Taste and Smell Functions in Long-term Survivors after Childhood Medulloblastoma/CNS-PNET

Abstract Purpose Our aim was to investigate taste and smell functions in survivors, with a minimum of 2 years follow-up time, after treatment of childhood medulloblastoma/CNS-PNET. Methods This cross-sectional study included 40 survivors treated ≤ 20 years of age. Taste strips with four concentrations of sweet, sour, salt, and bitter were used to assess taste function in all participants. Score from 0-16; ≥ 9 normogeusia, < 9 hypogeusia, and complete ageusia which equals no sensation. No sensation of a specific taste quality equals ageusia of that quality. Thirty-two participants conducted smell testing using three subtests of Sniffin’ sticks; threshold, discrimination, and identification. Together they yield a TDI-score from 1-48; functional anosmia ≤ 16.00, hyposmia >16.00 - < 30.75, normosmia ≥ 30.75 - < 41.50, and ≥ 41.50 super smeller. Results were compared with normative data. Survivors subjectively rated their taste and smell functions using a numerical rating scale (NRS) score 0-10. Results Forty survivors with a mean follow-up of 20.5 years, 13 (32.5 %) were diagnosed with hypogeusia, nine (22.5 %) of these being ageusic of one or more taste qualities. Seventeen (53 %) of 32 participants were diagnosed with hyposmia. Comparing survivors with hyposmia to those with normosmia, a significant difference (p<0.05) was found in TDI-score and in all the subtests. The mean NRS score of subjective ratings of functions were high.Conclusion Our study showed impaired taste and smell functions in long-term survivors of childhood MB/CNS-PNET using objective measurements. However, subjective ratings did not reflect objective findings.

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Smell and Taste Impairment After Total Laryngectomy

Annals of Otology Rhinology & Laryngology ◽

10.1177/0003489417709794 ◽

2017 ◽

Vol 126 (7) ◽

pp. 548-554 ◽

Cited By ~ 7

Author(s):

Giuseppe Riva ◽

Matteo Sensini ◽

Andrea Corvino ◽

Giancarlo Pecorari ◽

Massimiliano Garzaro

Keyword(s):

Multivariate Analysis ◽

Total Laryngectomy ◽

Taste Strips ◽

Control Subjects ◽

Significant Difference ◽

Identification Threshold ◽

Long Term Survivors ◽

Tdi Score

Objective: Aim of this observational study is the evaluation of olfactory and gustatory impairments in laryngectomized long-term survivors compared to control subjects. Correlation between smell and taste alterations, age, and previous adjuvant treatments in laryngectomees was investigated. Methods: Fifty control subjects and 50 patients who underwent total laryngectomy for advanced laryngeal carcinoma were evaluated. All subjects underwent symptoms evaluation, oropharyngeal exam, endoscopic fiberoptic nasal examination, and Taste Strips and Sniffin’ Sticks tests. Results: Hyposmia was reported by all laryngectomees and hypogeusia by 54% of patients. Sniffin’ Sticks and Taste Strips tests demonstrated a statistically significant difference between controls and laryngectomees regarding olfactory threshold, odor discrimination and identification, Threshold Discrimination Identification (TDI) score, and sour, salty, and gustatory Total Taste score ( P < .05). Multivariate analysis for Total Taste score in laryngectomees showed a statistically significant correlation with aging, having an odds ratio of 0.127 for age ≥65 years, but not with TDI score, radiotherapy, and follow-up time, whereas multivariate analysis for TDI score demonstrated no correlation with radiotherapy, age, and follow-up time. Conclusions: Total laryngectomy determines olfactory and gustatory impairments that should be taken into account in clinical practice. Relationships between sensorial alterations, aging, follow-up period, and adjuvant treatments should be further evaluated in prospective studies.

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Outcome and Complications of MR Guided Focused Ultrasound for Essential Tremor: A Systematic Review and Meta-Analysis

Frontiers in Neurology ◽

10.3389/fneur.2021.654711 ◽

2021 ◽

Vol 12 ◽

Author(s):

Mohit Agrawal ◽

Kanwaljeet Garg ◽

Raghu Samala ◽

Roopa Rajan ◽

Vikas Naik ◽

...

Keyword(s):

Essential Tremor ◽

Focused Ultrasound ◽

Rating Scale ◽

Meta Analysis ◽

Post Procedure ◽

Standard Mean Difference ◽

Significant Difference ◽

Long Term Follow Up

Background: Magnetic resonance guided focused ultrasound (MRgFUS) is a relatively novel technique to treat essential tremor (ET). The objective of this review was to analyze the efficacy and the safety profile of MRgFUS for ET.Methods: A systematic literature review was done. The post procedure changes in the Clinical Rating Scale for Tremor (CRST) score, hand score, disability and quality of life scores were analyzed.Results: We found 29 studies evaluating 617 patients. DTI based targeting was utilized in six cohorts. A significant difference was observed in the pooled standard mean difference between the pre and postoperative total CRST score (p-value < 0.001 and 0.0002), hand score (p-value 0.03 and 0.02); and the disability at 12 months (p-value 0.01). Head pain and dizziness were the most in procedure complications. The immediate pooled proportion of ataxia was 50%, while it was 20% for sensory complications, which, respectively, declined to 31 and 13% on long term follow up. A significant reduction (p = 0.03) in immediate ataxia related complications was seen with DTI targeting.Conclusion: MRgFUS for ET seems to be an effective procedure for relieving unilateral tremor. Use of DTI based targeting revealed a significant reduction in post procedure ataxia related complications as compared to traditional targeting techniques. Analysis of other complications further revealed a decreasing trend on follow up.

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Long-term Outcomes of Silastic Arthroplasty of the Thumb Metacarpophalangeal Joint

Hand ◽

10.1177/1558944719878841 ◽

2019 ◽

pp. 155894471987884

Author(s):

Charles A. Cefalu ◽

Philip E. Blazar ◽

Barry P. Simmons ◽

Brandon E. Earp

Keyword(s):

Rating Scale ◽

Numerical Rating Scale ◽

Metacarpophalangeal Joint ◽

Persistent Symptoms ◽

Academic Center ◽

End Stage ◽

Implant Dislocation ◽

Thumb Metacarpophalangeal Joint

Background: Silastic metacarpophalangeal arthroplasty (SMPA) has proven to be a durable option for end-stage arthritis in the non-thumb digits, while fusion has been the mainstay procedure for the thumb metacarpophalangeal joint (MP). Few studies exist to comment on the viability of thumb MP arthroplasty. This study reports both survival and objective outcomes following SMPA of the thumb. Methods: In an institutional review board-approved retrospective study, we identified 18 patients who underwent thumb SMPA at a tertiary academic center by 3 board-certified hand surgeons. Primary outcome measures were implant survival and post-operative complications. Secondary outcomes measures were quick Disabilities of the Arm, Shoulder, and Hand (quickDASH) scores, brief Michigan Hand Questionnaire (bMHQ), and postoperative pain as rated by the numerical rating scale. Results: Mean quickDASH and bMHQ scores at final follow-up were 35.6 and 70.6, respectively. The most common short-term complication was clinical deformity, followed by instability. The sole long-term complication was an implant dislocation in a previously asymptomatic patient. All patients reported reduction in pain. Three patients were indicated for revision surgery, 2 for persistent instability, and 1 for implant dislocation. Primary survivorship was 83% at mean follow-up of 5.8 years. Conclusions: Thumb SMPA is a viable option for end-stage arthritis. Pain relief in our series was unanimous. Among those that reported persistent symptoms or required revision, a majority had one or more key preoperative risk factors for failure as currently reported in literature. Larger, prospective series are needed to prove superior longevity and functional outcomes of thumb SMPA versus fusion.

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Long-term evolution of calcific tendinitis of the rotator cuff: clinical and radiological evaluation 10 years after diagnosis

Journal of Orthopaedics and Traumatology ◽

10.1186/s10195-021-00604-9 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Riccardo Compagnoni ◽

Alessandra Menon ◽

Simone Radaelli ◽

Francesco Lanzani ◽

Mauro B. Gallazzi ◽

...

Keyword(s):

Rotator Cuff ◽

Rating Scale ◽

Numerical Rating Scale ◽

Calcific Tendinitis ◽

Rotator Cuff Tears ◽

Radiological Evaluation ◽

Glenohumeral Osteoarthritis ◽

The Mean

Abstract Background Calcific tendinitis of the shoulder has a tendon involvement that could evolve to rotator cuff tear and shoulder osteoarthritis. This study aimed to evaluate the prevalence of glenohumeral osteoarthritis and rotator cuff tears in patients affected by calcific tendinitis at a minimum follow-up of 10 years after diagnosis. Methods Patients diagnosed with calcific tendinitis of the shoulder with a minimum follow-up of 10 years were contacted and invited for a clinical and radiological evaluation. Information on the demographics, affected and dominant side, bilateral shoulder pain, type of treatment, habits, systemic or musculoskeletal diseases, reoperation of the index shoulder, and subjective satisfaction was collected. The clinical evaluation was performed using Constant–Murley score (CMS), American Shoulder and Elbow Surgeons Score (ASES), and numerical rating scale (NRS); isometric strength in forwarding flexion and abduction was also measured. Each patient also underwent an ultrasound examination to evaluate rotator cuff tendon integrity and a shoulder radiograph to evaluate osteoarthritis. Results Seventy-nine patients were available for a phone interview, and 35 agreed to be examined. The mean age was 58.89 (± 7.9) years at follow-up. The prevalence of glenohumeral osteoarthritis was 17.14% in the study population, with significant progression in 14.29% of the cases, without rotator cuff full-thickness tears. x-Ray examination showed residual calcifications in 31 patients, with a mean diameter of 5.54 mm. In 30 cases, there was a reduction of the diameter; in 4 cases, the calcification increased in size; and in 1 case, the size did not change. The mean ASES score was 74.1 (± 22.7) in the group with calcifications larger than 2 mm and 89.4 (± 8.2) in patients with smaller calcifications (p = 0.08) without correlation with the type of treatment performed. Conclusions Calcific tendinitis is a self-resolving disease without rotator cuff tears at long-term follow-up or degenerative glenohumeral progression. Level of Evidence: 3, cohort study.

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Improved Pain Control with Combination Spinal Cord Stimulator Therapy Utilizing Sub-perception and Traditional Paresthesia Based Waveforms: A Pilot Study

Anesthesiology and Pain Medicine ◽

10.5812/aapm.113089 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Amnon A. Berger ◽

Ivan Urits ◽

Jamal Hasoon ◽

Jatinder Gill ◽

Musa Aner ◽

...

Keyword(s):

Spinal Cord ◽

Pain Relief ◽

Pain Control ◽

Rating Scale ◽

Pulse Generator ◽

Numerical Rating Scale ◽

Failed Back Surgery

Background: Chronic back and neck pain affects 20% of Americans. Spinal cord stimulation (SCS) is an effective therapy for otherwise refractory chronic pain. Traditional SCS relies on low-frequency stimulus in the 40 - 60 Hz range causing robust paresthesia in regions overlapping with painful dermatomes. Objectives: This study aims to determine the effect of superimposing sub-perception stimulation in patients who previously had good long-term relief with paresthesia. Methods: This is a prospective observational trial examining patients who had previously been implanted with paresthesia based SCS for failed back surgery syndrome (FBSS) or complex regional pain syndrome (CRPS). These patients presented for implantable pulse generator (IPG) replacement based on battery depletion with an IPG capable of combined sub-perception and paresthesia based SCS therapy. Patients were assessed immediately following the exchange and four weeks later using a telephone survey. Their pain was assessed on each follow up using a Numerical Rating scale (NRS); the primary outcome was the change in NRS after four weeks from the exchange day. Secondary outcomes included paresthesia changes, which included the subjective quality of sensation generated, the overall subjective coverage of the painful region, subjective variation of coverage with positional changes, and global perception of the percentage improvement in pain. Results: Based on our clinic registry, 30 patients were eligible for IPG exchange, 16 were consented for follow up and underwent an exchange, and 15 were available for follow up four weeks following. The average NRS decreased from 7.47 with traditional SCS to 4.5 with combination therapy. 80% of patients reported an improvement in the quality of paresthesia over traditional SCS therapy, and in most patients, this translated to significantly improved pain control. Conclusions: Our findings suggest improved pain relief in patients who had previously had good results with paresthesia based therapy and subsequently underwent IPG exchange to a device capable of delivering combined sub-perception stimulation. The mechanism of action is unclear though there may be an additive and/or synergistic effect of the two waveforms delivered. Larger studies with long-term follow-up are needed to elucidate the durability of pain relief and the precise mechanism by which combined subperception and paresthesia based SCS may improve overall patient outcomes.

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Comparison of the Efficacy and Tolerability of Dienogest and Dienogest Plus Ethinylestradiol on Endometriosis Related-Pain

Gynecology Obstetrics and Reproductive Medicine ◽

10.21613/gorm.2019.944 ◽

2019 ◽

pp. 1

Author(s):

Tolga Karacan ◽

Huseyin Kiyak ◽

Eser Ozyurek ◽

Mevlide San ◽

Engin Oral

Keyword(s):

Pelvic Pain ◽

Chronic Pelvic Pain ◽

Rating Scale ◽

Numerical Rating Scale ◽

Similar Efficacy ◽

Reproductive Age ◽

Pain Scores ◽

Significant Difference ◽

Pain Symptoms

Objective: Endometriosis is a common gynecological condition that affects many women of reproductive age worldwide and is a major cause of pain and infertility. Treatment of endometriosis can be either surgical, aiming to restore normal anatomy by removing endometriotic lesions, or hormonal. Various medical treatments with different doses, formulations, delivery systems, and regimens have been tested. The main objective of this study was to compare the efficacy and tolerability of dienogest and dienogest plus ethinylestradiol on endometriosis-related pain. Additionally, the effects on endometrioma size were examined.Study Design: A total of 81 patients with clinically diagnosed endometrioma, who had chronic pelvic pain, dysmenorrhea, or deep dyspareunia between January 2015 and December 2018 were studied retrospectively. The patients were divided into two main groups: continuous oral dienogest (n=43) (Visanne®, 2 mg/day) and continuous oral dienogest plus ethinylestradiol (n=38) (Dienille®, 2 mg/0.03 mg/day). The intensity of pain symptoms was evaluated before therapy, then after 3 and 6 months of treatment using a 10-point numerical rating scale (0 = no pain and 10 = worst possible pain) (NRS) provided to the patients in advance.Results: The pain scores related to chronic pelvic pain decreased 36% for dienogest and 49% for dienogest plus ethinylestradiol (p<0.05) and scores for dysmenorrhea decreased 38% and 44% respectively (p<0.05) at 6 months, significantly lower than before treatment. At the 6-month follow-up, a 28% decrease in the pain scores related to deep dyspareunia in the dienogest group was statistically significant. Although the dienogest plus ethinylestradiol group also decreased by 20%, the difference was not significant. There was no significant difference in endometrioma size between the two groups at the 6-month follow-up (dienogest and dienogest plus ethinylestradiol; 24.2±17.5 mm vs. 27.5±19.1 mm, respectively; p=0.42).Conclusion: Upon analysis of our 6 months of clinical data, estrogen-progestin and a progestin alone seem to be of similar efficacy for the temporary treatment of endometriosis-related pain. The dienogest plus ethinylestradiol combination was slightly less effective on deep dyspareunia but was still well tolerated. Similarly, the two hormonal regimens posed no superiority over one another with regard to endometrioma size reduction.

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Influence of maintaining apical patency in post-endodontic pain

10.21203/rs.3.rs-33734/v1 ◽

2020 ◽

Author(s):

Snigdha Shubham ◽

Manisha Nepal ◽

Ravish Mishra ◽

Kishor Dutta

Keyword(s):

Postoperative Pain ◽

Rating Scale ◽

Numerical Rating Scale ◽

Preoperative Pain ◽

Post Operative Pain ◽

Number Of Patients ◽

Significant Difference ◽

Number Of Visits ◽

Group B

Abstract Background The purpose of this study was to compare postoperative pain between apical patency and non-patency groups and to evaluate the influence of number of visits, vitality of teeth, group of teeth and preoperative pain on post-operative pain. Methods One hundred sixty patients were included in the study. Patients were randomly divided into: Group A (n = 80) contained apical patency maintaining group and Group B (n = 80) contained those treated without maintaining apical patency. Each group was subdivided into equal number of patients treated in single visit (n = 40) and multiple visits (n = 40), including vital (n = 20) and non-vital teeth (n = 20) and single- rooted teeth (n = 10) and multiple-rooted teeth (n = 10). Apical patency was maintained with a size 10 K-file during conventional hand filing step-back shaping procedure. Intensity of pain was recorded before treatment and on days 1, 2, and 7 after treatment using a numerical rating scale. Statistical analysis was done using Mann -Whitney U test and Spearman correlation. Results There was statistically significant difference (p < 0.05) in postoperative pain scores between the groups on 1st, 2nd and 7th day follow up. Postoperative pain in patency maintaining group was not influenced by number of visit and group of teeth treated. Whereas, vital teeth when patency was maintained in multiple visits root canal treatment post-operative pain was statistically significant (p = 0.02) in day 1 follow up. Pre-operative pain also influenced postoperative pain with statistically significant difference and positive correlation between the groups. Conclusions Our study concluded that maintenance of apical patency increased postoperative pain. Post-operative pain was not influenced by number of visits, and group of teeth. However, for patency group, vital tooth treated in multiple visits results in more postoperative in 1st day follow up. In addition, pre-operative pain also has influence on post-operative pain.

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Pain control and delay in time to skeletal-related events (SREs) in patients with metastatic castration-resistant prostate cancer (mCRPC) treated with abiraterone acetate (AA): Long-term follow-up.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.5_suppl.183 ◽

2012 ◽

Vol 30 (5_suppl) ◽

pp. 183-183

Author(s):

Ethan M. Basch ◽

Johann Sebastian De Bono ◽

Howard I. Scher ◽

Arturo Molina ◽

Cora N. Sternberg ◽

...

Keyword(s):

Rating Scale ◽

Numerical Rating Scale ◽

A Priori ◽

Abiraterone Acetate ◽

Double Blind Study ◽

Castration Resistant Prostate Cancer ◽

Double Blind ◽

Analgesic Use

183 Background: In study COU-AA-301, the androgen biosynthesis inhibitor AA significantly increased overall survival in mCRPC post-docetaxel (D) in both interim and updated analyses at 552 and 775 events, respectively. Interim data also showed a significant benefit of AA on patient (pt) reported pain. We present long-term outcomes of the effect of AA on pain and SREs. Methods: In this international randomized double blind study of AA (1 g QD) + prednisone (P) (5 mg BID) vs placebo + P in mCRPC post-D, pain was assessed at baseline and each treatment cycle until treatment discontinuation using the BPI-SF questionnaire. Palliation/progression of pain intensity (P-INT) and pain interference (P-INF) were evaluated using a priori definitions. P-INT palliation was defined as ≥ 30% improvement in pt reported “worst pain in last 24 h” (on 0-10 numerical rating scale) durable for ≥ 28 d without increased analgesic use (by WHO criteria) in eligible pts (those with significant baseline pain). Conversely, P-INT progression was defined as ≥ 30% deterioration, or increased analgesic use, over ≥ 28 d. Results: 797 pts were randomized to AA + P, 398 to placebo + P. Median follow-up was 20.2 mos. Median time to SRE was 25.0 mos (AA + P) vs 20.3 mos (placebo + P), p = 0.0001. Pain data were available for most patients; the cumulative amount of missing data ranged from 5% at Cycle 1 to 7% at Cycle 20. AA + P improved P-INT outcomes (Table); P-INF benefits were similar and also highly significant. Conclusions: Benefits of AA + P observed in the interim analysis, including superior and more durable pain relief and delay of pain progression and SREs, were maintained with longer follow-up. Additional analyses of the potential relationships between pain/SREs and other outcomes, as well as of prednisone’s effect on pain palliation in the control arm, are ongoing. [Table: see text]

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Frey’s procedure - does it improve quality of life? A single centre experience of long term outcome following Frey’s procedure

International Surgery Journal ◽

10.18203/2349-2902.isj20200814 ◽

2020 ◽

Vol 7 (3) ◽

pp. 733

Author(s):

L. Soundararajan ◽

Srinivasan Ulagendraperumal ◽

R. Prabhakaran ◽

O. L. Naganathbabu

Keyword(s):

Quality Of Life ◽

Rating Scale ◽

Numerical Rating Scale ◽

Insulin Requirement ◽

Term Outcome ◽

Long Term Outcome ◽

Frey’S Procedure

Background: The objective of the study was to find out long term outcome of patients who underwent Frey’s procedure for chronic calcific pancreatitis.Methods: This is a prospective observational study from retrospectively collected data of all patients who underwent Frey’s procedure for chronic calcific pancreatitis in Institute of Surgical Gastroenterology, Rajiv Gandhi Government General Hospital, Chennai from January 2012 to December 2014. All patients who have completed at least 48 months after surgery were followed up and their long-term postoperative quality of life were analyzed.Results: Totally 48 patients underwent Frey’s procedure during this period. Eight patients lost follow up. Preoperatively all patients had pain score above six in numerical rating scale but after surgery only two patients in the long term required stronger opioids for pain relief. Exocrine deficiency was present in 24 (60%) patients preoperatively, out of which seven patients showed improvement, eight patients had worsened exocrine deficiency and weight loss. Post operatively there were six patients who developed exocrine deficiency. Endocrine deficiency was seen in 23 (57.5%) patients preoperatively and during follow up none showed improvement, with two (5%) patients developed endocrine deficiency. Seven patients showed worsened endocrine deficiency as documented by increasing insulin requirement. Quality of life analysis using SF 36 showed poor quality of life in patients with worsened exocrine deficiency.Conclusions: Frey’s procedure although in long term showed improved outcome in terms of pain free survival and overall quality of life, exocrine and endocrine deficiency persisted in most and worsened in some patients.

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Clinical and Radiological Results of Treating Lumbar Spondylosis With Cortical Bone Trajectory Screws

10.21203/rs.3.rs-80155/v1 ◽

2020 ◽

Author(s):

Mateusz Bielecki ◽

Przemyslaw Kunert ◽

Artur Balasa ◽

Sławomir Kujawski ◽

Andrzej Marchel

Keyword(s):

Cortical Bone ◽

Rating Scale ◽

Numerical Rating Scale ◽

Leg Pain ◽

Lumbar Degenerative Disease ◽

Cortical Bone Trajectory ◽

Non Union ◽

Clinical And Radiological Results

Abstract Background: The cortical bone trajectory (CBT) technique is a popular minimally invasive spine surgery. Few studies have reported long-term outcomes. Here, we evaluated the complication profile and long-term follow-up of patients with lumbar degenerative disease treated with the CBT technique. Methods: This retrospective analysis included the first 40 consecutive patients that underwent the CBT technique. The indication for surgery was critical stenosis of the intervertebral foramen, which required removal of the entire intervertebral joint, on at least one side, during decompression. Results: The CBT technique was performed on one spine level, in 29 cases, and on two levels, in 11 cases. The last follow-up showed minimal clinically important differences in the numerical rating scale (NRS) of leg pain, the NRS of back pain, and the Oswestry Disability Index (ODI), in 97%, 95%, and 95% of patients, respectively. Thirty-nine patients completed long-term radiological follow-ups. Computed tomography demonstrated solid bone unions on 47 (92%) operated levels, collapsed unions on 2 (4%) levels, non-union on 1 (2%) level, and 1 (2%) lost to follow-up. Seven patients experienced complications (4 hardware-related). Three patients required four revision surgeries.Conclusions: The CBT technique effectively achieved spinal fusion; over 90% of patients achieved clinical improvement at a mean follow-up of 4.4 years (minimum 3 years in all cases).

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