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PubMed1990

Mechanically induced pelvic pain and organic dysfunction in a patient without low back pain.

Previous reports have identified mechanical disorders of the lumbar spine as a cause of pelvic pain and organic dysfunction (PPOD) in patients with low back pain. Less common however, are reports of mechanically induced pelvic pain and organic dysfunction in patients without accompanying low back pain. This report details the examination findings and treatment response of a patient with pelvic pain, organic dysfunction and clinical evidence of lower sacral nerve root compression (LSNRC) in whom low back pain was not an accompanying finding. Despite the absence of low back pain however, clinical evaluation revealed the characteristic findings of mechanically induced pelvic pain and organic dysfunction secondary to lower sacral nerve root irritation or compression as a result of a mechanical disorder of the low back. As in long standing cases of mechanically induced pelvic pain and organic dysfunction in which low back pain is present, this case also exhibited severe and widespread involvement of the pelvic organs. In spite of numerous failed attempts at treatment directed at the symptomatic component of the patients disorder, complete resolution of symptoms was achieved by manipulative treatment directed at the mechanical disorder of the lumbar spine.

Adult↗
PubMed1989

[Back injuries and the work site].

Payments through obligatory accident insurance for back injuries as a result of an accident in the legal sense are common. In contrast, the acceptance of back injuries as an occupational illness is associated with such strict legal prerequisites that, considering the early appearance and frequency of degenerative back diseases in the general population, the condition whereby a back injury must have been caused exclusively or predominantly, i.e. at least three quarters, by the occupational activity is satisfied only in rare cases. Epidemiological studies show that back conditions occur more frequently in certain types of exposed occupation. The high degree of causality required by the legislature is, however, not demonstrated so that back injuries could therefore be recognized as occupational illnesses only in rare cases. Because of this, prevention at the place of work is all the more important.

Accidents, Occupational↗
PubMed1980

The straight back syndrome.

The straight back syndrome, consisting of loss of normal upper thoracic spinal curvature associated with cardiac murmurs and radiographic cardiomegaly is considered a form of 'pseudoheart disease' which has been attributed to squashing of the heart in the reduced AP diameter of the chest. During an 18-month period 31 patients referred to a cardiologist were found to have a straight back. Forty-five relatives were subsequently examined and 27 were found also to have a straight back. Palpitations and chest pain were the commonest symptoms. On the lateral chest radiograph the distance from the middle of the anterior border T8 to a vertical line connecting T4 and T12 was found to be significantly reduced compared to controls, and a value less 1.2 cm is indicative of a straight back. Of the 58 subjects with the syndrome, 39 (67 per cent) had clinical and/or echocardiographic evidence of mitral valve prolapse. Respiratory function testing revealed no significant abnormality. HLA typing showed no association with an particular HLA antigen but indicates that the straight back syndrome is inherited as an autosomal dominant condition and suggested that the antigenic determinants may be located on chromosome 6. We conclude that the straight back syndrome should no longer be considered a form of pseudoheart disease and patients should be investigated for associated mitral valve prolapse and their relatives screened.

Adolescent↗
PubMed1995

The cemented acetabular component of a total hip replacement. All polyethylene versus metal backing.

The increasing use of a cementless acetabular component with a total hip replacement requires the need for metal backing, but metal backing with cement in the author's use has been less than optimal. The intention, therefore, was to evaluate all cemented acetabular components, with and without metal backing, used by the author, to offer a standard by which other acetabular components can be compared. From 1969 to 1983, 238 Charnley, 141 Mueller, 555 T-28, 100 Miami Orthopaedic Surgical Clinic total hip replacements with cemented all-polyethylene acetabula, and 134 Miami Orthopaedic Surgical Clinic total hip replacements with a cemented metal-backed acetabula were performed and followed from 1 to 22 years. The cemented acetabular component failure rates for the Charnley, T-28, and all-polyethylene Miami Orthopaedic Surgical Clinic were 14%, 10%, and 9%, respectively. There was a 20% failure rate in the Mueller and metal-backed Miami Orthopaedic Surgical Clinic acetabular components. The Charnley (p < 0.0001), T-28 (p < 0.0001), all-polyethylene Miami Orthopaedic Surgical Clinic (p < 0.0001), and Mueller (p < 0.012) total hip replacements demonstrated statistically improved survival rates as compared with the metal-backed Miami Orthopaedic Surgical Clinic acetabular components. The Charnley (p < 0.0001) and T-28 (p < 0.0003) sockets survived statistically better than the Mueller sockets.(ABSTRACT TRUNCATED AT 250 WORDS)

Acetabulum↗
PubMed1995

Regulation of calcium pump function in back inhibited vesicles by calcium-ATPase ligands.

OBJECTIVE: The aim was to evaluate the effect of changes in substrate-product concentrations of the overall sarcoplasmic reticular Ca(2+)-ATPase reactions on calcium pump function with an emphasis on those factors that modify back inhibition of the pump by intrareticular free calcium. METHODS: Sarcoplasmic reticular vesicles were isolated from the rabbit heart. Calcium uptake by the vesicles was measured with a calcium sensitive minielectrode and was related to ATPase activity, which was measured by the rate of inorganic phosphate (Pi) production or NADH oxidation. Back inhibition was varied by changing [oxalate]. RESULTS: At the high level of back inhibition and low calcium transport efficiency, calcium uptake by sarcoplasmic reticulum was stimulated by pH decrease, hydrophobic compounds, dimethyl sulphoxide, and ATP regeneration. These factors apparently modify either calcium binding to the low affinity binding site of Ca(2+)-ATPase or the effect derived from the binding of calcium to these sites. Under conditions where back inhibition was avoided and calcium transport efficiency was high, the same factors had a depressive effect on calcium uptake. Inorganic phosphate had a dual effect on the rate of calcium uptake supported by low [oxalate]: Pi < 2-3 mM strongly inhibited calcium uptake while further increase in [Pi] reversed this inhibition. At the lower level of back inhibition higher [Pi] was required to inhibit calcium transport. CONCLUSIONS: Changes in [H+], [ADP], and [Pi] can significantly affect calcium pump function, but the effect is dependent on the extent of back inhibition of calcium transport. Changes in the sarcoplasmic reticular Ca(2+)-ATPase environment which mimic those expected to take place at the start of reperfusion (pH increase to 7.0-7.1, high myoplasmic [Ca2+]) may have a depressive effect on the efficiency of calcium transport, provided that intrareticular free calcium is increased. Under those conditions factors able to decrease the inhibitory effect derived from the calcium binding to the low affinity binding sites are expected to improve the efficiency of calcium transport.

Adenosine Triphosphate↗
PubMed1994

[A retrospective study of the practice of "look-back" procedures, on the incidence of HIV-1/2-positive blood donors and the risk of transfusion-associated HIV infection in public-community blood banks in Germany].

OBJECTIVE: 'Look-back' investigations can reveal and confirm transfusion-transmitted infectious diseases and provide data for risk calculations of blood transfusions. DESIGN: In 1993 we distributed a questionnaire to all governmental and communal blood transfusion services in Germany. The questionnaire comprised questions about the methods, numbers and results of look-back investigations in case of HIV-1/2-positive blood donors with previous donations and in case of HIV-1/2-positive recipients of blood transfusions. The questionnaire was returned by almost all blood transfusion services (n = 75). One additional institution briefly informed us by telephone. SETTING: All governmental and communal blood transfusion services in Germany. PATIENTS: All recipients of blood or blood products in the years from 1985 till the end of 1992 who were treated in hospitals supplied by the transfusion services defined above. INTERVENTIONS: None. RESULTS: All blood transfusion services included have performed look-back studies since 1985. The methods used varied considerably. The interval of looking back mostly was sufficient. A main problem was the poor documentation in the medical records. The incidence of HIV-1/2-positive blood donations decreased from 11.6/100,000 in 1985 to 3.4/100,000 in 1992. Only 7 of 73 transfusion-transmitted HIV infections derived from transfusions after the introduction of HIV testing (October 1985). Since then the risk of transfusion-transmitted HIV infection can be calculated as 1/800,000 whole-blood donations of governmental and communal blood transfusion services. CONCLUSIONS: Since the introduction of HIV testing the risk of transfusion-transmitted HIV infection in Germany has been very low, at a rather stable rate of 1/800,000. The data from the look-back studies confirm the previous estimations of the risk of transfusion-transmitted HIV infections, which was calculated by the HIV incidence in the donor population. Nevertheless there is a need for standardization of look-back investigations.

AIDS Serodiagnosis↗
PubMed1994

[Study of prescriptions referred back to a health center].

OBJECTIVE: To study referred-back prescriptions, in the areas of source, consumption, cost and information supplied to the family doctor. DESIGN: Descriptive study of a prospective type. SETTING: "La Merced" Health Centre, Cádiz. PATIENTS AND OTHER PARTICIPANTS: All the reports sent over a two-month period from referral specialists (emergency, second level and hospital) to four consulting rooms at the Health Centre. MEASUREMENTS AND MAIN RESULTS: Out of the 6,499 on-demand consultations, 241 attended in order to obtain a referred-back prescription (3.74%). Of the total of 241 reports sent back by specialists, 12%, 7.9% and 69.7% did not report on diagnosis, recommended dosage and length of treatment, respectively. 44.8% were short-term treatments. In 47.7% of the referred-back prescription notes, only one prescription was required. Referred-back prescriptions supposed 9% of the prescriptions issued during the period under observation. CONCLUSIONS: The study only measured incidence, therefore underestimating referred-back prescriptions. In 48% of prescriptions, administrative time could have been saved by dispatching the prescription at its place of origin. There was a notable lack of information supplied in the reports, which we interpret as an indirect indicator of poor coordination between different levels of care. When prescription studies are carried out in Primary Care, the prescription profile of the referral specialists must be taken into consideration.

Community Health Centers↗
PubMed1993

Back transport: exploration of parents' feelings regarding the transition.

The purpose of this qualitative study was to explore parents' perceptions and the concepts involved in their preterm infant's back transport from a tertiary neonatal intensive care unit to their home community hospital. A convenience sample of fourteen parents were interviewed five to seven days after the back transport. Following data collection, the analysis of the parents' perceptions regarding the back transport of their premature infant identified a crisis theme that was influenced by several concepts. The subject's positive or negative meaning of the back transport during the pre-crisis phase defined the extent of the crisis during a three day transition period which led to an acceptance of events in the resolution phase. The subjects' perceptions of the previous events of hospitalization and communication of information regarding back transport influenced the meaning of the back transport for them. The extent of crisis during the transition phase was influenced by subjects' perceptions of medical complications, caretaking practice changes, environmental changes, feelings of powerlessness or empowerment, personal coping resources, and support systems available. Resolution in all cases occurred with an acceptance of events. Implications for practice and future research can be identified such as developing and testing education programs to prepare parents for the transition and strengthening the relationship between tertiary and community hospitals.

Adult↗
PubMed1996

Preliminary noninvasive back-pressure recordings of bladder pressure.

Obstructive voiding is best evaluated with urodynamics, including bladder pressure and urine flow rates. Until recently, the recording of bladder pressure required the use of a urethral catheter. In preliminary observations, a noninvasive back-pressure method using an external condom catheter has been introduced to determine bladder pressure. This device uses a side tube for pressure recording and an outlet tube that is clamped for short periods of time. We have investigated design criteria for back-pressure recording techniques. In the laboratory setting using a plastic model, we determined that a low compliance condom is needed. In addition, a back flow of fluid during the clamping procedure helps to obtain quick back pressures and facilitates evaluation of pressure when low flow rates are present. These modified condom devices were evaluated in four male subjects. Back pressures were not statistically different than bladder pressures recorded with a urethral catheter. The use of back pressures in the evaluation for obstructive uropathy can be enhanced by using a pressure and flow nomogram.

Humans↗
PubMed1997

[Predictive value of back fat thickness for body fat content in cattle].

Back fat thickness was measured at six points in 251 beef heifers aged 3 to 17 months, in 27 beef bulls aged 15 months and in 200 SMR-cows of different age. This was paralleled by estimation of body composition based on total body water analysis. All groups of animals showed the same pattern of back fat thickness for the measuring points investigated. This lead to the result of one optimum measuring point for determination of back fat thickness, which will be described. The portion of body fat relative to body weight change showed great variations in dependence on age. Therefore live weight is of limited relevance for the estimation of body condition. The correlation coefficients between back fat thickness and body fat content were estimated to be between 0.80 and 0.87 for all groups investigated. Change in back fat thickness by 1 mm corresponded to gain or loss of around 5 kg body fat in all animal groups. Hence, measurement of back fat thickness is a suitable method for objective estimation of body condition.

Adipose Tissue↗
PubMed1998

[Estimation of body composition based on total body water determination using phenazone for assessment of body fat gain in cattle. 2. Relationship between body fat content and back fat thickness].

Back fat thickness was measured at six points in 251 beef heifers aged 3 to 17 months, in 27 beef bulls aged 15 months and in 200 Holstein dairy cows of different age. This was paralleled by estimation of body fat content based on total body water analysis. All groups of animals showed the same pattern of back fat thickness for the measuring points investigated, which lead to the result of one optimum measuring point for determination of back fat thickness. The correlation coefficients between back fat thickness and body fat content were estimated to be between 0.80 and 0.87 for all groups investigated. Change in back fat thickness by 1 mm corresponded to gain or loss of around 5 kg body fat in all animal groups. Therefore it is possible to make concrete assessments of body fat content on the basis of back fat thickness.

Adipose Tissue↗
PubMed1998

Effect of a back massage and relaxation intervention on sleep in critically ill patients.

BACKGROUND: Critically ill patients are deprived of sleep and its potential healing qualities, although many receive medications to promote sleep. No one has adequately evaluated holistic nonpharmacological techniques designed to promote sleep in critical care practice. OBJECTIVES: To determine the effects of (1) a back massage and (2) combined muscle relaxation, mental imagery, and a music audiotape on the sleep of older men with a cardiovascular illness who were hospitalized in a critical care unit. METHODS: Sixty-nine subjects were randomly assigned to a 6-minute back massage (n=24); a teaching session on relaxation and a 7.5-minute audiotape at bedtime consisting of muscle relaxation, mental imagery, and relaxing background music (n=28); or the usual nursing care (controls, n=17). Polysomnography was used to measure 1 night of sleep for each patients. Sleep efficiency index was the primary variable of interest. One-way analysis of variance was used to test for difference in the index among the 3 groups. RESULTS: Descriptive statistics showed improved quality of sleep among the back-massage group. Initial analysis showed a significant difference among the 3 groups in sleep efficiency index. Post hoc testing with the Duncan procedure indicated a significant difference between the back-massage group and the control group; patients in the back-massage group slept more than 1 hour long than patients in the control group. However, the variance was significantly different among the 3 groups, and reanalysis of data with only 17 subjects in each group revealed no difference among groups (P=.06). CONCLUSIONS: Back massage is useful for promoting sleep in critically ill older men.

Aged↗
PubMed1998

Comparison between adjustable and non-adjustable hang-back muscle recession for concomitant exotropia.

We compared the results of strabismus surgery using adjustable and non-adjustable hang-back muscle recessions in 38 patients having concomitant exotropia. The two groups were matched for age of the patient, type of concomitant exotropia, amount of deviation, and type and amount of muscle surgery. At 6 months follow-up, 18 of the 19 patients (95%) in the adjustable hang-back recession group and 17 of the 19 patients (90%) in the non-adjustable hang-back recession group had ocular alignment within 10 prism diopters (PD) of orthophoria. At the most recent follow-up (mean 3.4 years), 12 of the 13 patients (92%) in adjustable hang-back recession group and 12 of the 14 patients (86%) in non-adjustable hang-back recession group had ocular alignment within 10 PD of orthophoria. There was no statistically significant difference in success rates between the two groups at 6 months postoperatively and at the most recent follow-up. This preliminary study suggests that non-adjustable hang-back muscle recession can be considered for routine concomitant exotropia.

Adolescent↗
PubMed1994

Personal history, training, and worksite as predictors of back pain of nurses.

Back pain among nurses is a common problem. Prior studies of this problem have been based on cross-sectional or retrospective data. This 18-month prospective study involving nurses newly graduated from nursing school investigated personal, worksite, and training factors associated with future risk of back pain. Each nurse underwent a preliminary interview and periodic follow-ups to identify those with back injuries. Contingency tables and logistic regression analyses demonstrated that prior significant back pain episodes (evidenced by previous job changes because of back pain, frequent medication use, etc.) were associated with increased future risk. Training at nursing school or on the job did not have a protective effect. This pilot study therefore suggests factors useful in placement and counseling of new nurses and indicates the need for further implementation of mechanical lift assist device use.

Accidents, Occupational↗
PubMed2006

Validity of pressure pain thresholds in female workers with and without recurrent low back pain.

Recurrent low back pain (LBP) is a common pain condition in elderly workers in a variety of occupations, but little is known about its origin and the mechanisms leading to an often disabling sensation of pain that may be persistent or intermittent. In the present study we evaluated the pressure pain thresholds (PPTs) in subjects suffering from recurrent LBP, as well as in healthy controls, to investigate if recurrent LBP is associated with an increased sensitivity of the muscular and ligamentous structures located on the lower back. One hundred and six female workers, aged between 45 and 62 years and working either in administrative or nursing professions were examined. The subjects were classified into LBP cases and controls based on the Nordic questionnaire. Subjects indicating 8-30 or more days with LBP during the past 12 months were graded as cases. PPTs were measured on 12 points (six on each side of the body) expected to be relevant for LBP (paravertebral muscles, musculus quadratus lumborum, os ilium, iliolumbar ligament, musculus piriformis and greater trochanter), as well as on a reference point (middle of the forehead) using a digital dolorimeter. The PPTs on all points on the lower back highly correlated with each other and a high internal consistency was found with a Cronbach alpha coefficient > 0.95. There was a moderate and significant correlation of the PPT on the forehead with the PPT on the lower back with correlation coefficients ranging from 0.36 to 0.49. In LBP cases from administrative professions, the PPT on the forehead was significantly decreased (P < 0.05). The PPT on the lower back did not significantly differ between the four groups studied, namely nurses and administrative workers with and without recurrent LBP. These results give evidence that recurrent LBP is not associated with an altered sensitivity of the muscular and myofascial tissues in the lumbar region. Furthermore, they raise questions about the value of reference point measurements in recurrent LBP.

Administrative Personnel↗
PubMed1998

Health-related fitness test battery for adults: associations with perceived health, mobility, and back function and symptoms.

OBJECTIVE: To evaluate the health-related content validity of nine fitness tests by studying how low, mid, and high levels of fitness are associated with perceived health and musculoskeletal functioning. DESIGN: Cross-sectional methodological study. SETTING: A research institute for health promotion. PARTICIPANTS: Middle-aged (37 to 57 years) men (n = 245) and women (n = 253), evenly selected from five age cohorts of a random population sample. MAIN OUTCOME MEASURES: The odds ratios (ORs) of selected health outcomes for low (least fit 20%), mid (next 40%), and high (most fit 40%) fitness categories in the different tests adjusted for several possible confounders. RESULTS: Cardiorespiratory fitness, as measured by 2-km walk test, was strongly and consistently associated with perceived health and mobility (stair climbing) in both genders (range of ORs, 2.4 to 17.6), and a somewhat weaker relationship was found with leg power and with leg strength (ORs, 2.5 to 7.2). Low fitness in back muscular endurance and upper-body strength were associated with mobility disability (ORs, 2.8 to 8.5) and with back dysfunction and pain (ORs, 2.9 to 6.1). High fitness in back endurance in men and in balance in women were related to positive back health (ORs, 2.5 to 3.7). Body mass index was associated with musculoskeletal disability in women (ORs, 2.4 to 5.3). Balance, leg strength, and leg flexibility in men; and leg power, trunk and leg flexibility in women were not associated with health outcomes. CONCLUSIONS: Among a middle-aged population, the majority of the evaluated fitness tests demonstrated health-related validity by strong associations with perceived health and musculoskeletal functioning, and by weaker associations with back symptoms.

Adult↗
PubMed1999

The power of the visible: the meaning of diagnostic tests in chronic back pain.

This article explores the meaning of diagnostic tests for people with chronic back pain. Lower back pain is one of the most common health problems in the US. Five to ten percent of the patients who visit a primary care provider for back pain ultimately develop a chronic condition. We draw on interviews with chronic back pain patients in Atlanta, Dallas and Seattle to argue that testing constitutes an important element in the legitimation of pain for these patients. We discuss three aspects that make testing an area of concern for patients: a strong historical connection between visual images and the medicalization of the interior of the body, a set of cultural assumptions that make seeing into the body central to confirming and normalizing patients' symptoms, and the concreteness of diagnostic images themselves. Our interviews show that when physicians cannot locate the problem or express doubt about the possibility of a solution, patients feel that their pain is disconfirmed. Faced with the disjunction between the cultural model of the visible body and the private experience of pain, patients are alienated not only from individual physicians but from an important aspect of the symbolic world of medicine. This paper concludes by suggesting that a fluid, less localized understanding of pain could provide a greater sense of legitimacy for back pain patients.

Adult↗
PubMed1997

Extensive reorganization of primary somatosensory cortex in chronic back pain patients.

The hypothesis of reorganization of the primary somatosensory cortex in states of chronic pain was assessed in 10 low back pain patients and nine matched healthy controls. Intracutaneous electric stimuli were applied to the left back and index finger at a standard, a non-painful and a painful intensity. Magnetic fields were recorded by a 37-channel BTi biomagnetometer from the hemisphere contralateral to the site of stimulation. The power of the early evoked magnetic field (< 100 ms) elicited by painful stimulation of the painful back in very chronic patients was elevated relative to that elicited by painful back stimulation of healthy controls and showed a linear increase with chronicity (r = 0.74). The maximum activity elicited in primary somatosensory cortex was shifted more medially in the very chronic back pain subjects. These data suggest that chronic pain is accompanied by cortical reorganization and may serve an important function in the persistence of the pain experience.

Adult↗