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The cause of “Goju-gata” is yet unknown, but in many it is felt to be due to disorder of the biceps mechanism or suprahumeral gliding mechanism. In most the condition can be cured within 18 months after onset by conservative therapy, but in some pain and motor disturbance persist.With the purpose of reducing the length of treatment, surgery was peaformed on 35 cases suffering severe pain. Pain subsided shortly after surgery and remission was attained with in one month in all but 3. However, considerable time was required to regain full range of movement. In 25 cases full range of movement was regained within six months after surgery, but in 10 pain associated with movement and limitation in range persisted for more than six months. Therefore, it is felt adequate functional trainig is necessary following surgery.

Presentation of Case A 26-year-old woman was admitted to the hospital because of a pericardial effusion. She was well until six years previously, when cough and fever developed and subsided. Three months thereafter she noticed that the ingestion of alcohol was followed in five to 10 minutes by a sudden, severe pain in the neck and shoulders. Six months later a respiratory-tract infection occurred, with a cough that persisted, and she continued to have pain, sometimes associated with vomiting, after consuming alcohol. Five years before entry she consulted a physician, and an x-ray film of the chest revealed hilar lymphadenopathy. . . .

Fifty arthroplasties of the hip in forty-three patients with use of the Crawford Adams cup are reported. See Images in the PDF file. In general, the results have been satisfactory. Severe pain, the primary indication for operation, was relieved in forty-five of the fifty hips. The majority of excellent results occurred in hips with arthritis secondary to trauma. Necrosis of the head beneath the cup, recognized as a possibility at the beginning of this series, materialized in three patients. One of these represents the only case of infection in the series, and this was probably present at the time of arthroplasty. Two cups broke because of mechanical faults. The method of manufacture has been changed so that the cup is now constructed of one piece of metal.

Careful search of the American, English and German literature yielded surprisingly little material and few completely reported cases of hemangio-endothelioma of the temporal bone. Frederick L. Jack, of Boston, reported a case in an adult. 1 REPORT OF CASE History .—A girl, 5 years of age, was admitted to St. Michael's Hospital on Dec. 8, 1932, complaining of severe pain in the left ear. According to the mother the child had been in perfect health until about the middle of October when she complained of pain in the left ear, which persisted and became progressively more severe. On the third day after the onset of the pain the mother noticed a gray, cauliflower-like growth deep in the external auditory canal. A physician removed a piece of the growth for microscopic examination. Subsequently he stated that he had received a report that it resembled cancer. Following the removal of a specimen

Introduction: Post-obturation pain is one of the primary problems following root canal treatment. Although in most cases pain does not last long, but could be a source of embarrassment to the dentist and annoying for the patient. Objectives: This prospective study was conducted to assess the incidence of postoperative pain after multivisit root canal treatment of teeth with vital and nonvital pulps. Methods: Total, 52 patients with teeth requiring endodontic treatment were identified and included in this study. The patients were randomly assigned and treated in a military hospital and in government dental college hospital into two groups. The teeth of patients in group 1 were with vital inflamed pulp; group 2 were with non-vital pulp with or without periapical radiolucency (0-5mm). Patients were treated in multiple visit procedure. They were asked whether they experienced any postoperative pain to rate the level of discomfort as no, mild, moderate, or severe pain. Data were analyzed statistically using the chi-square test. Results: No significant difference in postoperative pain was found between vital and non-vital pulps (p=0.2). Mild and moderate pain occurred in 4.34% and 4.34% respectively in teeth with vital pulp and 17.3% and 3.44% in teeth with non-vital pulp respectively. There was no significant difference in postoperative pain between the two groups (p>0.05). Conclusions: The incidence of postoperative pain did not differ between vital and non-vital teeth. Key words: Postoperative dental pain; root canal treatment; vital and non-vital pulp DOI: 10.3329/jafmc.v6i2.7271 JAFMC Bangladesh. Vol 6, No 2 (December) 2010 pp.28-31

Summary Nipple pain and nipple damage were studied in 287 mothers in the roomingin maternity wards of the Jefferson Hospital. Significantly more nipple trauma was found in mothers using alcohol, soap solution, or A and D concentrate on their nipples, as compared with the control group. Mothers using A and D ointment and hydrous lanolin had an incidence of pain and damage similar to the control group, although slightly less severe pain was noted. Number of feedings of the previous day, parity of the mother, experience of breast feeding a previous baby, and attitude toward lactation also were related to the occurrence of nipple trauma in the group studied.

A case is presented in which is considered the role of pain in making success possible in a guilt-ridden man. A glomus tumor of the toe and a peptic ulcer both acted as sources of severe pain for more than 25 years, during which the sufferer achieved great success in the business world. The diagnosis and successful surgical cure of both lesions, with complete and permanent relief of pain, marked the beginning of a progressive decline in his health and his fortunes. Each “successful” medical intervention was followed by a worsening of his general condition. But a final catastrophe, with consequences inaccessible to any further medical help, ended his success in the business world, but inaugurated a prolonged period of peace and tranquility for both patient and family. The case is presented as a contribution to the understanding of disease and to raise questions as to the goals of medical and surgical treatment.

Few cases of metastatic carcinoma of the optic nerve and choroid have been reported in the literature. In the case described in this report, it is debatable whether the metastasis was primarily in the nerve or choroid. A diagnosis of tumor of the optic nerve and choroid was made on the basis of the clinical signs and symptoms and proved by an examination of the enucleated eyeball in the laboratory. Regardless of whether the primary metastasis was in the choroid or in the optic nerve, the case is of great interest both clinically and pathologically because of its rarity. REPORT OF A CASE History .—Mrs. C. C., aged 42, an Italian housewife, was referred to Dr. Payne at the New York Eye and Ear Infirmary on Dec. 18, 1929. She was admitted to Dr. McDannald's service complaining of severe pain, complete blindness of the right eye and "drooping" of the

1. Ten patients whose shoulders had been anthrodesed for degenerative conditions were reviewed. 2. The operation was successful and satisfactory in six patients, all of whom had degenerative changes demonstrable roentgenographically in the glenohumeral articulation. Fusion is indicated when such changes cause severe pain and stiffness unrelieved by prolonged conservative treatment or lesser surgery. Postoperatively the pain was relieved and the resulting stiffness was more a nuisance than a major disability. Pain in the muscles supporting the scapula was a problem in only one patient. 3. All four patients with tears of the rotator cuff continued to complain of pain after operation but all had questionable fusion or fusion in malposition. Arthrodesis of the shoulder in such patients appears difficult to attain and is, therefore, not recommended.

SUMMARY 1. This study of early results and complications relates to the first 700 low friction arthroplasty procedures performed at The New York Orthopedic Hospital. 2. The results are encouraging in regard to the quality of the arthroplasty and are quite comparable to the results in series reported by others. 3. The incidence of early deep postoperative wound infection was low (less than 1 per cent), and no late infection was observed. The factor that might have favorably influenced the rate of infection in this series was the routine prophylactic use of antibiotics during operation. 4. The most serious complication was thromboembolism, which continues to be a problem with this major surgical procedure 5. We conclude that despite early gratifying results with this procedure, this operation must be reserved only for patients with severe pain and functional disability. 6. Excellent results can be achieved by careful selection of patients and strict adherence to aseptic technique.

1. Clinical and histological features in ten patients with smooth muscle tumours of the limbs are described. 2. Severe pain and tenderness and the radiographic demonstration of calcification are useful pointers to the diagnosis. 3. Local recurrence of the tumour occurred in four patients despite apparently adequate excision. In three of these the tumours were shown histologically to be benign.

No one medical regimen or surgical procedure has proved ideal for treating tic douloureux. However, gratifying relief from the severe pain is possible with one or more of the therapeutic measures discussed here.

Case I. A female, 56 years of age, was admitted under the diagnosis of Weil's disease. On the 7 th hospital day she began to complain of severe pain in the epigastrium, followed by rapid deterioration of the general condition, and died 15 days after the onset of jaundice. At necropsy, massive areas of hemorrhagic necrosis in the left lobe of the liver and widespread irregular-shared ulceration of the gastric mucosa were found.Case II. A man, aged 23, was admitted with chief complaints of anemia and jaundice. The following day, his symptome became worse and he lapsed into coma and died 4 months after the onset. Necropsy revealed a golf-ball-sized spherical zone of hemorrhage in the upper lobe of the left lung.In both cases, blood vessels included in the necrotic lesions were filled with clots containing erythrocytes, leucocytes and fibrin. The fungus-like organismus were present within the luminae and in the walls of these thrombosed vessels, and in the surrounding necrotic tissue. These organismus were branching, nonseptal hyphae from 30 to 50 microns in length and 10 to 15 microns in width. Without unsuccessful cultivation, it was considered that the fungi noted in both cases were to be identified as Mucormyces because of their shape and of charactristic tissue response to the fungus.

Introduction During the past three years a very general interest has arisen, especially in the United States, in tumors of the neuromyo-arterial glomus, which are small growths characterized clinically by severe pain, often of a paroxysmal nature. It has been very generally agreed that these must be one form of the painful subcutaneous tubercle first so designated by William Wood of Edinburgh in 1812, although previously described by Cheselden, Valsalva, Morgagni, Bisset, Pearson and others in the eighteenth century. But this is not the only lesion which may be called painful subcutaneous tubercle or tuberculum dolorosum as the continental writers named it. In 1854 Virchow first reported that a group of small tumors composed chiefly of smooth muscle and involving the skin of the thoracic wall in the neighborhood of the areola of a thirty-two-year-old man caused exactly the same type of paroxysmal pain as did tubercula dolorosa. Although Verneuil described a case of multiple cutaneous leiomyomas in a cadaver in 1858, and Duhring in 1873 and Kosinski in 1874, cases of undoubted multiple leiomyomas which they mistook for neuromas, the disease did not become well known until 1880, when Besnier published his comprehensive paper. After that, case reports multiplied so that now there are at least 132 cases of multiple dermatomyomas in the literature and the disease is well known in all parts of the world. During the years after Virchow9s paper, case reports of solitary superficial leiomyomas began to make their appearance. The earlier cases were all painless tumors—Forster9s, 1858, in the scrotum; Aufrecht9s, 1868, in a subcutaneous vein in the side of the foot; Klebs9, 1869, in the neck, Challand9s 1871, in the labium majus and in the scrotum; Sokolow9s, 1873, in the nipple. The first reported case of leiomyomatous tuberculum dolorosum occurred in the subcutaneous tissues of the poet Stranberg9s finger and was described in 1873 by Axel Key. In the year 1884 Malherbe was able to publish descriptions of five solitary painful leiomyomas which had come to his attention during the preceding nine years. Since these were the only cases of tuberculum dolorosum that he had ever seen, he supposed that the leiomyoma was its only form.

How can the physician tell whether his patient really has severe pain or whether he is overreacting to a relatively mild painful stimulus? Measuring the length of time a patient can keep his eyes open without blinking gives a good indication of his threshold for reaction to pain. This technic has potential in helping the physician evaluate the patient's complaints and direct his treatment.

Surgery for patients with deformities and severe pain from rheumatoid arthritis has been of great value. Early removal of the inflamed synovium is indicated when there is increasing destruction of the joint. Operations may be performed while the disease is active and the sedimentation rate elevated. Restoration of function of the hand has improved appearance as well. Recurrent effusions and pain in the knee have been almost completely alleviated by surgery. Various joints throughout the limbs may be treated by surgical reconstruction.

ON JANUARY 14, 1909, Frau S. M., aged 26, came into the Woman's Clinic at the University of Heidelberg and submitted to a curettage and suspension of the uterus because of dysmenorrhea, persistent backache and general weakness. She gave the following menstrual history. The menstrual periods began at 15; at first they were scanty, lasting two days. There was an intermenstrual discharge. After her last (second) delivery she nursed the baby for nine months; then there was a one-day period, followed by nine weeks' amenorrhea and this by a 14-day period of bleeding. Thereafter, every 14 days a five-day to six-day episode of bleeding accompanied by severe pain occurred. In October a moderately profuse bleeding lasted three to four weeks and then five-day to six-day menses continued at 24-day intervals, with above-mentioned symptoms of dysmenorrhea, backache and weakness. After the operation menstruation was regular and painless.

In recent years several authors (1, 2, 3) have described the typical myelographic appearance of herniation of the brain into the spinal canal, but in only two cases was the diagnosis made preoperatively by opaque contrast myelography. We are reporting the findings of one case because the myelographic appearance is characteristic and the diagnosis was made prior to operation. Case Report E. M., a 38-year-old white male, was admitted to the Neurosurgical Service of the Temple University Hospital on Nov. 30, 1948, complaining of severe pain in the back of the neck, radiating to the vertex and into both shoulders. The pain was of eight months duration and had become more severe during the two weeks preceding entry. It was accompanied by tingling and numbness in the fingers and to a lesser extent in the lower extremities. Sneezing and coughing aggravated the nuchal and occipital discomfort. Hospital admission was precipitated by the onset of difficulty in respiration and deglutition during the twenty-four hour...

The surgical procedure known as total hip replacement was developed primarily for patients suffering from severe arthritis of the hip. On admission, the patient is hobbling down the hall with aid of a cane. one or two crutches, a walker. or he may even be in a wheelchair with signs of severe pain on his face. Then, two weeks after his surgery. the patient is bearing full weight on the operative leg, has a relaxed smile on his face. is walking with a straight back, and is using a cane only for support. He is ready for discharge and is well on the way to leading a normal active life again. In the surgical procedure performed here at Cedars of Lebanon Hospital in Los Angeles by Drs. Sidney Grant, Mark Stern, and Phillip Spiegel. the acetabulum is replaced by one of polyethylene plastic and the head of the femur is replaced by a metal prosthesis. Both appliances are fixed into position with a cement. methyl methacrylate, which is mixed from a powder and liquid at the time of surgery. This surgery has been performed extensively in Great Britain and Canada. butt not as frequently in this country because the cement has not received Food and Drug Administration approval for general use. The criteria for patients undergoing total hip replacement at Cedars of Lebanon are that the patients be over 55 years of age, have no history of osteomyelitis or wound infections. and are well motivated. Other important criteria are that the severity of arthritic pain is increasing and that other forms of reconstructive surgery. have either failed or are not feasible. If both hips of a patient are affected, the second operation is done six months after the first.

Presentation of Case A fifty-six-year-old woman was admitted to the hospital because of shortness of breath. Six months previously increasing fatigue and weakness, accompanied by a chronic, nonproductive cough, developed. Three months before entry the patient was awakened by sudden, severe pain in the left arm extending to the elbow; the left hand was also painful. She perspired but was not dyspneic, and the pain disappeared spontaneously within an hour. Soon thereafter she began to experience exertional dyspnea, without orthopnea, paroxysmal nocturnal dyspnea, edema or chest pain. Two weeks before admission the exertional dyspnea rapidly increased in severity, and considerable . . .

Presentation of Case A fifty-four-year-old Italian woman was referred to the hospital because of pain in the chest and back. Eight days previously, while getting into a car, she experienced the sudden onset of ripping pain in the chest and back. The pain originated between the scapulas at the level of the first thoracic vertebra and radiated down the back to the level of the tenth thoracic vertebra and anteriorly to the substernal region, where it persisted as a dull, aching sensation. After fifteen minutes of severe pain she was able to drive home. Four days later she was admitted . . .

The variations in the distribution of the pneumatic cavities into the remotest parts of the mastoid and petrous portion of the temporal bone were well known for many years. Bezold, 1 Politzer, 2 Siebenmann, Hyrtl 3 and more recently Cheatle 4 and Mouret 5 accurately described the cellular structure showing the connection with the tympanum. It remained for Gradenigo, 6 however, to describe the apical cells systematically and to associate them with the peculiar symptoms that occur infrequently during the course of an acute suppurative otitis media. These signs and symptoms are: ( a ) abducens paresis or paralysis, ( b ) severe pain in one or more areas in the distribution of the trigeminal nerve, but most commonly localized in the temporoparietal region, in the eye or deep in the orbit and ( c ) an acute suppurative otitis media with or without perforation of the membrana tympani. Existing together, these symptoms constitute the "Gradenigo

CASE REPORT History .—Mrs. A. D., a widow, aged 45, consulted Dr. Peter Bassoe, Aug. 24, 1922, complaining of a severe pain on the right side of the face. The patient being unable to speak English, it was learned through an interpreter that several years previously she had come from Armenia to the United States. While in Asia, she had been well except for an attack of paralysis, accompanied by the inability to speak. Full recovery occurred before coming to America. During deportation from Armenia the patient had lost seven of her children and had suffered much mental agony on this account. Because of the negative physical findings and the previous history, a diagnosis of depressed mentality was made. In February, 1923, the patient again consulted Dr. Bassoe. The severe pains on the right side of the face had persisted. Dr. Bassoe could find no organic disease and believed the

In a double-blind cross-over comparison of two mild analgesic compound tablets patients in moderate or severe pain showed a significant preference for the pentazocine-paracetamol compound tablet. Side effects were of a minor nature only and no patient dropped out of the trial because of them. It is concluded that significantly more patients (p

A computer technique is described which presents maps of cross sections of the brain, with the probes used during stereotaxic procedures, to the neurosurgeon in the operating room. These procedures are often performed in the treatment of involuntary movement, such as Parkinson's disease, severe pain, certain forms of epilepsy and behaviour disorders. The cross sections, in the three cardinal planes are expanded or contracted according to the size of the brain of the patient undergoing the operation, and displayed on a Tektronix 4002 Graphics Terminal in the operating room driven by a DEC PDP-12 computer. The program displays projections of the recording, stimulating and cutting probes (leucotomes) on the cross sections with that part of the probe “behind” the current cross section shown in dashed lines. The program also can store the position of the recording probe tip when it detects a neuron firing in response to a specific stimulus along with a code letter to identify the type of neuron. These code letters can then be displayed — the results of recording from many patients on a common scale — so that recording sites can be compared. The outline of the therapeutic lesion can also be displayed before it is made, allowing more accurate placement.

Fifty-two cases of nontuberculous purulent arthritis seen at the Tobey Hospital during a 16 year period following the introduction of antibiotic therapy were reviewed. The clinical picture was found to be a consistent one with only one or two joints involved. There was usually high fever, leukocytosis, and severe pain, tenderness, and swelling of the involved joints. Early arthrocentesis with attempts to isolate the causative organism is important. Although antibiotic therapy has virtually eliminated the mortality from septic arthritis, significant residual disability occurs, especially when the hip is involved. Methods to facilitate early diagnosis and treatment are discussed.

This case must be considered one of suppuration of the petrous pyramid because of the following facts: 1. Following an acute mastoiditis, the development of intense deepseated pain behind the eye, severe pain over the right eye-brow and the parietal region; 2. The sudden profuse discharge of pus from the mastoid wound and to some degree from the external auditory canal; 3. The period of low grade sepsis following the mastoidectomy, until the flare-up of the temperature from the seventh to the tenth day after the first operation, when the inflammation in the petrous pyramid was at its height; 4. The extensively pneumatized development of the mastoid; 5. The roentgenologic findings showing positive evidence of bone destruction at the medial end of the right petron, and further evidence seven months later that there was some regeneration of the bone in this region; and 6. The abatement of the pain in the eye and the sudden improvement of the patient following the operation on his petrous pyramid.

1. Anomalous arterial circulation at the ankle is present in 3 per cent of the population, and predisposes to arterial injury by severe inversion, plantar flexion of the ankle.2. Arterial bleeding should be considered in the differential diagnosis of severe pain following inversion, plantar flexion

THE relief of chronic severe pain in the trunk, pelvis and legs by the intrathecal injection of phenol solutions was initiated by Maher,1 of Liverpool, and amplified by Nathan and Scott,2 of Queen's Square. The safety of this procedure as compared to the older intrathecal alcohol injections was emphasized in their series of cases by the relative lack of disabling complications such as paresis of the leg or bladder. This report describes the intrathecal use of phenol injections for the relief of pain in 87 patients. The indications for the injections were similar to those used for cordotomy and other . . .

The analgesic efficacy of pentazocine has been tested in severe pain due to gynecologic cancer. A comparative trial was conducted between 60 mg pentazocine, 10 mg morphine, and 10 mg placebo in 35 patients. The drugs were administered in a randomized order by the double-blind technique. Intensity and relief of pain were classified by scores. The analgesic efficacy was analyzed in 5 different ways. No significant difference in analgesic efficacy was observed between morphine and pentazocine. Both drugs have a significantly better analgesic efficacy than placebo.

Presented case is a 9 year old boy who fall down from a tree and had severe pain in the distal end of his left femur. Roentgenographic examination revealed a fracture in the distal one-third of the left femur. Distal fragment was slightly displased. There was a cyst like lesion in the fracture site. A solitary bone cyst was mostly suspected.The patient was treated conservatively, and fracture healed successfully. 8 months later cyst like lesion was disappeared roentgenographicaly.In 1963 Dr. G. Imhaeuser reported a new method of treatment for bone cysts. He osteotomized the affected bone, and made some displacement. Without curattage and bonegrafting excellent prognosis was resulted.This would be a excellent way treating bone cyst.

Simultaneous congenital defects in both the anterior and posterior arches of the atlas have been reported in 17 cases (1–3, 6–8, 10, 12–15, 19, 20, 22, 23). The majority of these were anatomic specimens described in the nineteenth century. Two additional cases, with the further finding of lateral offset of the atlas in relation to the axis, were recently observed. As our patients presented after injuries, differentiation from fractures of the ring of the atlas was essential. Case Reports Case I: A 45-year-old laborer was carrying a 100-lb. sack when he stepped into a deep crevice, landing with full weight upon his buttocks. He immediately felt pain in the neck, but was able to drive himself to a nearby hospital. There was no past history of any injury or difficulty referable to the neck. Physical examination revealed considerable restriction of voluntary motion, with severe pain deep in the neck elicited by the slightest movement of the cervical spine or mandible. There was no neurologic or other abnormal...

A case of acute otitic temporosphenoidal abscess is reported because of the rarity of the condition. It is said that only six cases of Gradenigo's syndrome associated with temporal abscess are to be found in the literature. 1 REPORT OF CASE History .—F. D., a boy, aged 16½, a student, was first seen on Feb. 14, 1925, giving a history of grip with symptoms referable to the upper respiratory tract. For three weeks there had been marked nasal obstruction with pus. Examination .—Physical examination gave negative results, except for swollen, boggy turbinal tissue with pus throughout the nasal fossae. He had suffered for several days with severe pain, referred to the ethmoidal regions. So great was the patient's distress, and so clear was the indication for some surgical treatment, that the antrums were washed out through the inferior meatuses. That this was not a case of pansinusitis was proved by clear

The clinical aspects and the post-mortem observations in 19 cases of dissecting aneurysm of the aorta are described. Clinically, these patients presented (1) old dissections, with intractable heart failure, which had (a) a “silent” history and course in regard to the dissection, or (b) an active history and course, with repeated attacks of severe pain in the chest that radiated into the neck and back; and (2) recent dissections with (a) a typical onset of pain or collapse and (b) an atypical onset with severe dyspnea. Physical signs of a variable character, such as cardiac murmurs, were outstanding, and did not conform to any definite pattern. The majority of patients with dissecting aneurysm of the aorta do not have a typical onset or course; the latter may extend over many months, but at some time present any or all of the physical signs which have been discussed.

Objectives: Knee osteoarthritis patient has the risk for ambulation disability as a result of knee pain. Nuhonni-Tulaar rheumatic exercise was designed to prevent complications of rheumatic diseasesincluding knee osteoarthritis. The purpose of this study is to investigate the effectivity of Nuhonni-Tulaar rheumatic exercise to reduce pain of knee osteoarthritis patient.Methods: Twenty two subjects did the rheumatic exercise thrice a week in the gymnasium of medicalrehabilitation department Cipto Mangunkusumo hospital. Twenty other subjects, the control group, didthe standard hamstring stretching exercise at home. Each group performed the exercise for 8 weeks.Pain was measured using Visual Analog Scale (VAS) each week and analyzed before and after theintervention.Results: After 8 weeks VAS was reduced 1.5 in the intervention group while in the control group the reduction was 0.9. VAS was then transformed into no pain, mild pain, moderate pain and severepain. VAS was significantly reduced in the intervention group (p=0.002) but not in the control group (p=0.059). VAS changes between the two groups was significantly different (p=0.004).Conclusions: Rheumatic exercise has greater benefit in reducing pain than standard stretching exercise.Warming up, core exercise II and cooling down is safe and comfortable for knee osteoarthritis patientwith grade I-II Kellgren Lawrence radiographic grading.Keywords: Nuhonni-Tulaar Rheumatic exercise, Knee osteoarthritis, Visual Analog Scale

CASE REPORT P. F., a girl, aged 7 years, was admitted to the Beth Moses Hospital on July 27, 1924, her chief complaint being persistent fever, pain in the right ear and severe headache. Previous Personal History .—The patient had the usual diseases of childhood. Two years previously she had an attack of acute otitis media in the right ear, from which she recovered without any complications. Several months later her tonsils and adenoids were removed. Otherwise, she had had comparatively good health. History of Present Illness .—Four days prior to admission to the hospital, the child was seized with severe pain in the right ear. Two days after, the drum ruptured spontaneously, but no relief from pain was experienced. On the sixth day of illness she was seen by an otologist, at which time the drum was freely incised. Following incision, there was a profuse discharge from the ear

We recently experienced a case of gas gangrene. The case was 29 years old woman, she fell down to the valley on July 2, 1972, and injuried left femur open fracture. The wound was highly damaged and flexor muscle ruptured completely. After adequate debriedement, we closed the wound primary at once. The next day she complained severe pain and cold sensation of the left leg, but general condition was so good, we observed her condition. Two days after injury, the wound become highily swelled and bad smell, tachycardia, drop of blood pressure, unconsciousness was noticed, and x-ray finding showed the typical shadow of gas gangrene, so we decided amputation of the left leg. But after operation general condition had not become better, and swelling infiltrated toward inguinal and hypochondral region. She died on July 7 at last.We realized importance of early diagnosis and early treatment, so reported this case.

Presentation of Case A seventy-seven-year-old woman was admitted to the hospital because of pain in the back and fever. Twenty-two years previously osteomyelitis of the left great toe had necessitated transmetatarsal amputation. Subsequently, she was found to have diabetes, which was treated with diet and insulin. She was well thereafter until four days before entry, when there was the onset of weakness of the legs and severe pain in the mid-lumbar area, without radiation to the legs or feet. The function of the bowel and bladder was not affected. She had a cough productive of small amounts of sputum, accompanied . . .

Case 1. —A woman, aged sixty, came to the clinic complaining of “stomach trouble” of one year's duration. She had been in excellent health and able to eat anything until one year before, when she had a sudden attack of severe pain in the left upper quadrant, radiating to the epigastrium, with nausea and vomiting. The attack lasted about five minutes; there was no residual soreness, but the patient became “yellow” half a day later, the discoloration lasting three days. Since that time she has had intermittent attacks of nausea about one hour after eating, relieved at once by vomiting or by soda, hunger pain relieved by food, belching, and sour eructations. One month before coming here she experienced a second attack, similar to the first but not so severe. At this time she consulted a physician, who found pus in the urine. Examination at the clinic revealed a movable tender mass in the right flank supposed to be a kidney. A roentgenogram revealed a large shadow in the area of the right kidney at the level ...

This study investigated the effects of several behaviors as potential self-controlling devices in the tolerance of a noxious stimulus. In a cold-pressor test, experimental groups were instructed: (1) to expect severe pain; (2) to verbalize aloud their momentary experiences; (3) to use a clock for setting a goal for tolerance; or (4) to view and describe slides, in order to enhance tolerance of the ice water. Duration of tolerance differed significantly, with a descending order of mean tolerance in groups (4), (3), (1), control, (2). Posttest questionnaires revealed varying use of other self-controlling mechanisms in the groups. The utility of Skinner's paradigm for the study of self-control was discussed.

SUMMARY The effects of oral administration of pentazodne were compared with those of non-DDA analgesics given orally and with those of DDA analgesics given orally and parenterally in patients with intractable pain, over a period of three days while awaiting treatment by percutaneous electrical cordotomy. The dose of pentazodne varied from 25–100 mg four times per day, comparisons being made with the previous treatment. The analgesic effect was assessed by direct questioning of the patients by a nurse assessment of the patients' comfort, and by the patients' opinion as to how well they slept during the night. A pain scoring system was used for comparing degrees of pain. The analgesic effectiveness of pentazodne approached that of oral and parenteral DDA analgesics. Nevertheless, the DDA analgesics were generally preferred by the patients. This may be attributable to the associated effects (e.g. euphoria) of these drugs. The effects of oral administration of pentazodne were compared with those of non-DDA analgesics given orally and with those of DDA analgesics given orally and parenterally in patients with intractable pain, over a period of three days while awaiting treatment by percutaneous electrical cordotomy. The dose of pentazodne varied from 25–100 mg four times per day, comparisons being made with the previous treatment. The analgesic effect was assessed by direct questioning of the patients by a nurse assessment of the patients' comfort, and by the patients' opinion as to how well they slept during the night. A pain scoring system was used for comparing degrees of pain. The analgesic effectiveness of pentazodne approached that of oral and parenteral DDA analgesics. Nevertheless, the DDA analgesics were generally preferred by the patients. This may be attributable to the associated effects (e.g. euphoria) of these drugs.

Behavioral studies were carried out on interactions of electric shock and pressure stimulation provided by vibration or by a sudden slap. The results show that: (a) vibration increases the amount of electric shock needed to evoke threshold and prick sensations but decreases the amount needed to produce severe pain; (b) vibration has prolonged aftereffects; and (c) a single slap presented as long as 50 msec before onset or after termination of a shock increases the voltage needed to produce threshold and prick sensations. These results indicate that pressure-induced volleys have a weak inhibitory effect on central cell activities evoked by shock, and that signal detection by central cells is based on prolonged monitoring of activities triggered by a sensory input. Some of these results can be explained in terms of processes occurring at the early stages of information transmission without resorting to mechanisms of “higher nervous activity.”