Neuronavigation by intraoperative three-dimensional ultrasound: initial experience during brain tumor resection

OBJECTIVE: Three-dimensional (3-D) ultrasound is an intraoperative imaging modality used in neuronavigation as an alternative to magnetic resonance imaging (MRI). This article summarizes 4 years of clinical experience in the use of intraoperative 3-D ultrasound integrated into neuronavigation for guidance in brain tumor resection. METHODS: Patients were selected for inclusion in the study on the basis of the size and location of their lesion. Preoperative 3-D MRI data were registered and used for planning as in other conventional neuronavigation systems. Intraoperative 3-D ultrasound images were acquired three to six times, and tumor resection was guided on the basis of these updated 3-D images. RESULTS: Intraoperative 3-D ultrasound represents a good solution to the problem of brain shift in neuronavigation because it easily provides an updated, and hence more accurate, map of the patient's true anatomy in all phases of the operation. Ultrasound makes it possible to follow the progression of the operation, and it improves the radicality of tumor resection by detecting tumor tissue that would remain if the imaging technology had not been used (in 53% of the cases). Integration of 3-D ultrasound with navigation technology solves the orientation problem experienced previously with two-dimensional ultrasound in neurosurgery. The technology makes it possible to directly compare intraoperative ultrasound and MRI data regarding visualization of the lesion. Ultrasound image quality is useful for guiding surgical procedures. CONCLUSION: Intraoperative 3-D ultrasound seems to provide a time- and cost-effective way to update high-quality 3-D maps used in neuronavigation.     

Fatigue interference with daily living among patients with inflammatory bowel disease

Purpose

The purpose of the study was to examine fatigue interference with daily living in patients with inflammatory bowel disease (IBD) and to explore relationships between severe fatigue interference and socio-demographic and clinical variables, including use of complementary and alternative medicine (CAM).

Methods

Data were collected using self-report questionnaires from adult IBD outpatients. Fatigue interference was assessed with the 5-item Fatigue Severity Scale, and scores ≥5 were defined as severe fatigue interference. CAM use was assessed with the International CAM Questionnaire. Multivariate logistic regression analysis was used to examine associations between severe fatigue interference and socio-demographic factors, clinical factors, and CAM use.

Results

In total, 428 patients had evaluable questionnaires (response rate 93 %). Severe fatigue interference was reported by 39 % of the total sample. Patients with Crohn’s disease (CD) (n = 238) were more likely than patients with ulcerative colitis (UC) (n = 190) to report severe fatigue interference (43 and 33 %, respectively, p = 0.003). In addition, patients reporting severe fatigue interference were more likely to have active disease than patients without severe fatigue interference (p < 0.001 for both diagnoses). Patients with inactive disease had scores comparable to the general population. Factors independently associated with severe fatigue interference in UC included disease activity and CAM use, while in CD they included disease activity and current smoking.

Conclusions

Severe fatigue interference is common among IBD patients with active disease. Among patients with UC, but not CD, CAM use was associated with severe fatigue interference. The relationship between fatigue interference and personal factors should be considered further in subsequent studies.     

Chronic fatigue is associated with impaired health-related quality of life in inflammatory bowel disease

Aliment Pharmacol Ther 2011; 33: 106–114

Summary

Background Fatigue is reported to reduce health‐related quality of life (HRQOL) in chronic diseases. Studies on the importance of fatigue and its implications for the patient’s HRQOL in inflammatory bowel disease (IBD) remain scarce and need to be explored. Aim  To investigate the influence of chronic fatigue on both generic and disease‐specific HRQOL in IBD. Methods Patients in remission, with mild and moderate IBD completed the Fatigue Questionnaire, the Short‐Form 36 (SF‐36) and the Norwegian version of the Inflammatory Bowel Disease Questionnaire (N‐IBDQ). In addition, demographic and clinical variables were obtained. Results In total, 140 patients were included; the mean age of patients with chronic fatigue was 44.2 years (s.d. = 15.8), that of nonfatigued was 44.7 years (s.d. = 16.0). Ulcerative colitis (UC)/Crohn’s disease (CD) = 92/48. Chronic fatigue was associated, after controlling for covariates, with a reduction of HRQOL scores in 6/8 SF‐36 dimensions in UC and 5/8 dimensions in CD. In N‐IBDQ, chronic fatigue was associated with a reduction of HRQOL in four subdimensions and total score in CD and all dimensions in UC. Conclusions Fatigue is associated with reduction of HRQOL scores in IBD. The physical HRQOL domains are particularly affected. The impact of fatigue on disability, sick leave, school and work attendance has to be studied further.     

Ulcerative colitis: patient characteristics may predict 10-yr disease recurrence in a European-wide population-based cohort

OBJECTIVES: Cumulative 10-yr relapse rates in ulcerative colitis (UC) of 70% to almost 100% have been reported in regional studies. The aim of this study was to determine the relapse rate in UC in a European population-based cohort 10 yr after diagnosis and to identify factors that may influence the risk of relapse. METHODS: From 1991 to 1993, 771 patients with UC from seven European countries and Israel were prospectively included in a population-based inception cohort and followed for 10 yr. A relapse was defined as an increase in UC-related symptoms leading to changes in medical treatment or surgery. The cumulative relapse rate, time to first relapse, and number of relapses in the follow-up period were recorded and possible causative factors were investigated. RESULTS: The cumulative relapse rate of patients with at least one relapse was 0.67 (95% CI 0.63-0.71). The time to first relapse showed a greater hazard ratio (HR) (1.2, CI 1.0-1.5) for women and for patients with a high level of education (1.4, CI 1.1-1.8). The number of relapses decreased with age, and current smokers had a lower relapse rate (0.8, CI 0.6-0.9) than nonsmokers. The relapse rate in women was 1.2 (CI 1.1-1.3) times higher than in men. An inverse relation was found between the time to the first relapse and the total number of relapses. CONCLUSION: In 67% of patients, there was at least one relapse. Smoking status, level of education, and possibly female gender were found to influence the risk of relapse.     

Low colectomy rates in ulcerative colitis in an unselected European cohort followed for 10 years

BACKGROUND & AIMS: The colectomy rate in ulcerative colitis (UC) is related to morbidity and to treatment decisions made during disease course. The aims of this study were to determine the colectomy risk in UC in the first decade after diagnosis and to identify factors that may influence the choice of surgical treatment. METHODS: In 1991-1993, 781 UC patients from 9 centers located in 7 countries in northern and southern Europe and in Israel were included in a prospective inception cohort study. After 10 years of follow-up, 617 patients had complete medical records, 73 had died, and 91 had been lost to follow-up. RESULTS: There were no significant differences in age, sex, or disease extent at diagnosis between patients followed for 10 years and those lost to follow-up. The 10-year cumulative risk of colectomy was 8.7%: 10.4% in the northern and 3.9% in the southern European centers (P < .001). Colectomy was more likely in extensive colitis than in proctitis, with an adjusted hazard ratio (HR) of 4.1 (95% CI: 2.0-8.4). Compared with the southern centers, the adjusted HR was 2.7 (95% CI: 1.3-5.6) for The Netherlands and Norway together and 8.2 (95% CI: 3.6-18.6) for Denmark. Age at diagnosis, sex, and smoking status at diagnosis had no statistically significant influence on colectomy rates. CONCLUSIONS: The colectomy rate was found to be lower than that in previous publications, but there was a difference between northern and southern Europe. Colectomy was associated with extensive colitis, but the geographic variations could not be explained.     

Health-related quality of life in patients with inflammatory bowel disease five years after the initial diagnosis

BACKGROUND: Health-related quality of life (HRQOL) has become an important tool in evaluating patient satisfaction in inflammatory bowel disease (IBD). So far, few prospective follow-up studies have been done to identify variables that influence HRQOL. We aimed to identify demographic and clinical variables that influence HRQOL 5 years after diagnosis in patients with ulcerative colitis (UC) or Crohn disease (CD) included in a prospective follow-up study from 1990 to 1994 (the IBSEN study). METHODS: All patients completed the Inflammatory Bowel Disease Questionnaire (IBDQ), a disease-specific quality-of-life questionnaire translated into Norwegian and validated. We present data from 497 patients (328 UC patients and 169 CD patients, mean age 43.3 years, 48% female). The impact of age, gender, smoking, symptom severity, disease distribution, rheumatic symptoms and surgery on IBD patients' HRQOL was analysed. RESULTS: Women had a reduction in IBDQ total score of 10 points compared to men, CD patients had a reduction of 7.5 compared to UC patients. The patients with moderate/severe symptoms had a 50 points lower score than the patients without symptoms. The patients with rheumatic symptoms had a 10 points lower total score than the patients without these symptoms. All differences were statistically significant. The multiple regression analysis showed that symptom severity, rheumatic symptoms and female gender were the strongest predictors of reduction in HRQOL for both diagnosis groups. CONCLUSION: IBD symptoms, rheumatic symptoms and female gender have a significant influence on patients' HRQOL as measured by IBDQ. This was confirmed by the regression analysis.     

Patients’ perceptions of quality of care and follow-up in inflammatory bowel disease

Background and aims Quality of care (QoC) has gained increased attention in IBD. A better QoC has, historically, been linked to improved treatment outcomes. Even so, factors of equal importance to patients may be quality of life (QoL), patient–physician communication and access to care. Recent surveys suggest that IBD care in Europe is suboptimal. Methods Patients were recruited from nine hospitals in the south-eastern and western part of Norway as a part of an observational, multicenter study In addition to clinical and socio-demographic factors; a purposely designed 26 item questionnaire was used to quantify aspects related to IBD care, including QoC. Moreover, the Fatigue Questionnaire (FQ) was used to investigate fatigue. Results In total, 411 patients were included. Of these, 231 were diagnosed with CD and 180 with UC. Furthermore, 86.1% (354/411) were satisfied with the quality of IBD follow-up and only 4.1% (17/411) were dissatisfied. Most dissatisfaction was related to: lack of focus on personal relations (18.2%), HRQoL (15.1%), general practitioner knowledge of IBD (13.9%), ability to talk about important topics (7.8%), and hospital discharge communication (9.4%). Higher age and longer disease duration was associated with improved QoC scores in both UC and CD. Fatigue was associated with decreased QoC scores in both diagnoses. Conclusions Patients are satisfied with quality of care in IBD. However, communication seems to be an important area of improvement – not only related to patient–physician communication, but also to transitional communication between different health-care levels.     

Health‐related quality of life in patients with inflammatory bowel disease five years after the initial diagnosis

Background: Health‐related quality of life (HRQOL) has become an important tool in evaluating patient satisfaction in inflammatory bowel disease (IBD). So far, few prospective follow‐up studies have been done to identify variables that influence HRQOL. We aimed to identify demographic and clinical variables that influence HRQOL 5 years after diagnosis in patients with ulcerative colitis (UC) or Crohn disease (CD) included in a prospective follow‐up study from 1990 to 1994 (the IBSEN study). Methods: All patients completed the Inflammatory Bowel Disease Questionnaire (IBDQ), a disease‐specific quality‐of‐life questionnaire translated into Norwegian and validated. We present data from 497 patients (328 UC patients and 169 CD patients, mean age 43.3 years, 48% female). The impact of age, gender, smoking, symptom severity, disease distribution, rheumatic symptoms and surgery on IBD patients' HRQOL was analysed. Results: Women had a reduction in IBDQ total score of 10 points compared to men, CD patients had a reduction of 7.5 compared to UC patients. The patients with moderate/severe symptoms had a 50 points lower score than the patients without symptoms. The patients with rheumatic symptoms had a 10 points lower total score than the patients without these symptoms. All differences were statistically significant. The multiple regression analysis showed that symptom severity, rheumatic symptoms and female gender were the strongest predictors of reduction in HRQOL for both diagnosis groups. Conclusion: IBD symptoms, rheumatic symptoms and female gender have a significant influence on patients' HRQOL as measured by IBDQ. This was confirmed by the regression analysis.     

Quality of life in patients with inflammatory bowel disease: translation, validity, reliability and sensitivity to change of the Norwegian version of the Short Health Scale (SHS)

Purpose

The aims of this study were to investigate the psychometric properties of the Norwegian version of the Short Health Scale (SHS), and to study the impact of socio-demographic and clinical data.

Methods

A total of 140 patients without severe disease activity were included. The participants completed the SHS and three other well-validated HRQoL questionnaires Short Form 36, Inflammatory Bowel Disease Questionnaire and the Rating Form of Inflammatory Bowel Disease Patient Concerns at the baseline. Sixty-three participants completed the SHS at a second visit after 6 months in order to calculate test–retest reliability and responsiveness. In addition, socio-demographic and clinical variables were obtained and entered into a linear regression analysis if they were found to be significantly associated with SHS outcome.

Results

Validity was confirmed by good correlation with other similar HRQoL constructs and the ability to discriminate between IBD symptom scores. The reliability was strong (Cronbach’s α 0.85). The test–retest reliability in three out of four SHS items was weak, but the questionnaire demonstrated a good responsiveness. Current IBD symptoms were the most important predictor of SHS outcome.

Conclusions

The Norwegian SHS demonstrated satisfactory psychometrical properties and is suitable for use in the follow-up of IBD patients.