Predicting Psychosocial Outcomes Using a Brief Measure of Quality of Life in a Sample of People with Spinal Cord Injury

Background:

Spinal cord injury (SCI) significantly impacts an individual’s quality of life (QOL). A brief and subjective measure of QOL is necessary to monitor the progress and outcomes of SCI rehabilitation.

Objective:

To determine whether this measure of QOL was associated with clinically important physical and psychosocial outcomes in a sample of people with SCI, to determine how people with SCI scored on this measure of QOL, and to determine whether people with SCI scored differently than nondisabled individuals on the QOL scale.

Methods:

Participants were 134 people with SCI (65% male; 35% female) and 227 nondisabled people (35% male; 65% female). Participants were assessed on a number of psychosocial and physiological variables at a large urban university and rehabilitation center. Variables examined were QOL, life satisfaction, depression, social interaction, pain, fatigue, and level of functioning.

Results:

Participants with SCI reported more low QOL scores and fewer high QOL scores than the nondisabled group. For participants with SCI, QOL was positively related to life satisfaction and social interaction and negatively related to pain, fatigue, and depression.

Conclusions:

Participants with SCI scored lower on the QOL measure than those without a disability, although the difference was not clinically significant. QOL was unrelated to level of functioning; people may still experience a high QOL despite their physical limitations. Depression and social interaction were significantly related to QOL and should be secondary targets for intervention following SCI rehabilitation.Key words: depression, disability, life satisfaction, pain, quality of life, social interaction, spinal cord injuriesQuality of life (QOL) can be defined as the quality of a person’s overall experiences of living. Individuals differ on what values they place on work, leisure activities, relationships with other people, intimacy with a spouse or partner, or participation in sports. Perhaps no other impairment impacts a person’s QOL as much as a spinal cord injury (SCI).¹ After the medical and functional problems are addressed in rehabilitation, individuals begin to think about how they can regain much of their previous lifestyle and QOL. There are substantial barriers in the physical and social environments that stand in the way of higher QOL, including medical issues; difficulties in constructing a suitable home environment; and challenges in keeping the family together, supporting oneself, and dealing with the subtle and not-so-subtle attitudes of others.² These problems and barriers can result in psychological issues, the most common of which is depression.³ It is not surprising that individuals find it difficult to regain a positive level of QOL after SCI.Considering that there are approximately 270,000 people currently living with SCI in the United States, with 12,000 new cases of SCI each year,⁴ the topic of QOL is important to the persons with SCI, their families, and to the clinicians who treat them. However, there is little agreement on the definition of QOL and therefore on its measurement. Most measures of QOL are either too long for clinicians to use in practice or are not measures of QOL itself, but rather are measures of life satisfaction, health status, or well-being. For example, The World Health Organization’s⁵ QOL measure, WHOQOL-BREF, is primarily a life satisfaction measure, and it takes more than 1 hour to administer. Even the SF-36,⁶ which many people inaccurately accept and use as a measure of QOL, is actually a measure of health status, according to the author.Experts in both QOL and SCI, including Dijkers⁷ and Tate,⁸ have argued that there is a need for a subjective measure of QOL that can be used to monitor a person’s progress of rehabilitation and as a measurable outcome of rehabilitation programs. Clinical practice requires brief measures that are reliable and valid and that can be incorporated into progress notes about the patient. This clinically oriented article addresses the issue of whether a brief measure of QOL can stand up to the rigors of scientific standards while still predicting clinically important outcomes of SCI and whether it is suitable for the practitioner as well as for persons with SCI.This article addresses 3 objectives. The first objective was to determine whether this measure of QOL was associated with clinically important physical and psychosocial outcomes in a sample of people with SCI. The second objective was to determine how people with SCI scored on this measure of QOL. The third objective was to determine whether people with SCI scored differently than nondisabled individuals on a subjective, single-item QOL scale.     

Immunologic heterogeneity of diffuse large cell lymphoma

The cellular lineage of 57 diffuse large-cell lymphomas (DLCLs) was determined using a panel of monoclonal antibodies directed against lineage-restricted and -associated T, B, and monocyte antigens. The majority (82%) were of B cell lineage as determined by the expression of sig and/or B1, with the remaining 16% being of T cell lineage and 2%, of monocyte-myeloid lineage. By the expression of other B cell- restricted and -associated antigens, two major and two minor subgroups could be identified. These subgroups expressed the following phenotypes: (1) B1+B4+sIG+B2- (51%); (2) B1+B4+sIg+B2+ (29%); (3) B1+B4+sIg-B2+ (10%); and (4) B1+B4-sIg+B2- (10)%. The morphology of transformed lymphocytes, the weak to absent expression of the early B cell antigens B2 and sIgD, and the absence of the late B cell differentiation antigens PCA-1 and PC-1 suggested that these tumors were the neoplastic counterparts of normal B cells at the mid-stages of differentiation. Further support for the notion that B-DLCLs correspond to transformed B lymphocytes was concluded from the observation that B cells could be identified in normal spleen that expressed the cell surface phenotype and morphological appearance of the majority of B- DLCLs.     

Lymphokine-induced phagocytosis in angiocentric immunoproliferative lesions (AIL) and malignant lymphoma arising in AIL

A factor that augmented the phagocytosis of IgG-coated ox red blood cells by the human monocyte/macrophage line U937 was identified in cell culture supernatants from two of two patients with angiocentric peripheral T cell lymphomas, three of three patients with angiocentric immunoproliferative lesions that were not frankly malignant, and one of two patients with T lymphoblastic malignancies. The factor was not present in supernatants derived from 14 nonangiocentric peripheral T cell lymphomas of other histologic types nor in ten cases of B cell lymphoma and two cases of Hodgkin's disease. A similar factor was present in the supernatants of concanavalin A (Con A)-stimulated normal peripheral blood mononuclear cells and in the supernatants of IL-2- dependent T cell lines derived from normal peripheral blood. The factor had an apparent mol wt of greater than 50,000 daltons, was heat labile (100 degrees C for two minutes), and stable at pH 2.0. Its stimulation of phagocytosis was independent of any increase in number of Fc receptors. Thus, this factor is probably not gamma-interferon. This factor may play a pathogenetic role in the hemophagocytic syndromes associated with certain T cell malignancies and immunodeficient states.     

Post‐mastectomy Radiotherapy for pT3N0 Breast Cancers: A Retrospective,Multi‐Institution Review

The role of post‐mastectomy radiotherapy for pT3N0 breast cancers remains undefined. The purpose of this study was to report institutional outcomes for women with pT3N0 breast cancers treated with and without post‐mastectomy radiotherapy. We collected data from two large tumor registries on pT3N0 breast cancers diagnosed between 1985 and 2014. Kaplan–Meier estimates were used to analyze freedom from local‐regional recurrence (FFLR), relapse free survival, and overall survival. This analysis identified 93 women with pT3N0 breast cancers. Of these, 53 received post‐mastectomy radiotherapy and 40 did not. Median follow‐up was 6.2 years and 5.3 years in the non‐post‐mastectomy radiotherapy and post‐mastectomy radiotherapy cohorts, respectively. Women not undergoing post‐mastectomy radiotherapy were more likely to be diagnosed in the 1980s and 1990s and were less likely to receive systemic therapies than women receiving post‐mastectomy radiotherapy (p < 0.05). There was a trend toward increased FFLR in the women receiving post‐mastectomy radiotherapy (p = 0.15). FFLR in the post‐mastectomy radiotherapy cohort was 98% at both 5 and 10 years. For women not receiving post‐mastectomy radiotherapy, FFLR was 88% at both 5 and 10 years. Women not receiving post‐mastectomy radiotherapy in our study had an isolated local‐regional failure rate of 12% at 10 years, despite receiving inferior systemic treatment by current standards. Local‐regional control after post‐mastectomy radiotherapy for pT3N0 breast cancers was excellent. Further research is needed to define post‐mastectomy radiotherapy indications for this patient population when receiving chemotherapy and endocrine therapy in line with current guidelines.     

Reconstruction of Complex Abdominal Wall Defects

Introduction

Reconstruction of large abdominal wall defects not amenable to primary closure remains a challenging problem. These defects result from trauma, previous surgery, infection and tumour resection. The primary objectives of abdominal wall reconstructions are to protect abdominal contents and provide functional support. The abdominal wall reconstruction aims at providing basic component parts, i.e. skin, soft tissue and fascia. For large soft tissue defects, pedicled or free flap closure can be used. In clean wounds, fascial replacement is accomplished with synthetic mesh provided there is adequate soft tissue coverage.

Methods

We treated a total of 20 consecutive patients with complex abdominal wall defects utilizing various reconstructive procedures. There were 15 males (75%) and 5 females (25%). The aetiology included dehiscence of laparotomy wounds in eight (40%), following ablative surgery for malignant tumours in seven (35%), trauma in three (15%) and congenital defects in two (10%) cases. The reconstructive procedures consisted of onlay prolene mesh in seven (35%), Gore-Tex (PTFE) dual mesh both as inlay and onlay in five (25%), facial partition release technique in three (15%), inlay prolene mesh covered with omentum and split skin graft in two (10%), inlay prolene mesh covered with expanded skin in two (10%), and Gore-Tex dual mesh covered with latissimus dorsi myocutaneous flap in one (5%) case. Postoperatively none developed mesh infection or extrusion. Three patients with malignant aetiology received postoperative radiotherapy. During follow up, one patient developed ventral hernia cephalad to the repair and one died due to recurrence of abdominal wall malignancy.

Conclusion

The reconstruction of an abdominal wall defect requires a comprehensive plan of preoperative and post operative care of the patient and aims toward restoration of abdominal structural integrity by a variety of procedures. The use of new biomaterials and tissue expanders provides reliable and durable abdominal wall closure along with good aesthetic results.Key Words: Abdominal wall defect, Mesh repair, Abdominal wall reconstruction     

Familial eosinophilic cellulitis, dysmorphic habitus, and mental retardation

Background: Eosinophilic cellulitis is a polymorphous, chronic disease characterized by eosinophil infiltration and granulomatous inflammation. Objective: Our purpose was to describe the clinical, histologic, and immunohistologic findings in three family members who have had eosinophilic cellulitis since childhood associated with mental retardation and abnormal body habitus. Methods: Family members were evaluated. Multiple skin biopsy specimens were obtained and examined after hematoxylin-and-eosin staining, by immunofluorescence and by electron microscopy. Blood specimens were analyzed by immunoassays for eosinophil granule proteins and eosinophil active cytokines. Results: Three short-statured, mentally retarded family members with abnormal body habitus in at least two generations had recurrent eosinophilic cellulitis. Peripheral blood and bone marrow eosinophilia was present. Plasma eosinophil granule major basic protein and eosinophil-derived neurotoxin levels were elevated with normal plasma eosinophil cationic protein levels. Eosinophil survival in culture was increased by patients’ plasma and was blocked with monoclonal interleukin-5 antibody. The level of plasma interleukin-5 was elevated. Lesional skin biopsy specimens showed massive staining for three eosinophil granule proteins. Electron microscopy showed eosinophil disruption. Conclusion: Eosinophilic cellulitis, mental retardation, and abnormal body habitus were likely inherited as a dominant syndrome in this family in which eosinophil involvement was striking. (J Am Acad Dermatol 1998;38:919-28.)     

Gunshot wounds to the spine associated with a perforated viscus

The cases of 42 patients with low-velocity gunshot wounds to the spine with an associated perforated viscus were reviewed. All viscus perforations occurred prior to the spinal injury. There were a total of 51 perforations, including 14 of the colon, 15 of the small bowel, 15 of the stomach, five of the esophagus, and two of the pharynx. All patients had significant neurologic deficits, with 23 patients suffering a complete neurologic injury. Average clinical follow-up was 18 months (range: 4-64 months). Only three patients developed documented spinal or paraspinal infections. One case of acute meningitis occurred after an isolated stomach perforation, while two other patients developed psoas abscesses after colon injuries. The roles of initial antibiotic therapy and of early bullet removal were evaluated in regard to infection. An extended course of broad spectrum antibiotics combined with bedrest appeared to significantly reduce the risk of spinal or paraspinal infection as compared with a previous study. Early bullet removal did not appear to be a significant factor in the prevention of infection. Prospective studies are needed to accurately delineate the role of initial antibiotic therapy for the prevention of spinal infection in these injuries.     

Dynamic computed tomography of the head and neck: differential diagnostic value

A retrospective review of the dynamic CT studies performed in our institution on head and neck lesions, excluding the brain, was carried out. Five basic types of density vs. time curves were obtained. Dynamic CT scanning is valuable in the differential diagnosis, management, and followup of such cases; its usefulness as an imaging modality in diagnosis and followup of hemangiomas is stressed.     

Effect of embryonic treatment with estradiol or testosterone on sexual differentiation of the quail brain. Critical period and dose-response relationships.

Japanese quail eggs were injected with estradiol benzoate (EB) after 10, 11, 12, 13, or 14 days of incubation, or were injected on day 10 with one of six dosages of EB or seven dosages of testosterone propionate (TP). EB injected on day 10 of 11 demasculinized the males; as adults they were incapable of copulating in response to exogenous TP. EB injected on day 13 or 14 was without effect, and EB injected on day 12 caused slight demasculinization. The critical period for sexual differentiation of the brain appears to end after about 12 days of incubation in this species. As little as 1 microgram EB reduced masculine sexual behavior. Injection of TP at dosages equal to or greater than 100 micrograms also demasculinized male quail.