Relationships among selected measures of impairment, functional limitation, and disability in patients with cervical spine disorders. (57/1040)

BACKGROUND AND PURPOSE: Little is known about the relationship among impairments, functional limitations, and disability in people with cervical spine disorders (CSD) despite the fact that these concepts are routinely used in clinical practice. The primary purpose of this study was to investigate the relationships among commonly assessed impairment, functional limitation, and disability measures in patients with CSD. A secondary purpose was to determine the influence of payment source and time since onset of symptoms on these same measures. SUBJECTS: Eighty patients (mean age=45.7 years, SD=15.9, range=20-88) with CSD who were referred for physical therapy participated in the study. METHODS: Data were obtained for 3 measures of impairment, 2 measures of functional limitation, and 3 measures of self-reported disability during the initial visit. RESULTS: All 3 sets of variables (ie, impairment, functional limitation, disability) correlated with each other, with the highest correlation occurring between the impairment measures and the functional limitation measures (r=.82). Other correlations were noted between individual variables. There was no effect of payment type or time since onset of symptoms on the variables. CONCLUSION AND DISCUSSION: Positive correlations were noted among the 3 sets of measures, which supports the assumption that impairments, functional limitations, and disability are related in patients with CSD.  (+info)

Studies on the vitamin C requirements of channel catfish (Ictalurus punctatus). (58/1040)

Three feeding studies on the vitamin C requirements of channel catfish were conducted with practical and semipurified diets. In a long-duration study in which fish achieved almost a 4,000% increase in weight, 50 mg of l-ascorbic acid/kg diet was required for maximal growth and food efficiency. A diet stability study revealed that excessive losses in activity of l-ascorbic acid occurred when practical diets were stored for 16 weeks at 20 degrees. The typical scoliosis condition associated with severe vitamin C deficiency in fish occurred in the nonsupplemented groups in the study with practical diets. Severe growth reductions were obtained from fish fed nonsupplemented semi-purified diets, yet no incidences of spinal abnormalities were noted.  (+info)

Posterior stabilization of the cervical spine with hooks and screws. A clinical evaluation of 26 patients with traumatic, degenerative or metastatic lesions, using a new implant system. (59/1040)

We operated on 26 patients with cervical spine disorders (13 with traumatic lesions, 3 with spinal stenosis and myelopathy, 1 with osteomyelitis and 9 with metastasis) with posterior stabilization. A new implant system (Cervi-Fix) based on rods, enabling a choice of either screw or laminar hook fixation in a free combination, was used. The system was evaluated for ease of use, for safety, regarding complications related to the system, and for efficacy, regarding loss of correction and signs of instability. The patients were followed for a mean period of 11 months, with ordinary and flexion/extension radiographs and clinical examination. No complications related to the implant system were observed. Loss of correction was observed in one patient. We found constructs with few vertebral fixation points, especially with screws, easy to handle, whereas multiple-claw constructs were time consuming. This implant system seems to be versatile, safe and efficient, but could be improved by the development of instruments for the insertion of the hooks.  (+info)

Cephalic spreading levels after volumetric caudal epidural injections in chronic low back pain. (60/1040)

The volumetric caudal epidural steroid injection has been advocated to facilitate the delivery of medications to the lesion site. This study was aimed to examine the actual spreading patterns of this technique, using epidurogram. A total of 32 patients with chronic low back pain accompanied by radiculopathy of various causes (degenerative spondylosis, herniated nucleus pulposus, spondylolisthesis, and spinal stenosis) were included. The volumetric caudal epidural injection of the 10 mL mixture of contrast medium 5 mL, 0.5% bupivacaine 1 mL, triamcinolone 1.5 mL (60 mg) and normal saline 25 mL was performed. Immediately after the cessation of the first spread, the subsequent solution of another 10 mL of contrast medium 5 mL, 0.5% bupivacaine 1 mL and normal saline 4 mL was injected. This procedure was repeated serially until the total volume to be 50 mL. Continuous fluoroscopic imaging was obtained after each injection. Average time taken to complete the study was 37 sec per every 10 mL. The spreading levels of the mixture were distributed mainly at mid to lower lumbar area in the majority of the patients. During the subsequent injections, the levels were not changed significantly. This was thought to be due to the minimal resistance in cephalad direction, anatomic variations and Starling effect of epidural space.  (+info)

Trapped in the neutral zone: another symptom of whiplash-associated disorder? (61/1040)

Instability of the cervical spine following whiplash trauma has been demonstrated in a number of studies. We hypothesized that, in patients with whiplash-associated disorder, rotation of the head would be accompanied by an earlier onset of neck muscle activity to compensate for intrinsic instability. The aim of the study was to examine the range of motion (RoM) of the cervical spine and the onset and activity of the sternocleidomastoid (SCM) muscles during axial rotation, in healthy control subjects and in patients with chronic whiplash-associated disorder. Forty-eight control subjects (42% male) and 46 patients (33% male) with chronic whiplash-associated disorder (symptoms lasting longer than 3 months) were examined. Cervical axial RoM differed significantly (P = 0.0001) between the groups, with the whiplash patients showing lower values (83 degrees +/- 30 degrees) than the healthy controls (137 degrees +/- 19 degrees). The whiplash patient group showed no evidence of the predicted earlier activation of SCM muscles. Many patients never reached the point in the RoM where SCM muscle activity rises steeply, as it does in the healthy controls (the 'elastic zone'), and their movements remained mostly within the region of low muscle activity (the 'neutral zone'). The whiplash patients appeared either unable or unwilling to drive the cervical spine into this region of high muscle activity, possibly because they were restricted by existing pain or fear of pain.  (+info)

The association of degeneration of the intervertebral disc with 5a/6a polymorphism in the promoter of the human matrix metalloproteinase-3 gene. (62/1040)

It has been suggested that matrix metalloproteinase-3 (MMP-3, stromelysin-1) has an important role in the degeneration of intervertebral discs (IVDs). A human MMP-3 promoter 5A/6A polymorphism was reported to be involved in the regulation of MMP-3 gene expression. We suggest that IVD degeneration is associated with 5A/6A polymorphism. We studied 54 young and 49 elderly Japanese subjects. Degeneration of the lumbar discs was graded using MRI in the younger group and by radiography in the elderly. 5A/6A polymorphism was determined by polymerase-chain reaction-based assays. We found that the 5A5A and 5A6A genotype in the elderly was associated with a significantly larger number of degenerative IVDs than the 6A6A (p < 0.05), but there was no significant difference in the young. In the elderly, the IVD degenerative scores were also distributed more highly in the 5A5A and 5A6A genotypes (p = 0.0029). Our findings indicate that the 5A allele is a possible risk factor for the acceleration of degenerative changes in the lumbar disc in the elderly.  (+info)

Prevalence of disabilities and associated health conditions among adults--United States, 1999. (63/1040)

In the United States, the number of persons reporting disabling conditions increased from 49 million during 1991-1992 to 54 million during 1994-1995. During 1996, direct medical costs for persons with disability were $260 billion. Surveillance of disability prevalence and associated health conditions is useful in setting policy, anticipating the service needs of health systems, assisting state programs, directing health promotion and disease prevention efforts, and monitoring national health objectives. The U.S. Bureau of the Census and CDC analyzed data from the Survey of Income and Program Participation (SIPP) to determine national prevalence estimates of adults with disabilities and associated health conditions. This report summarizes findings of that analysis, which indicate that disability continues to be an important public health problem, even among working adults, and arthritis or rheumatism, back or spine problems, and heart trouble/hardening of the arteries remain the leading causes. Better health promotion and disease prevention may reduce the prevalence of disability-associated health conditions.  (+info)

Effect of ibandronate on bone loss and renal function after kidney transplantation. (64/1040)

Severe osteoporosis frequently is observed after organ transplantation. In kidney transplantation, it adds to pre-existing renal bone disease and strategies to prevent osteoporosis are not established. Eighty kidney recipients were included in a randomized controlled prospective intervention trial. Treated patients (n = 40) received an injection of ibandronate, a bisphosphonate, immediately before and at 3, 6, and 9 mo after transplantation. The primary outcome measured was the change in bone mineral density. Secondary measures included graft outcome, spinal deformities, fracture rate, body height, and hormonal and metabolic data. Loss of spongy and cortical bone after transplantation was prevented by ibandronate. Changes of bone mineral density (ibandronate versus controls) were as follows: lumbar spine, -0.9 +/- 6.1% versus -6.5 +/- 5.4% (P < 0.0001); femoral neck, +0.5 +/- 5.2% versus -7.7 +/- 6.5% (P < 0.0001); and midfemoral shaft, +2.7 +/- 12.2% versus -4.0 +/- 10.9% (P = 0.024). Fewer spinal deformities developed with ibandronate (7 patients with 7 deformities versus 12 patients with 23 deformities; P = 0.047). Loss of body height was 0.5 +/- 1.0 cm versus 1.1 +/- 1.0 cm in control subjects (P = 0.040). Two bone fractures occurred in each group. There were fewer acute rejection episodes with ibandronate (11 versus 22; P = 0.009). Graft function after 1 yr was comparable. Bone loss, spinal deformation, and loss of body height during the first year after kidney transplantation are prevented by injection of ibandronate at intervals of 3 mo. The smaller number of rejection episodes of the ibandronate-treated group should be confirmed and its mechanism should be explored in additional studies.  (+info)