Assessing the correlation between the degree of disc degeneration on the Pfirrmann scale and the metabolites identified in HR-MAS NMR spectroscopy

OBJECTIVE

The objective of this study is to assess the correlation between the degree of degeneration of lumbar discs according to the Pfirrmann classification system and the concentrations of metabolites determined by means of 1H high-resolution magic angle spinning nuclear magnetic resonance (1H HR MAS NMR) spectroscopy.

MATERIALS AND METHODS

Twenty-six human intervertebral lumbar discs that were operated on due to degenerative disease were analyzed. Routine preoperative 1.5T, T2-weighed magnetic resonance (MR) images were used to classify the cases according to the Pfirrmann classification system. In all the cases, during microdiscectomy, the fragments of the annulus fibrosus and nucleus pulposus were harvested and their metabolic profile was examined by means of 1H HR MAS. The grades of disc degeneration on the Pfirrmann scale were correlated with the metabolite concentrations.

RESULTS

Spectral analyses of the intervertebral discs with Pfirrmann grades IV and V demonstrated significantly higher concentrations of creatine, glycine, hydroxyproline, alanine, leucine, valine, acetate, isoleucine, α,β-glucose, and myo-inositol, and a lower intensity of the N-acetyl peak of chondroitin sulfate, compared to the spectra with Pfirrmann grade III.

CONCLUSION

Our results demonstrate correlations between metabolite concentrations and the degree of lumbar disc degeneration assessed using the Pfirrmann grading system and provide another step toward the potential use of in vivo MR spectroscopy for investigation of biomarkers in lumbar disc degeneration.

The evaluation of the influence of selected patellofemoral joint geometry indicators observed in magnetic resonance imaging on the incidence of anterior knee pain in patients after anterior cruciate ligament reconstruction using hamstrings

BACKGROUND

Anterior knee pain (AKP) is a frequent serious clinical problem after anterior cruciate ligament (ACL) reconstruction, regardless of the graft material used. The author conducted prospective studies of the correlation between AKP and disturbed geometry of patello-femoral joint observed in magnetic resonance imaging (MRI), in patients with injured ACL reconstructed with the use of hamstrings.

MATERIAL AND METHODS

The study included 60 patients (34 males and 26 females), at the mean age of 31, who underwent ACL reconstruction with flexors. Only patients without clinical AKP symptoms or AKP factors after reconstruction were included in the study. Before surgery, in all patients MRI was performed in order to evaluate the patellar height, excessive patellar pressure (EPP) and patellar lateralization (PL). In the postoperative course, AKP and its correlation with the ratios mentioned above were observed.

RESULTS

In the group of patients included in the study, pathological patellar height was not observed, EPP was diagnosed in 15%, PL in 13.3% and EPP and PL jointly in 11.9% of the patients. AKP was observed in 8 out of 9 patients with abnormal lateral pressure, 7 patients with EPP and 7 patients with concomitant excessive lateral pressure and PL. The first symptoms of AKP appeared between the seventh and twelfth week after surgery and increased after 12 weeks.

CONCLUSIONS

The occurrence of excessive lateral pressure syndrom (EPP) and PL confirmed in MRI was very strongly correlated (89% and 100%, respectively) with the occurrence of AKP after ACL reconstruction. The evaluation of the patellofemoral joint geometry, taking into account the EPP and PL ratios in pre-operative magnetic resonance image (MRI) in patients with injured anterior cruciate ligament, may allow us to establish the AKP risk group and administer suitable preventive treatment (prophylaxis).

[Water birth in the parturients' estimation]

OBJECTIVES

The purpose of the study was to characterise a group of women who decided for under water birth and to show an influence of warm water on their psychosomatic reactions.

MATERIALS AND METHODS

The results of the inquiry conducted among 45 women bathed during first stage of normal labour and delivery under water were analysed. The demographic data, water birth knowledge and psychosomatic reactions were studied traditional. The age, education, obstetric history of the women was compared with a group of 45 women who gave birth in a way.

RESULTS

The average age of women in labour under water was 25.6 years and no significant difference to control group (25 years) was found. The most common in our research group was secondary education (62%), after that elementary (20%) and university education (18%). Worse educated women were more rarely decided for water birth (20% in research group vs 41% in control; p < 0.05). A midwife was the most important source of information about warm tub bath during delivery, especially among worse educated women (67%). Concerning reactions after entering the pool, in 69% cases decrease of labour pain and in 64% decrease of spasm pains was observed. In 58% cases the time of delivery was advanced, only in 13% it lasted longer after going into the warm tub. Immersion in the pool was sensed in a positive way by all the parturients. The women described appeasement (78%), relaxation (67%), better opportunities for mid-spasm rest (67%). The water tub bath during delivery was estimated good by all of the women. 76% of the group gave 5 points in 1 to 5 scale. As many as 87% of women wish they born another baby in a water.

CONCLUSIONS

A midwife has an essential role in information and making a decision of water birth. Entering the pool causes subjective decrease of labour pain and advance of delivery. Women very good estimate birth in water.

[Analysis of pregnancy and delivery ways in nulliparous women over 30 years old]

Courses of pregnancy and ways of delivery of 274 nulliparous women aged over 30, who delivered between 1992 and 1998 were analyzed. Control group consisted of 274 nulliparous women aged 22-27, who delivered in the same period. Among the women delivering over 30, premature labours, medical disorders during pregnancy and deliveries by cesarean sections were noticeable more frequent.

[Feto-maternal immunization and fetal hemolytic disease: invasive diagnostics and therapy in the Warsaw center of serological collision in years 1992-1999]

OBJECTIVE

The objective of this study was the assessment of intrauterine procedures, which are performed during the diagnostic phase and therapy of fetal hemolytic disease in the Warsaw Center of Serological Collision.

MATERIALS AND METHODS

The study covered 146 women, who were patients of the Center from 1992 to 1999. Analyzed were the time of commencement of diagnostic and treatment, type of operations, duration of therapy, time and manner of delivery after the past intrauterine procedures, the medical condition of infants born as a result of these deliveries and the necessity for blood treatment in the early neonatal stage.

RESULTS

451 intrauterine procedures were carried out, of which 159 were diagnostic punctures of the umbilical vessel and 292 were fetal transfusions. The diagnostics and treatment was performed between the 19 and 38 week of pregnancy. The number of punctures for each patient ranged from 1 to 4, and 1 to 10 for intrauterine transfusions. The therapy, which on average lasted 42 days, significantly improved the fetal blood morphology results. During the therapy 5 intrauterine demises were noted--3 as a result of advanced fetal hemolytic disease and 2 related to operation complications. The average pregnancy duration in the analyzed group was 36.4 for treated women and 37.4 weeks for diagnosed women. 52.7% of deliveries were vaginal, 47.3% were performed by cesarean section. The general condition of 87% of infants was good. However, 77% of infants required blood treatment during the early neonatal period.

CONCLUSIONS

Invasive methods of fetal hemolytic disease diagnostics and intrauterine therapy assure high efficiency in the guiding of serological collision and fetal hemolytic disease conflicted pregnancies. At the same time, these methods are safe and carry a low risk of complications.

[Autism, infantile: diagnostic aspects]

Autism is a rare disorder, whose frequency varies according to research from 0.7 to 4.5 per 10,000. The results of 40 children examined in the Out-patient Rehabilitation Union for Autistic Children showed that according to the DSM-III-R criteria 3 children suffered from autism. The authors suggest that the DSM-III-R criteria are either not known to the diagnosticians or are not used in the diagnosis.