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1.
Medicine (Baltimore) ; 100(9): e24747, 2021 Mar 05.
Artigo em Inglês | MEDLINE | ID: mdl-33655938

RESUMO

OBJECTIVE: This meta-analysis was performed to investigate whether percutaneous endoscopic lumbar discectomy (PELD) had a superior effect than other surgeries in the treatment of patients with lumbar disc herniation (LDH). METHOD: We searched PubMed, Embase, and Web of Science through February 2018 to identify eligible studies that compared the effects and complications between PELD and other surgical interventions in LDH. The outcomes included success rate, recurrence rate, complication rate, operation time, hospital stay, blood loss, visual analog scale (VAS) score for back pain and leg pain, 12-item Short Form Health Survey (SF12) physical component score, mental component score, Japanese Orthopaedic Association Score, Oswestry Disability Index. A random-effects or fixed-effects model was used to pool the estimate, according to the heterogeneity among the included studies. RESULTS: Fourteen studies (involving 2,528 patients) were included in this meta-analysis. Compared with other surgeries, PELD had favorable clinical outcomes for LDH, including shorter operation time (weight mean difference, WMD=-18.14 minutes, 95%CI: -25.24, -11.05; P < .001) and hospital stay (WMD = -2.59 days, 95%CI: -3.87, -1.31; P < .001), less blood loss (WMD = -30.14 ml, 95%CI: -43.16, -17.13; P < .001), and improved SF12- mental component score (WMD = 2.28, 95%CI: 0.50, 4.06; P = .012)) and SF12- physical component score (WMD = 1.04, 95%CI: 0.37, 1.71; P = .02). However, it also was associated with a significantly higher rate of recurrent disc herniation (relative risk [RR] = 1.65, 95%CI: 1.08, 2.52; P = .021). There were no significant differences between the PELD group and other surgical group in terms of success rate (RR = 1.01, 95%CI: 0.97, 1.04; P = .733), complication rate (RR = 0.86, 95%CI: 0.63, 1.18; P = .361), Japanese Orthopaedic Association Score score (WMD = 0.19, 95%CI: -1.90, 2.27; P = .861), visual analog scale score for back pain (WMD = -0.17, 95%CI: -0.55, 0.21; P = .384) and leg pain (WMD = 0.00, 95%CI: -0.10, 0.10; P = .991), and Oswestry Disability Index score (WMD = -0.29, 95%CI: -1.00, 0.43; P = .434). CONCLUSION: PELD was associated with better effects and similar complications with other surgeries in LDH. However, it also resulted in a higher recurrence rate. Considering the potential limitations in the present study, further large-scale, well-performed randomized trials are needed to verify our findings.


Assuntos
Descompressão Cirúrgica/estatística & dados numéricos , Discotomia Percutânea/estatística & dados numéricos , Endoscopia/estatística & dados numéricos , Deslocamento do Disco Intervertebral/cirurgia , Vértebras Lombares/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Dor nas Costas/etiologia , Dor nas Costas/cirurgia , Estudos de Casos e Controles , Estudos de Coortes , Descompressão Cirúrgica/métodos , Feminino , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Medição da Dor , Dor Pós-Operatória/etiologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento , Adulto Jovem
2.
BMJ Case Rep ; 14(3)2021 Mar 16.
Artigo em Inglês | MEDLINE | ID: mdl-33727290

RESUMO

We present a case of a giant ovarian cyst in a 20-year-old woman who presented atypically at our Emergency Department with left-sided back pain followed by acute left leg swelling. Blood tests showed significantly raised C-Reactive Protein and D-Dimer. CT-Abdomen-Pelvis demonstrated a large mass in the region of the right ovary with suspicious heterogeneous filling defects in the left external iliac vein, confirmed as a left-sided deep-vein thrombosis on ultrasound Doppler. MRI revealed the lesion to be cystic and the deep venous thrombosis was treated with twice-daily Clexane. Prior to removal of the cyst, an Inferior Vena Cava Filter was placed to reduce thromboembolic risk. The cyst was resected without complication and the postoperative period was uneventful. This case occurred while face-to-face services were limited by COVID-19 and illustrates the need for robust systemic measures to safeguard patients against the emergency sequelae of insidious gynaecological pathology.


Assuntos
Dor nas Costas/etiologia , Diagnóstico por Imagem/métodos , Cistos Ovarianos/complicações , Cistos Ovarianos/diagnóstico por imagem , Trombose Venosa/diagnóstico por imagem , Trombose Venosa/etiologia , Adulto , Diagnóstico Diferencial , Enoxaparina/uso terapêutico , Feminino , Fibrinolíticos/uso terapêutico , Humanos , Perna (Membro) , Imagem por Ressonância Magnética , Cistos Ovarianos/cirurgia , Ovário/diagnóstico por imagem , Ovário/cirurgia , Tomografia Computadorizada por Raios X , Ultrassonografia Doppler , Trombose Venosa/tratamento farmacológico , Adulto Jovem
3.
BMJ Case Rep ; 14(2)2021 Feb 04.
Artigo em Inglês | MEDLINE | ID: mdl-33542000

RESUMO

Infected aortic aneurysm is a rare disease and is often overlooked as a source of infection in septic elderly patients. We present a case of a septic elderly man with a ruptured infected aortic aneurysm caused by Salmonella enteritidis This condition was treated non-surgically with percutaneous endovascular aneurysm repair and antibiotics. The postoperative recovery was complicated a month later by spondylodiscitis and psoas abscess. He underwent radiologically guided drainage of the psoas abscess and was placed on lifelong suppressive antibiotics. We discuss the aetiology, treatment options and complications of this condition.


Assuntos
Aneurisma Infectado/cirurgia , Aneurisma da Aorta Abdominal , Discite/etiologia , Procedimentos Endovasculares , Salmonella enteritidis/isolamento & purificação , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Aneurisma da Aorta Abdominal/complicações , Aneurisma da Aorta Abdominal/cirurgia , Dor nas Costas/etiologia , Ceftriaxona/uso terapêutico , Drenagem/efeitos adversos , Humanos , Masculino , Abscesso do Psoas/etiologia , Sepse , Tomografia Computadorizada por Raios X
4.
BMJ Case Rep ; 14(2)2021 Feb 04.
Artigo em Inglês | MEDLINE | ID: mdl-33541995

RESUMO

Presentation of severe pain syndromes prior to onset of motor weakness is an uncommon but documented finding in patients with Guillain-Barré syndrome (GBS). Sciatica in GBS is a difficult diagnosis when patients present with acute radiculopathy caused by herniated disc or spondylolysis. A middle-aged woman was admitted for severe low back pain, symptomatic hyponatraemia, vomiting and constipation. On further investigation, she was diagnosed with radiculopathy, and appropriate treatment was initiated. Brief symptomatic improvement was followed by new-onset weakness in lower limbs, which progressed to involve upper limbs and right extraocular muscles. With progressive, ascending, new-onset motor and sensory deficits and laboratory evidence of demyelination by Nerve Conduction Study, a diagnosis of variant GBS was made. She was treated with intravenous immunoglobulin 2 g/kg over 5 days. The presentation of severe low back pain that was masking an existing aetiology and possible dysautonomia and the unilateral right extraocular muscles instead of bilateral make our case unique and rare.


Assuntos
Diagnóstico Diferencial , Imunoglobulinas Intravenosas/uso terapêutico , Síndrome de Miller Fisher/diagnóstico , Síndrome de Miller Fisher/tratamento farmacológico , Músculos Oculomotores/fisiopatologia , Radiculopatia/diagnóstico , Dor nas Costas/etiologia , Feminino , Síndrome de Guillain-Barré/diagnóstico , Hospitais , Humanos , Hiponatremia/etiologia , Extremidade Inferior/fisiopatologia , Pessoa de Meia-Idade , Síndrome de Miller Fisher/complicações
5.
BMJ Case Rep ; 14(1)2021 Jan 26.
Artigo em Inglês | MEDLINE | ID: mdl-33500296

RESUMO

Vertebral osteomyelitis is a rare diagnosis and often delayed diagnosis in children. This is a case of a child presenting with fever, back pain and raised C reactive protein who was found to have a Staphylococcus aureus (S.aureus) bacteraemia. Initial imaging with CT, MRI of the spine and abdominal ultrasound failed to demonstrate a vertebral osteomyelitis or identify another source of the bacteraemia. Due to the high clinical suspicion of a spinal source of the infection, second-line investigations were arranged. A bone scan identified an area of increase metabolic activity in the 12th thoracic vertebrae (T12) and subsequently a diagnosis was confirmed with a focused MRI of T12. This serves as an opportunity to discuss the diagnostic difficulty presented by paediatric vertebral osteomyelitis and more generally the need for clinicians to pursue their clinical suspicion in the face of false negative results to make an accurate and timely diagnosis.


Assuntos
Dor nas Costas/diagnóstico por imagem , Bacteriemia/diagnóstico , Osteomielite/diagnóstico por imagem , Espondilite/diagnóstico por imagem , Infecções Estafilocócicas/diagnóstico , Vértebras Torácicas/diagnóstico por imagem , Adolescente , Dor nas Costas/complicações , Dor nas Costas/etiologia , Bacteriemia/complicações , Feminino , Febre/etiologia , Humanos , Imagem por Ressonância Magnética , Osteomielite/complicações , Cintilografia , Espondilite/complicações , Staphylococcus aureus , Tomografia Computadorizada por Raios X , Ultrassonografia
6.
Internist (Berl) ; 62(1): 24-33, 2021 Jan.
Artigo em Alemão | MEDLINE | ID: mdl-33337525

RESUMO

A systematic survey of the symptoms of back pain in terms of the triggering event and onset, nature of the pain and the extent to which pain dynamics can be influenced (lying or standing, under stress, nocturnal pain, localized percussion tenderness, B symptoms, etc.), as well as a structured clinical examination (segment height, radiance, projection, reflex status, sensitivity, and motor function), allows an initial and therefore orienting classification of back pain as non-specific or specific. Thus, in the primary care setting, many patients can be treated extremely effectively and economically from a cost perspective. The more precise the initial findings are, the more effective the measures taken are in general. In addition to the fastest possible pain relief, it is important to prevent the disease taking an unfavorable course and to avoid chronicity. In addition to non-pharmacological measures (initial rest and starting home exercises early on, promoting everyday mobility, physiotherapy, manual therapy, etc.), a wide range of pharmacological treatment alternatives is available. In the further course of treatment, it may be necessary to consult medical specialists in the fields of radiology, orthopedics, neurology, neurosurgery, rheumatology, psychotherapy, and psychiatry, among others. Treatment is managed by the primary care provider, who should also receive and re-evaluate all findings during the course of the disease.


Assuntos
Dor nas Costas/diagnóstico , Dor nas Costas/terapia , Terapia por Exercício , Atenção Primária à Saúde/métodos , Dor nas Costas/etiologia , Humanos , Modalidades de Fisioterapia
7.
Internist (Berl) ; 62(1): 34-46, 2021 Jan.
Artigo em Alemão | MEDLINE | ID: mdl-33355682

RESUMO

Back pain is a common reason for consulting a general practitioner. For 80% of patients, the back pain is nonspecific. Specific back pain has a determinable cause that needs to be rapidly identified. The diagnostic work-up to clarify spinal pain involves a detailed patient history taking into account the "red flags", a clinical examination and further stepwise diagnostics. In addition to laboratory diagnostics, structured morphological imaging is necessary. Causes of specific back pain include: fractures, infections, radiculopathy, tumors, axial spondylarthritis, as well as extravertebral causes. The diagnosis, treatment and continuous follow-up of the patient with specific back pain is interdisciplinary and requires close communication with the relevant specialists.


Assuntos
Dor nas Costas/etiologia , Exame Físico , Atenção Primária à Saúde/métodos , Doenças da Coluna Vertebral/diagnóstico por imagem , Dor nas Costas/diagnóstico , Dor nas Costas/terapia , Diagnóstico por Imagem/métodos , Humanos , Dor Lombar/etiologia , Anamnese , Fatores de Risco , Doenças da Coluna Vertebral/complicações , Doenças da Coluna Vertebral/terapia , Avaliação de Sintomas/métodos
9.
Ann. intern. med ; 173(9): 739-748, Nov. 3, 2020. tab.
Artigo em Inglês | BIGG - guias GRADE | ID: biblio-1146639

RESUMO

The American College of Physicians (ACP) and American Academy of Family Physicians (AAFP) developed this guideline to provide clinical recommendations on nonpharmacologic and pharmacologic management of acute pain from non­low back, musculoskeletal injuries in adults in the outpatient setting. The guidance is based on current best available evidence about benefits and harms, taken in the context of costs and patient values and preferences. This guideline does not address noninvasive treatment of low back pain, which is covered by a separate ACP guideline that has also been endorsed by AAFP.


Assuntos
Humanos , Adulto , Dor nas Costas/terapia , Dor Aguda/terapia , Sistema Musculoesquelético/lesões , Dor nas Costas/etiologia , Dor nas Costas/tratamento farmacológico , Dor Aguda/etiologia , Dor Aguda/tratamento farmacológico
10.
J Surg Orthop Adv ; 29(3): 165-168, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33044158

RESUMO

The purpose of this study was to examine the relationship between smoking and back pain in a cross-sectional analysis. Using the Osteoarthritis Initiative database, a multi-center, longitudinal, observational cohort study with 4796 participants, we examined the prevalence of back pain and of limitations in activity due to back pain, as well as the frequency and severity of back pain in participants who were current smokers compared to those who had never smoked. Data was evaluated using binary and ordinal logistic regression analyses. An increase in prevalence, frequency and severity of back pain was strongly associated with smoking. This demonstrates a relationship between smoking and back pain; however, further studies are needed to evaluate causation. (Journal of Surgical Orthopaedic Advances 29(3):165-168, 2020).


Assuntos
Fumar Cigarros , Dor nas Costas/epidemiologia , Dor nas Costas/etiologia , Estudos Transversais , Humanos , Prevalência , Fumar/epidemiologia
11.
J Vasc Interv Radiol ; 31(10): 1683-1689.e1, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32921566

RESUMO

PURPOSE: To assess the safety and efficacy of multilevel thoracolumbar vertebroplasty in the simultaneous treatment of ≥ 6 painful pathologic compression fractures. MATERIALS AND METHODS: Retrospective review was conducted of 50 consecutive patients treated with vertebroplasty for ≥ 6 pathologic compression fractures in a single session for pain palliation at a tertiary single cancer center from 2015 to 2019. Outcomes measured included procedural safety according to Common Terminology Criteria for Adverse Events (CTCAE), change in 4-week postprocedure back pain by numeric rating scale (NRS), comparison of daily opioid medication consumption, and development of skeletal-related events. RESULTS: A total of 397 pathologic compression fractures were treated during 50 sessions (mean, 7.9 per patient ± 1.5). Mean procedure duration was 162 minutes ± 35, mean postoperative hospitalization duration was 1.6 days ± 0.9, and mean follow-up duration was 401 days ± 297. Seven complications were recorded, including 1 case of symptomatic polymethyl methacrylate pulmonary embolism. No major complications (CTCAE grade 4/5) were reported. NRS pain score was significantly decreased (5.0 ± 1.8 vs 1.7 ± 1.4; P < .0001), with a mean score decrease of 3.3 points (66%). Opioid agent use decreased significantly (76 mg/24 h ± 42 vs 45 mg/24 h ± 37; P = .0003), with a mean decrease of 30 mg/24 h (39%). Skeletal-related events occurred in 7 patients (14%). CONCLUSIONS: Multilevel vertebroplasty for ≥ 6 pathologic compression fractures is safe and provides significant palliative benefit when performed simultaneously.


Assuntos
Dor nas Costas/prevenção & controle , Fraturas por Compressão/terapia , Fraturas Múltiplas/terapia , Fraturas Espontâneas/terapia , Vértebras Lombares/lesões , Cuidados Paliativos , Fraturas da Coluna Vertebral/terapia , Vértebras Torácicas/lesões , Vertebroplastia , Idoso , Dor nas Costas/diagnóstico , Dor nas Costas/etiologia , Feminino , Fraturas por Compressão/complicações , Fraturas por Compressão/diagnóstico por imagem , Fraturas Múltiplas/complicações , Fraturas Múltiplas/diagnóstico por imagem , Fraturas Espontâneas/complicações , Fraturas Espontâneas/diagnóstico por imagem , Humanos , Vértebras Lombares/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fraturas da Coluna Vertebral/complicações , Fraturas da Coluna Vertebral/diagnóstico por imagem , Vértebras Torácicas/diagnóstico por imagem , Resultado do Tratamento , Vertebroplastia/efeitos adversos
14.
Niger J Clin Pract ; 23(6): 835-841, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32525120

RESUMO

Aims: This study aims to investigate the effectiveness of transforaminal epidural steroid injection (TFESI) in patients with lumbar radicular pain or radiculopathy caused by different spinal pathologies. Methods: One hundred and seventy seven patients who underwent single transforaminal epidural steroid injection were included in the study group and divided into 3 subgroups (central spinal stenosis + lateral recess stenosis, foraminal stenosis, lumbar disc herniation) according to existing spinal pathology. Patients' visuel analogue scale (VAS) measures and Oswestry Disability Index (ODI) scores were recorded and the patients who give favourable response to treatment were called respondents and who were not called as non-respondents. Subgroups were compared statistically at the end of 12 months. Results: Sixty patients (33.9%) were considered as respondents and 117 patients (66.1%) were non-respondents in the entire study group. Patients with foraminal stenosis included the vast majority of the respondents and showed better results of pain relief as opposed to patients of other groups at the end of 12 months (P < 0.001). Conclusion: TFESI was an effective treatment modality for pain relief and functional improvement in patients with foraminal stenosis. However, it could not produce the same results in patients with central spinal stenosis and lumbar disc herniations.


Assuntos
Dor nas Costas/tratamento farmacológico , Injeções Epidurais/efeitos adversos , Deslocamento do Disco Intervertebral/diagnóstico , Vértebras Lombares/fisiopatologia , Medição da Dor/métodos , Radiculopatia/tratamento farmacológico , Estenose Espinal/tratamento farmacológico , Esteroides/administração & dosagem , Adulto , Idoso , Dor nas Costas/etiologia , Feminino , Humanos , Vértebras Lombares/efeitos dos fármacos , Região Lombossacral/fisiopatologia , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Manejo da Dor/métodos , Medição da Dor/efeitos dos fármacos , Estudos Retrospectivos , Estenose Espinal/complicações , Estenose Espinal/diagnóstico , Esteroides/efeitos adversos , Resultado do Tratamento , Escala Visual Analógica
15.
Ann Rheum Dis ; 79(8): 1063-1069, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32522743

RESUMO

OBJECTIVES: To determine the prevalence of bone marrow oedema (BME) at the sacroiliac joint (SIJ) in early postpartum (EPP), nulliparous (NP) and late postpartum (LPP) women, and to identify factors associated with BME presence at the SIJ. METHODS: Three groups were obtained: NP (never given birth), EPP (given birth within 12 months) and LPP (given birth more than 24 months). The primary outcome was the presence of BME and/or structural lesions (erosions, osteophytes, ankylosis and sclerosis) at the SIJ MRI. RESULTS: BME prevalence was greater among EPP (33%) than NP (14%, p=0.001), but was not different to LPP (21%, p=0.071). The Assessment of SpondyloArthritis international Society (ASAS) MRI criteria for sacroiliitis were positive in 75%, 71% and 80%, respectively, of EPP, NP and LPP women with BME. EPP (38%) had similar prevalence of sclerosis than LPP (28%, p=0.135), but greater than NP (18%, p=0.001). Lastly, EPP (28%) had similar prevalence of osteophytes than LPP (42%) and NP (27%), although there was a difference between LPP and NP (p=0.006). CONCLUSIONS: EPP have higher BME prevalence at the SIJ than NP, EPP tend to have higher BME prevalence compared with LPP and BME presence decreases with time from delivery. Three-quarters of women with BME at the SIJ had a positive ASAS MRI criteria for sacroiliitis, indicating that BME presence as the main criterion for a positive diagnosis can lead to false-positive results. SIJ MRIs should not be interpreted in isolation, since age, time from delivery and other factors may outweigh the pertinence of MRI findings. Trial registration number NCT02956824.


Assuntos
Período Pós-Parto , Sacroileíte/diagnóstico por imagem , Espondilartrite/diagnóstico por imagem , Dor nas Costas/etiologia , Medula Óssea/diagnóstico por imagem , Medula Óssea/patologia , Edema/diagnóstico por imagem , Edema/patologia , Feminino , Humanos , Inflamação/diagnóstico por imagem , Inflamação/etiologia , Inflamação/patologia , Imagem por Ressonância Magnética , Paridade , Gravidez , Prevalência , Articulação Sacroilíaca/patologia , Sacroileíte/etiologia , Sacroileíte/patologia , Espondilartrite/patologia
16.
Updates Surg ; 72(3): 709-715, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32495281

RESUMO

The aim of this study was to define the clinical outcome and prognostic determinants of distal pancreatectomy with en bloc celiac axis resection (DP-CAR) for pancreatic body/tail cancer. A pooled data analysis was performed on individual data for patients who underwent DP-CAR for pancreatic body/tail cancer as identified by systematic literature search. A total of 32 articles involving 109 patients were eligible for inclusion. Postoperative morbidity and mortality were 53% and 4%, respectively. Preoperative abdominal and/or back pain was completely relieved immediately after surgery in 98% of patients. The 1, 3 and 5 years overall survival (OS) rates were 59%, 21% and 10%, and the median OS was 14 months. Patients who received neoadjuvant treatment had a median OS of 23 months. In conclusion, DP-CAR for locally advanced pancreatic body/tail cancer can be performed safely with low mortality and provides survival benefit when combined with neoadjuvant treatment.


Assuntos
Artéria Celíaca/cirurgia , Pancreatectomia/métodos , Neoplasias Pancreáticas/cirurgia , Dor Abdominal/etiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Dor nas Costas/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Terapia Neoadjuvante , Neoplasias Pancreáticas/complicações , Neoplasias Pancreáticas/mortalidade , Prognóstico , Taxa de Sobrevida , Resultado do Tratamento
17.
Vascular ; 28(5): 609-611, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32356683

RESUMO

INTRODUCTION: Noninfectious aortitis has been increasingly reported worldwide with a growing prevalence in western medicine. Attributed to our increasingly diverse population, western surgeons must be vigilant to promptly differentiate these cases from its more common infectious counterpart in order to ensure subsequent appropriate management of these patients. METHODS: We present a case report of a 71-year-old Indo-Caribbean male who presented with nonspecific abdominal and back pain, found to have aortitis of a noninfectious etiology.Results and conclusion: While our patient's process was ultimately managed without surgical intervention, the varied clinical presentation along with the lack of specific laboratory markers pose a challenge for surgeons to appropriately diagnose and manage aortitis. Appropriate diagnostic imaging, the utilization of a multidisciplinary team, and close patient monitoring are key components for effective management of this increasingly prevalent disease process.


Assuntos
Aortite/etiologia , Dor Abdominal/etiologia , Idoso , Aortite/diagnóstico por imagem , Aortite/tratamento farmacológico , Dor nas Costas/etiologia , Glucocorticoides/uso terapêutico , Humanos , Imunossupressores/uso terapêutico , Leflunomida/uso terapêutico , Masculino , Metilprednisolona/uso terapêutico , Resultado do Tratamento
18.
Womens Health (Lond) ; 16: 1745506520918335, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32419664

RESUMO

OBJECTIVES: Increases in breast size with age are common but have not been widely examined as a factor that could affect the health and psychological wellbeing of mature-aged women. The purpose of this study was to examine the relationships between breast size and aspects of health and psychological wellbeing in mature-aged women. METHODS: This was a cross-sectional study of mature-aged women (⩾40 years). Breast size (breast size score) was determined from self-reported bra size and was examined against health-related quality of life (Medical Outcomes Study Short-Form 36 and BREAST-Q), body satisfaction (numerical rating scale), breast satisfaction (BREAST-Q), physical activity levels (Human Activity Profile), the presence of upper back pain and breast and bra fit perceptions. RESULTS: Two hundred sixty-nine women (40-85 years) with bra band sizes ranging from 8 to 26 and bra cup sizes from A to HH participated. The mean (standard deviation) breast size score of 7.7 (2.7) was equivalent to a bra size of 14DD. Increasing breast size was associated with significantly lower breast-related physical wellbeing (p < 0.001, R2 = 0.043) and lower ratings of body (p = 0.002, R2 = 0.024) and breast satisfaction (p < 0.001, R2 = 0.065). Women with larger breasts were more likely to be embarrassed by their breasts (odds ratio: 1.49, 95% confidence interval: 1.31 to 1.70); more likely to desire a change in their breasts (odds ratio: 1.55, 95% confidence interval: 1.37 to 1.75) and less likely to be satisfied with their bra fit (odds ratio: 0.84, 95% confidence interval: 0.76 to 0.92). Breast size in addition to age contributed to explaining upper back pain. For each one-size increase in breast size score, women were 13% more likely to report the presence of upper back pain. CONCLUSION: Larger breast sizes have a small but significant negative relationship with breast-related physical wellbeing, body and breast satisfaction. Larger breasts are associated with a greater likelihood of upper back pain. Clinicians considering ways to improve the health and psychological wellbeing of mature-aged women should be aware of these relationships.


Assuntos
Dor nas Costas/etiologia , Imagem Corporal/psicologia , Mama/fisiologia , Saúde Mental , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Humanos , Pessoa de Meia-Idade , Qualidade de Vida
19.
Am J Emerg Med ; 38(7): 1545.e3-1545.e5, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32446535

RESUMO

BACKGROUND: Spontaneous celiac artery dissection is a rare visceral artery dissection that typically presents with acute abdominal or flank pain. CASE REPORT: We describe a case of a 54-year old previously healthy male who presented to the Emergency Department with subacute back pain and was found to have a spontaneous celiac artery dissection. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Emergency medicine physicians frequently consider acute aortic dissection in patients presenting to the Emergency Department with acute chest, back, and/or upper abdominal pain. Less commonly thought of are variations of arterial dissection, including those involving the celiac artery. Given readily available diagnostic imaging modalities and therapeutic interventions, it remains important to consider visceral arterial dissection, and to recognize the varied clinical manifestations of this rare clinical entity.


Assuntos
Aneurisma Dissecante/diagnóstico por imagem , Dor nas Costas/etiologia , Artéria Celíaca/diagnóstico por imagem , Angiografia por Tomografia Computadorizada , Humanos , Masculino , Pessoa de Meia-Idade
20.
J Clin Neurosci ; 77: 211-212, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32409217

RESUMO

We present a case of a midline thoracic disc herniation causing acute anterior spinal artery (ASA) syndrome successfully managed surgically. A 54-year-old female with no significant past medical history presented with sudden onset severe back pain followed by rapidly evolving paraparesis with urinary and bowel incontinence. Her neurological exam was consistent with ASA syndrome. An MRI revealed T2 signal change in the thoracic spinal cord and midline disc herniation at the level of T8/T9. Spinal angiography revealed an ASA arising the right T11 segmental artery with no flow towards the T8/T9 region. The patient underwent a T8/T9 discectomy with a lateral interbody fusion that resulted in dramatic clinical improvement. A postoperative angiogram confirmed improvement of flow in the ASA. This is the first report of an angiographically confirmed symptomatic ASA syndrome caused by a thoracic disc herniation successfully managed with up-front surgery.


Assuntos
Síndrome da Artéria Espinal Anterior/etiologia , Deslocamento do Disco Intervertebral/complicações , Deslocamento do Disco Intervertebral/cirurgia , Angiografia/métodos , Síndrome da Artéria Espinal Anterior/cirurgia , Dor nas Costas/etiologia , Discotomia/métodos , Feminino , Humanos , Imagem por Ressonância Magnética/métodos , Pessoa de Meia-Idade , Paraparesia/etiologia , Fusão Vertebral/métodos , Vértebras Torácicas/cirurgia
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