BACKGROUND: Conventional treatment for painful peripheral diabetic neuropathy is largely symptomatic and often ineffective, with unacceptable side-effects. We tested electrical spinal-cord stimulation for the management of chronic neuropathic pain. METHODS: Ten diabetic patients who did not respond to conventional treatment (mean age 51 [SD 9.3] years, six with type II diabetes, mean duration of diabetes 12 [6.3] years, mean duration of neuropathy 5 [2.1] years) were studied. The electrode was implanted in the thoracic/lumbar epidural space. Immediate neuropathic pain relief was assessed by visual analogue scale (VAS) after connecting the electrode, in a random order, to a percutaneous electrical stimulator or to a placebo stimulator. Exercise tolerance was assessed on a treadmill. FINDINGS: Eight subjects had statistically significant pain relief with the electrical stimulator (p < 0.02) and were therefore converted to a permanent system. Statistically significant relief of both background and peak neuropathic pain was achieved at 3 months (n = 7, p = 0.016), at 6 months (n = 7, p = 0.03), and at the end of the study (14 months, n = 7, background pain p = 0.06, peak pain p = 0.03). One patient died 2 months after the start of the study of unrelated cause while continuing to benefit from treatment and another patient ceased to benefit at 4 months. McGill pain questionnaire scores with the stimulator turned off did not change significantly from baseline scores, indicating that the severity of the underlying pain was unaltered. However, with the stimulator turned on, there was a statistically significant (p < 0.05) improvement in all four components of the score, by the end of the study. At the end of the study, six patients continued to gain significant pain relief and used the stimulator as the sole treatment for their neuropathic pain. For example, median background and peak pain scores at the end of study, were, respectively, 77 and 81 with the stimulator off and 23 and 20 with the stimulator on. Exercise tolerance significantly improved at 3 months (n = 7, median % increase 85 [IQR, 62-360], p = 0.015) and at 6 months (n = 6, 163 [61-425], p = 0.0007). Electrophysiological tests, vibration perception-threshold, and glycaemic control were unchanged. INTERPRETATION: Electrical spinal-cord stimulation offers a new and effective way of relieving chronic diabetic neuropathic pain and improves exercise tolerance. The technique should be considered in patients with neuropathic pain who do not respond to conventional treatment.

Chronic Disease↗

PubMedDate not supplied

Olfactory ability as a function of nasal air flow volume in laryngectomees.

This study tested a number of hypotheses concerning the interrelationships between the olfactory abilities and the volume of nasal airflow in laryngectomees. Data were collected from 25 laryngectomees and 25 control subjects and comprised the following: 1) Odor threshold and identification test results. In the threshold test, an 11-step aqueous dilution series of butanol was used. In the odor identification tests, 14 common odorants were used. 2) Measurement of nasal air flow volume in liters per minute. For olfaction and airflow, the laryngectomees' measurements were made under two conditions: 1) using unassisted airflow through the nose, and 2) using a laryngeal bypass that linked the stoma to the mouth and allowed airflow through the nose. The major findings showed that among laryngectomees olfactory abilities depend on nasal airflow. It is concluded that laryngectomees have intact olfactory mechanisms that function normally when adequate airflow volume is provided.

Humans↗

PubMedDate not supplied

Conscience and responsibility.

Explore the source record for details and available documents.

Christianity↗

PubMedDate not supplied

Age changes in the epithelial lining of the human larynx.

The change in size of the larynx with respect to age was investigated. In general the female larynx grows smaller with increasing age, but there is no similar age effect in men. The incidence and extent of squamous metaplasia was also studied. Two parts of the larynx showed age-related changes: in men, metaplasia of the vestibular folds became more common with age up to the age of 60, but then became less common again. In men also, the incidence and extent of squamous metaplasia increased with ageing. These age-related changes may relate to the development of laryngeal carcinoma, an event which must be preceded by squamous metaplasia.

Adult↗