Sciatica. Management for family physicians.

Sciatica or lower back pain with sciatic radiation is a frequent medical problem in primary care. The aim of this article is to better inform medical practitioners on diagnosis and management of lower back pain with sciatic radiation. Updated information on sciatica management is important for family physicians. Here, we review the available literature on sciatica. Relevant articles were identified via a literature search in PubMed by focusing on the following key points: diagnostic and definition criteria, red flags, and therapy. In addition, the authors' clinical experience has been utilised to propose a schema to assist in the assessment and treatment of sciatica in a primary care setting. Sciatica diagnosis is based on a careful history and clinical examination. Imaging is usually not necessary at first; testing with X-ray and MRI are key to diagnosing lumbar instability and herniated discs. Management includes physical conditioning, proper pain management, and surgery as a last resort. Pain treatment includes analgesics, anticonvulsants and muscle relaxants. A more aggressive approach would include epidural infiltrations and radiofrequency.

Carotid intima-media thickness as a screening tool in cardiovascular primary prevention.

BACKGROUND AND OBJECTIVE: Increased carotid intima-media thickness (CIMT) is associated with cardiovascular events. The purpose of this study was to identify advanced subclinical atherosclerosis in patients who are at low or intermediate risk. METHODS: Thousand hundred and eighteen Spanish subjects were prospectively enrolled in an ambulatory screening of cardiovascular risk (CVR). Three hundred and twenty patients aged over 30 years with low-intermediate CVR according to European SCORE function underwent carotid ultrasonography. Carotid IMT and plaque assessment were performed using high-resolution B-mode ultrasonography. Participants with abnormal CIMT were reclassified to high CVR. RESULTS: According to SCORE function, 104 patients (32·5%) were of low CVR and 216 (67·5%) of intermediate CVR. Mean carotid IMT was 0·62 ± 0·13 mm, and carotid plaque was found in 35 (10·9%) patients. Carotid ultrasonography changed the risk stratum in 59 (18·4%) patients, who were reclassified to high CVR. Reclassification was more frequent in the intermediate CVR group than in the low CVR group (22·7% vs. 9·6%, P = 0·005) and was associated to age (P = 0·002), history of arterial hypertension (P < 0·001) and increased systolic blood pressure (P = 0·05). CONCLUSIONS: CIMT calculated by high-resolution B-mode ultrasonography could become an important tool in preventive medicine. Measuring CIMT may be useful in identifying asymptomatic individuals with subclinical atherosclerosis not detected by the actual CVR functions.

[Carotid intima-media thickness and its current usefulness]. / El grosor íntimo-medial carotídeo y su utilidad actual.

Cardiovascular risk stratification is currently part of routine clinical practice to establish cardiovascular prevention strategies. A complementary approach to the assessment scales of cardiovascular risk stratification is the non-invasive evaluation of the atherosclerotic lesion to identify patients at high risk for cardiovascular complications. Carotid intima-media thickness is a non-invasive method based on ultrasound suitable for the detection of subclinical atherosclerosis. It allows us to stratify cardiovascular risk beyond conventional cardiovascular risk factors and would complement the cardiovascular risk functions. The inclusion of the carotid intima-media thickness in cardiovascular risk stratification may help identify asymptomatic individuals with a high cardiovascular risk not detected by current scales of cardiovascular risk stratification.