The prevalence and impact of respiratory symptoms in asthmatics and nonasthmatics during deployment

OBJECTIVE: The purpose of this study was to compare the prevalence, severity, and impact of respiratory symptoms in asthmatics and nonasthmatics during Operation Enduring Freedom and Operation Iraqi Freedom. METHODS: A survey was given to 1,250 active duty soldiers and Department of Defense contractors returning from Operation Enduring Freedom/Operation Iraqi Freedom. Subjects were asked about demographics, smoking habits, respiratory symptoms, and impact on job performance before and during deployment. Patients with a history of asthma were asked method of diagnosis, current symptoms, and asthma therapy. RESULTS: A total of 1,193 subjects returned the completed questionnaire (95% response rate). Mean age of respondents was 38 +/- 11 years, 83% (n = 977) were male, and 31% (n = 375) were past or present smokers. Sixty-one subjects (5%) reported a previous diagnosis of asthma. Both asthmatics and nonasthmatics had increased respiratory symptoms of wheezing, cough, sputum production, chest pain/tightness, and allergy symptoms during deployment compared to predeployment (p < 0.05 for all). When compared to nonasthmatics, asthmatic subjects reported more wheezing, sputum production, and chest pain/tightness during deployment (p < 0.0001, 0.05, 0.05 respectively), had more difficulty with military duties (p < 0.05), and were more likely to seek medical attention and receive duty restrictions (p < 0.0001). Twenty-six percent (n = 16) of asthmatics reported poor baseline symptom control, and this group had significantly increased symptoms, functional limitations, and health care utilization when compared to asthmatics who were symptom-controlled at baseline. CONCLUSIONS: Respiratory symptoms were common among both asthmatics and nonasthmatics during deployment. Differences in symptoms and health care utilization in this group of asthmatics were primarily due to subjects with poor baseline control.     

Development of an ambulatory recorder for evaluation of muscle tension-related low back pain and fatigue in soldiers' normal environments.

We have developed an ambulatory recorder capable of monitoring low back muscle tension, trunk motion, and ratings of pain and fatigue. It weighs 22 ounces, fits into a canteen belt, and records every second for 18 hours. Eleven subjects wore the recorder during all walking hours for between 3 and 5 days. Six subjects had chronic low back pain due to muscle tension, three experienced low back pain after labor, and two had no pain. Movement and muscle tension correlated highly when subjects were pain free but not when they were in pain. Muscle tension increased before pain was experienced.     

Sonography and MRI of the shoulder: comparison of patient satisfaction

OBJECTIVE: MRI and sonography are both used to evaluate patients with painful shoulders. This study was conducted to compare patients' perceptions and satisfaction with both tests. SUBJECTS AND METHODS: One hundred eighteen patients with shoulder pain and a clinically suspected rotator cuff tear underwent both MRI and sonography and filled out satisfaction surveys after both tests. Patients were asked the following questions: Did the test cause pain? If it did, they were asked to grade the pain on a scale of 1-10 (1, minimal pain; 10, severe pain). Did the test take too long? Would they be willing to undergo the test again? How would they grade their overall satisfaction with the test (1, poor; 2, fair; 3, good; 4, very good; and 5, excellent)? Which test did they prefer if both were equally accurate? RESULTS: Sonography caused pain above the baseline in 39 patients, with an average pain score (mean +/- SD) of 5.4 +/- 2.3, and MRI caused pain above the baseline in 40 patients, with an average pain score of 6.1 +/- 2.7 (p = 0.36). Two patients thought the sonography examination took too long, and 28 patients though the MRI examination was too long (p < 0.001). The average satisfaction level for sonography was 4.3 +/- 0.7 and for MRI, 3.6 +/- 1.2 (p < 0.001). The satisfaction score was higher for sonography in 54 patients, higher for MRI in 13 patients, and the same for both in 50 patients (p < 0.001). All patients were willing to repeat the sonography, but 10 patients were unwilling to repeat the MRI (p = 0.002). Ninety-three patients preferred sonography, eight patients preferred MRI, and 17 patients had no preference (p < 0.001). CONCLUSION: Most patients with shoulder pain prefer sonography to MRI.     

腰椎间盘MRI高信号区在诊断椎间盘源性下腰痛中的意义

目的:研究椎间盘源性下腰痛患者腰椎间盘纤维环后方MRI高信号区(HIZ)的临床意义。方法:回顾性分析2003年～2005年行MRI检查的下腰痛患者123例,合并有腰椎间盘突出、椎间盘炎、腰椎结核、滑脱、椎管狭窄等能引起下腰痛疾病的患者排除在本研究之外。对照组60例无典型的下腰部慢性疼痛,或有下腰部疼痛症状但临床检查已明确诊断为其它疾病。卡方检验比较两组HIZ出现率差异是否有显著性意义。结果:实验组出现HIZ患者67例(54%),明显多于对照组(9例,15%),P<0.001。结论:MRI显示的HIZ是椎间盘源性下腰痛的重要征象。     

Frequency of musculoskeletal symptoms in diagnostic medical sonographers. Results of a pilot survey

INTRODUCTION: We report the results of a pilot survey in diagnostic medical sonographers. Aim of the study was to evaluate the frequency of musculoskeletal disorders in sonologists and the relationship of these symptoms to ergonomic factors. MATERIALS AND METHODS: 340 sonographers (258 male, 82 female doctors; mean age 41.5 +/- 7.2 years) were given a questionnaire to fill out. The questionnaire asked questions about the sonologist's age, gender, technique of ultrasound procedure, physical activity, and work-related musculoskeletal complaints. Two symptom lists regarded carpal tunnel syndrome (CTS) symptoms (8 items) and other work-related musculoskeletal symptoms (13 items). The categorized response variables "have now" or "in the past" were provided. The symptoms experienced were categorized into three levels as no symptoms, few symptoms (1-4 symptoms), and many symptoms (> 5 symptoms). RESULTS: One third of the respondents reported having at least one or more work-related symptoms in the upper extremities. The most frequent symptoms were tingling (17.6%), numbness or finger pain (13.5%). Carpal tunnel syndrome had been diagnosed in 5 cases (1.5%). More than 60% of all respondents have experienced one or more musculoskeletal symptoms in the cervical or lumbar spine. The commonest symptom was neck and low back pain (67%). The pain was generally intermittent and occurred at the end of the workday. Motion impairment in the neck and/or back was present in 23.5% of cases. Twenty-five percent of respondents had received treatments for their symptoms and 10% reported having stopped work because of their symptoms. Data analysis showed that muscular efforts such as gripping the transducer, applying sustained pressure, and scanning with a correlated flexed or hyperextended wrist were significantly correlated with increasing severity of symptoms in the hand, wrist, and forearm area. On the other hand, low back pain appeared to be negatively correlated with correct position of the body. CONCLUSIONS: Several physical risk factors (e.g., repetitive work and force exertion, twisting of the body and poorly-adjustable chairs) have been identified for work-related upper extremity and spine disorders. Ergonomic redesign of the workstation configuration as well as allowing sufficient recovery time to body and arm muscles appear to be the main goals to achieve prevention of musculoskeletal disorders in sonographers.     

Recurrence of type I Modic inflammatory changes in the lumbar spine: effectiveness of intradiscal therapy

Here we report a case of recurrence of Modic type I inflammatory changes in the lumbar spine. A 49-year-old man was referred to our department with a history of chronic low back pain of at least 20 years. At the first consultation, he complained of low back pain only and had no other symptoms such as leg pain, numbness, or weakness. Although his pain was typically mild, he experienced one or two episodes of severe and incapacitating low back pain a year. After two intradiscal steroid injections, his pain disappeared immediately and completely. After 6 months of conservative treatment, Modic type I change switched to Modic type II change. However, 12 months after the first treatment, he once again experienced severe low back pain. Follow-up magnetic resonance imaging (MRI) indicated recurrence of Modic type I change that was stronger than the first occurrence. Two intradiscal injections relieved the pain. Six months after the second episode, follow-up MRI showed another switch of Modic type I change to Modic type II change. Switches of Modic change have been controversial, with mixed findings on pain, natural history, and degenerative changes. The present case reinforces the notion that Modic type I change corresponds to reversible local inflammation.     

中度高原地区坦克乘员腰痛的现患调查

目的：了解中度高原地区坦克乘员腰痛的发病情况、流行病学特点。方法：采用问卷调查、实地考察、物理检查、统计分析等方法，对中度高原地区1041名坦克乘员腰痛情况进行横断面调查。结果：1041名坦克乘员中腰痛患病率45．9％，各工种驾驶员检出率最高（P〈0．05）。腰痛随兵龄增加而明显升高，5年以上驾驶员患病率高达87．5％。经多元回归分析，吸烟、反复高举重物、训练中反复弯腰3种因素与腰痛相关。结论：中度高原地区坦克驾驶员腰痛患病率高，发病率随从业时间而增大。     

Returning athletes with severe low back pain and spondylolysis to original sporting activities with conservative treatment

The purpose of this study was to clarify the efficacy of conservative treatment in athletes with severe low back pain and spondylolysis, especially focusing on returning to original sporting activities. One hundred and four athletes (96 males and eight females), who consulted our sports medicine clinic during the 11-year period between September 1991 and October 2002 because of low back pain with an apparent defect of the pars interarticularis on plain radiographs, were subjected to conservative treatment. The mean age of the patients was 20.7 years. Of all the patients, 40 (38.5%) discontinued sporting activities due to severe low back pain, and were conservatively treated with activity restriction and antilordotic lumbosacral bracing, aimed at relieving low back pain by achieving stability of the fracture partly associated with fibrous union. After their low back pain was markedly reduced, the brace was removed and then individual training to return to the original sporting activities was started. Thirty-five patients (87.5%) could return to their original sporting activities in an average of 5.4 months (range: 1.0-11.5 months) after the onset of treatment, and could continue the activities for at least 6 months despite non-bony union. These results suggest that the outcome of conservative treatment with activity restriction and bracing appears to be satisfactory in controlling symptoms and returning to original sporting activities. Randomized controlled trials or comparative follow-up studies are needed to confirm our results.     

Self-reported health, physical activity and prevalence of complaints in elite cross-country skiers and matched controls

AIM: The purpose of this study was to compare physical health, physical activity and location for possible symptoms in high school students with cross-country skiers of the same age from ski high schools. Another aim was to study back pain with regards to influence on skiing. METHODS: The subjects studied were: 92% (n=120) of all Swedish cross-country skiers at ski high schools and 68% (n=993) of regular high school students from the North part of Sweden answered a reliable questionnaire (r=1) with regards to health, physical activity and location of possible symptoms/injuries during the last 3 months. Furthermore, the skiers answered questions on possible ski related back pain. RESULTS: All skiers were active also in other sports compared with 26% of the controls and at considerably higher levels of physical effort than the controls; 92% of the skiers and 76% of the controls described themselves as healthy, meaning 'very good' or 'good' (P=0.0001); 55% of the skiers and 64% of the controls reported recent symptoms (P=0.06); 47% of the skiers reported previous or present complaints of back pain, mainly low back pain, which could be relieved by changing body position from a flexed to a more extended one while skiing, and 77% reported their back pain to disappear during rest. CONCLUSIONS: These results show the need for encouraging regular high school students to participate in sport. It also shows the importance of introducing preventative strategies regarding back pain to long-distance cross-country skiers, who are exposed to a prolonged flexed position of their back.     

Outpatient care use among female veterans: differences between mental health and non-mental health users.

We examined the influence of mental health service use on outpatient health service use among female veterans. We conducted a retrospective and correlational study of treatment-seeking women and their pattern of health service use and the relationship between mental health and somatoform symptoms and service use. Data were obtained from a self-report measure designed to screen for mental and somatoform symptoms and from a federally maintained database of all outpatient contacts. Women who used mental health services were more likely to have a greater number of non-mental health visits than women who did not. The most commonly endorsed somatoform symptoms were feeling tired or having low energy and pain in extremities and joints. These symptoms were correlated with non-mental health service use, as were back pain, menstrual pain or problems, and trouble sleeping. We conclude that a history of somatoform symptoms might increase rates of health service use despite treatment for mental problems.     

Pulmonary decompression sickness at altitude: early symptoms and circulating gas emboli

INTRODUCTION: Pulmonary altitude decompression sickness (DCS) is a rare condition. 'Chokes' which are characterized by the triad of substernal pain, cough, and dyspnea, are considered to be associated with severe accumulation of gas bubbles in the pulmonary capillaries and may rapidly develop into a life-threatening medical emergency. This study was aimed at characterizing early symptomatology and the appearance of venous gas emboli (VGE). METHODS: Symptoms of simulated-altitude DCS and VGE (with echo-imaging ultrasound) were analyzed in 468 subjects who participated in 22 high altitude hypobaric chamber research protocols from 1983 to 2001 at Brooks Air Force Base, TX. RESULTS: Of 2525 subject-exposures to simulated altitude, 1030 (41%) had symptoms of DCS. Only 29 of those included DCS-related pulmonary symptoms. Of these, only 3 subjects had all three pulmonary symptoms of chokes; 9 subjects had two of the pulmonary symptoms; and 17 subjects had only one. Of the 29 subject-exposures with pulmonary symptoms, 27 had VGE and 21 had severe VGE. The mean onset times of VGE and symptoms in the 29 subject-exposures were 42 +/- 30 min and 109 +/- 61 min, respectively. In 15 subjects, the symptoms disappeared during recompression to ground level followed by 2 h of oxygen breathing. In the remaining 14 cases, the symptoms disappeared with immediate hyperbaric oxygen treatment. CONCLUSIONS: Pulmonary altitude DCS or chokes is confirmed to be a rare condition. Our data showed that when diagnosed early, recompression to ground level pressure and/or hyperbaric oxygen treatment was 100% successful in resolving the symptoms.     

Leisure physical activity and various pain symptoms among adolescents

OBJECTIVES: To investigate the association between leisure physical activity and various pain symptoms in adolescents. METHODS: In this nationwide cohort based cross sectional study in Finland, 698 schoolchildren, 344 girls and 354 boys, aged 10 to 17 years responded to a questionnaire on pain symptoms (neck and shoulder pain, upper back pain, low back pain, upper limb pain, lower limb pain, headache, and abdominal pain) and physical activity habits and also participated in a fitness test. RESULTS: Reported physical activity correlated with measured fitness. Musculoskeletal pains (p = 0.013) (in particular low back pain (p = 0.022), upper limb pain (p<0.001), and lower imb pain (p<0.001)) were found more often in subjects participating in large amounts of leisure physical activity, while non-musculoskeletal pains (p = 0.065) (in particular headache among boys (p = 0.004)) tended to be less common. Co-occurrence of different musculoskeletal pains was common in subjects participating in sports. CONCLUSIONS: In addition to its likely long term health benefits, vigorous physical activity causes musculoskeletal pains during adolescence. This should be considered when tailoring health promotion programmes to adolescents. Also, co-occurrence of musculoskeletal pains may occur as the result of sports activity, which should be considered as a confounder in epidemiological studies on fibromyalgia and related issues.     

Physical therapy and changes in disability for patients with low back pain

OBJECTIVE: The purpose of this study was to describe the changes in disability for patients being treated for low back pain (LBP) at a military physical therapy clinic from the time of initial evaluation to discharge from physical therapy and to compare those changes across categories of symptom duration and location. METHODS: Three hundred four consecutive patients who completed a course of physical therapy for LBP were evaluated with the Oswestry LBP Disability questionnaire at the time of initial evaluation and discharge from physical therapy. RESULTS: In all of the patient groups, mean Oswestry scores had decreased significantly from the time of initial evaluation to discharge from physical therapy, indicating that patients experienced significantly decreased levels of disability at the time of discharge from physical therapy. However, patients with LBP without lower extremity symptoms generally had greater decreases in disability than patients with LBP with lower extremity symptoms. Furthermore, whereas patients in the acute groups had the greatest decrease in disability, patients in the chronic groups had the smallest decrease in disability. CONCLUSION: Clinicians should use LBP symptom duration, as well as the presence or absence of lower extremity symptoms, to assist in developing treatment prognoses for patients with LBP.     

Clinical MR imaging of degenerative spinal disease: pulse sequences, gradient-echo techniques, and contrast agents.

DEGENERATION OF THE INTERVERTEBRAL disk is a ubiquitous process, seen at autopsy in 97% of adults by age 49 years (1). Low back pain is the most expensive health care problem in patients 20–50 years old, with $14 billion spent yearly on treatment and compensation (2). The greatest costs connected with low back pain occur in patients who have pain longer than 3 months and in those with recurrent pain episodes (3). Approximately 5.2 million people are disabled by back pain (3–5). These statistics indicate that the accurate diagnosis of back pain disease is obviously of great importance. In the diagnosis of disk degeneration and its sequelae, magnetic resonance (MR) imaging has become a key ingredient. The utility of conventional two-dimensional spin-echo MR imaging of the spine has been firmly established for extradural disease (6–8). Gradient-echo techniques have more recently been used to enhance the cerebrospinal fluid (CSF)-extradural interface in the evaluation of degenerative disease (9–13). Some of the new imaging findings and concepts regarding the use of contrast material and three-dimensional techniques in the evaluation of degenerative disease of the spine are reviewed.     

Low Back Pain in the Emergency Department—Are the ACR Appropriateness Criteria Being Followed?

PurposeTo assess the prevalence of appropriate imaging among emergency department (ED) patients with low back pain.MethodsOur level-1 ED records were retrospectively searched for patients with a chief compliant of “low back pain” from January to April 2013. Of 624 patients, 100 were randomly selected and analyzed for their demographics, presentation, imaging, treatment, and outcomes. The study indication for imaging was compared with the ACR Appropriateness Criteria, and the indication was deemed appropriate if it received a rating of ≥5.ResultsThe mean age of the study population was 48 years (50% women, 50% men). The majority presented with acute or acute on chronic low back pain (94 patients), and half had a precipitating event (50 patients). A total of 28 (28%) patients underwent imaging in the ED; 24 (24%) had outpatient imaging; 54 (54%) had neither ED nor outpatient imaging. In all, 96% (27 of 28) of patients imaged in the ED, and 96% (23 of 24) imaged as outpatients, were appropriately imaged. Of patients who did not undergo imaging, 96% (52 of 54) were appropriately not imaged. A total of 76 patients (76%) had follow-up after discharge: of these, 42 (55%) had resolution or return of pain to baseline with conservative management; 18 (24%) had improvement with intervention (epidural steroid injection or kyphoplasty); 8 (10%) improved with surgery; and 8 had persistent pain (11%).ConclusionsThe majority of patients presenting to the ED with low back pain did not undergo imaging. The vast majority of those who underwent imaging were appropriately imaged, based on the ACR Appropriateness Criteria.     

椎弓峡部裂在腰腿疼痛患者中的患病率及其与椎体滑脱的相关性

目的研究椎弓峡部裂在腰腿疼痛患者中的实际患病率,并探讨其与椎体滑脱的相关性。资料与方法筛选行MSCT扫描的5301例腰腿疼痛病例作为研究对象,详细记录有无椎弓峡部裂及椎体滑脱。结果 5301例中,发现椎弓峡部裂221例,其中男112例,女109例,男、女之间差异有统计学意义(χ2=220,P<0.001);在221例中有236个腰椎有椎弓峡部裂,其中单侧22个(9.95%),双侧214个。按照Meyerding分级,椎体Ⅰ度滑脱116个,Ⅱ度滑脱4个,无Ⅲ、Ⅳ度滑脱。双侧、单侧椎弓峡部裂滑脱发生率分别为55.14%、9.09%,二者之间差异有统计学意义(χ2=19.621,P<0.001,rs=0.277)。结论椎弓峡部裂在腰腿疼痛患者中的实际发生率约是4.17%(男性4.61%,女性3.80%),椎弓峡部裂与椎体滑脱呈低度相关。     

Die Ballonkyphoplastie in der Behandlung des Rückenschmerzes

BACKGROUND: Experience of just under 5 years has shown that balloon kyphoplasty can be just as successfully employed as the longer-stablished vertebroplasty for the treatment of back pain due to recent or prior osteoporotic fractures as well as new traumatic fractures. MATERIAL AND METHOD: Among 345 patients with a total of 690 treated vertebral bodies, the change in pain symptomatology was analyzed for a follow-up period of 12 months in 40 study patients who underwent kyphoplasty and a control group of 20 patients. In addition, the pain experienced by a further 29 patients with new traumatic vertebral body fractures was monitored over a 12-month period. These fractures were partly managed by fixateur interne alone and by a combination of fixateur interne and kyphoplasty. RESULTS: The 40 patients treated by kyphoplasty had a baseline VAS score of 26.2+/-2.00, which increased to 44.4+/-3.11 after 12 months, while the respective scores for the control group were 33.6+/-4.21 and 34.3+/-4.35. In the 29 patients with new traumatic vertebral body fractures, the initial VAS score was 62 and after 12 months a distinct reduction of pain was noted with a score of 20 (100 = maximum pain, 0 = no pain). The number of times that the 40 patients managed by kyphoplasty had to consult their general practitioner was significantly reduced by the pain therapy. CONCLUSION: Balloon kyphoplasty verifiably improved the pain symptomatology after vertebral fracture over a period of 12 months. Comparison with the control group, which received the same osteoporosis drug therapy, confirmed the effect of this minimally invasive treatment form.     

Radiating pain to the lower extremities caused by lumbar disk rupture without spinal nerve root involvement.

PURPOSETo locate the origin of the pain during lumbar diskography by means of a limited intradiskal injection of a local anesthetic.METHODSLumbar diskography by the direct central posterior approach was performed in 235 consecutive patients. In 17 patients, severe and persistent low back pain, with unilateral or bilateral radiation to the lower extremities, was provoked by contrast injection into only one disk. One milliliter of 1% lidocaine was then slowly injected in the center of these disks.RESULTSA 75% to 100% reduction of the low back pain was experienced by 13 patients, and a 75% to 100% reduction of the radiating pain was experienced by 16 patients within 60 seconds after the intradiskal injection of lidocaine. Radiographs demonstrated radial tears through the entire annulus thickness in 16 of 17 disks.CONCLUSIONOur results suggest that, in some patients with low back pain and unilateral or bilateral radiation to the lower extremities, the pain arises from within the disk. In these cases, pain radiating to the lower limb seems to be a referred type and seems unrelated to direct nerve root compression or irritation by a disk fragment in the epidural space.     

Transcatheter thrombolytic therapy for acute mesenteric and portal vein thrombosis

PURPOSE: The purpose of this study was to evaluate the utility of transcatheter thrombolytic therapy in 20 patients with acute or subacute (symptoms <40 days) portal and/or mesenteric vein thrombosis with severe symptoms, deteriorating clinical condition, and/or persistent symptoms despite anticoagulation. MATERIALS AND METHODS: This retrospective study examined 12 male patients and eight female patients seen over a period of 11 years. The average age was 37.6 years. Four of the patients had previously undergone liver transplantation. An anatomic classification system was established to describe the extent of thrombus at the time of diagnosis. Patients were treated with thrombolytic therapy via the transhepatic route, common femoral vein route, and/or superior mesenteric artery route. Improvement in symptoms, avoidance of bowel resection, complications, and radiographic evidence of clot resolution were the main clinical outcomes. RESULTS: Fifteen of the 20 patients exhibited some degree of lysis of the thrombus. Three patients had complete resolution, 12 had partial resolution, and five had no resolution. Eighty-five percent of patients (n = 17) had resolution of symptoms. Sixty percent of patients (n = 12) developed a major complication. No patients required bowel resection after thrombolytic therapy. One patient died with gastrointestinal hemorrhage and septic shock 2 weeks after thrombolytic therapy. Other major complications included bleeding and conditions requiring transfusion. No patients developed new portal or mesenteric thromboses. Two of the patients who received transplants eventually required repeat transplantation. CONCLUSIONS: Transcatheter thrombolysis was beneficial in avoiding patient death, resolving thrombus, improving symptoms, and avoiding bowel resection. However, there was a high complication rate, indicating that this therapy should be reserved for patients with severe disease. Further evaluation of these techniques and outcomes should continue to be pursued.