A narrative review of intra-articular corticosteroid injections for low back pain.

Objective: To summarize and to analyze the available literature on the efficacy of intra-articular injections of corticosteroids for low back pain.

Design: Publications, in English, French, and German, were obtained that reported the proportions of patients who obtained complete relief of pain following intra-articular steroids, and that provided any form of follow-up. These publications were analyzed to determine the rationale, indications, and outcomes of the treatment.

Evaluation of a revised instrument to assess the needs of men diagnosed with prostate cancer.

Background: This study was conducted to assess the face, content and construct validity and the internal validity of the revised version of an instrument to measure the perceived needs of men diagnosed with prostate cancer [Prostate Cancer Needs Questionnaire version 2 (PCNQv2)]. The PCNQ was constructed in two parts with Part 1 measuring needs at diagnosis and initial treatment and Part 2 measuring current needs.

Methods: A random sample of 650 men diagnosed with prostate cancer attending a Urologist of the Hunter Urology Group in Newcastle, New South Wales, Australia, were invited to participate in the study and sent by post the self-administered PCNQ.

How do the psychosocial consequences of ageing affect asthma management?

WHAT WE NEED TO KNOW: How do social, physical and psychological factors affect asthma and asthma management in older people? How can we minimise their impact and enhance quality of life for older people with asthma? Does inequity based on age, sex, socioeconomic status and/or area of residence affect accessibility, quality and effectiveness of care for older people with asthma? What is the extent of undiagnosed and undertreated asthma among older people, and what are the barriers to symptom reporting, diagnosis and treatment? WHAT WE NEED TO DO: Promote equity of access to diagnosis, investigation and treatment across age, sociodemographic and geographic groups. Encourage older people to seek help for symptoms and exacerbations. Encourage quality use of medicines among older people with asthma and comorbid conditions and disabilities.

Abnormal motion in spondylolytic spondylolisthesis.

Study Design: A retrospective, cohort study of the kinematics of the lumbar spine of patients with spondylolisthesis compared with asymptomatic normal subjects.

Objective: To determine if abnormal motion could be detected in the radiographs of patients with spondylolisthesis.

Summary Of Background Data: Contrary to the prevailing conviction that lumbar segments affected by lytic spondylolisthesis are unstable, multiple studies have failed to find evidence of increased or abnormal motion at these segments.

Ingenol 3-angelate induces dual modes of cell death and differentially regulates tumor necrosis factor-related apoptosis-inducing ligand-induced apoptosis in melanoma cells.

Ingenol 3-angelate (PEP005), one of the active ingredients in an extract from Euphorbia peplus, was shown in preclinical studies to have activity against human melanoma xenografts in nude mice. In the present study, we have tested its ability to induce the apoptosis of melanoma cells in vitro in the absence or presence of tumor necrosis factor-related apoptosis inducing ligand (TRAIL). The results showed that at relatively high concentrations (100 microg/mL), PEP005 killed melanoma cells mainly by induction of necrosis.

Is there an Aboriginal bioethic?

It is well recognised that medicine manifests social and cultural values and that the institution of healthcare cannot be structurally disengaged from the sociopolitical processes that create such values. As with many other indigenous peoples, Aboriginal Australians have a lower heath status than the rest of the community and frequently experience the effects of prejudice and racism in many aspects of their lives. In this paper the authors highlight values and ethical convictions that may be held by Aboriginal peoples in order to explore how health practitioners can engage Aboriginal patients in a manner that is more appropriate.

Case of recalcitrant necrobiotic xanthogranuloma.

A 53-year-old woman with necrobiotic xanthogranuloma presented as infiltrated eyelid plaques, with later development of arm and thigh lesions. Clinical features, including association with immunoglobulin G-kappa paraprotein, and pathological findings were typical of this disorder. Treatment for 15 months with varying combinations of prednisone and multiple chemotherapeutic agents (melphalan, cyclophosphamide and chlorambucil) has led to minimal or no improvement in the clinical lesions or paraprotein.

Novel role for decay-accelerating factor in coxsackievirus A21-mediated cell infectivity.

Decay-accelerating factor (DAF) is involved in the cell membrane attachment of many human enteroviruses. Presently, further specific active roles of DAF in mediating productive cell infection and in the pathogenesis of natural enterovirus infection are poorly understood. In an attempt to more fully understand the role of DAF in lytic cell infection we examined the specific interactions of the prototype strain of coxsackievirus A21 (CVA21) with surface-expressed DAF.

Diagnostic blocks: a truth serum for malingering.

Malingering is not a diagnosis. It is a behavior for which there are no established diagnostic criteria. Guidelines have been published according to which malingering might be suspected, but those guidelines do not discriminate between patients who are malingering and ones with genuine sources of chronic pain.

Pharmacological alternatives for the alleviation of back pain.

Drugs constitute a convenient option for low back pain and are commonly used. However, evidence for their efficacy is meagre. Many drugs used for back pain are no more, or only slightly more, effective than placebos.

The surgical anatomy of lumbar medial branch neurotomy (facet denervation).

Objective: To demonstrate the validity of placing electrodes parallel to the target nerve in lumbar radiofrequency neurotomy.

Design: Previous data on the anatomy of the lumbar dorsal rami were reviewed and a demonstration cadaver was prepared. Under direct vision, electrodes were placed on, and parallel to, the L4 medial branch and the L5 dorsal ramus.

Role of anesthesiologic blockade in headache management.

Local anesthetic blocks have been used in a variety of ways in the management of headache. Some practitioners use blocks of the supraorbital and greater occipital nerves as a form of treatment. Although the effect of each block is limited in duration, a series of injections appears to provide sustained relief.

An evaluation of three community-based projects to improve care for incontinence.

The Australian National Continence Management Strategy commissioned the implementation and evaluation of three community-based projects designed to improve care for people with incontinence by improving the detection and treatment of urinary incontinence. Projects were located in demographically diverse areas, overseen by co-operating professional groups with an interest in continence and aimed at facilitating a pathway of care for those with incontinence. Project activities focused on health care provider training and improving local referral networks, as well as raising public awareness.

Randomised controlled trial of health assessments for older Australian veterans and war widows.

Objective: To assess the effect of home-based health assessments for older Australians on health-related quality of life, hospital and nursing home admissions, and death.

Design: Randomised controlled trial of the effect of health assessments over 3 years.

Participants And Setting: 1569 community-living veterans and war widows receiving full benefits from the Department of Veterans' Affairs and aged 70 years or over were randomly selected in 1997 from 10 regions of New South Wales and Queensland and randomly allocated to receive either usual care (n = 627) or health assessments (n = 942).

Lumbar radicular pain.

Background: Radicular pain is caused by irritation of the sensory root or dorsal root ganglion of a spinal nerve. The irritation causes ectopic nerve impulses perceived as pain in the distribution of the axon. The pathophysiology is more than just mass effect: it is a combination of compression sensitising the nerve root to mechanical stimulation, stretching, and a chemically mediated noncellular inflammatory reaction.

Controlled zygapophysial joint blocks: the travesty of cost-effectiveness.

Objective: The aim of this study was to develop equations by which the costs could be compared of various models of performing diagnostic blocks for spinal pain.

Design: Algorithms were elaborated describing different strategies for the diagnosis of cervical or lumbar zygapophysial joint pain using placebo-controlled diagnostic blocks, comparative local anaesthetic blocks, or no control blocks, and its treatment with radiofrequency neurotomy. For each step in each algorithm cost functions were applied.

Impact of selective cyclooxygenase-2 inhibitors on anti-ulcer medication and non-steroidal anti-inflammatory drug use in patients with rheumatic disease.

Background: Anti-inflammatory medications are the most common treatment for rheumatic disease in Australia. Recent years have seen large increases in the use of selective cyclooxygenase-2 (COX-2) inhibitors. Predictors of use, costs and benefits of the new medications have not been evaluated.

The histone deacetylase inhibitor suberic bishydroxamate regulates the expression of multiple apoptotic mediators and induces mitochondria-dependent apoptosis of melanoma cells.

Histone deacetylase (HDAC) inhibitors have attracted much interest because of their ability to arrest cell growth, induce cell differentiation, and in some cases, induce apoptosis of cancer cells. In the present study, we have examined a new HDAC inhibitor, suberic bishydroxamate (SBHA), for its effect on a panel of human melanoma cell lines. We report that it induces varying degrees of apoptosis in the melanoma lines but not in melanocytes and fibroblasts.

Paraneoplastic pityriasis rubra pilaris in association with bronchogenic carcinoma.

Pityriasis rubra pilaris (PRP) is an uncommon dermatosis occasionally reported in association with an underlying malignancy. We report a 61-year-old woman in whom PRP preceded the diagnosis of bronchogenic carcinoma by approximately 11 months. The clinical picture in this case included atypical cutaneous signs and mucous membrane involvement.

The neck and headaches.

Referred pain from disorders of the cervical spine can be perceived as headache. The mechanism is convergence between trigeminal afferents and afferents of the upper three cervical nerves in the trigeminocervical nucleus. Cervicogenic headache cannot be diagnosed on clinical grounds alone.

Management of chronic low back pain.

Treatment for chronic low back pain (pain persisting for over 3 months) falls into three broad categories: monotherapies, mulitidisciplinary therapy, and reductionism. Most monotherapies either do not work or have limited efficacy (eg, analgesics, non-steroidal anti-inflammatory drugs, muscle relaxants, antidepressants, physiotherapy, manipulative therapy and surgery). Multidisciplinary therapy based on intensive exercises improves physical function and has modest effects on pain.

Health promotion in childcare centres: a survey of sun protection policy and practice.

Objectives: To describe sun protection policy and practice in child care centres in the Hunter region of New South Wales (NSW) and examine differences in sun protection policy and practice between those who attended a NSW Cancer Council SunSmart workshop and those who did not.

Method: One hundred and seventy-seven Hunter child care centres completed a CATI interview (95% consent rate).

Results: Ninety seven per cent of centres reported having a written sun protection policy (only 5% deemed comprehensive by review).