Impacto de la escuela de la espalda para lumbalgia crónica en el consumo de recursos sanitarios / Impact of back school for chronic low back pain on health resource consumption

Objetivo. Valorar si en los pacientes con dolor lumbar crónico, la escuela de la espalda (EE) asociado a un programa de capacitación lumbar (PCL) disminuye la asistencia a los servicios sanitarios tanto en atención primaria (AP), urgencias u otras consultas especializadas, en comparación con la realización única de PCL como intervención. Pacientes y método. Estudio descriptivo retrospectivo que incluye 2 grupos de pacientes con dolor lumbar crónico sin indicación quirúrgica, necesidad de continuar estudios ni ajuste de medicación analgésica habitual. El primer grupo recibe un PCL (grupo A) únicamente como intervención y el segundo realiza «además del PCL» la EE y (grupo B). Se analizó, tras un seguimiento comprendido entre 17 y 29 meses, la asistencia o no a los diferentes servicios sanitarios posterior al alta del programa de rehabilitación. Resultados. De los 59 pacientes analizados: 25 pertenecían al grupo A y 34 al B. La totalidad de los pacientes pertenecientes al grupo B no demandan una nueva valoración médica, acudiendo a los servicios de AP únicamente para analgesia puntual, frente al 28% del grupo A que ampliaron su estudio con una nueva valoración médica en otros servicios. Si analizamos la asistencia a los servicios de urgencias en general, el 36% de los pacientes pertenecen al grupo A frente al 20,6% en el grupo B. Conclusiones. Parece que los pacientes que complementan el PCL con la EE asimilan mejor el concepto de cronicidad y benignidad de su dolor lumbar, repercutiendo en una menor afluencia a los servicios sanitarios (AU)

Objective. To determine if the back school combined with a low back exercises program (LBEP) for patients with chronic low back pain reduces visits to the health care services (primary care, emergency or other specialized consultations) compared to use of LBEP alone. Patients and methods. A retrospective descriptive study was performed. It included two groups of patients with chronic low back pain who did not require surgery, need to continue studies or changes in their usual analgesics. The first group only received physical therapy consisting of a lumbar training program (group A) and the second one received the back school program as well as the LBEP (group B). After a follow-up of 17 to 29 months, attendance to the different health care services after discharge from the rehabilitation program was analyzed. Results. A sample of 59 patients was studied. Of these, 25 patients were included in group A and 34 in B. None of the patients in group B requested a new medical consultation. They only went to the primary care services for occasional analgesics. In group A, 28% returned for more studies in other Emergency services in general. If the visits to the emergency services are analyzed in general, 36% of the patients belong to group A versus 20.6% in group B. Conclusions. It appears that patients who combine the low back exercises program with the Back School better assimilate the concept of chronicity and benignness of their condition. This has an effect on fewer visits to the health care services (AU)

Physical and mechanical properties of a thermomechanically treated NiTi wire used in the manufacture of rotary endodontic instruments.

AIM: To compare physical and mechanical properties of one conventional and one thermomechanically treated nickel-titanium (NiTi) wire used to manufacture rotary endodontic instruments. METHODOLOGY: Two NiTi wires 1.0 mm in diameter were characterized; one of them, C-wire (CW), was processed in the conventional manner, and the other, termed M-Wire (MW), received an additional heat treatment according to the manufacturer. Chemical composition was determined by energy-dispersive X-ray spectroscopy, phase constitution by XRD and the transformation temperatures by DSC. Tensile loading/unloading tests and Vickers microhardness measurements were performed to assess the mechanical behaviour. Data were analysed using analysis of variance (α = 0.05). RESULTS: The two wires showed approximately the same chemical composition, close to the 1 : 1 atomic ratio, and the ß-phase was the predominant phase present. B19' martensite and the R-phase were found in MW, in agreement with the higher transformation temperatures found in this wire compared with CW, whose transformation temperatures were below room temperature. Average Vickers microhardness values were similar for MW and CW (P = 0.91). The stress at the transformation plateau in the tensile load-unload curves was lower and more uniform in the M-Wire, which also showed the smallest stress hysteresis and apparent elastic modulus. CONCLUSIONS: The M-Wire had physical and mechanical properties that can render endodontic instruments more flexible and fatigue resistant than those made with conventionally processed NiTi wires.

[Radiosurgery as adjuvant treatment of a recurrent adult medulloblastoma. Ultra-early response]. / Radiocirugía como tratamiento complementario del meduloblastoma recidivadodel adulto: respuesta ultratemprana.

The role of radiosurgery after multimodality treatment of recurrent desmoplastic adult medulloblastoma is analyzed. The ultra-early clinical and pathological response of this tumor to adjunctive radiosurgery is stressed.

[Usefulness of hyperbaric oxygen in the treatment of radionecrosis and symptomatic brain edema after LINAC radiosurgery]. / Eficacia del oxígeno hiperbárico en el tratamiento de la radionecrosis y el edemacerebral sintomáticos tras radiocirugía con acelerador lineal.

Radionecrosis with brain edema is a complication of radiosurgery. Three female patients harbouring a frontal pole, petrous and parasagital parietoocipital meningiomas respectively who had been treated with LINAC radiosurgery are presented. Those patients developed, between two and eight months later, a severe symptomatic radionecrosis with a huge brain edema resistant to the usual steroid therapy. Only after 40 sessions of hyperbaric oxygen, a good remission of the lesions was obtained. There are few cases reported in the literature with such a good outcome. Consequentely, this therapy must be taken into account to treat this type of radiosurgical complication before considering surgery.

Influence of sterilization on mechanical properties and fatigue resistance of nickel-titanium rotary endodontic instruments.

AIM: To evaluate the effect of repeated sterilization cycles in dry oven or autoclave, on the mechanical behaviour and fatigue resistance of rotary endodontic Ni-Ti instruments. METHODOLOGY: New Ni-Ti instruments were subjected to five consecutive sterilization cycles in a dry oven or steam autoclave. Microhardness was measured in the nonmachined parts of the shanks of instruments using a Vickers indenter. Specimens of Ni-Ti wires were submitted to the same sterilization protocol and tensile tested until rupture. A group of instruments were fatigued to one half of their average fatigue life and then sterilized. New and sterilized instruments were fatigue tested until rupture. anova tests at alpha = 0.05 were used for statistical analysis. RESULTS: Sterilization procedures resulted in no significant changes in Vickers microhardness, nor in the parameters describing the mechanical behaviour of the wires. However, the number of cycles to failure was statistically higher for all instruments after dry heat or autoclave sterilization cycles. In the instruments previously fatigued to one half of their fatigue life, autoclave sterilization gave rise to an increase of 39% in the remaining number of cycles to failure. CONCLUSIONS: Changes in the mechanical properties of Ni-Ti endodontic instruments after five cycles of commonly used sterilization procedures were insignificant. The sterilization procedures are safe as they produced a significant increase in the fatigue resistance of the instruments.

Physical and mechanical characterization and the influence of cyclic loading on the behaviour of nickel-titanium wires employed in the manufacture of rotary endodontic instruments.

AIM: To analyse the influence of cyclic loading on the mechanical behaviour of nickel-titanium (NiTi) wires employed in the manufacture of ProFile rotary endodontic instruments. METHODOLOGY: Nickel-titanium wires, 1.2 mm in diameter, taken from the production line of ProFile rotary endodontic instruments before the final machining step, were tensile-tested to rupture in the as-received condition and after 100 load-unload cycles in the superelastic plateau (4% elongation). The wires were characterized by X-ray energy-dispersive spectroscopy, X-ray diffraction and by differential scanning calorimetry and compared with new size 30, .06 taper ProFile instruments. The fracture surfaces of the wires were observed by scanning electron microscopy. RESULTS: The mechanical properties of the as-received wires, their chemical composition, the phases present and their transformation temperatures were consistent with their final application. Only small changes, which decreased after the first few cycles, took place in the mechanical properties of the cycled wires. The stress at maximum load and the plastic strain at breakage remained the same, while the critical stress for inducing the superelastic behaviour, which is related to the restoring force of the endodontic instruments, decreased by approximately 27%. CONCLUSIONS: The mechanical behaviour of the NiTi wires was modified slightly by cyclic tensile loading in the superelastic plateau. As the changes tended towards stabilization, the clinical use of rotary NiTi ProFile instruments does not compromise their superelastic properties until they fracture by fatigue or torsional overload, or are otherwise discarded.

Inhibitory effects of isomers of tocopherol on lipid peroxidation of microsomes from vitamin E-deficient rats.

NADPH-induced lipid peroxidation of hepatic microsomes from vitamin E-deficient rats has been used to assess the antioxidant effectiveness of dl alpha, d alpha- and gamma-tocopherol. When the tocopherols were added in ethanol to microsomes, the degree of inhibition of formation of thiobarbituric acid reactive substances (TBARS) decreased in the order dl alpha- greater than d alpha- greater than gamma-tocopherol. This reflected the difference in the solubility of the tocopherols in the microsomes, dl alpha-tocopherol being the most soluble and gamma-tocopherol the least. Using inhibition of TBARS produced per tocopherol content in microsome as a measure of antioxidant potency, the effectiveness of the isomers was gamma- greater than d alpha- greater than dl alpha. Despite addition of pharmacological concentrations of the isomers, it was not possible to inhibit lipid peroxidation to the same levels as were found in microsomes from vitamin E sufficient animals. Use of ethanol as a vehicle may not allow optimum orientation of the tocopherols into the lipid bilayer.