S Gerstner | PubMed Health

PubMed2007

Evaluation of the Tokuhashi prognosis score and its modifications in 217 patients with vertebral metastases.

AIM: The Tokuhashi prognosis score consists of six parameters. The sum of points rated for each parameter can be correlated with the prognosis. This study evaluates the score variations that have been done by different authors and Tokuhashi et al. themselves. METHODS: Two hundred and seventeen consecutive patients, surgically treated for vertebral metastases, were studied retrospectively. We calculated the original and modified score of Tokuhashi and evaluated the predictive value for the individual life expectancy. RESULTS: The original and modified Tokuhashi score assured a significant predictive value. Modified criteria by the authors showed the highest reliability between the predicted and real survival, and the patients could be allocated correctly to the desirable instrumentation. CONCLUSION: The original and modified Tokuhashi score showed a significant predictive value. The modified criteria by the authors showed the highest reliability between predicted and real survival.

Biopsy↗

PubMedDate not supplied

[Methylphenidate double-blind trial: indication and performing].

Hyperkinetic disorders or attention-deficit/hyperactivity disorders (ADHD) are among the psychiatric diagnoses most often encountered in children and adolescents. Symptoms include inattention, hyperactivity and impulsivity. Within the multi-modal treatment system, the therapy with psychostimulants (e. g. methylphenidate) proved to be an effective in patients with ADHD. A double-blind trial is indicated in cases of unclear efficacy of methylphenidate at initial application or if psychostimulants have regularly been applied for more than one year with an leave-out trial delivering unequivocal results. Further it is helpful in verifying potential undesirable side effects and improving patients' compliance.

Adolescent↗

PubMedDate not supplied

[Surgical treatment and evaluation of prognostic factors in spinal metastases of renal cell carcinoma].

AIM: The aim of this study was the evaluation of surgical results and prognostic factors in spinal metastases of renal cancer. METHODS: 37 surgical patients with spinal metastases of renal cell carcinoma were retrospectively analysed. In 2 patients the cervical, in 16 patients the thoracic, in 4 patients the thoraco-lumbar and in 16 patients the lumbar spine was involved. RESULTS: In 11 cases (29.7 %) a combined posterior-anterior spondylodesis with vertebral body replacement, in 26 cases (70.3 %) a single posterior instrumentation was done. Perioperatively, 24 complications appeared, 4 of them were lethal. Postoperatively, the neurological situation was unchanged in 26 patients, dischanged in 4 patients and improved in 7 patients. The level of pain was unchanged in 10 patients, dischanged in 3 patients and improved in 24 patients. The mean postoperative survival was 13.6 months. For the postoperative survival the Karnofsky-Index and the Frankel-Score were univariate highly significant, the factors nutritional condition and latency between the primary tumor and the development of spinal metastases showed a lower significancy. No prognostical influence for the postoperative survival could be detected for the factors gender, age, localisation of the metastases, type of operation and the factor solitary/multiple metastases. The multivariate analyses did not attempt any of the univariate significant prognostic factors for the postoperative survival. The postoperative survival was significantly (p: 0.0030) influenced by postoperative adjuvant therapy (radio- and/or chemotherapy). The analysis of each adjuvant therapy form (i. e. chemo-, radio- and combined therapy) attempts this prognostic effect (p: 0.0229). CONCLUSION: In most patients with spinal metastases of renal cell carcinoma, the singular posterior intrumentation combined with a decompression is a sufficient therapy. To avoid posterior implant failure, in patients with a prognosticated survival of more than one year, a combined posterior-anterior spondylodesis with vertebral body replacement should be done. The prognostic influence of an adjuvant postoperative treatment in the present study must be interpreted in the context of this small, highly selected patient collective. Further standardized studies should be performed to evaluate the prognostic influence of an adjuvant therapy.

Adult↗