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At least 1,441 records · Page 80Linked to original sources
PubMed2001

Rating specific chiropractic technique procedures for common low back conditions.

OBJECTIVE: To rate specific chiropractic technique procedures used in the treatment of common low back conditions. DESIGN AND METHODS: A panel of chiropractors rated specific chiropractic technique procedures for their effectiveness in the treatment of common low back conditions, based on the quality of supporting evidence after systematic literature reviews and expert clinical opinion. Statements related to the rating process and clinical practice were then developed through a facilitated nominal consensus process. RESULTS: For most low back conditions presented in this study, the three procedures rated most effective were high-velocity, low- amplitude (HVLA) with no drop table (side posture), distraction technique, and HVLA prone with drop table assist. The three rated least effective were upper cervical technique, non-thrust reflex/low force, and lower extremity adjusting. The four conditions rated most amenable to chiropractic treatment were noncomplicated low back pain, sacroiliac joint dysfunction, posterior joint/subluxation, and low back pain with buttock or leg pain. CONCLUSIONS: The ratings for the effectiveness of chiropractic technique procedures for the treatment of common low back conditions are not equal. Those procedures rated highest are supported by the highest quality of literature. Much more evidence is necessary for chiropractors to understand which procedures maximally benefit patients for which conditions.

Acute Disease↗
PubMed2001

[Dermatologic aspects of SAPHO-syndrome].

SAPHO syndrome (synovitis, acne, pustulosis, hyperostosis, osteitis) as a new disease entity was first described in 1987. The syndrome is characterized by the presence of pustular dermatoses together with aseptic osteoarticular lesions. The bone involvement includes hyperostosis, aseptic osteomyelitis or arthritis of the anterior chest wall, sacroiliac joints or long bones. Skin diseases include acne conglobata or acne fulminans, palmoplantar pustulosis and hidradenitis suppurativa. Authors describe the dermatological relationship of SAPHO syndrome reporting their 7 cases (3 acne fulminans, 4 palmoplantar pustulosis). Authors draw attention to the isotretinoin therapy as a possible provoking factor of the articular symptoms, and they emphasize the diagnostic role of bone scintigraphy.

Acne Vulgaris↗
PubMedDate not supplied

Staged closure of the pelvis in secondary repair of cloacal exstrophy in the older patient.

The authors describe a staged approach for pelvic closure applied in preadolescents and adolescents with previously failed closure of cloacal exstrophy. Closure of the pelvis was performed in four patients, 11 to 16 years old, with history of previous closures for their cloacal exstrophy that had resulted in either dehiscence or severe disfigurement. They were treated with pelvic osteotomies and external fixation; three later underwent internal fixation of the pubic rami. Genitourinary reconstructions were performed with the final stage of pelvic ring closure. Genitourinary closure was successful in all four patients despite a recurrent pubic diastasis resulting from sacroiliac joint instability in the patient not receiving internal fixation. Staged closure of the pelvis with iliac osteotomies, external fixation, gradual correction, and subsequent internal fixation of the approximated pubic rami can facilitate soft tissue closure of preadolescents and adolescents with unacceptably closed cloacal exstrophy.

Adolescent↗
PubMed2001

Acetabular osteitis in ankylosing spondylitis: does fibrillin figure in its pathogenesis?

In the hip and sacroiliac joints, ankylosing spondylitis attacks the acetabulum over the femoral head and the ilium in preference to the sacrum. Both sites involve inflammation in bone subjacent to fibrocartilage with relative sparing of opposing, hyaline cartilage-surfaced mates. This disease appears to target connective tissues rich in fibrillin-1. A cell-mediated autoimmune response may be involved.

Acetabulum↗
PubMedDate not supplied

[A new study on the midterm evolution of Fissinger-Leroy-Reiter syndromes seen in a military milieu (85 cases)].

Following-up a survey made in 1969 on 100 ex-soldiers suffering from the Fiessinger-Leroy-Reiter syndrome in Algeria, a new study investigated the evolution in 85 subjects, 85 percent of whom had suffered from the syndrome for 10 years or more. Those considered cured represented in the new study nor more than about 50 percent, instead of 65 percent, recurrences remained unchanged (15 cases out of 85 instead of 18 out of 100), the proportions with ankylosing spondylarthritis of the sacroiliac joints changed from 14 to 26 percent, and 5 patients remained unclassifiable. Sacro-iliac ankylosing spondylarthritis appeared in approximately half the cases in the 5 years that followed the commencement of the syndrome. Contrary to the findings in 1969, two cases of sacro-iliac ankylosing spondylarthritis were noted in patients who had experienced relapses. At present those in the cured group are those in whom the syndrome commenced the most recently and further deterioration in the figures may be expected in the years to come. Thus the long-term prognosis is difficult to evaluate from the initial symptoms. The severity of the evolution is only moderate, however, and without doubt the differences between individuals play an important role. The authors remain convinced of the principal that persons suffering from FLR are less likely to develop.

Arthritis, Reactive↗
PubMed1999

[Ankylosing spondylitis in Shantou: clinical experience in fifteen years].

OBJECTIVE: To evaluate the clinical features of ankylosing spondylitis (AS) in Shantou area and improve the diagnostic level and therapeutic effect. METHODS: Clinical and laboratory data, and the methods and effects of therapy were analyzed. Some patients were followed up. RESULTS: 94% of the cases had an insidious onset. Low back pain or discomfort, peripheral arthritis, positive "4" test and pressing tenderness over the sacroiliac joints and lumbar spine were the frequent symptoms and signs. The degree of sacroiliitis and involvement of hip and spine were related to the disease duration. However, hip joint involvement in juvenile onset AS did not relate to the disease duration. Some cases with disease duration as long as 16 years still remained at II of degree sacroiliitis. Clinical improvement was more obvious in the first two years of treatment. Although some patients came to a standstill condition after this period, yet the disease activity might still relapse with withdrawal of the treatment. The rate of adhering to the treatment for 1, 2, and over 5 years was 34.6%, 28.4%, and 10.3% respectively. The radiological changes frequently did not parallel with the clinical manifestations. CONCLUSION: Early diagnosis is of importance in improving the prognosis of AS and adherence to slow-acting anti-rheumatic drug therapy is beneficial in disease controlling. A follow up of more than 3 years is necessary to estimate the therapeutic efficacy, and the radiological change is the key indicator. AS is a heterogenic disease and the risk factors for prognosis should be further studied.

Adolescent↗
PubMed2002

Successful short term treatment of severe undifferentiated spondyloarthropathy with the anti-tumor necrosis factor-alpha monoclonal antibody infliximab.

OBJECTIVE: Tumor necrosis factor-alpha (TNF-alpha) has been detected in sacroiliac joints of patients with spondyloarthropathies (SpA). Anti-TNF-a therapy has been efficacious in patients with active ankylosing spondylitis (AS) and psoriatic arthritis. Similar to these SpA subtypes, therapeutic options in undifferentiated SpA (uSpA) are also limited. We tested the efficacy of the monoclonal anti-TNF-alpha antibody infliximab in patients with active and severe uSpA in an open observation trial. METHODS: Six patients with uSpA were treated with 3 infusions of infliximab in a dosage of 3 (n = 3) or 5 mg/kg (n = 3) at Weeks 0, 2, and 6. The total observational period was 12 weeks. The Bath AS Disease Activity Index (BASDAI), the Functional Index (BASFI), pain on a visual analog scale, the Bath AS Metrology Index (BASMI), and quality of life (SF-36) were assessed before, during, and after therapy. RESULTS: Significant improvement at Day 1 after the first infusion lasting until Week 12 was reported by 5/6 patients. Improvement of > or = 50% in all activity, function, pain, and swollen joint scores was observed in the patients taking 5 mg/kg. The 3 mg/kg dose was less effective, resulting in > or = 15% improvement in outcome variables. Peripheral arthritis, enthesitis, and spinal symptoms improved equally. C-reactive protein dropped in 4 patients. Health related quality of life increased. No serious side effects or infections occurred. CONCLUSION: These observations suggest that anti-TNF-alpha therapy has significant short term efficacy in patients with severe uSpA.

Acute Disease↗
PubMedDate not supplied

Symptomatic small non-obstructing lower ureteric calculi: comparison of ureteroscopy and extra corporeal shock wave lithotripsy.

OBJECTIVE: To compare the success, efficacy and complications of ureteroscopy (URS) and extra corporeal shock wave lithotripsy (ESWL) for the treatment of symptomatic small non obstructing lower ureteric calculi. SUBJECTS AND METHODS: This prospective non-randomised study was conducted simultaneously at two urological referral centres, included 280 patients with symptomatic small (4-10 mm) lower ureteric calculi (situated below the sacroiliac joint), with good renal function on intravenous urography. Patients were offered both the treatment options. One hundred and sixty patients chose ureteroscopy, whereas 120 patients were treated by ESWL. Standard techniques of ureteroscopy and ESWL were employed. Patients were followed-up to assess the success rates and complications of the two procedures. RESULTS: Ureteroscopy achieved complete stone clearance in one session in 95% of patients. In six patients ureteroscopy had failed initially and was later accomplished in second session improving the success rate to 98.7%. Two patients had a proximal migration of calculus that needed ESWL. Of the 120 patients treated by ESWL, 90% achieved stone free status at three months. Ureteroscopy was needed for twelve patients (10%) where ESWL failed to achieve stone clearance. There were no significant ESWL related complications. ESWL was administered on outpatient basis, while patients needed hospitalisation and anaesthesia for ureteroscopy. CONCLUSION: ESWL can be the primary mode of treatment for symptomatic small non-obstructing lower ureteric calculi as it is minimally invasive and safe. Ureteroscopy can be offered to patients who demand immediate relief or when ESWL fails.

Adolescent↗
PubMed2001

[Stiff painful spine in an 11-year-old girl with SAPHO syndrome].

Compression of the cervical spinal cord developed six months after the first signs of a stiff and painful spine in an 11-year-old girl. The clinical course, the association with other skeletal localization, particularly the sacroiliac joint and the roof of the acetabulum and the pathology findings of nonspecific inflammation led to the diagnosis of chronic recurrent multifocal osteomyelitis that can be included in a SAPHO syndrome (synovitis-acne-pustulosis- hyperostosis-osteitis). We report the specific findings in our case and review the literature to define the nosology framework of this rather uncommon condition. To our knowledge, this is the first report of spinal cord injury in a child related to SAPHO syndrome.

Acquired Hyperostosis Syndrome↗
PubMed1975

[HL-A B27 associated rheumatic disease].

Report on a HL-A B27 positive female patient with the typical cardiac lesion occasionally found inankylosing spondylitis, peripheral arthritis, and acute anterior uveitis but without clinical or radiological evidence of spine or sacroiliac joint involvement. The concept of "HL-A B27 associated disease", including ankylosing spondylitis as well as Reiter's disease or other forms of seronegative rheumatic diseases, is suggested.

Aortic Valve↗
PubMedDate not supplied

Thoughts concerning the early diagnosis of ankylosing spondylitis and related diseases.

The diagnosis of ankylosing spondylitis is mainly based on a radiograph of the sacroiliac joints. Thus, this is the standard imaging test. However, in the early phase of disease, conventional radiographs are often too insensitive to show sacroiliitis. In this clinical situation, HLA B27 testing and new imaging modalities such as magnetic resonance imaging may be helpful. Early forms of AS can be initially classified as undifferentiated spondyloarthritis. All subsets of spondyloarthritides may evolve later into AS. Since AS in association with psoriasis and chronic inflammatory bowel diseases is often HLA B27-negative, this test is of limited value under these circumstances. The usefulness of testing for HLA B27 and its subtypes differs among ethnic and racial groups. The value of this test for diagnosis depends on the individual pre-test probability in each setting.

HLA-B27 Antigen↗
PubMedDate not supplied

TNF-alpha antagonists for the treatment of juvenile-onset spondyloarthritides.

Juvenile-onset spondyloarthritides (SpA) is a term for a group of HLA-B27 related disorders. The hallmark signs and symptoms of this group of disorders include peripheral arthritis and enthesitis while sacroiliitis and spondylitis develop in some cases later on and extrarticular manifestations such as anterior uveitis occurs occasionally. Conventional medical therapy in children consists of non-steroidal anti-inflammatory drugs and corticosteroids that are administered intraarticulary, even in the sacroiliac joints. Sulfasalazine and methotrexate are given in cases of chronic synovitis or enthesitis. Unfortunately, these forms of therapy have limited efficacy in many cases and disease activity and damage may lead to various degrees of functional impairment. Recently, experience with TNFalpha-antagonists in adults has opened new perspectives for treating patients with refractory SpA, particularly ankylosing spondylitis (AS). So far there is only little experience in the treatment of juvenile-onset SpA, consisting of case reports and case series where etanercept or infliximab have been given to children suffering from refractory juvenile-onset AS and psoriatic arthritis. From these observations there is evidence that treatment seems to be as effective as in adults. Risks are likely to be the same as in patients suffering from other forms of juvenile idiopathic arthritides. However, without further studies no recommendations can be provided for indication for treatment, dosing, intervals and duration of treatment.

Age of Onset↗
PubMed2003

Physical and monetary costs associated with autogenous bone graft harvesting.

Although autogenous iliac bone is frequently used for bone graft, many well-documented complications are associated with this procedure-including chronic pain; nerve, arterial, and ureteral injury; herniation of abdominal contents; sacroiliac joint instability; pelvic fractures; hematoma; and infection. An understanding of the morbidities associated with bone graft harvesting and of the strategies for avoiding them is imperative for surgeons using this grafting source. In addition, although synthetic grafting materials are considered relatively expensive compared with autogenous sources, the majority of physicians are unaware of the actual direct and indirect costs associated with autogenous bone graft harvesting. Contemporary allograft and synthetic grafting composites are being developed to optimize and surpass the native qualities of autogenous sources (ie, osteogenesis, osteoinductivity, osteoconductivity). Careful comparison of the cost of these alternative sources with the physical and monetary costs of autogenous bone graft will undoubtedly make allograft, recombinant, synthetic graft composites the logical choice in the very near future.

Anesthesia↗
PubMed2003

Enthesalgia in childhood: site-specific tenderness in healthy subjects and in patients with seronegative enthesopathic arthropathy.

OBJECTIVE: The presence of pain over an enthesis defines enthesitis and is a major (or sole) clinical feature of childhood spondyloarthropathies. However, the presence or degree of tenderness of the entheses in healthy children is unknown. We studied the prevalence of enthesalgia and pain thresholds over entheses in healthy children and whether these sites are different from those in patients diagnosed with seronegative enthesopathic arthropathy (SEA syndrome). METHODS: We examined 234 schoolchildren aged 8 to 16 years for enthesalgia; those reporting tenderness were compared to randomly selected patients with SEA syndrome previously diagnosed in a tertiary outpatient clinic. RESULTS: Enthesalgia in at least one site was found in 68 children (29%). Schoolchildren had fewer sites than patients (mean 1.2 +/- 2.8 sites vs 8.1 +/- 4.5 sites; p < 0.0001). Enthesalgia was not associated with age, sex, or self-reported activity level. In schoolchildren, pressure thresholds were higher with age (p < 0.0001), and in boys (p = 0.014), and were decreased in those with enthesalgia (p = 0.003). The metatarsal heads had the lowest pain thresholds. Significant sites specific for SEA patients were: plantar fascial insertion (p < 0.0001), Achilles tendon insertion (p = 0.001), sacroiliac joint (p = 0.002), and inferior pole of the patella (p = 0.003). Of these 8 sites, only 10% of schoolchildren reported tenderness in 3 sites compared to 56% of children with SEA syndrome. CONCLUSION: Enthesalgia is not rare in children; metatarsalgia or a limited number of tender entheses should not define enthesitis. Enthesalgia in 3 of the 8 specific tender entheses noted above may better define childhood enthesitis.

Achilles Tendon↗
PubMedDate not supplied

Pelvic osteomyelitis in children: a comparison of decades from 1980-1989 with 1990-2001.

Since 1980, 64 children with pelvic osteomyelitis (40 boys) were treated at a major pediatric referral center. The average age was 11 years and 6 months. The presenting complaints included pain in 61 children, fever in 30, and altered weight-bearing in 31. The erythrocyte sedimentation rate was elevated in 56 and there was leukocytosis in 19. The most commonly affected sites were the ilium in 21 and the acetabulum in 20, followed by the pubis in 11 and the ischium in 10. Culture results were negative in 32 and positive for Staphylococcus aureus in 26. Treatment consisted of intravenous antibiotics in 62 and irrigation and debridement in five children, all of whom presented since 1990. The infection resolved in 62 children and persisted in two. Three developed complications, including fusion of the sacroiliac joint in one, deformity of the acetabulum in one, and one child with an underlying protein C deficiency developed thromboembolism. Recent patients have demonstrated increased severity, likely due to increased virulence of the organism.

Adolescent↗