BACKGROUND AND OBJECTIVES: This randomized double-blind study was designed to determine whether administration of ketorolac either on schedule or as a component of patient-controlled analgesia (PCA) to patients who have undergone spinal stabilization would decrease PCA morphine use, decrease side effects, and/or enhance analgesia. METHODS: Eighty inpatients undergoing spine stabilization by one surgeon were evaluated after excluding patients with contraindications to the use of ketorolac or morphine. All patients received PCA morphine. The patients were divided into four groups, which were given either intravenous saline (control group); intravenous ketorolac 15 mg every 6 hours; intravenous ketorolac 30 mg every 6 hours; or ketorolac added to the PCA morphine on a milligram per milligram basis. The outcome measures included pain scores. 24-hour morphine use, level of sedation, and side effect profile at six times during the first 24 postoperative hours. RESULTS: The total dose of morphine (P < .0001) and the cumulative doses for each of the six time periods (P varied between .02 and .0001 for the six time periods) were significantly higher in the control group than in the other three groups. There were no differences in doses administered by the other three groups. The pain scores were also significantly higher in the control group than in the other three groups, with no differences in pain scores among the other three. The sedation scores were higher (ie, patients more sedated) in the control group than in the other three groups at two of the six time periods (periods I and 6; P < .001). CONCLUSIONS: Ketorolac should be as a component of the PCA morphine in patients undergoing spine stabilization surgery. This results in decreased morphine consumption, decreased somnolence, and enhanced analgesia in comparison with patients who do not receive ketorolac.

Adult↗

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A plea for incidental appendectomy in pediatric patients with malignancy.

The evaluation of right lower quadrant (RLQ) abdominal pain in pediatric patients with malignancy can be difficult. However, since the mortality rate from peritoneal infections in these patients is very high, the differential diagnosis of RLQ peritoneal irritation, mainly of acute appendicitis (AA) versus neutropenic enterocolitis (NE), is crucial. Three cases of pediatric patients with malignancy demonstrating these difficulties are represented to enlighten this problem. The first patient died of multiorgan failure after operation for perforated appendicitis without generalized peritonitis. The second had a severe life-threatening postoperative complication because of delayed diagnosis of acute appendicitis. The third patient with malignant pelvic spread, underwent an unnecessary abdominal exploration for suspected AA. In all these cases and probably in many others, the clinical outcome could have been different if a previous incidental appendectomy had been performed during the primary abdominal operation. Incidental appendectomy in oncologic patients is recommended to facilitate the differential diagnosis of RLQ pain and to exclude the diagnosis of AA.

Adolescent↗

PubMedDate not supplied

Scoliosis in the elderly: a follow-up study.

A follow-up x-ray study of 554 subjects aged between 50 and 84 years has been carried out to determine the appearance, presence, and progression of scoliosis in the elderly and its relationship to osteoporosis and back pain. The subjects were chosen from a population group of 3600 subjects examined 7 to 13 years previously in the same investigators. Some degree of scoliosis was found in 70% of the subjects, and curves of 10 degrees or more in approximately 30%. Ten percent of the subjects had developed scoliosis de novo during the follow-up period. There was no direct relationship between the presence or progression of scoliosis and osteoporosis. There was no direct relationship between scoliosis and back pain or between scoliosis and degenerative changes in the spine. Since scoliosis in the elderly seldom becomes a clinical problem of significance, there would appear to be no valid reason for a more extensive study of the condition at this time.

Age Factors↗

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Progressive bone loss during long-term home total parenteral nutrition.

Metabolic bone disease occurs in patients receiving prolonged home total parenteral nutrition (HTPN). We studied bone-mass status in 10 patients (seven males, three females, age 19-66 years) who had been receiving HTPN for 0 to 67 months (mean 24 months), mostly for short-bowel syndrome. Four patients had spinal osteoporosis on radiograms. The density of various bone components at the wrist was measured noninvasively using a novel technique based on Compton scattering effect. The density of the cancellous and cortical bone was decreased in nine and six patients, respectively. During a follow-up period of up to 19 months, a further significant decrease in the density of both bone components was found. We conclude that prolonged HTPN is associated with an ongoing bone diminution, affecting mainly the cancellous bone.

Adult↗

PubMedDate not supplied

Osteoporosis of the spine, pelvis and hand. A comparative study in a femoral neck fracture series.

In a comparative study of the degree and prevalence of osteoporosis in the hand, pelvis and spine of a group of femoral neck fractures in the elderly, it was noted that spinal osteoporosis was much more frequent and appeared much earlier than pelvic osteoporosis. Similarly, a one way correlation existed between osteoporosis of the hand and spine. No relationship was noted between osteoporosis of the pelvis as measured by our criteria and by the Singh technique.

Adult↗

PubMedDate not supplied

The epidemiology of femoral neck fractures in Jerusalem. A prospective study (1967-1971).

A prospective study of 570 patients with fracture of the upper end of the femur was carried out between 1967 and 1971 in Jerusalem. Of three distinct ethnic groupings, Western or Ashkenazi females and Eastern or Sephardi males produced the highest incidence of fractured neck of the femur proportional to their makeup in the population at risk. No explanation for this is forthcoming as both groups are of differing sex and race. The age and sex incidence of these fractures in the Eastern and Western ethnic groups in this city showed a distinct resemblance to their geographicaly counterparts in other studies. There is an interesting seasonal pattern of incidence of fractures in females and correlation with increased physical activity during the three special holiday periods.

Age Factors↗