Karen Rohde

All medical records of patients treated for metastatic compression of the spinal cord or cauda equina in the eastern part of Denmark from 1979 through 1985 were reviewed. With regard to treatment response and survival, 345 patients could be evaluated. Carcinoma of the lung (19%), prostate (18%), breast (13%), and kidney (10%) were the most frequent primary malignancies causing spinal compression. The outcome of treatment depended primarily on the patients' condition at the time of diagnosis: 79% of the patients who were able to walk before the treatment remained ambulatory, whereas only 21% of the nonambulatory paraplegic patients and 6% of the paralytic patients regained walking ability. Patients treated with laminectomy followed by radiotherapy seemed to respond better than patients treated with radiotherapy or laminectomy alone, but when the patients' pretreatment motor function was taken into account no significant difference was found between the three forms of treatment. In the subgroup of nonambulatory patients, however, a significantly better restoration of gait was observed in patients treated with the combination of laminectomy and radiotherapy than in patients treated with radiotherapy alone. A longer survival in the group treated with the combination of laminectomy and radiotherapy may reflect that these patients were in a lower stage of disease and thus had a better potential of regaining motor function. The results call for prospective randomized studies.

A review of 158 cases of bacterial meningitis and meningococcal sepsis in adults is presented. The patients were admitted during a 11-year period, from 1980-1990. The incidence was 5.5/100,000 adults per year, which is high. The area had epidemics of meningococcal disease in the years 1987 and 1989. The bacterial agent was meningococci in 40.5%, pneumococci in 21.5% and unknown in 27.2%. The overall lethality was 13.9%, highest (26%) in patients who were infected by pneumococci. The meningococcal relative lethality was 14%. In the period of high meningococcal incidence 1986-1989, we found a relative lethality of 17%. The overall local hospital lethality was 18.3%, which has to be compared with 11.2% among patients primarily admitted to the County hospital. The lethality among patients who underwent emergency transfer from one of the local hospitals to the County hospital was 20%, which is as high as in the group of patients treated locally. Neither of these trends lethality are statistically significant at the level of 5%, tested by chi square tests.

A retrospective study of 398 patients suffering from metastatic compression of the spinal cord or cauda equina is presented. The study comprised almost all relevant medical records of patients admitted to hospital in the eastern part of Denmark in the period 1979 through 1985. Carcinoma of the lung, prostate, breast and kidney were the most frequent primary malignancies causing spinal compression. Most patients were treated with laminectomy, or radiotherapy or with laminectomy and radiotherapy combined. The effect of the treatment was estimated by evaluation of motor function and sphincter control. Treatment with laminectomy followed by radiotherapy was significantly superior to treatment with laminectomy or radiotherapy alone. But if the patients' motor function and primary tumour were taken into account, no significant difference between the treatments was observed. The efficacy of treatment depended upon the symptoms when the diagnosis was established, and accordingly early diagnosis is of the utmost importance. The incidence of metastatic compression increased during the period covered by the study, and since this condition must not go untreated, awareness of the symptoms, primarily pain, is essential.

As environmental restoration (ER) projects move toward completion, the planning, integration, and documentation of long-term environmental stewardship (LTES) activities is increasingly important for ensuring smooth transition to LTES. The Long-Term Environmental Stewardship Baseline Handbook (Handbook) prepared by the National Nuclear Security Administration (NNSA) Service Center Environmental Programs Department (EPD) outlines approaches for integrating site-specific LTES planning and implementation into site ER baseline documentation. Since LTES will vary greatly from site to site, the Handbook also provides for flexibility in addressing LTES in ER Project life-cycle baselines, while clearly identifying Environmental Management (EM) requirements. It provides suggestions for enacting LTES principles and objectives through operational activities described in site-specific LTES plans and life cycle ER Project baseline scope, cost, and schedule documentation and tools for more thorough planning, better quantification, broader understanding of risk and risk management factors, and more comprehensive documentation. LTES planning applied to baselines in a phased approach will facilitate seamlessly integrating LTES into site operational activities, thereby minimizing the use