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The Lund Concept for Severe Traumatic Brain Injury
No full textBackground
Severe traumatic brain injury is a significant cause of morbidity and mortality. Treatment strategies in management of such injuries are directed to the prevention of secondary brain ischaemia, as a consequence of disturbed post-traumatic cerebral blood flow. They are usually concerned with avoiding high intracranial pressure (ICP) or adequate cerebral perfusion pressure (CPP). An alternative to this conventional treatment is the Lund concept, which emphasises a reduction in microvascular pressures.
Objectives
To assess the role of the Lund concept versus other treatment modalities such as ICP-targeted therapy, CPP-targeted therapy or other possible treatment strategies in the management of severe traumatic brain injury.
Search methods
We searched the Cochrane Injuries Group's Specialised Register, Cochrane Central Register of Controlled Trials (CENTRAL; Issue 10, 2013), MEDLINE (OvidSP), EMBASE (OvidSP), CINAHL Plus (EBSCO Host), ISI Web of Science (SCI-EXPANDED and CPCI-S) and trials registries. We searched the reference lists of relevant studies and published reviews found with our search. The most recent search was 5 November 2013.
Selection criteria
Randomised controlled trials (RCTs, level 1 evidence) exploring the efficacy of the Lund concept in the treatment of traumatic brain injury.
Data collection and analysis
Two review authors independently selected papers and made decisions about the eligibility of potentially relevant studies.
Main results
We found no studies that met the inclusion criteria for this review.
Authors' conclusions
There is no evidence that the Lund concept is a preferable treatment option in the management of severe traumatic brain injury
Kinetics of Changes in Serum Concentrations of Procalcitonin, Interleukin-6, and C- Reactive Protein after Elective Abdominal Surgery. Can it Be Used to Detect Postoperative Complications?
No full textPostoperative increase in inflammation biologic markers is associated with a nonspecific inflammatory response to a surgical injury. We investigated the kinetics of changes in serum concentrations of procalcitonin (PCT), C-reactive protein (CRP) and interleukin-6 (IL-6) after abdominal surgeries and we focused on the behaviour of those markers in the case of development of the systemic inflammatory response syndrome (SIRS). In the single centre we conducted a prospective observational study and we included patients admitted to the ICU after elective abdominal surgery. A total of 41 patients were included and 8 (19.5%) of them had clinical and laboratory signs of SIRS. Sepsis was confirmed in one of the patients, a 72-year old patient operated due to having an abdominal aortic aneurysm. Plasma concentrations of PCT, CRP and IL-6 were measured in all the patients before surgery and at the postoperative day 1 (POD1), postoperative day 2 (POD2) and postoperative day 3 (POD3). Systemic release of PCT, CRP and IL-6 was present in all the measured time points after the abdominal surgery. Median concentrations of IL-6 (100.4 pg/mL) and PCT (1, 17 pg/mL) production were measured highest at POD1 and the median of CRP (147 mg/L) was measured at highest POD2. A larger increase of all three measured markers was found in patients with SIRS compared to those without. IL-6 at POD1 and POD 2 was a good predictor of SIRS (areas under curves were 0.71 and 0.765, respectively), showing the highest accuracy among investigated markers at those time points. CRP at POD3 was a good predictor of SIRS (AUC was 0.76). A cut-off of 95 mg/mL in the level of CRP at POD3 yielded a sensitivity of 87.5% and specificity of 66.7% in detecting SIRS. IL-6 and CRP were the best in detecting postoperative SIRS after abdominal surgery with the highest area under ROC curve. This study is showing that PCT is not a good marker of SIRS caused only by surgical injury without sepsis.Postoperativno povećanje serumskih koncentracija upalnih bioloških markera povezuje se s nespecifičnim upalnim odgovorom na kiruršku ozljedu. U na{em istraživanju proučavali smo dinamiku promjena serumskih koncentracija prokalcitonina (PCT), C-reaktivnog proteina (CRP) i interleukina-6 (IL-6) nakon elektivnih abdominalnih operacija s naglaskom na ponašanje ovih markera u slučaju razvoja sindroma sistemskog upalnog odgovora (SIRS, od engl. Systemic inflammatory response syndrome). Prospektivna opservacijska studija provedena u našem kliničkom bolničkom centru uključivala je pacijente koji su nakon elektivnih abdominalnih operacija bili primljeni na jedinicu intenzivnog liječenja. Ukupno su razmotrena 41 bolesnika, od kojih je 8 (19,5%) pokazivalo znakove SIRS-a. Sepsa je utvrđena u samo jednog bolesnika, 72-godišnjaka hospitaliziranog nakon operacije abdominalne aortalne aneurizme. Serumske koncentracije PCT, CRP i IL-6 mjerene su u svih ispitanika prije operacije, te u tri navrata nakon operacije, i to tijekom prvog (POD1), drugog (POD2) i tre}eg (POD3) postoperativnog dana. Tijekom svih mjerenja koja su uslijedila nakon abdominalne operacije zabilježeno je oslobađanje spomenutih markera u serum. Najveći medijani sekrecije za IL-6 (100,4 pg/mL) te za PCT (1,17pg/mL) zabilježeni su tijekom POD1 mjerenja, dok je za CRP najveći medijan izmjeren tijekom POD2 mjerenja (147 mg/mL). U pacijenata sa SIRS-om utvrđeno je veće povećanje u koncentraciji sva tri markera nego u onih bez sindroma sustavnog upalnog odgovora. IL-6 se tijekom POD1 i POD2 pokazao kao dobar predskazatelj mogućeg razvoja SIRS-a (područja ispod ROC-krivulje (AUC, prema engl. Area under curve) iznosila su 0,71 za POD1 te 0,765 za POD2), pokazujući najveću točnost među trima ispitanim markerima tijekom prva dva postoperativna dana. Mjerenje razina CRP-a tijekom POD3 također se pokazalo prediktivnima s obzirom na razvoj SIRS-a (AUC je iznosio 0,76). Prag od 95mg/ml za razine CRP-a tijekom POD3 polučio je osjetljivost od 87,5% te specifičnost od 66,7% pri otkrivanju SIRS-a. Razine IL-6 i CRP tijekom navedenih mjerenja pokazale su se kao dobri predskazatelji razvoja SIRS-a, za razliku od PCT-a, koji se tijekom ove studije nije pokazao kao dobar marker za otkrivanje SIRS-a uzrokovanog isključivo kirurškom ozljedo
In-hospital Cardiac Arrest: can we Change Something?
No full textCardiac arrest is classified as ‘in-hospital’ if it occurs in a hospitalised patient who had a pulse at the time of admission. A probability of patient’s survival until hospital discharge is very low. The reasons for this are old age, multiple co-morbidity of patients, late recognition of cardiac arrest, poor knowledge about basic life support algorithm, insufficient equipment, absence of qualified resuscitation teams (RTs) and poor organization. The aim of this study was to demonstrate characteristics of in-hospital cardiac arrests and resuscitation measures in University Hospital Osijek. We analysed retrospectively all resuscitation procedures data where anaesthesiology RTs provided cardiopulmonary resuscitation (CPR) during 5-year period. We analysed 309 in-hospital resuscitation attempts with complete documentation. Victims of cardiac arrest were principally elderly patients, neurological (30.4%), surgical (25.24%) and neurosurgical patients (15.2%) with many associated severe diseases. In 85.6% of the cases, resuscitation was initiated by ward personnel and RTs arrived within 5 min in 67% of the cases. However, in 14.6% of the cases resuscitation measures had not been started before RT arrival. We found statistical correlation between lower initial survival rates and length of hospital stay (p=0.001), presence of cerebral ischemia (p=0.026) or cardiomyopathy (p=0.004) and duration of CPR (p=0.041). Initial survival was very low (14.6%), and full recovery was accomplished in only eight patients out of 309 (2.59%). Identification of terminal chronic patients in which the CPR is not reasonable, a better organisation and ward personnel education can contribute to better overall success
painDETECT Questionnaire and Lumbar Epidural Steroid Injection for Chronic Radiculopathy
No full textThe painDETECT questionnaire (PD-Q) is a fast and uncomplicated way to ascertain the percentage of neuropathic pain in ‘total pain’ and is designed to detect neuropathic pain components in back pain. The purpose of this randomized, prospective study is to compare, with the assessment of the PD-Q, the efficacy of interlaminar (IL) and transforaminal (TF) steroid injections in patients with unilateral chronic lumbar radicular pain.
Methods: Patients were treated fluoroscopically with epidural steroids, using the IL or TF method and with confirmation of the epidural space by contrast, using random computerized classification. The patients received a series of three IL or TF epidural steroid injections (ESI) at 2-week intervals. The patients were monitored for 6 months from the first steroid injection.
Results: By analyzing the average values of the total sum of points in the PD-Q a dropping trend is confirmed for both groups. The trend equation (y = –1.1393x + 25.269) for the TF ESI shows a faster recovery than the IL ESI (y = –0.8089x + 26.654). The statistically significant difference in the two groups is proved between the first and the sixth visit (IL ESI, p = 0.014; TF ESI, p = 0.001). There is no statistically significant difference in the efficiency of the two dosages and the volumes of steroids between the IL and TF distribution of steroids.
Conclusions: Steroids are efficient; besides alleviating the overall pain, they also reduce the neuropathic component in chronic lumbar radicular pain, whether it is distributed epidurally by the IL or TF approach
Polimorfizmi vitamin K epoksid reduktaza kompleks 1 (vkorc1) gena u populaciji istočne Hrvatske
No full textVitamin K epoxide reductase (VKOR) is a key enzyme in the g-carboxylation of proteins associated with important bodily functions (coagulation, bone metabolism, etc.). This feature is particularly used in warfarin therapy, which blocks the VKOR enzyme and leads to production of dysfunctional coagulation proteins. Genetic factors, particularly vitamin K epoxide reductase complex 1 (VKORC1) gene, have greatest influence on warfarin therapy. The aim of this study was to determine the distribution of VKORC1 1173C>T and VKORC1 -1639G>A polymorphisms, which are most important for warfarin therapy. We investigated 420 unrelated healthy individuals, mostly blood donors, from region of the Eastern Croatia. Both investigated polymorphisms were in perfect linkage disequilibrium (LD) and showed identical results. 151 patients (36%) were homozygous for the wild-type (C/C and G/G), 196 (47%) were heterozygous (C/T and G/A) and 73 (17%) were homozygous for the variant allele (T/T and A/A). Number of normal alleles among individuals was 498 (59.3%), and number of variant alleles was 342 (40.7%). The data obtained are in good agreement with the results of studies in other European populations.Vitamin K epoksid reduktaza (VKOR) je ključan enzim u g-karboksilaciji proteina povezanih s važnim tjelesnim funkcijama (koagulacija, metabolizam kostiju i dr.). Ta značajka je posebno iskorištena u terapiji varfarinom koja blokira VKOR enzim i uzrokuje stvaranje nefunkcionalnih koagulacijskih proteina. Na terapiju varfarinom najveći utjecaj imaju genetski čimbenici, posebno vitamin K epoksid reduktaza kompleks 1 (VKORC1) gen. Cilj ovog istraživanja bio je utvrditi raspodjelu dvaju polimorfizama najznačajnijih za terapiju varfarinom: VKORC1 1173C>T i VKORC1 -1639G>A. Ispitano je 420 zdravih osoba, pretežno dobrovoljnih davatelja krvi, iz područja istočne Hrvatske. Rezultati su pokazali da su oba ispitivana polimorfizma u savršenoj neravnoteži povezanosti (eng. linkage disequilibrium – LD) i pokazali su identične rezultate. Za 151 ispitanika (36%) potvrđeno je da su homozigoti za divlji tip (C/C i G/G), 196 ispitanika (47%) su heterozigoti (C/T i G/A) a 73 (17%) su homozigoti za varijantni alel (T/T i A/A). Broj normalnih alela me|u ispitanicima bio je 498 (59,3%), dok je varijantnih alela pronađeno 342 (40,7%). Dobiveni podaci se dobro slažu s rezultatima studija u drugim Europskim populacijama
Smanjenje boli i poboljšanje kvalitete života u bolesnika s prijelomom acetabuluma
No full textThe rationale for this paper was to find out assessment tools and relevant factors that may reduce pain, and improve the quality of life and ability to perform activities of daily living in surgically and conservatively treated patients who sustained the acetabular fracture. One hundred and three patients with the acetabular injury were analysed during the 10-year retrospective case-control study. The case group consisted of 21 patients in whom the posterior acetabular wall was fractured and who were treated surgically. The control group comprised 82 patients with complex acetabular fracture in whom conservative treatment was applied. In order to assess post injury and postoperative quality of life different factors, such as the intensity and chronicity of pain, as well as the ability to resume activities of daily living, the patients were surveyed by anamnestic questionnaire to acquire the results. The quality of life was mostly better in patients from the case group who were operated on. At the follow-up, the features of pain were lower, management overall length shorter, and return to normal daily life activities faster in the surgically treated patients, compared to those who were not. In conclusion, based on our research we assume that surgery may notably decrease features of pain and improve the quality of life in patients with the acetabular injury
Onkogen PAX8-PPARg u folikularnim tumorima štitnjače – RT-PCR i imunohistokemijska analiza
No full textUS-guided fine needle aspiration cytology is currently the best diagnostic tool for thyroid nodules. However, it is not sensitive and specific enough for differentiating between benign and malignant follicular tumors. A potentially useful marker for this differentiation is the PAX8-PPARg rearrangement, identified in follicular thyroid carcinomas, but not in follicular adenomas or other types of thyroid tumors. The aim of this research was to determine the clinical significance of the PAX8-PPARg oncogene in diagnostics follicular thyroid tumors. The study included 62 patients with follicular or Hürthle cell tumors. Gene expression was determined by reverse transcription-polymerase chain reaction (RT-PCR) from paraffin embedded tissues, and PCR products were checked using the agarose gel electrophoresis. The immunohistochemical analysis was performed on archive paraffin embedded tissues with the monoclonal PPARã antibody. The statistical analysis has indicated that neither the expression of PAX8-PPARg mRNA, nor the immunohystochemical analysis with the PPARg antibody correlate with the patohystological diagnosis. The oncogene PAX8-PPARg has not met the expectations as a reliable tumor marker for differentiation between benign and malignant thyroid tumors, which makes the only reliable histological criteria – capsular and vascular invasion.Ciljana citološka punkcija pod kontrolom ultrazvuka metoda je izbora u u dijagnostici čvorastih promjena, no nedovoljno osjetljiva i specifična za razlikovanje benignih i malignih folikularnih tumora. Potencijalno koristan marker za njihovu diferencijaciju je onkogen PAX8-PPARã, identificiran kod folikularnog karcinoma, a ne kod folikularnog adenoma ni drugih tumora štitnjače. Cilj ovog istra`ivanja je određivanje kliničkog značaja PAX8-PPARã gena u dijagnostici folikularnih tumora štitnjače. U istraživanje su uključena 62 ispitanika s folikularnim ili Hürthleovim tumorom. Ekspresija gena je određena metodom lančane reakcije polimeraze s obrnutom transkripcijom (RT-PCR) iz parafinskih rezova, a PCR produkti provjereni elektroforezom na agaroznom gelu. Na arhivskim parafinskim rezovima je izvršeno imunohistokemijsko bojanje monoklonalnim protutijelom PPARã. Ekspresija PAX8-PPARg mRNA, kao ni imunohistokemijska analiza PPARg protutijelom ne korelira s patohistološkom dijagnozom. Onkogen PAX8-PPARg nije opravdao očekivanja u smislu pouzdanog tumorskog markera koji bi omogućio diferencijaciju benignih i malignih tumora štitnjače, te je i dalje jedino pouzdan histološki kriterij – proboj kapsule i vaskularna
Mogućnosti liječenja nosne polipoze u jednoj hrvatskoj bolnici
No full textAim To validate different operative techniques commonly used for nasal polyposis (NP) treatment.
Methods This is a retrospective study exploring data on the NP surgery during a five-year period at the Ear, Nose and Throat Department at Clinical Hospital Centre Osijek, Croatia. Data were analysed regarding patients’ gender, age, type of the surgery performed, and possible recurrence. Recurrence rate among patients that were followed up during that period of time and operated by different techniques (FESS vs. classical polipectomy) was compared.
Results Most frequently used operative technique was classical bilateral polypectomy, in 62.9% (154/245) of cases. The frequency of classical polypectomy was significantly decreased from 42/46 (91.3%) in 2006 to 34/60 (56.7%) cases in 2010, whereas the frequency of FESS in combination with classical polypectomy was significantly increased during that period (p<0.0001). Among patients with relapse that were followed up most of them were subjected to classical polypectomy at the time of their first surgery (9/10), thus implicating higher incidence of relapse in classically polypectomized patients.
Conclusion A higher incidence of recurrence in patients who underwent classical polypectomy implicates the need for additional precautions when choosing an operative technique. In addition, further investigation of NP and better understanding of etiology as well as the development of more specific drugs would be of great importance for the improvement of nasal polyposis treatment in the futureCilj Cilj istraživanja bio je ispitati učestalost i ishod različitih operativnih tehnika koje se koriste kod liječenja nosne polipoze (NP).
Metode Ovo je retrospektivna studija o kirurškom liječenju NP-a tijekom petogodišnjeg perioda na Klinici za uho, grlo i nos KBC-a Osijek (Hrvatska). Obuhvaćeni su svi pacijenti operirani zbog NP-a u tom periodu, te prikupljeni podaci o spolu, dobi, tipu primijenjene operacije i eventualnom relapsu bolesti. Kod pacijenata koji su bili praćeni tijekom tog razdoblja, uspoređena je učestalost pojave recidiva ovisno o primijenjenoj operativnoj tehnici.
Rezultati Klasična polipektomija bila je najčešće primjenjivana operativna tehnika 62,9% (154/245). Tijekom ispitivanog razdoblja zabilježen je značajni pad učestalosti klasične polipektomije, s 42/46 (91,3%) tijekom 2006. godine na 34/60 (56,7%) u 2010. godini, te porast učestalosti FESS-a u kombinaciji s klasičnom polipektomijom (p<0,0001). Među pacijentima s relapsom, koji su mogli biti praćeni tijekom promatranog razdoblja, većina ih je bila operirana klasičnom polipektomijom prilikom prve operacije (9/10), što sugerira veću incidenciju relapsa kod ove operativne tehnike.
Zaključak Viša incidencija recidiva kod bolesnika podvrgnutih klasičnoj polipektomiji implicira potrebu za povećanim oprezom pri odabiru operativne tehnike. Osim toga, suradnja između klinike i bazičnih medicinskih znanosti, daljnja istraživanja na području NP-a, bolje razumijevanje etiologije i razvoj specifičnijih lijekova, neophodni su za unapređenje liječenja nosne polipoze u budućnosti
Placebo in the pain Treatment
No full textUporaba farmakološki neaktivnih tvari ili postupaka poznatih kao ’placebo’ uvriježena je u medicinskim krugovima pri ispitivanju lijekova. Njihova primjena ima veliku važnost u kontroliranim kliničkim studijama liječenja boli i u istraživanjima mehanizama prijenosa bolnih podražaja. Novije studije pokazale su da je učinak placeba mjerljiv, praćen promjenama moždane aktivnosti i odgovarajućega subjektivnog doživljaja intenziteta boli. U ovom članku opisane su promjene koje se događaju kod placebne analgezije, intenzitet smanjenja boli u usporedbi s aktivnim lijekovima te osnovni problemi pri primjeni placeba u kliničkoj praksi i istraživanjima.Use of medical preparations having no specific pharmacological activity or dummy procedures administered to patients is known as placebo. Such maneuvers are important in the pain treatment and clinical studies investigating pain mechanisms. Several recent studies have shown that placebo treatment produces measurable psychophysiological effects, characterized by changes in specific brain functions and decreased subjective pain perception. This article reviews changes observed in placebo analgesia, its intensity as compared to active compounds, and principal problems observed during the placebo treatment and in clinical trials
IL12RB2 Gene is Associated with the age of Type 1 Diabetes Onset in Croatian Family Trios
No full textBACKGROUND: Common complex diseases are influenced by both genetic and environmental factors. Many genetic factors overlap between various autoimmune diseases. The aim of the present study is to determine whether four genetic variants known to be risk variants for several autoimmune diseases could be associated with an increased susceptibility to type 1 diabetes mellitus.
METHODS AND FINDINGS: We genotyped four genetic variants (rs2358817, rs1049550, rs6679356, rs9865818) within VTCN1, ANXA11, IL12RB2 and LPP genes respectively, in 265 T1DM family trios in Croatian population. We did not detect association of these polymorphisms with T1DM. However, quantitative transmission disequilibrium test (QTDT, orthogonal model) revealed a significant association between the age of onset of T1DM and IL12RB2 rs6679356 variant. An earlier onset of T1DM was associated with the rs6679356 minor dominant allele C (p = 0.005). The association remained significant even after the Bonferroni correction for multiple testing and permutation.
CONCLUSIONS: Variants originally associated with juvenile idiopathic arthritis (VTCN1 gene), sarcoidosis (ANXA11 gene), primary biliary cirrhosis (IL12RB2 gene) and celiac disease (LPP gene) were not associated with type 1 diabetes in our dataset. Nevertheless, association of IL12RB2 rs6679356 polymorphism with the age of T1DM onset suggests that this gene plays a role in defining the time of disease onset