Comprehensive Assessment of One-Year Outcomes and Determination of Minimum Clinically Important Difference in Pain, Disability, and Quality of Life After Suboccipital Decompression for Chiari I Malformation in Adults.

Published June 22, 2013

Neurosurgery. 2013 Jun 19;
Parker SL, Godil SS, Zuckerman SL, Mendenhall SK, Wells JA, Shau DN, McGirt MJ

To date, there has been no study to comprehensively assess the effectiveness of suboccipital craniectomy (SOC) for Chiari Malformation I (CMI) using validated patient-reported outcome (PRO) measures.We set out to determine the effectiveness and minimum clinically important difference (MCID) thresholds of SOC for treatment of adult patients with CMI utilizing PRO metrics.Fifty patients undergoing first-time SOC and C1 laminectomy for CMI at a single institution were followed for 1 year. Baseline and 1-year post-operative pain, disability, quality of life, patient satisfaction, and return to work were assessed. MCID thresholds were calculated using 2 anchors: health transition index (HTI) and NASS satisfaction.The severity of headaches improved in 37 (74%) patients. Improvement in syrinx size was seen in 12 (63%) and myelopathy was seen in 12 (60%) patients. All PROs showed significant improvement 1-year post-operatively (p value <0.05). Of the 38 (76%) patients employed preoperatively, 29 (76%) returned to work post-operatively at a median time of 6 weeks [IQR: 4-12 weeks]. MCID thresholds following SOC for CMI were 4.4 points for NRS-Head, 0.7 points for NRS-Neck, 13.8 percentage points for HDI, 14.2 percentage points for NDI, 7.0 points for SF-12 PCS, 6.1 points for SF-12 MCS, 4.5 points for Zung depression, 1.7 points for mJOA, and 0.34 QALYs for EQ-5D.Surgical management of CMI in adults via SOC provides significant and sustained improvement in pain, disability, general health, and quality of life, as assessed by patient-reported outcomes. This patient-centered assessment suggests that suboccipital decompression for CMI in adults is an effective treatment strategy. HubMed – depression

Age-related impact of depressive symptoms on functional capacity measured with 6-minute walking test in coronary artery disease.

Eur J Prev Cardiol. 2013 Jun 20;
Baldasseroni S, Pratesi A, Orso F, Foschini A, Marella AG, Bartoli N, Mossello E, Bari MD, Marchionni N, Tarantini F

Patients affected by coronary artery disease (CAD) have a high prevalence of depressive disorders. It has been suggested that depressive symptoms significantly reduce exercise stress test performance in CAD patients, whereas their influence on functional capacity tests, such as the 6-minute walking test (6WT), has been less investigated. The aim of this study was to evaluate the correlation between depressive symptoms and 6WT in patients with CAD and the role of age on this relationship.We enrolled 148 CAD patients. Global functional capacity was measured with 6WT and the presence of depressive symptoms with the 30-item Geriatric Depression Scale (GDS). GDS score was analysed as a continuous variable or categorized as depression absent (score <10), probable (10-14), or present (?15).A significant inverse correlation was observed between GDS score and distance walked at 6WT. Patients positive for depressive symptoms (probable or present) had a significantly worse performance compared to those with GDS score <10. In multivariable analysis adjusted for indexes of cardiovascular disease severity and comorbidity, the presence of depressive symptoms proved to be an independent predictor of distance walked at 6WT; the predictivity of depressive symptoms on 6WT was age dependent.Depressive symptoms negatively affect 6WT performance among older CAD subjects. Non-cardiovascular parameters, such as psycho-affective disorders, must be taken into account for the interpretation of 6WT performance in old age. HubMed – depression

In vivo assessment of human brain oscillations during application of transcranial electric currents.

Nat Commun. 2013 Jun 21; 4: 2032
Soekadar SR, Witkowski M, Cossio EG, Birbaumer N, Robinson SE, Cohen LG

Brain oscillations reflect pattern formation of cell assemblies’ activity, which is often disturbed in neurological and psychiatric diseases like depression, schizophrenia and stroke. In the neurobiological analysis and treatment of these conditions, transcranial electric currents applied to the brain proved beneficial. However, the direct effects of these currents on brain oscillations have remained an enigma because of the inability to record them simultaneously. Here we report a novel strategy that resolves this problem. We describe accurate reconstructed localization of dipolar sources and changes of brain oscillatory activity associated with motor actions in primary cortical brain regions undergoing transcranial electric stimulation. This new method allows for the first time direct measurement of the effects of non-invasive electrical brain stimulation on brain oscillatory activity and behavior. HubMed – depression

Management of Intra-articular Fracture of Calcaneus by Combined Percutaneous and Minimal Internal Fixation.

J Nepal Health Res Counc. 2013 Jan; 11(23): 70-75
Lamichhane A, Mahara D

Background: Fractures of the calcaneus are among the most challenging for the orthopaedic surgeon. The treatment of the intra-articular calcaneum fracture remains controversial due to complications and complexity of surgical anatomy. Treatment of calcaneal fracture ranges from non-operative treatment to operative. We present intraarticular fracture of calcaneus treated by combined percutaneous and minimal internal fixation. Methods: All cases evaluated either by X-ray or CT scan. All fractures were sanders two or three type evaluated by CT scan and either joint depression or tongue type fracture by X-ray. Lateral approach was used, posterior facet was exposed, reduced and fixed with one 4 mm canulated cancellous screws and 2 axial pins percutaneously from tuberosity. Clinical evaluation of the outcomes was done by modified Rowe Score. Results: Out of 22 patients, 14 were male and 8 cases were female. Average age of the patients was 30.5 yrs (15-63 yrs). Mode of the injury was RTA in 6 cases and fall from height in 16 cases. There was no soft tissue problem in any patient. All fractures united without secondary displacement in an average of 8 weeks. Average duration of follow up was 26 months (6-37 months). Average Modified Rowe Score was 80 (Range 55-95). Ten patients had excellent, 10 had good and 2 had satisfactory outcome. Conclusions: Intra-articular fracture of the calcaneus can be well managed by minimal opening at the fracture and fixation by single cancellous screw and 2 axial k-wires, so minimizes complications and results in comparable outcomes. Keywords: calcaneum; intra-articular fracture; internal fixation; Rowe Score. HubMed – depression