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Multidisciplinary pain treatment (MPT) is generally considered to be the most effective treatment of chronic pain, but its long-term effect has not yet been firmly established.This randomised controlled study compared the effect of outpatient MPT with that of treatment by general practitioners after initial supervision by a pain specialist (GP group) and with a six-month waiting list group (WL group). The participants were 189 patients with chronic non-malignant pain. On referral and at three and six months, the patients filled in questionnaires evaluating pain intensity, health-related quality of life (HRQL), and the use of analgesics.At six months, the patients allocated to MPT (N = 63) reported a reduction in pain intensity (p0.001), and an improvement in psychological well-being (p0.001), quality of sleep (p0.05), and physical functioning (p0.05). The WL group (N = 63) had a statistically significant deterioration in most of the HRQL measures. The only effect of treatment found in the GP group was a reduction in the use of short-acting opioids. In the MPT group, the use of opioids administered on demand and short-acting opioids was decreased (p0.001). No change in the use of analgesics was seen in the WL group.The study showed that (i) in the MPT group there was a significant reduction in pain intensity and an improvement in HRQL compared to the WL group, and (ii) the mere establishment of a pain diagnosis and management plan by a specialist was not sufficient to enable the referring GP to manage patients with severe chronic pain.

This study reports the short term surgical results in a consecutive series of 1473 patients undergoing cataract surgery (60% planned extracapsular cataract extraction (ECCE) and 40% phacoemulsification (KPE) on an outpatient basis in a major university eye clinic. Preoperatively, 80% of all cases had a corrected visual acuity of 0.3 (6/18) or lower. On the first day after surgery, 51% of all patients had a corrected visual acuity of 0.5 (6/12) or better and 9% had a visual acuity of 1.0 (20/20) or better. The unaided visual acuity was 0.5 (6/12) or better in 20% of all patients (78% of these after KPE). The average postoperative refraction was -0.43 D (+/- 1.03 D SD, range -6.00 D to +5.00 D). A significant improvement in refractive error was achieved in many patients. The mean intraocular lens (IOL) power prediction error was found to be +0.04 D (+/- 0.84 D). The surgically induced astigmatism (vector analysis) was found to be +4.91 D (+/- 2.08) in the ECCE cases and +1.37 D (+/- 1.38) in the KPE cases (p0.001). Capsular or zonular rupture and/or vitreous loss occurred in 43 (2.9%) of which 26 (1.8%) received an anterior chamber lens rather than the intended posterior chamber lens. The results of this study document the favourable results of modern cataract surgery.

During the last ten years hyperalgesia (H), allodynia (A) and myoclonia (M) has been reported at an increased frequency in human beings treated with morphine. The side effects are most common in cancer patients treated with high dose morphine, and has been reported for all routes of administration. The mechanisms are unknown, but human cases and experimental works have resulted in the following theories: 1) Morphine and morphine metabolites change the postsynaptic pain-transmission in dorsal horn neurones via non opioid-receptors (glycine and/or N-methyl-D-aspartate). 2) Morphine and morphine metabolites activate other opioid receptor populations. 3) Supplemental drugs in cancer management. 4) An abnormal metabolism of morphine or morphine metabolites. 5) A combination of one or more of the above-mentioned theories. The first mentioned theory is the most likely. The treatment of morphine induced H, A, and M seems to be to discontinue morphine administration and to initiate therapy with other opioids (fentanyl, sufentanyl, methadone or ketobemidone).

Clinical results are reported in a consecutive series of 111 patients undergoing cataract surgery by phacoemulsification. On the first day after surgery, 69% of all cases had a visual acuity of 20/40 or better without any spectacle correction. Four months later this percentage had increased to 79%. Compared with a series of patients, operated by conventional extracapsular extraction, the corneal astigmatism was found to be significantly reduced in the phacoemulsification series (p0.001). The decrease in surgically induced astigmatism together with tailoring of the power of the intraocular lens (IOL) accounted for the good unaided visual acuity in the phacoemulsification group. Phacoemulsification is concluded to offer good optical control of the postoperative refraction in cataract patients.

Cervical myelography was performed in fourteen patients under suspicion of cervical disc herniation. Prior to myelography, complete cranial-CT registration of the density in the subarachnoid space, intraventricularly, subcorticaly and periventriculary was performed. Control scans 3, 6, 24 and 48 hours following myelography disclosed intracranial contrast media at level of basal cistern, the fourth ventricle and Sylvian fissure. Nine and eleven patients, respectively, had enhancement in the third and lateral ventricles. All patients had subcortical enhancement and nine patients had periventricular enhancement. At the first three hours after cervical myelography minor subcortical and periventricular edema was disclosed, which resolved during the subsequent hours. Two days after myelography, minimal residual contrast was disclosed subcortically at the level at the Sylvian fissure and in the subarachnoid space at the level of the Sylvian fissure and the convexity. It is recommended, that diagnostic cranial-CT is performed before cervical myelography or at a minimum of three days after cervical myelography.

Dystrophia myotonica (DM) is an autosomally dominant hereditary multi-organ disease which is characterized primarily by myotonia and muscular atrophy and thereafter by cataract and disturbances in cardiac conduction. The prevalence is stated to be 2.5-5.5 per 100,000. The disease may be manifest at birth or may become manifest later, right up to the age of 60-70 years, on an average about the age of 20 years. The earlier the commencement of the disease, the more severe the course and the condition becomes crippling. The survival is reduced on an average by 25 years. The diagnosis is based on the clinical findings, information about familial occurrence of DM, electromyography and split lamp examination. The penetration of the DM gene is practically 100% by the age of 14 years but the expression varies greatly. By examination of chorion villi in informative families it will be possible to predict with 96-98% probability whether an embryo will develop DM or not. Genetic research in recent years has rendered prenatal diagnosis possible and diagnosis of the DM gene prior to conception in clinically healthy family members. No specific treatment is available.

The Klippel-Trenaunay-Weber (KTW) syndrome is a rare congenital syndrome of unknown etiology consisting of the triad: a large cutaneous naevus, congenital varicosities and hypertrophy of bones and soft tissues. A heterogenous group of vascular malformations may also occur. The case record of acute myelopathy in a patient aged 42 years with recognized KTW syndrome is presented. It is concluded that magnetic resonance imaging is indicated in cases of suspected intramedullary haemorrhage in patients with congenital vascular malformations.