ISSN:0362-2436    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Study Design.A retrospective analysis of 10 patients with pancreatitis after traumatic spinal cord injury.Objectives.To determine the conditions leading to nontraumatic pancreatitis in spinal cord injury.Summary of Background Data.Little is known in the literature about pancreatitis after spinal cord injury. A few authors suggest a multifactorial pathogenesis.Methods.Over a 4-year period the case reports of 338 patients with traumatically caused SCI were reviewed concerning p-amylase and/or lipase elevations. Acute pancreatitis was defined as an elevation of p-amylase and/or lipase of more than three times the upper normal limit.Results.Ten of 338 patients had p-amylase and/or lipase elevations three times higher than the upper normal limit. All 10 were male with a mean age of 40.4 years. The average onset time of acute pancreatitis was 16 ± 5.5 days after trauma. The usual etiologic factors of acute pancreatitis such as obstructive, toxic, or traumatic events were excluded.Conclusion.The clinical recognition of acute pancreatitis in paraplegic and quadriplegic patients is hampered by diminished or lost visceral sensitivity and therefore is based on laboratory investigations. The current authors therefore hypothesize that acute pancreatitis in the setting of high-level spinal cord injury may result from a combination of locally mediated sphincter of Oddi dysfunction and vagal dominant innervation of the pancreatic gland in autonomic failure.

ISSN:0362-2436    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Study Design.A case series of eight patients with idiopathic spinal cord herniation and a review of the literature.Objective.To report on this rare entity, provide insight on its natural history, and propose an optimal management strategy.Summary of Background Data.Idiopathic spinal cord herniation is a rare disease with 50 cases reported before the current study.Methods.Eight cases (follow-up 1 month to 8 years) are reported using available information from patient charts, interviews, and assessments. All imaging studies are reviewed. The review of the literature was performed using PUBMED.Results.Four patients, followed without surgical intervention, have not progressed. Of the three patients who underwent surgical repair by one of the authors, two improved and one was unchanged. A fourth patient, who was initially treated by another surgeon who failed to identify the dural defect and herniation, had a poor outcome.Conclusion.The pathophysiology of the dural defect is still uncertain. The typical presentation is Brown–Séquard syndrome. Microsurgical repair in cases with progression of neurologic deficits is usually successful in achieving recovery of function or arrest of progression.

ISSN:0362-2436    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Study Design.Case report.Objectives.To report and discuss the natural evolution of fortuitously found solitary radiodense or “ivory” vertebrae in two asymptomatic patients; to review the existing literature concerning ivory vertebrae; and to provide a practical guide for the diagnostic and management approach to the fortuitous finding of ivory vertebrae in asymptomatic patients.Summary of Background Data.The asymptomatic and apparently idiopathic ivory vertebra is often a very problematic clinical situation. Previous studies have hypothesized that although several etiologies have been known to be responsible for producing ivory vertebrae, the most likely etiology, particularly for so-called “idiopathic” ivory vertebrae, is early and asymptomatic Paget’s disease of bone.Methods.Two patients, each with an incidentally discovered ivory vertebra, were followed clinically over a period of 13 and 10 years, respectively. During this time the patients underwent a multitude of investigations in an attempt to identify the etiology of the ivory vertebra. After having eliminated ominous etiologies, the authors opted for a conservative approach to management (observation) so as to have a long-term follow-up of the patients and also attempt to determine the natural history of idiopathic solitary ivory vertebrae.Results.Despite the extensive workups, no etiology was ever found for either patient because the tests showed normal results for extended periods of time. Whereas in one patient Paget’s disease of bone was suspected, no definitive confirmation for the presence of Paget’s disease could be obtained, even on bone biopsy. Both patients remained entirely asymptomatic with respect to the ivory vertebra over the entire follow-up period.Conclusion.Based on the observations from the present study as well as a review of the literature on the subject, a decision-making algorithm is put forth for the investigative approach as well as for the subsequent follow-up and management of patients with idiopathic and asymptomatic ivory vertebrae whereby, after baseline screening tests eliminate ominous pathology, observation and periodic clinical reassessment are advised until symptoms develop or until there are radiographic changes in the appearance of the ivory vertebra.

ISSN:0362-2436    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Study Design.Case report. A hitherto unreported finding of a bony loose body found lying in the spinal canal causing spinal canal stenosis is presented.Summary of Clinical Details.A 68-year-old, fit man presented with a history of progressive neurologic claudication and neurologic deficit in both his lower limbs. Clinical examination revealed excellent range of movements in his lumbar spine and bilaterally normal straight leg raising. He had no significant pain in his back. Neurologic examination showed affection of L5 and S1 dermatomes and myotomes bilaterally. Magnetic resonance imaging scan showed severe localized lumbar spinal stenosis at L4–L5. In the absence of any obvious pathology on the scan, it was presumed that the stenosis was the result of infolding of the redundant ligamentum flavum. His walking distance and neurologic deficit continued to deteriorate, although sphincters were not involved. He underwent a posterior spinal decompression of L4–L5. On performing the laminectomy an ovoid and well-defined pearly white loose body was discovered lying loose in the spinal canal causing stenosis. Histologically, the loose body consisted of trabecular bone with areas of cartilage. The patient made a speedy recovery after surgery and was back to his previous level of activity within a month.Discussion.Several different types of foreign body have been identified in the spinal canal. However, this case of an autologous loose body in the spinal canal causing symptomatic canal stenosis is unique. Because the authors could not identify the source of this loose body, they have termed it “spinolith.”

ISSN:0362-2436    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Study Design.Case report.Objective.To increase awareness of spinal brucellosis and discuss demographics, diagnosis, and treatment.Summary of Background Data.Brucellosis is a rare cause of spinal infections in the United States, although there have been regional increases in its prevalence.Methods.Retrospective review of a patient with spinal brucellosis. She underwent a protracted course of treatment, with a long delay in diagnosis. History ultimately revealed regular consumption of unpasteurized goat cheese. Appropriate testing subsequently led to the diagnosis.Results.After multiple surgeries and medications, the condition responded well to definitive antibiotic therapy.Conclusion.Brucellosis is rare in the United States and thus often overlooked in the differential diagnosis of back pain. The changing risk pattern for this disease requires a high index of suspicion, which can result in early diagnosis and predictably favorable results to treatment.

ISSN:0362-2436    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Study Design.A subgroup of 195 patients with chronic low back pain, being part of a larger study of other musculoskeletal patients, were included in a randomized controlled prospective clinical study.Objectives.To evaluate the outcome in terms of return to work and cost-effectiveness of a light multidisciplinary treatment program with an extensive multidisciplinary program and treatment as usual initiated by their general practitioner.Summary of Background Data.Light multidisciplinary programs seem to reduce sick leave in patients with subacute low back pain. There are few, if any, previous studies of the effectiveness of lightversusextensive multidisciplinary treatment on return to work in patients with chronic low back pain.Methods.Patients with chronic low back pain (n = 195), on an average sick-listed for 3 months, were included. The patients were randomized to a light multidisciplinary treatment program, an extensive multidisciplinary program, or treatment as usual by their primary physician. Full return to work was used as outcome response, and follow-up was 26 months after the end of treatment. Cost–benefit was calculated for the treatment programs.Results.In men significantly better results for full return to work were found for the light multidisciplinary treatment compared with treatment as usual, but no differences were found between extensive multidisciplinary treatment and treatment as usual. No significant differences between any of the two multidisciplinary treatment programs and the controls were found for women. Productivity gains for the society from light multidisciplinary treatmentversus“treatment as usual” of 57 male patients with low back pain would during the first 2 years accumulate to U.S. $852.000.Conclusions.The light multidisciplinary treatment model is a cost-effective treatment for men with chronic low back pain.

ISSN:0362-2436    

出版商:OVID    

年代:2002

数据来源: OVID

ISSN:0362-2436    

出版商:OVID    

年代:2002

数据来源: OVID

ISSN:0362-2436    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Study Design.The mRNA expressions of cytokines and chemokines were assessed in herniated lumbar disc specimens.Objectives.To investigate whether the mRNAs of interleukin (IL)-1&agr;, tumor necrosis factor (TNF)-&agr;, RANTES, IL-8, IL-10, and transforming growth factor (TGF)-&bgr; are expressed in surgically obtained herniated disc specimens; and to discover which of them are the predominant cytokines associated with the clinical symptoms and signs, and whether any differences in the mRNA expression exist depending on the different types of disc herniations.Summary of Background Data.It has been postulated that cytokines are involved in causing radicular leg pain in lumbar disc herniations. Although a few studies have been done on lumbar disc herniations concerning IL-1&agr; and TNF-&agr;, almost none has been carried out in the cases of the other of cytokines and chemokines.Methods.Using a reverse transcription–polymerase chain reaction, mRNA expressions of cytokines and chemokines were investigated in herniated disc specimens. The straight leg raising test, development of radicular pain by back extension, symptom duration, pain intensity using a visual analogue scale, and herniation types were described.Results.The mRNAs of IL-8, TNF-&agr;, IL-1&agr;, RANTES, and IL-10 were expressed in 16 (70%), 15 (65%), 9 (39%), 4 (17%), and 2 (9%) of the 23 herniated disc specimens, respectively. The mRNA of TGF-&bgr; was expressed in 5 of 10 specimens (50%). IL-8 mRNA expression was associated with the development of radicular pain by back extension and short symptom duration (average 3.8 weeks). The mRNAs of IL-1&agr; were expressed more frequently in transligamentous extensions than in subligamentous extensions, but the expression was weak.Conclusion.Interleukin-8 appears to be associated with development of radicular pain by back extension and to be activated on acute or subacute disc herniations. IL-8 seems to participate in the pathomechanism of nerve root inflammation in lumbar disc herniations, which implies that it may be considered a target for therapeutic intervention.

ISSN:0362-2436    

出版商:OVID    

年代:2002

数据来源: OVID