Low back pain and urinary incontinence. A hypothetical relationship.

STUDY DESIGN: An apparent association of low back pain with urinary incontinence was observed. Sixteen patients were investigated for organic neurologic and genito-urinary disease or deficit, which could provide a conventional explanation for the incontinence. OBJECTIVES: The unusual association of low back pain alone, with urinary incontinence, should be brought to the attention of clinicians, in the search for neurologic mechanisms to explain the phenomenon. SUMMARY OF BACKGROUND DATA: Over 5 years, a spinal practice reviewed 5000 new patients, most presenting with low back pain. Sixteen low back pain patients had urgency incontinence of urine, of varying severity but sufficient in all cases to cause daily distress and disruption of routine. Twelve of the sixteen patients had surgery (spinal fusion in 11 and total hip replacement in one), and four are awaiting surgery. Follow-up ranged from 1 to 4 years. METHODS: Plain radiography, detailed neurologic examination, myelography, or computed tomography scanning of lumbar spine, urine culture, and urodynamic studies were the investigations used, with a few exceptions relating to those patients whose urinary symptoms were revealed retrospectively. RESULTS: When surgery reduced low back pain successfully (11 of 12 patients), the urgency incontinence was cured or improved. In one patient, the low back pain continued, associated with a pseudarthrosis in the fusion mass, and the urinary symptoms were unchanged. In the four patients awaiting surgery, the urinary symptoms are unchanged. The investigations did not reveal any neurologic or genito-urinary pathology in any patient. CONCLUSION: A rare association between severe low back pain and urgency incontinence of urine, not explained on the basis of any conventional neurologic or genito-urinary pathology, should be recognized.

Long-term results of revision total hip arthroplasty.

A total of 138 revision hip arthroplasties in 134 patients, all operated upon by one surgeon, were followed for an average of 7.4 years. The overall results were reasonable, with good to excellent Mayo hip scores in 62% and little or no pain in 86%. These results were independent of body weight, age, primary diagnosis and type of arthroplasty used. The incidence of radiological loosening was alarming, though comparable to that found in other series. Our findings indicate that it may be wise to replace both components even when, after careful assessment before and during operation, one of them seems to be securely fixed.

The use of peroxidase anti-peroxidase (PAP) complexes in the detection of plant viruses by ELISA.

An ELISA test system for detection of plant viruses in field samples is described, based on the unlabelled antibody method using a peroxidase-antiperoxidase (PAP) complex. Novel features of the system include the use of acid-treated naked bacteria as combined carrier-adjuvants for the production of rabbit antiviral antibodies, and the use of acid-treated chicken antibodies (IgY) for antigen trapping in the ELISA. Systems for detection of potato virus Y (PVY), potato leafroll virus (PLRV), grapevine fanleaf virus (GFV) and grapevine virus A (GVA) were developed and compared with conventional direct double antibody sandwich (DAS) systems in tests with both purified virus and field samples. The PAP systems offer improved sensitivity, no background problems in the outer rows of the microtitre plates and are much easier to visualize with the naked eye if no plate reader is available.