PubMed Health⌕ Search

Biomedical subjects

D Borenstein

Publications and source records attributed to D Borenstein.

At least 19 recordsLinked to original sources
PubMed2001

Celecoxib versus diclofenac in the management of osteoarthritis of the knee.

OBJECTIVE: A clinical trial was conducted in 600 patients with OA of the knee to test the hypothesis that the specific COX-2 inhibitor, celecoxib, has equivalent efficacy and a superior tolerability/safety profile when compared to diclofenac, the current worldwide standard of care. METHODS: Patients were administered celecoxib 100 mg BID, diclofenac 50 mg TID or placebo for 6 weeks in a multicentre, double-blind. placebo-controlled trial. RESULTS: Primary efficacy measures (index joint pain by VAS, WOMAC index) indicated statistically significant improvement versus placebo for both celecoxib and diclofenac and no statistically significant differences between celecoxib and diclofenac. American Pain Society (APS) measures to assess the rapidity of onset of action showed statistically significant and comparable pain relief versus placebo within 24 h for both celecoxib and diclofenac. More diclofenac patients reported GI side effects than patients treated with either placebo or celecoxib. Diclofenac-treated patients experienced statistically significant elevations in mean hepatic transaminases and serum creatinine and reductions in haemoglobin concentration when compared to placebo, events not observed with celecoxib. CONCLUSION: Celecoxib 200 mg daily is as effective as diclofenac 150 mg daily for relieving signs and symptoms of OA of the knee, including pain, and has a rapid onset of action. However, celecoxib appears to have a superior safety and tolerability profile.

Activities of Daily Living↗
PubMed1998

Hemodynamic performance of four mechanical bileaflet prosthetic valves in the mitral position: an echocardiographic study.

OBJECTIVES: The CarboMedics, Duromedics, Sorin Bicarbon and the St. Jude Medical valves are bileaflet mechanical prostheses of modern but different design. Choosing a valve with the best hemodynamic profile is of clinical importance in patients with small ventricles and a small mitral annulus. METHODS: The hemodynamic performance of these valves in the mitral position was compared in 76 asymptomatic, ambulatory patients with normally functioning prosthesis and left ventricle, using Doppler echocardiography. Of the 76 patients studied, 22 had the CarboMedics, 16 had the Duromedics, 17 had the Sorin Bicarbon and 21 had the St. Jude prosthesis. The patients ages ranged from 18 to 81 years. There were 44 women and 32 men. The time from implantation to echocardiographic study ranged from 1 to 55 months. RESULTS: The echocardiographic study was performed earlier after surgery in the Sorin Bicarbon group. There was no significant difference in women/man ratio, incidence of atrial fibrillation, left ventricular or left atrial diameters between the four groups. The mean prosthesis size was significantly smaller for Sorin Bicarbon and Duromedics valves compared to the CarboMedics and the St. Jude valves (mean+/-SD, 27.2+/-1.3, 27.1+/-1.1 and 30.0+/-1.9 and 30.0+/-2.7 mm, respectively, P<0.001). Despite its smaller size the Sorin Bicarbon valve had significantly larger effective valve area by Doppler compared to the CarboMedics valve (290+/-40 vs 250+/-60 mm2, respectively, P=0.014). The ratio of effective valve area to prosthesis size was significantly larger for the Sorin Bicarbon valve when compared with any other type of prosthesis. CONCLUSIONS: (1) The Sorin Bicarbon bileaflet valve offered the best hemodynamic results that may be explained by the valve's large leaflet opening angle and small thickness of the leaflets. (2) Since the Sorin Bicarbon is the newest bileaflet valve, durability of this valve remains uncertain.

Adolescent↗
PubMed1998

Epidemiology, etiology, diagnostic evaluation, and treatment of low back pain.

Low-income populations have a lower prevalence of low back pain than high-income populations. Pathologic processes affecting the intervertebral disc are affected by genetic factors and degeneration of annular fibers. Historical and physical findings are not helpful in identifying damaged tissues in patients with nonspecific low back pain. Agency for Health Care Policy and Research guidelines for plain radiographs in the evaluation of low back pain are too sensitive and expose patients unnecessarily to ionizing radiation. Clinical entities reviewed in the literature include septic sacroiliitis, prognosis of metastatic spinal tumors, and low back pain in health care professionals. Epidural corticosteroid injections are useful for leg pain and sensory deficits early in the course of sciatica secondary to a herniated nucleus pulposus. Poor nutritional state increases the risk for postoperative infections for spinal fusion patients.

Adrenal Cortex Hormones↗
PubMed1997

Prevalence of spinal disc disease among interventional cardiologists.

A suspected, but undocumented, excess of axial skeletal disease among interventional cardiologists (possibly a consequence of lead apron use) was investigated by comparing questionnaire responses from cardiologists, orthopedic surgeons, and rheumatologists (n = 714). Cardiologists reported more neck and back pain, more subsequent time lost from work, and a higher incidence of cervical disc herniations, as well as multiple level disc disease (all p <0.01): "interventionalist's disc disease" is a confirmed entity.

Adult↗
PubMed1996

Epidemiology, etiology, diagnostic evaluation, and treatment of low back pain.

Epidemiologic studies found mechanical low back pain to be the fifth most common reason for visiting a physician. Proteoglycan production is altered with the age of the host and may explain the development of degenerative disk disease. Important clinical low back pain entities reviewed in the literature include exercise-associated degenerative disk disease, sciatica in adults less than 21 years of age, fibromyalgia, apophyseal and sacroiliac joint pain, and sacral insufficiency fractures. No consensus exists among physicians concerning appropriate therapy for low back pain. Return to usual activity is the most effective therapy, according to a recent study. The first decompression operation for spinal stenosis has the best opportunity for a good outcome. Chiropractors are the most expensive health care providers for low back pain patients.

Adult↗
PubMed1995

Prevalence and treatment outcome of primary and secondary fibromyalgia in patients with spinal pain.

STUDY DESIGN: This was a prospective cohort study. OBJECTIVES: To determine the prevalence of primary and secondary fibromylagia and response to therapy in patients with spinal pain over a 12-month period. SUMMARY OF BACKGROUND DATA: Fibromyalgia is a syndrome characterized by generalized pain and widespread tenderness on palpation in specific areas of the musculoskeletal system, including the cervical and lumbosacral spine. Primary fibromyalgia is idiopathic, whereas secondary fibromyalgia occurs in association with underlying disorders such as ankylosing spondylitis, trauma, or surgery. The frequency of fibromyalgia in patients with spinal pain has not been determined. METHODS: One-hundred-twenty-five consecutive patients referred to a rheumatologist in a spine center for evaluation of back pain over a 4-month period were evaluated for fibromyalgia. Diagnosis at the time of referral and referring physician were recorded. Fifteen patients, six with primary fibromyalgia and nine with secondary fibromyalgia, were identified and followed for 12 months. Standardized therapy was offered to all patients with fibromyalgia. Patients with secondary fibromyalgia also received therapy for their underlying condition. RESULTS: At 12 months, the six patients with primary fibromyalgia had an improvement in symptoms. The treatment outcome for the nine patients with secondary fibromyalgia was less successful. CONCLUSIONS: Fibromyalgia is a disorder that occurs in a small proportion of patients with back pain. Fibromyalgia is not frequently recognized by referring physicians. In the authors' limited experience, patients with primary fibromyalgia appear to improve with conservative care. They have been less successful with those diagnosed as having secondary fibromyalgia.

Adult↗
PubMed1995

Epidemiology, etiology, diagnostic evaluation, and treatment of low back pain.

Epidemiologic studies document the overuse of surgical procedures in the United States compared with rates in 11 developed countries. Delay in return to work remains an expensive component in the cost of low back pain for workers' compensation claims. Injury to spinal nerve roots may occur secondary to compression with intraradicular edema or from inflammatory phenomena related to phlogistic properties of the nucleus pulposus, independent of nerve compression. Magnetic resonance imaging findings of intervertebral disk bulging and protrusion occur frequently in asymptomatic individuals. Reviews of adult scoliosis, postpartum back pain, diabetic radiculopathy, insufficiency fractures of the sacrum, diskitis, and facet syndrome have appeared in the literature over the past year. Patient education and minimal limitation of activity are associated with the greatest level of patient satisfaction. Long-term follow-up studies of surgical decompression for intervertebral disk herniation and spinal stenosis have resulted in good outcomes in appropriately selected patients.

Back Pain↗
PubMed1994

Epidemiology, etiology, diagnostic evaluation, and therapy of low back pain.

New data concerning the epidemiology, etiology, diagnostic evaluation, and treatment of low back pain have been reported over the past year. Patients who have a longer period of pain during the initial episode of pain are at greatest risk of recurrence of pain. Abnormalities of fibrinolytic activity may have predictive value in identifying patients who are at risk for a poor outcome from surgery. Scheuermann's kyphosis is a slowly progressive illness that rarely requires surgical stabilization of the spine. Contrast-enhanced magnetic resonance imaging may be able to identify symptomatic spinal nerve roots. Radiculopathy associated with disk herniations resolves frequently without surgical intervention. Large disk herniations may resolve spontaneously and do not require surgery. Spinal manipulation may be helpful on a short-term basis to decrease back pain but may be associated with occasional serious complications including cauda equina compression.

Humans↗
PubMed1993

Medical therapy of low back pain.

Low back pain is a common clinical symptom usually associated with mechanical disorders, primarily muscle strain, affecting the lumbosacral spine. The majority of patients with low back pain improve within a 2-month period with conservative medical management. Conservative management includes limited physical activity, injections, nonsteroidal anti-inflammatory drugs, and muscle relaxants. These therapies work best in combination and are very effective in decreasing low back pain.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed1992

Epidemiology, etiology, diagnostic evaluation, and treatment of low back pain.

New data concerning the epidemiology, etiology, diagnostic evaluation, and treatment of low back pain have been reported over the past year. Low back pain remains an expensive health problem for our country costing an estimated 24 billion dollars in direct medical expenses. The degeneration of intervertebral disks may be associated with the appearance of increased amounts of specific collagen types that are not present in normal disk specimens. In an important study of monozygotic twins, smoking was identified as an independent variable associated with advanced degeneration of intervertebral disks. Sacral insufficiency fractures are a significant cause of back pain particularly in elderly individuals with predisposing disorders and medications. Radiographic techniques continue to improve and offer earlier detection of the anatomic abnormalities associated with clinical disorders including inflammatory myelitis. Epidural corticosteroid injections are helpful for decreasing symptoms of radiculopathy, but the injections may only be placed in the correct location in the epidural space 50% of the time unless corroborated by radiographic techniques. Chiropractors suggest that manipulation therapy is cost effective for treatment of low back pain in comparison with therapies given by physicians.

Adrenal Cortex Hormones↗
PubMed1991

The American College of Rheumatology criteria for the classification and reporting of osteoarthritis of the hip.

Clinical criteria for the classification of patients with hip pain associated with osteoarthritis (OA) were developed through a multicenter study. Data from 201 patients who had experienced hip pain for most days of the prior month were analyzed. The comparison group of patients had other causes of hip pain, such as rheumatoid arthritis or spondylarthropathy. Variables from the medical history, physical examination, laboratory tests, and radiographs were used to develop different sets of criteria to serve different investigative purposes. Multivariate methods included the traditional "number of criteria present" format and "classification tree" techniques. Clinical criteria: A classification tree was developed, without radiographs, for clinical and laboratory criteria or for clinical criteria alone. A patient was classified as having hip OA if pain was present in combination with either 1) hip internal rotation greater than or equal to 15 degrees, pain present on internal rotation of the hip, morning stiffness of the hip for less than or equal to 60 minutes, and age greater than 50 years, or 2) hip internal rotation less than 15 degrees and an erythrocyte sedimentation rate (ESR) less than or equal to 45 mm/hour; if no ESR was obtained, hip flexion less than or equal to 115 degrees was substituted (sensitivity 86%; specificity 75%). Clinical plus radiographic criteria: The traditional format combined pain with at least 2 of the following 3 criteria: osteophytes (femoral or acetabular), joint space narrowing (superior, axial, and/or medial), and ESR less than 20 mm/hour (sensitivity 89%; specificity 91%). The radiographic presence of osteophytes best separated OA patients and controls by the classification tree method (sensitivity 89%; specificity 91%). The "number of criteria present" format yielded criteria and levels of sensitivity and specificity similar to those of the classification tree for the combined clinical and radiographic criteria set. For the clinical criteria set, the classification tree provided much greater specificity. The value of the radiographic presence of an osteophyte in separating patients with OA of the hip from those with hip pain of other causes is emphasized.

Hip Joint↗
PubMed1991

The current approach to the medical diagnosis of low back pain.

A small number of patients who present with low back pain will have an underlying medical disorder as the source of their pain. Patients who fail to respond to conservative management with controlled physical activity and nonnarcotic analgesics should have a thorough re-evaluation to detect possible sources of nonmechanical pain. Symptoms of fever, weight loss, recumbency pain, morning stiffness, acute severe pain, or colicky back pain represent specific entry points into the algorithm for diagnosis of back pain from underlying systemic illnesses. These patients will generally require a plain roentgenographic examination with subsequent scintography, MRI, CT, laboratory work, and biopsy as indicated by any positive findings during the diagnostic work-up. Therapy for individuals with nonmechanical low back pain is directed at the specific medical disorder that is the cause of their symptoms.

Algorithms↗
PubMed1991

Low back pain: epidemiology, etiology, diagnostic evaluation, and therapy.

During the past year, investigations involving the etiology, diagnostic evaluation, and therapy of low back pain have reported interesting new data. The natural history of degenerative intervertebral disk disease may be explained by peripheral annular fiber injury that results in damage to the nucleus pulposus. Diurnal changes in patient clinical symptoms and signs may have a correlate in alteration of spinal mechanics that occurs during the course of a day. The diagnostic evaluation of low back pain continues to be revolutionized by magnetic resonance imaging. Although magnetic resonance imaging is able to detect specific lesions with greater sensitivity than other radiographic techniques, correlation between clinical symptoms and signs and anatomic abnormalities is essential for correct diagnosis. Therapeutic controversies continue concerning the efficacy of chiropractic intervention and transcutaneous electric nerve stimulation for low back pain patients. Microsurgical techniques for disk removal may prove to be associated with less morbidity than diskectomy with laminectomy, but require additional study.

Back Pain↗
PubMed1990

The American College of Rheumatology criteria for the classification and reporting of osteoarthritis of the hand.

Clinical criteria for the classification of symptomatic idiopathic (primary) osteoarthritis (OA) of the hands were developed from data collected in a multicenter study. Patients with OA were compared with a group of patients who had hand symptoms from other causes, such as rheumatoid arthritis and the spondylarthropathies. Variables from the medical history, physical examination, laboratory tests, and radiographs were analyzed. All patients had pain, aching, or stiffness in the hands. Patients were classified as having clinical OA if on examination there was hard tissue enlargement involving at least 2 of 10 selected joints, swelling of fewer than 3 metacarpophalangeal joints, and hard tissue enlargement of at least 2 distal interphalangeal (DIP) joints. If the patient had fewer than 2 enlarged DIP joints, then deformity of at least 1 of the 10 selected joints was necessary in order to classify the symptoms as being due to OA. The 10 selected joints were the second and third DIP, the second and third proximal interphalangeal, and the trapeziometacarpal (base of the thumb) joints of both hands. Criteria derived using the "classification tree" method were 92% sensitive and 98% specific. The "traditional format" classification method required that at least 3 of these 4 criteria be present to classify a patient as having OA of the hand. The latter sensitivity was 94% and the specificity was 87%. Radiography was of less value than clinical examination in the classification of symptomatic OA of the hands.

Adult↗
PubMed1990

Low back pain.

Explore the source record for details and available documents.

Back Pain↗
PubMed1988

Localized isolated angiitis of the central nervous system associated with primary intracerebral lymphoma.

Isolated angiitis of the central nervous system (IACNS) is a form of granulomatous vasculitis that is confined to the nervous system. A patient with localized IACNS affecting the left internal carotid and posterior cerebral artery adjacent to a primary intracerebral lymphoma of the midbrain along with associated granulomatous inflammation of the dura, leptomeninges, and ependyma of the aqueduct of Sylvius is described. His course was complicated by many neurologic complications before his death. Prednisone and cyclophosphamide were unable to control his disease. More aggressive therapy may be indicated for patients with lymphoproliferative lesions and associated central nervous system (CNS) vasculitis who fail to respond to conventional therapy.

Brain Neoplasms↗
PubMed1986

Development of criteria for the classification and reporting of osteoarthritis. Classification of osteoarthritis of the knee. Diagnostic and Therapeutic Criteria Committee of the American Rheumatism Association.

For the purposes of classification, it should be specified whether osteoarthritis (OA) of the knee is of unknown origin (idiopathic, primary) or is related to a known medical condition or event (secondary). Clinical criteria for the classification of idiopathic OA of the knee were developed through a multicenter study group. Comparison diagnoses included rheumatoid arthritis and other painful conditions of the knee, exclusive of referred or para-articular pain. Variables from the medical history, physical examination, laboratory tests, and radiographs were used to develop sets of criteria that serve different investigative purposes. In contrast to prior criteria, these proposed criteria utilize classification trees, or algorithms.

Adult↗