[Sacroiliac pain: diagnosis and treatment]

The purpose of this review is to provide an overview of current literature on the diagnosis and treatment of sacroiliac pain. Designation as a source of lower back pain has been controversial; However, as knowledge about the joint increases, its role as a generator of chronic pain has become better elucidated. The literature states that sacroiliac joint is the cause of pain in up to 30% of patients. Clinically, diagnosing sacroiliac pain can be difficult to assess; However, pain semiology, patient posture/movement and manual testing are useful for making the presumptive diagnosis of sacroiliac dysfunction. The most effective diagnostic test is image-guided injection of anesthetic solutions into the joint, which is considered positive if there is at least 75% acute symptom relief. Treatment begins with physiotherapy and/or intra-articular infiltration of steroids. If these fails, a possible option is radiofrequency (rizotomy) denervation of the joint. If this does not provide adequate relief, surgery may be considered, in the form of fusion; various work supports favorable outcomes in selected patients.

Metastable Nonextremal Antibranes

We find new and compelling evidence for the metastability of supersymmetry-breaking states in holographic backgrounds whose consistency has been the source of ongoing disagreements in the literature. As a concrete example, we analyze anti-D3 branes at the tip of the Klebanov-Strassler throat. Using the blackfold formalism we examine how temperature affects the conjectured metastable state and determine whether and how the existing extremal results generalize when going beyond extremality. In the extremal limit we exactly recover the results of Kachru, Pearson, and Verlinde, in a regime of parameter space that was previously inaccessible. Away from extremality we uncover a metastable black Neveu-Schwarz five-brane (NS5) state that disappears near a geometric transition where black anti-D3 branes and black NS5 branes become indistinguishable. This is remarkably consistent with complementary earlier results based on the analysis of regularity conditions of backreacted solutions. We therefore provide highly nontrivial evidence for the metastability of antibranes in noncompact throat geometries since we find a consistent picture over different regimes in parameter space.

Salbutamol tolerability and efficacy in patients with spinal muscular atrophy type II

Spinal muscular atrophy (SMA) is an autosomal recessive disease caused by homozygous deletions or loss-of-function mutations in SMN1, which result in a degeneration of motor neurons in the spinal cord and brain stem. Even without a randomized placebo-controlled trial, salbutamol has been offered to patients with SMA in the neuromuscular clinics of most of hospitals for many years. We describe the response to salbutamol in 48 patients with SMA type II who were not taking any other medication. We investigate the changes over an eighteen-month period in motor functional scales and we analyze side effects and subjective response to treatment. Our results suggest that oral administration of salbutamol might be helpful in the maintenance of motor function in patients with SMA type II. An apparent beneficial effect was observed in functional scales of children under the age of 6, especially during the first 6 months of therapy. The majority of patients of all ages referred some kind of subjective positive effect associated with therapy intake. Salbutamol seemed safe and was well tolerated without serious side effects.

A national programme for patient and staff dose monitoring in interventional cardiology

A national programme on patient and staff dose evaluation in interventional cardiology made in cooperation with the haemodynamic section of the Spanish Society of Cardiology has recently been launched. Its aim is to propose a set of national diagnostic reference levels (DRLs) for patients as recommended by the International Commission on Radiological Protection and to initiate several optimisation actions to improve radiological protection of both patients and staff. Six hospitals have joined the programme and accepted to submit their data to a central database. First to be acquired were the quality control data of the X-ray systems and radiation doses of patients and professionals. The results from 9 X-ray systems, 1467 procedures and staff doses from 43 professionals were gathered. Provisional DRLs resulted in 44 Gy cm(2) for coronary angiography and 78 Gy cm(2) for interventions. The X-ray systems varied up to a factor of 5 for dose rates in reference conditions. Staff doses showed that 50 % of interventional cardiologists do not use their personal dosemeters correctly.

Biochemical markers of bone remodeling and bone sialoprotein in ankylosing spondylitis

The aim of this work was to determine bone mineral density (BMD) in a group of patients with ankylosing spondylitis (AS) and to study alterations in bone remodeling in these patients. Eighteen patients (16 males and two females) with AS, mean age 44.7, range 21-75, and 18 age- and sex-matched healthy controls were studied. BMD was evaluated by dual energy X-ray absorptiometry. The following biochemical markers of bone remodeling were studied: formation - serum amino and carboxyterminal propeptides of procollagen I (PINP and PICP); resorption - urinary total and free deoxypyridinoline and pyridinoline (TDpyr, FDpyr, TPyr and FPyr), crosslinked aminoterminal telopeptides of collagen I (NTX), carboxyterminal telopeptide of collagen I (CTX) and serum bone sialoprotein (BSP). Receiver operating characteristic (ROC) curves of markers were also performed. We found a decrease of bone mass and an increase in TPyr, FPyr, TDpyr, FDpyr, NTX and BSP in AS, but no significant differences were found in PICP, PINP and CTX. FDpyr, FPyr and TPyr showed the highest discrimination between patients and controls according to the results of the ROC curves. TPyr/TDpyr was higher in AS than in controls. We found osteopenia, with a normal formation and a significant increase in bone resorption in AS. FDpyr, FPyr and TPyr seem to present the best sensitivity for the study of alterations of bone resorption in this pathology, although NTX, TDpyr and BSP also show significant differences. The elevation in the ratio TPyr/TDpyr in AS compared to controls indicates that in AS there is a type I-collagen degradation in tissues different from bone.

[The injured pedestrian in motor vehicle traffic accidents: mortality in Mexico, 1985-1996]

OBJECTIVE

To describe the mortality of pedestrians injured at motor vehicle traffic accidents (PIMVTA) in Mexico.

METHODS

Analysis of death certificates registered in Mexico (1985-1996), identified by E codes of the International Classification of Diseases, 9th Revision. Mortality rates were stratified by age group.

RESULTS

From 1985 to 1996, 60,566 deaths in PIMVTA (rate of 7.42/100,000) were registered: 78.1% in men (11.7/100,000), and 21.9% in women (3.2/100,000). The mortality increased in direct relationship to age, the general mortality trend lightly descending in both sexes, but more marked from the 80 and more years old. The higher rate was is observed for Jalisco (9.7/100,000) and the lower rate was for Coahuila (2.1/100,000). According to the location size, the mortality shows a bimodal distribution: higher for localities of 15.000 to 19.999 and 1,000,000 (8.0/100,000 and 8.2/100,000 person-years, respectively.

CONCLUSIONS

The deaths of PLATVM are presented, mainly, in men, their frequency is incremented with the age, they show a tendency lightly descending, and they are observed with greater frequency in urban centers.

[Palliative care in primary care: the opinion of professionals]

OBJECTIVES

To find the views and attitudes of primary care professionals to the setting-up of a palliative treatments programme.

DESIGN

A qualitative research study with discussion groups.

SETTING

Primary care.

PARTICIPANTS

60 primary care professionals, 30 doctors and 30 nurses, selected at random and placed in 6 discussion groups.

MEASUREMENTS AND MAIN RESULTS

Collection and analysis of the views expressed in the discussion groups. The professionals saw as problems: poor communication between levels of care, inadequate organisation and communication within the primary care teams and difficulties in obtaining opiates at pharmacy offices. Lack of training was not seen as a problem. The care organisation models suggested varied from those based on the first care level to those exclusively dependent on specialist units.

CONCLUSIONS

The proper development of palliative treatment is subject to various problems identified by the professionals. These have to be tackled before the programmes are set up.

[Uroflowmetric nomogram in the adult population of Canary Islands]

In order to know the uroflowmetric values of our healthy population, a uroflowmetry was made to 214 healthy subjects of both sexes. 75% of our group of volunteers collected mictional volumes under 300 ml. with no differences either by age or sex. The corresponding nomograms, in the form of percentile, for peak and mean flow in both sexes, were created. We found a progressive increase of peak and mean flow values with regard to mictional volume. Time to peak flow is shorter in women than in men. Volume at peak flow represents under 50% of total mictional volume. No significant differences in the uroflowmetric data of our healthy population and those from Anglo-Saxon authors was found.

The cervical spine in psoriatic arthritis: a clinical and radiological study

Cervical spondylitis has been reported in 35-75% of patients with PsA. The clinical and radiological changes of the cervical spine were evaluated in 75 patients with PsA. Cervical spine involvement was found in 45% of those examined and 36% of patients X-rayed. The pattern of disease was ankylosing in 85% of patients, characterized by ankylosis, syndesmophytes and ligamentous ossification. Twelve per cent had radiological evidence of cervical spondylitis without clinical evidence of disease. The major predictor of cervical spine disease was the duration of psoriatic arthropathy. Cervical spondylitis was not related to disease severity, extent of skin or nail involvement and neither did it reflect any homogeneous pattern of disease.