ABSTRACT
Pain in the lumbosacral part of the spine in the course of degenerative disease is the most common cause of physical activity limitation in adults. Treatment includes pharmacotherapy, physiotherapy, psychotherapy, health promotion, and sometimes surgery. Surgical treatment is not always successful, and the various clinical and psychosomatic symptoms that result from surgical treatment failure are known as failed back surgery syndrome. For some patients with this condition, spinal cord stimulation can provide relief. The aim of the work was to define subjective and objective spinal cord stimulation effects by assessing chosen disability and physical activity limitation ratios. Pain intensity, level of disability, and presence of neurological symptoms were assessed. The examination was performed twice: before the stimulator implantation and at least 6 months postimplantation. The study was conducted at the Department of Neurosurgery and Paediatric Neurosurgery in Lublin. Thirty-six patients suffering from failed back surgery syndrome were recruited for this study. The Visual Analog Scale, modified Laitinen's pain questionnaire, and Oswestry Disability Index were used in this work. The study showed that spinal cord stimulation was effective in treating spinal and lower limb pain in 64% of patients, similar to results obtained in other departments. Although back pain and neuropathic pain radiating to the lower limbs decreased, moderate physical activity impairment was still observed according to the Oswestry Disability Index scale. The decrease in neuropathic pain radiating to the lower limbs had the most significant influence on reducing physical activity impairment.
Subject(s)
Chronic Pain/therapy , Failed Back Surgery Syndrome/therapy , Low Back Pain/therapy , Neuralgia/therapy , Spinal Cord Stimulation/methods , Adult , Aged , Aged, 80 and over , Cohort Studies , Female , Humans , Male , Middle Aged , Pain Measurement , Treatment OutcomeABSTRACT
INTRODUCTION: Acute lymphoblastic leukemia (ALL) and its treatment may lead to impairment of kidney function. The aim of the present study was to evaluate kidney function in children after treatment of ALL. We used our 99mTc-DTPA (diethylene triamine pentaacetic acid labeled with 99mTc) dynamic scintigraphy protocol. MATERIAL AND METHODS: The study group consisted of 48 ALL patients, aged 79-275 months, in complete remission (mean duration 51 months). Treatment was according to the guidelines of the Berlin Frankfurt Münster (BFM) BFM 86 and BFM 90 protocols in 36 (75%) and 12 (25%) children, respectively. Follow-up after treatment was up to 12 months in 10 (21%) children (group I), 12-60 months in 21 (44%) children (group II), and more than 60 months in 17 (35%) children (group III). 99mTc-DTPA dynamic renal scintigraphy was done in all patients. The glomerular filtration rate (GFR) was determined according to Gates and the diuretic test was done after 18 minutes of the examination. RESULTS: The glomerular filtration rate at the end of the 5-year follow-up was less than 80 mL/min/1.73 m2 (p < 0.002) in 3 (25%) children treated with the BFM 86 protocol. In the remaining 45 (94%) patients, GFR exceeded 80 mL/ min/1.73 m2. Normal renogram curves were obtained in 40 (83%) patients. Eight (17%) children had cumulative curves with normal clearance. This finding was interpreted as non-obstructive uropathy. There was no statistical correlation between outflow disorders seen during dynamic scintigraphy, type of chemotherapy protocol, and assignment to risks group. CONCLUSIONS: 1. There was no clinically significant kidney function impairment in children after treatment of ALL. 2. Dynamic renal scintigraphy can be a valuable and non-invasive method for the assessment of kidney function in patients with a risk factor in the form of previous potentially nephrotoxic antitumor treatment.
Subject(s)
Kidney/diagnostic imaging , Kidney/physiopathology , Precursor Cell Lymphoblastic Leukemia-Lymphoma/therapy , Adolescent , Adult , Antineoplastic Combined Chemotherapy Protocols/adverse effects , Child , Female , Glomerular Filtration Rate , Humans , Kidney Diseases/chemically induced , Kidney Diseases/diagnostic imaging , Male , Precursor Cell Lymphoblastic Leukemia-Lymphoma/complications , Radionuclide Imaging , Remission Induction , Technetium Tc 99m Pentetate , Young AdultABSTRACT
INTRODUCTION: Acute lymphoblastic leukemia (ALL) and its treatment may adversely affect kidney function. The aim of the present study was to determine whether 99mTc-DMSA static renal scintigraphy can be used to disclose kidney damage at the end of therapy for ALL in children. MATERIAL AND METHODS: The study group consisted of 48 ALL patients aged 6.6-22.9 years, with a mean time of continuous complete remission of 51 months. Static renal scintigraphy with 99mTc-DMSA was performed in all patients. RESULTS: Minor scars in the renal cortex were diagnosed with scintigraphy in 6 (13%) patients. A significant correlation was found between renal scarring and a history of urinary tract infection. CONCLUSIONS: No clinically significant kidney damage was found after completion of treatment of ALL. Static renal scintigraphy may be a valuable noninvasive method for visualization of renal cortex pathology.
