Does maintained spinal manipulation therapy for chronic non-specific low back pain result in better long term outcome?

To assess the efficacy of spinal manipulation therapy [SMT] for the management of chronic non-specific LBP and to determine the efficacy of maintenance SMT in long-term reduction of pain and disability levels associated with chronic low-back conditions after an initial phase of treatments. 60 patients with chronic, nonspecific low back pain [LBP] lasting at least 6 months were separated into 3 groups. The first group received 12 treatments of sham SMT. The second group received 12 treatments, consisting of SMT over a one-month period, but no treatments for the subsequent nine months. The third group also received 12 treatments over a one-month period, along with [maintenance spinal manipulation] every week for the following nine months. To determine any difference among therapies, we measured pain and disability scores at baseline and at 1-month, 4-month, 7-month and 10-month intervals. Patients in second and third groups experienced significantly lower pain and disability scores than first group at the end of 1-month period [P=0.0027 and 0.0029, respectively]. However, only the third group that was given spinal manipulations during the follow-up period showed more improvement in pain and disability scores at the 10-month evaluation. In the other two groups, however, the mean pain and disability scores returned back near to their pretreatment level. SMT is effective for the treatment of chronic non specific LBP. To obtain long-term benefit, this study suggests maintenance spinal manipulations after the initial intensive manipulative therapy

Transvaginal sonography [TVS] f or assessement of tubal patency

Assessement of tubal patency using the transvaginal ultrasound was performed in 24 infertile patients. We used a new technique which combines and modifies both the techniques of sonosalpingography of Richman et al. [1984] who have studied tubal patency following fluid injection using transabdominal sonography and the foley catheter techniques [FCT] of David et al [1979] for injecting a contrast media into the uterine cavity during HSG via a foley catheter instead of the traditional metallic cannula. We only consider flow of fluid in the cue-dc-sac seen as turbulence as an indicaticn of at least unilateral tubal patency. We compared our results with the findings obtained by HSG and/or Laparoscopy done for the same patients. We found That tubal patency test by TVS has a sensitivity of 100%, specificity 96% and accuracy of 98%. Transvaginal sonography for assessment of tubal patency is safe, more convenient and provide a reliable method for screening pelvic anatomy

Serum prolactin and thyroid stimulating hormone levels and polytomography in cases of secondary amenorrhea without galactorrhea

Serum prolactin [PRL] and thyroid stimulating hormone [TSH] were determined in 50 patients, presenting with secondary amenorrhea without galactorrhea, as well as 20 women with normal menstrual function as control. There was a significant increase of serum PRL in amenorrheic patients [42.09 +/- 9.63 ng/ml], when compared to that of control [11.1 +/- 4.9 ng/ml] at P < 0.0025. Serum PRL also showed a significant positive correlation to body weight and duration of the complaint in the amenorrheic group. Serum TSH values in both amenorrheic and control groups did not show any significant difference [P > 0.05]. Plain X-ray confirmed the presence of pituitary macro-adenoma in one out of ten hyperprolactinemic patients. When radiological examination was again performed using hypocycloidal polytomography, two further microadenomata were discovered. In the present study, the incidence of hyperprolactinemia and pituitary adenoma in non-galactorrheic amenorrheic patients was 20% and 6 respectively. Thirty percent of hyperprolactinemic patients had pituitary adenoma. In conclusion, serum PRL determination is essential in the diagnostic work-up of amenorrhea, even without galactorrhea. A combination of hyperproclactinemia and positive hypocycloidal polytomography of the sella turcica is specific for the diagnosis of prolactinoma