Morphine at "sub-analgesic" background infusion rate plus low-dose PCA bolus control pain better and is as safe as twice a bolus-only PCA regimen: a randomized, double blind study.

Morphine for postoperative pain control is commonly titrated via intravenous patient-controlled analgesia (IV-PCA). An IV morphine background infusion is rarely used. We investigated whether analgesia is effectively attained and morphine consumption is reduced if PCA titration is coadjuvated by a continuous infusion protocol.

Repeated and escalating preoperative subanesthetic doses of ketamine for postoperative pain control in patients undergoing tumor resection: a randomized, placebo-controlled, double-blind trial.

Background: Ketamine induces a short-term effect on postoperative pain when administered intravenously immediately before or during acute pain. Repeated administration of low-dose ketamine may induce long-term pain relief in chronic pain syndromes.

Objective: The aim of our study was to determine whether ketamine's effect on acute postoperative pain could be enhanced and prolonged and analgesia consumption reduced if it was administered intramuscularly in repeated and escalating subanesthetic doses many hours before surgery.

Higher postoperative pain and increased morphine consumption follow pre- rather than post-incisional single dose epidural morphine.

Background: Neuraxial administration of morphine is an effective way of controlling postoperative pain and reducing analgesic consumption. Some animal models have demonstrated that preemptive administration of neuraxial narcotics reduces pain, while others have revealed the contrary. In addition, there have been no consistent results in clinical settings.

Low-dose ketamine via intravenous patient-controlled analgesia device after various transthoracic procedures improves analgesia and patient and family satisfaction.

Ketamine was recently shown to attenuate postoperative pain when used in combination with morphine in patients who had undergone general and orthopedic surgery. We assessed its effects in 46 patients undergoing minimally invasive direct coronary artery bypass, off-pump coronary artery bypass, or thoracotomy and correlated them with patient and family satisfaction. Patient-controlled analgesia (PCA) was available for 72 hours.

Posttraumatic play in young children exposed to terrorism: An empirical study.

The phenomenon of "posttraumatic play" (PTP) has received much clinical recognition and little empirical support. The objective of this study was to examine various aspects of PTP in young children exposed to terror events and their relation to posttraumatic stress disorder (PTSD). Individual play sessions, conducted with 29 young Israeli children directly exposed to terrorism (M age = 5.

Effects of intravenous patient-controlled analgesia with buprenorphine and morphine alone and in combination during the first 12 postoperative hours: a randomized, double-blind, four-arm trial in adults undergoing abdominal surgery.

Background: Intense pain in the first 12 hours after major abdominal surgery requires the use of large amounts of analgesics, mainly opioids, which may produce undesirable effects. Buprenorphine (BUP) is not typically used intravenously in this setting, particularly in combination with morphine (MO), due to concerns that BUP might inhibit the analgesic effect of MO.

Objective: This study compared the analgesic effect of BUP and MO separately and in combination for postoperative pain control in patients undergoing abdominal surgery.

Morphine with adjuvant ketamine vs higher dose of morphine alone for immediate postthoracotomy analgesia.

Background: Thoracotomy is associated with severe pain. We hypothesized that the concomitant use of a subanesthetic dose of ketamine plus a two-third-standard morphine dose might provide more effective analgesia with fewer side effects than a standard morphine dose for early pain control.

Methods: We conducted a 6-month randomized, double-blind study in patients undergoing thoracotomy for minimally invasive direct coronary artery bypass or for lung tumor resection.

Ketamine for acute and subacute pain in opioid-tolerant patients.

Prolonged acute pain, especially that of oncologic neurological origin, is at times difficult to control; it is seldom entirely alleviated by opioids. We report eight patients with severe pain, three of whom suffered from new onset oncologic metastatic bone pain, others had previous pain syndromes and presented with exacerbation of pain. Pain was associated with hyperalgesia and allodynia phenomena in two patients and with phantom pain in a third one.

Ketamine spares morphine consumption after transthoracic lung and heart surgery without adverse hemodynamic effects.

Background: Thoracotomy is associated with severe pain. Large doses of morphine can depress respiratory drive and compromise hemodynamic stability. Ketamine reduces hyperalgesia, prevents opioid tolerance and resistance and lowers morphine consumption.

Subanaesthetic ketamine spares postoperative morphine and controls pain better than standard morphine does alone in orthopaedic-oncological patients.

Background: Postoperative pain in patients with bone and soft tissue cancer is different from that of other surgical patients due to the severity of the pain generated during surgery and because many of them have already been in pain preoperatively. The search for optimal intravenous pharmacologic management for this population is an ongoing one. We conducted a 10-month prospective, randomised, double blind study to compare the effects of a standard morphine dose to a 35%-lower dose plus a subanaesthetic dose of ketamine for postoperative pain control in patients undergoing bone and soft tissue cancer surgery under standardised general anaesthesia.

Dextromethorphan-associated epidural patient-controlled analgesia provides better pain- and analgesics-sparing effects than dextromethorphan-associated intravenous patient-controlled analgesia after bone-malignancy resection: a randomized, placebo-controlled, double-blinded study.

Unlabelled: Pain after bone malignancy surgery is intense and requires large amounts of analgesics. The augmented antinociceptive effects of dextromethorphan (DM), a N-methyl-D-aspartate receptor antagonist, were demonstrated previously. We assessed the use of postoperative patient-controlled epidural analgesia (PCEA) or IV patient-controlled analgesia (PCA) in patients undergoing surgery for bone malignancy under standardized combined general and epidural anesthesia with or without DM.

Complications of screening flexible sigmoidoscopy.

Background & Aims: Flexible sigmoidoscopy (FS) is recommended for mass screening for colorectal cancer (CRC), yet little is known about the risk of adverse events when FS is used in general clinical practice. We aimed to determine the incidence of gastrointestinal complications and acute myocardial infarction (MI) after screening FS.

Methods: Northern California Kaiser Permanente Medical Care Program members of average risk for CRC (n = 107,704) who underwent screening FS during 1994 to 1996 (109,534 FS), as part of the Colorectal Cancer Prevention (CoCaP) program.

The Children's Play Therapy Instrument (CPTI). Description, development, and reliability studies.

The Children's Play Therapy Instrument (CPTI), its development, and reliability studies are described. The CPTI is a new instrument to examine a child's play activity in individual psychotherapy. Three independent raters used the CPTI to rate eight videotaped play therapy vignettes.

Working through conflict with self-destructive preschool children.

This case history charts the treatment of a preschooler who first presented at the age of three years and ten months with aggressive and self-destructive behaviors. During the initial months of treatment, the therapist focused upon establishing a therapeutic alliance with the child in order to evoke a transference reaction. Compelling evidence of the transference in this case occurred in the ninth month of treatment when the therapist told the child that she would be going on vacation.

Merging and emerging realities: simultaneous treatment of parent and child.

The purpose of this paper is to invite dialogue concerning the variety of modalities possible in the spectrum of child treatment. Many issues remain to be discussed, such as the child's need to possess the therapist entirely, and the role of other family members. Countertransference issues for the therapist are complex and involve the risk of dual loyalties.

Early and long-term effects of electroconvulsive therapy and depression on memory and other cognitive functions.

Twenty-seven medication-free, depressed patients (Research Diagnostic Criteria, endogenous subtype) were administered a comprehensive battery testing memory and other cognitive functions before and after a series of bilateral, brief-pulse electroconvulsive therapy (ECT) administered according to a dosage-titration procedure (8.9 +/- 1.981 treatments).

Change in Attitude Toward Electroconvulsive Therapy: Effects of Treatment, Time Since Treatment, and Severity of Depression.

Attitudes toward electroconvulsive therapy (ECT) of patients with major depressive episodes who are treated with ECT were evaluated before the beginning of treatment, 1 to 2 days after completion of the 12th treatment, and 6 months after the termination of the series using a questionnaire (adapted from Freeman and Kendall, 1980). Attitudes toward ECT become more positive after treatment, and remain so at the 6-month follow-up. Attitude changes correlate with changes in depressive symptoms and with subjective side effects during treatment.

Retrieval from semantic memory using meaningful and meaningless constructs by depressed, stable bipolar and manic patients.

Eleven depressed, 11 stable bipolar and six manic patients, 20 normals and eight late middle-age normals were tested for speech production using a word-fluency task. Fluency was prompted by either a letter (a relatively automatic task), or a semantic category (an effort-demanding task). The results showed that depressed patients were more impaired in speech production than other patients when prompted by a semantic category than when prompted by a letter.

Frequency of carriers of chronic (type I) Gaucher disease in Ashkenazi Jews.

In this study we estimate the frequency of carriers of chronic (type I) Gaucher disease among Ashkenazi Jews by examining the glucocerebrosidase activity in leukocytes in a population of 635 blood donors (441 Ashkenazi) and 57 obligatory heterozygotes. Estimation using the defect in the enzyme glucocerebrosidase (beta-glucosidase) in leukocytes is complicated by the existence of considerable overlap between enzyme activity in normals and in heterozygotes. The assay was carried out with a natural substrate labeled with 14C.

Glucocerebroside storage in normal monocyte cultures.

Glucocerebroside in Gaucher disease is stored in large Gaucher cells of monocyte-macrophage origin. Our aim was to achieve storage of this substrate in monocytes in vitro, in order to mimick the Gaucher cells in vivo. The method described using glucocerebroside-albumin complex, enabled such uptake and storage.

Familial correlation of memory function in schizophrenia.

Chronic schizophrenic patients with first- or second-degree schizophrenic relatives were evaluated for memory function. Wechsler memory scale scores were significantly correlated between index cases and relatives (r = 0.56, p less than 0.

Ineffectiveness of vasopressin in the treatment of memory impairment in chronic schizophrenia.

A vasopressin derivative or placebo was administered to 21 chronic schizophrenia patients for 3 weeks in a randomized crossover double-blind design. The patients were divided into those above and below the median on baseline memory measured by the Wechsler memory scale. Vasopressin treatment did not improve memory either in those patients with below median baseline memory or in the group as a whole.