Patient satisfaction with nursing after surgery due to cervical or lumbar discopathy.

BACKGROUND: Relationships between patient satisfaction with nursing and patient clinical data have not been fully resolved in a Polish sample. Our objectives were to determine clinical factors associated with patient satisfaction with nursing and investigate differences between patients treated surgically for cervical or lumbar discopathy and degenerative changes. MATERIAL AND METHODS: This prospective and cross-sectional study included 63 consecutively selected patients treated surgically for lumbar discopathy and degenerative spine disease and 41 patients undergoing surgery for cervical discopathy and degenerative spine disease from 1st June 2009 to 31st September 2010 in the Department of Neurosurgery and Neurotraumatology of Poznan University of Medical Sciences. In the first stage of this study, socio-demographic data, medical history, and clinical patient characteristics were collected. A minimum 12-month follow-up formed the second part. Nineteen patients with lumbar discopathy were excluded because they were unable to answer the questionnaire. Finally, 44 consecutively selected patients treated surgically for lumbar discopathy and 41 patients undergoing surgery due to cervical discopathy were evaluated with the Polish version of the Newcastle Satisfaction with Nursing Scale (NSNS-PL). RESULTS: In patients with cervical and lumbar discopathy, the average Experiences of Nursing Care Subscale (ENCS) scores were 82.0 (SD 15.1) and 79.0 (SD 13.5), respectively, whereas the average Satisfaction with Nursing Care Subscale (SNCS) scores were 75.6 (SD 18.1) and 74.4 (SD 16.8), respectively. The study groups did not differ in regards to NSNS subscales. Associations between ENCS and SNCS scores were confirmed in both patient groups (rS=.73, p<0.001 and rS=.73, p<0.001, respectively). CONCLUSIONS: Our study highlights the importance of assessing the association between patient characteristics and patient perception of quality of nursing care. Satisfaction with treatment outcome and conviction about undergoing the same treatment affected experiences and satisfaction with nursing in the cervical group only.

Synovial cysts of the lumbar spine.

BACKGROUND AND PURPOSE: Synovial cysts of the spine occur most frequently in the lumbosacral region. Methods of treatment vary, but in cases of chronic pain or neurological deficits surgical intervention is undertaken. The aim of this paper is to present indications, surgical technique and efficacy of surgical treatment in patients with synovial cyst of the spinal canal. MATERIAL AND METHODS: The retrospective analysis included 11 patients, aged from 47 to 72 years, treated at the Department of Neurosurgery and Neurotraumatology, Poznan University of Medical Sciences, between 2004 and 2009. The length of medical history ranged from 2 months to 6 years. Conservative treatment applied before surgery was not effective. Neurological examination revealed unilateral or bilateral sciatica, superficial sensory disturbance or lower limb paresis. RESULTS: Synovial cysts were located mainly at the L4-L5 level (9 cases). Magnetic resonance imaging (MRI) of the spine was performed in all patients and showed the cystic lesion attached to the intervertebral joint. Surgical treatment consisted of a unilateral fenestration using microsurgical techniques in most cases. Back pain relief was observed in 9 cases. In 10 patients, symptoms of sciatica disappeared. Neurological deficits disappeared in 5 patients. CONCLUSIONS: Surgical treatment of spinal synovial cysts is safe, effective and ensures a long-lasting effect. Surgical treatment is indicated in patients in whom the clinical symptoms correlate with the presence of synovial cyst in imaging studies and do not resolve after conservative treatment.

[Symptomatic vertebral hemangioma related to pregnancy. A case report]. / Objawowy naczyniak kregoslupa u chorej w ciazy. Opis przypadku.

Hemangioma is the most common primary tumor of the spine. Pregnancy is a risk factor increasing the possibility of disclosure or exacerbation of symptoms of spinal hemangioma. This paper presents a case of 32-year-old woman with hemangioma of Th6 vertebrae, which was revealed by paresis of the lower limbs and sphincters dysfunction at 34 weeks gestation. Pregnancy has ended with a cesarean section. Then posterolateral thoracotomy and removal of hemangioma were performed. Spinal cord was decompressed and stabilization of the spine with metal implants was carried out. Histological examination discovered cavernous hemangioma weaving. The patient is followed up in the outpatient clinic. Despite the improvement of neurological status--enhancement of the sensory function and development of bladder and rectal sphincter automatism--she did not regain the ability to walk alone.

Nucleic acid-based technologies in therapy of malignant gliomas.

Malignant gliomas are the deadliest brain tumors, which are characterized by highly invasive growth, a rampant genetic instability and intense resistance to apoptosis. Such an aggressive behavior of malignant gliomas is reflected in the resistance to chemo- and radiotherapy and weak prognosis in spite of cytoreduction through surgery. Brain tumors preferentially express a number of specific protein and RNA markers, that may be exploited as potential therapeutic targets in design of the new treatment modalities based on nucleic acids. For almost three decades, a possibility to apply DNA and RNA molecules as anticancer therapeutics have been studied. A variety of antisense oligonucleotides, ribozymes, DNAzymes, and aptamers can be designed to trigger the sequence-specific inhibition of particular mRNA of interest. RNA interference (RNAi) is the latest and the most promising technique in the long line of nucleic acid-based therapeutic technologies. Recently, we designed and implemented the experimental therapy of patients suffering from malignant brain tumors based on application of double-stranded RNA (dsRNA) specific for tenascin-C (TN-C) mRNA. That therapeutic agent, called ATN-RNA, induces RNAi pathway to inhibit the synthesis of TN-C, the extracellular matrix protein which is highly overexpressed in brain tumor tissue. In the chapter specific problems of application of nucleic acid-based technologies in glioma tumors treatment will be discussed.

Surgical treatment of symptomatic vertebral haemangiomas.

BACKGROUND AND PURPOSE: Vertebral haemangiomas are relatively common, benign vascular lesions; symptomatic ones that cause spinal cord compression are rare, however. Only 0.9-1.2% of all vertebral haemangiomas are symptomatic. The aim of the paper is to present indications, operative techniques and stabilization methods in patients with symptomatic vertebral haemangiomas. MATERIAL AND METHODS: Clinical analysis included 7 patients treated between 1995 and 2007. There were 4 females and 3 males, aged 24 to 63 yrs (average age 44 yrs). Symptomatic vertebral haemangiomas were diagnosed on the basis of neuroradiological studies. Surgery was applied in all cases. Implantation of internal stabilization followed vertebral haemangioma resection. RESULTS: Localization of vertebral haemangiomas included 1 case in the cervical, 5 cases in the thoracic and 1 case in the lumbar segment of the vertebral column. Symptoms of medulla compression were observed in 7 patients. Neurological symptoms were caused usually by hypertrophy or ballooning of the posterior cortex of the vertebral body into the vertebral canal. The anterior surgical approach was carried out in 2 cases, posterolateral in 3 cases and posterior in 2 cases. Spinal stability was secured by various implant systems and autogenic bone grafts. Bone defects in the vertebral body were filled with acrylic cement in 4 patients. In histological examinations, cavernous types were found in all patients. Neurological condition improved after the treatment in 5 patients. CONCLUSIONS: No standard therapy exists for symptomatic thoracic vertebral haemangiomas. However, immediate surgical intervention is necessary in cases with acute compressive myelopathy before the symptoms become irreversible.

Promising human brain tumors therapy with interference RNA intervention (iRNAi).

Glioblastoma multiforme (GBM) is the most common type of malignant gliomas, characterized by genetic instability, intratumoral histopathological variability and unpredictable clinical behavior. Disappointing results in the treatment of gliomas with surgery, radiation and chemotherapy have fuelled a search for new treatment modalities. Malignant gliomas express preferentially a number of surface markers that may be exploited as therapeutic targets, such as tenascin-C (TN-C), an extracellular matrix glycoprotein that contributes to tumor cell adhesion, invasion, migration and proliferation. In this paper we describe a novel strategy for human brain tumors therapy based on RNA interference (RNAi) and its application after surgery (intervention with RNAi) to inhibit TN-C synthesis. We present data of 46 patients suffering from brain tumors resected and treated with dsRNA with the sequence homology of tenascin-C mRNA (ATN-RNA). The specific effect of ATN-RNA on TN-C downregulation was proved with antibodies against TN-C in glioblastoma multiforme cultured cells. A significant improvement in overall survival (OS) without loosing the quality of life (QOL) of patients was observed. MRI and CT studies showed tumor growth delay or lack of tumor recurrence. This novel therapy based on RNA interference shows a hopeful therapeutical potential. To our knowledge the intervention with RNAi (iRNAi) method is the first protocol of RNAi application in human brain tumor treatment.

Application of internal stabilisation in the surgical treatment of spinal metastases.

BACKGROUND AND PURPOSE: Neoplastic disease damages the spine more often than trauma. Metastatic tumour causes vertebral column instability and neurological deficit. Surgical intervention indications depend on the patient's general and neurological status. The aim of neuro-orthopaedic treatment is to achieve pain relief and neurological improvement. Spine stability is secured by various implant systems. The aim of the paper is to present indications, operative techniques and stabilisation methods in patients with metastatic spine disease. MATERIAL AND METHODS: There were 73 patients included in this study: 50 males and 23 females, aged 17-74 years. The dominant tumour location was the thoracic spine (41 cases), followed by the lumbar spine (19). Symptoms of spinal cord lesion were observed in 71 patients. Qualification for surgery and approach planning were based on different scales (ASA, DeWald, Frankel, Karnofsky, Denis, Tomita). Internal stabilisation implantation followed tumour resection. RESULTS: Anterior approach was used in 15 cases, posterolateral in 39, posterior in 13, and combined in 6 cases. Histological findings generally allowed the primary tumour location to be disclosed, which in most cases involved the kidney, prostate, lung and the haematopoietic system. Neurological improvement was observed in 82% of cases. Perioperative death occurred in 3% of all patients. CONCLUSIONS: Employed operative techniques are adequate for tumour removal, neural and vascular structures decompression and for implant placement.

A multivariate analysis of patients with brain tumors treated with ATN-RNA.

Glioblastoma multiforme (GBM) is the most common form of malignant glioma, characterized by genetic instability, intratumoral histopathological variability, and unpredictable clinical behavior. Malignant gliomas express preferentially a number of surface markers that may be exploited as therapeutic targets, such as tenascin-C, an extracellular matrix glycoprotein contributes to tumor cell adhesion, invasion, migration and proliferation. Disappointing results in the treatment of gliomas with surgery, radiation and chemotherapy have fuelled a search for new treatment modalities. Here we present the data for 46 patients suffering from brain tumor. They were resected and treated with dsRNA (ATN-RNA) complementary to the sequence of tenascin-C mRNA. MRI and CT follow up studies showed growth tumor delay or lack of its recurrence symptoms, due to inhibition of TN-C synthesis. A significant improvement in overall survival (OS) was observed without loosing of the quality of life (QOL) of patients. This novel therapy based on RNA interference shows a big therapeutical potential. To our knowledge intervention with RNAi (iRNAi) is the first protocol of application of RNAi in human disease treatment.

Suppression of human brain tumor with interference RNA specific for tenascin-C.

Glioblastoma multiforme (GBM) accounts for approximately 12-15% of intracranial neoplasms. The GBM remains refractory to therapy because of tumor heterogeneity, local invasion, and non-uniform vascular permeability to drugs. Patients with GBM have the median survival of approximately 8-10 months, and for those cases where tumor recurs, the average time of tumor progression after therapy is only eight weeks. A combination of different treatment modes as surgery and chemo- or/and radiotherapy extend survival only for a short time, if any. Recently, tenascin-C (TN-C) as a dominant epitope in glioblastoma has been discovered. It is transiently expressed during organogenesis, absent or much reduced in most fully developed organs, but reappears under pathological conditions such as infection, inflammation, or tumorigenesis. It was found that the intensity of TN-C staining correlates with the tumor grade and that the strongest staining indicates poor prognosis.

Analysis of structure and function of tenascin-C.

Tenascin-C is a multidomain large extracellular matrix glycoprotein composed of six monomers. The size of tenascin-C monomers (180-250 kDa) varies as a result of an alternative splicing of the fibronectin repeats at the pre-mRNA level. For the first time we applied bioinformatic and molecular modeling procedures, for detailed analysis of the organization of tenascin-C and we performed bioinformatic analysis of tenascin-C gene. We detected the presence of heat shock protein 33 in the tenascin-C N-terminal domain that may suggest its role in the protein-protein interactions and stress response. The number of fibronectin type III-like repeats and epidermal growth factor-like repeats were corrected to 15 and 14, respectively. Using polyactylamide gel electophoresis, RT/PCR analysis and microarrays data, we showed the higher level of tenascin-C in the human tumor tissues: brain, intestine and breast. These results suggested a new role of tenascin-C as the potential tumor marker and drug target.

[The indications for occipito-cervical fixation. A report of three cases]. / Wskazania do stabilizacji potyliczno-szyjnej. Opisy trzech przypadków.

Lesions of the cranio-vertebral junction which affect bony structures and ligaments may cause instability and compression of the nervous and vascular structures. The goal of surgery is decompression of these structures and stabilization. The paper presents indications for performing the stabilisation procedure with CCD implementation in three patients suffering respectively from rheumatoid arthritis and neoplastic disease. In one patient spinal instability and spinal cord compression were due to rheumatoid disease and surgery included anterior spinal decompression in connection with posterior stabilisation. In two patients with neoplasms the retromandibular decompression with posterior stabilisation was performed.

[Surgical treatment of spondylitic spine with transpedicular stabilisation]. / Leczenie operacyjne procesów zapalnych kregoslupa z zastosowaniem stabilizacji przeznasadowej.

BACKGROUND AND PURPOSE: Widespread use of antibiotics resulted in considerable reduction of spondylitis, but despite that progress there are some cases where conservative treatment has failed. In these patients surgical intervention should be carefully considered. Early surgery in patients with increasing neurological deficits causes the uncertainty which exists in relation to possible complications. Fewer doubts are associated with surgical treatment of late consequences (spine deformity, instability, etc). The goal of this study was to present indications for surgery, operative techniques of transpedicular stabilization and results of treatment of thoracic and lumbar spondylitis. MATERIAL AND METHODS: Clinical analysis includes 18 patients with spondylitis treated in the Department of Neurosurgery and Neurotraumatology University of Medical Sciences in Poznan between 1997 and 2004. There were 7 males (39%) and 11 females (61%) in the study group, and their mean age was 57+/-10 years (range 49-69). Spondylitis within thoracic segments was found in 15 (83%) cases and 3 (17%) patients had spondylitis within lumbar segments. Indications for early surgical intervention included increasing neurological symptoms, spine instability and failed conservative treatment. All patients underwent transpedicular stabilization following medulla and nerve root decompression. RESULTS: Non-specific inflammation was observed in 14 (78%) cases, and specific inflammation was discovered in 4 (22%) cases (bacteriological and histopathological findings). Very good and satisfactory results were achieved in 16 (89%) patients. Complications occurred in 4 (22%) patients. CONCLUSIONS: Spondylitic spine surgery limits inflammatory reaction, strengthens diagnosis, repairs vertebral column stability and improves neurological condition. Transpedicular stabilization is an effective method of achieving of internal spondylodesis.

The diagnosis and therapy of brain tumours.

Neoplasms arising from glial cells make up the most common group of primary brain tumors. The clinical outcome, especially the survival rates of the patients with brain tumours depend on tumour grade expressing its malignancy. A prognosis for glioblastomas (WHO IV) is very poor, but for astrocytomas (WHO I and II) it is relatively favourable. For oligodendrogliomas a longer survival time than for glioblastomas is observed. There is evidence that oxidative stress and reactive oxygen species (ROS) are crucial in the etiology and progression of a number of human diseases, including neoplasms. An oxidative damage of DNA, lipids and proteins is caused mainly with hydroxyl radical (*OH), the most reactive ROS species and may be seriously deleterious. In addition to all four basic nucleotides: adenosine (A), guanosine (G), tymidine (T) and cytosine (C), 5-methylcytosine (m5C) is a rare but normal component of cellular DNA and occurs mainly within a sequence of a structural gene or in regulatory regions. In the reaction with hydroxyl radical all DNA components can be modified, but m5C is relatively easily deaminated to thymine, which, in turn, pairs with adenine and after a round of replication, CG to TA transition occurs. Because thymine is a normal DNA base, therefore the product of spontaneous deamination of m5C is not so easily detected by cell's DNA repair system. Thus, 5-methylcytosine residue constitutes a mutational hotspot and DNA methylation pattern in patients might be useful as a primary diagnostic tool or as a marker for early detection of relapse of the disease. In recent years a new mechanism of posttranscriptional gene silencing has been discovered and named RNA interference (RNAi). This phenomenon is based on mRNA degradation mediated by small double-stranded RNA molecules, approximately 19-28 nucleotides in length, called short interfering RNAs (siRNAs). These molecules are produced from long dsRNAs by a dsRNA-specific endonuclease (DICER) and form 300 kD multi-enzyme complex (RISC) which by Watson-Crick base-pairing of noncoding strand with their mRNA-targets induce specific degradation. The high sequence-specificity of RNAi makes it a new, promising tool in a gene-function analysis as well as in potential therapeutics development.

A simple epigenetic method for the diagnosis and classification of brain tumors.

The new, simple, and reliable method for the diagnosis of brain tumors is described. It is based on a TLC quantitative determination of 5-methylcytosine (m(5)C) in relation to its damage products of DNA from tumor tissue. Currently, there is evidence that oxidative stress through reactive oxygen species (ROS) plays an important role in the etiology and progression of several human diseases. Oxidative damage of DNA, lipids, and proteins is deleterious for the cell. m(5)C, along with other basic components of DNA, is the target for ROS, which results in the appearance of new modified nucleic acid bases. If so, m(5)C residue constitutes a mutational hotspot position, whether it occurs within a nucleotide sequence of a structural gene or a regulatory region. Here, we show the results of the analysis of 82 DNA samples taken from brain tumor tissues. DNA was isolated and hydrolyzed into nucleotides, which, after labeling with [gamma-(32)P]ATP, were separated on TLC. Chromatograms were evaluated using PhosphorImager and the amounts of 5-methyldeoxycytosine (m(5)dC) were calculated as a ratio (R) of m(5)dC to m(5)dC + deoxycytosine + deoxythymidine spot intensities. The R value could not only be a good diagnostic marker for brain tumors but also a factor differentiating low-grade and high-grade gliomas. Therefore, DNA methylation pattern might be a useful tool to give a primary diagnosis of a brain tumor or as a marker for the early detection of the relapse of the disease. This method has several advantages over those existing nowadays.

[Acute cervical epidural hematoma as a complication of anterior cervical C5-C6 diskectomy. A case report]. / Ostry krwiak nadtwardówkowy w odcinku szyjnym kregoslupa--powiklanie po przedniej discektomii C5-C6, C5-C6. Opis przypadku.

A 32 year-old woman with cervico-brachial pain and progressive neurological disorders was admitted to the Department and Clinic of Neurosurgery and Neurotraumatology of the K. Marcinkowski University of Medical Sciences in Poznan. Neurological examination revealed right hemiparesis with muscular atrophy in the right upper limb, progressing in the past 3 months. MRI demonstrated relatively large herniations of C4-C5 and C5-C6 discs with spinal and nerve compressions. A surgery was carried out. Discectomy of C4-C5 and C5-C6 discs was performed using the anterior vertebral approach. After the removal of C4-C5 and C5-C6 discs and C5 vertebral body a fragment of the iliac bone strut was wedged between C4 and C6 vertebral bodies. The bone graft was fixed to C4 and C6 vertebral bodies with a titanium plate. Within 6 hours after the surgery the patient developed a complete loss of motor functions in the upper and lower limbs. MRI scan of the cervical spine showed a huge anterior epidural hematoma compressing the spinal cord. An emergency re-operation and removal of the hematoma was performed by the anterior approach. A complete neurological recovery followed during the first 24 postoperative hours.