Low back pain education and short term quality of life: a randomized trial

Background  

Different interventions can reduce the burden of the chronic low back pain. One example is the use of a 'Back School Programme'. This is a brief therapy that uses a health education method to empower participants through a procedure of assessment, education and skill development. This study aimed to evaluate to what extent the programme could improve quality of life in those who suffer from the condition.     

Factors affecting coronal fracture of anterior teeth in North Jordanian children

Abstract –  The aims of this study were to investigate the incidence of coronal fracture of the anterior teeth in North Jordanian schoolchildren and to study the main predisposing factors and the factors that may affect the severity of this fracture. A study group (958) comprising schoolchildren aged 13–15 years was chosen by a simple random method from five geographical areas in Irbid Governate, Jordan. All children completed a questionnaire related to history of trauma to their anterior teeth before they had a clinical examination for lip competence, lip line and amount of fracture. Overjet was recorded from a study cast made for each student. Statistical analysis was performed using chi-square test. The results showed a prevalence of 11% of coronal fracture with female-male ratio of 1:1. An increase in the overjet more than 3 mm doubled the incidence of coronal fracture while overjet more than 6 mm increased the incidence fourfold. There was higher incidence of coronal fracture associated with lip incompetence and low lip line ( P  < 0.01). The severity of fracture increased in children with a larger overjet ( P  < 0.001). It was concluded that overjet, lip competence and lip line were important predisposing factors to coronal fracture of the anterior teeth while the severity of the fracture was mainly determined by overjet.     

Osteoid osteoma of the first 2 cervical vertebrae. Report of 4 cases

Osteoid osteoma affects the spine in only 10% of cases. More than 50% of the spinal cases involve the lumbar and cervical vertebrae. Involvement of C-1 and C-2 vertebrae has previously been reported only very rarely in the published literature. The authors report 4 cases of upper cervical osteoid osteoma, 1 involving C-1 and the other 3 C-2, and they discuss different aspects of management in similar cases. The patients were 14, 17, 35, and 46 years old, and all presented with neck pain and various degrees of painful limitation of head rotation not ameliorated by ordinary analgesics. Radionuclide isotope bone scans, CT scanning, and MR imaging were helpful preoperative diagnostic modalities. The first attempt at eradication of the lesions failed in 2 cases and the lesions could be excised totally at a second approach. Postoperatively, the patients all became pain free and gained full range of neck motion. There has been no tumor recurrence and no sign of instability in short- to medium-term follow-up. Among the several etiologies mentioned for neck pain and torticollis, osteoid osteoma of the first 2 cervical vertebrae should be considered as a possible but rare cause. Even though different kinds of management have been mentioned for osteoid osteoma, resection of the lesion remains the best option for achieving a cure.     

Reliability, validity and factor structure of the GDS-15 in Iranian elderly

OBJECTIVES: Depressive disorders are a public health problem even in developing countries. Access to valid and reliable screening instruments is needed for conducting community surveys. The main objective of this study is to provide the Iranian version of the Geriatric Depression Scale-15 (GDS). METHODS: The GDS-15 Farsi version was developed by translation and back translation. Two hundred and four subjects aged 59 years or older, who were chosen randomly from residents of the Ekbatan district of Tehran, the capital city of Iran, completed the GDS-15. The Composite International Diagnostic Interview (CIDI) was used to establish a gold standard diagnosis of major depressive disorders. RESULTS: The GDS was found to be an internally consistent measure. Alpha, split-half coefficients and test-retest reliability were 0.9, 0.89 and 0.58 respectively. Two factors were extracted by using factor analysis and the principle component analysis (varimax rotation): 'depression' and 'psychosocial activity'. The Depression factor (omitting items 2, 9, 10, 13), which could be considered as a short form of the scale (alpha = 0.92), has significant correlation with the main scale (r = 0.58). Using receiver operating curve (ROC) analysis, the optimum cutoff score for GDS-15 is 7/8, yielding a sensitivity of 0.9 and a specificity of 0.84. The optimum cutoff score for GDS-11 is 6, yielding a sensitivity of 0.9 and a specificity of 0.83. CONCLUSION: The long and short forms of the GDS have excellent properties as screening instruments for major depression in older dwellers in Iran, particularly in urban areas, as presented in our findings.     

Surgical approach after failed enteryx injection for GERD.

OBJECTIVE: We report on 3 patients who underwent laparoscopic antireflux procedures for persistent symptoms of GERD after biopolymer injection. METHODS: Experienced laparoscopic surgeons completed all 3 procedures laparoscopically. In 2 patients, there was an extramural extravasation of the polymer outside and adherent to the esophageal wall. In these patients, a partial posterior fundoplication was used. The third patient, who had the polymer material deposits removed preoperatively by endoscopic mucosal resection, underwent a Nissen fundoplication. RESULTS: Postoperative recovery was uneventful in all cases. At follow-up of 6 to 12 months, all patients were symptom free, off medical therapy, and experiencing no dysphagia. CONCLUSION: Surgical therapy for patients after failed biopolymer injection is safe and effective. The choice of surgery may depend on whether the polymer mass can be removed preoperatively.     

Bilateral tibial lengthening over the nail: our experience of 143 cases

Introduction

Using lengthening over an intramedullary nail as a technique for cosmetic purposes improves the individuals’ quality of life and provides more satisfactory results due to less external fixator period.

Methods

This study reports a case series of 143 individuals who underwent bilateral tibial lengthening over an intramedullary nail for cosmetic purposes together with the review of parameters related to the surgery and complications. Level of satisfaction was measured with the standard visual analog scale at least 1 year after removal of external fixator.

Results

In this study, mean (SD) age of patients was 26.6 (7.26) years. 85 (59.4 %) participants were male and 58 (40.6 %) were female. Mean end lengthening of all individuals was 6.65 cm. The mean external fixator period was 93.7 days. Complication rate was 0.74 per segment but it decreased to 0.45 when pin-tract infection was excluded. Complications were categorized based on Paley et al.’s classification as 129 problems, 85 obstacles and no sequelae. Interestingly, 44 (30.8 %) individuals had no problem and obstacle.

Conclusions

Lengthening over an intramedullary nail provides bone formation in equal quality to that obtained by the conventional Ilizarov method, along with lower rate of complications. The large number of individuals involved in our study is a remarkable benefit which could be used as an appropriate sample to compare results for outcomes and complications.     

Symphysiotomy: a viable approach for delayed management of posterior urethral injuries in children

PURPOSE: The outcome of symphysiotomy for accessing pelvic fracture related, obliterative urethral strictures is described. MATERIALS AND METHOD: In 7 boys and 3 girls 4 to 13 years old (mean age 6) surgical correction of a pelvic fracture related, obliterative urethral stricture was achieved through symphysiotomy. The stricture involved a prostatomembranous location in boys and complete vesicourethral distraction in girls. Patients were followed an average of 2.5 years (range 6 months to 4 years) by physical examination, urethrography and endoscopy. RESULTS: The stricture was successfully corrected in all patients and all void with a normal flow. All boys are continent but 2 of the 3 girls had early incontinence, which resolved with time in 1. In 2 of the 10 cases a previous attempt at perineal repair had already failed. No patient required urethrotomy or dilation and none had significant hemorrhage, fistulization, bladder hernia, chronic pain or secondary gait disturbance. CONCLUSIONS: Symphysiotomy is hereby revisited as a simple and effective approach for repairing traumatic posterior urethral injuries in the pediatric population. It can be performed instead of transpubic urethroplasty to manage long or otherwise complicated strictures.     

Laser-induced thermal injury to dermal blood vessels: analysis of wavelength (585 nm vs. 595 nm), cryogen spray cooling, and wound healing effects

BACKGROUND AND OBJECTIVES: Successful laser treatment of cutaneous hyper-vascular lesions requires appropriate laser irradiation parameters for selective photothermolysis of ectatic dermal blood vessels as well as appropriate cooling parameters for epidermal protection based on an individual patient basis. Using the rabbit ear as an in vivo model for dermal vasculature, we investigated the influences of laser wavelength (585 nm vs. 595 nm) and cryogen spray cooling with various spurt durations on the laser-induced thermal injury to dermal blood vessels. Wound healing response was also evaluated in 2 hours and 4 days. STUDY DESIGN/MATERIALS AND METHODS: Flashlamp-pumped pulsed dye laser ScleroPlus (operated at the wavelength of 585 or 595 nm) was used for the comparison between the influences of two wavelengths (585 nm vs. 595 nm). R134-a cryogen spurts with the durations from 50 to 300 milliseconds were sprayed onto the sites to be irradiated and terminated 20 milliseconds before the onset of the laser pulses. In vivo rabbit ear was used as the model for cutaneous hyper-vascular lesions. Totally 10 New Zealand Albino white rabbits were experimented and in each rabbit ear six to seven sites were irradiated. Five animals were sacrificed 2 hours after the irradiation, and the remaining five sacrificed 4 days after the irradiation. Thermal injury to the blood vessel was assessed by hematoxylin and eosin stained histological sections and confirmed by an apoptosis assay. RESULTS: When the radiant exposures were above 10 J/cm2, 595 nm wavelength induced equivalent or more severe thermal injury to dermal blood vessels than 585 nm. Cryogen spray cooling with the spurt durations above 100 milliseconds resulted in increased depth of the most superficial thermal injury to dermal blood vessels than without cooling, indicating that superficial blood vessels were non-specifically cooled by the cryogen spurts applied at these parameters. Laser-induced thermal injury was significantly healed in the rabbit ear vasculature at 4 days post irradiation. CONCLUSIONS: Given sufficient radiant exposure, 595 nm wavelength can induce equivalent or more severe vascular injury compared with 585 nm. Cryogen spray cooling with the spurt durations above 100 ms may impair the photocoagulation of superficial blood vessels. Irreversible thermal injury to blood vessel can be achieved only when the basement membrane of blood vessel wall is irreversibly damaged.