Magnetic resonance imaging findings of the lumbar spine, back symptoms and physical function among male adult patients with Scheuermann's disease.

BACKGROUND: There are only a few studies on untreated Scheuermann's disease and magnetic resonance imaging (MRI) findings in the lumbar spine. The primary aim of this study was to clarify lumbar MRI findings in patients with Scheuermann's disease and to compare with subjects without diagnosed spine disease. METHODS: Twenty-two male adult Scheuermann's patients (mean age 64.7 years (Standard Deviation [SD] 6.4) and 26 males (mean age 59.7 years [SD 7.4]) from a national health survey were included in this study. From MR images, the dimensions of the vertebral bodies, intervertebral discs and the dural sac were measured. Spondylolisthesis, Modic changes (MC), high intensity zone values (HIZ), and Schmorl's nodes were registered from both groups as well as self-reported data concerning general health, quality of life, and back pain symptoms. RESULTS: Significantly more patients with Scheuermann's disease had at least one MC compared to the controls at the level L1/L2 (Odds Ratio [OR] 21.11, 95% Confidence Interval [95% CI] 2.31-192.96), at the level L3/L4 (OR 13.62, 95% CI 1.41-131.26), and at the level L5/S1 (OR 6.11, 95% CI 1.50-24.83). Patients had significantly more Schmorl's nodes compared to the controls (64% vs. 8%, p < 0.001). The area of the dura sac (L3/L4) was larger (mean 201 mm2 vs. 152 mm2, p = 0.017) in the patients compared to controls. At level L1/L2 patients had higher disc than controls (mean 7.9 mm vs. 6.8 mm, p = 0.038). After adjusting for age patients had more commonly constant back pain (OR 9.4, 95% CI 1.56-56.97), and difficulties in walking up one floor without resting (OR 9.8, 95% CI 1.01-95.34) than controls. CONCLUSIONS: Schmorl's nodes and Modic changes on lumbar MRI, back pain and physical function restrictions seem to be more prevalent among patients with Scheuermann's disease than in the general population.

Total joint replacement in inhibitor-positive haemophilia: Long-term outcome analysis in fifteen patients.

AIM: To collect data from joint replacement in inhibitor patients, evaluate haemostatic and patient outcomes, and analyse the costs. METHODS: We report our 21-year, single-centre cumulative experience of 15 joint arthroplasties in six inhibitor patients. RESULTS: Two low responder inhibitor patients were in the early days treated with FVIII, whereas bypassing agents were used in the rest of the high responder patients. The primary haemostatic outcome was good in 8/15, fair in 4/15 and poor in 3/15 operations. The overall patient outcome, including joint health and patient satisfaction, was good in 10/15, fair 4/15 and poor in 1/15. No deep infections were observed. Cost analysis was most beneficial in low responders and in two immune-tolerized, high responder patients. In all cases, factor replacement comprised the main treatment costs. CONCLUSION: Our experience supports the initial use of bypassing agents as well as preoperative immune-tolerance induction when possible. Despite the challenges of haemostasis and severe joint disease, total joint arthroplasty can reach a good outcome, even in inhibitor patients. The risk for deep infection might be smaller than previously reported. Individual planning, intense multidisciplinary teamwork and execution of operations should be centralised in a professional unit.

Does the eradication of Helicobacter pylori delay the diagnosis of gastric cancer?

OBJECTIVE: To assess the frequency of gastric cancer patients having received eradication treatment of Helicobacter pylori, and whether this treatment has any influence on the delay in the diagnosis or the stage of the tumours at the time of the operation. MATERIAL AND METHODS: A total of 119 consecutive patients with gastric cancer were interviewed preoperatively between 2001 and 2003 at the Department of Surgery, Helsinki University Central Hospital. Abdominal symptoms, previous endoscopies, previous H. pylori testing and eradication therapies were recorded. RESULTS. Of these patients, 112 (94%) had abdominal symptoms before the cancer diagnosis, and in 110 patients (92%) these symptoms were alarming or had changed before the cancer diagnosis. Thirty-five patients (29%) had received H. pylori eradication therapy prior to the diagnosis of gastric cancer (15 after onset or change in symptoms, 10 more than 5 years prior to the cancer diagnosis). The median duration of alarm, new or changed symptoms was longer among patients with H. pylori eradication therapy after the onset or change in their symptoms as compared to other patients (12.0 versus 4.5 months, p=0.001). However, there was no difference in the tumour stages at time of the operation between the eradication and no eradication groups. A previous gastroscopy within 2 years prior to the cancer diagnosis was performed in 17 (14%) patients. Diffuse-type cancers were missed significantly more often in endoscopies than cancers of intestinal type. CONCLUSION: Previous H. pylori eradication may delay the detection of gastric cancer if it is given during symptoms caused by tumour.