Do the National Institutes of Health consensus guidelines for parathyroidectomy predict symptom severity and surgical outcome in patients with primary hyperparathyroidism?

BACKGROUND: The National Institutes of Health (NIH) consensus guidelines for parathyroidectomy in primary hyperparathyroidism were developed addressing only the classic symptoms and physiologic markers of hyperparathyroidism. The purpose of this study was to assess whether NIH guidelines predict the severity of all symptoms and the outcome of operation. METHODS: Symptom severity measurements using a disease-specific outcome tool called the parathyroidectomy assessment of symptoms (PAS) scores were previously obtained in patients with hyperparathyroidism. Patients were retrospectively stratified into 2 groups: group A, in which 1 or more of the NIH guidelines were met; and group B. in which operation was performed without any of the NIH criteria. For comparison, group C consisted of patients with non-toxic thyroid disease. PAS scores were collected preoperatively, and at 7 days, 3 months, and 12 months postoperatively. RESULTS: There were 95 patients in group A, 22 in group B, and 58 in group C. The median preoperative PAS scores for group A (354) and B (301) were not significantly different, however, both were more symptomatic than group C (176, P <.01). After parathyroidectomy, patients in both group A and B had a significant improvement in their PAS scores (A=177 and B=130, P <.05). CONCLUSIONS: Patients with no NIH criteria for operation are equally symptomatic compared with those who meet the NIH guidelines. Parathyroidectomy significantly improved these symptoms whether or not the patient met the NIH consensus guidelines.     

Pasieka Illness Questionnaire: its value in primary hyperparathyroidism

Background: A prospective study was undertaken to assess the Pasieka Illness Questionnaire (PIQ) as a clinical evaluation and outcome tool in an Australian setting. The PIQ was specifically designed to assess the impact of surgery on the preoperative symptoms of patients with primary hyperparathyroidism (1° HPT). Methods: Sixty of 71 consecutive patients referred with 1° HPT completed the PIQ preoperatively and 3 months after parathyroid surgery. Fifty‐four of the 60 patients filled in a 12‐month follow‐up questionnaire that included a quality of life (QOL) and a self‐rated health uni‐scale. Serum calcium, ionized calcium and parathyroid hormone levels were obtained on each occasion Results: Eighty per cent of patients identified a significant decrease in symptoms following surgery. QOL and self‐rated health improved after undergoing parathyroid surgery. Serum calcium levels returned to normal in 97% of patients 12 months after surgery. Conclusions: The present study supports the use of the Pasieka Illness Questionnaire as a useful method to measure disease‐specific symptoms in patients with 1° HPT and is applicable to Australian patients. It also shows, once again, that parathyroid surgery produces a significant improvement in the preoperative symptoms of 1° HPT.     

Effects of transurethral resection of prostate on the quality of life of patients with benign prostatic hyperplasia

BACKGROUND: This article investigated the effects of transurethral resection of prostate on quality of life (QOL) and urinary symptoms in patients with benign prostatic hyperplasia (BPH). STUDY DESIGN: In a prospective study, 30 patients without significant comorbidities undergoing transurethral resection of prostate for BPH were studied. Patients completed four validated questionnaires: the International Prostate Symptom Score and the associated QOL index because urinary symptoms, the Montgomery and Asberg Depression Rating Scale, the McGill Pain Questionnaire, and the QOL questionnaire Short Form-36. These were completed preoperatively, on the first postoperative day, on discharge from hospital, and at 1 and 3 months postoperatively. RESULTS: The QOL of patients who undergo transurethral resection of prostate for BPH had significantly improved at 3 months after their operation. The International Prostate Symptom Score scores at 1 month (9.3+/-4.6) and 3 months (5.4+/-5.6) were less than they were preoperatively (19.9+/-7.1). The QOL index because urinary symptoms was less at 1 month (2.4+/-1.9) and at 3 months postoperatively (1.5+/-1.4) in comparison with the preoperative scores (4.5+/-1.2). The Montgomery and Asberg Depression Rating Scale scores at 1 month (5.4+/-6.8) and 3 months (4.9+/-6.5) were less than they were preoperatively (9.2+/-8.3). The McGill Pain Questionnaire sensory and pain rating index scores were less at 3 months than they were preoperatively (p=0.02 and p<0.02 respectively). The McGill Pain Questionnaire affective score was less at 1 month than it was preoperatively (p<0.03). The McGill Pain Questionnaire evaluative scores were less than the preoperative score at all times postoperatively. The role physical (p=0.007), bodily pain (p=0.006), social function (p=0.007), and physical component summary (p=0.007) subsections of the Short Form-36 were greater at 3 months postoperatively when compared with the preoperative scores. CONCLUSIONS: Transurethral resection of prostate is associated with significant improvement in the overall QOL, in addition to urinary symptoms, of patients with BPH at 3 months postoperatively. The magnitude and timing of this improvement may serve as a useful comparator in determining the optimal treatment of patients with BPH.     

A prospective surgical outcome study assessing the impact of parathyroidectomy on symptoms in patients with secondary and tertiary hyperparathyroidism

BACKGROUND: To assess the impact of surgery on preoperative symptoms in secondary (2 degrees ) and tertiary (3 degrees ) hyperparathyroidism (HPT) compared with primary (1 degrees ) HPT. METHODS: Twenty-two patients with 2 degrees HPT and 10 with 3 degrees HPT were enrolled. Age-matched patients, 32 with 1 degrees HPT and 32 with thyroid disease were enrolled for comparison. An outcome questionnaire documented symptoms expressed as the median symptom index score (MSIS) preoperatively and at days 7 and 3 and 12 months postoperatively. RESULTS: Preoperatively, the MSIS for the groups with 3 degrees, 2 degrees, and 1 degrees HPT and thyroid disease was 225, 572, 372, and 146, indicating that patients with HPT were more symptomatic than those in the thyroid group (P<.05). Patients with 1 degrees HPT had a decrease in their MSIS at day 7 (195, P<.05) and at 3 and 12 months (159 and 156). Patients with 3 degrees HPT also had a decrease in their MSIS over time. Patients with 2 degrees HPT had a decrease in their MSIS at day 7 (469, P<.05); however, they remained more symptomatic at 3 and 12 months (410 and 355). CONCLUSIONS: Parathyroidectomy reduces many of the preoperative symptoms in HPT. Patients with 1 degrees and 3 degrees HPT have a similar resolution of their symptoms. Patients with 2 degrees HPT have an improvement in many of their symptoms, although they remain more symptomatic at 1 year.     

Pasieka’s Parathyroid Symptoms Scores Correlate with SF-36 Scores in Patients Undergoing Surgery for Primary Hyperparathyroidism

Background Parathyroidectomy for primary hyperparathyroidism (PHPT) is expected to trigger an improvement in the quality of life. This has been demonstrated previously by using the SF-36 questionnaire, whose interpretation is difficult in routine clinical practice. As an alternative, the 13-item questionnaire developed by Pasieka et al. can be used to assess the severity of symptoms on a visual analogue from which a parathyroid assessment of symptoms score (PAS) can be calculated. The purpose of this study was to correlate results of these two assessment tools. Methods Prospective case-series study recruiting consecutive unselected patients who underwent successful parathyroidectomy for PHPT. SF-36(v2) and Pasieka’s questionnaires were collected before parathyroidectomy and at 3, 6, and 12 months postoperatively. Results Between November 2005 and December 2006, 101 patients were diagnosed with PHPT (30 men; aged 18–89 years). Preoperative PAS ranged 0–1040 and did not correlate with the severity of hypercalcemia (2.91 ± 0.25; range, 2.56–3.4 mmol/l). Scores from the SF-36 questionnaire were under the 50th percentile for the normal population in three domains (vitality, emotional role, and physical role). Minimally invasive parathyroidectomy was performed in 69 patients and bilateral cervical exploration in 32 patients. All were found to have a single parathyroid adenoma and were normocalcemic at 3–12 months after parathyroidectomy. At follow-up, there was a significant reduction of PAS from 460 ± 257 preoperatively to 254 ± 234 at 3 months postoperatively (n = 72), to 245 ± 215 at 6 months (n = 50), and 249 ± 212 at 12 months (n = 63) (p < 0.05, Student’s t-test). There was a significant and persistent improvement in five domains of SF-36 questionnaire: bodily pain, general health, vitality, social functioning and mental health. Overall analysis of 244 assessments using both questionnaires demonstrated a negative correlation between increasing PAS and decreasing mental component scores and physical component scores of the SF-36 assessment (r² = 0.372 and 0.301, respectively). Conclusions Pasieka’s parathyroid assessment of symptom scores (PAS) correlate with SF-36 questionnaire scores. Because PAS allows easier and faster analysis, we advocate that Pasieka’s questionnaire should be integrated into the assessment of patients with PHPT as a reliable tool to identify symptomatic changes that correlate with improved quality of life.     

Laparoscopic Nissen fundoplication improves quality of life in patients with atypical symptoms of gastroesophageal reflux

Laparoscopic Nissen fundoplication has been shown to improve overall quality of life (QOL) in patients with gastroesophageal reflux, but most studies have not addressed patients with atypical symptoms. We investigated the effect of laparoscopic Nissen fundoplication on QOL using the Gastrointestinal Quality of Life Index (GIQLI) survey modified to address both typical (heartburn, regurgitation, dysphagia) and atypical (hoarse voice, chronic cough, adult-onset asthma, vocal cord polyps) symptoms. One-hundred forty-eight patients underwent laparoscopic Nissen fundoplication for gastroesophageal reflux disease (GERD) at UCLA Medical Center from January 1, 1995 to May 1, 2002. Surveys evaluating pre- and postoperative QOL were administered after surgery: 55 per cent of patients responded (82/148). Forty-eight per cent of all patients (72/148) had atypical symptoms. Perioperative morbidity and mortality were 8.8 per cent and 0.7 per cent, respectively. Mean length of postoperative stay was 2.96 +/- 1.5 days. Mean follow-up for the entire cohort was 18.5 months. Postoperative dysphagia not present before surgery occurred in 4.7 per cent of patients. Eighty per cent of patients were medication-free following surgery. QOL scores for all participants increased significantly from 52.5 +/- 15.3 preoperatively to 72.0 +/- 14.9 postoperatively (P < 0.0001). Patients with atypical symptoms or typical symptoms alone showed significant mean QOL score increases from 48.3 +/- 17.6 preoperatively to 71 +/- 15.7 postoperatively (P < 0.0001) and from 55.7 +/- 12.6 to 72.8 +/- 14.4 (P < 0.0001), respectively. Laparoscopic Nissen fundoplication can effectively improve overall QOL for patients with GERD. Patients with atypical GERD symptoms can experience increases in QOL similar to those with only typical gastrointestinal symptoms.     

Prospective Surgical Outcome Study of Relief of Symptoms following Surgery in Patients with Primary Hyperparathyroidism

t -tests, ANOVA), and nonparametric comparisons (Mann-Whitney U-test) were calculated. The HPT group demonstrated a significant decrease in reported symptoms between the preoperatively assessment and 7 to 10 days after operation ( p < 0.001). There were no further statistically significant decreases in the HPT group’s symptoms at 3 and 12 months, but there was a trend for these symptoms to decrease over time. HPT patients perceived a 60% increase in their general health at 1 year; the comparison group perceived no increase. There was no significant change in the symptoms reported by the comparison group between each of the study intervals. Surgical intervention on HPT patients significantly reduces preoperative symptoms, and this reduction is most marked within the first 10 days after surgery.     

Aluminum Overload Hampers Symptom Improvement Following Parathyroidectomy for Secondary Hyperparathyroidism

Background

Aluminum overload and accumulation in tissues may lead to skeletal, hematological, and neurological toxicity. The aim of this study was to assess the effects of serum aluminum levels on presentations, postoperative recovery, and symptom improvement in patients undergoing parathyroidectomy for secondary hyperparathyroidism.

Methods

From 2008 to 2013, all patients with end-stage renal disease undergoing initial parathyroidectomy were included in the study. Serum aluminum level was measured preoperatively and/or within 1 week after surgery. Preoperative and postoperative biochemical profile and symptoms were compared between the low and high aluminum groups.

Results

A total of 176 patients were included in the study. Of these, 38 (22 %) patients had serum aluminum levels higher than 20 μg/L. A higher percentage of patients in the high aluminum group were on peritoneal dialysis than in the low aluminum group (24 vs. 4 %, p = 0.001). Both groups had similar bone mineral density and changes in biochemical profiles. The preoperative parathyroidectomy assessment of symptoms (PAS) score was not associated with serum aluminum levels (p = 0.349), whereas the postoperative PAS score showed positive association (p = 0.005). There was a negative association between serum aluminum levels and the improvement of total PAS scores (p = 0.001). The high aluminum group had more residual symptoms in three aspects: bone pain (p = 0.038), difficulty getting out of a chair or car (p = 0.045), and pruritus (p = 0.041).

Conclusions

A high serum aluminum level was associated with reduced symptom improvement in patients undergoing parathyroidectomy for secondary hyperparathyroidism.     

Post-parathyroidectomy hypocalcemia: incidence, risk factors, and management

The purpose of this study was to evaluate the incidence and severity of hypocalcemia after parathyroidectomy and delineate its risk factors. Data was retrieved from a prospective database. Patients with postoperative hypocalcemia were identified and risk factors were investigated including primary versus renal hyperparathyroidism (HPT), preoperative calcium, parathyroid hormone (PTH) and alkaline phosphatase levels, gland weight, pathology, extent of surgery, and reoperative surgery. Of the 162 patients who underwent parathyroidectomy, 84 (52%) were hypocalcemic postoperatively: 55 (42%) of 132 patients with primary and 29 (97%) of 30 patients with renal HPT (P = 0.0001). Patients with renal HPT had more profound hypocalcemia with a mean +/- SD calcium of 7.34 mg/dL +/- 1.07 versus 7.76 mg/dL +/- 0.59 for patients with primary HPT (P < 0.05). Symptoms were present in 28 (51%) of 55 patients with primary and 13 (45%) of 29 patients with renal HPT. Only three (2%) patients with primary compared to 29 (97%) with renal HPT were treated with intravenous calcium. The average length of stay for hypocalcemic patients was 0.7 days for primary HPT versus 4.7 days for renal HPT (P < 0.0005). Patients with primary HPT who underwent subtotal parathyroidectomy had significantly lower postoperative calcium levels (7.95 mg/dL +/- 0.64) than patients who had a single or double adenoma removed (8.49 mg/dL +/- 0.79) (P = 0.036). No other factor was predictive of postoperative hypocalcemia. Patients with renal HPT develop profound postoperative hypocalcemia requiring intravenous calcium and vitamin D therapy. Hypocalcemia in patients with primary HPT develop less severe hypocalcemia that is amenable to outpatient oral calcium therapy and should be routinely initiated following subtotal parathyroidectomy.     

Long-Term Symptom Relief from Primary Hyperparathyroidism Following Minimally Invasive Parathyroidectomy

Background  

The affect of the surgical approach for primary hyperparathyroidism (1HPT) on long-term symptom relief has not been studied. This study compares the long-term relief of symptoms assessed by the Parathyroidectomy Assessment of Symptoms (PAS) score in patients undergoing bilateral neck exploration (BNE) and minimally invasive parathyroidectomy (MIP).     

Psychological outcomes following surgical excision of facial skin cancers

Background

Patients undergoing surgery for basal and early squamous cell carcinomas are rarely offered psychological support as their malignancies have a low mortality. Nonetheless, 80 % of non-melanoma skin cancers occur in the head and neck, rendering both the malignancy and subsequent surgical scar clearly visible. This study was designed to quantify the social and emotional impact of facial skin malignancies pre- and postoperatively and to identify vulnerable groups who may benefit from increased support irrespective of tumour severity.

Methods

Fifty-three patients with facial skin malignancies were prospectively evaluated before and 3 months after surgery using the Skin Cancer Index (SCI); a 15-item, validated, disease-specific quality-of-life (QOL) assessment tool with emotion, social and appearance subscales. Higher scores reflect improvements in QOL.

Results

Surgical excision of the malignancy led to a significant increase in SCI (p?<?0.001). Increasing age was associated with greater post-surgery QOL, controlling for baseline scores (p?=?0.037). Other clinical/demographical variables were not significantly associated with SCI scores in most models; however, patients with squamous cell carcinomas reported greater improvements that those with basal cell carcinomas. Women had lower baseline scores but showed greater improvement in the emotional and appearance subscales. Men showed greater improvement in the social subscale. Preoperative SCI scores were generally better predictors of postoperative scores than demographic or clinical factors.

Conclusion

Lower preoperative SCI scores confirm the presence of anxiety among patients with cutaneous facial malignancies. Surgical excision improves social, emotional and cosmetic well-being, particularly in patients with squamous cell carcinomas. Female and younger patients appear most vulnerable to QOL anxieties preoperatively. Level of Evidence: Level III, prognostic study.     

Quality of Life Following Laparoscopic Anterior 90° Versus Nissen Fundoplication: Results from a Multicenter Randomized Trial

Background The short-term clinical outcomes from a multicenter prospective randomized trial of laparoscopic Nissen versus anterior 90° partial fundoplication have been reported previously. These demonstrated a high level of satisfaction with the overall outcome following anterior 90° fundoplication. However, the results of postoperative objective tests and specific clinical symptoms are not always consistent with an individual patient’s functional status and general well being following surgery, and quality of life (QOL) is also an important outcome to consider following surgery for reflux. Hence, QOL information was collected in this trial to investigate the hypothesis: improvements in QOL following laparoscopic antireflux surgery are greater after anterior 90° partial fundoplication than after Nissen fundoplication. Methods Patients undergoing a laparoscopic fundoplication for gastro-esophageal reflux at one of nine university teaching hospitals in six major cities in Australia and New Zealand were randomized to undergo either laparoscopic Nissen or anterior 90° partial fundoplication. Quality of life before and after surgery was assessed using validated questionnaires – the Short Form 36 general health questionnaire (SF36) and an Illness Behavior Questionnaire (IBQ). Patients were asked to complete these questionnaires preoperatively and at 3, 6, 12 and 24 months postoperatively. Results One hundred and twelve patients were randomized to undergo a Nissen fundoplication (52) or a 90° anterior fundoplication (60). Patients who underwent anterior fundoplication reported significant improvements in eight of the nine SF36 scales compared to four of the nine following a Nissen fundoplication. The majority of these improvements occurred early in the postoperative period. With respect to the illness behavior data, there were no significant differences between the two procedures. Both groups had a significant improvement in disease conviction scores at all time points compared to their preoperative scores. Conclusions Patients undergoing laparoscopic anterior 90° partial fundoplication reported more QOL improvements in the early postoperative period than patients undergoing a Nissen fundoplication. However, the QOL outcome for both procedures was similar at later follow-up.     

Comparison of patient-centered outcomes after laparoscopic Nissen fundoplication for gastroesophageal reflux disease or paraesophageal hernia

Background Patients undergoing laparoscopic Nissen fundoplication (LNF) with paraesophageal hernias (PEH) are not only older and less healthy than those with gastroesophageal reflux disease (GERD), but in addition the repair is more complicated. We evaluated whether outcomes relating to GERD symptoms and quality of life (QOL) were impacted by the presence of PEH. Methods Prospectively entered data from 149 patients (109 GERD and 40 PEH) were evaluated prior to and one year after LNF with standardized and validated symptoms scores. Scores for heartburn, dysphagia, disease-specific QOL (GERD-HRQL), and general health-related QOL (SF-12 physical and mental component scores) were compared between patients undergoing LNF for PEH or for GERD alone, at baseline and one year after surgery. p < 0.05 was considered statistically significant. Results Preoperative data for GERD-HRQL, heartburn, and dysphagia were available for 134 patients, with 96% one-year follow-up. SF-12 data were collected for 98 patients with 100% follow-up. PEH patients were older and had greater comorbidity. Preoperative GERD-HRQL and heartburn were significantly worse in the GERD group. One year after surgery, both GERD and PEH patients showed significant improvement in GERD-HRQL, heartburn and dysphagia scores, with no difference in any of these disease or symptom measures between the two study groups. Postoperative PCS and MCS scores showed improvement in GERD patients, while PEH patient scores remained at or below the population mean. Conclusions LNF is equally effective as an antireflux procedure in both GERD and PEH patients, prevents symptoms of reflux in PEH patients that have none preoperatively, and does not increase dysphagia in either group. Despite the increased complexity of the procedure, LNF provides an effective control of reflux symptoms in patients undergoing PEH repair. Supported by an unrestricted educational grant from Tyco Healthcare Canada     

Effect of Parathyroidectomy on Quality of Life and Neuropsychological Symptoms in Primary Hyperparathyroidism

Neuropsychological symptoms are found in a certain number of patients with primary hyperparathyroidism (PHPT). Preoperative and postoperative quality of life, anxiety, and depression are measured to analyze the impact of parathyroidectomy on these symptoms. In this prospective study, 66 patients underwent parathyroidectomy for PHPT and were evaluated pre- and postoperatively with two validated psychometric instruments (HADS, PHQ-9). Health-related quality of life was measured with a 12-item short-form health survey (SF-12). Preoperatively, the median physical component score (SF-12) of 43.0 and mental component score of 43.5 were lower than those of the general population (52.8 and 54.2 points, respectively). One year postoperatively the mental component score increased to 48.6 (p = 0.011), whereas the physical functioning scale scored 45.3 and therefore did not change significantly (p = 0.585). Preoperatively, symptoms of depression were found in 23.4% of the patients, and 15.6% of the patients displayed symptoms of anxiety (HADS). The prevalence of depression was significantly higher in patients with preoperative serum calcium levels > 11.2 mg/dl (2.8 mmol/L) (p = 0.015). Twelve months postoperatively, the overall proportion of patients with anxiety and depression decreased to 7.8% and 15.7%, respectively (p = NS). The severity of depression as measured with the PHQ-9 declined postoperatively as well. In this study, preoperative neuropsychological symptoms were related to the serum calcium levels. Postoperative health-related quality of life improved significantly. Among patients with preoperative symptoms of depression and anxiety, both symptoms were alleviated significantly at the 12-month follow-up. Therefore, surgery for PHPT seems to be effective in reducing neuropsychological morbidity associated with PHPT.     

Major depression due to primary hyperparathyroidism: a frequent and correctable disorder

While primary hyperparathyroidism (primary HPT) is recognized as a correctable cause of nephrolithiasis and osteoporosis, its role as an organic cause of major depression is less clear. The rate of major depression in primary HPT, response of symptoms to parathyroidectomy, and potential cost benefits were reviewed. From August 1994 to September 2002, 360 patients underwent parathyroidectomy for primary HPT. Thirty-five patients met Diagnostic and Statistical Manual of Mental Disorders IV-Text Revision (DSM IV-TR) criteria for major depression. Postoperatively, a modified form of the Outcomes Institutes Health Status Questionnaire 2.0 was used to evaluate patient mood and continued need for antidepressant medication (ADM). Cost analysis of ADM use was performed. Thirty-five of 360 patients (10%) with primary HPT met criteria for major depression. Thirteen of 35 (37%) required ADM preoperatively. Postoperatively, 29/35 (83%) patients responded to a phone survey: 90 per cent stated depression no longer impacted their ability to work or activities of daily living; 52 per cent reported an improved quality of life; 27 per cent discontinued preoperative ADM; and 27 per cent reduced their ADM dose. Reduction in ADM resulted in a savings of dollars 700 to dollars 3000 per patient per year. Major depression occurs in 10 per cent of patients undergoing parathyroidectomy for primary HPT. Parathyroidectomy reduces symptoms of major depression, improves quality of life, and can eliminate or reduce the need for antidepressant medication in up to 54 per cent of patients.     

Improvements in site-specific quality of life 6 months after endoscopic anterior skull base surgery: a prospective study

Object Endoscopic skull base surgery (ESBS) is a minimal-access technique that provides an alternative to traditional approaches. Patient-reported outcomes are becoming increasingly important in measuring the success of surgical interventions. Endoscopic skull base surgery may lead to improvements in quality of life (QOL) since natural orifices are used to reach the pathology; however, sinonasal QOL may be negatively affected. The purpose of this study was to assess the impact of ESBS on both site-specific QOL, using the Anterior Skull Base Questionnaire (ASBQ), and sinonasal-related QOL, using the Sino-Nasal Outcome Test (SNOT-22). Methods Consecutive patients from a tertiary referral center who were undergoing ESBS were prospectively enrolled in this study. All patients completed the ASBQ and SNOT-22 preoperatively as well as at regular intervals after ESBS. Results Sixty-six patients were included in the study, and 57.6% of them had pituitary adenoma. There was no significant decline or improvement in the ASBQ-measured QOL at 3 and 6 weeks after ESBS, but there were significant improvements at 12 weeks and 6 months postoperatively (p < 0.05). Improvements were noted in all but one ASBQ subdomain at 12 weeks and 6 months postsurgery (p < 0.05). Preoperative QOL was significantly worse in patients who had undergone revision surgery and significantly improved postoperatively in patients who underwent gross-total resection (p < 0.05). Scores on the SNOT-22 worsened at 3 weeks postoperatively and returned to baseline thereafter. The presence of a nasoseptal flap or a graft-donor site did not contribute to a decreased QOL. Conclusions Endoscopic skull base surgery is associated with an improvement in postoperative site-specific QOL as compared with the preoperative QOL. Short-term improvements are greater if gross-total resection is achieved. Sinonasal QOL transiently declines and then returns to preoperative baseline levels. Endoscopic skull base surgery is a valuable tool in the neurosurgical management of anterior skull base pathology, leading to improvements in site-specific QOL.     

Pretreatment depressive symptoms and treatment modality predict post-treatment disease-specific quality of life among patients with localized prostate cancer

PurposeThis study examines the prevalence of depressive symptoms before prostate cancer treatment and explores associations among pre-treatment depressive symptoms and post-treatment disease-specific QOL, controlling for treatment modality, and demographic and clinical covariates.Materials and methodsA case series of patients diagnosed with localized prostate cancer (T1-2N0M0) at a comprehensive cancer center was assessed. Of the 1,370 eligible patients, 869 (63.34%) completed questionnaires at diagnosis (baseline) and 6 months following treatment. Patients were treated with surgery (16.8%), brachytherapy (27.6%), or external beam radiation (EBRT; 55.6%). Depressive symptoms and disease-specific QOL were assessed with established measures (i.e., Center for Epidemiologic Studies Depression Scale (CES-D); sexual adjustment questionnaire (SAQ); and the American Urological Association symptom index).ResultsA fifth of the sample (19.7%) reported clinically elevated levels of depressive symptoms at baseline. The proportion of clinically elevated levels of baseline depressive symptoms was higher among surgery patients compared with patients treated with brachytherapy or external beam radiation. Depressive symptoms at baseline and treatment modality significantly predicted sexual and urinary dysfunction, related bother, activity limitation due to urinary dysfunction at 6 months, controlling for, age, PSA level, Gleason score, relevant baseline indicators of sexual and urinary dysfunction, related bother, and activity limitation (P < 0.05).ConclusionsPretreatment depressive symptoms and treatment modality predict QOL after PrCa treatment. Health care providers should be sensitive to the display of depressive symptoms before PrCa treatment and consider preventative interventions, including preparing patients for the changes in disease-specific QOL and related bother following prostate cancer treatment.     

Investigation of Factors Affecting the Clinical Results of Arthroscopic Anterior Talofibular Ligament Repair for Chronic Lateral Ankle Instability

This study aimed to examine the factors affecting the clinical outcomes of anterior talofibular ligament (ATFL) repair surgery with arthroscopy for chronic lateral ankle instability (CLAI). From 2015 to 2018, 18 consecutive patients diagnosed with CLAI after conservative treatment for ≥3 months underwent arthroscopic ATFL repair surgery using the Broström-Gould technique. Clinical scores at 1 year postoperatively on the Karlsson scoring scale (median, 85 points) and the Japanese Society for Surgery of the Foot scale (median, 90 points) were significantly improved compared with preoperative scores (median, 50 and 66 points; p < .001 and <.001, respectively). The median period to start jogging was 2 and 6 months for patients without (n = 11) and with (n = 7) cartilage damage, respectively, showing a significant difference (p = .006). Four patients with cartilage damage could not return to preinjury sports within 1 year after surgery. In the stress radiographs, the talar tilt angle (TTA) significantly improved from a median of 6° preoperatively to a median of 3.5° postoperatively (p = .002). Talar anterior drawer distance (TAD) significantly improved from a median of 6.5 mm preoperatively to a median of 4.1 mm postoperatively (p < .001). There was no significant difference in TTA or TAD between patients without and with cartilage damage. The period to start jogging postoperatively was significantly correlated with postoperative TTA and TAD. It is suggested that the postoperative period to start activities was delayed because of the larger postoperative TTA and TAD. According to our results, the postoperative period to start activities may depend on cartilage damage and instability remaining postoperatively.     

Assessment of Quality of Life after Laparoscopic Nissen Fundoplication in Patients with Gastroesophageal Reflux Disease

Background In this study two different quality of life items are compared, and correlation of patient satisfaction with preoperative and postoperative symptoms after laparoscopic Nissen fundoplication (LNF) for chronic gastroesophageal reflux disease is evaluated. Materials and Methods Between December 2002 and December 2004, 60 patients with a diagnosis of chronic gastroesophageal reflux disease scheduled for laparoscopic Nissen fundoplication were recruited prospectively and volunteered to participate in this study. Patients underwent endoscopy, and their disease-specific symptoms were scored on a scale. Quality of life was measured preoperatively and in the first and sixth postoperative months with two questionnaires: Short Form-36 (SF 36) (preoperatively) and the Gastroesophageal Reflux Disease—Health-Related Quality of Life (GERD-HRQL) (postoperatively). Results In more than 90% of the patients, typical symptoms (regurgitation and pyrozis) were controlled postoperatively (p < 0.001). In the first postoperative month, however, dysphagia (early dysphagia) was seen in 46 (76%) patients, whereas in the sixth postoperative month (late dysphagia) its incidence decreased to only 2 (3.3%) patients. Similarly, in the first postoperative month 42 (70%) patients had gas bloating, but the incidence of this symptom decreased to 26 (43.3%) patients by the sixth month (p = 0.01). The quality-of-life measurements obtained from both SF 36 and GERD-HRQL showed that quality of life of the patients improved significantly in the related domain of each item after surgery (p < 0.001). Conclusions Laparoscopic Nissen fundoplication is an effective operation that controls the typical symptoms and improves the quality of life of patients, but new-onset symptoms affect postoperative well-being. For closer evaluation of the benefits of the operation, we need new questionnaires that comprehensively evaluate the symptom spectrum of GERD both preoperatively and postoperatively.