[Lumbar disk prolapse surgery with or without free fat transplantation. A prospective triple-blind randomized study]. / Lumbal diskusprolaps-operation med eller uden fri fedt-transplantation. Prospektivt tripelblindt randomiseret studie.

The aim of this prospective triple-blind randomized study was to determine if a free fat transplant used in operation in lumbar disc herniation could reduce the degree of intraspinal scar tissue and to evaluate whether the scar tissue could lead to symptoms. Ninety-nine patients were subsequently examined after median 376 days. The clinical outcome was scored using the Low Back Pain Rating Scale. Enhanced CT-scanning was assessed regarding the degree of scar tissue and survival of the fat transplant. There was no difference in the clinical outcome between the two groups. Significantly fewer had dural scarring in the group who had a free fat transplantation, but there was no difference regarding the degree of radicular scarring. The transplant was shown on CT-scan at the follow-up examination in 66% of the patients who had a fat transplantation. Free fat transplantation can reduce the degree of dural scar tissue after operation for lumbal disc herniation, but does not result in a clinically better outcome.

First-time operation for lumbar disc herniation with or without free fat transplantation. Prospective triple-blind randomized study with reference to clinical factors and enhanced computed tomographic scan 1 year after operation.

STUDY DESIGN: This prospective triple-blind randomized study of 99 patients concerned the use of free fat transplantation for operation for lumbar disc herniation. OBJECTIVE: To subsequently examine the patients after median 376 days who were subjected to enhanced computed tomographic scan. SUMMARY OF BACKGROUND DATA: In studies on experiments with animals, the degree of intraspinal scar tissue has shown to be reduced in connection with free fat transplantation. Scar tissue is seen frequently after operation for lumbar disc herniation, but it is uncertain whether the scar tissue can lead to symptoms. METHODS: The clinical outcome was scored using the Low Back Pain Rating Scale. Enhanced computed tomographic scan was assessed regarding the degree of scar tissue and survival of fat transplant. RESULTS: There was no different in the clinical outcome between the two groups. Significantly fewer patients had dural scarring in the group who had a fat transplantation, but there was no difference regarding the degree of radicular scarring. The transplant was shown on computed tomographic scan at the follow-up examination in 66% of the patients who had a fat transplantation. CONCLUSIONS: Free fat transplantation can reduced the degree of dural scar tissue after operation for lumbar disc herniation but does not result in a clinically better outcome.

Retroperitoneal fibrosis treated with methylprednisolon pulse and disease-modifying antirheumatic drugs.

The conventional treatment of patients with ureteric obstruction due to retroperitoneal fibrosis (RF) is surgery in combination with long-term corticosteroids. This report describes 11 cases of RF with ureteric obstruction treated with methyl-prednisolon pulse therapy (MPPT) in combination with azathioprine or penicillamine following initial insertion of ureteral stents. The medial treatment suggested was successful in 7 patients, but only moderately effective in the last 4 patients. This principle of non-operative management of RF has not been previously reported.

Back pain, sciatica and disability following first-time conventional haemilaminectomy for lumbar disc herniation. Use of "Low Back Pain Rating Scale" as a postal questionnaire.

To determine the value of "Low Back Pain Rating Scale" as a postal questionnaire, a retrospective study was undertaken of patients who had undergone first-time lumbar disc surgery 14-72 months previously. Rate of response was 86% (261/304). From the results, it was concluded that 87% of the patients felt that a satisfactory surgical outcome was obtained; 67% had minor or major functional restrictions of their daily activities; 65% experienced significant low-back symptoms in the period prior to follow-up examination; and 57% experienced sciatica. Thirty-seven patients were receiving pensions in the postoperative period due to continued back pain. "Low Back Pain Rating Scale" used as a postal questionnaire was found to be useful in determining general overall assessment status in patients who had undergone lumbar surgery. This evaluation method could be used as a quality control in future studies regarding this patient group.

Analysis of preoperative prognostic factors in first-time surgery for lumbar disc herniation, including Finneson's and modified Spengler's score systems.

In a retrospective study, 18 preoperative demographic and physical variables were evaluated for their preoperative prognostic value in 261 patients, following first-time lumbar disc surgery. Special reference was given to the Spengler and Finneson index-scores. "Low Back Pain Rating Scale" was used as the outcome assessment instrument. Comprehensive statistical analysis was undertaken in order to separate only the contingently independent variables. Gender was a highly significant prognostic factor. Other independently statistically significant prognostic factors include dermatomal hypoalgesia, smoking, and the Finneson index score. Results of the study are discussed with reference to the available literature.

Peroperative prednisolone fails to improve the clinical outcome following surgery for prolapsed lumbar intervertebral disc. A randomized controlled trial.

Ninety three patients undergoing their first conventional hemilaminectomy for lumbar disc protusion were randomized to a double blind clinical trial. Half of the patients were treated immediately following surgery with prednisolone; 50 mg per day for fourteen days and then 25 mg per day for another 14 days. The other patients were treated for the same time period with placebo tablets. Assessments using subjective and objective outcome criteria at 26 weeks, 52 weeks and 156 weeks of follow-up, demonstrated no statistically significant differences between the randomized groups. It is concluded that systemic prednisolone administration in the pre- and postoperative period does not in this study improve the clinical outcome after first time lumbar discectomy.

Intensive dynamic back exercises with or without hyperextension in chronic back pain after surgery for lumbar disc protrusion. A clinical trial.

Sixty-two patients with chronic low back pain occurring 14-60 months after undergoing discectomy for the first time were randomized to two physical treatment groups: 24 sessions of intensive dynamic back exercises with hyperextension or 24 sessions of intensive dynamic back exercises without hyperextension. At the conclusion of therapy and at one-year follow-up, no difference was seen between the randomized groups, with regard to the combined assessments of pain, disability and objective measurements. A difference for back exercises without hyperextension to be superior to the other treatment regimen was statistically significant at the three-month follow-up. In the patient's qualitative assessment of treatment outcome there were seen no significant differences between back exercises with or without hyperextension. There was a similar and significant improvement of the isometric endurance of back muscles in both groups, but the flexibility of the spine was significantly improved only in the group using hyperextension exercises. The overall response rate of an earlier published investigation was reproduced. It is concluded that chronic back patients after first time discectomy may benefit from an intensive rehabilitation protocol including intensive exercises. The added use of hyperextension exercises does not confer any independent benefit. Furthermore, the training had to continue for more than 2-3 months before a statistical significant decrease in back pain was reported in the patient pain diary.

[Psychological stress before, during and after hospitalization for low back disease. Patients' experience illustrated by qualitative interviews]. / Psykisk belastning før, under og efter indlaeggelse for laenderygsygdom. Patientoplevelser belyst ved kvalitative interview.

Thirteen patients were interviewed 14 days after discharge for low back disease requiring hospitalization with the object of illustrating their experience of the period of waiting for admission, treatment in the primary and secondary health services, their relationships to children living at home during their illness and the effect of the low back disease on sexual life. The patients stated that the period of waiting was the worst, dominated by pain, uncertainty, loss of sleep and lowered self esteem. Treatment in the primary health sector was found to be unsatisfactory as regards relief of pain but satisfactory as regards contact with the general practitioner. In the secondary health sector, relief of pain was found to be satisfactory to varying extents while better contact with the doctor treating the case and the staff as a whole could be desired. Waiting and uncertainty while waiting for a diagnosis and result of treatment, inactivity and the poor contact with the staff were considered by the patients to be contributory causes to the increasing mental vulnerability. The relationship to children living at home was dominated by bad conscience prior to admission and by poor contact during hospitalization. Conditions improved after discharge. Practically no sexual activity occurred during the illness. This was not primarily experienced by the patients as a problem but they feared it might be so in the long run. Patients stated that they required mental support during hospitalization, better information and advice about practical problems after discharge.

[The social and occupational situation of patients 2 1/2 years after hospitalization for low back pain]. / Rygpatienters sociale og erhvervsmaessige situation 2 1/2 år efter indlaeggelse for laenderygsygdom.

Sixty-two of 84 patients hospitalized consecutively for low back pain completed a questionnaire during hospitalization and seven months and 30 months after hospitalization. Out of 43 patients who were occupationally active at the time of admission to hospital, only 23 were still occupied 2 1/2 years after. Fourteen had been granted disability pensions, two were under rehabilitation, two were unemployed and two were on sick leave and had lost their jobs. Patients who were under rehabilitation or on sick leave at the time of admission but had lost their jobs, had now been awarded disability pensions. Seven months after admission, twelve patients had been dismissed from work; of these two were now at work again and seven were disability pensioners. Significant associations were found between rejection from the labour force and the following variables: presence of pain, failure of resumption of work seven months after hospitalization, sick-leave longer than 120 days and dismissal from work after hospitalization. Low educational level and age over 45 years were also associated with rejection, and there was an almost significant trend for patients belonging to social classes 4 and 5. 72% of the patients still had low back pain at least once a week, slightly less than half the patients experienced sexual problems because of the back disease, and more than half had given up at least one leisure activity. 23% used analgesics or non-steroid-anti-inflammatory drugs every day. While 58% considered that the disease was caused by work, only six had applied for and two had been awarded compensation for occupational disease or injury.

Standardised Nordic questionnaires for the analysis of musculoskeletal symptoms.

Standardised questionnaires for the analysis of musculoskeletal symptoms in an ergonomic or occupational health context are presented. The questions are forced choice variants and may be either self-administered or used in interviews. They concentrate on symptoms most often encountered in an occupational setting. The reliability of the questionnaires has been shown to be acceptable. Specific characteristics of work strain are reflected in the frequency of responses to the questionnaires.

Auranofin versus penicillamine in rheumatoid arthritis. One-year results from a prospective clinical investigation.

Forty patients with definite or classical active rheumatoid arthritis were stratified by the minimization procedure to auranofin (6 mg/day) or penicillamine (go slow and low regime). This investigation is a prospective planned 3 year patient and 'doctor-open' as well as 'doctor-blind' clinical trial. This article describes the results after 12 months. Both drugs decreased disease activity and improved the functional capacity in a similar way. Two patients in the auranofin group and 5 in the penicillamine group stopped treatment due to major side effects. Four other patients in the auranofin group left treatment: 2 due to death from unrelated cause and 2 according to the Helsinki II Declaration. After one year a further patient in the auranofin group and 2 in the penicillamine group stopped treatment due to lack of clinical effect. Side effects due to auranofin were statistically more frequent distal in the gastrointestinal tract (loose stools/diarrhoea) than with penicillamine. In contrast, penicillamine produced significantly more side effects in the oral cavity (mainly taste disturbances) than auranofin. Other side effects were about equal in the two groups, but 2 cases of severe proteinuria and one with obstructive lung disease were observed in the penicillamine group. Only 3 patients did not complain of any untoward effect during the 12-month period. We conclude that on the basis of this one year investigation it is an open question whether one should select auranofin or penicillamine for the treatment of clinical active rheumatoid arthritis.

Hepatitis A, B, and non-A, non-B in Danish hospital nursing staff.

A stratified age matched sample of 564 general hospital nurses, assistant nurses, and porters was studied for antibody to hepatitis A virus (anti-HAV), hepatitis B surface antigen (HBsAg), and antibody to hepatitis B surface antigen (anti-HBs), and these data were compared with serum aspartate aminotransferase (AST) and identified episodes of hepatitis. The overall prevalence of anti-HBs was increased twofold compared with blood donors, while no evidence of increased exposure to hepatitis A virus was found. The serological survey showed porters to have a significantly higher prevalence of hepatitis A virus (52%) as well as hepatitis B virus (10.2%) markers compared with the nurses and assistant nurses (39% and 5.3% respectively). In contrast, the clinical data showed the incidence of hepatitis to be four times higher in nurses than in the two other groups during hospital employment. The serological survey may reflect differences in social background of the groups, while the clinical data identified nurses as having the highest occupational hepatitis risk. A number of episodes of hepatitis in nurses appeared to be due to non-A, non-B agents. AST values, however, did not show any case of liver inflammation not attributable to alcohol. Thus chronic non-A, non-B infections could not be shown in this population group.