Intermittent Back Pain Research Articles

Case report: Acute radiculopathy due to a haemorrhagic lumbar synovial cyst

Intraspinal synovial cysts are uncommon entities associated with facet joint degeneration. Clinically the most frequent presentation is with intermittent lower back pain without motor or sensory impairment, although more classical radicular symptoms and an acute exacerbation of symptoms may occur due to intracystic haemorrhage. Previous reports include MR images from only two cases of pathologically proven haemorrhagic cysts. We report a case of acute radiculopathy shown on MR to be due to a cystic lesion adjacent to the right L4/5 facet joint and which was surgically proven to be a haemorrhagic synovial cyst. The literature on this condition is reviewed.

Through uncharted waters

Contemporary general practice teaching encourages us to assess our patients' emotionalresponse to illness. As a profession our response is too often to medicalise feelings. Emotions are mistaken for psychopathology; fear and apprehension labelled as anxiety; sadness as depression. We compound matters by treating pharmacologically rather than reassuring. Reassurance is undervalued. If we explore our patients' fears and concerns, clarify their beliefs about their illness, if we can listen to them and given them time to talk we can begin to give them appropriate explanations about their illness and our proposed management. More importantly we allow the development of trust. I think it is this combination of addressing both intellectual and emotional issues that lessens fear and apprehensionand is the key to effective reassurance. Being a patient recently has been salutary. WhatI understood intellectually I have now experienced emotionally. “He had used his skills to allow me to express my fears and reflect on the facts.” Having had intermittent back pain for the past 10 years I dismissed another episode, this time with mild sciatica, brought on after a bout of winter digging. After two months,however, it was no better. I saw the physiotherapist. She cut through my self denial and said that it was a disc lesion. In spite of her treatment I got no better, probably because I declined her advice to take time off - I was a professional and indispensable. I hadpatients needing terminal care, …

Sacro-iliitis in women--a sequela to acute salpingitis. A follow-up study.

Follow-up information is presented on 37 women with SI and a history of severe acute salpingitis. It was found that 18 (49%) had clinical symptoms of intermittent or persistent back pain and stiffness indicating SI; 8 of them had serious and persistent discomfort. The rate of development varied greatly. The long-term prognosis appears to be good. Radiographic progression in the sacro-iliac joint was observed in 3 of the 11 patients who were re-examined. The findings indicate that salpingitis is a pathogenetic factor in SI in both HLA-B27 positive and negative women, but that the etiology and prognosis may differ between these two groups. The frequency of symptomatic SI tends to be higher among women carrying the HLA-B27 compared with those not having this antigen. In the latter group the course of disease was milder; the majority of the women had periodical symptoms or were asymptomatic.

Renal disease, inner ear deafness, and ocular changes; a new heredofamilial syndrome.

A CLINICAL syndrome characterized by progressive deafness, ophthalmological changes, and laboratory evidence of chronic renal disease has been observed and studied in four brothers. The results of clinical and laboratory investigations conducted while these patients were hospitalized yielded an almost identical picture in all four siblings. At the time of investigation, their ages were 18 (J.), 17 (I.), 16 (N.), and 14 (M.). In all instances, deafness was first noted at age 9 to 10 and was progressive. The youngest brother (M.) in addition had had intermittent back pain since the age of 12 (once with hematuria?) and amebic colitis at the age of 13. Physical examination in all instances revealed normal physical development, asthenic build, long extremities and fingers, and high palate. Their weights ranged from 55 kg. in the oldest to 40 kg. in the youngest. An apical systolic murmur was audible in all except N. A positive