As degenerative changes of lumbar spine and surrounding structures progress with aging, the strength of not only the bony tissues but also the supporting structures become weak and dysfunctional with pain. This phenomenon is increasingly evident as elderly population increases rather progressively in contemporary era. Therefore, the chronic back pain in this subpopulation group is relatively common and comprise of various pain syndromes originating from vertebral bodies, joints, muscles, and other soft tissues. The causes of chronic low back pain in elders also differ patient to patient. but common presentations seen in clinical setting are disorders related to intervertebral disc, spinal stenosis, spondylolisthesis, compression fracture related to osteoporosis, and pain originating from zygapophysial joints and other surrounding structures. Less common but other important causes include metastatic lesions, infection, and myofacical pain syndromes. Here, evidence-based literature review on common disorders affecting elderly patients causing chronic low hack pain is presented with special attention focused on diagnostic and therapeutic approaches based on etiologic processes and clinical presentations Every effort should be made to contemplate all possible factors that might have played roles in generating the chronic pain in these patients. Also, whatever management chosen it should have been decided based upon the clinical presentation that closely correlated with definitive findings from studies best available whenever possible.
Aged ; Aging ; Back Pain ; Chronic Pain ; Diagnosis ; Fractures, Compression ; Humans ; Intervertebral Disc ; Joints ; Low Back Pain* ; Muscles ; Osteoporosis ; Spinal Stenosis ; Spine ; Spondylolisthesis

No abstract available.
Diagnosis* ; Low Back Pain*

Radiofrequcy(RF) treatment has a long history, more than hundred years, for the management of chronic intractable pain of various causes. With better understanding of pain mechanism and advancement of technology, along with previous valuable experience, a simpler and safer method of delivering RF thermo coagulation to ideal sites are now available that can be expected to provide more beneficial effects to these patients with chronic disabling pain. This type of treatment will be especially helpful in aged in whom surgery is often contraindicated or highly risky due to medical problems. Here, using up-to-dated, evidence based knowledge and personal experience, authors have tried to introduce briefly the history and basic mechanism of RF technique and various clinical situations where this type of therapy is currently known to be indicated or effective in providing substantial pain relief. In summary, the RF thermocoagulation is proven to be effective way of providing significant pain relief in many chronic refractory pain states with numerous advantages such as minimal invasive, quantitative lesioning with temperature-controlled, well-circumscription of lesions, simplicity and feasibility of procedure, and most of all safety and cost-effectiveness. When it is selected based on careful investigation on type and cause of pain it can be expected to provide relatively long duration of pain relief and also to help to recover functional disabilities from such pain. However, judicious use is warranted because some painful conditions are known to be ineffective or contraindicated from this type of therapy and because there are possible serious complications, although very few. Use of latest technique of pulsed, high-frequency, low-temperatured thermocoagulation will possibly bring hope and new insights in the management of chronic intractable pain of neuropathic in nature. Further research and experience will be required before justifying this type of therapy in appling broader and more challenging situations.
Electrocoagulation ; Hope ; Humans ; Neuralgia ; Pain, Intractable*

BACKGROUNDS: Percutaneous radiofrequency neurotomy of posterior primary ramus has been in use as a treatment for persistent, mechanical low back pain for two decades. However, there has been limited studies regarding to prognostic factors related to outcome. We report our experience with at least 2-year follow up with special aftention on prognostic factors. METHODS: Of total 228 patients who underwent percutaneous radiofrequency neurotomy (PRN) of posterior primary ramus for refractory low back pain during last 3 years, 128 patients whose pain was considered to be originated from facets joints or their surrounding soft tissue and responded to temporary blocks were assigned to a group II. All patients had more than 6 months of pain. These patients were compared with 100 patients to whom PRN were provided for chronic nonspecific low back pain without all inclusion criteria (Group I). RF procedures were done under local anesthesia with C-arm intensifier guidance. Pain reliefs were estimated at 1week, 1month, 6months and 2 years using visual analog scale(VAS). For patients with more that 50% reduction of previous pain was regarded as positive responder. Various clinical variables such as age, sex, symptom duration, types of pain, bilaterality, and previous surgery were studied for prognostic factors. RESULTS: Positive responders were 56% at 1week, 46% at lmonth, 18% at 6months, and 13% at 2years after PRN in group I, and 78.9% at lweek, 75.4% at lmonth, 62.5% at 6months, and 54.7% at 2years in group II. Some variables were found to be significantly related to outcome including prominent local tenderness, percussion tenderness, combination of symptoms with pain on gefting up, extension, transitional movement, pain radiating to buttock and/or posterior thigh, and good immediate response. Age, sex, symptom duration, bilaterality, imaging study results, previous lumbar surgery, and degrees of pain relief from diagnostic block were not related to outcome. CONCLUSIONS: These results indicate that PRN of posterior primary ramus has a moderate overall long-term beneficial effect, with no morbidity in our series. But, the long-term good results will be anticipated only in properly selected patients with low back pain originating from facet joints and surrounding structures.
Anesthesia, Local ; Buttocks ; Follow-Up Studies ; Humans ; Joints ; Low Back Pain* ; Percussion ; Thigh ; Zygapophyseal Joint

Paroxysmal nocturnal hemoglobinuria(PNH) is a rare, acquired disease involving multiple hematopoietic lines. Characteristics of PNH are intrinsic hemolytic anemia, iron deficiency anemia and venous thrombosis. report a case of PNH with characterostoc MR and CT findings. The signal intensity of renal cortex was lower than that of medulla on both T1- and T2- weighted MR imaging. On T2 weighted MR images, the liver showed very low signal intensity but the signal intensity of the spleen was normal. On precontrast CT the attenuation of renal cortex was higher than that of renal medulla and the attenuation of liver was higher than that of the spleen. These findings of MR imaging and CT were the result from the deposition of hemosiderin in the cells of proximal convoluted tubules and transfusional hemosiderosis of liver.
Anemia, Hemolytic ; Anemia, Iron-Deficiency ; Hemoglobinuria, Paroxysmal* ; Hemosiderin ; Hemosiderosis ; Liver ; Magnetic Resonance Imaging ; Spleen ; Venous Thrombosis

No abstract available.
Polyps*

Although many approaches have been attempted in the evaluation of liver size such as measurement of length,area and volume, the linear measurements have been used most frequently because of simplicity. We measured theliver size using 4 linear measurements for evaluation of hepatic pliability on plain abdominal film in the erectand the supine position. Our cases consisted of 125 persons who have no symptom or signs clinically and havenormal liver function test. The results were as follows: 1. The measurements of the liver size using diagonaldiameter(DD), oblique diameter of right lobe(OD), midline vertical diameter(MD) and height of right dome of theliver(HD) were ; 19.6+-1.8cm, 13.7+-1.6cm, 2.03+-0.4cm in the supine position; and 20.5+-2.1cm, 21.9+-2.1cm,15.4+-2.1cm, 1.87+-0.4cm in the erect position, respectively. 2. The differences of each diameter between erectand supine position were 0.9+-1.0cm in DD, 0.9+-1.0cm in OD and 1.7+-1.4cm in MD, and they were longer in thesupine position (p<0.001). 3. The HD was slinghtly longer in the supine position than in the erect position(p<0.001). 4. Among the 4 measurements, the largest difference of linear diameter between the erect and the supineposition was by MD. 5. We found the change or size and shape of the normal liver in the different position.
Humans ; Liver ; Liver Function Tests ; Pliability ; Supine Position

No abstract available.
Pseudohypoparathyroidism*

OBJECTIVE: Recently, microdissection of tissue sections has been used increasingly for the isolation of morphologically identified homogeneous cell populations, thus overcoming the obstacle of tissue complexity for the analysis cell-specific expression of macromolecules. The aim of the present study was to establish the minimal conditions required for the RNA extraction and amplification from the cells captured by the laser captured microdissection. METHODS: Mouse ovaries were fixed and cut into serial sections (7 micrometer thickness). Oocytes were captured by laser captured microdissection (LCM) method by using PixCell IITM system. The frozen sections were fixed in 70% ethanol and stained with hematoxylin and eosin, while the paraffin sections were stained with Multiple stain. Sections were dehydrated in graded alcohols followed by xylene and air-dried for 20 min prior to LCM. All reactions were performed in ribonuclease free solutions to prevent RNA degradation. After LCM, total RNA extraction from the captured oocytes was performed using the guanidinium isothiocyanate (GITC) solution, and subsequently evaluated by reverse transcriptase -polymerase chain reaction (RT-PCR) for glyceraldehyde-3-phosphate-dehydrogenase (GAPDH). RESULTS: With the frozen sections, detection of the GAPDH mRNA expression in the number of captured 25 oocytes were not repeatable, but the expression was always detectable from 50 oocytes. With 25 oocytes, at least 27 PCR cycles were required, whereas with 50 oocytes, 21 cycles were enough to detect GAPDH expression. Amount of the primary cDNA required for RT-PCR was reduced down to at least 0.25 microl with 50 oocytes, thus the resting 19.75 microl cDNA can be used for the testing other interested gene expression. Tissue-to-slide, tissue-to-tissue forces were very high in the paraffin sections, thus the greater number of cell procurement was required than the frozen sections. CONCLUSION: We have described a method for analyzing gene expression at the RNA level with the homogeneously microdissected cells from the small amount of tissues with complexity. We found that LCM coupled with RT-PCR could detect housekeeping gene expression in 50 oocytes captured. This technique can be easily applied for the study of gene expression with the small amount of tissues.
Alcohols ; Animals ; DNA, Complementary ; Eosine Yellowish-(YS) ; Ethanol ; Female ; Frozen Sections ; Gene Expression* ; Genes, Essential ; Guanidine ; Hematoxylin ; Mice ; Microdissection* ; Oocytes* ; Ovary ; Paraffin ; Polymerase Chain Reaction ; Ribonucleases ; RNA Stability ; RNA* ; RNA, Messenger ; RNA-Directed DNA Polymerase ; Xylenes

Chronic low back pain (CLBP), defined as low back pain persisting more than 3 months, develops in about 5~7% of those who experience low back pain anytime during the lifetime. It is associated with not only substantial functional disability in each patient, but also a great socioeconomic burden. The etiology of CLBP is usually multifactorial. Also, known risk factors related to the development of CLBP are diverse, including age, sex, genetic factors, environment, previous trauma, dissatisfaction from work, etc. The more common causes of CLBP encounteredin clinical settings are disorders related to intervertebral disc, spinal stenosis, spondylolisthesis, compression fracture related to osteoporosis, pain originating from zygapophysial, and sacroiliac joints. Less common but other important causes include metastatic lesions, infection, and myofacial pain syndromes. Here, an evidence-based literature review on nonsurgical management of CLBP is presented with a special attention focused on various therapeutic approaches based on etiologic processes and clinical presentations. Nonsteroidal anti-inflammatory drugs, alone or in combination with muscle relaxants, relieve pain and improve overall symptoms of acute low back pain, but do not usually play a role in CLBP. Tricyclic antidepressants play a role in CLBP with its analgesic effect and sleep improvement. Tramadol, a centrally acting analgesic, also provides effects on moderate to severe CLBP but careful considerations, as with opioids, are necessary to prevent side effects and should be prescribed in refractory patients. Exercise therapy has strong evidence in the management of CLBP. Moderately strong evidence supports the use of manipulation in acute back pain but not in CLBP. Evidence for epidural steroid is strong for short-term relief of CLBP and is moderate to strong for long-term relief, especially with radicular pain, when performed transforaminally. Medial branch block (MBB) has moderate effects on facet-related pain and mechanical LBP, and the radiofrequency medial branch neurotomy has strong evidence of long-term effects when done properly in patients responsive to MBB. The use of facet injections, orthoses, traction, magnets, prolotherapy, trigger point injection, or acupuncture in the management of CLBP, unlike in acute LBP, is not supported by evidence for the long-term effectiveness. Sacroiliac joint injections are not indicated in the routine management of low back pain but show moderate effects in selected patients with CLBP. Conflicting evidence exists regarding the use of transcutaneous electrical nerve stimulation. For primary care providers and for those who specialize pain management, every effort should be made to contemplate all possible factors that might have played roles in generating the chronic pain and inform the patients of the natural course of various problems causing CLBP. Also, whatever management is chosen, the decision should be based upon the clinical presentation that closely correlates with definitive findings from studies best available whenever possible to provide the best treatment possible, not only to relieve the pain but also to provide functional capability to return previous social status as well as to prevent further development of disability and chronicity with refractory pain syndromes.
Acupuncture ; Analgesics, Opioid ; Antidepressive Agents, Tricyclic ; Back Pain ; Chronic Pain ; Diagnosis ; Exercise Therapy ; Facial Neuralgia ; Fractures, Compression ; Humans ; Intervertebral Disc ; Low Back Pain* ; Orthotic Devices ; Osteoporosis ; Pain Management ; Pain, Intractable ; Primary Health Care ; Risk Factors ; Sacroiliac Joint ; Spinal Stenosis ; Spondylolisthesis ; Traction ; Tramadol ; Transcutaneous Electric Nerve Stimulation ; Trigger Points