 60% in group II, and 66.7% in group III. The differences were not statistically significant. In conclusion, although further research is needed to improve the experimental model, in vivo freezing with ethyl chloride does not seem to impair free flap viability when used to treat spasm in recipient vessels.

In vivo freezing of microarteries with liquid nitrogen is known to relieve spasm without inducing thrombosis. In the present study the patency rates of microanastomoses in pre- and postfrozen vessels were investigated in the rat model. Freezing of the femoral artery was done with ethyl chloride. The artery was frozen before the anastomosis was performed on the left side (prefrozen), and after on the right side (postfrozen); patency rates were recorded at 2, 10, and 30 days. Patency rates were 100% in prefrozen vessels and 100% in postfrozen ones at all three time intervals. Histologic examination showed depopulation of all vessel walls with loss of the intima layer and fragmentation of the inner elastic lamina. Progressive cellular repopulation and regeneration of the endothelium occurred later, with no differences between pre- and postfrozen arteries. It is concluded that freezing of vessels with ethyl chloride reverts arterial spasm without inducing thrombosis and that frozen arteries can be repaired by microsurgical anastomosis with patency rates comparable to those of virgin arteries.

We present a four-year-old girl with a doubly rare form of granuloma annulare with non-typical localisation of superficial nodules on the palms and predisposition to ulceration which is very rare in this type of superficial nodules. The diagnosis was proved by histological examination. After the local cryotherapy (ethyl chloride) the lesions almost completely disappeared.

Pediatric cancer patients often become anxious, agitated, combative, and uncooperative due to the pain or fear of pain during invasive procedures. Generally, it is not the actual administration of medicines that produces this reaction, but the fear of the needle stick itself. Increased education and implementation of coping mechanisms is often not enough to allay this fear. The tangible solution of using ethyl chloride, an anesthetic spray, before port sticks, lumbar punctures, and bone marrow aspirations, was instituted by the hematology-oncology clinic to determine if the pain, emotional trauma, and fear of cancer treatments could be reduced in oncology patients. Survey results on 60 patients and 60 parents/caretakers showed that when given the choice to use the spray or to refuse its use, 68% of the parents thought that the patient had more of a sense of control and, thus, involvement in their treatment. Seventy-eight percent of the patients reported experiencing less pain associated with procedures. Staff noted an increase in cooperation, less combativeness, and more compliance with treatment. Perceiving the child's discomfort diminished, 87% of the parents/caretakers report feeling less anxious and, therefore, more capable of being supportive to each other and their child. These results verified the staff's perceptions of the advantages of using this noninvasive anesthetic. Ethyl chloride is an easy, effective, concrete approach to reducing procedural pain in pediatric oncology patients.

Dental patients with parafunctional habits (clenching and grinding of the teeth) may pose unique treatment problems for the dentist. Several patients suffering from such muscle hyperactivity disorders were studied longitudinally by use of the occlusalgraph method to preserve the photocclusal data recorded by each patient. This report suggests that the use of the described technique provides a quick and simple method of visualizing the problem and long-term monitoring of the treatment.

While in intensive medicine the somatic detoxication of suicidal intoxications and the methiazol chloride treatment (distraneurine) of delirious conditions belong to everyday work, outside psychiatric institutions the judgement and the immediate measures in all other acute psychopathological syndromes are still accompanied by uncertainty and sight differenciation. For the emergency therapy the cause-unspecific diagnosis of a syndrome must often be sufficient. The mode of effect, the differences of the indication and side-effects of the psycholeptics which are to be applied in psychiatric emergency cases are summarizingly described. Physostigmine is therapeutically too little used as an antidote against ethanol and ethyl chloride spray for the interruption of conversion-neurotic attacks and excitation conditions. On the other hand distraneurine is contra-indicated in alcohol intoxications without delirious symptomatology.

The DNA of V-79 Chinese hamster cells was examined by alkaline elution following treatment of cultures with eight different nitrosoureas. Drug incubations were performed under consistent biological conditions of equal toxicity and equal mutation induction at the hypoxanthineguanine phosphoribosyltransferase locus. The goals of this study were to determine whether DNA damage could be detected in cells treated with biologically relevant doses of nitrosoureas and to determine whether the type and number of observed DNA lesions could be correlated with the cytotoxic and mutagenic effects of the drugs. All of the compounds tested produced, to some degree, lesions that were observed as DNA strand breaks upon exposure of the DNA to alkali. The levels of DNA strand breaks and/or alkali-labile lesions were comparable for all of the drugs at the equimutagenic doses. DNA cross-linking was observed at both the equitoxic and the equimutagenic concentrations of the haloethylnitrosoureas, but cross-linking was not observed with methylnitrosourea or streptozotocin. Methylnitrosourea and streptozotocin required approximately 40 times the drug concentration to produce toxicity equal to the haloethylnitrosoureas. These data suggest that the ability to cross-link DNA confers increased cytotoxicity to the haloethylnitrosoureas.

The efficacy of trigger-point injection therapy in treatment of low-back strain was evaluated in a prospective, randomized, double-blind study. The patient population consisted of 63 individuals with low-back strain. Patients with this diagnosis had nonradiating low-back pain, normal neurologic examination, absence of tension signs, and lumbosacral roentgenograms interpreted as being within normal limits. They were treated conservatively for 4 weeks before entering the study. Injection therapy was of four different types: lidocaine, lidocaine combined with a steroid, acupuncture, and vapocoolant spray with acupressure. Results indicated that therapy without injected medication (63% improvement rate) was at least as effective as therapy with drug injection (42% improvement rate), at a P value of 0.09. Trigger-point therapy seems to be a useful adjunct in treatment of low-back strain. The injected substance apparently is not the critical factor, since direct mechanical stimulus to the trigger-point seems to give symptomatic relief equal to that of treatment with various types of injected medication.

The decision to use drugs systemically in the management of mandibular dysfunction must be made with consideration of the information summarized in this report. It has been shown that pharmacotherapy may be effective. It has also been demonstrated that systemic pharmacotherapy frequently produces side effects which are occasionally severe. The clinician must decide on the appropriateness of therapy with the knowledge that many other conservative measures may also have excellent success rates and that pharmacotherapy is likely to be palliative rather than curative.

Structure-activity studies of nitrosourea pharmacology have resulted in the synthesis of a new water-soluble agent,chlorozotocin, which has significant antitumor activity against the L1210 leukemia system and produces only a minor degree of inhibition of mouse and human bone marrow DNA synthesis compared to BCNU. It is important to emphasize that the bone marrow sparing feature of chlorozotocin is relative and that if the drug is administered at lethal dose levels in mice, myelosuppression is observed. The potential importance of these studies is the identification of a new and active nitrosourea antiumor agent with modified bone marrow toxicity. If aminoglucose modification of nitrosourea bone marrow toxicity can be confirmed in man without significant loss of antitumor activity, the use of such a compound could facilitate treatment of patients with neoplastic disease who have pre-existing abnormal bone marrow function. It would also allow the more effective use of a nitrosourea agent in combination with anticancer agents possessing more potent myelosuppressive properties.

Myofascial pain syndrome is an entity with which every podiatrist should be familiar. These disorders are usually the result of acute or chronic injury and are characterized by the presence of trigger areas and symptom complexes that have definite patterns. Once these patterns have been learned, the sources of pain can be readily predicted. Most of these conditions can be effectively treated in the podiatrist's office by local block techniques and/Or by application of Fluori-Methane spray. It is important to consult the appropriate medical specialist for diagnostic confirmation or for aid in treatment if uncertainty exists. Treatment regimens in this group of syndromes are based on the notion that in these disorders there is a self-sustaining cycle of pain-spasm-pain persisting after the precipitating cause has disappeared, which may be permanently abolished by interruption of the reflex mechanisms. In order to produce optimal results, the trigger area must be accurately located and treatment directed toward its elimination. Physical therapy and active exercise are necessary adjuncts to local blocks. Not all patients respond, and in many the response is slow, incomplete, and/or only temporary, but there are those in whom these simple measures provide relief of pain and disability in a manner as dramatic as one is likely to encounter in practice.

Five children with acute and chronic regional myofascial pain syndromes, involving the sternomastoid, the external oblique, the rectus abdominis and the biceps femoris, are described. The trigger points were treated initially by vapocoolant therapy followed by muscle stretching, and subsequently by moist heat applications and continuing muscle stretching. The pain resolved in all cases. Such syndromes received little attention in the medical literature, and consequently, affected patients have been given alternative diagnoses. The article seeks better recognition of such syndromes in order to provide adequate and appropriate management.

Chlorozotocin, 2-(3-(2-chloroethyl)-3-nitrosoureido)-D-glucopyranose, is a newly synthesized, water-soluble nitrosourea antitumor agent that is active against L1210 leukemia in mice. A 701% and a 401% increase in life-span were attained with a dose that was lethal to 10% of the animals (15 to 20 mg/kg, i.p.) in mice treated on Day 2 or Day 6 of L1210 tumor growth, respectivley. Sixity % of Day 2-treated mice and 30% of Day 6-treated mice survived for 90 days. At the maximally effective dose against L1210, chlorozotocin produced no significant depression in normal bone marrow DNA synthesis nor in peripheral neutrophil count, in contrast to a sustained greater than 90% inhibition in L1210 ascites cell DNA synthesis. If the antitumor activity and reduced bone marrow toxicity of chlorozotocin are confirmed in man the use of this compound would facilitate treatment of patients with neoplastic disease who have preexisting abnormal bone marrow function or would allow for the more effective use of a nitrosourea agent in combination with anticancer agents possessing more potent myelosuppressive properties.