Surgical resection and reconstruction after resection of tumors involving the sacropelvic region

Objectives Surgical management of the tumors in the sacropelvic region is a challenging field of spine surgery because of the complex local anatomy and biomechanics. Recent development in anesthesia and intensive care has allowed us to perform extended surgeries focused on the en bloc resection of sacropelvic tumors. Various techniques for the resection and for the reconstruction were published in the last decade. Methods Sacropelvic tumor resection techniques and methods for the biomechanical and soft-tissue reconstruction are reviewed in this paper. Results Literature data is based on case reports and case-series. Several different techniques were developed for the lumbopelvic stabilization after sacropelvic tumor resection according to three different reconstruction principles (spinopelvic fixation, posterior pelvic ring fixation, anterior spinal column fixation); however, long term follow up data and comparative studies of the different techniques are still missing. Soft-tissue reconstruction can be performed according to an algorithm depending on the surgical approach, but relatively high complication rates are reported with all reconstruction strategies. The clinical outcome of such surgeries should ideally be evaluated in three dimensions; surgical-, oncological-, and functional outcomes. The last, and most important step of the presurgical planning procedure is a careful presentation of the surgical goals and risks to the patient, who must provide a fully informed consent before surgery can proceed. Discussion Sacropelvic tumors are rare conditions. In the last decade, growing evidence was published on resection and reconstruction techniques for these tumors; however, experience at most medical centers is limited by the low case-number. Formation of international expert groups and initiation of multicenter studies is strongly encouraged to produce a high level of evidence in this special field of spine surgery

Surgical treatment of primary malignant tumors of the sacrum

Objectives The objective of the authors was to provide an up-to-date review about the epidemiology, diagnosis and surgical management of the malignant primary sacral tumors. Methods A PubMed search was conducted using a combination of the following items: (("Spinal Neoplasms"[Mesh]) AND "Sacrum"[Mesh]) NOT ("Metastasis" OR "Metastases" OR "Benign"). The literature review and the author's own surgical experiences were used to assess the current treatment strategies of the malignant sacral tumors. Results Twenty case series were identified, which studies discuss in detail the surgical strategies, the postoperative complications, the functional and onclolgic outcome, the recurrence free and the disease specific survival of this rare patient category. Discussion Sacral tumors are rare pathologies. Their management generates a complex medical problem, as they usually are diagnosed in advanced stages with extended dimensions involving the sacral nerves and surrounding organs. The evaluation and complex treatment of these rare tumors require a multidisciplinary approach, optimally at institutions with comprehensive care and experience. Although conventional oncologic therapeutic methods should be used as neoadjuvant or adjuvant therapies in certain histological types, en bloc resection with wide surgical margins is essential for long-term local oncologic control. This is often technically difficult to achieve, as just a few centers in the world perform sacral tumor surgeries on a regular basis, and have enough wide experience. Therefore international cooperation and organization of multicenter tumor registries are essential to develop evidence based treatment protocols

Genetically reduced FAAH activity may be a risk for the development of anxiety and depression in persons with repetitive childhood trauma

Fatty acid amide hydrolase (FAAH) inhibitors are addressed for promising anxiolytics, but human studies on genetically reduced FAAH activity, stress and affective phenotypes are scarce. We investigated the effect of a functional polymorphism of FAAH (FAAH C385A or rs324420; low FAAH activity and high anandamide concentration are associated with the A allele) together with childhood adversity on the anxious and depressive phenotypes in 858 subjects from the general population. Phenotypes were measured by the Zung Self-Rating Depression Scale (ZSDS), the depression and anxiety subscales of the Brief Symptom Inventory (BSI-DEP, BSI-ANX) and the State-Trait Anxiety scales (STAI-S, STAI-T). Childhood Adversity Questionnaire (CHA) was used to assess early life traumas. Frequency of the A allele was greater among subjects with high ZSDS scores compared to the CC genotype. Furthermore, FAAH C385A and the CHA have shown a robust gene-environment interaction, namely, significantly higher anxiety and depression scores were exhibited by individuals carrying the A allele if they had high CHA scores compared to CC carriers. These data provided preliminary evidence that genetically reduced FAAH activity and repetitive stress in the childhood are associated with increased vulnerability for anxiety and depression in later life. Our results together with earlier experimental data suggest that permanently elevated anandamide level together with early life stress may cause a lifelong damage on stress response probably via the downregulation of CB1R during the neurodevelopment in the brain. It may also point to pharmacogenomic consequences, namely ineffectiveness or adverse effects of FAAH inhibitors in this subpopulation

Mood parameters and severe physical symptoms of the female reproductive cycle

OBJECTIVE: The cyclic variation of physical and psychological phenomena has been accepted as a natural consequence of the cyclicity of the human female reproductive function. The exact nature of these changes, however, has not been fully understood. The aim of our study was to investigate the fluctuation of psychological and physical symptoms throughout the female reproductive cycle in healthy, non-PMDD women. METHOD: 63 psychiatrically healthy, non-PMDD women with normal regular menstrual cycles and not using hormonal contraceptive methods participated in the study. Participants completed the PRISM calendar every night for three consecutive cycles and on three predefined days of the first cycle they completed several other psychometric measures (SCL-51, STAI, ZSDS, EAT and Mind and Body Cathexis Scale). Based on an at least 66% increase in physical symptoms from the late follicular to the late luteal phase on the PRISM, subjects were assigned to LPPS (luteal phase physical symptoms) and nonLPPS (no luteal phase physical symptoms) groups. Average of psychometric scores obtained at the three predefined days were compared between the two groups. RESULTS: There was a significant difference between the two groups only in case of the interpersonal sensitivity subscale of the SCL-51. CONCLUSION: Our results indicate that the appearance of severe physical symptoms in the late luteal phase of the female reproductive cycle is not accompanied by a worsening of psychological symptoms. The appearance of enhanced psychological symptomatology attributed to the luteal phase of the female reproductive cycle thus seems to be independent of the appearance of severe physical symptoms

Az endokannabinoid rendszer genetikai asszociációs vizsgálatai szorongással összefüggésben = Genetic association analyses of the endocannabinoid system on anxious phenotype

Bevezetés: A stresszválasz és az érzelmi élet szabályozásában betöltött szerepéről egyre több adat gyűlt össze az endokannabinoid rendszerrel (ECS) kapcsolatban és komoly farmakológiai targetté vált elsősorban a szorongásoldás területén. Amellett, hogy az állatkísérletes vizsgálatok meggyőző, az anxiolítikus hatást megalapozó eredményekkelszolgálnak, a vonatkozó humán genetikai adatok meglepően hiányosak az irodalomban. Saját vizsgálatunkban az ECS-hez tartozó cannabinoid receptor 1 (CB1R) és a zsírsavamid hidroláz (fatty acid amide hydrolase, FAAH) gén polimorfizmusokat vizsgálatuk különböző interakciós modellekben a szorongással összefüggésben. Módszerek: Vizsgálatsorozatunkba kb. 900 önkéntes, átlagpopulációt reprezentáló résztvevőt vontunk be. A fenotípus méréséhez a Rövid Tünet Skála Szorongás alskáláját, valamint a STAI kérdőívet használtuk. A gyermekkori trauma előfordulását a Gyermekkori Adverzitás Kérdőív segítségével tártuk fel. A genetikai vizsgálatok elvégzéséhez szájnyálkahártya mintából izoláltunk DNS-t, majd MassArray Sequenom technikával történt a genotipizálás. A statisztikai elemzéshez generalizált lineáris regressziót, illetve post hoc teszteket végeztünk. Eredmények: Az egyes SNP-k önálló hatása nem bizonyult szignifikánsnak a fenotípusvarianciák tekintetében. Ezzel szemben az interakciós elemzések markáns összefüggéseket tárt fel. A CB1R gén promoterében elhelyezkedő rs2180619 polimorfizmus GG genotípus az 5-HTTLPR SS genotípussal együtt szignifikánsan magasabb STAI-T pontszámmal járt együtt (p=0.0006) összehasonlítva az ellenpárokkal. A GG és SS genotípus egyidejű hordozása majdnem 5-szörös rizikót jelentett a magas szorongáspontszámmal járó fenotípusra, mint az A és L allél hordozás (OR=4.64, 95% CI: 1.7-12.71). A FAAH gén C385A polimorfizmusát tekintve az A allél járt együtt magasabb BSI-ANX és a STAI-T pontszámmal abban az esetben, ha többszörös gyermekkori trauma szerepelt az anamnézisben ,szemben a C allél hordozókkal (pinteract=0.00002; pinteract=0.0023). Konklúzió: Vizsgálatunkban újabb megerősítést nyertek az ECS patogenikus szerepét igazoló korábbi adatok a szorongásra vonatkozóan. Eredményeink szerint a CB1R és a FAAH gén komplex módon, a szerotonintranszporter-génnel és a gyermekkori traumákkal interakcióban vesz részt a felnőttkori, humán szorongásos fenotípus kialakulásában

Egyénre szabott terápia: a gyógyszeripar rémálma?

Personalized medicine is a hot topic in the literature of the psychiatric field but it seems that regular clinical application of valid tests are awaited. Urgent requirement of objective tools for screening high-risk patients is postulated by prominent authors because long-term set up time, serious side effects or ineffectiveness of psychiatric agents mean a great challenge for clinicians to find optimal therapy on time. Unwanted suffering from inaccurate medicine, progression of the disorder and mistrust or in adherence of the patients are dramatic consequences of the delay of adequate therapy which is linked with irreversible health and mental damages and financial loss. On the other hand, a growing body of data are published on pharmacogenomic studies in association with psychiatric conditions. Although several pharmacogenetic tests are commercially available, accurate use of these tools are absent from clinical protocols. Here we give a short review on the most important pharmacogenomic results and a discussion on possible conflict of interests around pharmacogenetic tests. We conclude that all participants of the health care system could benefit from personalized medicine in psychiatry

The relationship between the big five personality dimensions and acute psychopathology: mediating and moderating effects of coping strategies.

BACKGROUND: Prior research suggests that the Big Five personality dimensions might be associated with coping strategies as well as acute psychopathology. The aim of the present study was to investigate direct and indirect associations between the Big Five personality traits, coping styles, and psychopathological variables. SUBJECTS AND METHODS: Subjects were 1140 adults from various institutions and regions in Hungary. A comprehensive test battery was administered including the Big Five Inventory (BFI), Psychological Immune System Inventory (PISI), and some subscales of the Brief Symptom Inventory (BSI). Several moderation-mediation analyses were conducted using the PROCESS tool in SPSS to test for influence paths. RESULTS: Coping and personality variables jointly accounted for 40% to 50% of variance in psychopathology outcome. Personality dimensions of Extraversion, Conscientiousness and Emotional Stability had strongest predictive values. Emotional Stability had a more direct and unmediated effect, whereas Extraversion and Conscientiousness effects were mediated by the Approach and Self-regulation coping systems. In comparison to personality, coping style was generally a stronger predictor. CONCLUSIONS: The findings of this study might add to better understanding of complex pathways leading from broad personality dimensions to coping strategies and psychological (mal)adjustment

Paradigmaváltás a csontmetasztázisok sebészetében. II. Gerincmetasztázisok kezelése

The incidence of spinal metastases is constantly growing, but due to the advancements in oncologic treatment methods, the survival and the quality of life of the patients are persistently improving. Choosing the optimal treatment method is essential, and several factors should be considered: type of the primary tumor, segmental stability, the symptoms caused by the metastasis and the general condition of the patient. Using modern radiotherapeutic methods combined with minimally invasive surgical techniques (minimally invasive stabilization, separation surgery) in the majority of patients permits adequate local control with low complication rate. In our review, we describe the state-of-the-art, modern spinal metastasis treatment options based on the recently published evidence. Orv Hetil. 2018; 159(8): 297-302