The role of caudal epidural injections in the management of low back pain.

The value of caudal epidural steroid injections (CEI) in treatment of low back pain and sciatica is controversial. It is believed that CEI are mainly effective in treating acute radiculopathy at intermediate term follow up and have no long-term benefit. The objective of this study was to evaluate the role of CEI in the management of low back pain.

Recurrent osteoid osteoma of the lunate: a case report and review of the literature.

Osteoid osteoma is a benign tumour of bone that rarely localises in the carpal bones. Its treatment by curettage and bone grafting is considered to be curative and its recurrence is thought to be rare. We report a case of an osteoid osteoma of the lunate, which recurred seven years after the initial operation.

Insertion of tantalum beads in RSA of the hip: variations in incidence of extra-osseous beads with insertion site.

Radiostereometric analysis (RSA) is a technique that can be used to measure the in-vivo micro-motion of the components of hip arthroplasty. It requires the insertion of tantalum beads into the bone permitting analysis of the radiographs. Extra-osseous beads reduce the usable bead pattern and previous studies have reported their incidence in the proximal femur as between 11% and 13% of all inserted beads.

A ligamentum flavum-preserving approach to the lumbar spinal canal.

Study Design: This is a retrospective study of a consecutive series of patients undergoing spinal decompression or disc enucleation with preservation of the ligamentum flavum. MacNab criteria and Prolo scoring was used to assess them pre- and after surgery.

Objectives: The aim of the study was to assess the incidence of perioperative complications and long-term clinical outcome of the procedure.

Determinants of survival in continuing care settings.

Objective: To assess the relationship between the Barthel Index, a widely used assessment measure of physical dependency, and long-term survival in continuing care settings.

Design And Subjects: One hundred and eighty five older people moving into continuing care (hospital or nursing home) were prospectively assessed with regard to physical and mental impairment in 1991/2 and this population was followed up in 1996.

Results: In addition to the 185 patients who were assessed, there were 41 patients who died before they could be seen.

Care management in three practices--scope for improvement?

Objective: The process of assessment of older people for residential/nursing home care may take place by hospital based social workers, or by care managers working in the community. We sought to compare the assessment process in each setting. The standards for the audit were that the data collection for both groups was equivalent, that both groups had a multi-disciplinary assessment, and that outcomes in both settings were appropriate.

Scott wiring for direct repair of lumbar spondylolysis.

Study Design: This is a retrospective study of consecutive patients who underwent Scott wiring for symptomatic lumbar spondylolysis using the MacNab criteria.

Objective: The aim of the study was to assess the clinical outcome of the procedure after a mean follow-up period of more than 10 years.

Summary Of The Background Data: Previous studies have shown this technique to be effective in the management of patients up to the age of 25 years who have symptomatic lumbar spondylolysis with or without a Grade 1 slip.

Measuring movement irregularity in the upper motor neurone syndrome using normalised average rectified jerk.

Movement irregularity is a feature of the upper motor neurone (UMN) syndrome which is difficult to measure. Average rectified jerk (ARJ) has been proposed as a measure of this movement irregularity, but ARJ depends upon the duration of movement. Since movements may be slower in UMN patients, duration dependence compromises ARJ as a measure of irregularity.

"Pepper-pot" arthrodesis of the small joints of the hand: our experience in 68 cases.

Sixty-eight small joint arthrodeses were performed in the hand using a new technique. Following removal of the articular cartilage, multiple drill holes are made through the subchondral bone, connecting the medullary canal with the joint space. The final joint position is maintained with an intraosseous wire loop and a Kirschner wire.

Allograft versus autograft in instrumented posterolateral lumbar spinal fusion: a randomized control trial.

Study Design: To evaluate the clinical outcome respective of the type of bone graft used, 69 patients undergoing instrumented lumbar spinal fusion were randomized to receive either their own bone (harvested from the iliac crest) or allograft bone (fresh-frozen femoral head from donors undergoing total hip joint arthroplasty). Self-completed questionnaires were administered before surgery and at intervals thereafter.

Objectives: To compare the clinical outcome of lumbar spinal fusion carried out using either allograft or autograft bone.

Asthma medications and their potential adverse effects in the elderly: recommendations for prescribing.

The incidence of drug-induced adverse effects is likely to increase as a result of advanced age and exposure of elderly patients to polypharmacy. Therefore, pharmacological therapy of asthma and chronic obstructive pulmonary disease (COPD) in the elderly patient can be potentially hazardous. beta(2)-agonists, administered as therapy for asthma and COPD, have recognised systemic sequelae, such as hypokalaemia and chronotropic effects, which may be life-threatening in susceptible patients.

Distraction lengthening of the radius for radial longitudinal instability after distal radio-ulnar subluxation and excision of the radial head: a case report.

The results of late surgery for symptomatic proximal migration of the radius after resection of the radial head for trauma are usually disappointing. Ulnar variance increases when the interosseous membrane is disrupted. Its integrity should be assessed to predict the results of further surgery.

A systematic review of discharge coding accuracy.

Background: The aim of the study was to review systematically the literature measuring the accuracy of routine UK hospital statistics that classify patients on discharge.

Methods: A systematic review was carried out of studies comparing routine discharge statistics about an episode of hospital care with the original medical record. Dual quality assessment and extraction was completed for included studies.

Post stroke depression.

Depression following stroke is common. Although it is highlighted as an issue in stroke guidelines, guidance on diagnosis or management is not given. This paper presents the original research from a literature review of Medline and the Cochrane Database on stroke and depression, and discusses some of the clinical implications of the findings.

Pictorial outcome measures for the hospital care of older patients--a suggested toolkit.

Objective: to propose three pictorial methods of presenting hospital outcome data, suitable for use in older patients entering medical specialties (including rehabilitation).

Patients: 224 patients (mean age 80.6 years, 56% female, 75% emergencies) admitted to a department of medicine for the elderly.

Fine needle aspiration of bone tumors.

Fine needle aspiration cytology (FNAC) was performed in 226 cases of bone tumors and the cytohistologic correlation was calculated to assess the technique's diagnostic efficacy aided by immunocytochemistry, considering histopathology as the gold standard. Of the 226 cases, 136 were malignant and 72 cases were benign tumors. In the remaining 18 cases, cytohistopathologic examination revealed no bony lesion.

Influenza and pneumococcal vaccination: patient perceptions.

The efficacy of the influenza vaccine in reducing mortality and hospital admissions is established, particularly in the elderly. However, up to 50% of those at risk do not receive the vaccine. These patients are also at risk from pneumococcal infection and there is considerable overlap between the target group for each vaccine.

Correlation between the MRI changes in the lumbar multifidus muscles and leg pain.

Aim: In the assessment of the lumbar spine by magnetic resonance imaging (MRI), changes in the paraspinal muscles are frequently overlooked. In this study, our objective was to investigate the relationships between lumbar multifidus (MF) muscle atrophy and low back pain (LBP), leg pain and intevertebral disc degeneration.

Methods: A retrospective study of 78 patients (aged 17-72) with LBP presenting with back pain with or without associated leg pain was undertaken.

Robotic assistance of an active upper limb exercise in neurologically impaired patients.

The principle of using robotic techniques to assist an active upper limb exercise is demonstrated in ten patients with weakness and spasticity. Using a servo motor to apply torque about the elbow, the mean range of active extension-flexion was increased in every patient. Sample kinematic and electromyographic (EMG) data are given.

Comparison of bending stiffness of six different colours of copolymer polypropylene.

This paper compares the bending stiffness of 5 different colours of copolymer polypropylene (CCP) with that of natural copolymer polypropylene (NCP). Flesh coloured and natural sheets are supplied thicker than other pigmented sheet. The bending stiffness of a specimen may be defined as EI, i.