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.     

Parathyroidectomy improves neurocognitive deficits in patients with primary hyperparathyroidism

BACKGROUND: Clinical guidelines for the treatment of primary hyperparathyroidism (pHPT) often suggest parathyroidectomy, but generally fail to consider neurocognitive and psychiatric symptoms because of the relative paucity of evidence. METHODS: In this prospective study, patients with pHPT (PTX) and benign euthyroid thyroid disease (THY) referred for operation were evaluated pre- and postoperatively with validated psychometric and neurocognitive instruments to determine whether learning, memory, or concentration improved with after parathyroidectomy. Statistical comparisons between groups were performed with univariate analysis and repeated measures of analysis of variance. RESULTS: Fifty-five subjects, mean age of 54 years, were evaluated preoperatively; 41 returned postoperatively. There were no significant differences between groups by age and gender. PTXs reported more depression symptoms preoperatively (P = .04) that improved postoperatively. There were no differences between the 2 groups on verbal memory and trait anxiety. For PTXs, average preoperative serum calcium concentration (11.3 mg/dL) and serum PTH level (100 pg/mL) normalized postoperatively. Preoperatively PTXs showed greater delays in their spatial learning (P = .03). All subjects learned across the 5 trials, but PTXs were more delayed (P = .03). After operation, PTXs improved and functioned at a level equivalent to the THYs. There was an interaction between trial (neurocognitive testing), visit (pre- vs postoperative), status (PTX vs THY), and change in PTH level (P = .06), suggesting that individuals with greater change in PTH were more likely to improve in their learning efficiency postparathyroidectomy. CONCLUSIONS: PHPT may be associated with a spatial learning deficit and processing that improves after parathyroidectomy. While longer-term follow-up is necessary, neurocognitive symptoms perhaps should be considered as criteria for parathyroidectomy.     

Improvement of Sleep Disturbance and Insomnia Following Parathyroidectomy for Primary Hyperparathyroidism

Background

The aim of the present study was to investigate the incidence of sleep disturbance and insomnia in patients with primary hyperparathyroidism (PHPT), and to evaluate the effect of parathyroidectomy.

Methods

A questionnaire was prospectively administered to adult patients with PHPT who underwent curative parathyroidectomy over an 11-month period. The questionnaire, administered preoperatively and 6 months postoperatively, included the Insomnia Severity Index (ISI) and eight additional questions regarding sleep pattern. Total ISI scores range from 0 to 28, with >7 signifying sleep difficulties and scores >14 indicating clinical insomnia.

Results

Of 197 eligible patients undergoing parathyroidectomy for PHPT, 115 (58.3 %) completed the preoperative and postoperative questionnaires. The mean age was 60.0 ± 1.2 years and 80.0 % were women. Preoperatively, 72 patients (62.6 %) had sleep difficulties, and 29 patients (25.2 %) met the criteria for clinical insomnia. Clinicopathologic variables were not predictive of clinical insomnia. There was a significant reduction in mean ISI score after parathyroidectomy (10.3 ± 0.6 vs 6.2 ± 0.5, p < 0.0001). Postoperatively, 79 patients (68.7 %) had an improved ISI score. Of the 29 patients with preoperative clinical insomnia, 21 (72.4 %) had resolution after parathyroidectomy. Preoperative insomnia patients had an increase in total hours slept after parathyroidectomy (5.4 ± 0.3 vs 6.1 ± 0.3 h, p = 0.02), whereas both insomnia patients and non-insomnia patients had a decrease in the number of awakenings (3.7 ± 0.4 vs 1.9 ± 0.2 times, p = 0.0001).

Conclusions

Sleep disturbances and insomnia are common in patients with PHPT, and the majority of patients will improve after curative parathyroidectomy.     

Elevated parathyroid hormone after parathyroidectomy delays symptom improvement

Background

Curative parathyroidectomy for primary hyperparathyroidism (PHPT) resolves various nonspecific symptoms related to the disease. Between 8% and 40% of patients with normocalcemia after parathyroidectomy have persistently elevated parathyroid hormone (ePTH) levels at follow-up. We investigated whether ePTH in the early postoperative period was associated with the timing of symptom improvement.

Materials and methods

This prospective study included adult patients with PHPT who underwent curative parathyroidectomy from November 2011 to September 2012. Biochemical testing at 2 wk postoperatively identified ePTH (defined as PTH > 72 pg/mL) versus normal PTH (nPTH). A questionnaire administered pre- and post-operatively at 6 wk and 6 mo asked patients to rate the frequency of 18 symptoms of PHPT on a five-point Likert scale. Student t-tests were used to compare pre- with postoperative changes in scores for individual symptoms.

Results

Of 194 patients who underwent parathyroidectomy, 129 (66%) participated in the study. Preoperatively, all patients were symptomatic, with a mean of 13 ± 4 symptoms. Two weeks postoperatively, 20 patients (16%) had ePTH. The percentage of patients with postoperative improvement for individual symptoms was compared between groups. At the early time point (6 wk), the ePTH group showed less improvement in 14 of 18 symptoms. This difference reached statistical significance for four symptoms: anxiety, constipation, thirst, and polyuria. By the 6-mo time point, these differences had resolved, and symptom improvement was similar between groups.

Conclusions

ePTH after curative parathyroidectomy may result in a delay in symptom improvement 6 wk postoperatively; however, this difference resolves in 6 mo.     

Parathyroidectomy improves concentration and retentiveness in patients with primary hyperparathyroidism

BACKGROUND: Many patients with primary hyperparathyroidism (PHPT) show symptoms of hypercalcemia syndrome, including psychologic and psychiatric disorders. The aim of this study was to find out whether parathyroidectomy improves cognitive performance with regard to concentration and retentiveness in patients with PHPT. METHODS: . Twenty patients with PHPT underwent psychologic testing preoperatively as well as 6 and 12 weeks postoperatively. Concentration under stress (timing) was proved by the d2-Test of Attention. To evaluate retentiveness, parts of the Wilde Intelligence Test were used. Patients were tested under identical circumstances with regard to time, location, and tester to minimize exterior influences. RESULTS: The patients' concentration enhanced significantly postoperatively (P <.001). The same applied to the total number of items processed (P <.01). Improvement of patients' ability to memorize numbers reached statistical significance when comparing the preoperative with the postoperative result (P =.0396); furthermore, there was a tendency to perform the tests more carefully and accurately (P =.069). CONCLUSIONS: Parathyroidectomy not only betters physical symptoms of PHPT but can also positively influence the patients' cognitive performance. These findings reflect the clinical observation of the patients' improved mental capacity after parathyroidectomy.     

Parathyroidectomy for primary hyperparathyroidism in octogenarians and nonagenarians: a plea for early surgical referral

BACKGROUND: Surgical referral of elderly patients with PHPT is often deferred because of the perceived risks of general anesthesia, increased age, and comorbidities and also because many of the symptoms of PHPT are difficult to distinguish from the aging process. HYPOTHESIS: Parathyroidectomy for primary hyperparathyroidism (PHPT) in elderly patients is beneficial and safe. DESIGN: Retrospective study of patients with PHPT who were 80 years and older. SETTING: Tertiary academic referral medical center. PATIENTS: Fifty-four consecutive patients (43 women and 11 men) with a mean age of 83.6 years who underwent parathyroidectomy for PHPT. MAIN OUTCOME MEASURES: Delay in surgical referral; improvement in symptoms and normalization of serum calcium and parathyroid hormone levels; and perioperative morbidity and mortality. RESULTS: Twelve (22%) of 54 patients had a mean delay of 5 years (range, 1.2-10.0 years) before surgical referral for a known diagnosis of PHPT. No patient had asymptomatic PHPT. There was no significant difference in the preoperative mean serum calcium level and symptoms of PHPT resulting from delay in surgical referral. Parathyroidectomy resulted in significant improvement of PHPT-associated symptoms of fatigue, weight loss, nocturia, bone pain, constipation, and major depression (P<.05). All patients had normal serum calcium and parathyroid hormone levels postoperatively. The average length of hospitalization was 1.9 days. There were 3 complications (9%): 1 urinary tract infection, 1 bladder perforation, and 3 transient hypocalcemia. There was no perioperative mortality. CONCLUSIONS: Parathyroidectomy in elderly patients is safe, curative, and beneficial. Surgical referral for parathyroidectomy should be considered in elderly patients with PHPT.     

Neuropsychologic changes in primary hyperparathyroidism after parathyroidectomy from a dual-institution prospective study

BackgroundThe impact of parathyroidectomy on neuropsychiatric symptoms in primary hyperparathyroidism remains poorly defined. The validated scales Patient Health Questionnaire-9 and Generalized Anxiety Disorder-7 can be used to assess depression and anxiety, respectively. Our aim was to prospectively characterize the changes in neuropsychiatric symptoms after parathyroidectomy.MethodsPatients undergoing parathyroidectomy and thyroidectomy (control) from two institutions between 2014 and 2019 were prospectively administered a questionnaire assessing neuropsychiatric symptoms before and after surgery. Paired t tests compared preoperative with postoperative neuropsychiatric symptoms and t tests compared differences in neuropsychiatric symptoms between parathyroidectomy and thyroidectomy.ResultsA total of 244 patients underwent parathyroidectomy and 161 underwent thyroidectomy. We observed improvement in neuropsychiatric symptoms after parathyroidectomy (6.2 [5.0–7.4], P < .01). Preoperatively, neuropsychiatric symptoms were more prevalent in patients undergoing parathyroidectomy when compared with thyroidectomy (11.2 ± 11.5 vs 7.5 ± 8.2, P < .01); however, after surgery there was no difference between the two groups (5.1 ± 7.1 vs 5.4 ± 7.2, P = .59). Preoperatively, 27.5% and 18.0% of patients endorsed moderate to severe depression and anxiety, which fell to 8.2% and 5.3%, respectively, (P < .01) after surgery.ConclusionPatients undergoing parathyroidectomy showed significant improvement in neuropsychiatric symptoms after surgery. Neuropsychiatric symptoms are more prevalent in patients with primary hyperparathyroidism. Neuropsychiatric symptoms should be assessed in all patients with primary hyperparathyroidism and should be considered a relative indication for parathyroidectomy.     

颈椎人工椎间盘置换术后患者负性心理的改善及其对预后的影响

目的 观察颈椎病患者行颈椎人工椎间盘置换术后负性心理的改善情况,探讨颈椎病患者抑郁、焦虑等负性心理发生的危险因素及其对预后的影响.方法 回顾性分析2010年1月-2012年1月于本院行颈椎椎间盘置换术的85例患者术前术后抑郁、焦虑心理状况.于术前及术后1周、3个月、6个月、1年及末次随访时采用Zung抑郁自评量表（self-rating depression scale,SDS）和Zung焦虑自评量表（self-rating anxiety scale,SAS）评估患者负性心理,颈部及上肢疼痛视觉模拟量表（visual analogue scale,VAS）评分、日本骨科学会（Japan Orthopedic Association,JOA）评分评估神经功能,SF-36量表评估生活质量,以单因素相关分析对结果进行统计处理.结果 所有患者临床症状和神经功能改善满意.12例（14.12%）患者术前出现明显的抑郁,21例（24.70%）患者出现焦虑;术后1周患者SDS和SAS评分均较术前改善,焦虑改善程度有统计学意义,抑郁改善程度无统计学意义.末次随访时患者抑郁和焦虑评分与VAS和SF-36评分显著相关,但与年龄和JOA评分无显著相关.结论 部分颈椎病患者术前存在抑郁及焦虑,颈椎人工椎间盘置换术可以部分改善这2种心理,患者负性心理对其预后具有负性作用.     

Prospective evaluation of quality of life (SF-36v2) and nonspecific symptoms before and after cure of primary hyperparathyroidism (1-year follow-up)

BACKGROUND: Only a minority of patients with primary hyperparathyroidism (pHPT) present with the "classic" symptoms. Most patients have numerous nonspecific symptoms. The aim of this study was to evaluate patients' quality of life and nonspecific symptoms before and after cure for pHPT. METHODS: This prospective, multicentric study, which took place from May 2003 to September 2004, included 100 patients. Six academic departments of Endocrine Surgery in France participated in the study: the University of Angers, Limoges, Nancy, Nantes, Marseille, and Poitiers. Only cured patients were included. All patients were given preoperative and postoperative questionnaires (the SF-36v2 Health Survey) at 3, 6, and 12 months to evaluate quality of life and nonspecific symptoms. RESULTS: Preoperatively, the main nonspecific symptoms included the following: anxiety (89%); muscular, bone, or join pain (87%); abdominal distention (82%); forgetfulness (81%); headaches (81%); and mood swings (79%). Quality of life was significantly improved at 3 and 6 months (P < .05). At 1 year postoperatively, statistically significant improvement (P < .05) persisted in all 8 domains of the SF-36v2. At 1 year after parathyroidectomy, 5 symptoms remained significantly improved: appetite loss, weight loss, thirst, headache, and nausea. CONCLUSIONS: Operative cure of primary hyperparathyroidism significantly improves quality of life and nonspecific symptoms for at least 1 year.     

Effects of Parathyroidectomy on Quality of Life: 10 Years of Data From a Prospective Randomized Controlled Trial on Primary Hyperparathyroidism (the SIPH-Study)

Primary hyperparathyroidism (PHPT) was previously considered a disease presenting with multiorgan involvement and a wide range of symptoms. Today, the disease presents with no symptoms or mild symptomatology in most patients. Data regarding nonspecific symptoms such as pain, fatigue, memory loss, depression, and other neuropsychiatric signs have been ambiguous, and results from prospective long-term randomized control trials are lacking. The Scandinavian Investigation on Primary Hyperparathyroidism (SIPH) is a prospective randomized controlled trial (RCT) with 10-year follow up, comparing parathyroidectomy (PTX) to observation without any treatment (OBS). From 1998 to 2005, 191 patients with mild PHPT were included from Sweden, Norway, and Denmark. A total of 95 patients were randomized to PTX and 96 to OBS. The generic Short Form-36 survey (SF-36) and the Comprehensive Psychopathological Rating Scale (CPRS) were studied at baseline, 2, 5, and 10 years after randomization. After 10 years, the PTX group scored significantly better on vitality (PTX 65.1 ± 20.2 versus OBS 57.4 ± 22.7; p = .017) compared to the OBS group in SF-36. We found no differences between the groups in the physical subscales. The OBS group had no significant change in any of the SF-36 scores throughout the study. The CPRS showed an improvement of symptoms in both groups for single items and sum scores after 10 years compared to baseline. There were, however, no significant differences between the two groups in the CPRS data. The results of this large and long-term RCT indicate improvement in some of the mental domains of SF-36 following PTX. However, the treatment effects between the groups were subtle with uncertain clinical significance. The observation group had stable SF-36 values and improvement in CPRS symptom-scores. Thus, in considering only quality of life (QoL) and in the absence of declines in renal and skeletal parameters, it may be safe to observe patients with mild PHPT for a decade. © 2020 American Society for Bone and Mineral Research (ASBMR).     

Preoperative psychological factors affecting surgical satisfaction of elderly patients with lumbar spinal stenosis

ObjectiveThe objective of this observational study was to investigate the effects of preoperative psychological factors on short-term patient satisfaction with surgery in elderly patients with lumbar spinal stenosis (LSS).MethodsSurgery was performed on 90 elderly patients with clinically and radiologically defined LSS: mean age at surgery, 73 years; 46 men and 44 women. Patients completed questionnaires before surgery and 1 year postoperatively. They used a self-administered the Roland Morris Disability Questionnaire (RDQ), the Japanese Orthopaedic Association Back Pain Questionnaire (JOABPEQ), MOS 36-Item Short-Form Health Survey (SF-36), and satisfaction for surgery (VAS) were completed. At baseline, psychological factors were assessed using the Self-Rating Questionnaire for Depression (SRQ-D), Hospital Anxiety and Depression scale (HADS), Pain Catastrophizing Scale (PCS), Pain Anxiety Symptoms Scale-20, and Brief Scale for Psychiatric Problems in Orthopaedic Patients (BS-POP). At follow-up, patient satisfaction was evaluated using 2 items: (1) satisfaction with surgery and (2) Would you undergo the same surgery again?.ResultsSatisfaction item 1 correlated negatively with the VAS for low back pain, leg pain, numbness, JOABPEQ social life disturbance score, SF-36 physical function score, and HADS anxiety score (p < 0.05). Satisfaction 2 correlated negatively with age at surgery, VAS of leg pain, PCS magnification score, and BS-POP score (p < 0.05). Multiple regression analysis showed significant associations between satisfaction 1 and SF-36 physical function and HADS anxiety scores, and between satisfaction 2 and PCS magnification score (p < 0.05).Statistical analysisThe preoperative factors independently associated with surgical satisfaction were analyzed utilizing Speaman’s rank correlation coefficient and multiple regression analysis.ConclusionPhysical function and anxiety were identified as preoperative factors that affected patient satisfaction with surgery. Preoperative assessment of psychological factors and interventions for anxiety may help improve patient satisfaction after surgery for LSS.     

Preliminary Report: Functional MRI of the Brain May Be the Ideal Tool for Evaluating Neuropsychologic and Sleep Complaints of Patients with Primary Hyperparathyroidism

Background The incidence, pattern, and severity of sleep disturbance and cognitive dysfunction has not been well characterized for patients with primary hyperparathyroidism (PHPT). There is no agreement on the mechanism of the development or resolution of such symptoms, and in no previous study has cerebral activity been functionally assessed and change documented following surgical cure of patients with PHPT. Methods We undertook a prospective analysis to obtain pilot data on 6 patients with PHPT. Functional magnetic resonance imaging (fMRI), formal neuropsychologic (NP) tests, and health-related quality of life (HRQL) measures that included sleep assessments were performed on patients before and after parathyroidectomy. Changes in cortical activation under both conflict and neutral conditions (distracting tasks) were recorded. Results Functional MRI demonstrated postoperative changes in medial prefrontal cortex activity during cognitive processing of conflict and nonconflict tasks. Further postoperative changes were noted in the dorsolateral prefrontal cortex and parietal cortex with shifts in activations. In addition to the fMRI findings, the patients demonstrated improvements in sleep and social behavior. They tended to experience less fatigue and their processing speed on cognitive tests improved. Conclusions These data support the feasibility and willingness of patients with PHPT to undergo fMRI assessment. Preliminary findings reflected a generalized improvement in processing efficiency postoperatively compared with a patient’s preoperative state, and the HRQL measures showed improved sleep. These findings mirror those expected with sleep dysfunction. Longitudinal assessment with advanced brain imaging technology, neuropsychological (NP), and sleep evaluations is warranted to further explore cognitive, sleep, and HRQL improvement after parathyroidectomy.     

Persistent symptomatic improvement in the majority of patients undergoing parathyroidectomy for primary hyperparathyroidism

Background  

Parathyroidectomy for primary hyperparathyroidism (PHPT) is followed by a decrease in the severity of symptoms reported on the Pasieka’s parathyroid symptoms score (PPSS) and SF-36 questionnaires. Some argue that such benefits are short-lived. This study investigates the severity of symptoms at more than 12 months after parathyroidectomy.     

Relation Between Depression,Some Laboratory Parameters,and Quality of Life in Hemodialysis Patients

Depression is common in patients with end-stage renal disease (ESRD) and is associated with increased mortality and morbidity. Several investigators have estimated that depression occurs in about 20% to 30% of dialysis patients. The aim of this study was to investigate the relationship between depression, some laboratory parameters, and quality of life (QOL) in hemodialysis patients. Forty-three hemodialysis patients (mean age 40.5 ± 15.2; M = 28, F = 15) were included in the study. Hamilton Depression Scale (HAMD), Hamilton Anxiety Scale (HAMA), and short form with 36 (SF-36) were used for evaluation. Subsequently, patients were divided into two groups according to HAMD scores: group 1, those who had a low HAMD score (between 0 and 7), and group 2, those who had a high HAMD score (over 7). The two groups were compared in terms of anxiety scores, QOL scores, and some laboratory parameters. The group 2 patients (n = 21; M = 13, F = 8) had lower levels of hemoglobin than the group 1 patients (9.5 ± 1.7 vs. 10.7 ± 1.4 g/dL, respectively; p< 0.01). Group 2 patients also had lower SF-36 scores than group 1 patients (91.5 ± 21.3 vs. 74.9 ± 13.6, respectively; p = 0.03). On the contrary, the patients of group 2 had higher HAMA scores than group 1 patients (16.6 ± 6.9 vs. 6.3 ± 3.5, respectively; p< 0.01) and CRP level (10.7 ± 4.6 vs. 4.5 ± 3.8, respectively; p< 0.001). A significant correlation was found between depression scores and C-reactive protein (CRP) (r = 0.57, p< 0.001) and HAMA scores (r = ? 0.43, p< 0.05). In contrast, a negative correlation was found between HAMD scores and albumin (r = ? 0.43, p< 0.05), hemoglobin (r = ? 0.38, p =0.015) and SF-36 scores (r = 0.39, p = 0.032). These findings demonstrate that there is a relationship among high depression score, low levels of hemoglobin and albumin, high CRP level, low SF-36 score, and high anxiety score. Evaluation of psychiatric status should be part of the care provided to hemodialysis patients.     

Should Depression Be Treated Before Lower Extremity Arthroplasty?

Background

Patient optimization is becoming increasingly important before arthroplasty to ensure outcomes. It has been suggested that depression is a modifiable risk factor that should be corrected preoperatively. It remains to be determined whether psychological intervention before surgery will improve outcomes. We theorized that the use of preoperative depression scales to predict postoperative outcomes may be influenced by the pain and functional disability of arthritis. To determine whether depression is a modifiable risk factor that should be corrected preoperatively we asked the following questions: (1) What is the prevalence of depression in arthroplasty patients preoperatively? (2) Do depressive symptoms improve after surgery? (3) Is preoperative depression associated with outcome?

The effect of the psychological status of breast cancer patients on the short-term clinical outcome after mastectomy

PURPOSE: to analyze the effect of anxiety and depression on the postoperative complications and length of hospitalization of patients with breast cancer. Beck's Depression Inventory (BDI) and Hospital Anxiety and Depression Scale (HADS) were filled out by the patients pre-operatively. Patients were asked to rate their pain by the visual analogue scale (VAS) after surgery. Age, seroma volume, day of drain withdrawal, complications, and pathological stages were noted. The median age of 49 patients with the diagnosis of breast cancer was 51 (36-80). There was a significant correlation between the pain score and Beck, HADS, HADS (anxiety) and HADS (depression) (8 hours ; p = 0.021, 0.001, 0.004, 0.005 and 24 hours ; p = 0.005, 0.012, 0.006, 0.120). The mean HADS depression score in those patients with complications was 9.1 +/- 4.2 and that of patients with no complications was 6.6 +/- 3.1 (p = 0.047). The mean hospital stay of patients with a normal HADS score (< 19) was 2.9 +/- 1.1 days, whilst that of patients with an abnormal HADS score was 3.8 +/- 1.2 days (p = 0.016). Patients with abnormal HADS anxiety and abnormal HADS (total) scores had an earlier stage of breast cancer (p = 0.077, p = 0.063). The psychological status of breast cancer patients effects their postoperative recovery period and it is easy to diagnose these patients by some brief questionnaires.     

全膝关节置换术前心理状态与术后早期膝关节功能的相关性研究

  目的 探讨全膝关节置换术前患者心理状态与术后膝关节功能的相关性。方法 2010年7至10月接受全膝关节置换且符合纳入标准的骨关节炎患者 111例（155膝）,按照医院焦虑抑郁量表（Hospital Anxiety and Depression Scale,HADS）对术前心理状态进行评估。HADS≥8分（有焦虑、抑郁）者纳入心 理组（21例）,HADS0.05）;与术后6个月膝关节疼痛呈正相关（r=0.613,0.530,0.500,0.473;P0.05）。结论 患者术前的焦虑、抑郁状态对全膝关节置 换术后膝关节功能的恢复有负面影响。     

Osteoprotegerin Levels in Primary Hyperparathyroidism: Effect of Parathyroidectomy and Association with Bone Metabolism

The effect of parathyroid hormone (PTH) on the production of osteoprotegerin (OPG) remains controversial. Most in vitro studies indicate that PTH decreases OPG secretion by the osteoblast, but in vivo observations are conflicting. In primary hyperparathyroidism (PHPT), hypersecretion of PTH leads to enhanced bone resorption and formation with increased risk of fracture. Patients with PHPT are cured by surgery, resulting in normalization of PTH levels and bone metabolism, but the concomitant effects on OPG production are not known. The hypothesis of the present study was that the circulating level of OPG is diminished in patients with PHPT and increases with successful parathyroidectomy. We also speculated that serum OPG may determine the magnitude of bone loss up to the time of surgery. In the present study, 20 patients (17 women and 3 men, mean age 62 y) with PHPT who were candidates for surgical cure were examined before and 12 months after surgery. Bone turnover markers decreased and BMD increased significantly after surgery. Serum OPG did not correlate with PTH before surgery (r = 0.07, P = 0.77) and was not affected by parathyroidectomy (P = 0.79). After normalization of PTH, bone formation markers showed significant (P1NP) and near-significant (osteocalcin) correlations with serum OPG. In conclusion, serum OPG is not decreased in patients with PHPT, nor is serum OPG to any demonstrable extent regulated by PTH pre- or postoperatively.     

The influence of mental health on outcomes following total shoulder arthroplasty

BackgroundAnxiety and depression symptoms have been associated with higher pain and lower functional scores in patients with glenohumeral osteoarthritis (GHOA). The influence of mental health on outcomes following total shoulder arthroplasty (TSA) for GHOA has not been fully investigated .MethodsThis observational cohort study included 143 shoulders in 135 subjects undergoing TSA for GHOA. Preoperative imaging was assessed for glenoid wear pattern. Patients completed preoperative and postoperative American Shoulder and Elbow Surgeons (ASES) score, Visual Analog Pain Scale (VAS), and PROMIS Upper Extremity (UE), Physical Function (PF), and Pain Interference (PI) scores. The Western Ontario Osteoarthritis Score (WOOS) was collected postoperatively. Mean postoperative pain and functional scores, improvement from preoperative scores, and surgical regret were compared between varying severity of anxiety or depression and pattern of glenoid wear.ResultsCompared to subjects without anxiety, those with moderate-to-severe anxiety reported worse postoperative ASES (p=0.019), WOOS (p<0.01) and PROMIS UE (p=0.02) and higher PROMIS PI scores (p<0.01). Compared to those without depression, those with moderate-to-severe depression reported worse postoperative ASES and WOOS and higher VAS and PROMIS Pain scores (p<0.01). Linear regression showed that anxiety and concentric glenoid wear were associated with worse postoperative PROMIS scores. There were no significant differences in pre-to-postoperative improvement in any outcome measures among those with and without anxiety or depression. Patients with moderate-to-severe depression were less likely to want to undergo the same procedure again (p=0.035).DiscussionPatients with anxiety and depression report similar improvements in pain and function following TSA similar to those without depression or anxiety. Despite the similar improvement, those with moderate-to-severe depression and anxiety symptoms reported persistently lower functional and higher pain scores. Though most patients are satisfied following TSA, those with moderate-to-severe depression may be more likely to regret undergoing surgery. Future studies should identify mental health symptoms preoperatively and evaluate the effect of preoperative intervention on postoperative outcomes following TSA.     

Predictors of Early Postoperative Quality of Life after Elective Resection for Colorectal Cancer

Introduction Measurement of quality of life (QoL) is assuming increasing importance in cancer care. Predictors of early postoperative QoL after colorectal cancer resection are not clear and the aim of this study was to identify these factors. Methods A consecutive series of eligible patients undergoing elective resection for colorectal cancer were invited to participate. Standardised, reliable and validated psychological questionnaires (HADS, PANAS, MRS, FACT-C, EQ-5D) were administered seven days prior to surgery and then six weeks after discharge. Results One hundred and four patients with colorectal cancer were recruited. There were 70 males (67.3%) and the mean age of the group was 67.6 years. Postoperative anxiety and depression were closely related to the preoperative anxiety and depression scores (p < 0.001). Other QoL scores also showed significant correlation with the respective preoperative scores. Anxiety, depression, and FACT functional wellbeing scores were also correlated with the incidence of postoperative morbidity. On multiple regression analysis postoperative morbidity, tumour node metastasis (TNM) stage, presence of stoma and preoperative QoL scores were found to independently predict postoperative QoL scores. Conclusion Routine preoperative QoL measurement in cancer patients can identify patients at risk of having a poor QoL postoperatively. Suitable psychological and pharmaceutical intervention can be planned in advance for this group.