Return to sport after lumbar fusion among patients with degenerative spinal disease

Abstract Introduction and purpose Low-back pain (LBP) is one the most common causes of medical visits. Although specific diagnosis cannot always be made, degenerative spinal disease may be one. Non-surgical approach is the treatment of choice in most cases and provides satisfactory results. However, some patients require surgery when conservative treatment fails. Among different interventions, lumbar fusion is one of the most important. Common question arising from patients qualified for this type of surgery is the possibility of returning to sport (RTS). Description of the state of knowledge Successful RTS may be achieved with proper rehabilitation without surgery. However, invasive intervention, including lumbar fusion, is indicated when a non-surgical approach fails. Return to recreational sport is highly plausible among patients operated for spinal structures degeneration. The timing of RTS varies on the type of sport, nonetheless one may expect to rejoin sporting activities within a year. The return to golf has been well documented in the literature in comparison to other sport types. Golfers may expect successful recovery as 79-100% of them re-engage in golfing activities. Positive RTS is feasible for professional athletes and some of them are able to compete at elite level after surgery. The need for a well-structured rehabilitation protocol is underlined. Summary Successful RTS can be achieved in the vast majority of cases after lumbar fusion procedures. The suggested timeframes has been set as 6-12 months depending on the sport type. There are no strict recommendations, but general criterias include: 1) complete/nearly complete pain reduction; 2) adequate flexibility, strength and range of motion; 3) radiographic evidence of successful fusion

Large deletion causing von Hippel-Lindau disease and hereditary breast cancer syndrome

Patients with intragenic mutations of the VHL gene have a typical disease presentation. However in cases of large VHL gene deletions which involve other genes in the proximity of the VHL gene a presentation of the disease can be different. To investigate whether large VHL deletions that remove the FANCD2 gene have an effect on the disease phenotype, we studied a family with a 50 kb large deletion encompassing these two genes. Four patients in this family were affected by VHL-related lesions. However one carrier of the deletion also had bilateral ductal breast cancer at age 46 and 49. Both tumors were of ~2 cm in diameter. On one side lymph nodes were affected. One tumor was ER- and PR-negative (HER2 s unknown) and the second was ER- and PR-positive, and HER2-negative. Our study suggests that a deletion of FANCD2 gene, an important gene in the DNA repair pathway, may be associated with an increased risk of breast cancer, but further studies are needed in this regard

Analysis of Selected Physicochemical Properties of Commercial Apple Juices

The paper presents the comparison of quality of six different commercial apple juices produced in Poland. The apple juices came from two different Polish companies. From each manufacturer three various juices were selected: two cloudy and clarified one produced as a mixture of different apple varieties. The following properties were evaluated: density, soluble solid content, viscosity, total phenolic contents, phenolic acid, and antiradical activity. The obtained results showed that three from fourth cloudy juices (M1Sz, M1A and M2A) differed from clarified juices. The highest differences were noticed for total phenolic contents, phenolic acids, antiradical activity and viscosity. The values of these properties ranged between 60.72–103.6 mg GAE·100-1 mL-1 for phenolic contents, 78.3–90.9% for antiradical activity and 2.68–5.79 mPa·s for viscosity. The remaining cloudy juice (M2Sz) was more similar to the clarified ones. The strong correlation between total phenolic content and antiradical activity of apple juices was found. The high correlation coefficient obtained between these features indicates that both producers do not apply excessive amounts of vitamin C during the production of cloudy apple juices. There was also a strong interrelation between the density of juice and solid soluble content. However, no correlation was found between the solid soluble content and the viscosity of the tested juices

Diagnostic value of non-enhanced computed tomography in identifying location of ruptured cerebral aneurysm in patients with aneurysmal subarachnoid haemorrhage

Background. In patients with SAH and multiple aneurysms, the ruptured lesion must be identified to prevent recurrent bleeding.Aim of the study. To assess the diagnostic value of non-enhanced computed tomography (NECT) in identifying the rupture site in patients with subarachnoid haemorrhage (SAH) and multiple aneurysms.Material and methods. We included patients with SAH revealed by NECT and multiple aneurysms detected on computed tomography angiography (CTA) in whom a ruptured aneurysm was identified during neurosurgery. Two radiologists predicted the location of the ruptured aneurysm based on the distribution of the SAH and location of intracerebral haematoma (ICH) by NECT.Results. Eighty-three patients with a mean age of 55.7 ± 14.4 years were included. Ruptured aneurysms were significantly larger (mean size 7.7 ± 4.7 mm) than unruptured aneurysms (mean size 5.9 ± 4.5 mm; p = 0.014). Interobserver agreement was 0.86 (p < 0.001). Overall sensitivity and specificity of radiological prediction were 78.3% (95% CI, 68.6%-87.1%) and 96.4% (95% CI, 94.3%-97.8%) respectively. Overall PPV and NPV were 78.3% (95% CI, 67.6%-86.3%) and 96.8% (95% CI, 94.8%-98.1%) respectively. The sensitivity and PPV for aneurysms in the anterior communicating, anterior, and middle cerebral arteries appeared to be significantly higher than in other locations (p = 0.015 and 0.019 respectively). Analysis of independent predictive factors of correct radiological location revealed that ICH predisposes to a correct radiological diagnosis with an odds ratio of 8.57 (95% CI, 1.07-68.99; p = 0.03).Conclusions. NECT has a high diagnostic value in identifying the source of bleeding in patients with multiple aneurysms for anterior circulation aneurysms, especially with coexisting ICH. For other locations, NECT is not reliable enough to base treatment decisions upon

Executive Functions and Psychopathology Dimensions in Deficit and Non-Deficit Schizophrenia

This study: (a) compared executive functions between deficit (DS) and non-deficit schizophrenia (NDS) patients and healthy controls (HC), controlling premorbid IQ and level of education; (b) compared executive functions in DS and NDS patients, controlling premorbid IQ and psychopathological symptoms; and (c) estimated relationships between clinical factors, psychopathological symptoms, and executive functions using structural equation modelling. Participants were 29 DS patients, 44 NDS patients, and 39 HC. Executive functions were measured with the Mazes Subtest, Spatial Span Subtest, Letter Number Span Test, Color Trail Test, and Berg Card Sorting Test. Psychopathological symptoms were evaluated with the Positive and Negative Syndrome Scale, Brief Negative Symptom Scale, and Self-evaluation of Negative Symptoms. Compared to HC, both clinical groups performed poorer on cognitive flexibility, DS patients on verbal working memory, and NDS patients on planning. DS and NDS patients did not differ in executive functions, except planning, after controlling premorbid IQ and negative psychopathological symptoms. In DS patients, exacerbation had an effect on verbal working memory and cognitive planning; in NDS patients, positive symptoms had an effect on cognitive flexibility. Both DS and NDS patients presented deficits, affecting the former to a greater extent. Nonetheless, clinical variables appeared to significantly affect these deficits

Assessment of Complement Cascade Components in Patients With Bipolar Disorder

Introduction: The immune system is undoubtedly involved in the pathogenesis of various psychiatric disorders, such as schizophrenia, bipolar disorder, or depression. Although its role is not fully understood, it appears that this area of research can help to understand the etiology of mental illness. One of the components of the human immune system is the complement system, which forms a part of the innate immune response. Physiologically, except for its essential protective role, it is a vital element in the regeneration processes, including neurogenesis. To date, few studies have tried to clarify the role of the complement cascade in mental disorders.Materials and Methods: We evaluated concentrations of C3a, C5a, and C5b-9 complement cascade components in the peripheral blood of 30 patients suffering from bipolar disorder (BD) for at least 10 years, in euthymia, who were not treated with lithium salts. In addition, we divided our study sample into BD type I (BD-I, 22 persons), and BD type II (BD-II, 8 patients). The control group consisted of 30 healthy volunteers matched for age, sex, BMI, and smoking habits.Results: Compared to healthy controls, BD patients had elevated concentrations of all the investigated components. Furthermore, in patients with BD-II, we observed higher concentrations of C5b-9 as compared to patients with BD-I. However, there was a significant effect of BD diagnosis only on the levels of C3a and C5a but not on the level of C5b-9 after adjustment for potential confounding factors.Conclusions: Increased concentrations of components C3a and C5a of the complement system in the investigated group as compared to healthy controls suggest involvement of the complement cascade in the pathogenesis of BD, and provides further evidence of immune system dysregulation in BD patients

Changes in cervical range of motion following anterior cervical discectomy with fusion — preliminary results

Background. The biomechanics of the cervical spine after anterior cervical discectomy with fusion (ACDF), and in particular changes in its global mobility, are phenomena that have not yet been sufficiently studied. Consequently, their effect on the eventual result of treatment is not fully understood. The aim of this study was to assess changes in global and segmental mobility of the cervical spine after ACDF.Material and methods. 28 patients who underwent ACDF for cervical spondylosis were examined. The study was divided into two stages: preoperative and postoperative. Range of motion (ROM) was analysed based on X-ray AP, lateral and functional images: C1-C7, C1-C2, C2-C7, C1-C4, C4-C7, and segments adjacent to the stabilisation. The patients were divided into groups depending on the length of spondylodesis and the occurrence of adjacent segment degeneration (ASDeg).Results. A statistically significant difference was found in the total ROM of C2-C7, C1-C7 and C4-C7 after ACDF. The ROM of C2-C7 decreased by 23%, of C1-C7 by 20%, and of C4-C7 by 38%. These changes occurred by reducing the extension ROM C2-C7 by 33%, C1-C7 by 31%, and C4-C7 by 12%. There was a statistically significant (31%) reduction in total ROM in the segment above ACDF, a 41% reduction in extension ROM of this level in the non-ASDeg group, and a 73% increase in the segmental extension ROM above ACDF in patients with ASDeg.Conclusions. ACDF reduces the total ROM of the cervical spine in the sagittal plane. This change occurs by reducing the neck extension, and its severity depends on the length of the spondylodesis. In patients without ASDeg after ACDF, the mobility of the level above the stabilisation decreases. The occurrence of ASDeg is associated with a higher postoperative ROM of the segment located above the spondylodesis

Zmiany torbielowate okolicy siodłowo-nadsiodłowej — diagnostyka i leczenie

The differentiation of cystic lesions located in the sellar-suprasellar region is a significant problem in clinical practice because of the similarities in their clinical, radiological, and even histopathological picture. Arriving at the right diagnosis is vital for taking appropriate therapeutic decisions. The most frequent clinical manifestation of lesions located in the sellar-suprasellar region is headache. It often co-exists with symptoms of anterior pituitary gland insufficiency or hyperprolactinaemia caused by compression of the pituitary stalk. Diabetes insipidus, obe­sity, mental disorders, and circadian rhythm disorders may be associated with lesions penetrating the suprasellar space. It is extremely important to rule out the possible coexistence of pituitary microadenoma and Rathke’s cleft cyst, which became possible with the use of 11C-methionine positron emission tomography/computed tomography (C-MET PET/CT). Reports from literature indicate that pituitary microadenoma may coexist with Rathke’s cleft cyst in 10% of patients. Cystic lesions of the sellar-suprasellar region should also be differentiated from a cystic pituitary adenoma or abscess. The first-choice therapy in symptomatic cystic lesions of the sellar-suprasellar region is neurosurgery, which usually relieves headache and improves vision impairment, while less frequently restores normal pituitary function. In suprasellar lesions, neurosurgery may trig­ger or aggravate pre-existing symptoms of damage to the hypothalamus. Patients undergoing neurosurgery for cystic lesions located in the sellar-suprasellar region should be monitored for a few years due to their high recurrence rate, potential malignant transformation of these lesions, and possible adenoma development through metaplasia. The advent of targeted therapy of the BRAF/MEK pathway is associated with new therapeutic opportunities for patients with craniopharyngiomas.Różnicowanie zmian torbielowatych okolicy siodłowo-nadsiodłowej stanowi istotny problem w praktyce klinicznej, ze względu na ich podobieństwo w obrazie klinicznym, radiologicznym, a nawet histopatologicznym. Postawienie właściwego rozpoznania ma kluczowe znaczenie w podejmowaniu prawidłowych decyzji terapeutycznych. Najczęstszą manifestacją kliniczną zmian okolicy siodłowo-nadsiodłowej są bóle głowy. Często współistnieją z nimi objawy niedoczynności przedniego płata przysadki lub hiperprolaktynemia wywołana uciskiem na szypułę. Moczówka prosta, otyłość, zaburzenia psychiczne i zaburzenia rytmów dobowych mogą występować przy zmianach penetrujących do przestrzeni nadsiodłowej. Szczególnie ważne jest wykluczenie współwystępowania mikrogruczolaka przysadki z torbielą kieszonki Rathkego. Stało się to możliwe przy zastosowaniu znakowanej metioniny w badaniu PET/CT (C-MET PET/CT). Doniesienia z piśmiennictwa wskazują na możliwość współwystępowania mikrogruczolaka przysadki u 10% chorych z torbielą kieszonki Rathkego. Należy także mieć na uwadze różnicowanie zmian torbielowatych okolicy siodłowo-nadsiodłowej z torbielowatym gruczolakiem przysadki lub ropniem. Leczeniem z wyboru w przypadku objawowych zmian torbielowatych okolicy siodłowo-nadsiodłowej jest zabieg neurochirurgiczny, który zazwyczaj powoduje zmniejszenie dolegliwości bólowych głowy i zaburzeń widzenia, natomiast rzadziej prowadzi do przywrócenia prawidłowej czynności przysadki. W przypadku zmian nadsiodłowych w następstwie zabiegu neurochirurgicznego mogą pojawić się lub pogłębić istniejące wcześniej objawy uszkodzenia podwzgórza. Obserwacja pacjentów ze zmianami torbielowatymi okolicy siodłowo-nadsiodłowej po leczeniu neurochirurgicznym powinna trwać kilka lat z uwagi na dużą nawrotowość zmian, ich potencjalne ryzyko transformacji złośliwej i możliwość powstania gruczolaka na drodze metaplazji. Wprowadzenie terapii celowanej inhibitorami szlaku BRAF/MEK stwarza nowe szanse w leczeniu czaszkogardlaków

Quality of Life and Sleep in Patients with Pituitary Adenoma in Relation to Tumor Type and Compression of the Optic Chiasm

Objective: To determine the effect of transsphenoidal surgery on quality of life and sleep in patients with pituitary adenomas depending on tumor type and compression of the optic chiasm. Methods: In this prospective study, patients with pituitary adenomas who were scheduled for transsphenoidal surgery completed the Short Form 36 Questionnaire, Pittsburgh Sleep Quality Index, and Epworth Sleepiness Scale preoperatively and 7.5 (±1.5) months after surgery. Patients were analyzed based on tumor type and compression of the optic chiasm. Results: Significant improvements with large effect sizes were seen for patients with Cushing’s disease in general health (Z = −2.37; p = 0.018), vitality (Z = −2.05; p = 0.041), and mental health (Z = −2.06; p = 0.040). A significant deterioration with large effect size occurred in physical functioning (Z = −2.02; p = 0.043) in patients with acromegaly. A significant improvement with medium effect size was seen in subjective sleep quality, (Z = −2.24; p = 0.025), sleep duration (Z = −2.11; p = 0.035), and habitual sleep efficiency (Z = −2.26; p = 0.024) after decompression of the optic chiasm. Multiple significant correlations were observed between sleep parameters and Short Form 36 subscales before and after treatment. Conclusions: Changes in quality of life during the follow-up period depend on tumor type. Circadian rhythm disturbances may resolve promptly after decompression of the optic chiasm. Quality of life in pituitary adenoma patients is associated with quality of sleep in many dimensions, thus implying that developing strategies to improve sleep quality could increase overall well-being and everyday functioning in pituitary adenoma patients

Evaluation of the Accero Stent for Stent-Assisted Coiling of Unruptured Wide-Necked Intracranial Aneurysm Treatment with Short-Term Follow-Up

Background: Stent-assisted coiling is an effective method of treating intracranial aneurysms. The aim of the study was to assess the safety and efficacy of the new Accero stent for the treatment of intracranial aneurysms. Materials and Methods: It was a retrospective, single-center study. Eighteen unruptured intracranial aneurysms were treated using the stent-assisted coiling method with the Accero stent. Patient demographics, aneurysm characteristics, procedural parameters, grade of occlusion, complications, and clinical results were analyzed. Follow-up magnetic resonance (MR) was performed 6 months after intervention. Results: Seventeen patients with 18 incidental unruptured aneurysms were electively treated with coiling and the Accero stent. The aneurysms were located on internal carotid artery (ICA), middle cerebral artery (MCA) and basilar artery (BA). All stents were deployed successfully. Immediate complete occlusion rate Raymond-Roy occlusion classification (RROC) class I was achieved in 13 cases and class II in 4 cases. Complications occurred in 2/17 treatments and included guidewire stent perforation with subarachnoid hemorrhage (SAH) and stent deformation. Vascular spasm in the subarachnoid hemorrhage (SAH) patient subsided before discharge. Ninety days after intervention, the modified Rankin Scale (mRS) value was 0. RROC class I was observed in 88.23% of cases in follow-up. Conclusion: The Accero stent provides excellent support for coil mass. It constitutes an efficacious device with good initial occlusion rate for treating wide-necked unruptured intracranial aneurysms