Neurodegenerative Properties of Chronic Pain: Cognitive Decline in Patients with Chronic Pancreatitis

Chronic pain has been associated with impaired cognitive function. We examined cognitive performance in patients with severe chronic pancreatitis pain. We explored the following factors for their contribution to observed cognitive deficits: pain duration, comorbidity (depression, sleep disturbance), use of opioids, and premorbid alcohol abuse. The cognitive profiles of 16 patients with severe pain due to chronic pancreatitis were determined using an extensive neuropsychological test battery. Data from three cognitive domains (psychomotor performance, memory, executive functions) were compared to data from healthy controls matched for age, gender and education. Multivariate multilevel analysis of the data showed decreased test scores in patients with chronic pancreatitis pain in different cognitive domains. Psychomotor performance and executive functions showed the most prominent decline. Interestingly, pain duration appeared to be the strongest predictor for observed cognitive decline. Depressive symptoms, sleep disturbance, opioid use and history of alcohol abuse provided additional explanations for the observed cognitive decline in some of the tests, but to a lesser extent than pain duration. The negative effect of pain duration on cognitive performance is compatible with the theory of neurodegenerative properties of chronic pain. Therefore, early and effective therapeutic interventions might reduce or prevent decline in cognitive performance, thereby improving outcomes and quality of life in these patients

The apicomplexan plastid and its evolution

Protistan species belonging to the phylum Apicomplexa have a non-photosynthetic secondary plastid—the apicoplast. Although its tiny genome and even the entire nuclear genome has been sequenced for several organisms bearing the organelle, the reason for its existence remains largely obscure. Some of the functions of the apicoplast, including housekeeping ones, are significantly different from those of other plastids, possibly due to the organelle’s unique symbiotic origin

Clinical outcome of T1 glottic carcinoma since the introduction of endoscopic CO2 laser surgery as treatment option

Background. Since the introduction of endoscopic laser surgery at our institution in 1996, 189 patients have been treated for T1 glottic carcinoma, Methods. Treatment allocation (radiotherapy vs laser surgery) and outcome were evaluated. Results. Fifty-one percent of T1a lesions were considered suitable for laser surgery. Sixteen percent of T1 a patients treated with laser surgery needed additional treatment because of positive resection margins. Overall local control and larynx preservation were 89% and 96%. Both were poorer in T1a patients with larger lesions treated with radiotherapy (local control 75% versus 89%, p =.05, larynx preservation 83% vs 100%, p =.001). Conclusion. Outcome for T1a patients selected for laser surgery is excellent. In patients with larger lesions treated with radiotherapy, outcome is inferior to patients selected for laser surgery, but also to that reported for (unselected) T1a carcinomas treated with radiotherapy in literature. Strategies to improve treatment results in patients deemed unsuitable for laser surgery should be designed. (c) 2008 Wiley Periodicals, Inc

Functional outcomes after radiotherapy or laser surgery in early glottic carcinoma: A systematic review

Background Early glottic carcinoma is treated with laser surgery or radiotherapy, but which treatment has better functional outcomes is unclear. This systematic review compared functional outcomes (voice, swallowing, quality of life [QOL]) in more extended T1a and limited T2 tumors (1) between treatments and (2) between greater and lesser laser resections. Methods A systematic literature search covered relevant databases from 1990 to 2009, combining all patient/problem, intervention, comparison, outcome (PICO) keyword variations. Results A total of 19 papers met the inclusion criteria, all of which were level IV evidence. Papers reported only voice and QOL. Heterogeneity of outcome measures prevented data pooling. Uncertainty about tumor comparability (depth, extent) between the 2 treatments, small subject numbers, and poor-quality reporting hindered interpretation. Conclusions To allow comparison of laser surgery versus radiotherapy, a standardized method is needed that accurately measures tumor extent and depth. Agreement on functional outcome measures is necessary to allow comparison of treatments and resection types. Multicenter studies should be encouraged to guarantee adequate subject numbers. (c) 2011 Wiley Periodicals, Inc. Head Neck, 201

Outcome of radiotherapy in T1 glottic carcinoma: a population-based study

We evaluated the radiation outcome and prognostic factors in a population-based study of early (T1N0M0) glottic carcinoma. Survival parameters and prognostic factors were evaluated by uni- and multivariate analysis in 316 consecutive irradiated patients with T1 glottic carcinoma in the Comprehensive Cancer Center West region of the western Netherlands. Median follow-up was 70 months (range 1-190 months). Five and ten-year local control was 86 and 84%. Disease specific survival was 97% at 5 and 10 years. In multivariate analysis, pre-existent laryngeal hypertrophic laryngitis was the only predictive factor for local control (relative risk = 3.0, P = 0.02). Comorbidity was prognostic for overall survival. No factor was predictive for disease specific survival. Pre-existent laryngeal hypertrophic laryngitis is a new risk factor associated with reduced local control in T1 glottic carcinoma treated with radiotherapy