Lordosis manoeuvre in the diagnosis of lumbar facet syndrome. / Efectividad de la maniobra lordosante en el diagnóstico del síndrome facetario lumbar.

UNLABELLED: In lumbar pain patients an aetiopathogenic diagnosis leads to a better management. When there are alarm signs, they should be classified on an anatomical basis through anamnesis and physical examination. A significant group is of facet origin (lumbar facet syndrome [LFS]), but the precise clinical diagnosis remains cumbersome and time-consuming. In clinical practice it is observed that patients with an advanced degenerative disease do not perform extension or rotation of their lumbar spine when prompted to extend it, but rather knee flexion, making the manoeuvre meaningless. For this reason, a new simple and quick clinical test was developed for the diagnosis of lumbar facet syndrome, with a facet block-test as a confirmation. HYPOTHESIS: The new test is better than a classic one in the diagnosis of facet syndrome, and probably even better than imaging studies MATERIALS AND METHODS: A prospective study was conducted on a series of 68 patients (01/01/2012-30/06/2013). A comparison in between: classic manoeuvre (CM), imaging diagnostics (ID), and the new lordosis manoeuvre (LM) test. Examination and block test by one author, and evaluation of results by another one. EXCLUSION CRITERIA: Deformity and instability. using a physical. OBJECTIVE: To determine the effectiveness of a new clinical test (LM) for the diagnosis of LFS (as confirmed by a positive block-test of medial branch of dorsal ramus of the lumbar root, RMRDRL). STATISTICS: R package software. RESULTS: The LM was most effective (p<.0001; Kappa 0.524, p<.001). There was no correlation between either the CM or ID and the block-test results (Kappa, CM: 0.078; p=.487, and ID: 0.195; p=.105). There was a correlation between ID (CAT/MR) and LM (p=.024; Kappa 0.289 p=.014), although not with CM. There was no correlation between ID (plain X-rays) and CM or LM. CONCLUSIONS: A new test for diagnosis of LFS is presented that is reliable, quick, and simple. Clinical examination is more reliable than imaging test for the diagnosis of LFS.

Prevalence of obesity and its association with blood pressure, serum lipids and selected lifestyles in a Puerto Rican population of adolescents 12-16 years of age

OBJECTIVES: To describe the prevalence of obesity and determine its association with blood pressure, serum lipids and lifestyles in adolescents attending a public junior-high school in San Juan, Puerto Rico. METHODS: During the 1999-2000 academic school year, 352 students, ranging in age from 12 years to 16 years, were screened for weight, height, and blood pressure. A sub-sample of voluntary adolescents (n = 26) was screened for serum lipids and lifestyles were assessed using a standardized questionnaire. RESULTS: The prevalence of level I obesity and level II obesity among 12 to 16 years old adolescents were 33.2 per cent and 2 per cent, respectively. The mean systolic and diastolic blood pressures were significantly higher in obese than in non-obese adolescents (p < .001). There were no significant differences in serum lipids between the study groups (p > .05). However, the obese group showed higher median levels of total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and triglycerides. The study group reported engaging in hazardous lifestyles (alcohol intake, smoking, and unhealthy eating patterns), but no real differences in lifestyles were found between obese and non-obese groups (p > .05). CONCLUSIONS: A high prevalence of level I and level II obesity was found in this population. In addition, significant positive correlations between blood pressure and body mass index were observed. This study underscores the need to assess the burden of obesity in Puerto Rico in order to develop community intervention strategies encouraging early detection and conduct modification towards healthier lifestyles.

Risk factors for dengue infection during an outbreak in Yanes, Puerto Rico in 1991.

In November 1991, during a five-month dengue outbreak, we performed epidemiologic and serologic surveys linked to an earlier entomologic study in a community of 425 houses in Yanes (Florida), Puerto Rico. We obtained a household response rate of 95% (98 of 103) and blood samples from 84% (345 of 410) of the participants. Dengue incidence, as volunteered by the respondents, was 5% (21 of 410), but serologic diagnosis (immunoglobulin M and IgG-enzyme-linked immunosorbent assays [ELISA]) indicated a recent infection rate of 18% (59 of 331). The presence of anti-dengue antibodies was detected in 277 (84%) of 331 persons tested. In our final sample of 65 households and 112 persons, we analyzed (by univariate and multivariate logistic regression methods) the association of 12 entomologic, environmental, and behavioral variables with the proportion of household members with laboratory-confirmed recent dengue. The number of female Aedes aegypti per person was the only significant (P = 0.02) household risk factor. The results of our study underscore the importance of intradomiciliary mosquito populations in dengue transmission, and may serve as a guide for mosquito control efforts.

Microsurgery as an aid to middle cerebral artery endarterectomy.

1. Instrumentation and technique for microsurgical reconstruction of small arteries are described. 2. Two cases are reported in each of which an obstruction was removed from the middle cerebral artery for early hemiplegia. 3. The work presented is of a preliminary nature. No conclusions can be drawn as to ultimate value. Further clinical trial seems justified.

Skeletal muscle function in patients with hemophilia A and unilateral hemarthrosis of the knee.

Acute hemarthrosis is a frequent complication of hemophilia A. To test the hypothesis that recurrent hemarthrosis has an adverse effect on neuromuscular function, ten patients with hemophilia A and history of unilateral hemarthrosis of the knee were studied. The uninvolved (U) side was used as the control. The time since diagnosis, factor level, and the number of bleeding episodes in the involved (I) knee averaged 11.6 +/- 6.6 years, 7.7 +/- 5.1%, and 7.0 +/- 7.4, respectively. Neuromuscular function was evaluated on a Cybex 340 isokinetic dynamometer. Knee extensor strength measured at 60 degrees/sec was significantly (p less than .05) lower in the I side (mean = 58Nm) than in the U side (mean = 85Nm). Similarly, lower (p less than .05) total work (I = 479J, U = 656J) and average power output (I = 59W, U = 83W) values were obtained. Adjusting for thigh circumference did not eliminate any of these differences. Testing the extensors at faster angular velocities (180 degrees/sec and 240 degrees/sec) and the flexor muscle groups at the three speeds revealed no differences between I and U. X-rays showed minimal changes. These data show that patients with hemophilia A and history of unilateral hemarthrosis of the knee have neuromuscular dysfunction in the I extremity that precedes the appearance of radiologic evidence of joint pathology. It is suggested that strength training should be started early in the rehabilitation of hemophiliacs.