Treatment of fibrositis by novocain infiltration

The following series of cases consitutes a clinical study of the effect of local anaesthetic injection on certain painful conditions previously not amenable to quick relief. The aim was originally merely to reduce the period of disability, while continuing more orthodox treatment, but it was found that cure frequently occurred from injection alone.The cases treated fall into the following groups: (a) chronic fibrositic affections in various situations. (b) sprains and minor traumata, regarded as cases of acute fibrositis.The local anaesthetics employed were:- (a) novocain in various strengths dispensed in normal saline. (b) a proprietary preparation of 3% novocain made up in Ringer's solution. (c) a proprietary preparation of 2% novocain in Ringer.Most of the cases came from : - (a) a part of a battalion of soldiers, originally middle -aged and elderly men, and so excellent material for the chronic fibrositic group, particularly as many of them were facing unaccustomed exposure to rigorous weather conditions and vigorous physical activity. (b) workers on long shifts in the cold and damp conditions of a dockyard. (c) patients in ordinary civilian practice. (d) certain Naval and Air Force personnel, and those on leave in the district.It will thus be seen that the bulk of these are individuals who at the present time can ill be spared for long periods of rest from the occupations on which they are engaged.The technique employed was as simple as could be arranged, in view of the demands of a fairly busy practice. Usually five or ten minutes sufficed for any one case at a time, and the injections t'rere carried out in the con - sulting- room, or medical inspection room in the case of the soldiers, or in the patient's home. Ho special_ apparatus or instruments were necessary, and no elaborate sterile technique employed. In short, the method is admirably suited to the resources of either the general practitioner or the regimental medical officer

Upper airway dynamics during negative expiratory pressure in apneic and non-apneic awake snorers

BACKGROUND: The ability of negative expiratory pressure (NEP) technique to differentiate between awake snorers with and without obstructive sleep apnea-hypopnea (OSAH) was investigated. METHODS: Forty-eight subjects with sleep disordered breathing (SDB) and 7 healthy subjects, as non-snorer controls, underwent the NEP application of -5 and -7 cmH(2)O in the seated and supine position during wakefulness, after performing a sleep study. The upper airway collapsibility was assessed by computing the volume exhaled during the first 0.5 sec. (V,NEP(0.5)) and 1 sec. (V,NEP(1)) following the NEP start. RESULTS: Patients with severe (AHI ≥ 30) (n = 19) and mild-to-moderate (AHI <30 and >5) (n = 15) OSAH had lower V,NEP(0.5 )(340 ± 88 ml) as compared to snorers (AHI ≤ 5) (n = 14) (427 ± 101 ml; p < 0.01) and controls (n = 7) (492 ± 69 ml; p < 0.001) in the supine position with NEP -5 cmH(2)O. Less significant differences among the different groups were observed for V,NEP(0.5 )in the seated position with NEP -5 cmH(2)O and in both positions with NEP -7 cmH(2)O (only OSAH patients vs controls, p < 0.001). Similar results were obtained for V,NEP(1 )in either position by using both NEP -5 cmH(2)O and -7 cmH(2)O. In spite of this, a substantial overlapping of V,NEP(0.5 )and V,NEP(1 )between snorers and OSAH patients did not allow to identify a reliable diagnostic cut-off level. An inverse correlation with AHI was found for V,NEP(0.5 )in the supine position with NEP -5 cmH(2)O (r(s )= -0.46, p < 0.05) in severe OSAH patients. CONCLUSION: The awake OSAH patients exhibit values of V,NEP(0.5 )and V,NEP(1 )lesser than those of awake snorers. The NEP technique, however, appears to have a limited usefulness as clinical tool for routine screening of the OSAH patients during wakefulness

Impediment in upper airway stabilizing forces assessed by phrenic nerve stimulation in sleep apnea patients

BACKGROUND: The forces developed during inspiration play a key role in determining upper airway stability and the occurrence of nocturnal breathing disorders. Phrenic nerve stimulation applied during wakefulness is a unique tool to assess Upper airway dynamic properties and to measure the overall mechanical effects of the inspiratory process on UA stability. OBJECTIVES: To compare the flow/pressure responses to inspiratory and expiratory twitches between sleep apnea subjects and normal subjects. METHODS: Inspiratory and expiratory twitches using magnetic nerve stimulation completed in eleven untreated sleep apnea subjects and ten normal subjects. RESULTS: In both groups, higher flow and pressure were reached during inspiratory twitches. The two groups showed no differences in expiratory twitch parameters. During inspiration, the pressure at which flow-limitation occurred was more negative in normals than in apneic subjects, but not reaching significance (p = 0.07). The relationship between pharyngeal pressure and flow adequately fitted with a polynomial regression model providing a measurement of upper airway critical pressure during twitch. This pressure significantly decreased in normals from expiratory to inspiratory twitches (-11.1 ± 1.6 and -15.7 ± 1.0 cm H(2)O respectively, 95% CI 1.6–7.6, p < 0.01), with no significant difference between the two measurements in apneic subjects. The inspiratory/expiratory difference in critical pressure was significantly correlated with the frequency of nocturnal breathing disorders. CONCLUSION: Inspiratory-related upper airway dilating forces are impeded in sleep apnea patients

Can Music Therapy Engage Patients in Group Cognitive Behaviour Therapy for Substance Abuse Treatment?

INTRODUCTION AND AIMS: Despite the availability of effective treatments for substance use disorders, engaging people in treatment remains a challenge. This clinical study describes a 7-week trial of music therapy as an adjunct to group cognitive behaviour therapy with the aim of increasing patient engagement in a private hospital open group programme. DESIGN AND METHODS: Patient attendance rates and perceptions of the music therapy were collected at the end of each music therapy session by means of an anonymous survey, and only data from each patient\u27s first survey were used in the analysis. Twenty-four surveys were analysed, representing feedback from 10 men and 14 women, aged between 17 and 52 years. RESULTS: The average attendance rate over the 7-week trial was 75%. The results indicated that enjoyment and motivation to participate during the sessions was uniformly high (mean ratings of 4.3 and 4.0 out of 5, respectively). The majority (83%) of participants reported that they would attend another music therapy session, and almost half (46%) endorsed that \u27(music therapy) would help them to feel more a part of the group\u27. Additional analyses revealed that music therapy was able to engage patients regardless of their age group (25 years and under vs. over-25 years) or substance (alcohol only vs. other drugs). DISCUSSION AND CONCLUSIONS: Music therapy is a promising approach to improving engagement in substance abuse treatment groups

Music therapy and emotional exploration: Exposing substance abuse clients to the, experiences of non-drug-induced emotions

Recent cognitive behavioral therapy (CBT) approaches to treatment of substance use disorder (SUD) have emphasized the need for clients to explore emotional regulation and experiential avoidance. This study aimed to determine whether music therapy programs situated within a CBT framework facilitated the exploration of emotions in 24 adults with SUD attending a hospital open group CBT program. In a 7-week trial, the impact of a single music therapy session on participants' emotional experience was assessed using a self-report questionnaire at the end of each participant's first session. Results indicated that music therapy sessions facilitate the experiencing of predominantly positive emotions, and that these were experienced to a moderate or high degree. Participants reported that music therapy was beneficial in allowing them to experience emotions without the need for substance use. It is recommended that clinicians include interventions that encourage the exploration of negative emotions so that clients can experience these in a safe environment. (C) 2007 Elsevier Inc. All rights reserved