Psycho-social characteristics in patients with discopathy: Quality of Life, coping strategy and mood state

The pathologies of the musculoskeletal apparatus are the most common cause of chronic diseases, with a huge impact on people and society. Scientific literature has discovered how experiencing chronic pain directly affects peoples' well-being, lifestyle, social relationships and can also cause psychological distress. The present study aims to investigate pain experience in patients with hernias or protrusions of the cervical and lumbosacral tract on a sample of 120 patients, recruited from patients of Poliambulatorio Oberdan, medical centre in Brescia (Italy) specialized in physical rehabilitation and CT-guided oxygen ozone therapy. In a bio-psychosocial perspective, the research aimed to investigate how the perception of pain, the mood state associated with it, the coping strategies adopted and the quality of life differ according to each patient's gender and to the more or less prolonged use of pain medication. The data were collected by means of medical and psychological anamnestic interviews and self-report tests (WHOQOL-BREF, COPE-NVI, POMS). The quantitative analysis, carried out through SPSS 25 (2017) software, showed how functional impairment of one's autonomy (walking, driving) affects mood states. In particular, the female sample expressed a more deflected mood, despite the greater use of relational and/or transcendent support (coping strategies) compared to men. The study suggests that the greater impairment of the moods of women can be attributed both to the caregiving role they play, which often results in a greater fatigue and difficulties in redefining this role following the algic condition, and more general differences in the expression of suffering, which, on a cultural level, sees men emotionally coerced. The analysis also shows how taking pain medication for a long period of time has a negative impact on the quality of life. The results suggest that the patients treated with analgesic therapy tend to adopt avoidant coping styles, which usually escalate into postponement of the time when dealing with a stressful situation and, if used in the long run, may lead to worsening health condition.

Cerebrospinal fluid diversion in patients with enlarged Virchow-Robin spaces without ventriculomegaly

OBJECTIVE

Enlarged Virchow-Robin spaces (eVRS) are an MRI biomarker in several neurological diseases of inflammatory, neurodegenerative, vascular, metabolic, or genetic origin. We report on a further condition in which eVRS were observed in patients with an ongoing chronic hydrocephalus-like clinical picture without ventriculomegaly who improved after CSF diversion, and we discuss the possible mechanisms underlying this finding.

MATERIALS AND METHODS

A retrospective study of seven patients presenting progressive gait, cognitive, and urinary disturbances in association with eVRS was undertaken.

RESULTS

All patients presented an Evans ratio <0.30 and >20 eVRS at the level of basal ganglia and periventricular parenchyma as assessed by T2-weighted MRI. All patients underwent prolonged external lumbar drainage (PELD) with good response. Six patients received ventriculoperitoneal shunt with improvement of their clinical status compared to that before PELD (follow-up: 8-58 months, mean 24.6). The seventh patient did not undergo ventriculoperitoneal shunt and received a second PELD with persistent improvement (follow-up: 14 months).

CONCLUSIONS

Our results indicate that a mechanism involving CSF accumulation and stasis in the subarachnoid space was at least a concurrent factor of this clinical picture. This study should stimulate new perspectives on the role of CSF disturbances in the pathogenesis of diseases associated with VRS enlargement.

Changes in aqueductal CSF stroke volume in shunted patients with idiopathic normal-pressure hydrocephalus

BACKGROUND AND PURPOSE

Aqueductal CSF stroke volume (ACSV) measured by phase-contrast MR imaging is a tool for selection of surgical patients with idiopathic normal-pressure hydrocephalus (iNPH). The aim of the present study was to investigate whether there is a relationship between clinical outcome and changes in ACSV in patients with iNPH who have been shunted.

MATERIALS AND METHODS

Sixty-five shunted patients with iNPH underwent clinical evaluation and ACSV measurements 7-30 days before and 1, 3, 6, and 12 months after surgery.

RESULTS

Two patients were excluded from the study for the occurrence of a perioperative complication. In a group of 35 clinically improved patients, the mean preoperative ACSV (157.01 microL) decreased to 18% one month after ventriculoperitoneal shunt (VPS) and < or =49% at 12 months post-VPS. In a group of 15 unimproved patients, the lower mean preoperative ACSV (84.2 microL) decreased to 14.3% one month post-VPS and < or =34% at 12 months post-VPS. In the other 8 improved patients who developed a subdural fluid collection (SDFC), ACSV values decreased by 43%-75% in the 3 months post-VPS. A postoperative ACSV increase was noted in 6 patients with a shunt system malfunction. One patient experienced both SDCF and shunt malfunction.

CONCLUSIONS

ACSV decreases in all patients in whom the VPS system works properly, with the rate of ACSV decrease being higher in the patients who show clinical improvement. Postoperative ACSV increase suggests shunt malfunction. A precipitous drop of ACSV values after VPS may be the consequence of increased drainage and herald the occurrence of SDFC.

Changes in aqueductal CSF stroke volume and progression of symptoms in patients with unshunted idiopathic normal pressure hydrocephalus

BACKGROUND AND PURPOSE

Idiopathic normal pressure hydrocephalus (iNPH) represents a diagnostic challenge, given its variable presentation and progression. Stroke volume (SV), defined as the mean volume of CSF passing through the aqueduct during both systole and diastole, greater than or equal to 42 muL, serves as a selection criterion for patients with good probabilities of improvement after ventriculoperitoneal shunt surgery (VPS). In this study, we evaluated the changes in SV during the progression of clinical symptoms in patients with suspected NPH.

MATERIALS AND METHODS

Nine patients who presented with clinical and radiologic evidence of NPH, but refused treatment with VPS, were evaluated every 6 months for up to 2 years for progression in their clinical symptoms and changes in their SV, as measured by phase-contrast cine MR imaging (PCCMR).

RESULTS

SV seems to increase between the onset of the symptoms and the following 18 to 20 months, then seems to plateau, followed in the next 18 to 20 months by a slight decline, and finally to a more precipitous drop in the next 12 months. During this time, however, the patient's clinical symptoms progressively worsen.

CONCLUSION

Patients with a low SV have not necessarily had brain atrophy and can show, in the following months, a progressive increase in SV, which qualifies them as good candidates for VPS. The progressive reduction of the SV in untreated patients with worsening clinical symptoms may be a sign of a progressive cerebral ischemic injury, which renders the NPH irreversible.

Intracranial meningioma containing metastatic colon carcinoma

Tumour-to-tumour metastasis is a rare pathological entity. Meningioma is the most common intracranial tumour to host metastases, the majority of which arise from breast and lung cancers. We present the first report of a colonic cancer metastasis within an intracranial meningioma.A 76-year-old woman presented with a one month history of partial seizures. Her medical history included resection of an adenocarcinoma of the descending colon followed by adjuvant chemotherapy 1 year before our evaluation. Magnetic resonance imaging revealed a homogeneously enhancing lesion in the right frontal convexity.A well capsulated tumour attached to the frontal dura was surgically removed. The pathological examination demonstrated a mixture of fibrous meningioma and colloid adenocarcinoma. Possible explanations for the development of a cohesive chimeric mass of composite pathology are investigated.

A professional and cost effective digital video editing and image storage system for the operating room

We propose an easy-to-construct digital video editing system ideal to produce video documentation and still images. A digital video editing system applicable to many video sources in the operating room is described in detail. The proposed system has proved easy to use and permits one to obtain videography quickly and easily. Mixing different streams of video input from all the devices in use in the operating room, the application of filters and effects produces a final, professional end-product. Recording on a DVD provides an inexpensive, portable and easy-to-use medium to store or re-edit or tape at a later time. From stored videography it is easy to extract high-quality, still images useful for teaching, presentations and publications. In conclusion digital videography and still photography can easily be recorded by the proposed system, producing high-quality video recording. The use of firewire ports provides good compatibility with next-generation hardware and software. The high standard of quality makes the proposed system one of the lowest priced products available today.

Results of surgical and endovascular treatment of intracranial micro-arteriovenous malformations with emphasis on superselective angiography

BACKGROUND

The authors retrospectively reviewed the results of two different treatment modalities (surgery and endovascular approach) in patients with intracranial micro-arteriovenous malformations (micro-AVMs). The goal of this study is to evaluate the respective role of surgical treatment and superselective acrylic embolization in the management of micro-AVMs.

METHOD

Fourteen patients with micro-AVMs who had been treated by surgical resection or endovascular acrylic embolization during a 6-year period were analyzed. The average age at presentation was 44.6 years (range, 24-65 yr) with no sex dominance. All patients presented with an intracranial haemorrhage, which was superficial in twelve patients and in eloquent brain areas in seven patients. Severe neurological deficits were observed in eleven patients.

FINDINGS

Digital subtraction angiography (DSA) demonstrated micro-AVMs in eleven patients (78.5%) while in three patients (21.5%) the micro-AVM was detected only by superselective angiography (SA). Eight patients underwent surgical intervention which led to definitive resection in seven with no peri-operative morbidity. SA was performed in nine patients and followed by successful acrylic embolization of the micro-AVM in seven with haemorrhagic complications in two patients. All fourteen lesions were completely obliterated as demonstrated angiographically. Outcomes were classified according to the Modified Rankin Scale. With a mean long term clinical follow-up of 33 months (range, 8-75 mo), seven patients were Grade 0, six patients were Grade I and one patient was Grade IV.

CONCLUSIONS

SA is deemed necessary to visualize micro-AVMs in case of questionable or negative findings also at delayed DSA in young healthy patients with otherwise unexplained intracranial haemorrhage. Obliteration of micro-AVM can be accomplished either surgically or endovascularly; however, the endovascular approach is associated with a defined procedural risk for haemorrhagic complications and long term angiographic follow-up is necessary.

Radiation leukoencephalopathy associated with moderate hydrocephalus: intracranial pressure monitoring and results of ventriculoperitoneal shunting

Delayed neurological sequelae of radiotherapy have several manifestations; leukoencephalopathy is one of the most common. Pathogenetic relationships between radiation leukoencephalopathy and other findings of diffuse radiation injury (brain atrophy and progressive ventriculomegaly) are not well defined. Moreover, no guidelines have been established for the treatment of hydrocephalus when associated with radiation leukoencephalopathy. Our study reports intracranial pressure (ICP) monitoring in two patients with radiation leukoencephalopathy with moderate hydrocephalus. High intraventricular mean pressure and high peaks were found, and marked improvement of clinical status after shunting was achieved. This study, although restricted to only two patients, shows that ventriculoperitoneal shunting insertion is useful in radiation-induced hydrocephalus, when ICP monitoring detects high mean pressure. A hypothesis is advanced concerning radiation-induced hydrocephalus with high ICP, emphasizing periventricular astrocytosis and its connections with cerebral compliance.