In the arms of Morpheus the development of morphine for postoperative pain relief.

PURPOSE: To analyse the historical development of morphine for postoperative analgesia and how this development was shaped by the evolution of anesthetic techniques. METHODS: After a systematic review of the literature, information was gathered from primary sources. PRINCIPAL FINDINGS: In ancient medicine, some plant derivatives were used to alleviate pain including: alcohol, cannabis, mandrake, and opium. Over the past two centuries, opium and its derivatives have become the most widely used analgesics for severe pain. Before the development of general anesthesia, surgery was only performed out of extreme necessity. It is probable that an analgesic such as opium would have been given following surgery although its use may not have been recorded. The first description of postoperative opium was by James Moore in 1784. Morphine was isolated from opium by Friedrich Serturner in 1805. However, it was not until the development of the hypodermic needle and syringe nearly 50 yr later that the use of morphine became widespread. Over the last century, various delivery systems for morphine have been developed including subarachanoid and epidural injection, and more recently patient-controlled intravenous, epidural and intranasal analgesia. In addition, many new opioids have been synthesized. CONCLUSION: Since its isolation from opium almost 200 yr ago, morphine remains the most widely used analgesic and the standard against which all new opioids for postoperative pain relief are compared.

Outbreak of hepatitis A spread by contaminated drinking glasses in a public house.

Ten cases of hepatitis A were associated with a public house whose barman had chronic non-infectious diarrhoea and had served drinks while incubating hepatitis A himself. Eight cases had drunk in the public house in the two weeks before the barman became ill, had no other risk factors for hepatitis A infection, and were regarded as primary cases. Two other cases had visited the pub during the same period, but were classified as secondary cases because they became ill later and were contacts of primary cases. Sexual transmission was excluded. Fomite transmission by contamination of glasses was a more likely route of spread of the infection among the eight primary cases than food or contaminated surfaces in the toilet.

Evaluation of acupuncture for pain control after oral surgery: a placebo-controlled trial.

BACKGROUND: Acupuncture is increasingly being used by the general population and investigated by conventional medicine; however, studies of its effects on pain still lack adequate control procedures. OBJECTIVES: To evaluate the (1) efficacy of Chinese acupuncture in treating postoperative oral surgery pain, (2) validity of a placebo-controlled procedure, and (3) effects of psychological factors on outcomes. DESIGN: Randomized, double-blind, placebo-controlled trial. SETTING: Dental School Outpatient Clinic, University of Maryland at Baltimore. PARTICIPANTS: Thirty-nine healthy subjects, aged 18 to 40 years, assigned to treatment (n=19) and control (n=20) groups. MAIN OUTCOME MEASURES: Patients' self-reports of time until moderate pain, time until medication use, total pain relief, pain half gone, and total pain medication consumption. RESULTS: Mean pain-free postoperative time was significantly longer in the acupuncture group (172.9 minutes) than in the placebo group (93.8 minutes) (P=.01), as was time until moderate pain (P=.008). Mean number of minutes before requesting pain rescue medication was significantly longer in the treatment group (242.1 minutes) than in the placebo group (166.2 minutes) (P=.01), as was time until medication use (P=.01). Average pain medication consumption was significantly less in the treatment group (1.1 tablets) than in the placebo group (1.65 tablets) (P=.05). There were no significant between-groups differences on total-pain-relief scores or pain-half-gone scores (P>.05). Nearly half or more of all patients were uncertain of or incorrect about their group assignment. Outcomes were not associated with psychological factors in multivariate models. CONCLUSIONS: Acupuncture is superior to the placebo in preventing postoperative dental pain; noninsertion placebo procedure is valid as a control.

Fatal outcome of transmission of hepatitis B from an e antigen negative surgeon.

Investigation of the death of a 77 year old woman from acute hepatitis B infection revealed that she had undergone orthopaedic surgery two and a half months earlier. The surgeon was found to be a hepatitis B surface antigen carrier, hepatitis B e antigen (HBeAg)negative, but with antibodies to HBeAg. Viruses from the surgeon and the patient were identical, apart from a single nucleotide substitution. Both had a precore mutation, which prevents expression of e antigen. A look back exercise was undertaken on the patients operated on by the surgeon during the previous year. The surgeon had performed exposure prone procedures on 253 patients, 188 of whom provided blood specimens. No HBsAg carriers were detected, and no serological markers of recent transmission were found.

Optimal trajectory for the basketball free throw.

Using a theoretical approach, we studied the basketball free throw as a function of angle, speed and spin at release. The ball was constrained to the sagittal plane bisecting the hoop and normal to the backboard, and was permitted to bounce and change spin on both backboard and hoop. Combinations of angle, speed and spin resulting in a successful shot were calculated analytically. Standard deviations for a shooter's angle and speed were used to predict the optimal trajectory for a specific position of release. An optimal trajectory was predicted which had an initial angle and speed of approximately 60 degrees and 7.3 m s(-1) respectively over the domain of spins (-2 to +2 m s(-1) surface speed; -16 to +16 rad s[1]). The effect of air resistance and the sagittal plane constraint on the predicted optimal trajectory were discussed and quantified. The optimal trajectory depended on both the anthropometric characteristics and accuracy of the shooter, but generally a high backspin with an angle and speed combination which sent the ball closer to the far rim of the basket than the near rim was advantageous. We provide recommendations for shooters as a function of the height of ball release.

Influence of activity on plantar force distribution.

The purpose of the study was to quantify the influence of physical activity on force distribution on the plantar surface of the foot. Eleven healthy subjects each performed 10 walking trials over a force distribution platform: five trials before and five trials after a 30-min run. For the analysis the foot was divided into three different regions (rearfoot, midfoot, forefoot), and maximal and average forces were determined for each region. The only statistically significant difference was found in the maximal force in the forefoot, but the difference was relatively small (<3%). The results suggested that the half-hour run did not have a large effect on the plantar force distribution. Differences between subjects were significant for all variables, indicating that relevant information on individual foot structure and/or gait may be obtained from the plantar force distribution.