The Neck Disability Index (NDI) and its correlation with quality of life and mental health measures among patients with single-level cervical disc disease scheduled for surgery.

BACKGROUND: The Neck Disability Index (NDI) is widely used as a self-rated disability score in patients with cervical radiculopathy. The purpose of this study was to evaluate whether the NDI score correlated with other assessments of quality of life and mental health in a specific group of patients with single-level cervical disc disease and corresponding radiculopathy. METHODS: One hundred thirty-six patients were included in a prospective, randomized controlled clinical multicenter study on one-level anterior cervical discectomy with arthroplasty (ACDA) versus one-level anterior cervical discectomy with fusion (ACDF). The preoperative data were obtained at hospital admission 1 to 3 days prior to surgery. The NDI score was used as the dependent variable and correlation as well as regression analyses were conducted to assess the relationship with the short form-36, EuroQol-5Dimension-3 level and Hospital Anxiety and Depression Scale. RESULTS: The mean age at inclusion was 44.1 years (SD ±7.0, range 26-59 years), of which 46.3 % were male. Mean NDI score was 48.6 (SD = 12.3, minimum 30 and maximum 88). Simple linear regression analysis demonstrated a significant correlation between NDI and the EuroQol-5Dimension-3 level [R = -0.64, 95 % confidence interval (CI) -30.1- -19.8, p < 0.001] and to a lesser extent between NDI and the short form-36 physical component summary [R = -0.49, 95 % CI (-1.10- -0.58), p < 0.001] and the short form-36 mental component summary [R = -0.25, 95 % CI (-0.47- -0-09), p = 0.004]. Regarding NDI and the Hospital Anxiety and Depression Scale, a significant correlation for depression was found [R = 0.26, 95 % CI (0.21-1.73), p = 0.01]. Multiple linear regression analysis showed a statistically significant and the strongest correlation between NDI and the independent variables in the following order: EuroQol-5Dimension-3 level [R = -0.64, 95 % CI (-23.5- -7.9), p <0.001], short form-36 physical component summary [R = -0.41, 95 % CI (-0.93- -0.23), p = 0.001] and short form-36 mental component summary [R = -0.36, 95 % CI (-0.53- -0.15), p = 0.001]. CONCLUSION: The results from the present study show that the NDI correlated significantly with a different quality of life and mental health measures among patients with single-level cervical disc disease and corresponding radiculopathy.

Treatment of vestibular schwannomas. Why, when and how?

Sporadic vestibular schwannoma (VS) causes unilateral hearing loss, tinnitus, vertigo and unsteadiness. In many cases, the tumour size may remain unchanged for many years following diagnosis, which is typically made by MRI. In the majority of cases the tumour is small, leaving the clinician and patient with the options of either serial scanning or active treatment by gamma knife radiosurgery (GKR) or microneurosurgery. Despite the vast number of published treatment reports, comparative studies are few, and evidence is no better than class III (May, 2006). The predominant clinical endpoints of VS treatment include tumour control, facial nerve function and hearing preservation. Less focus has been put on symptom relief and health-related quality of life (QOL). It is uncertain if treating a small tumour leaves the patient with a better chance of obtaining relief from future hearing loss, vertigo or tinnitus than by observing it without treatment. Recent data indicate that QOL is reduced in untreated VS patients, and may differ between patients who have been operated and patients treated with GKR. In the present paper we review the natural course and complaints of untreated VS patients, and the treatment alternatives and results. Furthermore, we review the literature concerning quality of life in patients with VS. Finally, we present our experience with a management strategy applied to more than 300 cases since 2001.

Acoustic neuroma--treatment modalities. Surgery, gamma-knife or observation?

We present our results of 211 patients with acoustic neuroma over a period of 10 years, 1988-97. We operated on 100 and 111 had Gamma-knife (GK) treatment (69 were available to follow-up). The results are excellent for surgery on small and intracanalicular tumours. In tumours of the same size, surgery and GK treatment give comparable, but somewhat different, results. In the GK group of 54 primary treated patients, 3 patients had to be operated on and another 4 developed hydrocephalus. A group of 35 acoustic tumours was observed for more than 3 years. Nineteen did grow (54%). Hearing was unchanged in 23%. We performed surgery in 11 patients and gave 2 patients GK treatment because of tumour growth of > 2 mm in diameter a year. We conclude that either treatment is effective for small and medium-sized acoustic neuromas. Hearing preservation was best in the GK-treated group (80%), compared to only 12.5% in the group operated via the suboccipital route. Larger tumours and most medium-sized tumours should be operated, as should smaller tumours with persistent symptoms of vertigo and pain. Medical contraindications to surgery or reluctance to undergo surgery make GK treatment a good alternative. Treatment of residual tumours with the GK could also be a solution to a difficult problem.

[Central nervous pain in patients with spinal cord injury. Medical and surgical treatment]. / Sentral neurogen smerte ved traumatisk ryggmargsskade. Medikamentell og kirurgisk behandling.

About 50% of patients with spinal cord injury suffer from persistent central neurogenic pain. The authors review the case of a patient with traumatic paraplegia who developed persistent central neurogenic pain. The pain was described as burning in the buttock area, icing in the rectum area and as lancinating pain to the lower extremities. The combination of amitryptilin and morphine had a slight, short-term effect, but the pain did not respond to treatment with simple analgetica, dextropropoxyphen or ketobemidone, neither administered alone nor in combination with tricyclic antidepressants, carbamazepine or baclophen. Transcutanous nerve stimulation and acupuncture had no effect. The patient was operated on by means of the computer-assisted dorsal root entry zone (DREZ)-microcoagulation technique 2.5 years after the trauma. This technique is described in brief. The prevalence and classification of neurogenic pain, and possible medical and surgical treatment, are also discussed.

[Atypical sciatica. Decreasing pain and increasing paresis--a serious sign]. / Atypisk isjias. Avtakende smerte og økende parese--et alvorlig tegn.

During the last seven years 14 patients with lumbar disc hernias were admitted who presented with a short period of sciatica before experiencing relief of pain accompanied by paresis. Ten patients had marked paresis and were operated on, most of them during the first week after the start of paresis. Three patients had minor paresis in regression, and one patient suffered complete paralysis for five months. These four patients were not operated on. Motor function improved significantly in nine out of ten operated patients. Four of them had no paresis at all. The three patients with mild paresis in regression still showed some motor impairment 9-24 months later, and the condition of the patient with paralysis remained unchanged. In conclusion, patients who develop painless sciatica and marked paresis deteriorate seriously, and early surgery is necessary in order to avoid permanent disturbance of motor function.

Effects of water temperature on performance: a practical evaluation of a neutral buoyancy facility.

Manual and cognitive performance of two female and four male divers was evaluated in "cold" and "warm" water in a Neutral Buoyancy Facility (NBF). A test battery of six manual and cognitive tests was applied in a fixed sequence in three separate, 3-h dives: Dive 1) Water temp.: 18-19 degrees C, wet suit 3-5 mm thick; Dive 2) Water temp.: 32-33 degrees C bathing suit and T-shirt; and Dive 3) Water temp.: 18-19 degrees C, tailor made wet suit 6.5 mm thick. No significant differences in performance between the three conditions were recorded. Mean rectal temperatures decreased by 1 degree C in all dive conditions, except in females in Dive 2. Ventilation was significantly higher in Dive 1 than in Dives 2 and 3. Thermal discomfort was reported only after 2 h in Dive 1. We suggest that support divers may work safely, comfortably and effectively for at least 2 h in water of 18-19 degrees C, if dressed in thermal protective wet suits.

Pulmonary mechanical function and diffusion capacity after deep saturation dives.

To assess the effects of deep saturation dives on pulmonary function, static and dynamic lung volumes, transfer factor for carbon monoxide (T1CO), delta-N2, and closing volume (CV) were measured before and after eight saturation dives to pressures of 3.1-4.6 MPa. The atmospheres were helium-oxygen mixtures with partial pressures of oxygen of 40-60 kPa. The durations of the dives were 14-30 days. Mean rate of decompression was 10.5-13.5 kPa/hour. A total of 43 divers were examined, six of whom took part in two dives, the others in one only. Dynamic lung volumes did not change significantly but total lung capacity (TLC) increased significantly by 4.3% and residual volume (RV) by 14.8% (p less than 0.05). CV was increased by 16.7% (p less than 0.01). The T1CO was reduced from 13.0 +/- 1.6 to 11.8 +/- 1.7 mmol/min/kPa (p less than 0.01) when corrected to a haemoglobin concentration of 146 g/l. Effective alveolar volume was unchanged. The increase in TLC and decrease in T1CO were correlated (r = -0.574, p less than 0.02). A control examination of 38 of the divers four to six weeks after the dives showed a partial normalisation of the changes. The increase in TLC, RV, and CV, and the decrease in T1CO, could be explained by a loss of pulmonary elastic tissue caused by inflammatory reactions induced by oxygen toxicity or venous gas emboli.

Giant cell glioblastoma: a work-up of 2 cases with long survival.

Two patients, in whom visual disturbance (Case 1) and sudden hemiparalysis due to a hemorrhagic lesion (Case 2) had led to craniotomy and histological diagnosis of giant cell glioblastoma, each had an unexpectedly long survival period of 7 and 9 years, respectively. Radiologically, the tumours were well demarcated, but without any distinguishing features, by comparison with glioblastomas in general. The tumours, to a great extent, consisted of cells with large, bizarre multiple nuclei. The highly pleomorphic cells displayed strong cytoplasmic GFAP immunopositivity, which suggested an astroglial origin. Thus, these tumours were considered a variant of glioblastoma ("giant cell glioblastoma") with a more favourable prognosis than experienced by most patients with glioblastoma.

Glioblastoma associated with multiple sclerosis: coincidence or induction?

A 63-year-old man died of a brain tumor 29 years after onset of multiple sclerosis (MS). The MS diagnosis was based upon clinical evidence of two brain stem lesions, separate in time, retinal periphlebitis, a fluctuating course of the disease, and supported by the observation of definite cognitive impairment at the age of 41 years, and an increased number of lymphocytes in the cerebrospinal fluid which normalized during gradual recovery. The MS diagnosis was confirmed at autopsy, which also revealed a glioblastoma developing adjacent to typical MS plaques.

Elevated concentrations of glutamate and aspartate in human ventricular cerebrospinal fluid (vCSF) during episodes of increased CSF pressure and clinical signs of impaired brain circulation.

In the ventricular cerebrospinal fluid (vCSF) of 10 hydrocephalic patients the mean (+/- S.D.) concentrations of glutamate and asparate were 2.9 +/- 0.2 and 0.2 +/- 0.2 microM, respectively. Significantly higher concentrations of these amino acids were found in two patients (glutamate 37.8 and 22.4 microM, aspartate 2.2 and 0.6 microM) with symptoms of impaired brain tissue perfusion, i.e. relative ischemia due to severely increased intraventricular CSF pressure. Our results are consistent with recent experiments in rats showing increased extracellular concentrations of glutamate and aspartate during transient cerebral ischemia.