A randomized controlled trial of chiropractic spinal manipulative therapy for migraine.

OBJECTIVE: To assess the efficacy of chiropractic spinal manipulative therapy (SMT) in the treatment of migraine. DESIGN: A randomized controlled trial of 6 months' duration. The trial consisted of 3 stages: 2 months of data collection (before treatment), 2 months of treatment, and a further 2 months of data collection (after treatment). Comparison of outcomes to the initial baseline factors was made at the end of the 6 months for both an SMT group and a control group. SETTING: Chiropractic Research Center of Macquarie University. PARTICIPANTS: One hundred twenty-seven volunteers between the ages of 10 and 70 years were recruited through media advertising. The diagnosis of migraine was made on the basis of the International Headache Society standard, with a minimum of at least one migraine per month. INTERVENTIONS: Two months of chiropractic SMT (diversified technique) at vertebral fixations determined by the practitioner (maximum of 16 treatments). MAIN OUTCOME MEASURES: Participants completed standard headache diaries during the entire trial noting the frequency, intensity (visual analogue score), duration, disability, associated symptoms, and use of medication for each migraine episode. RESULTS: The average response of the treatment group (n = 83) showed statistically significant improvement in migraine frequency (P < .005), duration (P < .01), disability (P < .05), and medication use (P< .001) when compared with the control group (n = 40). Four persons failed to complete the trial because of a variety of causes, including change in residence, a motor vehicle accident, and increased migraine frequency. Expressed in other terms, 22% of participants reported more than a 90% reduction of migraines as a consequence of the 2 months of SMT. Approximately 50% more participants reported significant improvement in the morbidity of each episode. CONCLUSION: The results of this study support previous results showing that some people report significant improvement in migraines after chiropractic SMT. A high percentage (>80%) of participants reported stress as a major factor for their migraines. It appears probable that chiropractic care has an effect on the physical conditions related to stress and that in these people the effects of the migraine are reduced.

[Aorto-coronary dysplasia and pseudoxanthoma elastica]. / Dysplasie aorto-coronaire et pseudoxanthome élastique. A propos d'un cas.

The authors report the case of a 50 year old man with pseudowanthoma elastica with a history of myocardial infarction and severe aortic regurgitation. Angiography showed multiple coronary artery aneurysms and aneurysmal dilatation of the aortic annulus. The outcome after triple coronary bypass surgery with aortic valve replacement in a valved Bentall conduit was favourable. Pseudoxanthoma elastica is a rare condition in which the prognosis depends on the degree of vascular involvement. In this context, coronary artery aneurysms and aneurysmal dilatation of the aorta are rare complications.

Requirements for chiropractors involved as occupational health and safety consultants in Australia.

A literature review was conducted to determine significant factors for chiropractors progressing towards classification as an Occupational Health & Safety (OHS) consultant in Australia.A number of priority areas for investigation were identified as significant for OHS consultants. These included: work site assessment, risk control and prevention, spinal care awareness and injury prevention, OHS committee, training procedures and induction manuals, ergonomic improvements, stress management, first aid, forklift safety, accident records, job rotation and supervisor training. Several issues are important considerations where chiropractor's knowledge may be deficient. Lack of awareness of the issues may leave the chiropractor liable for prosecution due to misrepresentation as an OHS consultant.

Classic migraine or not classic migraine. That is the question.

OBJECTIVE: To identify the main characteristics of classic migraine, with specific regard to diagnostic criteria for manual therapy practitioners, including chiropractors and osteopaths. METHOD: Ten case studies on migraine were reviewed for the symptoms and clinical features. RESULTS: The majority of cases reviewed as classic migraines were in reality not correct diagnoses in accordance with standard classification systems. Some cases had classic signs which may have been misinterpreted, whilst other cases had possible inconsistent symptoms making diagnosis difficult. DISCUSSION: The various classification systems are presented with guidelines for diagnosis to assist practitioners making the accurate diagnosis.

Effects of growth hormone and estrogen on T lymphocytes in older women.

OBJECTIVE: To assess the effect on peripheral blood T lymphocytes of recombinant human growth hormone administered to healthy older women. DESIGN: Prospective, open study. SETTING: Veterans Administration clinical research unit and community surrounding Palo Alto, California. PARTICIPANTS: Thirty-three women were recruited in two age groups: 20 to 40 years (n = 13) and 70 years or older (n = 24). Subjects were healthy, community-dwelling volunteers. INTERVENTIONS: Recombinant human growth hormone at a dose of 0.025 mg/kg body weight/day was administered to the older subjects by daily subcutaneous injection over a 6-month study period. MAIN OUTCOME MEASURES: Mean percentage and number of peripheral blood CD45RA + ("naive") T cells, mean counts per minute (CPM) of [3H]-thymidine incorporation following stimulation of peripheral blood mononuclear cells with phytohemaglutinin (T cell proliferation). RESULTS: Before therapy, mean percentage and number of peripheral blood CD45RA + T cells and T cell proliferative responses were significantly reduced in older compared with younger women. The fraction of older women with CD45RA + T cell levels or T cell proliferative responses in the young range was significantly decreased in those who were receiving estrogen (1/10) compared with those who were not (9/14). After treatment with growth hormone, there were no significant changes in the mean CD45RA + T cell levels or proliferative responses of the older women. CONCLUSIONS: The results suggest that T cell changes associated with the age-related decline in secretion of growth hormone cannot be reversed by growth hormone therapy during the eighth decade.

Interexaminer reliability of chiropractic evaluation for cervical spine problems--a pilot study. Part 1: Graduates from one institution.

OBJECTIVE: A pilot study was conducted to determine whether untrained examiners could agree on palpatory findings in the cervical spine. DESIGN: Fifty-three university students, (most of whom were chiropractic students), had their cervical spines examined by seven different chiropractors using their own clinical methods, of which motion palpation was a common, but not standard component. SETTING: Chiropractic Centre in Macquarie University. PARTICIPANTS: Volunteer university students. MAIN OUTCOME MEASURES: Individual clinical methods, which included static and/or motion palpation, vertebral springing, range of motion and applied kinesiology. RESULTS: Statistically, for the total group, there was poor interexaminer reliability. Of eight examiners, four did not disagree significantly, the next two examiners disagreed with each other but only at a single level and the remaining two examiners disagreed with most of the other examiners and each other. CONCLUSION: In the cervical spine, it appears that C6 is the level of highest contention, followed by C1 and C5. Essentially the results suggest that combinations of examiners show reasonable consistency at identifying the same entity while using their own typical examination techniques. The nature of these palpable findings, leading to a diagnosis of subluxation or vertebral dysfunction is ill defined. Several issues were considered as important: expectations of examiners, research design, subject compliance, role of asymptomatic subjects and what the examiners were actually detecting.

Preliminary findings of analysis of chiropractic utilization and cost in the workers' compensation system of New South Wales, Australia.

OBJECTIVE: To review the literature and test a new methodology of assessing chiropractic utilization and cost-effectiveness on workers' compensation claimants. DESIGN: A retrospective analysis of data from the WorkCover Authority (WCA) of New South Wales, Australia. MAIN OUTCOME MEASURES: Average chiropractic treatment cost per case, average medical treatment cost per case, comparisons with total compensation payments, assessments of related indirect costs (e.g., pathology tests). RESULTS: From the total number of employment injuries (n = 51,077) in NSW for 1991-92, 1,289 cases met selection criteria. Approximately 30% of the total injuries were described as back problems. The total utilization rate for chiropractic intervention in spinal injuries for workers' compensation claimants was 12%. Payments for physiotherapy and chiropractic treatment totalled over $25.2 million and represented 2.4% of total payments for all cases. Average chiropractic treatment cost for a sample of 20 randomly selected cases was $299.65; average medical treatment cost per case was $647.20. Further analysis of the 20 selected cases seemed to show an average cost per claim that was significantly different from WCA database figures. CONCLUSION: The methodology used was found to be able to provide a basis for comparison of costs for care apportioned to chiropractic and other interventions. An analysis of 20 randomly selected cases from the WCA suggested that chiropractic intervention for certain conditions may be more cost-effective than other forms of intervention.

[Stenosis of the thoraco-abdominal aorta by endovascular calcification, with hypertension. Surgical treatment (author's transl)]. / Sténose de l'aorte thoraco-abdominale par calcification endovasculaire révélée par une hypertension artérielle. Cure chirurgicale.

A case of a 24 year-old man in whom, following acute pulmonary oedema complicating hypertension known for a period of three years, stenosis of the thoraco-abdominal aorta produced by a large calcification within a zone of the aorta with an inflammatory appearance was demonstrated. This case is included within the context of the aortic syndrome. Operation led to normalisation of blood pressure immediately afterwords, but there was moderate hypertension 56 months later.