Role of facet joints in spine pain and image-guided treatment: a review.

Chronic low back and neck pain remain prevalent medical concerns, with much debate regarding the effective evaluation and treatment. Facet disease has been implicated as a source of axial nonradiating low back pain. We discuss patient evaluation, the role of imaging, current and emerging image-guided therapies for facet-related pain, and the increasing importance of outcome-related research in this arena.

Higher prevalence of cortical lesions observed in patients with acute stroke using high-resolution diffusion-weighted imaging.

Ischemic lesion conspicuity on routine diffusion-weighted imaging (DWI, 30 seconds) was compared with an improved sequence (high-resolution DWI [DWI-HR], 256 seconds) having increased spatial resolution and signal to noise and decreased eddy current artifact in 42 patients with acute ischemic stroke. Total lesion volumes were similar; however, twice as many lesions were identified on DWI-HR, predominately in cortical gray matter. Modest improvements to imaging resulted in increased conspicuity, potentially affecting diagnosis, suspected pathogenic mechanism, and therapeutic decision.

Accessibility and reliability of cutaneous laser surgery information on the World Wide Web.

The World Wide Web has provided the public with easy and affordable access to a vast range of information. However, claims may be unsubstantiated and misleading. The purpose of this study was to use cutaneous laser surgery as a model to assess the availability and reliability of Web sites and to evaluate this resource for the quality of patient and provider education. Three commercial methods of searching the Internet were used, identifying nearly 500,000 possible sites. The first 100 sites listed by each search engine (a total of 300 sites) were compared. Of these, 126 were listed repeatedly within a given retrieval method, whereas only 3 sites were identified by all 3 search engines. After elimination of duplicates, 40 sites were evaluated for content and currency of information. The most common features included postoperative care suggestions, options for pain management or anesthesia, a description of the way in which lasers work, and the types of lasers used for different procedures. Potential contraindications to laser procedures were described on fewer than 30% of the sites reviewed. None of the sites contained substantiation of claims or referrals to peer-reviewed publications or research. Because of duplication and the prioritization systems of search engines, the ease of finding sites did not correlate with the quality of the site's content. Our findings show that advertisements for services exceed useful information.

Immediate pigment darkening thresholds of human skin to monochromatic (362 nm) ultraviolet A radiation are fluence rate dependent.

When human skin is irradiated with ultraviolet radiation (340-400 nm) there is an immediate pigment response, termed Immediate Pigment Darkening (IPD). This reaction is thought to be due to photooxidation of preexisting melanin, precursors and/or melanin metabolites because it appears during exposure. It has been demonstrated that UVA-induced skin reactions, including erythema and pigmentation, are oxygen dependent. Therefore, these reactions should also be irradiance (fluence rate) dependent. The purpose of this investigation was to determine the dependence of the IPD threshold on fluence rate. We exposed the forearm of 12 volunteers (skin type II-V) to monochromatic UVA radiation (362 nm) at a range of fluence rates of 6-115 mW/cm2 and determined the fluence at which pigment was perceptible. The threshold fluence for the IPD reaction increased by a factor of 2.7 as the fluence rate increased by a factor of 18. Therefore, we conclude that the IPD reaction following exposure to 362 nm radiation is dependent on fluence rate, and independent of skin type.