Ozone therapy versus surgery for lumbar disc herniation: A randomized double-blind controlled trial.

OBJECTIVES: Surgery is the treatment of choice for symptomatic disc herniation after conservative management. Several studies have suggested the potential utility of intradiscal ozone infiltration in this pathology. The aim of this trial was to compare intradiscal ozone infiltration vs. oxygen infiltration vs. surgery. DESIGN AND INTERVENTIONS: This was a randomized, double-blinded, and controlled trial in patients on a waiting list for herniated disc surgery. There were three treatment groups: surgery; intradiscal ozone infiltration (plus foraminal infiltration of ozone, steroids, and anesthetic); intradiscal oxygen infiltration (plus foraminal infiltration of oxygen, steroids, and anesthetic). MAIN OUTCOME MEASURES: The requirements for surgery. RESULTS: Five years after the treatment of the last recruited patient (median follow-up: 78 months), the requirement for further surgery was 20 % for patients in the ozone group and 60 % for patients in the oxygen group. 11 % of patients initially treated with surgery also required a second surgery. Compared to the surgery group, the ozone group showed: 1) significantly lower number of inpatient days: median 3 days (interquartile range: 3-3.5 days) vs. 0 days (interquartile range: 0-1.5 days), p = 0.012; 2) significantly lower costs: median EUR 3702 (interquartile range: EUR 3283-7630) vs. EUR 364 (interquartile range: EUR 364-2536), p = 0.029. CONCLUSIONS: Our truncated trial showed that intradiscal ozone infiltrations decreased the requirements for conventional surgery, resulting in decreased hospitalization durations and associated costs. These findings and their magnitude are of interest to patients and health services providers. Further validation is ongoing.

Are obesity and other physical comorbidities related to mental illness?

BACKGROUND: Several studies have shown that patients with persistent or severe mental illness are at increased risk for obesity, both from the illness itself and from its treatment. Nevertheless, obesity in these patients could be related to other sociodemographic, psychosocial, and genetic factors. AIM: To explore whether obesity, and other physical comorbidity, are more prevalent in long-term psychiatric outpatients as compare to standard population. DESIGN: Cross sectional study in a rural Community Mental Health Setting, comparing physical and demographic data from psychiatric outpatients with data from the general population of the region, controlling for age, gender, body mass index (BMI) and physical comorbidity. RESULTS: Psychiatric patients were older, with higher BMIs and more chronic diseases. They are more frequently diagnosed with hypertension and hyperlipidemia. However, obesity is related to age, gender and comorbidity, but not to the presence or absence of psychiatric illnesses. CONCLUSIONS: Psychiatric patients are more obese than the general population, but it might be related to physical and demographic correlates: age, chronic illness and lifestyle. These factors can be also responsible for their increase risk of hypertension and hyperlipidemia. All those factors could be more relevant than the presence of mental illness itself or its treatment.

Psychomotor performance and fitness to drive: the influence of psychiatric disease and its pharmacological treatment.

Both psychiatric disorders and psychiatric drug treatments produce changes of psychomotor performance which can disturb and/or interfere with the ability to drive safely. We studied the influence of current psychiatric drug treatments on psychomotor functions and on driving performance of 77 consecutive psychiatric outpatients in two different clinical situations: at admission, when patients are destabilized and their mental disorders untreated, and after 6 weeks of pertinent psychotropic treatment. Fitness to drive and psychomotor performance were assessed using the electronic LNDETER 100 battery. Treatment effects on global functioning were assessed using the Clinical Global Impression of Change (CGIC) scale. One-way repeated measures analysis of variance and post hoc comparisons with the Bonferroni correction were performed. At the time of diagnosis, 90% of the patients failed to achieve scores sufficient to renew their driving licenses. After 6 weeks of adequate treatment, 83% improved their mental condition, and 17% either remained unchanged or deteriorated. Of those who improved, 25% had scores sufficiently high for them to drive legally, and the rest improved their performance from baseline assessment. Three of the four sub-tests were able to discriminate between patients with different clinical conditions. The study clearly suggests that medical treatment of psychiatric problems has a positive effect on driving tests.