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Biomedical subjects

S Shabat

Publications and source records attributed to S Shabat.

At least 19 recordsLinked to original sources
PubMed2006

Failure of conservative treatment for lumbar spinal stenosis in elderly patients.

Spinal stenosis syndrome affects mainly patients at their 5th-6th decades of life. There is a strong debate in the literature whether patients with spinal stenosis should be operated or treated conservatively. Our aim was to evaluate patients with lumbar spinal stenosis who were treated conservatively. All patients over 65 years of age who were handled conservatively in the private clinic of the senior author due to spinal stenosis syndrome were evaluated. There were 21 males and 15 females aged between 65 and 88 years. Intermittent claudication was the dominant clinical presentation. The radiological examination showed a frequent narrowing at the level L4-L5. All patients had a severe stenosis of less than 10mm diameter of the spinal canal. All patients underwent a conservative therapy which included physical therapy with ultrasound waves, short waves, and flexion exercises. All patients were offered to undergo an epidural or nerve root injection. Twenty-four patients agreed also to have one of these procedures to relieve their symptoms. All patients were followed between 6 and 10 months after the initial diagnosis. We used the Oswestry index category for evaluation. In all parameters the conservative treatment failed to improve the symptoms in the vast majority of patients. None of the patients was very satisfied with the results of conservative treatment while 33 patients (92%) were not so satisfied or unsatisfied with the results. We conclude that conservative treatment for lumbar spinal stenosis is not a success for elderly patients. These patients should be convinced to undergo operative treatment.

Aged↗
PubMed2006

Pulsed radiofrequency in the treatment of patients with chronic neuropathic spinal pain.

In recent years there has been debate among spinal surgeons, neurosurgeons and pain physicians regarding the efficacy of radiofrequency (RF) ablation when treating patients with a neuropathic pain source. It is usually considered as a treatment option after conservative treatment has failed. Twenty-eight patients with a minimal follow-up of 1 year were examined in our institution after they had undergone pulsed radiofrequency (PRF) procedures due to neuropathic spinal pain. Nineteen patients (68 %) reported long-term pain relief (more than 1 year) which was defined as a reduction of the visual analogue score by at least 30 %. No complications were found in this study except for mild discomfort in the treated area which spontaneously resolved up to 3 weeks after the procedure. We concluded that PRF is a safe and an effective procedure for patients who suffer from chronic neuropathic pain from spinal origin. It should be tried after conservative treatment has failed.

Adult↗
PubMed2005

The effect of insoles on the incidence and severity of low back pain among workers whose job involves long-distance walking.

The prevalence and incidence of low back pain in general society is high. Workers whose job involves walking long distances have an even higher tendency to suffer from low back pain. A positive effect of insoles in reducing low back pain was found in professional sports players. This was not examined on people whose job involves walking long distances. In this double blind prospective study we examined the effectiveness of insoles constructed in a computerized method to placebo insoles in 58 employees whose work entailed extensive walking and who suffered from low back pain. The evaluation was performed by the MILLION questionnaire, which is considered as a valid questionnaire for evaluation of low back pain. We calculated the differences of the pain intensity before and after the intervention, in the employees using the insoles manufactured by computer in comparison to the users of the placebo insoles. In each group, the analysis was performed in comparison to the baseline. A total of 81% of the employees preferred the real insoles as effective and comfortable in comparison to 19% of the users of the placebo insoles (P<0.05). The results of this study indicate a substantial improvement in the low back pain after the use of the true insoles. The average pain intensity according to the MILLION questionnaire before the use of the insoles was 5.46. However, after the use of the real insoles and the placebo insoles, the average pain intensity decreased to 3.96 and 5.11, respectively. The difference of the average pain intensity at the start of the study and after the use of the real insoles was significant: -1.49 (P=0.0001), whereas this difference after the use of the placebo insoles was not significant: -0.31 (P=0.1189). The reported severity of pain also decreased significantly: a level 5 pain and above was reported by 77% of the subjects at the start of the study. After the use of the real insoles only 37.9% of the subjects reported a similar degree of pain severity, and 50% of the subjects did so after the use of the placebo insoles (P< 0.05). We did not find a link between low back pain and other variables such as gender, age, number of offspring, work seniority, smoking, previous use of insoles and previous medication. This study demonstrates that the low back pain decreased significantly after the use of real insoles compared to placebo ones.

Adult↗
PubMed2005

Percutaneous posterior lumbar interbody fusion using the B-twin expandable spinal spacer.

Sixty-two suitable subjects (mean age: 49.3 years) underwent percutaneous posterior lumbar interbody fusion (PPLIF) using the B-Twin expandable spinal spacer (B-Twin ESS) and were followed thereafter for 2 years or longer. The clinical outcome was expressed by the change in pain intensity as scored on a visual analogue scale and the change in degree of disability as scored by the Oswestry Disability Index. The results were compared with those of a previous trial of PLIF using the B-Twin ESS in which the latter was introduced via the open surgical approach (OPLIF). Mean duration of operation was 103 minutes. Blood loss was negligible. No operative difficulties or complications were encountered. No participant was lost to follow-up. Disc space height had increased by a mean of 10 %. At that time there were no radiographic signs of non-union in any patient. The mean pain intensity and disability scores decreased by 66 % and 61 %, respectively, as compared to those on admission. The clinical outcome of the percutaneous method was comparable to that of the open procedure using the B-Twin ESS; however, the results can be interpreted as favoring the former in the context of minimal invasiveness. Should this outcome be validated in further trials, the technique may be adopted in selective cases.

Back Pain↗
PubMed2004

Rehabilitation after knee immobilization in octogenarians with patellar fractures.

Between January 1990 and December 1999, 14 octogenarians (8 women and 6 men) underwent surgery for comminuted patellar fracture. Average patient age was 83 years (range: 80-88 years). Follow-up ranged from 1-8 years (mean: 3.5 years). Ten of 14 patients were totally independent, whereas 4 patients used a cane for mobilization. Twelve patients had background diseases. Patients underwent operative treatment with tension band wires followed by cast immobilization (knee in approximately 10 degrees of flexion) for 6 weeks. Immediate full weight bearing was initiated in all patients, and intense rehabilitation was performed after cast removal to increase range of motion. Complete union was noted for all fractures. All patients but 1 had an active extension lag of 10 degrees-20 degrees before physiotherapy and maximum flexion was 70 degrees. After physiotherapy, 4 patients regained full active extension and all patients achieved >100 degrees of flexion. Twelve of 14 patients returned to their pre-injury functional level. A slight deterioration was noted in 2 patients. Although knee immobilization may cause severe limitation in range of motion, its use in elderly patients followed by intense rehabilitation is advocated and showed good results.

Aged↗
PubMed2004

Operative treatment for hip fractures in patients 100 years of age and older: is it justified?

OBJECTIVES: To evaluate a unique group of elderly patients over 100 years of age who had hip fractures. DESIGN: Retrospective database analysis. SETTINGS: Academic teaching hospital. PATIENTS: All patients who had hip fractures between January 1990 and December 2001 and were over 100 years old were included. INTERVENTION: In this study, we evaluated the age, gender, type of fracture, type of treatment, background disease, rehabilitation, and time until death of all patients over 100 years, whether treated operatively or nonoperatively. RESULTS: Twenty-three patients (17 females and 6 males) were identified with ages ranging from 100 to 107 (mean: 101.8). The group had 4 subcapital and 19 pertrochanteric fractures and between 1 and 4 major background diseases. Four patients were treated nonoperatively (1 due to major pneumonia and 3 refused the operative procedure). Three of those 4 patients died in the same month of admission, and 1 patient died during the second month. Among the 19 patients who underwent operation, 17 patients have died, living between 0 and 78 months (mean: 13.8) postoperatively. Two are still alive (21 and 45 months) after the operation. Eight patients died prior to 6 months, and 11 lived more than a year after the operation. A comparison between these 2 groups showed greater major background disease in the patients who died prior to 6 months (P < 0.05). CONCLUSIONS: Most hip fractures in patients over 100 years of age are pertrochanteric. Patients with 2 or more major background diseases have an increased risk for dying in the first 6 months after the operation. Most patients having operations in this age group had a postoperative reduction in mobility status and in performing basic activities of daily living.

Age Factors↗
PubMed2004

Does obesity affect the results of lumbar decompressive spinal surgery in the elderly?

The prevalence of obesity among the population is increasing, including in many elderly people. The purpose of this study was to evaluate whether lumbar spinal surgery in elderly patients with different body mass indices influences pain, satisfaction rate, and activities of daily living. Two hundred ninety-eight elderly patients (older than 65 years), 153 women and 145 men, who had decompressive laminectomy, discectomy, or combinations of these procedures during 1990 to 2000 were followed up. Indications for surgery included limitation in doing activities of daily living, severe pain, or both. The patients were classified into one of four categories in terms of their body mass index. The operative parameters, pain reduction, satisfaction rate, and activities of daily living using the Barthel index were assessed. The more obese patients were younger, tended to be female, and were more symptomatic. All four groups of patients had reduction in pain, improvement in activities of daily living, and were satisfied with the operation. Our data suggest that it is reasonable to operate on patients who are elderly and obese and who have lumbar symptoms, with the appropriate indications.

Activities of Daily Living↗
PubMed2004

Histopathologic changes in dental and oral soft tissues in 2-butoxyethanol-induced hemolysis and thrombosis in rats*.

BACKGROUND: 2-Butoxyethanol (2-BE; ethylene glycol monobutyl ether) is extensively used as a solvent in surface coatings, such as lacquers, enamels, and varnishes in industrial and household cleaning products. Its major toxicity is manifested in the circulation, as it induces hemolytic anemia and thrombosis in various organs. While 2-BE has been implicated in the induction of anemia in different species, the rat has proven most sensitive, especially the female of this species. The purpose of this study was to document the effects of 2-BE on dentition, the periodontal ligament, the tongue, the salivary glands, and the oral mucosa in male and female Fischer 344 rats. METHODS: The experiment included 40 rats divided into five groups. Four groups were exposed to 2, 3, or 4 daily doses of 2-BE, and a fifth group served as control. The rats were killed on days 2, 3, 4, and 29. The teeth and soft oral tissues were prepared for histopathologic observation. RESULTS: The histopathologic analysis showed that the major effect of 2-BE was exerted on the odontoblasts of the incisors and on molars, with greater effect on the incisors. Foci of damaged muscle cells in the tongue were also observed. The blood vessels were dilated and congested, and a primary thrombosis was seen in the dental pulp. CONCLUSIONS: The results of this study revealed a resemblance between the dental injuries in this rat model and those seen in sickle cell anemia in humans. This 2-BE animal model holds potential to assist in the discovery of preventive measures and/or treatment for dental injuries that occur in human diseases with hemolytic anemia.

Anemia, Hemolytic↗
PubMed2004

[Relief of chronic cervical pain after selective blockade of zygapophyseal joint].

Osteoarthrosis of the zygapophyseal joint (Z-joint) is a potential cause of chronic cervical pain. The diagnosis of thirty patients, with pain of more than 12 months duration and with no history of trauma, was confirmed with intra-articular fluoroscopy-guided infiltration of anesthetic. The patients were subsequently treated with intra-articular corticosteroids (Depo-Medrol 40 mg). Visual Analogue Scale was used for evaluation purposes. The mean time for relapse of 50 percent of the pre-injection level of pain was 12.47 +/- 1.89 weeks, significantly longer than 3 days as reported in patients similarly treated following whiplash neck injury. At this point selective blockade of Z-joints may be offered as an adjunct for diagnostic and therapeutic purposes for patients with chronic neck pain due to facet osteoarthrosis in the ambulatory setup.

Anti-Inflammatory Agents↗
PubMed2003

The role of radiofrequency in the treatment of mechanical pain of spinal origin.

Radiofrequency (RF) ablation is a method that has been gaining popularity over the past few years among spinal surgeons. It has a role when dealing with pain of spinal origin, either mechanical or neuropathic, after conservative treatment has failed. In the present study, 122 patients with a minimal follow up of 1 year were examined at our institution after having undergone RF heat lesion of the medial branch for mechanical spinal pain (low back pain, thoracic pain or cervical pain). They were followed up 1, 3, 6 and 12 months after treatment. Twenty-two of them were additionally followed up at 18 months. After 1 month, 91 patients (75%) were satisfied with the results. After 3 months, 87 patients (71%) had significant pain relief, while in 35 patients (29%) there was no improvement. After 6 months of follow-up, 80 patients (66%) had pain relief and in 42 patients (34%) there was no effect. At 12-months follow-up, 77 patients (63%) showed good results and 45 patients (37%) had no effect. In the case of the 22 patients who were followed for 18 months, all showed significant pain relief. Minor complications occurred in 27 patients (22%), who had transient discomfort and burning pain. We concluded that RF is a safe and partially effective procedure for mechanical back pain.

Adult↗
PubMed2003

Osteonecrosis in a chemically induced rat model of human hemolytic disorders associated with thrombosis--a new model for avascular necrosis of bone.

Bone injury occurs in human hemolytic disorders associated with thrombosis, such as beta-thalassemia and sickle cell disease. Exposure of rats to 2-butoxyethanol (BE) has been associated with hemolytic anemia, disseminated thrombosis, and infarction in multiple organs including bone. This rat model apparently mimics acute hemolysis and thrombosis in humans. To elucidate the extent of bone injury, male and female Fischer F344 rats were given 4 daily doses of 250 mg BE/5 ml water/kg of body weight. Tail vertebrae were studied by histopathology and magnetic resonance imaging (MRI). Thrombosis and infarction were seen in both sexes, but females were more severely affected. Lesions were characterized by extensive medullary fat necrosis, granulomatous inflammation, fibroplasia, growth plate degeneration, and new woven bone formation adjacent to necrotic bone trabeculae. MRI mean and standard deviation tissue-density data for both sexes indicated a significant (P < or = 0.05) decrease following 4-days treatment and a significant increase (P < or = 0.05) following an additional 24 days without treatment. Thus, MRI was useful in revealing BE-induced bone injury, which was predominantly necrotic initially and subsequently regenerative with proliferation of connective tissue and bone following postischemia recovery.

Animals↗
PubMed2003

Simultaneous distal radius and hip fractures in elderly patients--implications to rehabilitation.

PURPOSE: The reasons for fractures in the elderly patients are multifactorial. Osteoporosis is considered to be the main pathology. Other reasons are the increase in fall frequency and the protective response to trauma. The most common sites at which these fractures occur are the hip, vertebra and distal radius. A combination of these is uncommon. METHODS: All patients who were treated between January 1990 and December 2000 with a combination of distal radius and hip fractures and were older than 65-years were retrospectively evaluated. The following parameters were evaluated: age; sex; pre fall function; use of drugs; chronic and acute comorbidity; circumstance of the fall; hospitalization length of stay; treatment procedure; complications; and post-hospitalization rehabilitation. RESULTS: Forty-six patients met the study's criteria. Group I consisted of 16 patients between 65-80 years, and group II consisted of the remaining 30 patients older than 80 years. All patients suffered low energy trauma. Ten out of the 16 patients in group I, and eight out of the 30 patients in group II were totally independent, while the remaining patients needed some help with activity of daily living (ADL). In all patients the simultaneous fractures were ipsilaterally. For 45 patients hospital stay ranged from 5-23 days. Twenty-eight patients were transferred to a geriatric rehabilitation centre. Twenty-six of them returned to their previous ADL after a period of 60 days on average. Among the 18 remaining patients, 11 gained full recovery (6 from group I and 5 from group II) and seven patients (5 from group II) had a slight reduction in ADL. CONCLUSIONS: A combination of these fractures is probably more traumatic and occurs in the higher-age group. It is always located in the ipsilateral side. The double trauma represents a better pre-morbid condition relative to patients in the same age group, and thus it may serve as a prognostic indicator for success in rehabilitation.

Activities of Daily Living↗
PubMed2003

Dynamic force distribution during level walking under the feet of patients with chronic ankle instability.

OBJECTIVES: To examine changes in the pattern of force transfer between the foot and the floor associated with chronically sprained ankles by measuring the peak forces and their timing under several regions of the feet during level walking. METHODS: Twelve young male subjects (mean (SD) age 21 (2) years) with recurrent ankle sprains were studied. Seven of them had unilateral and bilateral chronic instability and laxity, and five had bilateral instability. Twelve healthy men (without orthopaedic or medical disease) served as a control group. Subjects walked at their own pace along a 7 m walkway, which included a Mini-EMED pressure distribution measuring system. The variables measured were relative peak force (fraction of body weight) and relative timing (fraction of stance time). These variables were measured under six regions of interest in each foot print: heel, midfoot, medial, central, and lateral forefoot, and toes. RESULTS: (a) A significant delay to the time of peak force under the central and lateral forefoot and toes in subjects with chronic ankle instability. (b) A significant decrease in the relative forces under the heel and toes and an increase in the relative forces under the midfoot and lateral forefoot in subjects with chronic ankle instability. (c) In the patients with unilateral instability, there were no significant differences in any of the variables between the injured and non-injured foot. CONCLUSIONS: In patients with chronic ankle instability, there is a slowing down of weight transfer from heel strike to toe off, a reduced impact at the beginning and end of the stance phase, and a lateral shift of body weight.

Adult↗
PubMed2003

Subtalar distraction arthrodesis using a ramp cage.

Subtalar distraction bone block arthrodesis has been described to treat late complications of displaced calcaneal fractures. A "ramp cage" can be used to restore the talocalcaneal relationship by providing stable correction in the coronal and sagittal dimensions.

Adult↗
PubMed2003

[Scales for evaluation of the geriatric patient with hip fracture during the acute and rehabilitation phases].

The elderly population is increasing in the modern world. Societies in general and medical personnel are facing new ethical and medical dilemmas when treating extremely old patients. Many factors are known to cause fractures in elderly patients. Probably, the most important one is osteoporosis, which was shown to be the main pathology in elderly patients who fractured their hips. The increase in fall frequency, orientation to falls and the protective response to trauma were found to play a role in the pathogenesis as well. The rehabilitation of this group of patients is an important factor that helps to return the elderly patient to his or her own environment and to his or her skills prior to the falls. The decision of the potential for rehabilitation and the evaluation of the progress that the elderly does is very difficult and can vary substantially from one examiner to another. Reviewing the literature that exists on the evaluation of the geriatric patient with hip fracture during the acute and rehabilitation phases is our goal.

Activities of Daily Living↗
PubMed2002

Deep skin slough following skin traction for hip fractures.

INTRODUCTION: Elderly patients who fracture their hips are susceptible to complications associated with bed rest before surgery. In some institutions a skin traction device is used in order to relieve pain before surgery. The authors followed ten patients who developed severe (deep) skin slough and evaluated the relationship to the skin traction device. The need for use of a skin traction device is debated and the need for multidisciplinary treatment if this complication develops is emphasised. PATIENTS AND METHODS: All patients who had serious skin slough between January and December 2000 were evaluated. A serious skin slough was defined as any new and abrupt case of a full-thickness skin loss involving damage or necrosis of subcutaneous tissue, but not through the underlying fascia and not extending to underlying bone, tendon or joint capsule. Preoperative assessment including background illness and medications, the application of a skin traction device, the type of surgery that was performed, and complications were noted. RESULTS: Ten patients (nine females and one male) aged 76-90 years met the criteria of serious skin slough. The leading chronic illness was cardiovascular. Among these patients there were intertrochanteric fractures (n = 5), subcapital fractures (n = 4) and a subtrochanteric fracture (n = 1). In all patients a skin traction device was used. In seven out of the ten patients the skin slough occurred during or immediately after surgery. Other postoperative complications included uncontrolled glucose levels (> 130 mg/dl during fasting) (two cases) and urinary tract infections (two cases). The skin slough was treated with a daily wound care regimen by a trained nurse and included daily changing of wet dressings and application of Vaseline gauze. All patients were allowed immediate ambulation after the surgery and were discharged 9-15 days after the surgery. Although improvement of the slough was noted in all patients, none of them had fully recovered, and they had to continue treatment in outpatient clinics. DISCUSSION: The main goal of treatment in elderly patients who fractured their hips is to return them to their previous activities of daily living. A skin traction device, although useful for many of the patients, has the disadvantage of causing serious skin slough. This complication can interfere with the normal curve of rehabilitation and cause prolonged hospital stay. Whenever this complication is expected, the application of the skin traction device should be avoided. Moreover, careful handling of the patients by physicians, physiotherapists and nurses is mandatory. If this complication develops, vigorous multidisciplinary care is recommended.

Aged↗