Normality and reliability in the clinical assessment of backache.

Backache is common yet its routine medical assessment is imprecise, unreliable, and poorly interpreted. Reproducibility studies on 475 patients improved the reliability of clinical interview and examination in backache, while studies of 335 normal subjects defined the limits of normality. Assessment of nerve function was found to be reliable but assessment of the back itself had to be considerably modified and examination improved by incorporating actual measurements. The validity and clinical utility of the information were analysed to determine the minimum amount of information which should be collected to permit clear diagnosis and management.     

Backache in adept teen-agers in occupations producing spinal strain--morbidity, predisposition]

In total 1,149 pupils of the III class of the mechanical, metallurgical, building, power engineering and chemical vocational schools were examined. Backache was diagnosed in 50 cases while the same ailment in parents or siblings were diagnosed in 148 cases, i.e. 17.2%. Percentage of persons with congenital spine disorders (low intervertebral disc, narrow spinal channel, segmentation disorders spondylolysis, and asymmetry of intervertebral joints) was estimated as 30%. Such disorders predispose to backache. A risk of backache in the group under study was estimated however as 50% of pupils preparing for professions producing significant overload to the spine. Possibilities and difficulties of the proper classifications of candidates to such vocations are discussed.     

An Ounce of Discretion Is Worth a Pound of Wit — Ergonomics Is a Healthy Choice

Objective

The objective of the study was to identify the occurrence and outcome of low back ache amongst computer users and their relation to age, gender, occupation and duration of computer use.

Materials and Methods

A self reported questionnaire tailored from Occupational Health and Safety Act of the Ministry of Labor, Ontario, Canada was used.

Results

416 participants 55.5% males and 45% females using computers for a minimum of five years with age range 22 to 59 years belonged to different occupational groups. Consecutive hours of computer work was found to be associated with work related backache or discomfort in 27.4% (n = 114) participants (16.1% male, 11.3% female). Frequent short breaks improved backache (p value <0.001) in 93 (22.4%) participants (13.2% male, 9.2% female). No significant relation was observed with the duration of computer usage or usage per day; between the two genders or occupational groups. Backache had no significance within age groups.

Conclusion

Our study identifies the occurrence of low back pain among those who are using computer for consecutive hours without breaks and the results suggest the need to create health awareness especially use of short breaks to minimize the risk and occurrence of low back pain. The result of this study can also be used to improve ergonomic design and standards.     

Long term backache after childbirth: prospective search for causative factors.

OBJECTIVES--To assess in a prospective randomised study the association between motor block resulting from high and low dose epidural infusions of bupivacaine in labour and the incidence of long term backache after childbirth, and to compare the incidence of backache in women not receiving epidural analgesia. DESIGN--Women requesting epidural analgesia in labour between October 1991 and March 1994 were randomised to receive infusions of either bupivacaine alone or low dose bupivacaine with opioid. Data were collected during labour and the immediate postpartum period from these women and from women recruited at random over the same time from those who had laboured without epidural analgesia. A postal questionnaire about symptoms was sent three months after childbirth to all women. Further data were collected one year after childbirth from those who had reported new backache at three months. SETTING--St Thomas''s Hospital, London. SUBJECTS--599 women were recruited, of whom 450 (75%) replied to a follow up questionnaire. RESULTS--152 women (33.8% of responders) reported backache lasting three months after delivery and, of these, 33 (7.3%) had not previously suffered with backache. There were no significant differences between the treatment groups in the incidence of postnatal backache overall or of new backache or any symptoms after childbirth. Among all demographic, obstetric, and epidural variables examined the only factors significantly associated with backache after childbirth were backache before and during pregnancy. CONCLUSIONS--The incidence of new long term backache was not significantly increased in women who received epidural analgesia in labour. Motor block resulting from epidural local anaesthetic administration was not a significant factor in the development of backache.     

Assessing long term backache after childbirth.

OBJECTIVES--To investigate the factors associated with long term backache after childbirth, to assess all women reporting new onset long term backache, and to investigate any relation with pain relief in labour. DESIGN--Data collected from obstetric records and postal questionnaires or telephone interviews on morbidity after childbirth from all women delivering their first baby between March 1990 and February 1991, followed by analysis of data collected from outpatient consultations. SETTING--St Thomas''s Hospital, London. SUBJECTS--Questionnaires were sent to 1615 women who had delivered their first baby in the defined period; 1015 either replied by post or were contacted by telephone. RESULTS--299 women (29.5% of responders) reported backache lasting more than six months and of these 156 (15.4%) said they had had no back problems previously. Those women who had received epidural analgesia in labour were significantly more likely to report new onset backache (17.8%; 95% confidence interval 14.8% to 20.8%) than those who did not (11.7%; 8.6% to 14.8%). Younger women, unmarried women, and those reporting other antenatal symptoms were significantly more likely to report new long term backache. The 156 women reporting new backache were asked to attend an outpatient clinic and 36 (23%) did so. The majority had a postural backache which was not severe. Psychological factors were present in 14 women. CONCLUSIONS--Though new long term backache is reported more commonly after epidural analgesia in labour, it tends to be postural and not severe. There were no differences in the nature of the backache between those who had or had not received epidural analgesia in labour.     

Chest diseases-epitomes of progress: new diagnostic techniques for thrombophlebitis

In 1974 in California, 72,645 patients were admitted to hospital for backache. In 50 percent of these patients there was a diagnosis compatible with discogenic disease. Surgical treatment was done in 27 percent of the patients admitted to hospital. Total figures were determined for hospital costs and the costs of physician-related services. Costs for surgical treatment exceeded medical costs. Extrapolated to a national scale, it appears that the national cost for patients in hospital because of backache in 1974 was $1.38 billion. This does not include outpatient care expense or loss of income.     

Epidural anaesthesia and long term backache after childbirth.

OBJECTIVE--To examine the relation between epidural anaesthesia and long term backache after childbirth. DESIGN--Data from postal questionnaire on morbidity after childbirth sent to women who had delivered in one maternity hospital between 1978 and 1985 were linked to maternity case notes for each woman. SETTING--Maternity hospital in Birmingham. SUBJECTS--11,701 Women who had delivered their most recent baby at the maternity hospital during the defined period and who returned their completed questionnaires. MAIN OUTCOME MEASURES AND RESULTS--Of the 1634 women who reported backache, 1132 (69%) had had it for over a year. A significant association was found between backache and epidural anaesthesia (relative risk = 1.8); 903 of 4766 women (18.9%) who had had epidural anaesthesia reported this symptom, compared with 731 of the 6935 women (10.5%) who had not had epidural anaesthesia. This association was consistent in both "normal" and "abnormal" deliveries, the only exception being after an elective caesarean section when no excess backache occurred after epidural anaesthesia. CONCLUSIONS--The relation between backache and epidural anaesthesia is probably causal. It seems to result from a combination of effective analgesia and stressed posture during labour. Further investigations on the mechanisms causing backache after epidural anaesthesia are required.     

地塞米松对腰硬联合麻醉剖宫产术后腰背痛及神经并发症影响

目的：硬膜外腔注射地塞米松对腰硬联合麻醉腰背痛及神经并发症的预防效果。方法：将200例ASA I-II腰联合麻醉下择期剖宫产患者随机分成2组,A组吗啡2 mg＋生理盐水稀释至10ml硬膜外腔注射;B组向硬膜外腔注射吗啡2mg＋地塞米松5mg＋生理盐水稀释至10 ml硬膜外腔注射。术毕两组均行静脉术后镇痛。观察并记录患者术后24,72 h的腰背痛及神经并发症情况,同时记录每例患者试穿次数。结果：B组患者术后24,72 h的背痛发生率为11.0%,4.0%,明显低于A组（P〈0.05）;穿刺1次和2次及以上背痛的发生率分别为5.1%和19.5%,明显低于A组（P〈0.05）。两组72h内神经并发症差异无统计学意义。结论：硬膜外腔注射地塞米松有效预防腰硬联合麻醉剖宫产术后腰背痛,但对神经并发症的影响还有待进一步观察。     

Pelvic Osteo-arthropathy of Pregnancy: (Section of Obstetrics and Gynæcology)

Excessive relaxation of the pelvic joints during pregnancy has as its chief symptoms chronic backache and locomotor disturbances. Goldthwait and others have for long drawn attention to the frequent part played by softening of the sacro-iliac joint structures in the production of the common backache of pregnancy. The frequency of this symptom may be gauged by the fact that 114 women out of a successive series of 3,030 cases at the antenatal clinic, or 3.7%, suffered in such a degree as to lead them to call for treatment. In 69, or 60.5%, the pain commenced before the 28th week, whilst in the remaining 45 or 39.5%, it commenced later.     

大型医院科技节能整体解决策略研究与实践

医院节能工作是一项系统工作，采用层次分析法建立医院节能策略评估模型，对医院节能领域进行分析，指导节能工作决策，制订医院节能建设规划，将节能技术的突破和合理使用作为节能的核心，统筹安排，分步实施，同时利用专业化能源诊断、审计及能源信息化的手段做好节能管理，提高了我院的能源使用效率，降低运行成本。     

Symptoms and signs: physical disease or illness behaviour?

The amount of treatment received by 380 patients with backache was found to have been influenced more by their distress and illness behaviour than by the actual physical disease. Patients showing a large amount of inappropriate illness behaviour had received significantly more treatment (p less than 0.001). The symptoms and signs of illness behaviour need to be clearly distinguished from those of physical disease, and better assessment of illness behaviour is essential if everyday clinical practice is to fulfil the ideal of treating patients as well as diseases.     

THE DON'TS OF SPINAL ANESTHESIA

Spinal anesthesia is an essentially safe procedure with no unavoidable complications, except headache and backache in a relatively small number of cases, if certain well defined contraindications are observed and if there is rigid adherence to a careful and rational technique of administration and of preparation of materials.     

How applicable is the general adaptation syndrome to the unicellular Tetrahymena?

Hormone receptors, hormones and signal transduction pathways characteristic of higher vertebrates can be observed also in the unicellular Tetrahymena. Previous work showed that stress conditions (starvation, high temperature, high salt concentration, formaldehyde or alcohol treatment) elevated the intracellular level of four hormones (ACTH, endorphin, serotonin and T₃). Here, the effect of other stressors (CuSO4 poisoning, tryptophan hydroxylase inhibitor parachlorphenylalanine (PCPA) treatment) on the same and other hormones (epinephrine, insulin, histamine) was studied, using immunocytochemistry and flow cytometric analysis. It was found, that each effect increased the intracellular hormone contents, but some hormones (histamine, T₃) were less reactive. Insulin—which is a life‐saving factor for Tetrahymena—itself provoked elevation of hormone amounts in association with a stressor, further increased the level of hormones. It was concluded that the ancestor of Selye's General Adaptation Syndrome (GAS) can be found already at unicellular level, and this possibly has a life saving function. Copyright © 2008 John Wiley & Sons, Ltd.     

Cost analysis of PAPNET-assisted vs. conventional Pap smear evaluation in primary screening of cervical smears

OBJECTIVE: To assess the difference in costs between PAPNET-assisted and conventional microscopy of cervical smears when used as a primary screening tool. STUDY DESIGN: We performed time measurements of the initial screening of smears by four cytotechnologists in one laboratory. Time was measured in 816 conventionally screened smears and in 614 smears with PAPNET-assisted screening. Data were collected on the components of initial screening, clerical activities and other activities in the total work time of cytotechnologists in the routine situation and on resource requirements for both techniques. RESULTS: PAPNET saved an average of 22% on initial screening time per smear. Due to costs of processing and additional equipment, the costs of PAPNET-assisted screening were estimated to be $2.85 (and at least $1.79) higher per smear than conventional microscopy. The difference in costs is sensitive to the rate of time saving, the possibility of saving on quality control procedures and the component of the initial screening time in the total work time of cytotechnologists. CONCLUSION: Although PAPNET is time saving as compared with conventional microscopy, the associated reduction in personnel costs is outweighed by the costs of scanning the slides and additional equipment. This conclusion holds under a variety of assumptions. Using PAPNET instead of conventional microscopy as a primary screening tool will make cervical cancer screening less cost-effective unless the costs of PAPNET are considerably reduced and its sensitivity and/or specificity are considerably improved.     

A case of active acromegaly with reduced height and type 1 renal tubular acidosis

A 41-year-old man with acromegaly was suffering from chronic, progressive backache and aware of reduction in his body height. Endocrine studies revealed increased glucose non-suppressible serum growth hormone (GH) and serum prolactin (PRL). Pituitary microadenoma was detected by a computerized axial tomogram and subsequently resected by trans-sphenoidal adenomectomy. The tumor proved to be a mixed GH- and PRL-secreting adenoma by electron microscopy and immunoperoxidase staining. Concurrent investigation of backache and reduced height disclosed markedly reduced radiodensity of the spinal bones, bilateral nephrocalcinosis, and hypercalciuria, which were ascribed to renal tubular acidosis (RTA) demonstrated by reduced urinary excretion of acids and insufficient reduction of urinary pH following oral administration of ammonium chloride. From the analogy to certain endocrinopathies, it appears likely that enhanced calcium metabolism and resultant hypercalciuria due to excess GH and PRL have led to the development of RTA, which further enhanced calciuria. Such enhanced calcium metabolism and consequent hypercalicuria conceivably led to accelerated demineralization of the spine and resulted in the reduced height of this patient in his early forties.     

Use of a new steroid (Org OD 14) in the climacteric syndrome

A double-blind study was carried out in 60 women with climacteric symptoms: 30 women were given Org OD 14 (2.5 mg) and 30 were given a placebo to be taken daily for six weeks. The effects of the medication on the climacteric symptoms, the subjective sensations, the plasma FSH levels and endometrial histology were studied. In the treated group compared with the control group the relief or improvement of the following climacteric symptoms were recorded: perspiration, palpitations, irritability and backache. A favourable effect on the subjective sensations was noted in both groups, although no significant difference for the group which received Org OD 14 was found. At the end of the treatment with Org OD 14, the FSH levels were found to be greatly reduced in comparison with the basal values; this, however, was not the case with the placebo group. With regard to endometrial histology, no sign of hyperplasia was found in any of the patients. No relevant side effects or symptoms of estrogenic or androgenic stimulation were recorded. For the climacteric patient needing estrogen therapy, it can be concluded that Org OD 14 is an effective and innocuous medication in the doses used.     

同批次细胞基质收获甲肝和麻疹病毒制备联合疫苗的方法

采用同一批次细胞基质收获甲肝和麻疹病毒.应用甲肝L-A-1株和麻疹D3T11株,间隔3周先后感染同一批次人胚肺二倍体细胞2BS株,待两种病毒同时达到增殖高峰期时收获病毒液(以下简称HAM).对HAM分别进行病毒滴定、特异性检查、猴体安全性和免疫效果试验.结果显示,HAM的甲肝和麻疹病毒滴度与同批单价甲肝和麻疹疫苗病毒滴度,差异均无显著意义.该方法用于制备甲肝-麻疹联合疫苗,省时省力,操作简便,并可显著降低疫苗生产成本.     

后路椎弓根螺钉内固定结合后外侧植骨融合治疗胸腰椎骨折的临床观察

目的：观察后路椎弓根螺钉内固定结合后外侧植骨融合治疗胸腰椎骨折的临床效果及安全性。方法：回顾性分析2010年6月-2012年4月在我院脊柱骨科住院治疗的71例胸腰脊椎骨折患者,所有患者随机被分成2组,治疗组38例接受采用后路椎弓根螺钉内固定结合后外侧植骨融合治疗,对照组33例接受传统椎弓根螺钉内固定。术后对患者椎体前缘高度、脊柱Cobb’s角、腰背痛、神经功能恢复情况、内固定并发症等方面进行手术效果的评价。结果：治疗组术后及随诊患者的椎体前、后缘高度的比值与对照组相比,均有统计学差异（P〈0．05）;治疗组术后及随诊患者的Cobb’s角较对照组明显减小,差异有统计学意义（P〈0．05）,治疗组手术时间与对照组相比差异有统计学意义（P〈0．05）;两组患者医疗费用、神经功能改善筝级相互比较,无统计学意义咿0．05）。结论：后路复位椎弓根螺钉内固定结合后外侧植骨融合治疗胸腰椎骨折的临床疗效确切。     

Adjustment of the Sleep-Wake Cycle to Small (1-2h) Changes in Schedule

Changes of schedules larger than 3 h, such as jet lag and shift work, require an adjustment period of several days to resynchronize the sleep-wake cycle and several weeks to resynchronize other circadian rhythms to the new schedule. Initial studies on adaptation to small changes of schedule (1-2 h) found that the sleep-wake cycle adapts to the new schedule in less than 48 h, and such modifications are generally not studied because they may be confounded by a potential masking effect. This article summarizes the few published studies on Daylight Saving Time (DST) and sleep during weekends, two examples of small changes in schedule. There are individual differences in adaptation to daylight saving time, while some persons adjust immediately; other persons require more than 2 weeks. During weekends, people tend to go to bed and wake up later, and to extend their sleep. Delay and extension of sleep depend on factors such as shift of work during weekdays and chronotype (morningness-eveningness). Both DST and sleep during weekends offer the opportunity to study adaptation of the sleep-wake cycle in recurrent, social conditions. Studying these phenomena is also relevant to some socioeconomic issues, like the reportedincrease of traffic accidents and complaints from the population during daylight saving time; or the possible decrease in productivity and absenteeism during the 'Blue Monday'.