Improved functional outcome after spinal cord injury in iNOS-deficient mice

STUDY DESIGN: Functional outcome was evaluated following experimental compression-type spinal cord injury (SCI) in wild-type mice and knockout mice, lacking the inducible nitric oxide synthase (iNOS) gene. OBJECTIVES: To evaluate the role of the nitric oxide generating enzyme iNOS in SCI. METHODS: The experimental animals were subjected to an extradural compression of the thoracic spinal cord. Functional outcome was studied during the first 2 weeks post-injury using a scoring system for assessment of hind limb motor function. RESULTS: Injury resulted in initial paraplegia followed by gradual improvement of motor function in most cases. Mice lacking the iNOS gene (iNOS-/-) clearly tended to have a better functional outcome than wild-type mice. The difference was significant on day 14 after injury. CONCLUSION: In accordance with a few earlier experimental studies, showing beneficial effects of pharmacological iNOS inhibition, the present report would indicate a destructive influence of iNOS following spinal cord trauma.     

A systematic review of functional ambulation outcome measures in spinal cord injury

STUDY DESIGN: Systematic review. OBJECTIVES: To systematically review the psychometric properties of outcome measures used to assess ambulation in people with spinal cord injury (SCI). SETTING: Vancouver, BC, Canada. METHODS: A keyword literature search of original articles that evaluated the psychometric properties of ambulation outcome measures in the SCI population was conducted using multiple databases. Multidimensional scales of function were included if specific data were available on ambulation-related subscales. Reliability, validity and responsiveness values were extracted and conclusions drawn about the psychometric quality of each measure. RESULTS: Seven outcome measures were identified and were broadly categorized into timed and categorical measures of ambulation. Timed measures included timed walking tests that showed excellent reliability, construct validity and responsiveness to change. The psychometric properties of the categorical scales were more variable, but those that were developed specifically for the SCI population had excellent reliability and validity. Categorical scales also exhibited some floor or ceiling effects. CONCLUSION: Excellent tools are available for measuring functional ambulation capacity. Further work is required to develop and evaluate outcome measures to include environmental factors that contribute to the ability to achieve safe, functional ambulation in everyday settings.     

Radiological and functional outcome after anterior lumbar interbody spinal fusion

Outcome after anterior spinal fusion has mainly been studied radiologically and reported fusion rates vary greatly. The aim of this study was to investigate radiological and long-term clinical outcome. The study comprised 120 consecutive patients, operated on during the period 1979–1987, with single-or two-level anterior interbody spinal fusion due to disc degeneration or isthmic spondylolisthesis with lumbar instability. In 64 patients a suplemental facet joint fusion was performed. Clinical outcome was evaluated 5–13 years after surgery using the patient-administered Dallas Pain Questionnaire (DPQ). Radiological outcome was determined on the basis of radiographs taken at a 2-year follow-up assessed by independent observers. The radiological follow-up rate was 98%. Complete fusion was found in 52%, questionable fusion in 24%, and definitive pseudoarthrosis in 24% of patients. Radiological results were poor in patients who had undergone previous spinal surgery (P<0.05) and in those with two-level fusion (P<0.05). The DPQ reply rate was 80%. Sixty-six patients claimed improvement in all functional groups. Patients with complete or questionable union had significantly better results than did those with non-union (P<0.01). Poorer functional outcome was found in patients who had undergone previous spinal surgery (P<0.01) or fusion at the L4/L5 level (P<0.05), in those who had responded poorly to the preoperative test brace (P<0.05), and in those above 45 years old at the time of surgery (P<0.05). Radiological and functional outcome did not vary according to whether patients were treated postoperatively with a plaster jacket or with facet screw fixation. The study demonstrated a functional success rate of approximately 66% following anterior lumbar spinal fusion after a mean follow-up of 8 years. There was a clear tendency for poorer prognosis for patients who had undergone previous spinal surgery, those aged above 45 years, those operated at the L4/L5 level and those who had responded poorly to the preoperative test brace. DPQ scores correlated well with radiological outcome.     

Usefulness of routine electrocardiography for heart disease screening in patients with spondyloarthropathy or rheumatoid arthritis

ObjectiveTo assess the usefulness of routine electrocardiography for heart disease screening in patients with spondyloarthropathy (SpA) or rheumatoid arthritis (RA).MethodsWe included consecutive patients with SpA or RA or with degenerative joint disease (control group) admitted over a 6-month period and free of cardiovascular events. A 12-lead electrocardiogram (ECG) was obtained and was interpreted by a cardiologist who was unaware of the diagnosis.ResultsWe included 108 patients with SpA (mean duration, 11 ± 10 years), 106 with RA (mean duration, 12 ± 9 years), and 74 with degenerative joint disease (controls). No patient had cardiovascular symptoms or a prior history of cardiovascular disease. The only difference in cardiovascular risk factors across the three populations was a higher prevalence of diabetes in the RA and control groups. We found no differences between the SpA or RA groups and the control group regarding the rates of the following ECG findings: premature beats, atrioventricular block (2.8% in the SpA group, 1.9% in the RA group, and 2.7% in the control group), complete or incomplete left bundle branch block (0.9%, 0.9%, and 2.7%, respectively), complete right bundle branch bloc or left bundle branch block (0.9%, 4.7%, and 4.1%, respectively); and abnormalities suggesting myocardial ischemia (10.2%, 19.8%, and 17.6%, respectively).ConclusionIn patients with SpA or RA who have no cardiovascular symptoms or history of cardiovascular disease, a routine ECG shows no increase in the cardiac abnormalities specifically associated with these joint diseases, compared to controls with degenerative joint disease.     

下肢远端原发恶性骨肿瘤患者的生存和肢体功能分析

目的 分析下肢远端原发恶性骨肿瘤患者的生存情况,评估保肢后的肢体功能.方法 2003年11月至2010年1月,20例下肢肢体远端原发恶性骨肿瘤接受保肢或截肢手术.男性15例,女性5例,平均年龄20岁.肿瘤位置:胫骨远端14例,腓骨远端3例,跟骨3例.肿瘤分期:ⅠB期3例,ⅡB期16例,Ⅲ期1例.除3例胫骨下端肿瘤截肢外,其他11例胫骨远端肿瘤行自体骨(4例)或异体骨(7例)踝关节融合手术,6例腓骨远端和跟骨肿瘤行自体骨重建手术.平均随访36.4个月.结果 5例异体骨踝关节融合和1例跟骨自体骨重建患者伤口延迟愈合,自体骨和异体骨对伤口愈合的影响差异有统计学意义(P=0.036).2例异体骨出现吸收和不愈合(其中1例截肢,另1例更换为骨水泥临时假体),1例胫骨远端骨肉瘤术后11个月复发截肢,2例分别于确诊后22和48个月死于肺转移.患者2和5年的总生存率分别为92.9%和79.6%,12例高度恶性骨肉瘤的2和5年生存率分别为87.5%和70.0%.保肢患者功能MSTS评分为82%.结论 下肢肢体远端原发恶性骨肿瘤的整体生存情况相对较好,保肢可以获得良好的肿瘤控制和肢体功能.     

Usefulness of diagnostic imaging in primary hyperparathyroidism

BACKGROUND: In patients with primary hyperparathyroidism, prevention of urinary stone recurrence can be achieved by surgical removal of the enlarged parathyroid gland. To ensure the efficacy of surgery for primary hyperparathyroidism, preoperative localization of the enlarged gland is important. In the present study, usefulness of diagnostic imaging for localization of the enlarged gland was investigated in primary hyperparathyroidism. METHODS: We retrospectively examined the findings of imaging studies and clinical records in 79 patients (97 glands) who underwent surgical treatment for primary hyperparathyroidism at Chiba University Hospital between 1976 and 2000. The detection rates of accurate localization were investigated for imaging techniques, such as ultrasonography (US), computed tomography (CT), magnetic resonance imaging (MRI), thallium-201 and technetium-99m pertechnetate (Tl-Tc) subtraction scintigraphy and 99mTc-methoxyisobutylisonitrile (MIBI) scintigraphy, and analysed in relation to the size and weight of the gland and pathological diagnosis. RESULTS: The detection rates by US, CT, MRI, Tl-Tc subtraction scintigraphy and MIBI scintigraphy were 70%, 67%, 73%, 38% and 78%, respectively. The overall detection rate changed from 50% to 88% before and after 1987. The detection rate of MIBI scintigraphy was superior to Tl-Tc subtraction scintigraphy. CONCLUSION: In primary hyperparathyroidism, improvement of accurate localization of an enlarged parathyroid gland was demonstrated along with recent advances in imaging techniques including MIBI scintigraphy.     

Nonoperatively treated type A spinal fractures: mid-term versus long-term functional outcome

This study focuses on the mid-term (four years) and long-term (ten years) functional outcome of patients treated nonoperatively for a type A spinal fracture without primary neurological deficit. Functional outcome was measured using the visual analogue scale spine score (VAS) and the Roland–Morris disability questionnaire (RMDQ). The 50 patients included were on average 41.2 years old at the time of injury. Four years post injury, a mean VAS score of 74.5 and a mean RMDQ score of 4.9 were found. Ten years after the accident, the mean VAS and RMDQ scores were 72.6 and 4.7, respectively (NS). No significant relationships were found between the difference scores of the VAS and RMDQ compared with age, gender, fracture sub-classification, and time between measurements. Three (6%) patients had a poor long-term outcome. None of the patients required surgery for late onset pain or progressive neurological deficit. Functional outcome after a nonoperatively treated type A spinal fracture is good, both four and ten years post injury. For the group as a whole, four years after the fracture a steady state exists in functional outcome, which does not change for ten years at least after the fracture.

---

Résumé  Cette étude va pour but de se focaliser sur les résultats à moyen terme (4 ans) et à long terme (10 ans) du devenir fonctionnel des patients traités orthopédiquement pour une fracture de type A du rachis sans déficit neurologique. Méthode:le devenir fonctionnel a été mesuré en utilisant une échelle visuelle analogique (VAS) et le score RMDQ Roland-Morris. Résultats: les 50 patients inclus avaient un age moyen de 41,2 ans au moment du traumatisme. 4 ans après l’accident, le score douleur VAS était de 74,5 avec un score moyen RMDQ à 4,9. 10 ans après l’accident les scores VAS et RMDQ sont respectivement de 72,6 et 4,7. Il n’existe pas de relation significative entre le score VAS et le score RMDQ ni d’autre part avec l’age et le sexe ainsi que de la classification de la fracture. 3 patients (6%) ont eu un mauvais résultat à long terme. Aucun patient n’a nécessité une reprise chirurgicale ou présentait un déficit neurologique progressif. En conclusion: le devenir fonctionnel des fractures du rachis de type A traitées orthopédiquement est bon à 4 ans aussi bien qu’à 10 ans. Pour ce groupe de patients leur statut à 4 ans n’a pas évolué sur le plan fonctionnel, après une nouvelle évaluation, 10 ans après le traumatisme.

     

Correlation of functional outcome and X-ray findings after Perthes disease

Purpose

The purpose of this study was to evaluate the functional impairments during gait after Legg-Calvé-Perthes Disease (LCPD) and to correlate these data with the clinical and radiographic outcome.

Methods

In 13 individuals with LCPD in recovery or final stage (mean age 9.5 ± 3.5 years) with unilateral hip involvement the clinical result was graded according to Tönnis and the radiographic outcome according to Heyman and Herndon; the functional impairment during gait was compared to a group of healthy children (n = 30, mean age 8.1 ± 1.2 years). All children underwent computerised three-dimensional gait analysis.

Results

The standard physical examination resulted in 69.2% normal range of movement according to Tönnis, but overall analysis of gait revealed that only 30.7% had a normal gait pattern. All children with an excellent or good radiographic (n = 6) outcome walked normally or showed minor deviations.

Conclusions

The results of the standard clinical examination do not reflect the function of the hip joint during gait. Additional information is revealed from gait analysis and should be part of outcome studies in LCPD.     

Intraspinal MDL28170 microinjection improves functional and pathological outcome following spinal cord injury

Although calpain (calcium-activated cysteine protease) inhibition represents a rational therapeutic target for spinal cord injury (SCI), few studies have reported improved functional outcomes with post-injury administration of calpain inhibitors. This reflects the weak potency and limited aqueous solubility of current calpain inhibitors. Previously, we demonstrated that intraspinal microinjection of the calpain inhibitor MDL28170 resulted in greater inhibition of calpain activity as compared to systemic administration of the same compound. In the present study, we evaluated the ability of intraspinal MDL28170 microinjection to spare spinal tissue and locomotor dysfunction following SCI. Contusion SCI was produced in female Long-Evans rats using the Infinite Horizon impactor at the 200-kdyn force setting. Open-field locomotion was evaluated until 6 weeks post-injury. Histological assessment of tissue sparing was performed at 6 weeks after SCI. The results demonstrate that MDL28170, administered with a single post-injury intraspinal microinjection (50 nmoles), significantly improves both locomotor function and pathological outcome measures following SCI.     

A systematic review of screening questionnaires for obstructive sleep apnea

Purpose

Obstructive sleep apnea (OSA) may lead to life-threatening problems if it is left undiagnosed. Polysomnography is the “gold standard” for OSA diagnosis; however, it is expensive and not widely available. The objective of this systematic review is to identify and evaluate the available questionnaires for screening OSA.

Source

We carried out a literature search through MEDLINE, EMBASE, and CINAHL to identify eligible studies. The methodological validity of each study was assessed using the Cochrane Methods Group’s guideline.

Principal findings

Ten studies (n = 1,484 patients) met the inclusion criteria. The Berlin questionnaire was the most common questionnaire (four studies) followed by the Wisconsin sleep questionnaire (two studies). Four studies were conducted exclusively on “sleep-disorder patients”, and six studies were conducted on “patients without history of sleep disorders”. For the first group, pooled sensitivity was 72.0% (95% confidence interval [CI]: 66.0-78.0%; I² = 23.0%) and pooled specificity was 61.0% (95% CI: 55.0-67.0%; I² = 43.8%). For the second group, pooled sensitivity was 77.0% (95% CI: 73.0-80.0%; I² = 78.1%) and pooled specificity was 53.0% (95% CI: 50-57%; I² = 88.8%). The risk of verification bias could not be eliminated in eight studies due to insufficient reporting. Studies on snoring, tiredness, observed apnea, and high blood pressure (STOP) and STOP including body mass index, age, neck circumference, gender (Bang) questionnaires had the highest methodological quality.

Conclusion

The existing evidence regarding the accuracy of OSA questionnaires is associated with promising but inconsistent results. This inconsistency could be due to studies with heterogeneous design (population, questionnaire type, validity). STOP and STOP-Bang questionnaires for screening of OSA in the surgical population are suggested due to their higher methodological quality and easy-to-use features.     

Usefulness of an immunochromatographical assay, PSA Rapid Test as a primary screening test for prostate cancer

Background The recent rapid increase of mass screening for prostate cancer by measuring PSA in Japan will increase the economic burden to the healthcare system. PSA Rapid Test (PRT) is a simple inexpensive test. The usefulness of PRT as a primary screening test for prostate cancer was evaluated. Methods When we conducted educational lectures for prostate cancer in our city, screening for prostate cancer using PRT was offered to the male participants. The results of the tests were handed to participants in writing at the end of the lectures. When the results were judged as positive, letters of referral to our institute were enclosed. Results One hundred and fourteen (18.6%) of 614 men were judged as positive by PRT. Of the 114 men with positive PRT, 73 (64%) visited our institution. Finally, 37 men underwent a transrectal prostate biopsy and a diagnosis of prostate cancer was made in 21 men (3.4% of all participants). The total costs for the PSA tests in this study were summed to be approximately $2,300, while they would be approximately $9,200 if all participants had undergone screening using the conventional quantitative method from the outset. Conclusion PRT is a low-cost method to detect patients with prostate cancer. We believe the PRT is useful as an initial screening test for detecting prostate cancer and that the combination of the PRT and more precise quantitative testing would be a reasonable way to reduce the cost and achieve high detection rate.     

Influence of functional bowel disease on outcome of surgical antireflux procedures

Patients with gastroesophageal reflux disease (GERD) have a coexisting diagnosis of functional bowel disease (FBD) in approximately 30% of cases. Symptom improvement after surgical therapy for GERD may be less in patients with FBD when compared to patients without this coexisting problem. A retrospective review of patients undergoing Nissen fundoplication between 1996 and 2000 evaluated patients with documented FBD or FBD symptoms to determine operative outcome. Poor postoperative outcome included recurrent heartburn, gas bloat syndrome, dysphagia requiring reoperation or dilation, or delay in resumption of normal diet. Bivariate comparison and multivariate logistic regression evaluated the independent impact of a documented diagnosis of FBD or preoperative symptoms of FBD on outcome. This study examined 155 patients: 32% reported having symptoms of FBD and 10% had a confirmed diagnosis of FBD. Poor postoperative outcomes occurred in 27%. Patients with a documented diagnosis of FBD were significantly more likely to have a poor outcome when compared to patients without symptoms of FBD (53% vs. 23%, P= 0.01). Patients with preoperative symptoms of FBD (but without a documented diagnosis of FBD) also had a higher incidence of poor outcome (5% vs. 23%, P= 0.09). Patients with FBD are at increased risk of poor results after antireflux surgery. Patients with these conditions should be counseled preoperatively regarding the potential for recurrent postoperative symptoms. Presented in part at the Annual Meeting of the Association for Academic Surgery, Philadelphia, Pennsylvania, November 18–20, 1999 (poster presentation).     

Function after spinal treatment,exercise and rehabilitation (FASTER): improving the functional outcome of spinal surgery

Background  

The life-time incidence of low back pain is high and diagnoses of spinal stenosis and disc prolapse are increasing. Consequently, there is a steady rise in surgical interventions for these conditions. Current evidence suggests that while the success of surgery is incomplete, it is superior to conservative interventions. A recent survey indicates that there are large differences in the type and intensity of rehabilitation, if any, provided after spinal surgery as well as in the restrictions and advice given to patients in the post-operative period.     

Usefulness of prostate-specific antigen velocity in screening for prostate cancer

BACKGROUND: The cut-off value of prostate-specific antigen velocity (PSAV) was investigated in relation to the initial prostate-specific antigen (PSA) value in subjects with initial values of 1.0-4.0 ng/mL, and the usefulness and limitations of PSAV as a screening test for prostate cancer were examined. METHODS: In this study, 4883 men who underwent mass screening for prostate cancer two or more times between 1987 and 1998 and had initial PSA levels of 1.0-4.0 ng/mL were investigated. The subjects ranged in age from 42 to 96 years (mean: 68.0 +/- 6.6 years). The cut-off value of PSAV was set at 0.1-1.5 ng/mL per year, and the sensitivity, specificity, efficiency and positive predictive value (PPV) of PSAV for detecting prostate cancer were determined according to the initial PSA value. A similar examination of the average PSAV was carried out in 2888 subjects with three or more visits for mass screening for prostate cancer. RESULTS: The diagnostic efficiency of PSAV was optimal with cut-off values of 0.3 and 0.75 ng/mL per year in those subjects with initial PSA levels of 1.0-1.9 and 2.0-4.0 ng/mL, respectively, but the PPV was low at 1.8% in subjects with initial PSA levels of 1.0-1.9 ng/mL. When the cutoff value of PSAV was set at 1.2 ng/mL per year in individuals with initial PSA levels of 1.0-1.9 ng/mL, the PPV increased to 7.3% and the sensitivity was 40%. The diagnostic efficiency of the average PSAV was optimal at the cut-off values of 0.2 and 0.4 ng/mL per year in subjects with initial PSA levels of 1.0-1.9 and 2.0-4.0 ng/mL, respectively, but the PPV was low at 2.2% in the subjects with initial PSA values of 1.0-1.9 ng/mL. When the cut-off value of PSAV was set at 0.75 ng/mL per year in individuals with initial PSA levels of 1.0-1.9 ng/mL, the PPV was 9.8% and the sensitivity was 46%. CONCLUSION: It is possible to improve the diagnostic accuracy of prostate cancer screening using the cut-off value of PSAV and average PSAV in subjects with initial PSA levels of 1.0-4.0 ng/mL. The cut-off values of PSAV should be set at 1.2 and 0.75 ng/mL per year in individuals with initial PSA levels of 1.0-1.9 and 2.0-4.0 ng/mL, respectively. The cut-off values of the average PSAV should be set at 0.75 and 0.4 ng/mL per year in individuals with initial PSA levels of 1.0-1.9 and 2.0-4.0 ng/mL, respectively.