Geriatrics 2002 Mar;57(3):30-2, 35-6, 41-2
Charles R. Drew University, College of Medicine, King-Drew Medical Center, Los Angeles, CA, USA.
[Medline record in process]
Abdominal pain is a common occurrence in older persons and a frequent catalyst for office and emergency room visits. Complaints must be investigated thoroughly because they often indicate serious underlying pathology such as Infection, mechanical obstruction, malignancy, biliary disease, cardiac problems, and GI ischemia. One means of overcoming a sprawling differential diagnosis is to determine whether the problem falls into one of four general categories: peritonitis, bowel obstruction, vascular catastrophe, or nonspecific abdominal pain. A comprehensive history, careful physical examination, and use of abdominal imaging studies facilitate effective assessment. As atypical presentations are frequently encountered in older persons, liberal use of ultrasound and contrast CT and early surgical consultation are recommended.
PMID: 11899547, UI: 21897407
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J Pain Symptom Manage 2002 Feb;23(2):161-4
Multidiciplinary Pain Center, Herlev University Hospital, Herlev, Denmark
A cancer patient receiving long-term oral sustained-release morphine treatment and periodically presenting with unusually high plasma M3G/M6G ratios is described. We found the patient's formation of M6G more unstable and perhaps delayed compared to the formation of M3G. There is no apparent explanation for this phenomenon and the high M3G/M6G ratios had no implications for the patient's pain experience or side effects from the morphine treatment.
PMID: 11844638, UI: 21833652
Spine 2002 Jan 15;27(2):215-7
Publication Types:
PMID: 11805671, UI: 21664547
Spine 2002 Jan 15;27(2):211-4
Department of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center, Maywood, Illinois 60153, USA.
STUDY DESIGN: Compliance monitor measurement of orthosis wearing time during laboratory climate tests and normal volunteer subject tests were compared to normal diaries. OBJECTIVE: To develop and test the accuracy and reliability of a device designed to measure spinal orthosis wearing time. SUMMARY OF BACKGROUND DATA: Orthosis wearing time is an important factor in orthotic treatment for spine disorders. A reliable and objective method for measuring orthosis wearing time currently is lacking. METHODS: Four pressure switches and a data logger embedded in each thoracolumbosacral orthosis recorded orthosis wearing time. Orthoses were assumed to be worn when at least two switches were "on." Laboratory climate tests and normal volunteer tests were conducted to assess the ability of the compliance monitor to measure orthosis wearing time. A manual wearing-event diary was kept during all the tests. The length of each wearing-time interval, the daily wearing time, and the cumulative wearing time were calculated from data recorded by the compliance monitor and the manual diaries. RESULTS: A linear regression was performed on all orthosis wearing-time intervals as recorded by the compliance monitor and by the manual diaries. Climate chamber tests yielded 121 sensor trigger-event intervals (R2 = 0.998; slope = 1.003; P < 0.0001). Normal subject testing yielded 72 orthosis wearing-time intervals (R2 = 0.998; slope = 0.998; P < 0.0001). CONCLUSION: As indicated by the regression analyses, the compliance monitor accurately quantified the orthosis wearing-time intervals during the laboratory climate tests and the tests with normal volunteers.
PMID: 11805670, UI: 21664546
Spine 2001 Dec 1;26(23):2641-3
PMID: 11725251, UI: 21582174
Spine 2001 Dec 1;26(23):2587-95
Department of Physical Medicine and Rehabilitation, University Hospital of Oulu, Kajaanintie 50, FIN-09220 Oulu, Finland. jaro.karppinen@ppshp.fi
STUDY DESIGN: A subgroup analysis of a prospective, randomized controlled trial was performed. OBJECTIVE: To describe the cost effectiveness of periradicular infiltration with steroid in subgroups of patients with sciatica. SUMMARY OF BACKGROUND DATA: A recent trial on periradicular infiltration indicated that a methylprednisolone-bupivacaine combination had a short-term effect, as compared with that of saline. This report describes the efficacy and cost effectiveness of steroid in subgroups of patients with sciatic. METHODS: This study involved 160 patients with unilateral sciatica. Outcome assessments were leg pain (100-mm visual analog scale), disability on the Oswestry Low Back Disability Questionnaire, and the Nottingham Health Profile. Data on medical costs and sick leaves also were gathered. Patients were randomized for periradicular infiltration with either methylprednisolone-bupivacaine or saline. The adjusted between-group treatment differences at each follow-up assessment, the number of patients free of leg pain (responders, cutoff 75%), and efficacy by the area-under-the-curve method were calculated. For the cost-effectiveness estimate, the total costs were divided by the number of responders. The rate of operations in different subgroups was evaluated by Kaplan-Meier analysis. RESULTS: In the case of contained herniations, the steroid injection produced significant treatment effects and short-term efficacy in leg pain and in Nottingham Health Profile emotional reactions. For symptomatic lesions at L3-L4-L5, steroid was superior to saline for leg pain, disability, and straight leg raising in the short term. By 1 year, steroid seemed to have prevented operations for contained herniations, costing $12,666 less per responder in the steroid group (P < 0.01). For extrusions, steroid seemed to increase the operation rate, and the steroid infiltration was more expensive, costing $4445 per responder (P < 0.01). CONCLUSIONS: In addition to short-term effectiveness for contained herniations and lesions at L3-L4-L5, steroid treatment also prevented surgery for contained herniations. However, steroid was countereffective for extrusions. The results of the subgroup analyses call for a verification study.
PMID: 11725240, UI: 21582163
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