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We the presence of osteoporotic verte- truly believe that the that there is a bral fractures in clinical practice buy hytrin 5mg on line. Guermazi · used methods to determine the sever- in the context of epidemiological F order hytrin 1 mg fast delivery. Genant (✉) ity of such fractures in clinical re- studies and clinical drug trials; how- Osteoporosis and search are the semiquantitative as- ever generic 2mg hytrin visa, the studies would be flawed if Arthritis Research Group, Department of Radiology, sessment of vertebral deformities, quantitative morphometry were to be University of California San Francisco, which is based on visual evaluation, performed in isolation without addi- 350 Parnassus Avenue, and the quantitative approach, which tional adjudication by a trained and San Francisco, CA 94117, USA is based on different morphometric highly experienced radiologist or Tel. Therefore the evaluation of spinal radiographs for prevalent and inci- Osteoporosis is a serious public health problem. The inci- dent vertebral fractures is important in both clinical and dence of osteoporotic fractures increases with age. Fewer population, the financial and human costs associated with than 1% of back pain episodes are related to vertebral osteoporotic fractures will multiply exponentially. Therefore vertebral fractures are often not cording to the International Osteoporosis Foundation, more suspected in patients reporting back pain, unless associ- than 40% of middle-aged women in Europe will suffer ated with trauma. Trauma-related fractures, however, are one or more osteoporotic fracture during their remaining not considered as classical osteoporotic fractures. Some Vertebral fractures are the hallmark of osteoporosis height loss is expected with aging due to compression of and occur with a higher incidence earlier in life than any the intervertebral discs and postural changes. However, other type of osteoporotic fractures, including hip frac- height loss could also be due to multiple fractures, which tures. The importance of fragility fractures, of which represent significant and irreparable damage. Therefore it vertebral fractures are the most common, was acknowl- has been concluded that height loss is an unreliable indi- edged by the World Health Organization classification cri- cator of fracture status until it exceeds 4 cm. The criterion of the vertebral fractures are often not being considered in clini- World Health Organization defines severe osteoporosis cal patient evaluation, and it is relatively uncommon for as low bone mass (T score below –2. Improvements in detecting and report- The definition of osteoporosis is centered on the level ing vertebral fractures in patients with osteoporosis would of bone mass, which is measured as bone mineral density increase the potential of therapeutic intervention to pre- (BMD). In Radiographic assessment of vertebral fractures addition, many other risk factors have been identified, some of which are known to add to the risk independently of Radiographic diagnosis is considered to be the best way to BMD measurements. The combination of BMD with such identify and confirm the presence of osteoporotic verte- risk factors increases the gradient of risk/standard devia- bral fractures in clinical practice. Several clinical tional lateral radiographs of the thoracolumbar spine have trials have demonstrated that a substantial improvement in been visually evaluated by radiologists or clinicians to the assessment of the risk for future fractures can be ac- identify vertebral fractures. However, there is still no in- complished by the assessment of prevalent vertebral frac- ternationally agreed definition for vertebral fracture. One tures in combination with BMD measurements [2, 5, 15, global prospective study (the IMPACT study) compared 27, 31, 36, 39, 41]. Nonetheless, it remains a common the results of local radiographic reports from five conti- clinical practice to consider low BMD to be a risk fac- nents with that of subsequent central readings in more tor irrespective of the presence of vertebral fractures. This study demonstrated that vertebral fractures were frequently underdiagnosed radiologically worldwide, with false-neg- Clinical identification of vertebral fractures ative rates as high as 30% despite a strict radiographic protocol that provided an unambiguous vertebral fracture It has been shown that both symptomatic and asympto- definition and minimized the influence of inadequate film matic vertebral fractures are associated with increased quality. It was concluded that the failure was a global morbidity and mortality [8, 22, 35]. Morbidity associ- problem attributable to either lack of radiographic detec- ated with these fractures includes decreased physical func- tion or use of ambiguous terminology in reports. Large-scale prospec- the diagnosis of osteoporosis and to assess the severity or tive studies demonstrate that only about one of four verte- progression of the disease as well as to rule out nonfrac- bral fractures becomes clinically recognized. They introduced a classification of ver- and there would have to be changes in vertebral shape in tebral deformities as diagnosed from lateral thoracolum- order to account for incident vertebral fractures on follow- bar radiographs for the purpose of diagnosing the severity up radiographs. This method grades only the most se- fractures consist of a combination of wedge and endplate verely deformed vertebra on the radiograph. From a radiological prospective, there are vertebral bodies T3 (or T7) to L4 are evaluated.

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These consist of Gou Qi Zi (Fructus Lycii) purchase hytrin 2 mg with amex, Tu Si Zi (Semen Cuscutae) discount 5 mg hytrin, Fu Pen Zi (Fructus Rubi) buy hytrin 5mg on line, Wu Wei Zi (Fructus Schisandrae), etc. For spleen vacuity, Bu Zhong Yi Qi Tang (Supplement the Center & Boost the Qi Decoction) was added. This consists of Huang Qi (Radix Astragali), Dang Shen (Radix Codonopsitis), Bai Zhu (Rhizoma Atractylodis Macrocephalae), Sheng Ma (Rhizoma Cimicifugae), Chai Hu (Radix Bupleuri), etc. For spleen-kidney dual vacuity, a combination of the above two formulas was added. One packet of these medicinals was decocted in water and administered in three divided doses per day. External treatment consisted of 10 grams of powdered Wu Bei Zi (Galla Rhois) mixed with an appropriate amount of rice vinegar and applied to the umbilicus. This paste was applied one time per night for five consecutive days (one course of treatment), and then the treatment was stopped for two days. Study outcomes: Fifteen cases (60%) were cured, eight cases (32%) improved, and two cases (8%) had no improvement. From The Treatment of 105 Cases of Pediatric Enuresis with Acupuncture by Gao Jie-yin, Hu Bei Zhong Yi Za Zhi (Hubei Journal of Chinese Medicine), 1992, #5, p. The patients were between 5-10 years old in 56 cases, between 10-14 years old in 43 cases, and more than 14 years old in six cases. These cases of enuresis were often accompanied by poor appetite, a lusterless facial complexion, and decreased essence- spirit. Compared to other children their age, these children had a lower body weight. Treatment method: The main points consisted of: Chinese Research on the Treatment of Pediatric Enuresis 121 Guan Yuan (CV 4) Qi Hai (CV 6) San Yin Jiao (Sp 6) Auxiliary points included: Shen Shu (Bl 23) Zhong Ji (CV 3) Zu San Li (St 36) Two to four points were chosen each time and these points were alternated. Hand stimulation was applied to the points, and the needles were retained for 20 minutes. The patient received two treatments each week, and 2-4 treatments equaled one course. Study outcomes: After 1-2 courses of treatment, 76 cases were cured, 29 cases improved, and two cases did not improve. From The Treatment of 53 Cases of Pediatric Enuresis Using Bai Hui (GV 20) & Pattern Discrimination by Dong Wen- yi & Wu Chao, Liao Ning Zhong Yi Za Zhi (Liaoning Journal of Chinese Medicine), 1995, #9, p. Eighteen cases were less than five years old, 27 cases were between 6-10 years old, and eight cases were between 11-14 years old. The Chinese medical pattern discrimina- tion was heart-kidney yang vacuity in 38 cases and spleen-lung qi vacuity in 15 cases. Treatment method: Bai Hui (GV 20) was the main point used in this protocol. If there was heart-kidney yang vacuity, the following points were added bilaterally: Shen Shu (Bl 23), Tai Xi (Ki 3), Shen Men (Ht 7), and 122 Treating Pediatric Bed-wetting with Acupuncture & Chinese Medicine Guan Yuan (CV 4). If there was spleen-lung qi vacuity, then San Yin Jiao (Sp 6), Zu San Li (St 36), Nei Guan (Per 6), and Qi Hai (CV 6) were added. The even supplementing-even draining method of stimulation was used on all these points except for Bai Hui which was supplemented. Needles were retained for 15 minutes and stimulated three times during this period. One treatment was given per day, and 10 treat- ments equaled one course. The least number of courses a patient was treated was one, and the most was four courses of treatment. Study outcomes: The following table shows the comparative outcome between those manifesting different patterns. RESULTS HEART-KIDNEY YANG SPLEEN-LUNG QI TOTAL NUMBER VACUITY PATTERN(%) VACUITY PATTERN(%) OF CASES (%) Cured 27 (52. Due to these functions, Bai Hui is an important addition to acupuncture and tuina protocols when treating enuresis. From The Treatment of 83 Cases of Pediatric Enuresis with Acupuncture by Xu Guang-li & Cui Da-ming, Ji Lin Zhong Yi Yao (Jilin Chinese Medicine & Medicinals), 1994, #4, p.

Discussion: The author of the Ling Shu (Spiritual Axis) order hytrin 2 mg on-line, in the chapter titled hytrin 2 mg with mastercard, Root Art buy discount hytrin 5mg online, says [If there is] vacuity, [then there is] nocturnal enuresis; [If there is] nocturnal enuresis, then supplement. Shen Men and Subcortex regulate the excitability of the cerebral cortex and the process of controlling urination. Endocrine regulates the function of the endocrine system and the cerebral cortex. Urinary Tract and External Genitalia are points for the local area that is affected in this disease. From The Treatment of 198 Cases of Pediatric Enuresis with Ear Points by Gao Mei-ling & Gao Rui-ying, Yun Nan Zhong Yi Za Zhi (Yunnan Journal of Chinese Medicine), 1994, #1, p. Of these, 105 cases had been treated with acupuncture, herbal medicine, or magnet therapy without success. Of these 198 patients, 102 were male and 96 were female, and all were between the ages of 3-30 years. Seventy-six cases were between 3-7 years old, 86 cases were between 8-15 years old, 28 cases were between 16-20 years old, and eight cases were between 21-30 years old. Most cases had enuresis from 1-4 times per night, and 25 cases had enuresis 2-3 times per night. Among the patients involved in the study, 85 cases also had enuresis during the day when they slept. One hundred forty- seven cases (74%) had PNE with enuresis since infancy, former heaven insufficiency, spleen-kidney qi vacuity, and deep sleep and difficulty waking. After being able to control the urine for some time, the patient was now not able to control their urination at night. Treatment method: Ear points used in this protocol included: Kidney Bladder Spleen Lung Subcortex 176 Treating Pediatric Bed-wetting with Acupuncture & Chinese Medicine Brain Point Mid Ear Forehead Lumbosacral Vertebrae If there was accompanying urinary tract infection, the doctors added Endocrine. The points were pressed by the patient 5-6 times per day until they felt numbness, soreness, distention, and/or heat. The ear seeds were changed every 3-5 days, and five times equaled one course of treatment. Study outcomes: Of the 198 cases, 121 cases (61%) were cured, 71 cases (36%) improved, and six cases (3%) did not improve. From The Treatment of 30 Cases of Pediatric Enuresis Using a Combination of Ear Acupuncture & Chinese Medicinals Applied to the Umbilicus by Fan Li-li, He Bei Zhong Xi Jie He Za Zhi (Hebei Journal of Integrated Chinese-Western Medicine), 1999, #1, p. The course of disease was less than one year in 16 cases, was 1-5 years in 10 cases, and was more than five years in four cases. All these patients had been examined to elim- inate the possibility of organic causes and to discover if the intelli- gence and development was normal. Treatment method: The main ear points used in this study were: Enuresis Points Kidney Bladder Chinese Research on the Treatment of Pediatric Enuresis 177 Urinary Tract Brain These points were combined with the following auxiliary points: Triple Burner Lung Spleen Liver Vacuity Point Using pattern discrimination, 4-5 appropriate points were selected for use each time. The ear adhesives were changed one time every other day, and 10 days equaled one course of treatment. The points were pressed 3-5 times each day, and each time they were pressed 10 times. When pressing the points, it was impor- tant for the child to feel soreness or pain. Chinese medicinals applied to the navel consisted of: blast-fried Fu Zi (Radix Lateralis Praeparatus Aconiti Carmichaeli) Bu Gu Zhi (Fructus Psoraleae) Sang Piao Xiao (Ootheca Mantidis) These medicinals were combined together and pounded with a pestle into a fine powder. Then Sheng Jiang (uncooked Rhizoma Zingiberis) was then pounded with a pestle into a mash, com- bined with the previous medicinals, and applied to the navel. This was performed one time every other day, and 10 days equaled one course of treatment, with 1-3 courses administered. From A Clinical Summary of the Treatment of 36 Cases of Pediatric Enuresis with Yi Zhi Ren Zi (Alpinia Seeds) by Wang Xiao, Jiang Su Zhong Yi (Jiangsu Chineses Medicine), 1990, #8, p. The course of disease was less than a year in eight cases, 1-5 years in 16 cases, and more than five years in 12 cases.

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Pavlow With 2 Figures Posterior approach to the degenerative cervical spine buy cheap hytrin 5 mg. Aebi With 6 Figures and 1 Table EDITORIAL Marek Szpalski The aging of the population: Robert Gunzburg Christian Mélot a growing concern for spine care Max Aebi in the twenty-first century The aging of the population in indus- Approximately 59% of US residents trialized countries appears to be a over 65 are affected by osteoarthritis purchase hytrin 5 mg visa, non-reversible phenomenon generic hytrin 2mg mastercard. Increase which is the main cause for disability in life expectancy, due in great part. Costs per shifted from a pattern of high birth capita increase gradually up to the rates and high mortality rates to one 55–64 age group, and then the costs of low birth rates and delayed mor- increase very rapidly and explode af- tality. Aging alone In Europe, the proportion of sub- will generate an increase of more jects over 65 was 10. The pro- the most frequently encountered portion of subjects over 75 has grown complaints of older people and the from 2. The spine is a very specific anat- When only western Europe is con- omic and functional unit. Whereas sidered, the proportion of individuals degenerative knee or hip changes M. These numbers are just a little smaller in all elderly subjects, nearly all will Molière Longchamp, Brussels, Belgium in the USA. This was Intensive Care Unit, The global consequences of this demonstrated by several high-quality Erasme University Hospital, distortion of the age pyramid on studies. Furthermore, the exis- Brussels, Belgium healthcare development, access and tence of degenerative images on M. Müller Institute proximately 80% of all individuals not predict in any way subsequent for Evaluative Research and Documentation in Orthopaedic Surgery, over 65 have at least one chronic complaints after several years. The relation between the aging and 2 degenerative process and the possi- path but, once again, a highly expen- not appear to be such a priority. That will be ex- orders, for which high-quality stud- tures induces interactive alterations actly what elderly subjects will de- ies are rare. The comparison with the at many levels: bone, disc, facet mand and they will expect us to use treatment outcomes in hip and knee joints, ligaments. Some of these de- all the available technological arma- degeneration casts further doubt on generative lesions can be responsible mentum. New instruments measures the appropriateness of treatment of for damage to the neural elements by such as the Disability Adjusted Life degenerative spine conditions. It is we, spine spe- terms of quality of life have also re- without shortcomings. Not verely osteoporotic subjects, mostly tween population health and medical only do we have to fulfill the expec- women. Recent studies have shown care, inevitable differences will be tations of the patients but also those that osteoporotic vertebral fractures seen in the outputs of their estimates of the financing parties. Any different out- way to do this will be to demonstrate, of mortality and a decreased qual- puts may imply different priorities. These discrepancies remain porotic fractures, including vertebral a problem to be solved in the near 1. Boden SD, Davis DO, Dina TS, Patronas NJ, Wiesel SW (1990) Ab- osteoporotic compression fractures. Bone Joint Surg 72-A:403–408 percutaneous treatment modalities Spinal care in the elderly is, in 2. Among those is gene share of the limited resources will trends in aging US and worldwide. MMWR 52:101–106 term delivery of molecules to retard Compared to treatment for cardio- or even revert degenerative process- vascular disorders or diabetes, the es. It appears to be a very promising treatment of spinal conditions does 3 5. National Center for Chronic Disease dependent variation in burden of dis- national Institute for Applied Systems Prevention and Health Promotion, ease estimates: implication for policy. Gold MR, Stevenson D, Fryback DG 27 April 2003 Aging 12:3 (2002) HALYS and QUALYS and 9. Pluijm SM, Tromp AM, Smit JH, Deeg DALYS, oh my: similarities and differ- al (1999) Vertebral fractures and mor- DJ, Lips P (2000) Consequences of ences in summary measures of popula- tality in older women: a prospective vertebral deformities in older men and tion health.

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