[De Quervain thyroiditis. Corner points of the diagnosis].

Related Articles

[De Quervain thyroiditis. Corner points of the diagnosis].

Orv Hetil. 2014 Apr 1;155(17):676-80

Authors: Oláh R, Hajós P, Soós Z, Winkler G

Abstract
Inflammatory disorders of the thyroid gland are divided into three groups according to their duration (acute, subacute and chronic). De Quervain’s thyroiditis (also termed giant cell or granulomatous thyroiditis) is a subacute inflammation of the thyroid, which accounts for 5% of thyroid disorders. The etiology is unknown, it usually appears two weeks after an upper viral respiratory infection. The clinical feature includes neck pain, which is aggraviated during swallowing, and radiates to the ear. On palpation, the thyroid is exquisitely tender. The erythrocyte sedimentation rate is markedly elevated, the leukocyte count, C-reactive protein are normal or slightly elevated. The natural history of granulomatous thyroiditis involves four phases: the destructive inflammation results temporarily in hyperthyroidism followed by euthyroidism. After a transient hypothyroidism the disease becomes inactive and the thyroid function is normalised. Ultrasonographic findings are diffuse hypoechogenic structures, but nodules may also occur. The disease often remains unrecognised, or the first phase of the disease is diagnosed and treated as hyperthyroidism. The diagnosis can be confirmed by the presence of the thyroid autoantibodies, radioiodine uptake and fine needle aspiration cytology. There is no special treatment, non-steroid anti-inflammatory drugs or steroid should be given to relieve the pain. The aim of the authors is to shed light the key points of diagnosis and differential diagnosis by the presentation of four slightly different cases. Orv. Hetil., 2014, 155(17), 676-680.

PMID: 24755450 [PubMed – in process]

A randomized, controlled trial of acupuncture for chronic low-back pain.

Related Articles

A randomized, controlled trial of acupuncture for chronic low-back pain.

Altern Ther Health Med. 2014 May-Jun;20(3):13-9

Authors: Bahrami-Taghanaki H, Liu Y, Azizi H, Khorsand A, Esmaily H, Bahrami A, Xiao Zhao B

Abstract
Background • Chronic low-back pain (cLBP) is a common condition throughout the world, and acupuncture is widely sought for treatment. As clinical evidence for the benefits of acupuncture grows, acupuncture for cLBP is receiving increased recognition and acceptance by both patients and professionals. Time method acupuncture has been previously researched with respect to chronic gastritis. Objective • For individuals with cLBP in the current study, the research team examined the efficacy of adding confluent acupoints, related to the daytime period in time method acupuncture, to regular acupuncture and also evaluated the persistence of the benefits of such acupuncture in comparison with regular acupuncture. Design • The study was a randomized, controlled trial (RCT). Setting • The setting was an outpatient clinic of the Dongzhimen Hospital in Beijing, China. Participants • Participants were Chinese men and women with cLBP. Intervention • Sixty participants were randomly divided into 2 groups to receive acupuncture. The control group received a treatment that followed a routine acupuncture (RA) protocol, while the intervention group received a treatment that followed an RA protocol plus acupuncture in confluent points related to time (TA). Outcome Measures • The research team measured the change in participants’ scores using the visual analogue scale (VAS), the number of therapy sessions needed, the number of days that participants were absent from work during the treatment period and at 12 wk posttreatment, and the number of pain relapses between the end of treatment and the 4- and 12-wk follow-ups. Results • VAS scores decreased from 69.6 ± 7.9 to 11.8 ± 4.9 in the intervention group compared with a decrease from 69.2 ± 8.0 to 15.7 ± 10.0 in the control group (P = .001). The intervention group received fewer therapy sessions (8.1 ± 2.0) than did the control group (10.1 ± 2.0, P < .001). Compared with the controls, the intervention group showed fewer days absent from work (0.5 vs 1.4; P = .03) and fewer pain relapses (4.0 vs 7.0; P = .04) at the 12-wk follow-up. In the 2 groups combined, VAS decreased from 69.4 ± 7.9 before the first session of acupuncture to 13.8 ± 8.0 after the last session (P < .001), and the number of therapy sessions needed for pain relief was 9.1 ± 2.2. Conclusion • Accompanying routine acupuncture with time method acupuncture can enhance the efficacy of treatment and the persistence of its benefits in individuals with cLBP.

PMID: 24755566 [PubMed – in process]

Expectations for treatment outcomes in neck/back patients regarding improvements in pain and function: A cross-sectional pilot study.

Related Articles

Expectations for treatment outcomes in neck/back patients regarding improvements in pain and function: A cross-sectional pilot study.

Eur J Phys Rehabil Med. 2014 Apr 23;

Authors: Skatteboe S, Røe C, Fagerland MW, Granan LP

Abstract
BACKGROUND: Literature has suggested that patients’ pre-treatment expectations may influence both prognosis and outcome. Investigation of these possible benefits requires knowledge about what is actually expected among these patients.
AIM: To investigate neck/back patients’ expectations for treatment outcomes (pain and functional improvement) prior to their first meetings with specialists in physical medicine and rehabilitation (PMR).
DESIGN: Cross-sectional pilot study.
SETTING: PMR Neck/Back Outpatient Clinic, Oslo University Hospital.
POPULATION: Patients with neck/back pain and/or functional problems referred for the first time to a neck/back PMR outpatient clinic.

PMID: 24755775 [PubMed – as supplied by publisher]

The Idiopathic Intracranial Hypertension Treatment Trial: Clinical Profile at Baseline.

Related Articles

The Idiopathic Intracranial Hypertension Treatment Trial: Clinical Profile at Baseline.

JAMA Neurol. 2014 Apr 21;

Authors: Wall M, Kupersmith MJ, Kieburtz KD, Corbett JJ, Feldon SE, Friedman DI, Katz DM, Keltner JL, Schron EB, McDermott MP, for the NORDIC Idiopathic Intracranial Hypertension Study Group

Abstract
IMPORTANCE To our knowledge, there are no large prospective cohorts of untreated patients with idiopathic intracranial hypertension (IIH) to characterize the disease. OBJECTIVE To report the baseline clinical and laboratory features of patients enrolled in the Idiopathic Intracranial Hypertension Treatment Trial. DESIGN, SETTING, AND PARTICIPANTS We collected data at baseline from questionnaires, examinations, automated perimetry, and fundus photography grading. Patients (n = 165) were enrolled from March 17, 2010, to November 27, 2012, at 38 academic and private practice sites in North America. All participants met the modified Dandy criteria for IIH and had a perimetric mean deviation between -2 dB and -7 dB. All but 4 participants were women. MAIN OUTCOMES AND MEASURES Baseline and laboratory characteristics. RESULTS The mean (SD) age of our patients was 29.0 (7.4) years and 4 (2.4%) were men. The average (SD) body mass index (calculated as weight in kilograms divided by height in meters squared) was 39.9 (8.3). Headache was the most common symptom (84%). Transient visual obscurations occurred in 68% of patients, back pain in 53%, and pulse synchronous tinnitus in 52%. Only 32% reported visual loss. The average (SD) perimetric mean deviation in the worst eye was -3.5 (1.1) dB, (range, -2.0 to -6.4 dB) and in the best eye was -2.3 (1.1) dB (range, -5.2 to 0.8 dB). A partial arcuate visual field defect with an enlarged blind spot was the most common perimetric finding. Visual acuity was 85 letters or better (20/20) in 71% of the worst eyes and 77% of the best eyes. Quality of life measures, including the National Eye Institute Visual Function Questionnaire-25 and the Short Form-36 physical and mental health summary scales, were lower compared with population norms. CONCLUSIONS AND RELEVANCE The Idiopathic Intracranial Hypertension Treatment Trial represents the largest prospectively analyzed cohort of untreated patients with IIH. Our data show that IIH is almost exclusively a disease of obese young women. Patients with IIH with mild visual loss have typical symptoms, may have mild acuity loss, and have visual field defects, with predominantly arcuate loss and enlarged blind spots that require formal perimetry for detection. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01003639.

PMID: 24756302 [PubMed – as supplied by publisher]

Activation of Spinal NF-?B/p65 Contributes to Peripheral Inflammation and Hyperalgesia in Rat Adjuvant-Induced Arthritis.

Related Articles

Activation of Spinal NF-κB/p65 Contributes to Peripheral Inflammation and Hyperalgesia in Rat Adjuvant-Induced Arthritis.

Arthritis Rheumatol. 2014 Apr;66(4):896-906

Authors: Luo JG, Zhao XL, Xu WC, Zhao XJ, Wang JN, Lin XW, Sun T, Fu ZJ

Abstract
OBJECTIVE: It is known that noxious stimuli from inflamed tissue may increase the excitability of spinal dorsal horn neurons (a process known as central sensitization), which can signal back and contribute to peripheral inflammation. However, the underlying mechanisms have yet to be fully defined. A number of recent studies have indicated that spinal NF-κB/p65 is involved in central sensitization, as well as pain-related behavior. Thus, the aim of this study was to determine whether NF-κB/p65 can facilitate a peripheral inflammatory response in rat adjuvant-induced arthritis (AIA).
METHODS: Lentiviral vectors encoding short hairpin RNAs that target NF-κB/p65 (LV-shNF-κB/p65) were constructed for gene silencing. The spines of rats with AIA were injected with LV-shNF-κB/p65 on day 3 or day 10 after treatment with Freund’s complete adjuvant (CFA). During an observation period of 20 days, pain-related behavior, paw swelling, and joint histopathologic changes were evaluated. Moreover, the expression levels of spinal tumor necrosis factor α (TNFα), interleukin-1β (IL-1β), and cyclooxygenase 2 (COX-2) were assessed on day 14 after CFA treatment.
RESULTS: The presence of peripheral inflammation in rats with AIA induced an increase in NF-κB/p65 expression in the spinal cord, mainly in the dorsal horn neurons and astrocytes. Delivery of LV-shNF-κB/p65 to the spinal cord knocked down the expression of NF-κB/p65 and significantly attenuated hyperalgesia, paw edema, and joint destruction. In addition, spinal delivery of LV-shNF-κB/p65 reduced the overexpression of spinal TNFα, IL-1β, and COX-2.
CONCLUSION: These findings indicate that spinal NF-κB/p65 plays an important role in the initiation and development of both peripheral inflammation and hyperalgesia. Thus, inhibition of spinal NF-κB/p65 expression may provide a potential treatment to manage painful inflammatory disorders.

PMID: 24757142 [PubMed – in process]