Arthritis and pain. Current approaches in the treatment of arthritic pain

Current evidence suggests that although persistent arthritic pain is initiated and maintained by articular pathology, it is also heavily influenced by a range of other factors. Strategies for treating arthritic pain are therefore different from those adopted for acute pain. Although published guidelines offer general assistance, the complexity of underlying mechanisms requires that measures designed to relieve pain must take into account individual biological, psychological and societal factors. It follows that a combination of both pharmacological and non-pharmacological approaches offers the best opportunity for therapeutic success, although determining the effectiveness of such complex interventions remains difficult. Pharmacological therapy is often prolonged, and safety and tolerability issues become as important as efficacy over time.     

Current methods for Saccharomyces cerevisiae. II. Sporulation

Saccharomyces cerevisiae seems to be a particularly suitable model organism for studying eukaryotic differentiation. It is a unicellular eukaryote that can be approached with microbial genetic techniques. It undergoes meiosis and sporulation, a process analogous to gametogenesis in higher organisms. During meiosis, genetic recombination and chromosome segregation occur, leading to the generation of new genotypes. Sporulation takes place in a single cell, thereby eliminating the necessity of studying complex cell-cell interactions that occur during differentiation o of multicellular organisms.The intent here is to introduce the sporulation practicum of S. cerevisiae. Back-ground information is provided for facilitating the selection of strains and sporulation methods. The accompanying article (1) summarizes methods of growth, handling, and biochemical analysis of S. cerevisiae.     

Current methods for Saccharomyces cerevisiae. I. Growth

Interest in the study of yeast biology has increased dramatically in the past few years. Since these organisms are eukaryotic, some phenomena observed in yeast may provide a useful model for similar phenomena in multicellular organisms. Yeast has several advantages as an experimental organism and many methods used for bacteria can be adapted to them. Yeast is simple to grow, cultures are easily maintained, and classical and molecular genetic techniques can be used. The ability to approach problems genetically and biochemically has lead to substantive progess with this group of organisms in areas such as cell biology (1) and gene expression (2). This review is intended to introduce investigators to practical techniques for the growth and radioactive labeling of yeast, primarily of Saccharomyces cerevisiae. For genetic techniques, readers are referred to a recent laboratory manual (3) and reviews (4,5).     

Policy for controlling pain after surgery: effect of sequential changes in management.

OBJECTIVE--To observe the effects of introducing an acute pain service to the general surgical wards of a large teaching hospital. DESIGN--A study in seven stages: (1) an audit of current hospital practice succeeded by the sequential introduction to the general surgical wards of (2) pain assessment charts; (3) an algorithm to allow more frequent use of intramuscular analgesia; (4) increased use of local anaesthetic techniques of wound infiltration and nerve blocks; (5) an information sheet for patients about postoperative pain; (6) the introduction of patient controlled analgesia; (7) a repeat audit of hospital practice. Data were collected on each patient 24 hours after operation. SETTING--University Hospital of Wales, which has both district general and tertiary referral functions. PATIENTS--2035 patients over nine months from all surgical specialties (excluding cardiac) at the hospital. General surgical operations were studied in detail and separated into major, intermediate, and minor for data collection. MAIN OUTCOME MEASURES--A change in the median visual analogue pain scores 24 hours after surgery for pain during relaxation, pain on movement, and pain on deep inspiration at each stage of the study. RESULTS--There was a reduction in median visual analogue scores during the study. The median (95% confidence interval) scores for pain during relaxation decreased from 45 (34 to 53) in stage 1 to 16 (10 to 20) in stage 7 for major surgical procedures. Pain on movement decreased from 78 (66 to 80) to 46 (38 to 48), and pain on deep inspiration decreased from 64 (48 to 78) to 36 (31 to 38). The reductions in median scores for intermediate and minor operative procedures showed similar patterns. CONCLUSIONS--The introduction of an acute pain service to the general surgical wards led to considerable improvement in the level of postoperative pain as assessed by visual analogue scores. Simple techniques of regular pain assessment and the more frequent use of intramuscular analgesia as a result of using an algorithm were particularly effective.     

Incidence of early post-operative iliofemoral thrombosis.

The doppler ultrasound probe was used to study 138 patients after major surgery to assess the incidence of iliofemoral thrombosis in the early postoperative period. The patients were simultaneously studied with the 125-I-fibrinogen uptake test. The accuracy of the ultrasonic technique was assessed concurrently by comparing its results with those of ascending phlebography in a separate group of patients. The ultrasound probe detected thrombus proximal to the calf but was inaccurate in locating its exact site. Of the 138 patients studied postoperatively 28 developed calf vein thrombosis detected istopically, but there was no evidence of iliofemoral thrombosis in any patient. Thus, spontaneous iliofemoral thrombosis in the early postoperative period is rare.