An unusual cause of low back pain? A case report

STUDY DESIGN: Case report. OBJECTIVE: To highlight the evaluation of a patient with low back pain after an incidental radiographic finding clouded routine management. SUMMARY OF BACKGROUND DATA: Greenfield filters have been used for 20 years with good results. Complications have been seen and documented, but the natural history of filter placement in young patients is not fully appreciated. A prong from a Greenfield filter embedded within a vertebral body has been reported once as an incidental finding in a patient undergoing prophylactic monitoring for recurrence of tumor. METHODS: A 31-year-old woman had a pulmonary embolus after surgery for a benign adnexal mass. A bleeding complication occurred after systemic anticoagulation, and a vena caval filter was placed to limit the possibility of further emboli. The patient was referred to the orthopedic clinic 5 years later with low back pain and an unusual finding on computer tomographic scan: One prong of the filter was embedded within a vertebral body. RESULTS: A bone scan was obtained to evaluate the status of bone activity around the prong. Bone reaction was not evident. Conservative management of her low back pain was instituted, and after 2 years, the patient remains asymptomatic. CONCLUSION: The overall use of vena caval filters has produced favorable results, although numerous complications have been reported. All long-term sequelae have not been completely identified.     

Latissimus dorsi pedicled graft. An unusual cause of shoulder pain

An unusual complication after the use of a pedicled latissimus dorsi flap is reported. The flap was used to reconstruct a facial defect after excision of a high grade mucoepidermoid carcinoma of a parotid gland. The tendinous insertion of the latissimus dorsi on the humerus was left intact and the flap pivoted around this point. Subsequent use of his arm caused the patient disabling shoulder pain from traction on the tendon. Symptoms resolved after the tendon was divided.     

Prevalence of immunity to hepatitis A in recruits to the British Army and Royal Air Force

Between 1989 and 1992, 92% of a sample of 2790 Service recruits aged between 17 and 35 years (mean age 19 years 7 months) were found not to be immune to infection by hepatitis A virus. The proportion of males with immunity was consistently greater than that for females. There was a significantly increased probability of immunity if individuals originated from Northern England, the Midlands and Scotland, in particular the suburbs. Among male recruits there were significantly increased probabilities of immunity associated with travel to Southern and Eastern Europe or to the Tropics, and for females with travel to North West Europe or to Southern and Eastern Europe.     

An unusual cause of low back pain. Osteomyelitis of the spinous process

STUDY DESIGN: A case report of osteomyelitis of the spinous process. OBJECTIVE: To describe the diagnosis and successful treatment of a patient with spinous process osteomyelitis. SUMMARY OF BACKGROUND DATA: Spinous process osteomyelitis is exceedingly rare and may be misdiagnosed as paraspinal muscle strain, discitis, or vertebral body osteomyelitis. The clinical presentation of spinous process osteomyelitis is subtle, laboratory findings are nonspecific, and radiographs are often normal. METHODS: The diagnosis, treatment, and outcome of two patients with spinous process osteomyelitis (an adult and a child) with insidious, nonspecific lumbar pain and fever are reviewed. RESULTS: Magnetic resonance imaging with and without gadolinium enhancement demonstrated increased signal of the spinous process with paraspinous musculature enhancement, a finding consistent with spinous process osteomyelitis. Biopsy results demonstrated the presence of staphylococcus aureus in the child and no organisms in the adult. Treatment with intravenous antibiotics led to resolution in both cases. CONCLUSIONS: The use of magnetic resonance imaging technology permitted the early and accurate diagnosis of spinous process osteomyelitis.     

An unusual cause for collapse in a patient with arthritis

We present the clinical case of a patient who was admitted to the intensive care ward with severe central nervous system symptoms and cardiovascular collapse within a week of starting sulphasalazine; in the absence of any other diagnosis, these symptoms were felt to be due to a previously unreported adverse effect of sulphasalazine.     

Non-cardiac chest pain: a real clinical problem

Non-cardiac chest pain is a frequent clinical problem. Between 10 and 50% of patients with anginal pain who are referred for arteriography are found to have normal coronary arteries. An oesophageal source of non-cardiac chest pain is reported in up to 60% of cases, most of which are attributable to gastro-oesophageal reflux disease. The exclusion of heart disease and the identification of an oesophageal origin of the pain may require an extensive work-up. The outcome in patients with non-cardiac chest pain is influenced by both the underlying diagnosis and the patient's perception of his or her symptom.     

Thymoma in a case of scleroderma

A case of scleroderma with manifestations in the oesophagus and both lungs and a concomitant thymic lympho-epithelioma is presented. This case represents a further documentation of the well-established association between thymoma and collagen disorders.     

Evaluating chest pain in the emergency department

1. Purification of horse-liver glutathione reductase was obtained by affinity chromatography on N6-(6-aminohexyl)-adenosine-1'5'-bisphosphate Sepharose (N6-2'5'-ADP-Sepharose) and Reactive Red-120-Agarose, and chromatography on DEAE-Sephadex and Sephacryl S-300. 2. The final preparation had 248 U/mg specific activity after 11,174-fold purification with 47% final recovery, and was homogeneous by SDS-electrophoresis. It showed charge heterogeneity in non-denaturing electrophoresis and chromatofocusing, with several peaks of pI between 5.7 and 6.7. 3. The enzyme was homodimeric (107,000 native MW), with S20w = 6.31 S, and 41.22 A of hydrodynamic radius. It showed absorption peaks at 270, 370 and 462 nm, a characteristic of flavoproteins. 4. When NADPH was substituted by deamino-NADPH or NADH the enzyme showed 69 and 8.5% activity, respectively, while with glutathione-CoA mixed disulfide the enzyme had 23% of the activity shown with GSSG. Apparent Km values of 8.8, 680, 59, and 560 microM were measured for NADPH, NADH, GSSG and ferricyanide, respectively.     

Spiral CT in acute non-cardiac chest pain

The sturgeons (order Acipenseriformes) are extant representatives of a group of ancient Actinopterygian (ray-finned) fish. Galanin and scyliorhinin I (a tachykinin with limited structural similarity to mammalian substance P) have been isolated from an extract of the gastrointestinal tract of a sturgeon (an F1 hybrid between the shovelnose sturgeon, Scaphirhynchus platorynchus, and the pallid sturgeon, Scaphirhynchus albus). The primary structure of sturgeon galanin (Gly-Trp-Thr-Leu-Asn-Ser-Ala-Gly-Tyr-Leu10-Leu-Gly-Pro-His-Ala-Val -As p-Gly-His-Arg20-Ser-Leu-Ser-Asp-Lys-His-Gly-Leu-Pro.NH2) contains only two amino acid substitutions (Ser23 --> Asn and Pro29 --> Ala) compared with galanin from the bowfin, Amia calva (Amiiformes), but five amino acid substitutions compared with galanin from the trout (Teleostei). Similarly, the sturgeon tachykinin (Ser-Lys-Tyr-His-Gln-Phe-Tyr-Gly-Leu-Met.NH2) contains only one amino acid substitution (Tyr3 --> Ser) compared with scyliorhinin I previously isolated from bowfin stomach but five amino acid substitutions compared with trout substance P. The data support the hypothesis that the Acipenseriformes and the basal Neopterygians (gars and bowfin) share a close phylogenetic relationship.