Fluoroscopy-guided Sacroiliac Joint Steroid Injection for Low Back Pain in a Patient with Osteogenesis Imperfecta.

BACKGROUND: Osteogenesis imperfecta, also known as 'brittle bone disease', is a genetic connective tissue disease. It is characterized by bone fragility and osteopenia (low bone density). In this case, a 57-year old female presented to the University Hospital of the West Indies (UHWI), Physical Medicine and Rehabilitation Clinic with left low back pain rated 6/10 on the numeric rating scale (NRS). Clinically, the patient had sacroiliac joint mediated pain although X-rays did not show the sacroiliac joint changes. Fluoroscopy-guided left sacroiliac joint steroid injection was done. METHODS: Numeric rating scale and Oswestry Disability Index (ODI) questionnaire were used to evaluate outcome. This was completed at baseline, one week follow-up and at eight weeks post fluoroscopy-guided sacroiliac joint steroid injection. RESULTS: Numeric rating scale improved from 6/10 before the procedure to 0/10 post procedure, and ODI questionnaire score improved from a moderate disability score of 40% to a minimal disability score of 13%. Up to eight weeks, the NRS was 0/10 and ODI remained at minimal disability of 15%. CONCLUSION: Fluoroscopy-guided sacroiliac joint injection is a known diagnostic and treatment method for sacroiliac joint mediated pain. To our knowledge, this is the first case published on the use of fluoroscopy-guided sacroiliac joint steroid injection in the treatment of sacroiliac joint mediated low back pain in a patient with osteogenesis imperfecta.

Abbreviated regimens of zidovudine prophylaxis and perinatal transmission of the human immunodeficiency virus.

BACKGROUND: The Pediatric AIDS Clinical Trials Group Protocol 076 reported a reduction in the rate of perinatal transmission of the human immunodeficiency virus (HIV) from 25.5 percent to 8.3 percent with a three-part regimen of zidovudine given ante partum, intra partum, and to the newborn. We examined the effects of abbreviated zidovudine regimens on perinatal HIV transmission using data from the HIV polymerase-chain-reaction (PCR) testing service of the New York State Department of Health. Pregnant women who received abbreviated regimens rather than the recommended regimens did so because of limited prenatal care or by choice. METHODS: The requisition form used by the PCR testing service included information on the demographic characteristics of the infants and the timing of any perinatal treatment with zidovudine. We also analyzed data on the timing of zidovudine prophylaxis collected by chart review in a subgroup of 454 infants as a means of validating the results in the entire cohort. RESULTS: From August 1, 1995, through January 31, 1997, specimens from 939 HIV-exposed infants who were 180 days of age or younger were submitted for PCR testing. The rates of perinatal HIV transmission varied depending on when zidovudine prophylaxis was begun. When treatment was begun in the prenatal period, the rate of HIV transmission was 6.1 percent (95 percent confidence interval, 4.1 to 8.9 percent); when begun intra partum, the rate was 10.0 percent (3.3 to 21.8 percent); when begun within the first 48 hours of life, the rate was 9.3 percent (4.1 to 17.5 percent); and when begun on day 3 of life or later, the rate was 18.4 percent (7.7 to 34.3 percent). In the absence of zidovudine prophylaxis, the rate of HIV transmission was 26.6 percent (21.1 to 32.7 percent). CONCLUSIONS: These results confirm the efficacy of zidovudine prophylaxis and suggest that there are reductions in the rates of perinatal transmission of HIV even with the use of abbreviated regimens that are begun intra partum or in the first 48 hours of life.

Vertical transmission of HIV in New York State: a basis for statewide testing of newborns.

Infants (n = 313) of HIV-infected mothers were enrolled (mean age 1.9 weeks, range 0-8 weeks) in a 3-year prospective study of vertical transmission. Fifty-six infants (17.9%) had laboratory and clinical evidence of HIV infection. Polymerase chain reaction (PCR) provided early and reliable identification of infected infants. Thirty-one of the 56 infected infants had specimens submitted when the infants were 4 weeks of age or less and 30 (97%) tested PCR positive. This percentage increased to 100% by 8 weeks of age when 51 of the 56 infected infants had specimens tested for that time period. Immune complex dissociation (ICD) antigen testing was a sensitive method for diagnosis of infection but only in infants older than 1 month. p24 antigen testing, although free of false positives, is less sensitive than either of the other methods. Among surrogate markers of HIV infection, elevation of soluble CD8 levels precedes an increase in immunoglobulin levels or a decline in CD4 T lymphocytes. Vertical transmission is significantly lower in Central and Western New York State than other regions. Transmission is significantly higher in low birthweight babies and in infants whose mothers have CD4 counts < 500. This study provided the basis for establishing a Pediatric HIV PCR Testing Service for the early diagnosis of HIV infection in neonates.

Screening of blood and urine for drugs of abuse utilizing diagnostic products corporation's Coat-A-Count radioimmunoassay kits.

Solid-phase radioimmunoassay methods for the uniform analysis in hemolyzed whole blood and urine of opiates, methamphetamine, cocaine, free morphine, and phencyclidine using Coat-A-Count kits available from Diagnostic Products Corporation were tested for cost effectiveness without compromising the reliability of the results. Results indicate these kits are superior in performance in cross-reactivity studies, noted particularly in the methamphetamine assay, labor conservation, and cost-effectiveness to double-antibody radioimmunoassay methods.

Tandem mass spectrometry (MS/MS) utilizing electron impact ionization and multiple reaction monitoring for the rapid, sensitive, and specific identification and quantitation of morphine in whole blood.

A single step liquid-liquid extraction procedure followed by pentafluoropropionic anhydride derivatization was developed for the analysis of free morphine in blood. The specificity of the method was enhanced with the use of tandem mass spectrometry (MS/MS) using multiple reaction monitoring. Two molecular transitions were monitored. The first transition was where the first quadrupole (Q1) transmits the molecular ion of morphine-3,6-dipentafluoropropionate, 577. The 577 ion undergoes subsequent collision induced dissociation with argon and the last quadrupole (Q3) then transmits the 414 daughter ion. The second transition monitored was where Q1 transmits the 414 base peak and Q3 transmits the resultant 266 daughter ion. Deuterated morphine was included as an internal standard and analyzed similarly. Morphine was confirmed only in instances where both the m/z 577 to 414 and 414 to 266 transitions occurred simultaneously. Linear and reproducible calibration curves have been obtained for morphine at concentrations from 1.0 to 500 ng/mL achieving correlation coefficients of greater than 0.994. A signal-to-noise ratio of approximately 5:1 was observed for the 1.0-ng/mL samples.

Intravenous immune globulin treatment of pulmonary exacerbations in cystic fibrosis.

The effect of intravenously administered immune globulin (IVIG) on patients with cystic fibrosis with an acute exacerbation of pulmonary infection was evaluated in a double-blind study. Patients at least 12 years of age, with chronic respiratory tract colonization with Pseudomonas aeruginosa and hospitalized with a reduction in pulmonary function, were randomly assigned to receive 20% dextrose (control subjects: n = 8) or 100 mg/kg IVIG (Gamimune) (experimental subjects: n = 8) on days 1, 2, and 3; all patients received intravenous antibiotics and chest physiotherapy. There were no differences between groups on admission; patients had moderate to severe disease as measured by Shwachman-Kulczycki scores and pulmonary function tests. Both groups improved clinically. The IVIG treatment was associated with significant increases in forced vital capacity and forced expiratory volume in 1 second (p less than 0.01) and with greater percent improvement in forced expiratory volume and forced expiratory flow (25% to 75%) (p less than 0.05). There was no effect on length of hospitalization (18.3 +/- 11.9 days control vs 17.6 +/- 6.5 experimental). The C3 level was decreased at discharge in IVIG-treated patients; circulating immune complex levels were unchanged. One patient in each group experienced side effects. There were no differences on follow-up at 6 weeks. We conclude that IVIG infusion early in treatment for pulmonary exacerbations in cystic fibrosis patients with moderate to severe disease may be associated with greater improvement in pulmonary function than standard treatment alone.

Myeloradiculopathy associated with wasp sting.

A 12-year-old girl developed a reversible myeloradiculopathy 1 week after a wasp sting. Delayed neurologic hypersensitivity reactions to Hymenopteran stings occur primarily in adults. Reactions involving both the peripheral and central nervous systems are extremely rare and have never been reported in a child. The mechanisms underlying this uncommon reaction may be related to age-dependent differences in immunologic responses.

Progressive varicella in three patients with Wiskott-Aldrich syndrome: treatment with adenine arabinoside.

Patients with Wiskott-Aldrich Syndrome have an increased incidence of serious infections, often with microorganisms that usually produce mild disease in immunologically normal subjects. Three patients with Wiskott-Aldrich syndrome complicated by progressive varicella are reported. There have been no previous reports of similar cases. Two of the patients were treated with adenine arabinoside and had rapid recovery.

Comparison of 3H- and 125I-radioimmunoassay and gas chromatography/mass spectrometry for the determination of delta 9-tetrahydrocannabinol and cannabinoids in blood and serum.

Blood and serum specimens from 100 subjects in a driving study were tested for the presence of delta 9-tetrahydrocannabinol (THC) by 3H- and 125I-labeled RIA and GC/MS. The specimens were also analyzed for 11-nor-9-carboxy-delta 9-tetrahydrocannabinol by the two RIA methods. Blind quality control specimens containing THC were included with each batch of subject specimens and sent coded to three participating laboratories. The methods were assessed for accuracy, reproducibility, detectability, specificity, and the results correlated. It was found that serum was a better matrix than blood for determination of cannabinoids. The three methods gave parallel but significantly different quantitative results, apparently due to calibration problems. However, each technique was capable of measuring THC concentrations up to three hours after usage.