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PubMed2006

Recombinant interferon gamma1b immune enhancement in 20 patients with hematologic malignancies and systemic opportunistic infections treated with donor granulocyte transfusions.

BACKGROUND: The response to antifungal therapy alone often is suboptimal in patients with cancer who have therapy-refractory neutropenia, and even donor-derived granulocyte transfusions (GTX) are not always successful. The authors evaluated the safety and efficacy of immune enhancement using recombinant interferon gamma1b (rIFN-gamma1b) in patients with cancer who received GTX for refractory, systemic, opportunistic infections. METHODS: Twenty recipients of high-dose donor GTX ( approximately 5.5 x 10(10) neutrophils per transfusion) who had received concurrent rIFN-gamma1b between October 2001 and December 2004 were evaluated retrospectively. RESULTS: The median age (+/- standard deviation [SD]) was 45 +/- 17 years. Ten patients (50%) were men, 17 patients (85%) had leukemia, and 3 patients (15%) had myelodysplastic syndrome. The median +/- SD Acute Physiology and Chronic Health Evaluation II score was 15 +/- 4 (range, 7-22). Most patients (n = 18 patients; 90%) had recurrent or refractory cancer. In 6 patients (30%) who received allogeneic hematopoietic stem cell transplantation, GTX plus rIFN-gamma1b was given a median +/- SD of 26 +/- 100 days (range, 12-372 days) after transplantation. Seventeen patients (85%) had neutropenia during GTX therapy. Five patients (25%) had possible invasive fungal infection, 3 patients (15%) had probable invasive fungal infection, and 11 patients (55%) had proven invasive fungal infection. One patient (5%) had refractory Pseudomonas aeruginosa sepsis. Eight patients (40%) received corticosteroids during GTX plus rIFN-gamma1b therapy. Patients received a median +/- SD of 8 +/- 7 GTX doses (range, 4-28 doses) and 9 +/- 7 rIFN-gamma1b doses (range, 1-28 doses), for a mean +/- SD cumulative dose (CD) of 400 +/- 2621 microg. Other concomitant cytokines were granulocyte-colony stimulating factor (12 +/- 3 doses; CD, 6720 +/- 4721 microg) in 15 patients (75%) and granulocyte-macrophage-colony stimulating factor (12 +/- 9 doses; CD, 4750 +/- 4410 microg) in 14 patients (70%). Four patients (20%) developed fever, and 2 patients (10%) developed skin rashes. Reversible liver dysfunction (n = 3 patients; 15%) and tachycardia (n = 1 patients; 5%) were considered rIFN-gamma1b-associated adverse reactions; whereas, in 1 patient (5%), transient dyspnea was attributed to GTX. Four weeks after therapy started, 9 patients (45%) had complete or partial resolution of infection; and, in another 3 patients (15%), the invasive fungal infection had become stable. CONCLUSIONS: The current results indicated that no serious adverse events were associated with rIFN-gamma1b immune enhancement in patients with systemic opportunistic infections who received donor GTX therapy.

Adrenal Cortex Hormones↗
PubMedDate not supplied

Calcium supplementation in premenstrual syndrome: a randomized crossover trial.

OBJECTIVE: To determine the efficacy of calcium supplementation in women with premenstrual syndrome (PMS). DESIGN: Randomized, double-blind crossover trial. SETTING: Outpatient medical clinic of a large city hospital. PARTICIPANTS: Seventy-eight women were initially screened. Trial selection was based on a history of recurrent PMS symptoms and on the results of a prospective assessment of daily symptom scores. Only women with symptom scores during the late luteal phase that were at least 50% greater than those during the intermenstrual phase were selected. Thirty-three women completed the trial. INTERVENTION: A preliminary evaluation included physical examination, routine laboratory tests, dietary assessment, and psychiatric evaluation. Each participant received six months of treatment involving three months of daily calcium supplementation (1,000 mg of calcium carbonate) and three months of placebo. MEASUREMENTS: Efficacy was assessed prospectively by changes in daily symptom scores over a six-month period and retrospectively by an overall global assessment. Multivariate repeated measures analysis of variance on symptom ratings derived from daily PMS symptom scores demonstrated a reduction in symptoms on calcium treatment during both the luteal (p = 0.011) and the menstrual phases (p = 0.032) of the reproductive cycle. Calcium supplementation had no effect during the intermenstrual phase. Retrospective assessment of overall symptoms confirmed this reduction: 73% of the women reported fewer symptoms during the treatment phase on calcium, 15% preferred placebo, and 12% had no clear preference. Three premenstrual factors (negative affect [p = 0.045]; water retention [p = 0.003]; pain [p = 0.036]) and one menstrual factor (pain [p = 0.02]) were significantly alleviated by calcium. CONCLUSION: Calcium supplementation is a simple and effective treatment for premenstrual syndrome, but further studies will be needed to determine its precise role in PMS.

Adult↗
PubMed2005

Pre-formed articulating knee spacer in two-stage revision for the infected total knee arthroplasty.

We performed a prospective study to assess safety and effectiveness of a pre-formed articulating spacer made of gentamicin-impregnated acrylic cement in the management of infected total knee arthroplasty. Twenty-one consecutive patients with unilateral deep infection were treated by two-stage revision in two centres. Two patients were excluded, and 19 patients remained available for assessment. The mean implantation time of the spacer was 12 weeks. The rehabilitation programme between stages consisted in early range of motion exercises and partial weight bearing. Mean follow-up after removal of the spacer and insertion of the final prosthesis was 24 (range, 12-43) months. No patient had recurrence of infection at the latest follow-up. The mean Knee Society functional score during spacer management was rated 75 points and was rated 84 points at the latest follow-up. No device-related complication was observed.

Aged↗
PubMed2006

Feasibility of primary inguinal hernia repair with a new mesh.

BACKGROUND: The purpose of this study was to evaluate the feasibility of primary inguinal repair with open tension-free and sutureless technique using a new polypropylene "patch and plug system" (Prolene 3D patch), and the quality of the treatment in terms of reduction of postoperative discomfort. METHODS: Fifty-six consecutive patients, mean age 54.5+/-11.2 years, with primary unilateral uncomplicated inguinal hernia, were treated in a day-surgery setting. Collected data included: pain scores at 24 hours, 72 hours, and 7, 15, and 30 days after operation, analgesic medications, return to work and to heavy house and/or moderate sporting activities, and quality of life as measured by Short Form 36 health survey questionnaire (SF-36) before the operation and at 6 months follow-up. RESULTS: Postoperative pain was low: the mean visual analog scale (VAS) scores were 2.8 at 24 h, 1.8 at 72 h, and 0.9, 0.3, and 0.04 at 7, 15, and 30 days, respectively. Analgesic drugs were not used by 66.0% (n=37) of the patients. The mean global time to return to work and to heavy activities was 9.9+/-4.6 and 14.6+/-7.0, days, respectively. Patient satisfaction showed a significant improvement in all SF-36 domain scores at 6 months follow-up (P<0.001). There were no major complications, recurrences, or mortality. CONCLUSIONS: The new mesh seems to satisfy all requirements of a feasible, reliable, and effective device for repairing primary inguinal hernia with high patient comfort.

Activities of Daily Living↗
PubMed2004

Genetic complexity of an obesity QTL ( Fob3) revealed by detailed genetic mapping.

Obesity is proving to be a serious health concern in the developed world as well as an unwanted component of growth in livestock production. While recent advances in genetics have identified a number of monogenic causes of obesity, these are responsible for only a small proportion of human cases of obesity. By divergent selection for high and low fat content over 60 generations, we have created Fat (F) and Lean (L) lines of mice that represent a model of polygenic obesity similar to the situation in human populations. From previous crosses of these lines, four body fat quantitative trait loci (QTL) were identified. We have created congenic lines (F(chr15L)), by recurrent marker-assisted backcrossing, to introgress the QTL region with the highest LOD score, Fob3 on Chr 15, from the L-Iine into the F-line background. We have further mapped this QTL by progeny testing of recombinants, produced from crosses between the F-line and congenic F(chrl5L) mice, showing that the Fob3 QTL region is a composite of at least two smaller effect QTL-the proximal QTL Fob3a is a late-onset obesity QTL, whereas the distal Fob3b is an early-onset obesity QTL.

Analysis of Variance↗
PubMed2002

A further modification of fundoplication. 90 degrees anterior fundoplication.

BACKGROUND: Laparoscopic Nissen fundoplication is the most widely applied procedure for the surgical treatment of gastroesophageal reflux. However, it can be followed by adverse outcomes, including dysphagia and "wind-related" problems. To reduce the likelihood of side effects, we have progressively modified this procedure to an anterior 90 degrees partial fundoplication. METHODS: The procedure entails posterior hiatal repair, posterior esophagopexy, accentuation of the angle of His, and construction of a 90 degrees anterior partial fundoplication. Clinical follow-up was performed prospectively using a standardized questionnaire. RESULTS: From February 1999 to June 2001, 83 patients underwent 90 degrees anterior fundoplication for gastroesophageal reflux disease. In 45 the procedure was chosen because of specific patient or surgeon preference, and in 38 it was performed within the context of an ongoing randomized trial. Operating time ranged from 20 to 140 minutes (median, 52 min), and all but one of the procedures were completed laparoscopically. One patient experienced a major postoperative complication--small bowel injury from Veress needle. Follow-up extends up to 2 years (median, 1 year). Two patients have undergone further surgery, both for recurrent reflux. Control of reflux has been acceptable, with a reduction in heartburn symptom scores and high overall satisfaction. Postoperative dysphagia measured using a visual analog scale was less following surgery compared with preoperative scores. Eighty-two percent of patients could belch normally 3 and 12 months after surgery. CONCLUSIONS: Ninety-degree anterior fundoplication achieves good control of reflux and a low incidence of side effects. To further evaluate its potential, we are currently undertaking a prospective randomized trial.

Adult↗
PubMed2005

Traumatic epidural haematomas of nonarterial origin: analysis of 30 consecutive cases.

BACKGROUND: The purpose was to analyse the clinical and radiological findings, and management approaches used in 30 consecutive cases of traumatic epidural haematoma of nonarterial origin treated at one centre. METHOD: Medical records for 30 patients surgically treated for epidural haematoma of nonarterial origin between 1997 and 2003 were reviewed. Epidural haematoma of nonarterial origin was diagnosed based on computed tomography (CT) and the bleeding source was confirmed intra-operatively. Admission status, outcome, fracture location, haematoma location/size/volume, and additional intracranial pathology were among the data noted. Two groups were formed for analysis: venous sinus bleeding (group 1) and other venous sources (group 2). FINDINGS: The 30 cases accounted for 25% of the total number of traumatic epidural haematomas (n = 120) treated during the same period. The epidural haematomas of nonarterial origin locations were transverse sigmoid sinus (n = 11; 36.7%), superior sagittal sinus (n = 6; 20%), venous lakes (n = 5; 16.6%), diploë (n = 5; 0.16%), arachnoid granulations (n = 2; 6.7%), petrosal sinus (n = 1; 3.3%). There were 12 postoperative complications in 9 patients: recurrence (n = 4; 13.3% of the 30 total), pneumonia (n = 4; 13.3%), meningitis (n = 2; 6.7%), hydrocephalus (n = 1; 3.3%) and subdural effusion (n = 1; 3.3%). All recurrence cases were re-explored. Six (20%) patients died. Glasgow Outcome Scale (GOS) scores (mean follow-up 13.3 +/- 7.8 months) revealed 22 (73.3%) patients with favourable results (GOS 4-5) and 8 (26.7%) had poor results (GOS 1-3). CONCLUSIONS: Cases of epidural haematoma of nonarterial origin differ from the more common arterial-origin epidural haematomas with respect to lesion location, surgical planning, postoperative complications, and outcome. Epidural haematoma of nonarterial origin should be suspected if preoperative CT shows a haematoma overlying a dural venous sinus or in the posterior fossa and convexity. The sinus-origin group had a high frequency of fractures which crossed the sinuses, and this might be diagnostically and surgically useful in such cases.

Adolescent↗
PubMed1993

Spectrum of right heart involvement in patients with ventricular tachycardia unrelated to coronary artery disease or left ventricular dysfunction.

We studied 41 patients with clinically symptomatic ventricular tachycardia in the absence of coronary artery disease or left ventricular dysfunction to define the extent of right and left heart derangement and their relation to electrophysiologic and clinical data. Individual echocardiographic measurements as well as global assessment scores of the right and left heart demonstrated a wide spectrum of right heart echocardiographic abnormalities. There was much less variation in the left heart, with the majority of patients being close to normal. There was an association between the right heart score, the clinical presentation of arrhythmia, the response to programmed electrical stimulation, and the recurrence of arrhythmia (p < 0.05). Thus echocardiographic findings demonstrate the whole spectrum of right heart involvement in patients with apparent idiopathic ventricular tachycardia and can give insight into clinical history, arrhythmia inducibility, and prognosis.

Adolescent↗
PubMed1993

Increased hepatocyte expression of hepatitis B virus transcription in patients with features of fibrosing cholestatic hepatitis.

BACKGROUND: Recurrent hepatitis B after liver transplantation may be complicated by fibrosing cholestatic hepatitis. This syndrome is associated with rapid graft failure and is characterized by ballooning degeneration of hepatocytes and abundant viral antigen expression. METHODS: To study this disorder further, in situ hybridization studies were performed on 36 liver biopsy specimens from 14 transplanted patients with recurrent hepatitis B and 18 nontransplanted controls with chronic hepatitis B. Biopsy specimens were scored for histological features and intensity of riboprobe hybridization signal to hepatitis B virus (HBV) DNA and RNA. RESULTS: HBV DNA hybridization signals of 2+ to 3+ intensity were observed in 53% of the posttransplant biopsies but none of the nontransplanted samples (P < 0.001). HBV RNA signals of this intensity were found in 42% of the transplant biopsy specimens compared with 17% of the nontransplant specimens (P < 0.07). Features of fibrosing cholestatic hepatitis were noted in 12 biopsies; 11 of these displayed RNA signals of 2+ to 3+ intensity (92%) compared with 4 of 24 (17%) biopsy specimens without this diagnosis (P < 0.001). The level of hepatocyte RNA correlated with the extent of hepatocellular ballooning (P < 0.007). CONCLUSIONS: These data suggest that fibrosing cholestatic hepatitis is associated with enhanced hepatitis B virus transcription and support a cytopathic role for the virus in the development of this syndrome.

Adult↗
PubMed1994

The effect of hyperthermia on reoxygenation during the fractionated radiotherapy of two murine tumors, FSa-II and MCa.

PURPOSE: To investigate the effect of hyperthermia on the tumor reoxygenation during fractionated irradiations. It has been shown that hyperthermia increases the size of hypoxic cell fraction in some murine tumors and reoxygenation is critical for successful radiotherapy. METHODS AND MATERIALS: Tumors were early generation isotransplants of spontaneous murine fibrosarcoma (FSa-II) and mammary carcinoma (MCa) in C3Hf/Sed mice. Treatments were initiated when they reached an average diameter of 4 mm. A local heat treatment at 43.5 degrees C for 45 min was given in a constant temperature water bath 24 h before irradiation(s). This interval was selected to avoid heat-radiation interaction and to simply investigate the heat effect on the reoxygenation process. Tumors were irradiated under hypoxic conditions or in air and observed for recurrences for 120 days. The foot reaction of animals with controlled-tumors was scored on the last day of experiments. The TCD50 (50% tumor control dose) and RD50 (dose to induce partial foot atrophy in 50% of treated animals) were calculated. RESULTS: The TCD50s following a various number of fractions were obtained for FSa-II and MCa with or without hyperthermia. The difference between the TCD50 (hypoxia) and TCD50 (in air) without hyperthermia increased with an increasing number of fractions, suggesting that significant reoxygenation occurred during the fractionated irradiation. The TCD50s (with heat, in air) were smaller than the TCD50s (radiation alone, in air) following fractionated irradiations, indicating that hyperthermia did not affect tumor reoxygenation. The difference between these TCD50 values was greater for heat-sensitive MCa than for heat-resistant FSa-II, suggesting that this difference was due to additive heat cytotoxicity. An unexpected observation was that heat significantly enhanced the foot reaction with no resultant therapeutic gain for both MCa and FSa-II tumors. CONCLUSION: Hyperthermia given independently prior to fractionated irradiation did not affect tumor reoxygenation, nor was there a therapeutic gain for the two murine tumors. These results suggest that selective tumor heating is essential in clinical thermoradiotherapy.

Animals↗
PubMed2004

Treatment of anterior vaginal wall prolapse with porcine skin collagen implant by the transobturator route: preliminary results.

OBJECTIVE: To assess the feasibility and efficacy of porcine skin collagen (Pelvicol) implant by the transobturator route for the treatment of anterior vaginal wall prolapse. PATIENTS AND METHODS: Twenty-seven women with stage III or IV prolapse underwent anterior vaginal wall repair with porcine skin collagen implantation by the transobturator route, together with bilateral sacropinofixation; respectively 17 and 16 women underwent hysterectomy and bilateral sapingo-oophorectomy during the same procedure. The feasibility and peri/postoperative complications of the transobturator procedure were assessed, together with anatomical and functional outcome. RESULTS: Porcine skin collagen implantation was feasible in every case. The transobturator procedure lasted a median of 25 min (range 20-35). There were no vessel or bladder injuries and no postoperative complications (including infections). Median follow-up was 14 months (range 8 to 24). No rejection of the porcine grafts occurred. Twenty-two women (81%) had optimal anatomic results, while the remaining five women (19%) had persistent asymptomatic stage I or II anterior vaginal wall prolapse (1 and 4 cases, respectively). In one case the collagen implant had to be removed after one year because of persistent pain due to transfixing vaginal stitch. One patient with optimal anatomic results had recurrent stage III Ba prolapse at 18 months. Quality of life and urinary discomfort scores improved significantly after the procedure (p<0.0001 and p<0.005, respectively). CONCLUSION: These preliminary results suggest that porcine skin collagen implantation by the transobturator route is a safe and effective treatment for anterior vaginal wall prolapse.

Aged↗
PubMed2004

Expression of interleukin-11 receptor alpha and interleukin-11 protein in the endometrium of normal fertile women and women with recurrent miscarriage.

Interleukin-11 (IL-11) is a member of the IL-6 family of cytokines. Previous studies have suggested that IL-11 may play a role in human endometrial function. In this study, we have used immunocytochemistry to compare endometrial IL-11Ralpha and IL-11 expression in precisely timed peri-implantation biopsies from 9 normal fertile women and 16 recurrent miscarriage (RM) women. Immunocytochemistry was semi-quantified by obtaining an H-score value, which showed increased expression of both IL-11 and IL-11Ralpha in epithelial cells compared to stromal cells in all biopsies. There was a significant (P<0.01) reduction in epithelial cell IL-11, but not stromal cell IL-11, expression in endometrium from RM women compared to normal fertile women. There were no significant differences in expression of IL-11Ralpha protein in both stromal and epithelial cells in endometrium from the two groups of women. This work shows the presence of IL-11 and IL-11Ralpha within the endometrium of RM women during the peri-implantation period. The decreased expression of IL-11 in epithelial endometrium in RM women suggests that this cytokine may play a role in preventing miscarriage.

Abortion, Habitual↗
PubMed2004

Mixed states in bipolar II disorder: should full hypomania always be required?

The aim of the study was to test whether the definition of depressive mixed states (DMX) in bipolar II disorder should require satisfaction of full criteria for hypomania or if only a few hypomanic symptoms should be required. Consecutive outpatients with bipolar II major depressive episode (MDE) (n=260) were assessed with the Structured Clinical Interview for DSM-IV. Presence of hypomanic symptoms during MDE was systematically assessed, and symptoms were graded by rating scale. The following three definitions of DMX were compared: (1) MDE plus full criteria for hypomania, (2) MDE plus three or more hypomanic symptoms (DMX3), and (3) MDE plus one or two hypomanic symptoms (DMX1-2). DMX definitions were compared on variables typically associated with bipolar disorders (young age of onset, many recurrences, atypical features of depression, and bipolar family history). The distributions of hypomanic symptom scores, age, and age of onset were studied by Kernel density estimation curves and by histograms. Bimodality would support distinct disorders, whereas lack of bimodality would support continuity among the different DMX definitions. The frequency of DMX+full hypomania was 12.3%, that of DMX3 was 46.9%, and that of of DMX1-2 was 38.8%. Comparisons among the groups on bipolar validators found that most differences were not significant. Kernel density estimation curves and histograms did not show bimodality, and had near normal distribution shapes. The findings do not support a categorical definition of bipolar II DMX like that of DSM-IV for bipolar I mixed state but are consistent with a dimensional definition of bipolar II DMX. The high frequency of DMX in bipolar II MDE supports the need for controlled studies to test the effects of antidepressants on depressive mixed state (as clinical observations suggest possible negative effects).

Adult↗
PubMed2001

Target vessel revascularization without cardiopulmonary bypass in elderly high-risk patients.

BACKGROUND: Coronary artery bypass grafting in patients over 75 years is associated with high operative risk. Target vessel revascularization without cardiopulmonary bypass is a promising option for highly selected, older patients. However, the outcome remains uncertain. METHODS: We investigated 44 patients over 75 years, matched for preoperative risk and left ventricular function, who underwent coronary artery bypass grafting either with or without cardiopulmonary bypass (CPB). We analyzed patients characteristics, Parsonnet score, EuroSCORE, short as well as midterm outcome and quality of life (freedom from recurrence of angina, anti-anginal therapy, sf36 test). RESULTS: Perioperative mortality was higher in the patient group operated with CPB (15.9) as compared to patients operated without CPB (4.5%, p = 0.0226). Patients operated with cardiopulmonary bypass received more grafts (3.1 +/- 0.1) than patients operated without cardiopulmonary bypass (1.6 +/- 0.1, p = 0.0001) and and were more likely to undergo complete revascularization (with CPB 100%, without CPB 63.6%, p = 0.0010). Perioperative complications were more frequent and midterm survival was worse in the patient group operated with CPB (log rank p = 0.0228). Quality of life was comparable in both groups. CONCLUSIONS: The concept of incomplete target vessel revascularization of the culprit lesion seems to be a promising option for selected high-risk patients, predominantly due to lower perioperative mortality.

Aged↗
PubMed1993

Fibronectin expression on surgical specimens correlated with the response to intravesical bacillus Calmette-Guerin therapy.

Attachment of bacillus Calmette-Guerin (BCG) organisms to the bladder during intravesical therapy is thought to be mediated exclusively by the glycoprotein fibronectin, which is expressed variably on epithelial surfaces and on basement membranes. We examined the relationship between the degree of fibronectin expressed on surgical specimens obtained from 50 candidates for BCG therapy and the subsequent clinical response. Immunoperoxidase staining for fibronectin was performed on tumor, nonadjacent normal mucosa and basement membrane tissues, and the intensity of the staining was scored on a scale of 0 to 3+ (control 2+). In the absence of recurrence at quarterly surveillance cystoscopy, a course of Tice BCG therapy consisted of 6 weekly and 12 monthly instillations. Recurrence of noninvasive tumor prompted a second BCG course. Followup ranged from 24 to 66 months (median 40 months). Of the 50 patients (11 with carcinoma in situ) disease progression occurred in 9 (none with carcinoma in situ). Compared to the results for tumors or for basement membranes, the degree of fibronectin expression on normal mucosa was well correlated with the clinical response (r = 0.59, p < 0.001 by Kendall Tau B). Routine assessment of fibronectin expression on the normal mucosa associated with superficial bladder cancer may be useful for predicting the clinical response to BCG therapy.

Administration, Intravesical↗
PubMed1996

A long-term outcome study of 170 surgically treated patients with compressive cervical radiculopathy.

BACKGROUND: There is a general impression that publications in neuro-surgical journals have comprehensively evaluated the relative merits of various operative techniques with long-term follow-up in patients treated for compressive cervical radiculopathy. However, in some 20,000 neurosurgical papers over the past 50 years, only 74 (0.3%) have addressed this common surgical problem. METHODS: Long-term outcome was assessed by the standardized Functional Economic Outcome Rating Scale of Prolo. Information was obtained primarily by telephone interviews and office visits. No patients were operated upon without a confirmatory neuroradiologic study. Single level soft discs were removed through a posterior-lateral foraminotomy with hemilaminectomy or laminectomy the root was decompressed by the same technique with hard discs. RESULTS: One hundred seventy patients were operated on from 1959-91 with a 96% follow-up. The mean follow-up period was 15 years. Patients who had sedentary occupations and housewives, had statistically higher Economic Prolo scores (p < 0.001) than those who did strenuous work. Of 10 patients with a total Prolo score of 5 or less, seven did strenuous work and had Workers' Compensation claims; the remaining had legal claims or were at psychologic risk for operation. In 86% of patients outcome was good; defined as a Prolo score of 8 in 5%, 9 in 38%, and 10 in 43%. Of 10 recurrences (6%), seven occurred within 3 years after operation and were treated by discectomy and anterior cervical fusion. There were two patients with postoperative deltoid motor weakness who recovered within 1 year. CONCLUSIONS: Although outcome studies must have subjective criteria, the Prolo Scale is more objective and quantitative than currently used methods. The posterior approach to disc lesions causing compressive cervical radiculopathy should be compared to other techniques using the Prolo Outcome Scale.

Adult↗
PubMed2003

Long-lasting cognitive impairment in unipolar major depression: a 6-month follow-up study.

The aim of the study was to investigate cognitive impairment in major depression both acutely and after 6 months. All patients were investigated within a neurocognitive experimental setting at two testing sessions: at inclusion and after 6 months. Automatic and effortful information processing was investigated with a visual search paradigm. Twenty-one patients with recurrent major depression according to DSM-IV and a Hamilton Depression Rating Scale score >18 were included in the study. Healthy subjects, matched for age and gender, were used as a control group. The results showed that the depressed patients performed equal to the control group on trials requiring automatic information processing at both sessions. However, the patients were impaired compared to the control group on trials requiring effortful information processing, also at both sessions. The depressed patients showed no improvement in cognitive performance from test 1 to test 2. The results indicate that the depressed patients had an impaired performance for effortful, but not automatic, visual search performance, and that the impairment remained after 6 months, despite significant improvement in their depression scores.

Adult↗
PubMed2001

Dysautonomia syndrome in the acute recovery phase after traumatic brain injury: relief with intrathecal Baclofen therapy.

In the initial phase of severe head injury, dysautonomic abnormalities are frequent. Within the framework of a prospective study, evaluating the efficacy of continuous intrathecal Baclofen therapy (CIBT) on hypertonia during the initial recovery phase of severe head injury, the authors report on the preliminary results of this treatment on paroxysmal dysautonomia about four patients. Continuous intrathecal Baclofen infusion was first delivered, for a test period, continuously for 6 days. If a relapse of dysautonomia occurred at the end of the test period, an implantation of a continuous intrathecal infusion pump delivering Baclofen was performed. Results were assessed with four continuous variables; duration (days), dose of Baclofen per day (microg/d), number of dysautonomic paroxysmal episodes per day, and initial recovery evaluated by a scale of the first initial stages of head injury coma recovery. For three patients: (1) the number of dysautonomic paroxysmal episodes per day and the doses of Baclofen during the follow-up period were correlated (p = 0.02, p < 0.001, p = 0.008, respectively, distribution-free test of Spearman), (2) during the test period and the relapse after the test period, the number of paroxysmal episodes and the Baclofen dose are correlated to p < 0.05, p = 0.03, p = 0.04, respectively (distribution-free test of Spearman). The second statistical test was used to prove that Baclofen doses and number of paroxysmal dysautonomic episodes are correlated independently of the duration of follow-up. The fourth patient improved with CIBT without any recurrence at the end of the treatment test period. For the four patients, recovery score increased during the overall follow-up. In the authors' experience CIBT is very efficient to control paroxysmal dysautonomia during the initial recovery phase in severe head injury, and seems to facilitate recovery.

Acute Disease↗