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pain Two controlled studies have provided evidence of the inef cacy of another popular treatment for this type of low back pain, namely, corticosteroid injections into the facet joints (Carette et al; Lilius et al) Notwithstanding these studies, we have found the injection of analgesics and steroids in and around the facet to be a useful temporizing measure in some patients In any case, this group of patients does not require operation Some patients have discovered that they may obtain temporary relief from facet pain by forcefully twisting or stretching the back and creating an audible pop at the affected joint, comparable to chiropractic manipulation Over time, they acquire a laxity of the supporting structures of the joint, which may actually perpetuate the problem Lumbar Adhesive Arachnoiditis This also is a somewhat vague entity in which the arachnoid membrane is thickened and opaque in the vicinity of the cauda equina The term is also applied to thickening of the arachnoidal sheaths around roots (normal roots have essentially no epineurium) According to a British review, lumbar arachnoiditis is rare, having been seen in only 80 of 7600 myelograms Judging by American writings, it is much more frequent (see Symposium, in the References) The usual clinical features are intractable low-back and leg pain and paresthesias, all positionally sensitive, in combination with neurologic abnormalities referable to lumbar spinal roots In our patients, multiple myelograms, disc rupture, operative procedures, infections, and subarachnoid bleeding have been causally involved Some cases have followed spinal anesthesia and even epidural anesthesia by a period of months or years The presumption is that the dura had been breached and often there were clinical signs of an aseptic meningitis soon after the procedure The MRI shows eccentrically thickened meninges in the spinal canal with arachnoid adhesions and collections of CSF that displace nerve roots (Fig 11-6) Abnormalities are even more striking on CT myelographic studies in which the contrast is broken up and fails to outline the roots Treatment is unsatisfactory Lysis of adhesions and administration of intrathecal steroids have been of little value, although some experienced surgeons claim otherwise Epidural injection of steroids is occasionally helpful, according to some orthopedists Ankylosing Spondylitis This disorder, referred to in the past as rheumatoid spondylitis and as von Bechterew or Marie-Strumpell arthritis, affects young adult males predominantly Its prevalence in the general population has been variously estimated at 1 to 3 per 1000 Approximately 95 percent of patients with ankylosing spondylitis are marked by the histocompatibility antigen HLA-B27 (which is present in only 7 percent of nonaffected persons) Pain, usually centered in the low back, is the main complaint, at least in the initial stages of the disease Often it radiates to the back of the thighs and groin At rst the symptoms are vague (tired back, catches up and down the back, sore back), and the diagnosis may be overlooked for many years Although the pain is recurrent, limitation of movement is constant and progressive; over time, it dominates the clinical picture Early in the course of disease there is only morning stiffness or an increase in stiffness after periods of inactivity; these ndings may be present long before radiologic changes become manifest Rarely, a cauda equina compression syndrome may complicate ankylosing spondylitis, the result apparently of an in ammatory reaction and later a proliferation of connective tissue in the caudal canal (Matthews) Limitation of chest expansion, tenderness over the sternum, decreased motion and ten-. mvc pdf viewer free Display PDF file and upload to Database using C# in ASP . Net ...
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Hi everyone! I'd like to allow users to upload a . pdf file via the file upload control ( if that's the best method), save the file to the db and then ... dency to progressive exion of the hips, and the characteristic immobility and exion deformity of the spine ( poker spine ) may be present early in the course of the disease The radiologic hallmarks are, at rst, destruction and subsequently obliteration of the sacroiliac joints, followed by bony bridging of the vertebral bodies to produce the characteristic bamboo spine When this occurs, the pain usually subsides, but the patient has by then little motion of the back and neck An unusual additional feature, almost unique to this condition, is an extreme dilatation of the lumbar thecal sac Ankylosing spondylitis may also be accompanied by the Reiter syndrome, psoriasis, and in ammatory diseases of the intestine (see also Chap 44) The great risk in this disease is fracture dislocation of the spine from relatively minor trauma, particularly exion-extension injuries Occasionally ankylosing spondylitis is complicated by destructive vertebral lesions This complication should be suspected whenever the pain returns after a period of quiescence or becomes localized The cause of these lesions is not known, but they may represent a response to nonunion of fractures, taking the form of an excessive production of brous in ammatory tissue When it is severe, ankylosing spondylitis may involve both hips, greatly accentuating the back deformity and disability When it affects the spine, rheumatoid arthritis may be con ned to the cervical region; it is considered further on in this chapter open pdf file in iframe in asp.net c# Asp.net Open PDF File in Web Browser using C#, VB.NET - ASP ...
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