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Biomedical subjects

D J Mazanec

Publications and source records attributed to D J Mazanec.

15 recordsLinked to original sources
PubMed2003

Chronic non-malignant musculoskeletal pain in older adults: clinical issues and opioid intervention.

Musculoskeletal pain is common, frequently under-reported, and inadequately treated in the older adult. The objective of this article is to review the management of musculoskeletal pain syndromes in older adults emphasising the potential role of opioid agents in carefully selected patients. Systematic analysis of the relevant literature was done. Even in cognitively impaired patients, assessment of musculoskeletal pain is mandatory. An algorithm for musculoskeletal pain is presented emphasising a stepwise pharmacological approach in combination with an array of non-pharmacological therapies. Comorbid conditions may limit therapeutic choices, particularly in the elderly. Repeated assessment of pain levels as well as functional status is critical for optimal pain management.

Aged↗
PubMed1999

Evaluating back pain in older patients.

Low back pain in the elderly has a much wider range of possible causes than in younger patients. In addition to nonspecific mechanical causes, malignancy presenting as back pain occurs more often in older patients. Other systemic and visceral causes of back pain such as polymyalgia rheumatica, aortic aneurysm, Paget disease, Parkinson disease, and osteoporosis with compression fracture occur almost exclusively in persons over age 50. Keys to diagnosis and management of low back pain in older patients are presented.

Age Factors↗
PubMed1995

Contrast-enhanced MR imaging in acute lumbar radiculopathy: a pilot study of the natural history.

PURPOSE: To prospectively study clinical findings and contrast material-enhanced magnetic resonance (MR) images over time in patients with acute lumbar radiculopathy. MATERIALS AND METHODS: Twenty-five patients underwent physical examination and MR imaging at presentation, 6 weeks, and 6 months. Initial symptoms and clinical course were correlated with type, size, location, and enhancement of disk herniations. RESULTS: Eighteen patients had a herniated nucleus pulposus (HNP) at one or more levels, two had synovial cysts and stenosis, and five had normal findings. Patients with an HNP had marginally more severe neurologic symptoms than did patients without an HNP (P = .07) at presentation. Twenty-two patients completed the 6-week examinations and 14 patients the 6-month examinations; three patients were eliminated from the study after surgical treatment. Among HNPs larger than 6 mm, substantial reduction in size was noted in 36% at 6 weeks and in more than 60% at 6 months after presentation. CONCLUSION: Agreement between clinical and MR findings for level and side of HNP and radicular symptoms was excellent. There was no correlation of pain and disability with disk size, behavior, or type.

Acute Disease↗
PubMed1991

Conservative treatment of rheumatic disorders in the elderly.

Rheumatic syndromes are the most common cause of limited activity and disability in elderly patients. Those over age 65 are particularly susceptible to adverse reactions to antirheumatic therapy, especially to nonsteroidal antiinflammatory drugs (NSAIDs). A therapeutic approach that emphasizes safety by fully utilizing nondrug therapy, employing conservative prescribing techniques, and monitoring high-risk patients for adverse reactions is the focus of this article.

Aged↗
PubMed1989

Methotrexate for corticosteroid-resistant polymyalgia rheumatica and giant cell arteritis.

Three patients (one with polymyalgia rheumatica with jaw claudication and two with biopsy-proven giant cell arteritis) were initially treated using prednisone (40-60 mg daily). The response was good in all three, but each experienced exacerbation of symptoms and elevation of Westergren sedimentation rates (WSR) with dose reduction. The addition of methotrexate (7.5-12.5 mg/wk) resulted in diminished symptoms and lower WSR and proved to be steroid-sparing.

Aged↗
PubMed1989

Drug-induced osteoporosis.

Use of corticosteroids has been most frequently associated with bone loss, but heparin and methotrexate, when used in relatively high doses, have also been linked to the development of osteoporosis. Clinical features of bone loss associated with these agents, possible pathophysiologic mechanisms, and strategies for avoiding this complication are reviewed.

Adrenal Cortex Hormones↗
PubMed1987

Abnormal lymphocyte function in scleroderma: a study on identical twins.

This paper describes immunologic studies on a set of identical twins discordant for the presence of scleroderma. The affected twin had a low absolute T-cell count, low numbers of T4 helper/inducer cells, and an increase in the T8 suppressor/cytotoxic cell count. The T cells of the patient responded poorly to mitogens and to allogeneic and autologous stimuli. By contrast, T-cell-helper activity for pokeweed mitogen-induced IgM synthesis was markedly enhanced in the patient. Furthermore, activated mononuclear cell supernatants from the patient markedly enhanced the synthesis of collagen by normal cultured fibroblasts. The unaffected twin by contrast displayed normal responses in these assays. The results suggest that the immunologic defects in scleroderma are not entirely genetically determined.

Diseases in Twins↗
PubMedDate not supplied

Back pain: medical evaluation and therapy.

Most patients with acute low back pain or sciatica improve with appropriate conservative therapy, and most require no immediate diagnostic studies beyond a careful history and examination. In patients with "red flags" for visceral, malignant, or infectious causes or possible cauda equina syndrome, a more aggressive evaluation is mandatory. In patients whose pain does not respond to initial management or who have chronic symptoms, diagnostic re-evaluation is appropriate.

Acute Disease↗
PubMedDate not supplied

The injured worker: assessing "return-to-work" status.

In workers injured on the job, the physical findings tell only part of the story. Physicians must also consider psychologic, economic, social, and legal factors when performing a return-to-work assessment.

Accidents, Occupational↗
PubMedDate not supplied

Methotrexate for systemic lupus erythematosus: a retrospective analysis of 17 unselected cases.

We report a retrospective study of 17 patients with systemic lupus erythematosus who were treated with oral methotrexate given as a mean weekly dose of 8.47 +/- 1.72 mg. Methotrexate treatment resulted in symptomatic improvement in 57% of patients and allowed the reduction of the mean daily dose of prednisone from 16.66 mg initially to 8.99 mg at one year follow-up. Twelve of 17 patients (70.6%) experienced at least one episode of toxicity. Factors which might be associated with toxicity are analyzed. Because of its potential as a corticosteroid-sparing agent, controlled studies of methotrexate for the treatment of systemic lupus erythematosus are indicated.

Adult↗