The development of the Tuebingen Cushing's disease quality of life inventory (Tuebingen CD-25). Part I: construction and psychometric properties

Objective To develop a disease‐specific questionnaire for Cushing’s disease (CD), the Tuebingen Cushing’s disease quality of life inventory (Tuebingen CD‐25). Methods Sources for item generation consisted of technical literature, interviews with patients and the rating of neurosurgeons, endocrinologists and a neuropsychologist. A preliminary inventory with 64 items was handed out to 63 CD patients. Twenty‐eight patients filled out the questionnaire preoperative, the remaining 35 patients evaluated their health‐related quality of life (HRQoL) retrospectively. Item reduction and scale generation followed the principles of classical test theory. Validation was performed with the WHOQoL‐BREF. Results The final version of the Tuebingen CD‐25 contained 25 items, showed high reliability (Cronbach’s alpha = 0·93) and validity (r = ?0·65) and includes the subdomains Depression, Sexual Activity, Environment, Eating Behaviour, Bodily Restrictions and Cognition. The retrospective rating of the Tuebingen CD‐25 showed similar results compared to the pretreatment group. We found a non‐linear correlation between the Tuebingen CD‐25 scores and patients’ age, younger (21–30 years) and middle‐aged (51–60 years) patients having inferior HRQoL than patients between 31 and 50 years and older than 61 years. Preoperative 24 h urinary free cortisol (UFC) levels correlated significantly with the subscale Cognition and only marginally failed significance level for the subscale Eating Behaviour, while preoperative cortisol and ACTH levels did not correlate with any scale. Conclusion The Tuebingen CD‐25 is a valid and reliable instrument to evaluate HRQoL in CD. Based on impairment of HRQoL for the different subdimensions, specific support can be offered to the patients.     

Health-related quality of life and psychiatric symptoms improve effectively within a short time in patients surgically treated for pituitary tumors—a longitudinal study of 106 patients

Background

Reduced health-related quality of life (HRQoL) is a common complaint in patients suffering from pituitary tumors. Although successful tumor treatment has been reported to lead to an improvement in perceived HRQoL, the temporal gradient at which these improvements occur has not been fully addressed.

Methods

Using three validated health-related questionnaires (SF-36, SCL-90-R, QLS-H), we assessed HRQoL in 106 adult patients harboring pituitary tumors (mean age 48.0?±?16.0 years) before as well as 3 and 12 months after initiation of treatment. The AcroQoL questionnaire was additionally applied in acromegalic patients.

Results

There was a significant improvement in all but one scale (role-physical) of the SF-36 questionnaire and all but two scales (interpersonal sensitivity, paranoid ideation) of the SCL-90-R, the QLS-H score and the AcroQoL subscales within 3 months after surgical treatment. The trend to amelioration continued at the 12 month re-assessment, but did not reach statistical significance. Linear regression analyses revealed that younger age and male gender favor a more distinct improvement of HRQoL after treatment.

Conclusions

HRQoL is considerably reduced before treatment for pituitary disease. Improvement is an early postoperative phenomenon and occurs within 3 months after treatment. Men and younger patients are more likely to improve within this time span.     

Radical combined colonic resection for cancer recurrence

Experience of reoperative radical combined colonic resection for colonic cancer in 9 patients was presented. There were no complications, nor mortality. The preoperative radiation therapy and chemotherapy conduction had permitted to create an optimal conditions for the surgical intervention performance, which promoted the patients life span increase and improved its quality significantly.     

Restoration of colonic continuity after the Hartmann's surgery

The intestinal continuity restoration after performance of Hartmann's operation in presence of long rectal stump was done using the method of the duplicature anastomosis formation, which was elaborated in the clinic. The frequency of postoperative complications occurrence was 9.8%: In presence of short rectal stump the colon was descended on perineum via submucosal tunnel in rectal stump according to the method, which was elaborated in the clinic. The frequency of the postoperative complications occurrence was 16.7%. The data presented trusts the expediency of application of the methods elaborated in the clinic for restoration of intestinal continuity after performance of Hartmann's operation in presence of long and short rectal stumps.     

Application of endolymphatic therapy using catheterization of femoral lymphatic vessels in complex of treatment of oncological diseases

Endolymphatic way of the medicinal preparations administration promotes their more effective influence on pathological focus. The experience of conduction of more then 15,000 of the lymphatic vessels catheterization manipulations was summarized, permitting to perform the treatment of patients successfully.     

Primary intrasellar schwannoma: clinical, aetiopathological and surgical considerations

Schwannomas originating within the sella turcica are extremely rare. We describe the clinical, radiological and intraoperative findings of a patient with an intrasellar and suprasellar schwannoma. Gross total tumour removal was performed by a trans-sphenoidal approach. Perivascular or ectopic Schwann cells, lateral nerve plexus within the cavernous sinus, as well as Schwann cells from small nerve twigs of the dura are some of the current histopathological hypotheses for the origin of these lesions.     

Antibiotic prophylaxis in penetrating injuries of the chest.

Most prospective studies recommend antibiotic prophylaxis whilst a thoracostomy tube is in place or even longer. We conducted a randomised study of 188 patients with penetrating chest injuries requiring a chest drain. Of these patients, 95 received a single dose of ampicillin before insertion of the chest tube, the remaining 93 patients received additional antibiotic prophylaxis for as long as the drain was in place. The incidence of intrathoracic sepsis (pneumonia or empyema) was 3.1% and 3.2%, respectively. It is concluded that single-dose prophylaxis in penetrating chest trauma is as effective as prolonged prophylaxis. The importance of chest physiotherapy immediately after the drain insertion and of early removal of the drain is stressed. The role of various possible risk factors in the development of sepsis is discussed.