Assessment of patient's pain-related behavior at physical examination may allow diagnosis of recent osteoporotic vertebral fracture

Background contextAlthough innumerable studies have analyzed the multiple aspects of osteoporotic vertebral fractures, no study has focused on the clinical features related to spine pain in patients with recent osteoporotic vertebral compression fractures (VCFs).PurposeTo determine whether the assessment of pain-related behavior (P-RB) of patients with osteoporotic VCFs of recent onset may allow the fracture to be strongly suspected, or even diagnosed, at physical examination.Study designPain-related behavior of elderly patients attending an outpatient spine clinic was evaluated on the basis of six consecutive movements made on the examining table.Patient sampleFifty-six patients complaining only of lumbar or thoracic pain. The fractured patients (FPs), representing the fracture group (FG), were the 19 who had a recent VCF, whereas the control group (CG) consisted of the remaining 37 patients.MethodsAssessment of P-RB was based on six parameters: grimacing, sighing, clenching or blocking eyelids, gaping or strongly tightening the lips, need for help to take positions, and extreme difficulty to turn in the prone position. A score of 1 or a decimal was assigned to each parameter, the final score to each patient being 0 to 6. Three types of injury, acute (I), subacute (II), or chronic (III), were identified on the basis of the time elapsed from the probable occurrence of the fracture. The diagnosis of recent fracture was based on magnetic resonance images. Patients were videotaped during their movements. An examiner, unaware of the clinical history and diagnosis, gave a P-RB score to all patients and indicated whether they had to be placed in FG or CG, and also their presumable type of fracture. Subsequently, a DVD with the videotapes of all patients was given to three independent examiners, not specifically expert of spine conditions, who were asked to make the same evaluations as the first examiner.ResultsThe mean scores for P-RB given by the first examiner were 4.6 to FG and 0.7 to CG (p<.01). He identified as FPs 89% of those who were in FG. The type of fracture was indicated correctly in 88% of patients identified as FPs. The mean scores for the three types of fracture ranged from 5.4 (Type I) to 3.3 (Type III) (p<.001). The mean scores for P-RB given by the independent examiners to FG and CG were similar to those of the first examiner. The rates of correctness in identifying the type of fracture in patients indicated as FPs varied from 87% to 80%. The mean scores assigned to the patients included in the three types of fracture ranged from 5.4 to 2.8.ConclusionsPain-related behavior evaluation of patients with osteoporotic VCF during their movements on the examining table may allow to suspect, or even diagnose, the presence of a fracture, particularly in the initial 4 to 6 weeks after the occurrence. Even orthopedic surgeons not particularly familiar with spine care may be able to suspect the injury during physical examination.     

Ex vivo histological analysis of the thermal effects created by a 445-nm diode laser in oral soft tissue biopsy

The aim of this study was to evaluate, ex vivo, the histological effects of 445-nm diode laser (Eltech K-Laser srl, Treviso, Italy), during an oral soft ti     

Combining nerve and tendon transfers in tetraplegia: a proposal of a new surgical strategy based on literature review

European Journal of Orthopaedic Surgery & Traumatology - Spinal cord injury (SCI) is very common, most frequently resulting from motor vehicle accidents and falling from a height. Often, SCI...     

A Quantitative Comparison of Physical Accuracy and Numerical Stability of Lattice Boltzmann Color Gradient and Pseudopotential Multicomponent Models for Microfluidic Applications

The performances of the Color-Gradient (CG) and the Shan-Chen (SC) multicomponent Lattice Boltzmann models are quantitatively compared side-by-side on multiple physical flow problems where breakup, coalescence and contraction of fluid ligaments are important. The flow problems are relevant to microfluidic applications, jetting of microdroplets as seen in inkjet printing, as well as emulsion dynamics. A significantly wider range of parameters is shown to be accessible for CG in terms of density-ratio, viscosity-ratio and surface tension values. Numerical stability for a high density ratio $\mathcal{O}(1000)$ is required for simulating the drop formation process during inkjet printing which we show here to be achievable using the CG model but not using the SC model. Our results show that the CG model is a suitable choice for challenging simulations of droplet formation, due to a combination of both numerical stability and physical accuracy. We also present a novel approach to incorporate repulsion forces between interfaces for CG, with possible applications to the study of stabilized emulsions. Specifically, we show that the CG model can produce similar results to a known multirange potentials extension of the SC model for modelling a disjoining pressure, opening up its use for the study of dense stabilized emulsions.     

Axillary vein thrombosis as the first clinical manifestation of inflammatory breast cancer: report of a case

Inflammatory breast cancer is a rare and aggressive form of breast cancer. Venous thromboembolism is often related to cancer conditions but this report presents a case in which the thromboembolic event predicted the diagnosis of cancer. A 48-year-old female was admitted with the evidence of acute right axillary vein thrombosis. There was also erythema and edema of the skin of the right breast. Further evidence revealed a case of inflammatory breast cancer. The patient underwent anticoagulant therapy, and neoadjuvant systemic chemotherapy was initiated. The patient underwent extensive unilateral mastectomy following neoadjuvant chemotherapy. Follow-up (after 2 months of anticoagulation therapy for deep vein thrombosis) revealed recanalization of the right axillary vein, without evidence of residual thrombus. A case of acute vein thrombosis as the first manifestation of breast cancer may delay the diagnosis and subsequent appropriate treatment.