Analysis of 22,655 presentations with back pain to Perth emergency departments over five years

BACKGROUND: Back pain is a significant cause of disability in the community, but the impact on Emergency Departments (EDs) has not been formally studied. Patients with back pain often require significant time and resources in the ED. AIMS: To examine the characteristics of patients presenting with back pain to the ED, including final diagnosis, demographics of those attending and temporal distribution of presentations. METHODS: Emergency presentations in the metropolitan area of Perth, Western Australia, for 2000-2004 were searched using a linked database covering all the major hospitals (Emergency Care Hospitalisation and Outcome Study database). All presentations with the triage code for back pain were extracted and analysed. RESULTS: A total of 22,655 presentations with back pain were identified, representing 1.9% of total presentations. Simple muscular or non-specific back pain accounted for only 43.8% of presentations, with other causes such as renal colic and pyelonephritis accounting for the majority. The young (75 years old) were more likely to have non-muscular causes for their back pain. Muscular back pain presentations occurred mostly between 0800 and 1600, with high proportions presenting on the weekends. Patients with simple muscular back pain spent a mean of 4.4 h in the ED, representing a significant outlay of resources. CONCLUSION: Back pain has a significant impact on EDs, and staff should be alert for another pathology presenting as back pain. There is a need for multidisciplinary back pain teams to be available 7 days a week, but only during the day

Vertebral Erosion Resulting from a Chronic Retroperitoneal Rupture of an Abdominal Aortic Aneurysm

AbstractWe report a case of a chronic ruptured abdominal aortic aneurysm (AAA). The patient had back pain for 2 months. On examination, there was a pulsatile mass in his abdomen with no other abnormalities. Abdominal CT scan showed a retroperitoneal hematoma and vertebral body erosion. At operation, we found a retroperitoneal pseudoaneurysm due to a rupture in the posterior wall of an AAA. We repaired the aneurysm with an aorto-bi-iliac bypass graft.ConclusionA chronic posterior retroperitoneal rupture of an AAA can rarely erode the vertebral body without other symptoms

PTFE patching to prevent anastomotic aneurysm formation in Takayasu's arteritis

AbstractEur J Vasc Endovasc Surg 25, 478-480 (2003

The relation of serum levels of muscle enzymes with clinical findings in rheumatoid arthritis

The aim of this study was to evaluate the association of serum levels of muscle enzymes with disease activity measures in patients with rheumatoid arthritis. Twenty-five patients with rheumatoid arthritis (RA) and 16 healthy female controls with comparable age, height, weight and body mass index were enrolled in this study. Serum creatine kinase (CK) and CK-MB, lactic dehydrogenase (LDH) were measured and isoenzyme determination, CK and LDH electrophoresis were performed in all subjects, and those values were compared with disease activity measures (erythrocyte sedimentation rate, CRP, tender joint count and swollen joint count, and pain assessment by visual analogue scale). Subgroup analysis regarding exercise level, serum rheumatoid factor level, corticosteroid use, presence of deformity or swollen joints was also made. Only the CK levels were significantly different (p<0,01). Subgroup analysis revealed a significantly higher LDH5 isoenzyme level in the exercising RA patients. While serum CK levels showed a negative correlation with tender joint count, swollen joint count and pain, serum LDH levels correlated positively with CRP. Serum CK levels may be lower in patients with RA. Hence, if one just relies on the serum CK levels in the patients with RA who also have acute myocardial infarction or inflammatory muscle disease, he may be misleaded