Search

Objectives:To compare and evaluate the safety, efficacy and results for the treatment of adhesive capsulitis by Physiotherapy, Peri-articular injections followed by physiotherapy and Manipulation under Anaesthesia (MUA) followed by physiotherapy. Results: Adhesive capsulitis was found to be more prevalent among males. 55% of the patient in our study were Males, peak incidence of adhesive capsulitis between age group of 40 to 70 year. Maximum number of cases were found between 41-50year (50%) and 51 to 60 year (38.33%). Highest no of patients were found as daily wage worker (33) 27.5% followed by house wife (32) 26.67%. Least patients were found in student class (2)1.67%. Side of affection was majorly left shoulder. Results were evaluated on the basis of clinical improvement of certain parameters such as Pain, Tenderness, Muscular Atrophy and Range of Movement Of Shoulder. Atrophy of muscle was seen in 71 patients. Atrophy of only Deltoid muscle was observed in 36 patients. Except in 4 patients all pts had tenderness over shoulder. All the treatment modalities were found to be significant with all p values less than 0.05. Good grade was observed nearly equivalent in MUA with PT (80.43%) and Injection with PT (78.57%) with a difference of 1.86%. Poor grade was found maximum in Physiotherapy (28.12%) and minimum in MUA with PT (4.35%). Conclusion: The study conclude MUA with PT and Inj with PT showed nearly equivalent good results. Physiotherapy alone showed maximum poor results. This study supports the use of Manipulation under Anaesthesia with PT and Peri-articular injection with PT over Physiotherapy alone.

Measurements of the static dielectric constant at 10 KHz, the refractive index (using a sodium light) and the complex dielectric constant at 9.34 GHz have been made for three substituted acetophenones in a dilute solution of benzene over the temperature range 30-60 °C. Dielectric relaxation times τ(1) and τ(2) have been calculated using the single-frequency concentration-variation method as suggested by Higasi. Comparison with a few available results indicates that τ(2) leads to relaxation times for overall molecular rotation, whereas τ(1) becomes an explicit function of both inter- and intramolecular-relaxation times. τ(2), as well as the distribution parameter (α), show a systematic decrease with increase in temperature. Values of the dipole moments are also reported for these acetophenones.

Postthoracotomy pain management is essential imme diately after surgery and crucial for the patient suffering from this problem for a long duration. Understanding the causative and pathophysiological basis for this condition requires frequent assessment and a multidi mensional approach. Inadequate pain control has detri mental effects on the routine activities of patients as well as on their physical and emotional well-being. During the last 2 decades, the understanding of various pain-related issues has been strengthened resulting in early intervention and pain management. Various phar macological modalities including the role of nonopiates, opiates, and adjuvant drugs are helpful in combating postthoracotomy pain. A selective group of patients will benefit from interventional techniques. The treat ment decision requires a clear understanding of the disease and its impact on the patient. There must also be an understanding of risk and benefits as well as cost and benefits for various drugs and techniques before selecting the appropriate therapy.

Postoperative pain management is essential and must be approached as an integral part of the perioperative care. It should be systematic and based on sound physiological and pharmacological principles. The intra operative management of pain is crucial, because there is perhaps an important role for preemptive analgesia. Because of its unique nature, pain is difficult to assess; for good results, adequate and repeated assessment are vital. The literature also points to the detrimental ef fects of inadequate pain control. There are a variety of methods available for pain management. In choosing a method, various factors need to be considered includ ing: (1) physician skill, (2) knowledge of analgesics and routes of administration, (3) patient and clinically re lated circumstances, (4) the availability of an environ ment supportive of effective pain management, and (5) the knowledge and skill of staff to assess and monitor patients. These need to be considered along with the risk-benefits and cost-benefit of the various drugs and techniques. The cornerstone of therapy is opioids, which can be administered by a variety of routes. The use of thoracic epidural analgesia (TEA) with opioids and local anesthetics is highly beneficial, especially in high-risk patients. The aim should be to provide all patients a balanced analgesic regimen based on the identification of multiple mechanisms involved in postoperative pain.

By December 31, 1992, the 12 nations of the European Community (EC) plan to drop their internal trade barriers to create a single market of 320 million consumers. Implementation of this plan will dramatically change the way marketing is conducted in Western Europe. This article examines the marketing strategy implications of Europe 1992 from the viewpoint of non-EC companies. A framework identifying the underlying variables is developed. A research agenda for future research on regional market integration is proposed.

International advertising standardization/adaptation has been a dominant area in the international marketing literature. In this chapter, we explore the evolution of thought related to international advertising standardization/adaptation beginning in the 1920s. Through a stage theory historical analysis, we decompose thought in international advertising standardization/adaptation into three unique stages: (1) practitioner evolution, (2) scholarly initiation and (3) conceptual and empirical refinement. Given this approach, we contend that the factors considered in earlier stages were necessary for later development. Further and more importantly, we argue that, for the evolution of thought in relation to international advertising standardization/adaptation to evolve, researchers must begin to engage in a number of acts central to building a unified foundation. We propose a series of issues that need to be addressed in order to advance our understanding of international advertising standardization/adaptation.

Pain management is one of the corner stones in the treatment of pancreatitis. There are a variety of pharmacological and non-pharmacological strategies to manage the symptoms. Recognizing the type of pain, nociceptive or neuropathic, is essential for appropriate treatment. The pharmacological armamentarium currently available is substantial and includes adjuvant analgesics, non-steroidal anti-inflammatories, and opioids that are customized to the etiology of the pain. When pain relief is suboptimal with pharmacological interventions, celiac block and other interventions should be considered. In acute pancreatitis the use of opioids is widely accepted while its use in chronic states is more controversial. When opioids are utilized, special care has to be taken for the assessment of indicators of misuse or abuse. A multidisciplinary approach to manage these complex patients will result in a high yield of success in controlling this and other symptoms. and IAP.

When injected directly into the tail, U50,488H is a potent analgesic in the tailflick assay (ED50 3.1 micrograms). The analgesic activity is lost if the radiant heat is focused 1 cm away from the site of injection. The kappa 1-opioid receptor antagonist nor-binaltorphimine given systemically reverses the local analgesic response of U50,488H, but the antagonist is 100-fold more potent when injected directly into the tail. Intrathecal antisense treatment with a probe targeting the mRNA encoding the kappa 1-opioid receptor blocks the local analgesic actions of U50,488H in the tail, suggesting that U50,488H is acting on dorsal ganglia neurons.

PoAicnt: C.S., a 78-yr-old white male. Dx: Submaxillary gland adenocareinoma, resolved with surgical excision and radiotherapy. Pain related to usteocactmnecrosis. Status, postfailed hyperbaric oxygen therapy, Extent ~Dismte: Dime-sized draining sinus over mandible revealing fractured necrotic bone. Pain Site~Distribution: Unilateral extending from ear to chin with radiation to root of neck (third division of cranial nerve V, anterior divisions of second and third cervical nerves), Charac/,~: Severe, sharp, continuous aching with occasional paroxysms, exacerbated by chewing and talking. Prior Analgesics: Trial of sustained release morphine preparation (MS Contin) 30 mg bid failed because of excessive sedation and mild confusion. Present Analgesics, E~cacy, .Side E~eca: Viscous lidocaine as needed, ibuprofen 800 mg tid, acetaminophen and codeine preparation (Tylenol 4t4), 8 tablets daily. This regimen "takes edge off pain, making it barely tolerable for an hour or two." Moderate drowsiness and moderate constipation are major side effeL~. Other Drags: Antibiotics, amitriptyline 10 mg rid. Other Pt'r~nent Data: Clinically depressed, widowed 2 yr prior. Supportive family. Refused surgical intervention (hemimandibulectomy). Living alone with strong preference to maintain apartment and automobile. Prob/em: Depre~ian and persistent pain. Intolerance of analgesics. Strong desire to nu~intain independent lifestyle. Solution: Diagnostic/prognostic block of mandibular nerve with local anesthetic produced complete (transient) relief of racial pain with some residual cervical pain. On follow-up visit 1.2 cc of absolute alcohol was injected near the mandibub~ ne.":e, p.~,:oiln~ng low-term relief. Local anesthetic injected in the vick'ti*.y of the second cervical nerve root relieved cervical pain temporarily and was followed by injection of 2.0 cc of phenol to the same region under radiologic guidance. These nerve blocks have been re* peated about every four too. Pain remains under control 3 yr since initial treatment. Patient chews and speaks more easily. Took amitriptyfine 75 mg hs and aspirin with codeine twice daily throughout most of treaunent. Lesion has begun to heal and the patient has been pain free without an~gesics for 6 too. D/sco.eion: Although cancer had resolved, the patient pr.Tesented with pain as a complication of

High-activity remote afterloading was recently adapted at Memorial Sloan-Kettering Cancer Center for the treatment of carcinoma of the lung recurrent to the major airways. An anesthesia approach is presented which aids in the performance of this beneficial procedure. The remote afterloader is a device containing a high-intensity radioactive source which is applied intraluminally to control both endobronchial and endotracheal tumors. The patient is intubated with an endobronchial or endotracheal tube which facilitates passage and measurement of the Gamma Med catheter. The potential usage for airway maintenance is a secondary benefit. After bronchoscopic placement is verified radiographically, computerized treatment is initiated. The several advantages of this technique are presented.

Gough's theory that psychopathy stems from a deficiency in role taking, the ability to perceive and evaluate one's own behaviour as it is perceived and evaluated by others in the same culture, was tested. The Socialization scale, developed by Gough to assess role taking, was administered to a group of 20 female psychiatric patients with histrionic personality disorders, and a control group of female depressives of similar age and intelligence. Socialization scores of the histrionic personalities were significantly lower, indicating impaired role taking, and this difference was not attributable to depression of mood. The Socialization scale was a better discriminator between the groups than the scales of two other personality inventories or a test to elicit meta-impressions.

The beneficial effects of transcutaneous nerve stimulation (TNS) and cryoanalgesia for post-thoracotomy pain were compared against each other and against a control group through pulmonary function testing in the immediate and delayed postoperative period. Patients receiving cryoanalgesia did not perform well in the first 24 hours after operation. However, by the fifth postoperative day, they did as well as or even better than the TNS patients. Both cryoanalgesia and TNS were significantly effective in the management of postoperative pain as compared with controls.

A prospective randomized double-blind study was undertaken to evaluate the efficacy of transcutaneous nerve stimulation (TNS) in relief of acute post-thoracotomy pain by comparing postoperative narcotic requirements in 22 patients having TNS and in 22 patients having sham electrical stimulation. All patients in both groups had intrathoracic malignancies. When TNS was used, 22.7% of the patients required no narcotics in the first 24 hr postoperatively. All patients having sham stimulation required postoperative narcotics.