Industrial back belts and low back pain: Mechanisms and outcomes

The recent increased utilization of industrial back belts as personal protective equipment in the workplace has generated considerable controversy among occupational health and safety professionals in the United States. The purpose of this article is to review the literature regarding proposed mechanisms of action of these devices and studies related to outcome of belt utilization in the prevention of low back pain and disability in the workplace. At the present time, neither the suspected mechanisms of action nor the efficacy of these devices in the primary, secondary, and tertiary prevention of work-related low back pain has been adequately demonstrated in clinical trials. As a result, generally accepted guidelines regarding the safe use of belts in the occupational setting have not been established. Based on this review it is recommended that further well-controlled, prospective, randomized clinical trials are necessary to evaluate the effectiveness of these devices as personal protective equipment. During the interim, the decision to prescribe belts to employees in the workplace should be at the discretion of an adequately trained occupational health care provider. These devices should not be provided as an alternative to appropriate administrative and/or engineering controls.     

Ethical dilemmas in today's nuclear medicine and radiology practice.

Throughout history, societies have developed their own codes of ethics, including those pertaining to the practice of medicine. In the United States, physicians have adopted a set of ethics based on religious values and historical teachings. We, as physicians, have been presented several codes of ethics, including the American Medical Association Code of Ethics and the American College of Radiology Code of Ethics. Over time, we have learned to appropriately apply these codes to our daily practice. With the advent of new technologies in imaging, we may lose sight as to the transfer of these principles to reflect current conditions. Recent history has shown a trend of new technology leading to potential misuse of this technology and further leading to stricter governmental regulations. It is the purpose of this review to give guidelines for dealing with new technologies, such as PET imaging, and we describe a radiologist's ethical responsibility in a doctor-patient relationship. A historical review of medical ethics will lead to discussions about various issues affecting radiologists and nuclear physicians. To be sure, not all ethical situations are black and white, and therefore there are many gray areas. The opinions expressed in this article are those of the authors and are based on extension of already established rules of ethical conduct.     

International disaster mental health.

This article distills key issues and controversies in the field of international disaster mental health. It offers perspectives from cross-cultural research and describes current controversies, including the appropriateness of bringing to bear Western structures of mental health and psychiatric diagnosis to non-Western settings. It reports early lessons learned from the field regarding what might best constitute assistance within a foreign culture and where to place emphasis. It recommends becoming involved within the relief establishment.     

Indirect blood pressure measurement in pregnancy: Korotkoff phase 4 versus phase 5.

Controversy exists regarding which Korotkoff phase should be used to estimate diastolic blood pressure during pregnancy, some authorities recommending phase 5 (disappearance of sounds) and others suggesting phase 4 (muffling). Available data indicate that Korotkoff phase 5 more closely approximates true intraarterial diastolic pressure in pregnant women. Nonetheless, it has been suggested that phase 5 is unmeasurable in a significant number of gravid women, making this end point less desirable. However, studies examining this issue indicate that Korotkoff phase 5 is determinable in more than 90% of gravid women and that the incidence of an indeterminable phase 4 is at least as great as that for phase 5. Moreover, there appears to be greater observer variability in the measurement of phase 4 compared with phase 5. We conclude that available evidence supports recommendations for the use of Korotkoff phase 5 as the preferred end point to estimate diastolic blood pressure during pregnancy. In those few patients having very low or indeterminate phase 5 determinations, both phase 4 and phase 5 should be recorded and the former used to guide patient management. An alternative strategy is to record both phases in all gravid women beginning at the first prenatal visit so that baseline phase 4 values are available in the event that phase 5 becomes indeterminate.     

A leg ulcer as manifestation of metastatic squamous cell vaginal carcinoma

Cutaneous metastasis of vaginal carcinoma is extremely rare. So far, the total number of reported skin metastasis of vaginal carcinoma is only one. We present another case with an unusual manifestation of vagina carcinoma metastasis: skin metastasis presenting as a leg ulcer on the lower leg.     

High tolerance of lampreys to Kepone® toxicity

Larval sea lampreys (Petromyzon marinus) were exposed to the organochlorine insecticide Kepone^® in freshwater solution in a continuous flow diluter system at 12 and 20°C. At 12°, the 36-hr LC50, 96-hr LC50, and incipient lethal concentrations were 1,100, 444 and 145 g Kepone/ L, respectively, while at 20°, the 96-hr LC50 was 414 g/L. These are the highest LC50 values for Kepone ever reported for a fish species. Rates at which larval lampreys accumulate and clear Kepone were measured at 12°C. The depuration rate constant (K_d: 0.13–0.46 per day) was the highest ever reported in a fish species, so rapid elimination may contribute to the exceptional ability of lampreys to survive acute Kepone poisoning. The uptake rate constant (K_u) was 450–650 per day, and the bioconcentration factor averaged about 1900. The most likely source of high tolerance of lampreys to Kepone is an ability to withstand high tissue levels: Lampreys survived body burdens of 500–600 g Kepone/g, exceeding all other known vertebrates. Technical difficulties associated with the use of Kepone solutions are discussed, such as precipitation and loss from solution through apparent volatilization.     

Myelin deficiency in female rats due to a mutation in the PLP gene.

Myelin deficiency (md) in female rats due to a mutation in the X-linked proteolipid protein (PLP) gene is caused by X-chromosome monosomy. Cytogenetic analysis revealed a single X karyotype [41,X(md/0)]. An immunocytochemical, electron microscopic, and biochemical study was performed on male and female md rats. The central nervous system (CNS) of the female md rat [41,X(md/0)] revealed the same total lack of PLP as the CNS of the affected male littermate [42,XY(md/Y)]. Immunocytochemistry for myelin basic protein (MBP), myelin-associated glycoprotein (MAG), and 2',3'-cyclic nucleotide-3'-phosphodiesterase (CNP) revealed "islands" of myelin sheath-like reaction product in both. Electron microscopy showed great paucity of compact myelin sheaths in 41,X(md/0) and 42,XY(md/Y). Reduced levels of MPB, MAG, and CNP were confirmed for both sexes but MAG and CNP were substantially higher in 41,X(md/0). Sexual differentiation of the brain may account for the observed differences since normal female reproductive organs are present in the md female rat.     

Parathyroid hormone related protein in hypercalcaemia of Hodgkin''s disease.

The role of parathyroid hormone related protein (PTHRP) as a humoral mediator of hypercalcaemia was investigated in a patient with lymphocyte depleted Hodgkin's disease during an episode of hypercalcaemia, using an immunohistochemical staining technique for PTHRP on the tumour tissue and an immunoradiometric (IRMA) assay for PTHRP1-86 on the patient's plasma. The plasma PTHRP was less than 0.23 pmol/l in the range found in normocalcaemic controls, and the immunohistochemical staining was not positive for protein. PTHRP did not have a role in the pathogenesis of hypercalcaemia in this patient.