Are the presence of MODIC changes on MRI scans related to "improvement" in low back pain patients treated with lumbar facet joint injections?

BACKGROUND: Modic changes (MC) have been linked with low back pain (LBP) and worse outcomes from some treatments. No studies have investigated the impact that MCs may have on patient outcomes from lumbar facet injections. Therefore, the purpose of this study is to investigate whether the presence of Modic changes is related to 'improvement' in patients undergoing imaging-guided lumbar facet injection therapy. METHODS: Outcomes from 226 patients with MRI scans within 3 months of their imaging-guided lumbar facet injections were investigated to determine whether MCs are related to 'improvement' post injection. At 1 day, 1 week and 1 month post injection the Patients Global Impression of Change scale answers were collected by postal questionnaire. This was the primary outcome measure. The numerical rating scale for pain data was collected prior to treatment and at the same post injection time points. The MRI scans were independently evaluated by two examiners for the presence/absence of Modic changes and the type of Modic change if present. Kappa statistics were used for reliability of diagnosis analysis. Chi-squared test and logistic regression analysis tested MCs with 'improvement'. RESULTS: Intra- and inter-examiner reliability for the diagnosis of MCs was Kappa = 0.77 and 0.74. Intra- and inter-examiner reliability for categorizing MCs was K = 0.77 and K = 0.78. At 1 month post injection 45.2 % of patients without MCs reported clinically relevant 'improvement' compared to 34.2 % of patients with MC I and 32.1 % of patients with MC II. However, this did not reach statistical significance. Logistic regression found that Modic changes were not predictive of 'improvement'. CONCLUSIONS: There was a tendency for patients without MCs to have better outcomes but this did not reach statistical significance. The reliability of diagnosing MCs was substantial.

Hypersensitivity to mugwort (Artemisia vulgaris) in patients with peach allergy is due to a common lipid transfer protein allergen and is often without clinical expression.

BACKGROUND: The observation of mugwort-specific IgE antibodies in patients with peach allergy suggests that mugwort sensitization might play a role in sensitization to peach. OBJECTIVE: We sought to study the clinical manifestations of mugwort hypersensitivity in patients with peach allergy, identify the common allergens, and evaluate their IgE crossreactivity. METHODS: Patients with oral allergy syndrome for peach and specific IgE antibodies to mugwort were investigated for respiratory symptoms during the mugwort season. Peach and mugwort allergens were identified by means of SDS-PAGE and IgE immunoblotting. Immunoblotting inhibition experiments were done to study cross-reactivity between peach and mugwort and other pollens. RESULTS: Seventeen patients were studied, 10 with no seasonal respiratory symptoms and 7 with clear late summer respiratory symptoms. In IgE immunoblotting the 10 asymptomatic patients reacted only to a 9-kd allergen of both mugwort and peach, whereas the 7 patients with pollinosis reacted to other allergens. Ten patients with mugwort allergy, no history of allergy to peach, and negative results for peach-specific IgE antibodies were also studied. The mugwort 9-kd protein was identified as a lipid transfer protein (LTP) homologous to peach LTP. Immunoblotting inhibition showed that IgE binding to the peach 9-kd band was totally inhibited by 4 microg of peach LTP but only by 400 microg of mugwort LTP, whereas 4 microg of both mugwort and peach LTP totally inhibited the mugwort immunoblotting. The results were similar with other pollens. CONCLUSIONS: Patients sensitized only to the 9-kd LTP of mugwort do not present hay fever symptoms, and this sensitization is a consequence of the peach sensitization.

Etiología y diagnóstico de la esteatosis hepática / Etiology and diagnosis of hepatic steatosis

Con los objetivos de conocer los factores etiológicos en juego en las esteatosis hepáticas y de evaluar la ecografía y la laparoscopía en el diagnóstico de dicha patología, se estudió un grupo de 48 pacientes que consultaron en la Clínica de Nutrición y Digestivo de la Facultad de Medicina. A todos ellos se les realizó una encuesta etiológica, exámenes de laboratorio, ecografía y, a 28 de ellos, punción biópsica hepática (PBH). De los resultados se destaca que en la mitad de los casos, la etiología fue única y en la otra mitad se asociaron factores, especialmente el alcohol y la obesidad, llamando la atención la presencia de dislipemias como cofactor y nunca como causa aislada. La ecogrfía y la laparoscopía tuvieron excelente rendimiento en el diagnóstico de la esteatosis hepática (EH), con 100 por ciento, 93 por ciento de sensibilidad respectivamente, y ambas con 100 por ciento de valor predictivo positivo (VPP). El enzimograma hepático alterado identificó un grupo especial de riesgo de EH moderado o severa y en ocasiones, asociada a otras entidades histológicas. Estas ultimas no fueron detectables ecográficamente. Se discuten estos resultados y se los compara con los de la literatura extranjera. Se concluye que, una vez que la ecografía plantea el diagnóstico de EH, ésta seguramente está presente, pero si existe probabilidad de lesiones asociadas, debe realizarse PBH