Improved outcome after lumbar microdiscectomy in patients shown their excised disc fragments: a prospective, double blind, randomised, controlled trial.

BACKGROUND: Lumbar microdiscectomy (LMD) is a commonly performed neurosurgical procedure. We set up a prospective, double blind, randomised, controlled trial to test the hypothesis that presenting the removed disc material to patients after LMD improves patient outcome. METHODS: Adult patients undergoing LMD for radiculopathy caused by a prolapsed intervertebral disc were randomised into one of two groups, termed experimental and control. Patients in the experimental group were given their removed disc fragments whereas patients in the control group were not. Patients were unaware of the trial hypothesis and investigators were blinded to patient group allocation. Outcome was assessed between 3 and 6 months after LMD. Primary outcome measures were the degree of improvement in sciatica and back pain reported by the patients. Secondary outcome measures were the degree of improvement in leg weakness, paraesthesia, numbness, walking distance and use of analgesia reported by the patients. RESULTS: Data from 38 patients in the experimental group and 36 patients in the control group were analysed. The two groups were matched for age, sex and preoperative symptoms. More patients in the experimental compared with the control group reported improvements in leg pain (91.5 vs 80.4%; p<0.05), back pain (86.1 vs 75.0%; p<0.05), limb weakness (90.5 vs 56.3%; p<0.02), paraesthesia (88 vs 61.9%; p<0.05) and reduced analgesic use (92.1 vs 69.4%; p<0.02) than preoperatively. CONCLUSION: Presentation of excised disc fragments is a cheap and effective way to improve outcome after LMD.

Cognitive sequelae of methanol poisoning involve executive dysfunction and memory impairment in cross-sectional and long-term perspective.

Methanol poisoning leads to lesions in the basal ganglia and subcortical white matter, as well as to demyelination and atrophy of the optic nerve. However, information regarding cognitive deficits in a large methanol sample is lacking. The principal aim of the present study was to identify the cognitive sequelae of methanol poisoning and their morphological correlates. A sample of 50 patients (METH; age 48 ± 13 years), 3-8 months after methanol poisoning, and 57 control subjects (CS; age 49 ± 13 years) were administered a neuropsychological battery. Forty-six patients were followed in 2 years' perspective. Patients additionally underwent 1.5T magnetic resonance imaging (MRI). Three biochemical and toxicological metabolic markers and a questionnaire regarding alcohol abuse facilitated the classification of 24 patients with methanol poisoning without alcohol abuse (METHna) and 22 patients with methanol poisoning and alcohol abuse (METHa). All groups were compared to a control group of similar size, and matched for age, education, premorbid intelligence level, global cognitive performance, and level of depressive symptoms. Using hierarchical multiple regression we found significant differences between METH and CS, especially in executive and memory domains. METHa showed a similar pattern of cognitive impairment with generally more severe executive dysfunction. Moreover, all METH patients with extensive involvement on brain MRI (lesions in ≥2 anatomical regions) had a more severe cognitive impairment. From a longitudinal perspective, we did not find any changes in their cognitive functioning after 2 years' follow-up. Our findings suggest that methanol poisoning is associated with executive dysfunction and explicit memory impairment, supposedly due to basal ganglia dysfunction and disruption of frontostriatal circuitry proportional to the number of brain lesions, and that these changes are persistent after 2 years' follow-up.

[Radiation-induced sarcomas]. / Luchevye sarkomy.

Secondary tumors developed in the zone of exposure fields in 6 patients treated with radiation for different malignancies. Tumors appeared, on the average, 12 years after radiotherapy.

[Endolymphatic infusions in oncological patients]. / Ob éndolimfaticheskikh infuziiakh u onkologicheskikh bol'nykh

Utilization of endolymphatic infusions against the background of the impaired barrier function of lymph nodes is inherent in a higher rate of tumor metastasization. The hazard increases in cases when tumore cells in the lymph system (especially in the thoracic duct) are in a free state, and substances dilating lymph vessels are employed. Therefore, endolymphatic infusions should be accomplished taking into account all the factors that could lower either directly or indirectly the barrier function of the lymphatic system.

[Lymphography and the possibility of tumor cell dissemination]. / Limfografiia i vozmozhnost' disseminatsii opukholevykh kletok.

It is concluded that endolymphatic infusion of X-ray contrast substance in the presence of migrating tumor cells in lymphatic routes is inherent in a potential danger of tumor dissemination. Although getting of tumor cells in blood does not always result in metastases, nevertheless, a due account should be taken of the fact that lymphography is frequently performed in poor immunological resistance patients, preliminarily subjected to chemo- and radiotherapy. The decrease of immune resistance of the organism, in which the lymphatic system is of primary importance, is known to contribute per se to generalization of the tumor process. Another important conclusion is that the principal mass of tumor cells is ejected in the immediate period after endolymphatic injection of X-ray contrast substance. Thus, the cannulation of the thoracic duct during this period may prevent or reduce getting of massive amounts of tumor cells into the total blood flow.

Survival of patients with glioblastoma multiforme has not improved between 1993 and 2004: analysis of 625 cases.

Glioblastoma is the most common primary brain tumour. The aim of this study was to determine trends in survival over a 12-year period. Survival data were collected retrospectively for 625 patients who had surgery for histologically-confirmed glioblastoma between 1993 and 2004 in a single centre. Data including age, sex, preoperative Karnofsky performance score, tumour site, date of surgery, and type of surgical and adjuvant treatment were collected. Overall median survival was 189 days; there was no significant change in survival over 12 years. Multivariate analysis identified the following independent positive prognostic factors: age <60 years (p < 0.0005), Karnofsky score > or = 70 (p < 0.0001), tumour debulking, rather than biopsy (p < 0.001), right-sided lesion (p < 0.05), unilateral tumour (p < 0.05) and radiotherapy (p < 0.0001). Despite neurosurgical advances, the survival of patients with glioblastoma has not changed for more than a decade. Although, overall, glioblastoma has a short survival, our data show that individual patient survival is heterogeneous.

[Late radiation injuries of the skin of the head and their treatment]. / Pozdnie luchevye povrezhdeniia kozhi golovy i ikh lechenie.

The authors have summed up their experience gained in the diagnosis and treatment of radiation injuries of the head and maxillofacial region developing after radiotherapy of malignant tumors (105 patients) and non-tumorous diseases (47 patients).

[Changes in some ventilation and respiration parameters in patients with chronic obstructive lung disease in prospective longitudinal study]. / Zur Veränderung einiger ventilatorischer und respiratorischer Parameter bei Patienten mit chronisch-obstruktiven Lungenkrankheiten in einer prospektiven Longitudinalstudie.

The changes of several parameters of ventilation and respiration in 104 men taken into prospective longitudinal observation were analysed. All men in average 53.3 years old at the time of first examination were suffering from chronic obstructive lung diseases. The time between last and first examination amounted to 52 months in average. During this period the functional state did not change in one third of all patients; in the other two thirds the condition has impaired and 19 (18.3%) among 104 had died. The functional parameters evaluated showed a statistically significant decrease of FEV1 (71 ml in average every year) and of pulmonary diffusion capacity for CO by the steady state and single breath methods whereas the changes of airway resistance being insignificant in these cases. The results give rise to the statement that progression of the disease would occur in the area of peripheral airways and alveoli.