[The phenomenon of pain in the history of music ­ observations of neurobiological mechanisms of pain and its expressions in western music]. / Der Schmerz in der Musikgeschichte. Betrachtungen über die neurobiologischen Mechanismen des Schmerzes und seine Darstellungen in der abendländischen Musik.

Purpose of this essay is to provide a historical overview how music has dealt with the emotion and sensation of pain, as well as an overview over the more recent medical research into the relationship of music and pain. Since the beginnings of western music humans have put their emotions into musical sounds. During the baroque era, composers developed musical styles that expressed human emotions and our experiences of nature. In some compositions, like in operas, we find musical representations of pain. During Romanticism artists began to intrude into the soul of their audience. New expressive harmonies and styles touch the soul and the consciousness of the listener. With the inception of atonality dissonant sounds where experienced as a physical pain.The physiology of deep brain structures (like thalamus, hypothalamus or limbic system) and the physiology of the acoustic pathway process consonant and dissonant sound and musical perceptions in ways, that are similar to the perception of pain. In the thalamus and in the limbic system music and pain meet.The relationships of music and pain is a wide open research field with such interesting questions as the role of dopamine in the perception of consonant or dissonant music, or the processing of pain during music listening. Musicology has not yet embarked on a general investigation of how musical compositions express pain and how that has developed or changed over the centuries. Music therapy, neuro-musicology and the performing arts medicine are scientific fields that offer a lot of ideas for medical and musical research projects.

[Integrative and personalized health care--requirements for a timely health-care system]. / Integrative und personalisierte gesundheitsversorgung--forderungen für ein zeitgemässes gesundheitssystem.

In medical and public debates, the concept "personalized" or "individualized" medicine (PM) is increasingly used for the orientation of medicine towards individual genetic, molecular and biological characteristics. However, this tunnel view neglects that the human "person" or "individual" encompasses more than just the molecular and biological side, and that patients increasingly call for a more holistic and more person-centred form of health care. Therefore the authors propose to extend the concept of PM in the framework of an integrative health-care concept, so that with respect to a modern and patient-centred health-care system not only the biological, but also the relevant psychological, mental, social, cultural, spiritual, and economic aspects of the human individual are accounted for in health care. The Faculty of Health of Witten/Herdecke University proposes the term "integrative and personalised health care" for such a holistic form of PM.

[The relations between music and medicine in history and present]. / Die Beziehung von Musik und Medizin in Geschichte und Gegenwart.

Since the ancient world relations exist between music and medicine. In the prehistoric music, dance, rhythm and religious practice were important parts of shamanism and early medical procedures. Important philosophers of the classic period already began with the scientific research of musical and medical questions. During the middle age convents conserved ancient knowledge. They offered medical care and taught the ancient knowledge of medicine, arts and music. The Gregorian choral was created. Traditions of popular believe expressed the relations between music and medicine. The Renaissance became the great époque of art, music and science. Leonardo da Vinci and Andreas Vesalius presented a new style of artistic working and scientific knowledge. Also the basics of western music, like tonality was developed. With the separation of scientific subjects in natural sciences and humanities, the relationships between music and medicine fall into oblivion. During the classic and romantic era music and art were important parts of cultural live of the well educated society. With the development of neurology, psychiatry and psychoanalysis more physicians and scientists were interested in musical questions. Questions about the role of music in human behavior and the ancient method to use music in medical treatment became popular. In the early 20th century the music therapy was developed. Today the effects of music to the human brain are investigated with radionuclear methods. A lot of investigations showed the effect of music and music performance to humans. Music plays an important part in psychotherapy, therapeutic pedagogy and medical care, the importance of music and music therapy increases. In the 80ies of the 20th century the performing arts medicine was developed, which asks for the medical problems of performing musicians.

Evidence-based management of pain after haemorrhoidectomy surgery.

BACKGROUND: Haemorrhoidectomy is associated with intense postoperative pain, but optimal evidence-based pain therapy has not been described. The aim of this systematic review was to evaluate the available literature on the management of pain after haemorrhoidal surgery. METHODS: Randomized studies published in the English language from 1966 to June 2006, assessing analgesic and anaesthetic interventions in adult haemorrhoidal surgery, and reporting pain scores, were retrieved from the Embase and MEDLINE databases. RESULTS: Of the 207 randomized studies identified, 106 met the inclusion criteria, with mixed methodological quality. Of these, 41 studies evaluating surgical and alternative interventions were excluded. Quantitative analyses were not performed, as there were limited numbers of trials with a sufficiently homogeneous design. CONCLUSION: Local anaesthetic infiltration, either as a sole technique or as an adjunct to general or regional anaesthesia, and combinations of analgesics (non-steroidal anti-inflammatory drugs, paracetamol and opiates) are recommended. If appropriate, a stapled operation may be preferable.

[Organisation of postoperative acute pain therapy in Germany compared to other European nations - results of a postoperative analgetic therapy observational survey (PATHOS)]. / Organisation der postoperativen Schmerztherapie Deutschlands im europäischen Vergleich - Ergebnisse einer europaweiten Umfrage (PATHOS).

BACKGROUND: From 2004 to 2005, a survey concerning the structure and organisation of postoperative acute pain therapy (APT) was conducted in 1358 hospitals from 7 EU states. METHODS: Anaesthesiologists, general and abdominal surgeons, orthopaedic / trauma surgeons, gynaecologists and ENT specialists were interviewed concerning: Education of medical and non-medical employees, patient information, protocols for acute pain therapy and methods of pain assessment. RESULTS: 1558 questionnaires from 746 hospitals were returned, among them 516 questionnaires from Germany where surgeons were more often responsible for acute pain therapy (50 vs. 36 %, p < 0.05). A budget for APT existed in only 8 % of German hospitals (vs. 22 % of hospitals in other nations, p < 0.05). German surgeons were more often responsible for the APT education of nurses on the general ward (58 vs. 20 %, p < 0.05). Patient information about APT was more often presented in Germany in selected cases (45 vs. 23 %, p < 0.05), APT protocols were developed more often (42 vs. 30 %, p < 0.05) and the influence of APT on morbidity and mortality was judged to be higher by German physicians (p < 0.05 each) as compared to other nations. Nevertheless, postoperative pain was not assessed at all in 53 % of all German hospitals, and only in 25 % of the hospitals of other nations (p < 0.05). CONCLUSION: Further initiatives to improve postoperative acute pain therapy are urgently needed in all nations under evaluation. National measures in Germany have to take into account the specific problems identified in this large survey and should focus on the interests and needs of German surgeons.

[Evidence for laser acupuncture in cases of orthopedic diseases : a systematic review]. / Evidenz zur Laserakupunktur bei orthopädischen Erkrankungen : Ein systematisches Review.

BACKGROUND AND OBJECTIVES: The aim of this review is to evaluate the evidence for laser acupuncture in selected orthopaedic diseases. MATERIAL AND METHODS: Randomized controlled studies, meta-analyses and systematic reviews were identified by a systematic search strategy in Medline and the Cochrane library. The studies were evaluated using the quality criteria of the Oxford Centre of Evidence Based Medicine. RESULTS: For the selected orthopedic diseases (medial and lateral epicondylitis, myofascial pain syndrome of the neck, back and shoulder and osteoarthritis), meta-analyses, systematic reviews and eight randomized controlled studies were found. All other published studies used laser therapy without consideration of classical acupuncture points. All studies had significant drawbacks in methodological quality and the number of patients included. In more recent trials, improvement towards higher methodological quality was obvious. Although current evidence is equivocal, positive effects can be assumed in myofascial pain syndromes of the neck, back and shoulder. Laser acupuncture is advantageous in terms of side effects compared to classical acupuncture techniques. CONCLUSION: Better, well designed randomized studies with higher power are mandatory in orthopedic diseases.

[Implementation of a standardized perioperative pain management concept in three hospitals of a consortium]. / Implementierung eines standardisierten perioperativen Schmerzmanagementkonzepts in drei Krankenhäusern eines Klinikverbundes.

BACKGROUND: Provision of sufficient perioperative pain therapy is an obligation in the clinical management of patients suffering from pain. The implementation of a standardized pain management concept was planned to be introduced in the clinical routine. The results of three hospitals are shown. MATERIAL AND METHODS: The concept included tools which gave information about legal aspects and basic fundamentals of pain relief, management modules regarding agreements on the implementation of perioperative pain therapy, instruments to measure pain intensity, assigning accountability and documentation modules. Questionnaires were carried out according to Picker. RESULTS: The project revealed that, according to the Picker questionnaire, about 50% of the patients treated in the hospitals had pain, 30-40% still had intensive pain during the stay in hospital and 90% of the patients received pain relief medication within 10 min of the request. More than 78% of the patients thought the hospital staff did their best to relieve the pain and over 92% found the pain treatment adequate. CONCLUSION: It was possible to implement a standardized perioperative pain therapy concept in three hospitals of a consortium. Whether an adequate pain relief can be improved with the help of standard measurements and documentation, could not be evaluated in this study.

Year-to-year correlations in blood metal levels among individuals of two species of North American sea ducks.

Sea duck populations have declined in North America. Contaminants, especially metals, have been listed as possible contributing factors. Sea ducks are long-lived. Thus, individuals chronically exposed to elevated metal levels may be at greatest risk. Information about long-term exposure (> or =1year) of individuals to metals is absent. To address this information gap, we examined year-to-year correlations among individual White-Winged Scoters and King Eiders in levels of blood cadmium, lead, mercury and selenium. Positive correlations (r> or =0.43), were found in six, five, five and two of seven correlations for cadmium, selenium, lead and mercury. Thus, certain individuals of these species may be exposed over two or more years to higher levels of cadmium, selenium and lead (but apparently not mercury) than other individuals. Single blood samples are appropriate metrics of exposure for studies that examine long-term effects of certain metals on these birds.

[Pain therapy in addicted patients]. / Schmerztherapie bei suchtmittelabhängigen Patienten.

Each individual is entitled to an adequate and sufficient pain therapy. However, only a few studies have examined the peculiarities of pain management in drug-dependent or formerly addicted patients. Any addiction is disadvantageous for a successful pain therapy, since some of the prescribed drugs may themselves cause addiction. Drug-dependent patients are often tolerant to opioids. Additionally, there is a risk of iatrogenic pain becoming chronic due to disregard for already known risk factors and comorbidities. However, a history of addiction should not prevent sufficient pain therapy, especially since there is no risk of addiction when the pain therapy employed is adequate for the pathophysiology involved. There are adequate pain therapies for addicted patients. The best results are achieved by taking into account the physiological and psychological peculiarities of drug-dependent patients. Importantly, this should be combined with a variety of different, optimized, multimodal therapeutic regimes, as well as with an interdisciplinary approach.

Concentrations of cadmium, mercury and selenium in blood, liver and kidney of common eider ducks from the Canadian arctic.

We determined concentrations of selected trace elements in livers, kidneys and blood samples from common eiders (Somateria mollissima borealis) from the eastern Canadian arctic during 1997 and 1998. Concentrations of total mercury and organic mercury were generally low in the livers of these birds (less than 6 and 4 microg g(-1) dry wt, respectively). Selenium ranged between 11-47 microg g(-1) in livers. Renal cadmium concentrations were among the highest ever published for this species (range: 47-281 microg g(-1)). The regressions of log-transformed concentrations of these trace elements in blood samples on those in liver or kidney were significant (all P-values < 0.05) and positive. However, except for organic mercury (R2 = 0.83), the co-efficients of determination were low to moderate (range of R2: 0.26-0.52), suggesting poor to moderate predictive capability. Furthermore, the relationships between total mercury in blood and liver changed between 1997 and 1998, suggesting that it would not be possible to predict consistently, concentrations of mercury in blood from those in liver based on samples taken in one year. Blood samples can be used to determine concentrations of these trace elements in common eiders (and probably other sea duck species as well). The use of blood samples is especially warranted when it is undesirable to kill the animal such as when working with rare or endangered sea duck species or when the objective is to relate trace element exposure to annual survival rates. However, the predictive equations developed here should not be used to predict expected concentrations in one type of tissue from those in the other.

Diagnosis and treatment of diverticular disease: results of a consensus development conference. The Scientific Committee of the European Association for Endoscopic Surgery.

BACKGROUND: With the aim of resolving the current controversy over the diagnosis and treatment of diverticular disease, this consensus development conference set out to summarize the actual state of the art. METHODS: A multidisciplinary panel of international experts (n = 16) was selected to take part in the consensus process. Prior to the conference, all experts were asked to answer a series of questions on diverticular disease. The consensus statement compiled out of these evaluations was modified during a joint meeting of the panel members, then presented for discussion in a public session, and finally revised by the expert panel. The finalized statement was mailed to all panel members for approval (Delphi method). RESULTS: Asymptomatic diverticulosis, diverticular disease (with actual or recurrent symptoms), and complicated diverticular disease were defined separately. No agreement was reached on whether barium enema or colonoscopy is the better choice as an initial diagnostic tool in uncomplicated cases. In complicated cases, computed tomography is recommended for diagnosis. After two attacks of diverticular disease, elective resection should be considered. For patients in whom a concomitant carcinoma cannot be excluded and those with chronic complications (fistula, stenosis, or bleeding) surgery is also indicated. Laparoscopic sigmoid colectomy is recommended only for uncomplicated and, after percutaneous drainage of abscesses, Hinchey stage I and II cases. CONCLUSIONS: Laparoscopic surgery has already begun to influence the management of diverticular disease, but the randomized controlled trials needed to support therapy decisions are largely missing.

Histamine release in dogs by Cremophor E1 and its derivatives: oxethylated oleic acid is the most effective constituent.

Several preparations of Cremophor E1, several of other non-ionic detergents and several components of Cremophor E1 were tested for their histamine-releasing capacity in dogs. Lutensol AP 10 and a derivative of 1,2-propylenglycol were ineffective, but showed excellent properties as detergents. Thus the histamine-releasing capacity was not necessarily combined with the tenside effect of the surfactants. Oleic acid found in Tween 80 as well as in Cremophor E1 seems to be the most effective constituent, but the alcohol seems also to be important for the histamine-releasing capacity. The development of a non-toxic solubilizer for lipophilic drugs seems of considerable clinical interest.