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A retrospective study of the practice of an orthopedic surgeon at a university teaching hospital was done to evaluate the significance of low back pain in older adults. All 259 patients in a 3-year period 50 years of age and over whose presenting complaint was low back pain or sciatica or both were identified and classified by final diagnosis. A comparison was similarly identified and classified. Systemic disease, particularly cancer, was much more prevalent in the older group. It was demonstrated that a simple screening routine consisting of measuring the erythrocyte sedimentation rate and serum concentrations of alkaline phosphatase and calcium would identify all cases of unsuspected malignant disease--that is, at least one of the values would be abnormal in every case.
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PMID:The significance of low back pain in older adults. 13 93

Out of 16 patients, spinal leptomeningeal neoplastic disease was diagnosed by MRI in 4 patients, myelography in 14 patients and CT myelography in 12 cases. MR was superior to myelography in 2 patients, in another 2 patients MRI was equally diagnostic. The cerebrospinal fluid of every patient contained malignant cells. Histological evidence for primary central nervous system tumors was found in 5 cases. In 10 cases, non-neuraxial malignancy consisted of small cell carcinoma of the lung (7 cases), and leukemia and lymphoma (3 patients). In 1 patient, primary leptomeningeal malignant melanoma was confirmed at autopsy. Preferential thoracolumbar neoplastic morphologic manifestation correlated with the presence of conus and cauda equina syndrome in 9 patients, low back pain, paresthesia and spinal root signs in 7 patients. False-negative interpretation of myelography in 2 patients with positive MR findings, and the impressive sensitivity of gadolinium Dota to improve visualization of subarachnoid spread, favor MRI as an alternative imaging technique in the assessment of patients with suspected intradural extramedullary malignancy.
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PMID:Spinal leptomeningeal neoplastic disease. Evaluation by MR, myelography and CT myelography. 131 84

Large administrative databases are increasingly valuable tools for health care research. Although increased access to these databases provides valuable opportunities to study health care utilization, costs and outcomes and valid and comparable results require explicit and consistent analytic methods. Algorithms for identifying surgical and nonsurgical hospitalizations for "mechanical" low back problems in automated databases are described. Sixty-six ICD-9-CM diagnosis and 15 procedure codes that could be applied to patients with mechanical low back problems were identified. Twenty-seven diagnosis and two procedure codes identify hospitalizations for problems definitely in the lumbar or lumbosacral region. Exclusion criteria were developed to eliminate nonmechanical causes of low back pain, such as malignancies, infections, and major trauma. The use of the algorithms is illustrated using national hospital discharge data.
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PMID:Use of the International Classification of Diseases (ICD-9-CM) to identify hospitalizations for mechanical low back problems in administrative databases. 138 43

Three cases of spontaneous peripelvic extravasation after the operation of rectal cancer are reported. In case 1, a 65-year-old female complained of left flank pain one month after high-anterior resection for rectal cancer. Drip infusion pyelography (DIP) and retrograde pyelography (RP) showed extravasation from the left renal pelvis. The ureteral stent was indwelled, and the extravasation showed remission. In case 2, a 55-year-old female complained of left lumbago 6 months after Miles' operation for rectal cancer. DIP showed extravasation from the left renal pelvis. The same findings were confirmed on the repeated DIP after 10 days. The ureteral stent was indwelled, and the extravasation was cured. In case 3, a 69-year-old male complained of left flank pain and left abdominal tumor 10 months after Miles' operation for rectal cancer. DIP and RP showed extravasation from the right renal pelvis, and computed tomographic (CT) scan showed urinoma formation. Drainage of the urinoma was performed and the ureteral stent was indwelled. The urinoma and the extravasation was cured. We emphasized the usefulness of indwelling the ureteral stent for the conservative management of spontaneous peripelvic extravasation caused by a malignant tumor, and a discussion of the relevant literature follows.
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PMID:[Spontaneous peripelvic extravasation after the operation of rectal cancer, treated by indwelling the ureteral stent: report of three cases]. 152 10

Of 753 adult patients undergoing SPECT and planar bone scintigraphy for the evaluation of low back pain, 43 (6%) showed either unilateral or bilateral increased sacroiliac joint (SIJ) uptake. Five of the 58 abnormal joints were only identified with SPECT (9%), whereas 20 of the 58 abnormal joints were much more convincingly demonstrated by SPECT (34%). Fifteen of the 43 patients with increased SIJ uptake had undergone prior lumbar laminectomy and/or spinal fusion. Such spinal surgery can increase impact loading on the SIJ, leading to mechanical overload and sacroiliitis. Degenerative joint disease, trauma, or other benign pathology accounted for the remaining patients with increased SIJ uptake. The authors conclude that for patients with a history of lumbar spinal fusion and/or laminectomy, increased SIJ uptake usually is caused by altered spinal mechanics rather than malignancy or infection.
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PMID:Increased sacroiliac joint uptake after lumbar fusion and/or laminectomy. 153 56

A 64-year-old woman with Borrmann type 4 gastric cancer was treated by intraaortic (celiac artery) one-shot infusion chemotherapy with adriamycin (ADM) and mitomycin C (MMC). One month after the first administration of 30 mg ADM and 20 mg MMC, the second administration of 50 mg ADM and 20 mg MMC was done. The third administration of 50 mg ADM and 20 mg MMC was performed one month after the second administration. Clinical symptoms of back pain, lumbago and anorexia had almost disappeared soon after the third administration. Although the findings of the X-ray examination of stomach, gastroscopy and celiac angiography showed marked improvement, total gastrectomy with lymphadenectomy was performed 2 months after the third administration because residual cancer cell nests were highly suspect. Histological examination of the resected stomach and lymphnodes revealed no cancer cells. The patient has been in good health without any recurrent signs for 16 months after operation.
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PMID:[A case of Borrmann type 4 gastric carcinoma which disappeared by intraaortic infusion chemotherapy with ADM and MMC]. 211 4

The patient was a 63-year-old women who visited our hospital with the chief complaints of swelling, chills, fever and right lumbago. Fifteen years ago, she received surgical exploration for right renal stones at another department of urology. A large, soft and round kidney was palpable from the right upper quadrant of abdomen to the right lower abdomen. The parenchyma of the right kidney was thinned and inside the kidney there was a huge amount of yellowish mucin. The histological diagnosis was mucin-producing cyst-adenoma (borderline malignancy) of the renal pelvis and ureter. Mucin-producing cystadenoma of the renal pelvis and ureter origin was very rare, and only 4 similar cases to our patient were so far reported.
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PMID:[Mucin-producing cystadenoma (borderline malignancy) of the renal pelvis and ureter. A case report]. 220 48

An entity is described which is characterized by low back pain and increased radionuclide uptake in the sacrum at bone scintigraphy in postmenopausal women having received radiotherapy towards the pelvis because of gynaecological malignancy. The findings stimulate bone metastases, but are in all likelihood caused by insufficiency fractures of the sacrum promoted by bone weakness induced by postmenopausal osteoporosis and radiotherapy combined. The increased radionuclide activity has a characteristic appearance which in the fully developed fracture acquires the shape of an 'H'. In plain radiography, changes are absent or subtle. The proper complementary examination is CT, in which the fractures can be visualized and malignant changes excluded. Awareness of this benign entity is important to avoid overdiagnosis of bone metastases.
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PMID:Insufficiency fractures of the sacrum after radiotherapy for gynaecological malignancy. 233 74

A case of retroperitoneal germ cell tumors in a 32-year-old male is reported. He was admitted to our hospital with complaints of lumbago and abdominal mass. He was diagnosed with primary retroperitoneal malignant tumor and underwent resection of the tumor with retroperitoneal lymphadenectomy. The final pathological diagnosis revealed germ cell tumors of more than one histological type in the retroperitoneal space. Serum human chorionic gonadotropin (hCG) and hCG-beta levels were very high preoperatively (4,8000 mIU/ml, 57 ng/ml, respectively) and they decreased to normal after vinblastine-bleomycin cisplatin combination chemotherapy three times postoperatively. The patient later developed a solitary lung metastasis and died in another hospital 7 months after the operation. Retroperitoneal germ cell tumors in adults are rare. One question continually arises: are they extragonadal occurrences or germ cell tumors or do they represent metastatic lesions from occult testicular tumors?
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PMID:[Retroperitoneal germ cell tumors with high level of serum and urine hCG in an adult: a case report]. 247 50

To evaluate the toxicity and efficacy of recombinant human granulocyte-colony-stimulating factor (rh G-CSF) administered with intensive chemotherapy, 39 patients with advanced pulmonary cancers were enrolled in a dose escalation trial of rh G-CSF. Three days after initiation of chemotherapy rh G-CSF was administered i.v. for 14 consecutive days at five dose levels (50-800 micrograms/m2). Absolute neutrophil counts showed a dose-dependent increase with an increasing dose of rh G-CSF and the durations of neutropenia (less than 1000/mm3) shortened significantly at doses of 200, 400, and 800 micrograms/m2 compared to those at 50 micrograms/m2 (P less than 0.01). The duration of neutropenia was shortened significantly at all five dose levels following treatment with rh G-CSF compared to treatment without rh G-CSF (P less than 0.05). Adverse side effects associated with rh G-CSF administration were fever higher than 38 degrees C (21%), chest pain, and low back pain (13%). No intolerable side effects were experienced. It can be concluded that rh G-CSF is effective in shortening the duration of neutropenia following intensive chemotherapy at a dose level of 100 to 200 micrograms/m2 i.v. a 400-micrograms/m2 dose of rh G-CSF is recommended in patients with prior treatment because of the possibility of a lower bone marrow response.
Cancer Res 1989 Sep 15
PMID:Dose escalation study of recombinant human granulocyte-colony-stimulating factor (KRN8601) in patients with advanced malignancy. 247 45


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