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Prediktivni čimbenici u ishodu liječenja glioblastoma
No full textTreatment of glioblastoma is challenging due to its aggressive and highly invasive nature, and no significant advances in survival have been achieved recently. The aim of our retrospective study was identification of predictive factors and consequent survival outcome in patients who underwent surgical and oncologic treatment of glioblastoma. The study was conducted at the Department of Neurosurgery, Osijek University Hospital Centre. The authors designed a retrospective cohort study in 63 patients who underwent surgical and oncologic treatment between January 1, 2012 and December 31, 2017. Data were collected by reviewing medical records of the patients with histologically proven glioblastoma. Statistical analysis of study results revealed a significant impact of postoperative radiotherapy (p=0.002) and chemotherapy (p=0.016) on progression-free survival and overall survival (p=0.001 and p=0.009, respectively). Postoperative Karnofsky performance scale (p=0.027) was found to be significant in progression-free survival, and so was the interval between surgery and commencement of oncologic therapy (p=0.049). In conclusion, overall survival and prognosis in the treatment of glioblastoma remain poor, although prompt approach in postoperative adjuvant treatments improved progression-free survival.Liječenje glioblastoma je izazovno zbog njihove agresivne i vrlo invazivne prirode te u posljednje vrijeme nije postignut značajan napredak u preživljenju. Cilj našega retrospektivnog istraživanja bio je identificirati prediktivne čimbenike i posljedični ishod preživljenja kod bolesnika koji su bili podvrgnuti kirurškom i onkološkom liječenju glioblastoma. Studija je provedena na Klinici za neurokirurgiju Kliničkog bolničkog centra Osijek. Provedena je retrospektivna kohortna studija na 63 bolesnika koji su bili podvrgnuti kirurškom i onkološkom liječenju između 1. siječnja 2012. i 31. prosinca 2017. Podatci su prikupljeni pregledom medicinske dokumentacije bolesnika s histološki dokazanim glioblastomom. Statistička analiza rezultata istraživanja otkrila je značajan utjecaj poslijeoperacijske radioterapije (p=0,002) i kemoterapije (p=0,016) na preživljenje bez progresije bolesti i ukupno preživljenje (p=0,001, p=0,009). Poslijeoperacijska vrijednost na ljestvici Karnofsky (p=0,037) nađena je značajnom za preživljenje bez progresije bolesti, kao i kraći vremenski interval između operacije i početka onkološke terapije (p=0,049). Ukupno preživljenje, kao i prognoza liječenja glioblastoma i dalje su loši, iako pravodobni pristup poslijeoperacijskom adjuvantnom liječenju poboljšava razdoblje preživljenja bez progresije bolesti
Interference of M-protein on Thrombin Time Test: A Case Report
No full textObjective: A case of interference of monoclonal protein (M-protein) on thrombin time (TT) test in a 39-year-old Caucasian male patient is presented. Methods: Coagulation screening tests were performed where altered results only for TT result (>150 seconds) and activated partial thromboplastin time (aPTT) result (36 seconds) were measured. Further specific coagulation testing included measurement of individual coagulation factors FII, FV, FVII, FVIII, FIX, FX, FXI, and FXII. Diagnostic steps in detection and identification of monoclonal protein included serum protein electrophoresis and immunofixation (both serum and urine specimen). Results: Monoclonal protein immunoglobulin G kappa detection and identification in serum and urine clarified the situation.
Conclusion: Unexpectedly altered results of screening coagulation tests without any appropriate clinical signs and symptoms in a patient without any anticoagulant therapy needs to be critically considered in the context of extended next diagnostic steps in order to clarify the cause of pathological test results
Significance of Anthropometric and Nutritive Factors in Oral and Oropharyngeal Cancer Patients Undergoing Free Flap Reconstruction
No full textPurpose: This study analyzed associations between preoperative nutritional status and the incidence of early postoperative complications as a primary outcome in patients with oral and oropharyngeal cancer undergoing free flap reconstruction. We hypothesized that preoperative nutritional status may be linked with specific complications, allowing for better preoperative risk assessment.
Patients and Methods: This longitudinal, retrospective cohort study encompassed 113 patients, all treated surgically for oral and oropharyngeal cancer in the period from March 2013 up to March 2018 in a tertiary referral center. Variables considered were preoperative and postoperative serum albumin and protein values; body mass index; waist-to-hip ratio; circumference of the neck, waist, hip, and thigh; number of cigarettes smoked per day during the 10-year period before surgery; average alcohol consumption; operative time; and postoperative albumin administration.
Results: Our study identified preoperative protein serum concentration (#62 g/L), postoperative albumin administration (450 minutes) to be associated with postoperative complications.
Conclusions: This is the first study reporting cutoff values of clinical significance in assessing patient preoperative nutritional status in light of reducing postoperative complications after free flap reconstruction
Role of Neuroanesthesiologist in ” Thrombectomy Revolution”
No full textBackground: Endovascular mechanical thrombectomy is mainstay of therapy for patients with acute ischemic stroke (AIS). During the last decades we observed the “thrombectomy revolution”, it is the one of the most expanding, advancing and challenging clinical field. Still there is ongoing debate of whether the use of general anesthesia (GA) or conscious sedation (CS) might influence functional outcome. The choice is always controversial and remains in the hands of (neuro)anesthesiologist’s.
Clinical case-series: We present a single “mothership” center experience that has a high volume neurointerventional level. Last several years half of all procedures were thrombectomies - in average 60 cases per year. We preferred general endotracheal anesthesia, with target controlled infusion (TCI) technique using propofol and remifentanil, and rocuronium for intubation. Short acting drugs allow rapid neurological examination after procedure. Using this strategy, we avoid excessive BP variability, patient’s discomfort and movements are decreased, airway is secured and optimal carbon dioxide control levels are achieved. Three-month Modified Rankin Scale (mRS) is 0-2 in more than 30% of patients.
Discussion: The effect of thrombectomy is very time dependent. Understanding of the current and the future developments in that field should be subject of specific interest and challenge for neuroanesthesiologist. Anesthetic management for this patients is much more than anesthetic plan of sedation or GA. Strategies include an individualized approach to hemodynamic and respiratory parameters, intravascular fluids and neuroprotection that can be essential for a favorable outcome. Taking into account our clinical experience, as well as technical factors, we found GA the most suitable anesthetic technique for that kind patients.
Learning points: Although optimal anesthetic management for AIS remains controversial, due to lack of evidence from randomized trails, experience and dedication of the team may yield a greater effect on the outcome than an anesthesia technique. In stroke “mothership” center establishing, one of the milestones is creation of a competent neuroanesthesiologist who is able to provide care for that kind patients. As with many aspects of neuroanesthesia, attention to detail is absolutely vital due to the vulnerability of cerebral tissue to hypoperfusion and ischaemia Drugs fine titration, accurate BP and respiratory function monitoring, good plan in dealing with possible complication and close cooperation with neuroradiologist are essential for favourable outcome
The Effect of Transcutaneous Electric Nerve Stimulation (TENS) on Anxiety and Fear in Children Aged 9-14 Years
No full textZubni strah ili zubna fobija rezultat je neugodnog iskustva i boli zbog kojih odgađamo ili izbjegavamo posjet stomatologu. Najčešće to završava tako da pojedinci izbjegavaju odlazak stomatologu dok bol potpuno ne naruši kvalitetu života. Cilj: Transkutana električna stimulacija živaca (TENS) metoda je za ublažavanje boli koja uključuje blagu električnu struju. Glavni cilj ove studije bio je ispitati utječe li uređaj TENS na smanjenje tjeskobe i straha tijekom stomatoloških zahvata. Materijal i metode: Istraživanje je provedeno na uzorku od 125 ispitanika u dobi od 9 do 14 godina. Statistička značajnost razlika između rezultata prije tretmana i nakon njega na svim primijenjenim mjernim instrumentima potvrđena je t-testom za ovisne uzorke. Izračun je učinjen za sve ispitanike i pojedinačno za tri promatrane skupine. Za procjenu anksioznosti i straha korišten je dječji program ankete o strahu – CFSS-DS (Dječji program za ispitivanje straha – zubna subskala). Rezultati: Rezultati na CFSS-DS ljestvici za sve ispitanike nisu se statistički značajno razlikovali prije tretmana i nakon njega (p > 0,05). Rezultati na CFSS-DS ljestvici za ispitanike koji su primili TENS statistički su se značajno razlikovali prije liječenja i poslije njega (p 0.05). The results on the CFSS-DS scale in subjects who received TENS were statistically significantly different before and after treatment (p < 0.01). The results on the CFSS-DS scale in subjects who received local anesthesia were statistically significantly different before and after treatment (p < 0.05). Conclusion: The TENS device had an anxiolytic effect after the first visit
Hrvatski fond za zdravstveno osiguranje ne prepoznaje razlike u troškovima različitih modaliteta revizije totalne artroplastike kuka
No full textIn recent years, there has been increased interest in the cost of treatment for revision interventions for hip and knee prostheses. In all publications so far, the authors note the high cost of treatment for revision interventions, especially if infection is present. The aim of this study was to compare the cost of treatment and health insurance reimbursements between revision total hip arthroplasty (THA) for infection and revision for aseptic indications (aseptic instability and periprosthetic fracture). Hospital data on 168 patients having undergone revision THA between 2010 and 2018 at the Department of Traumatology, Sestre milosrdnice University Hospital Centre from Zagreb were analyzed. Financial data were collected from the Hospital Information System. Financial analysis included total cost per patient, Croatian Health Insurance Fund reimbursements, cost of implants, and length of hospital stay. The difference between the mean total cost per patient and the mean Croatian Health Insurance Fund reimbursements was -262.83 € (-6.08%) for aseptic instability, -1694.94 € (-17.25%) for infection and -916.49 € (-17.33%) for periprosthetic fracture. The Croatian Health Insurance Fund does not recognize differences in the cost of revision THA for aseptic instability, infection and periprosthetic fracture. Health insurance reimbursement is inadequate for centers that offer revision hip surgery.Posljednjih godina sve je veći interes za troškove liječenja revizijskih intervencija kod endoproteza kuka i koljena. U svim dosadašnjim publikacijama autori bilježe visoke troškove liječenja revizijskih intervencija, osobito ako je prisutna infekcija. Cilj ove studije bio je usporediti troškove liječenja i naknade zdravstvenog osiguranja između revizije totalne artroplastike kuka za infekciju i revizije za aseptične indikacije (aseptična nestabilnost i periprotetski prijelom). Analizirani su bolnički podaci 168 bolesnika koji su bili podvrgnuti reviziji totalne artroplastike kuka u razdoblju od 2010. do 2018. godine na Klinici za traumatologiju Kliničkog bolničkog centra Sestre milosrdnice u Zagrebu. Financijski podaci prikupljeni su iz bolničkog informacijskog sustava. Financijska analiza uključivala je ukupni trošak po bolesniku, troškove hrvatskog zdravstvenog osiguranja, troškove implantata i duljinu boravka u bolnici. Razlika između srednje vrijednosti ukupnog troška po bolesniku i srednje vrijednosti povrata hrvatskog zdravstvenog osiguranja bila je -262,83 € (-6,08%) za aseptičnu nestabilnost, -1694,94 € (-17,25%) za infekciju i -916,49 € (-17,33%) za periprotetski prijelom. Hrvatski fond za zdravstveno osiguranje ne prepoznaje razlike u troškovima revizije totalne endoproteze kuka za aseptičnu nestabilnost, infekciju i periprotetski prijelom. Naknada za zdravstveno osiguranje nije odgovarajuća za centre koji obavljaju reviziju kuka
Osamdeset godina elektrokonvulzivne terapije u Hrvatskoj i u Kliničkom bolničkom centru Sestre milosrdnice
No full textIn 1937, Ugo Cerletti and Lucio Bini performed electroconvulsive treatment (ECT) in Rome for the first time. That was the time when different types of ‘shock therapy’ were performed; beside ECT, insulin therapies, cardiazol shock therapy, etc. were also performed. In 1938, Cerletti and Bini reported the results of ECT. Since then, this method has spread rapidly to a large number of countries. As early as 1940, just two years after the results of the ECT had been published, it was also introduced in Croatia, at Sestre milosrdnice Hospital, for the first time in our hospital and in the then state of Yugoslavia. Since 1960, again the first in Croatia and the state, we performed ECT in general anesthesia and continued it down to the present, with a single time brake.Ugo Cerletti i Lucio Bini prvi put su izveli elektrokonvulzivnu terapiju (EKT) 1937. godine u Rimu. To je bilo doba kada su se provodile različite vrste “šok terapija”; uz EKT bile su to još inzulinske terapije, kardiazolski šokovi itd. O rezultatima EKT Cerletti i Bini izvijestili su 1938. godine i od tada se ta metoda vrlo brzo proširila u velik broj zemalja. Već 1940., samo dvije godine nakon objave rezultata o EKT, uvodi se i u Hrvatskoj u Bolnici Sestara milosrdnica, prvi puta u nas i u ondašnjoj državi Kraljevini Jugoslaviji. Od 1960. godine, opet prvi u Hrvatskoj i ondašnjoj državi, u našoj bolnici radimo EKT u općoj anesteziji sve do današnjih dana samo s jednim prekidom
Ambroise Paré: His Contribution to the Future Advancement of Neurosurgery and the Hardships of His Times Affecting His Life and Brilliant Career
No full textAmbroise Paré was celebrated surgeon of the 16th century whose practical accomplishments, books, and ideas transformed surgery and was a precursor for the later development of neurosurgery. He developed many surgical innovations related to wound management, arterial ligation for the prevention of hemorrhage during limb amputations, and the treatment of war-related head and spine injuries. He maintained that a surgeon should operate gently to reduce pain and improve outcome, and he dedicated his career to the wounded, sick, and poor. He also served 4 consecutive French monarchs—Henri II and his 3 sons François II, Charles IX, and Henri III. As a Huguenot (a Reformed Protestant) by faith, he lived in an environment dominated by Catholicism. Hence, his practice and life were sometimes hindered by political circumstances and religious prejudice. In this historical vignette, we will discuss the professional accomplishments of Ambroise Paré that influenced the future development of neurosurgery, including his descriptions of phantom-limb pain and peripheral nerve injury, his innovations in neurotraumatology, and the saws he invented for use in skull surgery. We will also highlight Paré’s broad neurosurgical contributions to the field. Finally, we will discuss his personal life during the difficult and dangerous political circumstances of 16th century France
Long-term Outcome and Prognostic Features of Differentiated Thyroid Cancer Patients Treated at Croatian Referral Centre
No full textThe aim of the study was to assess survival rates and prognostic features of papillary (PTC) and follicular (FTC) thyroid cancer patients (pts) treated and followed-up up to 50 years in one institution