[MR-guided core biopsy of the shoulder: possibilities and experience with a vertically open 0.5T system]

PURPOSE

The availability of open whole body MRI magnets and MR-compatible instrumentarium were essential conditions for the progression of interventional MRI. The advantages of an MR-guided biopsy at the musculoskeletal system are the visualization of the puncture site of a representative area for tumor histology, the absence of exposure to radiation and the free selection of imaging planes. The purpose of the study was the development of a new technique of a secure MR-guided biopsy of intraosseus lesions in the humeral head.

MATERIAL AND METHODS

MR-guided core biopsy of a intraosseus lesion of the humeral head was performed in five male patients on a vertical open, whole body MRI magnet (SIGNA SP/i 0.5T, GE Medical Systems). The technique using interactive MRI and the MR-compatible instrumentarium are described.

RESULTS

A secure core biopsy could be obtained from a representative area for tumor histology in all cases. No complications occurred, especially no nerve or vessel lesion, no rotator cuff lesion and no intra-articular contamination of the shoulder joint were observed.

CONCLUSION

A new technique is presented to obtain MR-guided core biopsies of intraosseous lesions of the humeral head. Furthermore, clinical indications of this technique are described.

Comparative investigation of alloplastic materials for hernia repair with improved methodology

BACKGROUND

A variety of alloplastic materials are used for hernia repair. We discuss the long-term stability and possible shrinkage of these materials. In the past, measurement of pore sizes was used to study the physical properties of alloplastic meshes. The aim of this study was to evaluate the measurement of pore sizes with regard to its correlation to possible mesh alteration.

METHODS

The water absorption of different polypropylene (PP) and polyester (PE) mesh materials under defined conditions was studied. For shrinkage studies, meshes were stored in formaldehyde, distilled water, saline solution, trypsin solution, urea solution, and hydrogen peroxide. The measurement of the relation between material and pore was evaluated to investigate the potential shrinking and enlargement processes. This material-pore index (MPI) before as well as 1, 7, and 14 days after incubation was measured.

RESULTS

In comparison to measuring single pore sizes, MPI determination is the more efficient method to evaluate the possible shrinking or enlargement processes of alloplastic materials. With this technique, incorrect determination of pore sizes due to the dynamic textile structure of meshes and to shrinkage or enlargement, is excluded. All tested alloplastic materials showed an insignificant increase in water absorption under the condition of rehydration up to 0.4%. We did not observe variances in the material in shrinking or enlargement.

CONCLUSIONS

MPI was found to be more reliable than measuring single pores to investigate possible external influences on polymer materials. Biomaterials such as PP and PE proved to be absolutely inert under various in vitro conditions.

Malignant oesophago-pleuro-pericardial fistula in a patient with oesophageal carcinoma

Pericardial and cardiac fistulae secondary to oesophageal or gastric tumours are a rare complication. We report about a 50-year-old male patient with a 10-month history of distal oesophageal carcinoma with lung and liver metastases who was referred to our hospital after 6 cycles of palliative chemotherapy at the beginning of March 2004. The patient presented with dysphagia, dyspnea, tachycardia, and hypotension. Purulent pericardial and bilateral pleural effusion was diagnosed, and the patient was treated with antibiotics, repeated pleurocentesis and pericardial drainage with daily polihexanide lavage. Oesophagogastroduodenoscopy, Peritrast swallow and computed tomographic scans of chest revealed a malignant oesophago-pleuro-pericardial fistula. A total of three coated, expandable metal stents were inserted into the oesophagus, which sealed successfully the fistula. Unfortunately, the patient succumbed to his carcinoma three months later.

[Frequency of dementia and pre-dementia in elderly people requesting an Autonomy Adapted Assistance grant in the department of Nièvre]

This study was carried out in the French county of Nièvre after the establishment of a new state funded grant for elderly people called the Autonomy Adapted Allocation. The study looks at the medical evaluations conducted in the homes of elderly people aged 60 and over who have submitted a request for this new grant (a total of 2388 requests were received). The study points to a high level of dependence within the target population of those who are "susceptible to dementia". It also demonstrated that the current scale used for identifying those who are susceptible to dementia is insufficient for its purpose in this case, and unfortunately it lacks the ability to include a portion of the population who should be considered as recipients of these funds. This gap corroborates the difficulty in fully appreciating and understanding the functional repercussions of dementia.

Pankreasorganentnahme durch externe Teams

Combined pancreas and kidney transplantation is an established procedure for terminal or preterminal, uremic, type 1 diabetics. The current procurement technique allows simultaneous recovery of liver and pancreas. One problem is the assessment of organ quality. It remains unclear how many pancreas organs must be withdrawn during back-table preparation. Between June 1994 and December 2003, 271 pancreas transplantations were performed at our transplant centre. Two hundred sixty-two (89.7%) pancreas grafts were harvested by teams which were not part of the transplant team. Twenty-one (8.0%) grafts were discharged for transplantation at the time of back-table preparation. Liposis of the graft and critical vessel situations were the main reasons for withdrawal. Two kidney grafts were not usable for transplantation, and 92% of the pancreas grafts were. This demonstrates the high standard of pancreas procurement in the Eurotransplant region.

Neoquadruple induction with antithymocyte globulin/azathioprine/cyclosporine/prednisolone in simultaneous pancreas and kidney transplant recipients: 8.5-year results

Ten years ago therapy with antithymocyte globulin or OKT3, azathioprine, cyclosporine, and prednisolone was the most common induction treatment for simultaneous pancreas/ kidney (SPK) recipients. Although immunosuppression was started after surgery, there was a high incidence of acute rejection episodes. In 1995, we modified the application of antithymocyte globulin and prednisolone by starting prior to reperfusion. Between 1995 and 1996, 30 patients underwent a first SPK. Prior to reperfusion, antithymocyte globulin (4-6 mg/kg body weight) and 250 mg prednisolone were administered. Intraoperatively, another 250 mg prednisolone were administered as well as intravenous azathroprine 3 mg/kg. After surgery up to 10 doses of antithymocyte globulin were administered and cyclosporine trough levels targeted to 200 to 250 ng/mL. Prednisolone was reduced gradually. After a median period of 8.5 years (range: 7.8-9.5 years) patient, pancreas, and kidney graft survival were 93.3%, 70%, and 76.7%, respectively. Sixteen acute rejection episodes were diagnosed in 11 patients (36.7%), who were treated with prednisolone bolus (n = 4), prednisolone with OKT3 (n = 8), prednisolone with antithymocyte globulin (n = 1), cyclosporine to tacrolimus conversion (n = 2), or plasmapheresis (n = 1). Two recipients died after SPK due to severe infection or carcinoma with functioning grafts. Seven further pancreas grafts were lost. Five kidney losses were observed besides the two recipients who died with functioning grafts. While previous protocols yielded a rejection incidence after SPK between 50% and 80%, we observed 60% of patients with no rejection episode during an 8.5-year median follow-up.

Precoating of alloplastic materials with living human fibroblasts—a feasibility study

BACKGROUND

The use of alloplastic materials such as polypropylene and polyester has reduced the recurrence of abdominal wall hernias. Concomitantly, new problems have arisen such as inflammatory response against the implanted material and the development of enteric fistulas in case of direct contact of the bowel to polypropylene and polyester. A precoating of the PP with collagen and other absorbable materials seems to reduce the incidence of adhesions and fistulas. The aim of this study was to show the technical feasibility of a precoating of polypropylene with living human fibroblasts and to investigate the growth properties of the cells under these conditions in vitro.

METHODS

The textile structure of three different alloplastic materials is described (SurgiPro), TycoHealthcare; Parietene3 PP1510, Dallhausen; VIPRO II, Ethicon Endosurgery). Enhanced Green Fluorescence Protein (EGFP) transduced human foreskin fibroblasts (KiF5) were seeded onto these different alloplastic materials. Proliferation was analyzed by FACS analysis of Ki67 expression. The coating process of the whole mesh area was observed over time with UV-light microscopy, immunostaining, and scanning electron microscopy (SEM). The expression of collagen type I and III was investigated by immunostaining.

RESULTS

The three alloplastic materials used were knitted fabrics with different textile structures. KiF5 colonized the entire alloplastic material within 4-6 weeks. Cells were proliferating, as detected by Ki67 expression. SEM showed surface ruffles and long cellular extensions, indicating an active cell metabolism. Light microscopy and SEM suggested that the cells modify the apolar surface by deposition of extracellular matrix components before colonization.

CONCLUSION

Our study shows the feasibility of precoating of polypropylene meshes with living human fibroblasts and opens the possibility for clinical use in the future.

Single-Shot Antithymocyte Globuline and Daclizumab Induction in Simultaneous Pancreas and Kidney Transplant Recipient: Three-Year Results

Since 1996, preoperative single-shot dose antithymocyte globuline (ATG) with prednisolone (PRD), mycophenolate mofetile (MMF), and tacrolimus (TAC) is the favorite induction therapy in our center. In a series of 25 first simultaneous pancreas and kidney transplant (SPK) recipients, 5 doses of daclizumab were administered in addition to standard induction. Here we present our 3-year experience. Immunosuppression was started prior to reperfusion consisting of daclizumab (1 mg/kg body weight [bw]), ATG (4-6 mg/kg bw) and 250 mg PRD. After surgery, PRD was reduced gradually, TAC trough levels were between 8-15 ng/mL, MMF was given twice daily (2-3 g/d) as well as 4 further doses dacilzumab every 14 days. After 3 years, patient, pancreas, and kidney graft survival rates are 100%, 84%, and 92%, respectively. Four pancreas grafts were lost (chronic allograft dysfunction, n = 2; recurrent abdominal infection, n = 1; acute rejection [AR] without treatment, n = 1). Both patients suffering from severe infection and untreated AR lost their kidney graft too. During the first 3 months after SPK, 3 AR episodes were observed in 2 patients (8%). After a 3-year period, 8 AR episodes occurred in 7 recipients (28%). AR was treated using PRD (n = 5) or ATG (n = 1). In 1 case, immunosuppression was switched from TAC to sirolimus successfully. Overall, 8 AR episodes occurred in 7 patients (28%) during the first 3 years after SPK. One severe infection led to graft lost 13 months after SPK. In this series, the combination of ATG and daclizumab prevented AR episodes, successfully providing considerable 3-year survival rates.

Pediatric MR-guided interventions

MRI guided interventions are a relatively new but steadily growing field within surgery in pediatric age. Besides the advantages of MRI, such as multiplanar capability and excellent soft tissue contrast and spatial resolution, particularly relevant for the pediatric population is the lack of ionizing radiation. There is meanwhile a group of well defined diagnostic or therapeutic indications for applying MR imaging during pediatric interventions. Aim of this review is to give an overview about indications of MR-guided procedures in children as well as the advantages and disadvantages of MR-guided interventions. We also briefly discuss interventional MR-systems and MR-compatible devices. It is our opinion that MR-guidance for pediatric interventions is a promising technique at the beginning of its development.

[Combined pancreas kidney transplantation after isolated kidney transplantation]

Simultaneous pancreas kidney transplantation (SPK) is an established therapy for type 1 diabetics with end stage or preterminal renal disease. SPK is superior to isolated kidney transplantation (KTX) in diabetic patients. Even pancreas-re-transplantations are more common in these patients now, mostly after SPK. But Experience with SPK after KTX is rare. Between 1994 and 2003 six Re-SPK 4.5 to 8.5 years after KTX were performed in our department. Average age of the recipients was 40.5 years. They had been suffering from diabetes for an average of 29.3 years. Four recipients were on dialysis again, whereas two had preterminal renal insufficiency. Pancreas transplants were drained through the bladder (n = 1) or into the small intestine (n = 5) with systemic venous anastomosis. After a median observation period of 28 months (8 to 99 months) all six recipients are insulin free. One patient lost his kidney graft due to severe acute rejection. Therefore kidney graft survival is 83 %. Four acute rejections (66 %) were observed in 4 patients. Only one rejection was treated successfully by steroids. Two rejections could be stopped with antibodies. 3 patients had infections in the early postoperative period (sinusitis, urinary tract infection, wound infection). Even after KTX with graft failure, diabetic patients suffering from renal disease can be re-transplanted successfully with SPK.

Computerized CT-Based 3D Visualization Technique in Living Related Liver Transplantation

INTRODUCTION

For living donor liver transplantation (LDLT) accurate diagnostic workup is essential. Multiple imaging approaches are currently used. Problems arise in the assessment of vascular and bile duct anatomy, liver graft volume, and vascular territories involved. A 3D visualization system that improves anatomic assessment, allows interactive surgery planning, and acts as an intraoperative guide with enhanced precision is required. Refinements in computed tomography (CT) technology with the introduction of multidetector-row CT scanners and implementation of mathematical methods on computerized digital data has enabled CT-based 3D visualizations.

MATERIALS AND METHODS

Sixteen LDLT candidates and three LDLT recipients were assessed by multislice CT examination. Image processing of the digital raw data for 3D visualization included segmentation and calculation of center lines. A hierarchical mathematical model representing the vascular and biliary tree was created. This allowed calculation of individual vascular territories.

RESULTS

3D CT-based visualization in LDLT facilitates diagnostic workup with high accuracy for analyses of vascular and bile duct variants, volumetry, and assessment of the optimal surgical splitting line of the living donor liver. Resultant areas of either arterial devascularization or venous congestion can be displayed and quantified preoperatively. The diagnostic method is of major impact on patient selection and directly influences intraoperative surgical guidance. The currently practiced "multiple imaging approach" approach, especially with regard to invasive diagnostics, can be avoided in the future.

Single-Shot Antithymocyte Globulin (ATG) Induction for Pancreas/Kidney Transplantation: ATG-Fresenius Versus Thymoglobulin

Single-shot antithymocyte globulin (ATG) prior to reperfusion followed by tacrolimus (TAC), mycophenolate mofetil (MMF), and prednisolone (PRD) is an established induction therapy in simultaneous pancreas kidney transplant (SPK) recipients. We retrospectively analyzed 6-month data from 105 patients who received their first SPK. From January 1996 to December 2000, ATG-Fresenius was used. Since January 2001, Thymoglobulin has been administered. In the first group, 58 patients were treated with ATG-Fresenius (4-6 mg/kg body weight). In the second group, 47 patients received Thymoglobulin (1.5-2.5 mg/kg body weight). HLA-mismatch was comparable. After an observation period of 6 months, patients, kidney, and pancreas graft survival is 98.3%, 96.6%, and 93.1% in group I and 97.9%, 97.9%, and 85.1% in group II, respectively. In each group, one death with functioning graft (DWFG) was observed. Twenty (34.5%) acute rejection episodes (AR) were observed (18 patients) in group I. They were treated with steroids (n = 16) or steroids/OKT3 (n = 4). One kidney graft failure was observed due to rejection and one due to DWFG. Four pancreas grafts were lost (thrombosis, n = 2; AR, n = 1; DWFG, n = 1). In group II, 15 AR (31.9%) were seen in 12 patients and were treated with steroids (n = 12), steroids/ATG (n = 1), or steroids/OKT3 (n = 2). Seven pancreas (thrombosis, n = 5; rejection, n = 1; DWFG, n = 1) and one kidney (DWFG, n = 1) graft losses occurred. These data clearly establish that single-shot ATG prior to reperfusion, followed by TAC, MMF, and PRD results in a low incidence of AR (34.5% in group I and 31.9% in group II) after SPK. Only 6.9% (group I) and 6.4% (group II) of the patients received antibodies for rejection treatment.

Konventionelle oder laparoskopische Operation der perforierten Appendizitis - Eine vergleichende Studie

INTRODUCTION

Laparoscopic therapy of complicated appendicitis is still discussed controversially. This retrospective study compared the clinical results of open and laparoscopic appendectomy in a single centre.

PATIENTS AND METHODS

Within a period of three years (1999 to 2001) 493 patients with suspected acute appendicitis were operated prospectively at a German district hospital (250 open appendectomies, 243 laparoscopic appendectomies). Twenty percent of the patients in every group had a complicated appendicitis (48 open, 44 laparoscopic appendectomies) and were analysed retrospectively considering demographic data, operative time, body mass index, preoperative inflammatory parameters (white blood cell count, C-reactive protein and body temperature) and postoperative complication rate.

RESULTS

Both groups were comparable with regard to demographic data. One patient of the laparoscopic group needed an open operation (conversion rate 2.3 %). The body mass index of the laparoscopic group was significantly higher (26.3 vs. 24.1 kg/m(2)). Preoperative white blood cell count, C-reactive protein, body temperature as well as postoperative antibiotic therapy and analgesics requirement were comparable in both groups. There was no significant difference between the length of operative time (open 48 min, laparoscopic 53.5 min). The postoperative hospital stay was significantly shorter in the laparoscopic group (8 vs. 9 days, p = 0.032). Complication rate was significantly lower in the laparoscopic group (11.5 vs. 35 %, p = 0.014).

CONCLUSION

Laparoscopic appendectomy is a safe procedure for the treatment of complicated appendicitis with a significantly decreased complication rate and shorter postoperative stay.

Effect of chronic wheel running on the fatty acid composition of phospholipids and triacylglycerols in rat serum, skeletal muscle and heart

AIM

The purpose of this study was to examine the effects of long-term wheel running on the fatty acid composition of phospholipids (PL) and triacylglycerols (TG) in rat serum, skeletal muscle (soleus and extensor digitorum longus) and heart.

METHODS

To this end, the relevant tissues of 11 trained male Wistar rats were compared with those of 14 untrained ones.

RESULTS

There were several significant differences between the two groups regarding the concentrations and percentages of individual fatty acids in serum PL and TG, with most differences appearing in the fatty acid distribution of PL. Monounsaturated fatty acids of muscle PL were significantly lower in the trained rats. Estimated elongase activity was significantly higher, whereas Delta(9)-desaturase activity was significantly lower in the trained muscles. Monounsaturated fatty acids of PL were also significantly lower in the trained hearts. The fatty acid composition of PL in the skeletal muscles and the heart adapted to training in a comparable manner, whereas most of the changes in the fatty acid profile of TG were tissue-dependent. Judging from the magnitude of the effect sizes and the percentage differences between trained and untrained animals, there were many large effects of chronic exercise on the fatty acid composition of the tissues examined.

CONCLUSION

Long-term wheel running modified the fatty acid profile of PL and TG in rat serum, skeletal muscle and heart, and could thus be considered as a modulator of tissue fatty acid composition.

[Post-processing of radiological data for preoperative planning in skull base surgery]

Preoperative planning in skull base surgery is usually based on numbers of different radiological data. To use this complex data digital post-processing is necessary. There is a significant difference between radiological and surgical post-processing. Planning the approach, resection of the tumour and reconstruction of the defect are supported by the software demonstrated in this study. Integration of the results in a closed workflow of Information-Guided Therapy will increase the potentials of surgical post-processing in the future (i. e. intraoperative navigation and visualization). Evidence based medicine will use digital data of surgical planning.

Erste klinische Erfahrungen mit einer erweiterten Eingriffsplanung und Navigation am interventionellen MRT

PURPOSE

To present an advanced concept for patient-based navigation and to report on our first clinical experience with interventions in the cranium, of soft-tissue structures (breast, liver) and in the musculoskeletal system.

MATERIALS AND METHODS

A PC-based navigation system was integrated into an existing interventional MRI environment. Intraoperatively acquired 3D data were used for interventional planning. The information content of these reference data was increased by integration of additional image modalities (e. g., fMRI, CT) and by color display of areas with early contrast media enhancement. Within 18 months, the system was used in 123 patients undergoing interventions in different anatomic regions (brain: 64, paranasal sinus: 9, breast: 20, liver: 17, bone: 9, muscle: 4). The mean duration of 64 brain interventions was compared with that of 36 procedures using the scanner's standard navigation.

RESULTS

In contrast with the continuous scanning mode of the MR system (0.25 fps), the higher quality as well as the real time display (4 fps) of the MR images reconstructed from the 3D reference data allowed adequate hand-eye coordination. With our system, patient movement and tissue shifts could be immediately detected intraoperatively, and, in contrast to the standard procedure, navigation safely resumed after updating the reference data. The navigation system was characterized by good stability, efficient system integration and easy usability. Despite additional working steps still to be optimized, the duration of the image-guided brain tumor resections was not significantly longer.

CONCLUSION

The presented system combines the advantage of intraoperative MRI with established visualization, planning, and real time capabilities of neuronavigation and can be efficiently applied in a broad range of non-neurosurgical interventions.

Comparison of the toxicity of reference mycotoxins and spore extracts of common indoor moulds

There is an unclear endangering potential by toxic influences of inhaled conidiospores and therefore the conidia of indoor mould species were cultured and toxicologically examined after their mechanical disintegration. For this purpose high-performance liquid chromatography (HPLC) and three colorimetric bioassays, the PTGT (pollen tube growth test), the MB (methylene blue) and the MTT (methylthiazoltetrazolium) assay were applied. The sensitivity of the biological methods was evaluated by using 12 reference mycotoxins and 3 structural cell wall components. Only in one extract of disintegrated spores (Aspergillus fumigatus) a mycotoxin (0.22 microg gliotoxin/6.2 x 10(8) spores) was determined. All nine spore extracts, however, turned out to be cytotoxic and in this case the MTT assay was remarkably more sensitive than the two other test methods. The IC50 values of six different spore extracts determined by the MTT assay were lower than 10(6) spores/well (well = 0.2 ml) whereas the IC50 values determined by the MB assay and PTGT were higher than 10(6) spores per 0.2 ml for each spore extract. An examination of four spore extracts, which were fractionated depending on their polarity by HPLC, showed that single substances as well as synergistic effects contribute to the toxic properties of the spores. The results of this work indicate a health hazard due to toxic effects after the inhalation of extremely high spore concentrations of indoor moulds. This risk will also exist if the spores do not contain any mycotoxins.

[Acceptance of a patient passport in secondary prevention of coronary heart disease]

BACKGROUND AND OBJECTIVE

Over the long term a large percentage of patients exhibit inadequately managed cardiovascular risk factors following an acute cardiac event. It remains unclear whether the patients would accept a health pass and which sociodemographic variables have an effect on the number of its users.

PATIENTS AND METHODS

437 patients (25% women, 69 +/- 10 years; 75% men 63 +/- 10 years) with diagnosed coronary heart disease were issued a health pass before being discharged from in-patient rehabilitation care. Besides their medical history, the passes contained the patients' latest values for hypertension, glucose, lipids, body mass index (kg/m(2)), and smoking. How many patients actually use the health pass was checked by the patients' physicians after 3, 6, and 12 months. In addition, cardioprotective drugs and cardiac events were logged.

RESULTS

185 (44%) of the patients used the pass continually over the course of one year. These patients tended to be older (> or = 60 years vs. < 60 years, p = 0.023), to be white-collar workers (white-collar vs. blue-collar, p = 0.043), and to have a higher level of education (> 10th class vs. < or = 10th class, p = 0.039) compared to "non-users".

CONCLUSION

The acceptance of a passport is low, because fewer than half the patients used it in connection with the secondary prevention of coronary heart disease. Therefore the health pass in its present form did not show up as a useful device in patient care, particularly in single persons and those of a low sociodemographic status.

A direct comparison of MR images and thin-layer plastination of the shoulder in the apprehension-test position

Until now, patients with a shoulder instability being examined using magnetic resonance imaging have been placed in a position with the arm adducted or in the ABER position, as a result of the way conventional MR systems are built. Magnetic resonance systems with an open configuration have made it possible, for the first time, to examine patients in the apprehension-test position, which is a representative diagnostic position for anterior shoulder instability. This new examination position requires an exact understanding of layered imaging anatomy in order to clearly identify MR structures. The purpose of this study is to make possible a direct comparison of the respective abilities of MR cross-section imaging and thin-layer plastination to clearly identify all MR structures of the shoulder positioned in the apprehension-test position. The two shoulders of a body donor were separated and stored in special position supports in the apprehension-test position. The magnetic resonance examination was carried out using a vertically open 0.5-T MR system (Signa SP/i, General Electric Medical Systems, Milwaukee, WI). The following sequences were used: 2D GRE, TR 42.5 ms, TE 20 ms, layer width 3 mm, matrix 512x512, FOV 24 cm. The coronary und transversal MR cross-section segments were subsequently planned in conjunction with thin-layer plastination for both shoulders. Using a direct comparison of MR images with the corresponding thin-layer plastination, it was possible to clearly identify all MR structures.

Health-related quality of life in patients with inflammatory bowel disease five years after the initial diagnosis

BACKGROUND

Health-related quality of life (HRQOL) has become an important tool in evaluating patient satisfaction in inflammatory bowel disease (IBD). So far, few prospective follow-up studies have been done to identify variables that influence HRQOL. We aimed to identify demographic and clinical variables that influence HRQOL 5 years after diagnosis in patients with ulcerative colitis (UC) or Crohn disease (CD) included in a prospective follow-up study from 1990 to 1994 (the IBSEN study).

METHODS

All patients completed the Inflammatory Bowel Disease Questionnaire (IBDQ), a disease-specific quality-of-life questionnaire translated into Norwegian and validated. We present data from 497 patients (328 UC patients and 169 CD patients, mean age 43.3 years, 48% female). The impact of age, gender, smoking, symptom severity, disease distribution, rheumatic symptoms and surgery on IBD patients' HRQOL was analysed.

RESULTS

Women had a reduction in IBDQ total score of 10 points compared to men, CD patients had a reduction of 7.5 compared to UC patients. The patients with moderate/severe symptoms had a 50 points lower score than the patients without symptoms. The patients with rheumatic symptoms had a 10 points lower total score than the patients without these symptoms. All differences were statistically significant. The multiple regression analysis showed that symptom severity, rheumatic symptoms and female gender were the strongest predictors of reduction in HRQOL for both diagnosis groups.

CONCLUSION

IBD symptoms, rheumatic symptoms and female gender have a significant influence on patients' HRQOL as measured by IBDQ. This was confirmed by the regression analysis.