No abstract

In conclusion, the treatment modality described may be a new approach to the treatment of wrinkles.

We have determined the depth and duration of analgesia to needle insertion after topical application of EMLA cream (Eutectic Mixture of Local Analgesics). EMLA was applied for 30, 60, 90 and 120 min and the sensory and pain threshold depths were determined before analgesia (1.0 and 1.9 mm, respectively) and up to 4 h after the cream was removed from the skin. The maximal depth of analgesia (approx. 5 mm) was observed 30 min after a 90-min application and during the 60-min period after a 120-min application of EMLA cream, for both sensory and pain thresholds. For application times shorter than 120 min, the depth of analgesia increased during the period after removal of the cream. This suggests new guidelines for the use of this topical analgesic.

Ketamine is a noncompetitive N-methyl-D-aspartate (NMDA) receptor channel blocker known to inhibit "wind-up" and hence central hyperexcitability of dorsal horn neurons. We sought to assess the effect of ketamine on single and repeated nociceptive stimuli. A placebo-controlled, human (12 volunteers) experimental study was conducted in which several psychophysical (pain detection and tolerance thresholds, magnitude ratings) and electrophysiologic (withdrawal reflex) techniques were used 1) to investigate whether a ketamine (0.5 mg/kg) bolus followed by a 20-min infusion (9 micrograms.kg-1.min-1) inhibits central temporal summation to repeated nociceptive electrical stimuli, and 2) to assess quantitatively the hypoalgesic potency using several experimental nociceptive stimuli (argon laser, pressure, electrical). Facilitation of the withdrawal reflex to and pain rating of repeated electrical stimuli (five pulses at 2 Hz) were inhibited by ketamine. Reflex and pain rating to a single stimulus did not change. The pressure pain detection and tolerance thresholds were increased significantly by ketamine, whereas the laser heat pain and tolerance thresholds remained stable compared with placebo. The stimulus response function showed that ketamine reduced the responses to the highest electrical stimulus intensities (1.4, 1.6, and 1.8 times the reflex threshold). We conclude that ketamine inhibits central temporal summation in humans and has a marked hypoalgesic effect on high intensity nociceptive stimuli.

By decreasing the outer diameter of a needle, the frequency of insertion pain can be reduced and may encourage patients to adhere to demanding injection regimens such as recurrent insulin administration.

The objective of this study was to determine the reliability and validity of a Danish translation of the Tinnitus Handicap Inventory (THI), a self-report measure of perceived tinnitus handicap. The Danish version of the THI was administered to 50 patients reporting tinnitus as their primary complaint or secondary to hearing loss. Construct validity was assessed using tinnitus symptom rating scales, the Beck Depression Inventory (BDI), the State-Trait Anxiety Inventory (STAI), the Tinnitus Coping Style Questionnaire (TCSQ), the Eysenck Personality Questionnaire (EPQ), and perceived tinnitus loudness and pitch. The Danish translation of the THI and its subscales showed good internal consistency reliabilities (c = 0.93 to alpha = 0.74) comparable to those of the original version. High to moderate correlations were observed between THI and psychological distress, tinnitus symptom ratings, neuroticism and maladaptive tinnitus coping. A confirmatory factor analysis failed to validate the three subscales of THI, and high intercorrelations found between the subscales question whether they represent three distinct factors. The results suggest that the Danish THI-Total scale may be a reliable and valid measure of general tinnitus related distress that can be used in a clinical setting to quantify the impact of tinnitus on daily living.

Background and Objectives: The reaction to intense pulsed light (IPL) on Asian skin often differs from that on Caucasian skin. The study reported herein evaluated the effect on acne vulgaris of IPL alone and when IPL was combined with photodynamic therapy (PDT) using topical methyl aminolevulinate (MAL) in Asians. Study Design/Materials and Methods: Thirty Chinese subjects with phototypes IV or V and moderate acne were enrolled for a randomized, half-facial treatment study with IPL alone, IPL with PDT, or as controls. Sixteen percent MAL cream was applied to half of the face 30 minutes before treatment in the PDT group. The IPL was provided by the Ellipse Flex system (Danish Dermatologic Development, Denmark), which emitted wavelengths of 530 to 750 nm. The subjects were treated four times at 3-week intervals. Single passes of double pulses with a 10 milliseconds delay and a pulse duration of 2.5 milliseconds were used. The assessment of inflammatory and non-inflammatory acne lesions by two blinded investigators was based on standardized photographs that were taken before each treatment, and at 4 and 12 weeks after the final treatment. Results: Twenty-three patients completed the study. The mean reduction of the inflammatory lesion count was 53% in the PDT group, 22% in the IPL group, and 72% in the control group at 4 weeks, and 65% in the PDT group, 23% in the IPL group, and 88% in control group at 12 weeks. The mean clearance of non-inflammatory lesions was 52% in the PDT group, 15% in the IPL group, and 14% in the control group at 4 weeks, and 38% in the PDT group and 44% in the IPL group at 12 weeks, when and an increase of 15% was noted in the control group. Most patients experienced a reduction of inflammatory lesions that was not statistically significant on the PDT-treated side (P ¼ 0.06) or the IPLtreated side (P ¼ 0.82) at 12 weeks after treatment. Pretreatment with MAL resulted in a better clearance of inflammatory acne than IPL alone. There were no statistically significant differences between the intervention groups and the control group in the mean reduction of inflammatory lesions. Significant reductions of non-inflammatory lesions were observed in the MAL-PDT group (38%, P ¼ 0.05) and IPL groups (43%, P ¼ 0.00) 12 weeks after treatment. Twenty-five percent of the subjects in the PDT group withdrew because of intolerance to procedurerelated discomfort. Conclusions: MAL-PDT using IPL and MAL in Asians did not lead to significant improvement of moderate inflammatory acne compared with the control group. However, there was a delayed effect on non-inflammatory lesions, with significant reductions in both the PDT and IPL groups. A proportion of patients could not tolerate the discomfort that was related to PDT despite the short MAL incubation.

The purpose of this study was to evaluate the low-power laser on the treatment of tinnitus. In a randomized, prospective, double-blind, placebo-controlled trial, either active or placebo low-power laser irradiation was given through the external acoustic meatus of the affected ear towards the cochlea. The active laser applied 50 mW (cw, 830 nm) over a period of 10 min per session. Forty-nine patients with severe, chronic uni- or bilateral tinnitus were studied. The main outcome was measured using psychoacoustical match of tinnitus loudness and pitch, Visual Analogue Scale (VAS) ratings of subjective loudness, annoyance and attention involved, scores on the Tinnitus Handicap Inventory (THI), the Tinnitus Coping Style Questionnaire (TCSQ), and a number of psychosocial questionnaires. The results showed only moderate (18%) subjective improvement with no statistically significant differences between the effects of the active laser and placebo treatments. Also, there were no statistically significant differences in prepost measurements of tinnitus loudness, VAS scores, THI scores, or TCSQ scores for patients treated with active laser compared with those treated with placebo. We conclude that low-power laser treatment is not indicated in the treatment of tinnitus. Reports of significant benefits of this treatment in previous, mostly uncontrolled or single-blinded studies may be explained by the placebo effect.