A prospective randomised 2-year follow-up study on patients undergoing lumbar disc herniation surgery. The objective was to investigate the relationship between peridural scarring and clinical outcome, the scar development 6 and 24 months postoperatively by using MRI, and if ADCON-L (a bioresorbable carbohydrate polymer gel) has an effect on scar size and/or improve patients' outcome after lumbar disc herniation surgery. The association between peridural scarring and recurrent pain after lumbar disc herniation surgery is debated. Numerous materials have been used in attempts to prevent or reduce postoperative peridural scarring; however, there are conflicting data regarding the clinical effects. The study included 119 patients whose mean age was 39 years (18-66); 51 (47%) were women. Sixty patients (56%) were perioperatively randomised to receive ADCON-L, and 48 (44%) served as controls. All patients underwent MRI at 6 and 24 months postoperatively, and an independent radiologist graded the size, location and development of the scar, by using a previously described scoring system. Preand 2-year postoperatively patients graded their leg pain on a visual analogue scale (VAS). At the 2-year follow-up patients rated their satisfaction with treatment (subjective outcome) and were evaluated by an independent neurologist (objective outcome), using MacNab score. There was no relationship between size or localisation of the scar and any of the clinical outcomes (VAS, subjective and objective outcome). The scar size decreased between 6 and 24 months in 49%, was unchanged in 42% and increased in 9% of the patients. Patients treated with ADCON-L did not demonstrate any adverse effects, nor did they demonstrate less scarring or better clinical outcome than control patients. No significant association between the presence of extensive peridural scar or localisation of scar formation and clinical outcome could be detected in the present study. Further, no positive or negative effects of ADCON-L used in disc herniation surgery could be seen.
Centrally located lumbar disc herniations have been reported to be of predictive value for poor post-operative clinical outcome. One hundred and fifty patients undergoing lumbar disc herniation surgery were prospectively included. Herniation-related parameters, including the grading of contours, were assessed from pre-operative computed tomography (CT) and magnetic resonance imaging (MRI) images using a new three-dimensional grading system. The radiological findings were compared with outcome parameters two years post-operatively (patient-assessed pain, function/health scores and evaluation by an independent observer). An intra- and inter-observer validation of the classification was performed in a subgroup of patients. High intra-observer and good inter-observer reliability for both CT and MRI was seen. In the study population, no relation between the distribution or size of the herniations and outcome at 2-year follow-up were found. The distribution and size of the lumbar disc herniations with the three-dimensional classification were not found to be of importance for the clinical outcome.
To compare survival after local intra-arterial and intravenous administration of doxorubicin, VX-2 carcinoma was implanted in one kidney of 48 rabbits. Treatments were given 9-14 days after tumor implantation. Survival after doxorubicin was significantly longer than the controls, whereas no difference was established between intra-arterial or intravenous treatment. Overall only 9 of 32 doxorubicin-treated rabbits were cured at autopsy after 18 months. It was assumed that circulating tumor cells from tumor implantation resulted in "primary" lung metastases. To kill circulating tumor cells intravenous doxorubicin was given immediately before implantation in 40 rabbits, followed by combinations of nephrectomy and doxorubicin. Doxorubicin without nephrectomy cured 8 of 16 rabbits, whereas doxorubicin combined with nephrectomy cured 4 of 16. Doxorubicin improved survival in responders, but likelihood of response was limited. Nephrectomy did not improve survival, most likely due to metastatic seeding at implantation. Intravenous doxorubicin immediately before did not prevent metastatic spread in connection with tumor implantation.
When regional intraarterial infusion is applied in the treatment of malignant tumors it is essential to reach the tumor via all its major feeder vessels. In this study VX-2 carcinoma was implanted into the lower pole of the left kidney in 24 rabbits to investigate whether the renal capsular artery takes part in tumor feeding. The rabbits were divided into four groups that were followed for 8, 10, 12 or 14 days after tumor implantation. At that time the renal artery was ligated close to the kidney and subsequently silicone rubber on barium sulfate/gelatin suspension was injected into the capsular artery. The tissue was cleared, and the tumor carefully removed and examined microscopically for traces of silicone rubber. When barium sulfate had been injected, the kidney was examined radiographically in order to detect possible presence of contrast medium in the tumor. This study revealed no vascular supply to the implanted VX-2 carcinoma from the capsular artery when the tumor was confined intracapsularly, i.e., up to 12 days after tumor implantation in untreated rabbits.
Serum electrolytes, creatinine, urea, protein, albumin, bilirubin and glucose were examined every 4 days until time of death in rabbits with VX-2 carcinoma implanted in one kidney. The rabbits were treated with doxorubicin, nephrectomy or combinations thereof and observed for up to 1 year. Rabbits treated with doxorubicin only showed a slight creatinine rise initially, but over time creatinine reached almost the same concentration as that in nephrectomized rabbits receiving equivalent doses of doxorubicin. Creatinine concentrations increased significantly above the normal range following nephrectomy combined with doxorubicin. Doxorubicin nephrotoxicity in rabbits occurs at lower doses than previously reported. In all rabbits the parameters except creatinine remained stable within the established normal ranges, except for the last 4 days before time of death in the animals with metastatic disease. Weight loss was the best parameter for making a prognosis for an individual rabbit, since peak weight was noted 16-20 days before death. In experimental work with VX-2 carcinoma, weight is thus the most important indicator of the time at which rabbits not responding to treatment can be put to death to avoid unnecessary suffering before the end of the experiment.
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