Long-term follow-up of patients treated with cervical radiofrequency neurotomy for chronic neck pain.

OBJECTIVE: To determine the long-term efficacy of percutaneous radiofrequency medial branch neurotomy in the treatment of chronic neck pain. METHODS: Between 1991 and 1996, radiofrequency neurotomy was performed in 28 patients diagnosed as having cervical zygapophysial joint pain on the basis of controlled diagnostic blocks. The procedure was repeated in patients whose pain recurred. Outcome measures were the proportion of patients who responded to the initial procedure and the duration of relief subsequently obtained. Outcome was correlated with the operator performing the procedure, the type of electrode used, litigation status, and the type of diagnostic blocks used to establish the diagnosis. RESULTS: Complete relief of pain was obtained in 71% of patients after an initial procedure. No patient who failed to respond to a first procedure responded to a repeat procedure, but if pain returned after a successful initial procedure, relief could be reinstated by a repeat procedure. The median duration of relief after a first procedure was 219 days when failures are included but 422 days when only successful cases are considered. The median duration of relief after repeat procedures was at least 219 days; several patients had ongoing relief at the time of follow-up. Outcome did not differ according to the operator, the type of electrode used, litigation status, or the type of diagnostic block used. CONCLUSION: Radiofrequency neurotomy provides clinically significant and satisfying periods of freedom from pain, and its effects can be reinstated if pain recurs.

Sensation of smell does not determine nutritional status in patients with cystic fibrosis.

Poor nutritional status in patients with cystic fibrosis (CF) is associated with increased mortality. Patients with CF often have a decreased sensation of smell secondary to recurrent sinus infections or sinus surgery; in other CF populations, a decreased sensation of smell has been associated with poor nutritional status. We hypothesized that a decreased sensation of smell would be associated with worse nutritional status in patients with CF. We studied 50 (26 F and 24 M) of 58 consecutive patients with CF (86%) aged 14-53 years (28 +/- 8; mean +/- SD) who attended the University of Washington Medical Center from June 1994 to March 1995 and who agreed to participate. Demographic information was obtained, and nutritional status was assessed by ideal body weight, arm muscle area, arm fat area, pancreatic sufficiency, insulin-requiring diabetes, vitamins A and E levels, albumin, iron, iron binding capacity, ferritin, cholesterol, and zinc levels. Objective sensation of small was examined (Sensonics, Philadelphia, PA), a sinus compacted tomogram (CT) was performed, and a questionnaire for prior sinus symptoms, sinus surgery, medications, and subjective sensation of smell was administered. Twenty-seven of 49 subjects (55%) had an objective decrease in sensation of smell, 23/50 (46%) had had prior sinus surgery. 46/50 (92%) were pancreatic insufficient, and 8/50 (16%) were insulin-requiring diabetics. Weight for height ranged from the 38th to 157th percentile (100 +/- 18; mean +/- SD). Arm muscle area ranged from the < 5th to the 75th percentile (25 +/- 23; mean +/- SD). Arm fat area ranged from the < 5th to the 95th percentile (45 +/- 39; mean +/- SD). Sinus CT scans were abnormal in all patients (100%). Patients with anosmia were more likely to have had sinus surgery, but their nutritional status was no different from that of patients with a normal sensation of smell. We conclude that decreased sensation of smell is common in patients with CF, especially those with prior sinus surgery. Subjective sensation of smell and sinus CT scans were unreliable indicators of a decreased objective sensation of smell. In this pilot study, no association was found between sensation of smell and nutritional status.

Long-term oxygen therapy delivery systems.

Three major systems are currently available in most urban settings for the delivery of long-term oxygen therapy. These are compressed oxygen in tanks, liquid oxygen, and oxygen concentrators. Each system has advantages and disadvantages. The choice of system for any individual patient must be based on relative cost, the need for portability, and safety features. The cost of oxygen and regulations governing its reimbursement vary widely throughout the country. Oxygen should be supplied by reputable vendors who meet specific criteria for assuring quality service. In many instances referral to a home care agency for teaching and supervision of the patient is essential. Patient compliance with long-term oxygen therapy is often poor due to factors such as lack of significant subjective improvement, unrealistic fears or embarrassment concerning use of oxygen, and feelings of depression or hopelessness that the patient may experience when told he needs oxygen.

Individual differences in the coming out process for gay men: implications for theoretical models.

One hundred ninety-nine self-defined homosexual males were asked about the ages at which milestone events occurred in the coming out process (i.e., initial awareness of same-sex attractions, same-sex acts, self-designation as homosexual, initial involvement in a long-term relationship, self-disclosures to significant others, and acquiring a positive gay identity). Overall findings indicated that an orderly developmental sequence underlies the coming out process; however, not all subjects progressed in a predictable fashion from an awareness of same-sex feelings through behavior to eventual self-labelling, self-disclosure, and final stabilization of a positive gay identity. A number of individual differences emerged: 18% of the sample labelled themselves "homosexual" in the absence of any overt same-sex sexual experience; 22% arrived at homosexual self-definitions while participating in a long-term relationship with another man; 23% adopted homosexual self-definitions only after involvement in such a relationship. Fifteen percent of the respondents indicated that they had not acquired a positive gay identity (i.e., were not glad to be gay). These individuals differed from the remainder of the sample on a number of significant measures reflective of psychological health. Significant differences were also found among three cohort groups with respect to age at occurrence of particular milestone events. Findings from the present investigation were explored in relation to both the theoretical conceptions and available empirical data concerned with homosexual identity formation.

Homosexual identity formation as a developmental process.

Homosexual identity is conceptualized as a life-spanning developmental process that eventually leads to personal acceptance of a positive gay self-image and a coherent personal identity. Habermas' theory of ego development is utilized to provide a synthesis and understanding of the literature on the construction and maintenance of the homosexual identity. It is concluded that the homosexual identity generally emerges in a three-stage process in which the person progresses from: (1) an egocentric interpretation of homoerotic feelings to (2) an internalization of the normative, conventional assumptions about homosexuality to (3) a post-conventional phase in which societal norms are critically evaluated and the positive gay identity is achieved and managed. Developmental tasks associated with each stage are outlined in terms of their ego-integrative functions. Although the stages in the process of homosexual identity formation are theoretically the same for females and males, because of the paucity of research on the homosexual identity in females, this paper deals chiefly with males.

Sex-role self-concepts of homosexual men and their attitudes toward both women and male homosexuality.

A nonclinical sample of 88 homosexual males responded to a questionnaire that assessed their sex-role self-concept and their attitudes toward both women and male homosexuality. Results indicated that in terms of socially valued masculine and feminine characteristics, the majority of homosexual males viewed themselves as predominantly androgynous. These respondents also favored equality between the sexes, reflecting positive attitudes toward women. Similarly, those homosexual men who supported equality between the sexes also held more positive attitudes toward male homosexuality.

Percutaneous radio-frequency neurotomy for chronic cervical zygapophyseal-joint pain.

BACKGROUND: Chronic pain in the cervical zygapohyseal joints is a common problem after whiplash injury, but treatment is difficult. Percutaneous radiofrequency neurotomy can relieve the pain by denaturing the nerves innervating the painful joint, but the efficacy of this treatment has not been established. METHODS: In a randomized, double-blind trial, we compared percutaneous radio-frequency neurotomy in which multiple lesions were made and the temperature of the electrode making the lesions was raised to 80 degrees C with a control treatment using an identical procedure except that the radio-frequency current was not turned on. We studied 24 patients (9 men and 15 women; mean age, 43 years) who had pain in one or more cervical zygapophyseal joints after an automobile accident (median duration of pain, 34 months). The source of their pain had been identified with the use of double-blind, placebo-controlled local anesthesia. Twelve patients received each treatment. The patients were followed by telephone interviews and clinic visits until they reported that their pain had returned to 50 percent of the preoperative level. RESULTS: The median time that elapsed before the pain returned to at least 50 percent of the preoperative level was 263 days in the active-treatment group and 8 days in the control group (P=0.04). At 27 weeks, seven patients in the active-treatment group and one patient in the control group were free of pain. Five patients in the active-treatment group had numbness in the territory of the treated nerves, but none considered it troubling. CONCLUSIONS: In patients with chronic cervical zygapophyseal-joint pain confirmed with double-blind, placebo-controlled local anesthesia, percutaneous radio-frequency neurotomy with multiple lesions of target nerves can provide lasting relief.

New-onset asthma after exposure to the steam system additive 2-diethylaminoethanol. A descriptive study.

Through a leak in the steam heating system, the anticorrosive agent 2-diethylaminoethanol was released into the air of a large office building. Irritative symptoms were experienced by most of the 2500 employees, and 14 workers developed asthma within 3 months of exposure. This study was undertaken to review clinical characteristics of these asthmatics. Environmental exposure monitoring data and medical records were reviewed. Seven of 14 cases were defined as "confirmed" and 7 of 14 as "suspect," using the National Institute for Occupational Safety and Health surveillance case definition of occupational asthma. Spirometry was positive in 4 of 14 of the cases and peak flow testing in 10 of 14. Three cases were diagnosed on the basis of work-related symptoms and physical examination alone. The study suggests that acute exposure to the irritating steam additive 2-diethylaminoethanol was a contributing factor in the development of clinical asthma in this population.

Improvement in mood, physical symptoms, and function with nortriptyline for depression in patients with chronic obstructive pulmonary disease.

Although recent epidemiologic studies have established that patients with chronic medical illness and depressed mood are more disabled than euthymic patients, detailed data on the benefits and risks of antidepressant treatment in medically high-risk patients have been slow to accumulate. The authors have examined multiple outcome indicators in patients with disabling chronic obstructive pulmonary disease and comorbid depression. Thirty patients completed a 12-week, randomized controlled trial of nortriptyline. Nortriptyline was clearly superior to placebo for treatment of depression. Nortriptyline treatment was accompanied by marked improvements in anxiety, certain respiratory symptoms, overall physical comfort, and day-to-day function; placebo effects were negligible. Physiological measures reflecting pulmonary insufficiency were generally unaffected by treatment. These data provide impetus for renewed efforts to improve recognition and treatment of mood disorders in even severely disabled medical patients.

Characterization of rainbow trout cell lines using microsatellite DNA profiling.

Ten microsatellite loci (Omy27DU,Omy325(A3)UoG, OmyFGT5TUF,OmyFGT14TUF, OmyFGT15TUF,OmyFGT23TUF, Omy77DU,Ssa20.19NUIG, Ots1BML, andOne18ASC) were amplified using the polymerase chain reaction to create genetic profiles for nine cell lines (RTG-2, RTH-149,RTL-W1,RTgill-W1, RTS-11, RTS-34st, RTP-2, RTP-91E and RTP-91F) from rainbow trout(Oncorhynchus mykiss) and one cell line (CHSE-214) from Chinook salmon (O. tschawytscha). A cell line (PHL) from anon-salmonid, the Pacific herring (Clupea harengus pallasi), was included as a control. The ten loci clearly revealed the uniqueness of each cell line, except for two cell lines (RTP-91E andRTP-91F) from the same fish. RTP-91E and RTP-91F were identical at all loci except Ssa20.19NUIG. The most useful locus for demonstrating uniqueness was Ots1BML. The information was used to demonstrate that an uncharacterized rainbow trout cell line (Clone 1A)was in fact CHSE-214, illustrating the usefulness of multiplexed microsatellites for the creation of genetic profiles for salmonid cell lines and for the testing of cell line cross-contamination.

The cost and efficacy of home care for patients with chronic lung disease.

A randomized controlled trial was conducted to assess efficacy and cost of sustained home nursing care for patients with chronic lung disease. Three hundred one patients were randomly assigned to a respiratory home care group (RHC) that received care from respiratory home care nurses, a standard home care group (SHC) that received care from regular home care nurses, or an office care group (OC) that received whatever care they needed except for home care. Patients were followed for 1 year. At the end of the study year, there was no difference in survival, pulmonary function, or everyday functioning among the three groups. Average annual cost of care for all study patients was $7,647 (1981-82 dollars). The average annual health care costs for patients in the RHC group was $9,768; for those in the SHC group, $8,058; and for those in the OC group, $5,051 (F = 6.45, df = 2/298, P = 0.02). These results suggest that the current policy of limited coverage of home nursing services by Medicare and other third-party payers may be appropriate.