Läkartidningen
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Review Comparative Study
[Use of snuff entails lower risk of cardiovascular diseases than does smoking].
Oral snuff, a form of smokeless tobacco, causes an immediate rise in heart rate and blood pressure, but snuff users do not show permanent changes in heart rate or blood pressure when not exposed to tobacco. Cardiac output during workload and maximal work capacity are unaffected. Snuff users usually do not show the biochemical stigmata that regular smokers do with the exception of a possible excess risk of type 2 diabetes. ⋯ Results on the risk of myocardial infarction have provided conflicting evidence, two case-control studies showing the same risk as in non-tobacco users and one cohort study showing an increased risk of cardiovascular death. A nested case-control study failed to show an excess risk of stroke in snuff users. It is concluded that the use of smokeless tobacco (with snuff being the most studied variant) entails a lower risk of adverse cardiovascular effects than does smoking.
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A pathophysiological mechanism named "nociceptive sensory sensitisation" is introduced to explain part of the fibromyalgia pain syndrome as well as several local or regional long standing pain conditions like epicondylitis, chronic low back pain, whiplash associated disorder, temporomandibular pain disorder and trochanteritis. The article is based on a vast rheumatological clinical experience on patients presenting with local or wide-spread pain, and on literature studies. ⋯ Sensory sensitisation should be considered as a pathophysiological reaction originating from tissues and organs exposed to "external" overload or trauma, either physical, chemical or biochemical. The sensitisation process is usually facilitated by "internal" psychological distress.
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Tramadol is a centrally acting opioid analgesic which is increasingly used in Sweden. Dependence, abuse and withdrawal has been reported in patients treated with tramadol. ⋯ Patients with a history of substance abuse might be at higher risk than others to develop dependence. The number of forged tramadol prescriptions uncovered in Swedish pharmacies was relatively low in 2001, compared to those of prophoxyphene and codeine, but increasing.
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New effective methods to reduce spasticity and dystonia are now included in the treatment of children with cerebral palsy (CP): selective dorsal rhizotomy (SDR), continuous intrathecal infusion of baclofen by an implanted pump or intramuscular injections of botulinumtoxin A. SDR is the only method that can reduce the spasticity permanently. ⋯ In Lund physicians and physiotherapeuts from different disciplines such as paediatric orthopaedic surgery, neurosurgery and neurology form a central spasticity team which co-operates with the local child habilitation services. We have found that a common structured and standardized follow-up programme with early intervention against muscle hypertonia and imbalance can prevent hip luxation and contractures in children with CP.