Prospective study of microdiscectomy for lumbar disc herniation: evolution of pain, quality of life and satisfaction of Lebanese patients at short and long-term follow-up

Lumbar disc herniation frequently affects young patients and is responsible for high rate of worker's compensation claims. The aim of this study is to evaluate at short and long term the results of microdiscectomy in terms of pain control, quality of life and patient's satisfaction. In this prospective study, 28 patients were enrolled and operated on by micro- discectomy for lumbar disc herniation. Three questionnaires were administered preoperatively. They evaluated the pain, the quality of life and the expectation of the patients. Four questionnaires were administered at six months and two years postoperatively evaluating pain, quality of life, results and satisfactions. A 62.3% and 53.2% improvement of low back pain at 6 months and 2 years respectively, and a 91.7% and 88.4% improvement of radicular pain were reported. A 73,2% and 79.8% improvement in quality of life was recorded respectively. Patient's expectation was evaluated at 3.85 and results estimated 3.24. Patient's satisfaction was 93.3% and 88.3% respectively. It was positively correlated to radicular pain, and inversely correlated to patient's expectations. Microdiscectomy for lumbar disc herniation offers a marked improvement in back and radicular pain. Quality of life is much improved. Although satisfaction is high, it is somewhat decreased for patients with high expectations

[Brain tumors and epilepsy: postoperative evaluation of surgical procedures]

To study the efficacy of surgery on the postoperative control of epilepsy in patients operated for brain tumors. Forty patients operated for supratentoriel cerebral tumors with epilepsy, at Hotel-Dieu de France [HDF] hospital center, between 1983 and 2005, were included in this study. Clinical, paraclinical and surgical information were collected. The extent of the tumor resection was based on the postoperative MRI results. The mean duration of the follow-up was 52 +/- 6 months [from 6 months to 10 years]. 62.5% of our patients have had acute seizures [<1 year] and 37% had experienced chronic seizures [>/= 1 year]. The histopathologic exam revealed 2 DNET, 3 pilocytic astrocytomas, 2 diffuse astrocytomas, 6 A oligodendrogliomas, 7 B oligodendrogliomas, 7 anaplastic astrocytomas and glioblastomas and 13 meningiomas. Twenty-two patients had a complete resection, whereas the postoperative MRI of 18 patients have shown a tumoral remnant. After one year of follow-up, a complete remission was noted in 57,5% of the patients [EngelI]. The prognostic factors of good outcome were: low-grade glial tumors [I +/- II], meningiomas, and complete tumor resection. The efficacy of surgery for epilepsy associated to cerebral tumors, established by the majority of articles, matched the results obtained for the patients operated at HDF, with complete seizures control in 57,5% of patients. This control depended essentially on the extent of tumor resection and on tumor's nature

Chronic subdural haematoma: a comparative study between twist-drill craniostomy and burr-hole technique

Surgical treatment of chronic subdural haematoma [CSH] is well established but the optimal technique to be used is still controversial. We performed a non-randomised retrospective comparative study on 154 patients with 199 CSHs [45 being bilateral] operated at the Hotel-Dieu de France Hospital between January 1995 and January 2004. The mean age was 61 years with male to female ratio of 125 male / 29 female. The two categories of patients treated with trepanation and twist-drill were comparable regarding age, sex, bilateral, clinical score of Markwalder and computed tomography scan results. The surgical technique used was trepanation in 109 and twist-drill in 45. The twist-drill technique is that described by Shulman with some modifications. Clinical evaluation was performed at 1 and 6 months after surgery. The postoperative complications, mortality and recurrence rate were respectively 10, 0.91 and 13.75% in the trepanation group and 2.2, 0.5 and 2.2% in the twistdrill group. Hospitalisation time was significantly lower in the twist-drill group [40% of the patients were discharged on the third day compared to 10% in the trepanation group]. We believe that the twist-drill technique for evacuation of CSH is less invasive, can be performed under local anaesthesia and allows for slow decompression of the brain with less complications, decreased possibility of recurrence and shorter hospital stay. More prospective randomised studies are needed to confirm this treatment of choice

[Microsurgical facial nerve decompression for hemifacial spasm]

The results of a series of 8 patients with hemifacial spasm [HFS], treated with microsurgical vascular decompression [MVD] are reported. A magnetic resonance imaging [MRI] of the brain was performed in all patients prior to surgical. The presence of arterial hypertension [HT] was noted. MVD was performed through a retromastoid approach, and Gortex [rigestrited sign] was interposed between the nerve and the conflicting vessel. The offending vessels found were: the antero-inferior cerebellar artery in 50% of the cases, the postero-inferior cerebellar artery in 25% and the vertebral artery in 25%. These findings were positively correlated with MRI in only 50% of cases. The surgical resultes were the following: total and immediate relief in 62.5% of cases, delayed relief in 25%, and partial relief in 12.5%. Neither failure, nor recurrence were noted. In terms of complications, two cases of persisting hearing loss, one case of transient hearing loss, and two cases of persisting facial palsy. Hypertension improved in 20% of cases. This study shows the success of MVD in the treatment of HFS. Intraoperative monitoring is helpful in reducing the complication rate. In our practice, the correlation between MRI findings and surgery was poor, as opposed to the results found in literature

[Lumbar synovial cysts: six case studies]

The purpose of this study is to discuss the clinical and radiological aspects as well as the controversies in the management of lumbar synovial cysts. We report a retrospective analysis of a series of 6 cases of lumbar synovial cysts. Patients presented with unilateral radicular pain mimicking a disc herniation. An MRI [magnetic resonance imaging] was performed in all patients. A computerized tomography scan was performed in one case and X rays in 2 cases. All patients were operated on and the cyst resected. Arthrodesis was not performed in any of our patients. Functional outcome was marked by a significant improvement. Excellent results were found in 4 patients. Three patients who presented with a motor deficit recovered after the surgery. Lumbar synovial cysts should be considered in the differential diagnosis of any radicular compression. MRI is the examination of choice. Surgical resection is the definitive treatment with low rates of complications and recurrences

Urodynamic studies with noristerat

Cystometry, urofiowmetry and profilometry were done for 20 women to study the effect of one injection of Noristerat [200mg norethisterone enanthate] on the lower urinary tract function. Cystometric studies after injection revealed a non-significant increase in volume at first sensation to void and volume at maximum cystometric capacity. Also, there was a non-significant decrease in detrusor contraction at first sensation, but there was a significant decrease in detrusor contraction at maximum cystometric capacity, as well as a non significant decrease in maximum detrusor activity. Results of urethral pressure profile showed no significant difference before and after injection as regard maximum urethra pressure, urethral closure pressure and functional urethral length. Results of uroflowmetric studies before and after injection showed no difference in both maximum flow rate and average flow rate but a non significant increase in flow time, voided volume and residual volume were demonstrated after injection. The results of the present work suggest that Noristerat injectable contraceptive increases the bladder capacity and decreases bladder tone but does not affect the urethral physiology, Enuresis did not recur in women who were enuretic during adolescence after a single Noristerat injection. However, the implication of these results on problems of recurrent enuresis after prolonged use of Noristeral and treatment of detrusor instability by progestogens still deserve more investigation with prolonged use

Fluconazole single oral [150 capsules] in the treatment of vaginal candidiasis

Fluconazole in single oral 150 mg capsule was used to treat fifty females with vaginal candidiasis. Pruritus, discharge and burning were very prominent in all cases before therapy. Follow-up of these symptoms after treatment showed disappearance of the above symptoms in 5, 41 and 46 cases respectively in visit 2 [7-14 days after treatment] while improvement of the same symptoms occurred in the rest of the cases. High mycological response was achieved, as the organism was eradicated in 43 cases in visit 2 [7-14 days after therapy]. The drug showed excellent tolerability in 48 cases without any side effects while mild transent gastric upset was reported in 2 cases