Rapid Geriatric Assessment, Physical Activity, and Sleep Quality in Adults Aged more than 65 Years: A Preliminary Study.

OBJECTIVE: (1) To evaluate geriatric syndromes using the Rapid Geriatric Assessment; (2) To investigate possible association of geriatric syndomes with physical activity and sleep quality in adults aged more than 65 years who applied to outpatients physical medicine and rehabilitation clinic. DESIGN: A cross-sectional study. SETTING: Outpatient physical medicine and rehabilitation clinic in Edirne, Turkey. PARTICIPANTS: A total of 56 adults (mean aged 69.7 ± 4.0 (range, 65-80) years, 33 women). MEASUREMENTS: The Rapid Geriatric Assessment, which includes the FRAIL Questionnaire Screening Tool for frailty, Simplified Nutritional Assessment Questionnaire (SNAQ), SARC-F Screen for Sarcopenia, and Rapid Cognitive Screen (RCS), was used to assess geriatric syndromes. The International Physical Activity Questionnaire (IPAQ) was used to obtain data regarding health-related physical activity. The Pittsburgh Sleep Quality Index (PSQI) was used to measure sleep quality during the past month. RESULTS: The mean age of the patients was 69.7 ± 4.0 years. Of the 56 patients, 12.5% were frail, 50.0% were pre-frail, 35.7% had sarcopenia, 44.6% had a risk of weight loss, 33.9% had dementia, 57.1% were physically inactive, and 53.6% had poor sleep quality. The total FRAIL and SARC-F scores were positively correlated with the global PSQI score (correlation coefficient (r) = 0.300, p < 0.05; r = 0,327, p < 0.05, respectively) and negatively correlated with the total RCS score (r= -0,267, p < 0.05; r = -0,314, p < 0.05, respectively)). The total FRAIL score was positively correlated with the SARC-F score (r = 0.695, p < 0.001), and the concurrence of frailty and sarcopenia in the same patients was 10.7%. The global PSQI score was negatively correlated with the SNAQ score (r = -0.273, p < 0.05). CONCLUSION: Frailty and sarcopenia were positively correlated with poor sleep quality and negatively correlated with cognition and physical activity. In clinical practice, the Rapid Geriatric Assessment and determination of physical activity level could assist in disability prevention.

Monitoring of renal function using 99mTc-DMSA and 99mTc-DTPA scintigraphy in patients with spinal cord injury

Objetivo. El objetivo de este estudio fue evaluar el grado de alteración funcional renal mediante el estudio gammagráfico con 99mTc-ácido demercaptosuccínico (99mTc-DMSA) y 99mTc-ácido dietilentriaminopentaacético (99mTc-DTPA) en pacientes con lesión de médula espinal (SCI). Material y métodos. Estudio prospectivo que incluye a 22 pacientes consecutivos con SCI (15 parapléjicos y 7 tetrapléjicos) (media de edad: 49,1±13,4 años) sin síntomas urinarios. La lesión medular se había producido hacía, 45,6±48,8 meses. Dieciséis pacientes tenían al menos historia de infección del tracto urinario. La gammagrafía renal con 99mTc-DMSA, el renograma con 99mTc-DTPA y la ecografía renal se realizaron en un periodo de 2 semanas. Resultados. En la gammagrafía cortical con 99mTc-DMSA 4 pacientes (18%) presentaron alteraciones severas, unilaterales o bilaterales, en el parénquima renal y aumento de la captación de fondo. Dos de ellos tenían ectasia pielocalicial grado 3-4 en la ecografía. Además, 2 de los 18 pacientes restantes tenían ectasia pielocalicial grado 2 en la ecografía. En el renograma con 99mTc-DTPA 16 pacientes (73%) presentaron retraso, o retraso y disminución de la función, en uno o en los 2 riñones. Sin embargo, solo 4 pacientes tenían ectasia pélvica grado 2 a 4 y ninguno de ellos, cicatrices corticales. Conclusión. El uso combinado de la gammagrafía cortical renal y el renograma con radiotrazadores puede contribuir, junto con la ecografía, en el seguimiento a largo plazo de pacientes con SCI. Los casos con alteraciones en la gammagrafía o en el renograma deben tener un seguimiento más estrecho; de este modo, un tratamiento adecuado precoz puede reducir la morbilidad y la mortalidad en este tipo de pacientes(AU)

Aim. The aim of this study was to assess the degree of alterations of renal function by using 99m-technetium dimercaptosuccinic acid (99mTc-DMSA) and 99m-technetium diethylenetriaminepentaacetic acid (99mTc-DTPA) scintigraphy in spinal cord injury (SCI) patients. Material and methods. Twenty-two consecutive SCI (15 paraplegic and 7 tetraplegic) patients (mean age: 49.1±13.4 years) who had no urinary symptoms participated in this prospective study. The mean duration of injury was 45.6±48.8 months before. Sixteen patients had at least one urinary tract infection history. Renal cortical scintigraphy with 99mTc-DMSA, radionuclide renography with 99mTc-DTPA and renal ultrasound were performed within 2-week period. Results. Four (18%) patients had serious pathology on their kidneys such as unilateral or bilateral parenchymal scarring and increased background uptake in their renal cortical scintigraphy with 99mTc-DMSA. Two of them had grade 3-4 pelvicaliceal ectasia on ultrasound. Additionally, 2 of 18 remaining patients had grade 2 pelvicaliceal ectasia on ultrasound. Sixteen (73%) patients had markedly delayed or delayed and decreased functions of one or both of kidneys on radionuclide renography. However, only four patients had grade 2-4 pelvicaliceal ectasia and none of them had a finding of loosening of renal parenchyma. Conclusion. Combined use of renal cortical scintigraphy and radionuclide renography appears to be contributive to renal ultrasound in the long-term follow-up of patients with SCI. Patients with abnormal findings should be closely followed, and early therapeutic interventions may enable lower morbidity and mortality rates in these patients(AU)

Monitoring of renal function using 99mTc-DMSA and 99mTc-DTPA scintigraphy in patients with spinal cord injury.

AIM: The aim of this study was to assess the degree of alterations of renal function by using 99m-technetium dimercaptosuccinic acid ((99m)Tc-DMSA) and 99m-technetium diethylenetriaminepentaacetic acid ((99m)Tc-DTPA) scintigraphy in spinal cord injury (SCI) patients. MATERIAL AND METHODS: Twenty-two consecutive SCI (15 paraplegic and 7 tetraplegic) patients (mean age: 49.1±13.4 years) who had no urinary symptoms participated in this prospective study. The mean duration of injury was 45.6±48.8 months before. Sixteen patients had at least one urinary tract infection history. Renal cortical scintigraphy with (99m)Tc-DMSA, radionuclide renography with (99m)Tc-DTPA and renal ultrasound were performed within 2-week period. RESULTS: Four (18%) patients had serious pathology on their kidneys such as unilateral or bilateral parenchymal scarring and increased background uptake in their renal cortical scintigraphy with (99m)Tc-DMSA. Two of them had grade 3-4 pelvicaliceal ectasia on ultrasound. Additionally, 2 of 18 remaining patients had grade 2 pelvicaliceal ectasia on ultrasound. Sixteen (73%) patients had markedly delayed or delayed and decreased functions of one or both of kidneys on radionuclide renography. However, only four patients had grade 2-4 pelvicaliceal ectasia and none of them had a finding of loosening of renal parenchyma. CONCLUSION: Combined use of renal cortical scintigraphy and radionuclide renography appears to be contributive to renal ultrasound in the long-term follow-up of patients with SCI. Patients with abnormal findings should be closely followed, and early therapeutic interventions may enable lower morbidity and mortality rates in these patients.

Perioperative administration of gabapentin 1,200 mg day-1 and pregabalin 300 mg day-1 for pain following lumbar laminectomy and discectomy: a randomised, double-blinded, placebo-controlled study.

INTRODUCTION: Gabapentin and pregabalin have been compared in studies conducted on management of neuropathic and postoperative pain. In neuropathic pain studies, the analgesic effects of the two drugs were compared, and pregabalin has been found to be more potent. However, in postoperative pain studies, the effects of each drug were examined separately. This study compared the analgesic effects of pregabalin (300 mg day-1), gabapentin (1,200 mg day-1) and a placebo in managing postoperative pain following laminectomy and discectomy. METHODS: 90 patients were randomly assigned to three groups (pregabalin, gabapentin and placebo) of 30 patients each. Pregabalin 150 mg, gabapentin 600 mg and a placebo were administered every 12 hours, two times pre- and post surgery. Study data collected included morphine consumption, Visual Analogue Scale records, preoperative anxiety, patient satisfaction, adverse effects and observation notes. RESULTS: In the gabapentin and pregabalin groups, overall morphine consumption, preoperative anxiety, pruritus, postoperative shivering were significantly lower (p-value less than 0.05 for all), and patient satisfaction was significantly higher than those in the placebo group (p-value less than 0.05). CONCLUSION: This study showed that both pregabalin 300 mg day-1 and gabapentin 1,200 mg day-1 have more analgesic, anxiolytic and opioid-sparing effects, higher patient satisfaction and are more effective for preventing postoperative shivering than the placebo following lumbar laminectomy and discectomy. The findings revealed that pregabalin 300 mg day-1 had equivalent analgesic, adverse and opioid-sparing effects and patient satisfaction as gabapentin 1,200 mg day-1.

Unusual localization of an unusual tumor: calcifying pseudoneoplasm of the foramen magnum.

OBJECTIVE: We report a rare case of calcifying pseudoneoplasm in the foramen magnum. A large variety of tumors can be found in the foramen magnum; meningiomas, neurofibromas, chordomas, chondrosarcomas and metastases are among those that have been reported. Based on the histopathological structure of the tumor, radical excision or, in the case of tumors with good behavioral pattern, only decompressive debulking can be applied, in an effort to avoid unnecessary morbidities. Thus, it is important to know the nature of the tumor before planning the surgery. CASE REPORT: A 53-year-old man with a 1-year history of pain on the left side of his face was admitted to our service. Magnetic resonance imaging revealed a calcific mass at the left side of the spinal cord at the level of the foramen magnum. Median suboccipital craniectomy and total tumor resection were performed and there was no additional neurological deficit postoperatively. CONCLUSION: We report, to our knowledge, the second case of a calcifying pseudoneoplasm of the foramen magnum. We emphasize that these tumors are pathologically benign and do not require aggressive surgical treatment and suggest that asymptomatic cases can be followed radiologically.

Parental perception of weight and weight-related behaviour in 2- to 4-year-old children in the eastern part of the Netherlands.

Parental perception of weight status and weight-related behaviour of their toddler was determined through a questionnaire survey in child health care centres (CHCs). Complete data on weight, length, sex and age were available for 635 of 682 children (93.1%). The median age of the children was 37.0 months (range 24-56 months). Of all 635 children, 76.5% were normal weight, 16.2% underweight and 7.2% overweight. Parents' perception of the weight of their child compared with their peers was moderately related to the actual weight status. Of the parents of overweight and underweight children, 87.0% and 89.3%, respectively, were not concerned. Only the parents' perception of the amount of food eaten by their child was significantly related to the weight status. The primary goal of CHC workers should be to create parental awareness in case of their child being overweight or underweight and to support them in accomplishing a healthy lifestyle.

Keyhole approach for posterior cervical discectomy: experience on 84 patients.

Anterior cervical discectomy with or without fusion has been commonly used for cervical disc disease since the description by Smith and Robinson in 1958. In this report, surgical technique, advantages, and disadvantages of the posterior approach, known as the posterior keyhole laminotomy-foraminotomy, are reviewed and motion versus fusion surgery discussed. Between 1996 and 2004, the keyhole laminotomy-foraminotomy was performed on 84 patients suffering from lateral cervical soft disc herniation or osteophytes. All the procedures were performed under the surgical microscope. A high-speed drill was used for drilling the bone. In 49 patients (58%), soft disc herniation was removed, while in 35 patients (42%) there were osteophytes. Successful relief of radiculopathy symptoms was achieved in 80 patients (96%). In 4 patients the symptoms recurred. One patient (1.2%) developed kyphosis. The only complication observed intraoperatively was a partial root injury in one patient (1.2%). Mean hospitalization time was 48 hours. The posterior approach is particularly appropriate in patients whose root compression is located posterolaterally. Advantages of this surgery are minimal lamina resection, good visualization of the nerve root, postoperative early mobilization and minimal hospitalization. Microsurgery enables us to both preserve the motion of operated segment and avoid cervical instability.

Chordoma of the lumbar spine: a case report.

Chordomas are rare tumors and they may arise anywhere along the spinal column and clival bone. The vast majority of tumors are found at skull base and sacrum. Chordomas involving the lumbar spine are rare. Approximately 6% of spinal chordomas originate in the lumbar vertebrae. We report a case of this chordoma arising from the lumbar vertebra.

Tuberculosis of the craniocervical junction: a case report.

Craniocervical tuberculosis (TB) is very rare. Despite the use of magnetic resonance imaging (MRI) and cranial tomography (CT), diagnosis of craniocervical tuberculosis is frequently difficult. In this study, we present a craniocervical tuberculosis abscess case which demonstrates the role of transoral surgery for both diagnosis and treatment.

Quality of life of primary caregivers of spinal cord injury survivors living in the community: controlled study with short form-36 questionnaire.

OBJECTIVE: To compare the quality of life scores of primary caregivers of spinal cord injury survivors living in the community with healthy age matched-population based controls and to determine the relationship between some severity parameters related with spinal cord injury and the quality of life scores of primary caregivers. SETTING: University hospital, rehabilitation centre. METHODS: Fifty primary caregivers of spinal cord injured patients living in the community and 40 healthy age-matched controls completed SF-36 (short form-36) questionnaire forms. Questionnaires were administered by interviewers who were physiatrists and the authors of the present study. All the patients were rehabilitated by the authors and data about the duration of injury, lesion levels, ASIA scores, degree of spasticity, presence of bladder and bowel incontinence and pressure sores were gathered from the hospital recordings and/or by physical examinations during control visits when the primary caregivers were administered the questionnaires. RESULTS: Quality of life scores measured by SF-36 were significantly low in the primary caregivers group compared to age-matched healthy population based controls. No significant relation was demonstrated between the quality of life scores of primary caregivers and parameters such as the duration of injury, lesion levels, ASIA scores, degree of spasticity, bladder and/or bowel incontinence and pressure sores respectively. CONCLUSION: According to the results of the present study, being a primary caregiver of a spinal cord injured victim significantly interferes with quality of life; some severity parameters related to the injury however do not seem to have an additional impact on the primary caregiver's life quality.

Effects of iloprost on vasospasm after experimental spinal cord injury: an electron and light microscopic study.

It has been increasingly reported that traumatic and ischemic insults to the spinal cord may produce tissue damage through both direct and indirect mechanisms. In spite of many theories about post-traumatic spinal cord injury, there is still no satisfactory account of the exact mechanism. Vasospasm may be related to the trauma and release of vasoconstrictor or vasoactive amines. This study aims at studying the possible protective mechanisms of iloprost, a stable analogue of prostacyclin, after spinal cord injury on the rabbit. Forty-two adult male rabbits (New Zealand albino) were inflicted injuries by epidural application of an aneurysm clip to the spinal cord. Twenty-one rabbits received an i.v. infusion of 25 microg kg(-1) x h(-1) iloprost. The remaining twenty-one rabbits received an i.v. infusion of saline as the control group. Intravenous treatment started immediately after the infliction of the spinal cord injury and lasted for 1 h. Iloprost treatment had no side effects on the general physiological parameters in the rabbits. Control and iloprost treatment groups were divided into three sub-groups. The first group of animals was deeply anesthetized and spinal cords were removed 15 min after treatment. Second and third group animals were sacrificed in the 3rd and 24th hours respectively. All spinal cords were removed for light and electron microscopic examination. The width of anteriolar smooth muscle cells and the ultrastructural analysis of sulcal arterioles and venules in the ventral median fissure of spinal cords treated by iloprost revealed less thickening in all groups especially on the 24th hour group (p < 0.01), but less thickening was observed on the 3rd hour group. Iloprost-treated groups had limited edema and moderate protection of myelin and axons. These results suggest that iloprost treatment after spinal cord injury has a highly protective effect, and the possible protective effect of iloprost is resolution of vasospasm due to spinal cord injury.

Early protective effects of iloprost after experimental spinal cord ischemia in rabbits.

The potential role of Iloprost, a stable analogue of prostocyclin, in treating spinal cord ischemia was investigated in rabbits subjected to aortic occlusion for 15 minutes. Ten adult rabbits weighing 2-2.5 kg received an intravenous infusion of saline (SF) as a control group and 14 rabbits received an intravenous infusion of Iloprost, 25 microg/kg/h. Iloprost infusion was started immediately after clamping of the aorta and continued 60 minutes thereafter. Cortical somatosensorial evoked potentials (CSEP) were recorded during the pre-ischemic period as a baseline and post-ischemic readings were taken at 15, 30 and 60 minutes. There was no statistically significant difference between CSEP of the saline and Iloprost treated groups (p < 0.05). All animals were examined neurologically by using a modification of Tarlov scale and all subjects were then deeply anesthetized and their spinal cords were removed for light and electron microscopic examinations at 24 h after spinal cord ischemia. In order to obtain an accurate comparison of ultrastructural changes between saline treated and Iloprost treated groups, a grading scale was performed. The light microscopic and ultrastructural analysis of the Iloprost treated group revealed that there was moderate protection of the myelin and axons and edema was attenuated. Findings of this study suggest that Iloprost exerts a protective effect on spinal cord ischemia. However, further studies are needed to reveal possible mechanisms of protection provided by Iloprost.

Effects of different doses of epidural midazolam on spinal somatosensory evoked potentials.

The aim of this study is to find out the effects of different doses of midazolam, when used epidurally, on somatosensory evoked potentials (SEP) by delaying neuronal conduction. Thirty two New Zeland albino male rabbits were divided into four groups. All rabbits were anesthetised with ketamine and xylasine combination and atracurium was used as muscle relaxant. 10 mg/kg/hr ketamine infusion was used for maintenance of anesthesia. After insertion of the epidural catheter surgically; Group 1 received 1.5 ml isotonic saline (Control), Group 2 received 150 microg/kg, Group 3 received 250 microg/kg, and Group 4 received 500 microg/kg midazolam epidurally. With the stimulation of sciatic nerve. SEP records were recorded from the epidural space. Records were received before the injection of the drug, and 20, 40, 60 minutes after injection of the drug. "Latency" results were increased according to control in all groups (including isotonic saline-control-group). Increase in latency in the control group was interpreted as due to the effect of temperature mismatch of the saline and the rabbits. While in the first and second group amplitudes showed no differences, group 3 and 4 showed decreases of up to 50%. Epidurally administered midazolam up to 150 microg/kg caused no change in SEP records, but 250 and 500 microg/kg doses caused decreases in SEP records which can lead to misinterpretation as neurological damage.

Early protective effects of Iloprost after experimental spinal cord injury.

This investigation was undertaken to study the early protective effects of Iloprost, a stable analogue of prostacyclin, after spinal cord injury in rabbit. Sixteen adult male rabbits (New Zealand Albino) were injured by application of epidural aneurysm clip. Eight rabbits received an intravenous (i.v.) infusion of 30 micrograms kg-1 Iloprost, and eight rabbits received an infusion of saline (SF). Treatment with Iloprost started immediately after spinal cord injury and continued for one hour. Evoked potentials were recorded for each rabbit at one, 15, and 60 minutes after the spinal cord injury. Twenty-four hours later, all the rabbits were deeply anesthetized and spinal cords were removed for histopathological examinations. There was no meaningful statistical difference between cortical somatosensorial evoked potentials (CSEP) of the saline and Iloprost group. However, light and electron microscopic studies showed that the Iloprost treated group had moderate protection of myelin and axons; and limited edema. These results suggest that intravenous Iloprost treatment after spinal cord injury has a highly protective effect without any side effects.

Mature teratoma of the lateral ventricle: report of two cases.

In this paper, two cases with mature teratoma of the lateral ventricle are presented. Teratomas are rare intracranial tumours and the most common location is in the midline pineal region. Lateral ventricle as the site of location is very rare. Between the years 1975 and 1996, 120 cases were operated on for lateral ventricle tumours at the University of Ankara, Department of Neurosurgery, and only two cases (% 1.6) were histologically identified as mature teratomas. It is generally accepted that benign teratomas are radioresistant and total removal of these tumours results in cure. If mature teratoma of the lateral ventricle is totally removed, as done in our cases, the prognosis is usually good.