Diagnostic approach to low back pain

Low back pain is an important cause of pain referrals in the primary care setting. Overall, 85% of initial admissions are considered to be nonspecific low back pain that resolves in a few weeks without the need for additional evaluation. Myofascial pain, lumbar disc herniation, spinal stenosis, facet joint and disc degeneration, and sacroiliac joint pathologies are common causes of mechanical low back pain. Non-mechanical low back pain includes infections of the vertebral corpus and disc, malignant tumors and metastases, and inflammatory diseases. Red flag symptoms suggestive of serious diseases should be evaluated in all patients with low back pain, and the diagnosis process should be accelerated in patients with these symptoms. The so-called "yellow flags" associated with chronic low back pain include psychosocial factors. In the diagnosis process, pain relief is observed in patients with non-specific low back pain without the need for imaging methods. Laboratory tests and imaging methods can be used to distinguish other causes of low back pain

The effect of local anesthesia types on erectile function in TRUS biopsy: A prospective study

Aim: To evaluate the effect of local anesthesia types on erectile function during transrectal ultrasound guided biopsy (TRUS-Bx).Material and Methods: Between February 2014 and February 2015, 50 men who underwent TRUS-Bx at our institution were included in this prospective study. The 50 patients were randomized and divided into two groups according to the type of anesthesia used. All patients were asked to indicate the level of pain experienced on a visual analogue scale (VAS) 10 min after the TRUS biopsy. All patients had to fill in the IIEF standardized questionnaire. Groups were evaluated in terms of pre-biopsy IEFF score (IIEF-1), post-biopsy 1st month IIEF score (IIEF-2) and post-biopsy 2nd month IIEF score (IIEF -3). Patient characteristics, mean VAS score and IIEF score were compared between the two groups.Results: The mean age,IIEF-1,tPSA level, prostate volume and VAS score were 60.86±0.95 years,18.68,6.81±0.54 ng/ml,51.10±3.82 cc and 3.5±0.26 in all patients, respectively. The difference in VAS scores between the groups was statistically significant (p<0.05). In Group 1 the IIEF-1, IIEF-2, and IIEF-3 were different from each other statistically. There was no statistically significant difference between IIEF-1 and IIEF-3 scores in group 2(p=0,136 z=-1,492).So it was observed that the initial IIEF scores were reached at the end of the second month in group 2 administered 12.5 g 2% lidocaine HCl jel.Conclusion: Our study indicates that although local periprostatic anesthesia by injecting 6 ml of 2% lidocaine provides more effective anesthesia for pain relief, intrarectal 12.5g 2% lidocaine HCl jel maintains less impact on erectile dysfunction for TRUS-Bx

An assessment of marital adjustment in patients with rheumatoid arthritis

Aim To investigate marital adjustment in patients with rheumatoid arthritis and factors affecting this. Methods A total of 32 patients diagnosed with Steinbrocker class 1-2 rheumatoid arthritis and 32 healthy individuals from a similar age group were included. Sociodemographic characteristics, the Beck Depression Inventory (BDI), short–form 36(SF-36) and the dyadic adjustment scale (DAS) were evaluated in both groups. A visual analogue scale (VAS), the disease activity score 28 (DAS28) and a health assessment questionnaire (HAQ) were also investigated in the patient group. Results Mean ages were 46.5±9.2 years in the patient group and 47.7±8.1 in the control group (p=0.5). No significant difference was determined between the two groups in terms of sociodemographic characteristics. No statistically significant correlation was observed between erythrocyte sedimentation rate (ESR), patient and physician global VAS, DAS28, HAQ and morning stiffness and DAS total score. Comparison of DAS subunits revealed a significant difference in dyadic satisfaction and affectional expression in the patient and control groups (p=0.046 and p=0.037). A statistically significant negative correlation was observed between duration of the disease and marital adjustment (p=0.01;r= -0.58). Conclusion Due to its progressive and prolonged course rheumatoid arthritis can also affect individuals’ social relationships besides restricted daily living activities. Activation of rheumatoid arthritis did not affect marital adjustment in this study, but adjustment decreased with duration of the disease

An unusual complication of ureteral double-J stent placement: ureteral perforation

Ureteral double-J stent implantation has become a routine procedure in the management of a variety of urinary tract pathologies. Although this is a safe and simple procedure, there can be unexpected severe complications such as malpositioning, encrustation, ureteral erosion, intravascular migration, hematoma and ureterovascular fistula. Intraoperative fluoroscopic examination and postoperative imaging modalities are useful in early diagnosis and prevention of these complications. We present a case of right ureteral perforation during retrograde double-J stent implantation. To our knowledge ureteral perforation due to double-J stent placement has not been previously described

The clinicopathologic observation, c-KIT gene mutation and clonal status of gastrointestinal stromal tumor in the sacrum

<p>Abstract</p> <p>Background</p> <p>It is very rare that gastrointestinal stromal tumor (GIST) occurs in the sacrum. Only one case of GIST occuring in the sacral region, with intracranial metastasis, has been reported in the literature. Moreover, only few cases have been published in literature about its clonal origin.</p> <p>Case presentation</p> <p>In this report, we present a rare case of GIST occuring in the sacrum and describe its clinicopathologic features, c-KIT gene mutation and clonal status. Microscopically, the lesion was composed of spindle cells arranged in cords, knitted and whirlpool patterns. Trabecula of bone were found in the lesion. The cytoplasm of tumor cells were abundant, and the nuclei were fusiform. Mitotic figures were rare. Immunohistochemically, the tumor cells showed positive reactivity for CD117 and CD34. On mutation analysis, a c-KIT gene mutation was found in exon 11. The result of clonal analysis demonstrated that the GIST was monoclonal.</p> <p>Conclusion</p> <p>In summary, we showed that tumor material, phenotypically identical with GISTs was found in the sacrum. It is difficult to differentiate GISTs from other spindle cell tumors, hence the need for immunohistochemistry, the examination of c-KIT gene amplification and sequencing.</p