Repository of the Sestre milosrdnice University Hospital Center
Not a member yet
502 research outputs found
Sort by
Surgical Treatment and Predictive Factors for Atypical Meningiomas: A Multicentric Experience
No full textBACKGROUND: Atypical meningiomas are characterized by a high rate of recurrence and shorter overall survival (OS) compared with grade I meningioma. Predictive parameters for OS and recurrence-free survival (RFS) are controversial.
METHODS: Patient age, sex, preoperative symptoms, tumor localization, size, Simpson grade, postoperative complications, extent of resection, number of mitoses, MIB1 proliferation index, brain invasion, postoperative radiotherapy, and clinical outcome (Karnofsky performance scale [KPS] postoperatively and at long-term follow-up) were evaluated. Data regarding recurrence rate, mortality, OS, and RFS at 1-, 3-, and 5-year follow-up were also collected. Median follow-up was 76 months; all patients had at least 3 years of follow-up.
RESULTS: Between 2007 and 2017, 73 patients underwent surgery for atypical meningiomas (World Health Organization grade II) at 2 centers. Preoperative KPS score >80 as well as 1-month, 6-month, and 1-year follow-up KPS scores were related to better OS. Postoperative complications did not modify OS and RFS. Gross total removal (Simpson grade I, II) was achieved in 80.8% of patients. RFS was statistically influenced by extent of resection (P [ 0.002). MIB1 proliferation index >8 was a negative predictive factor for recurrence at univariate and multivariate analysis (P [ 0.001 and P [ 0.021). Radiotherapy was statistically related to a worse outcome. The incidence of recurrence was 38%. RFS was 98.6% at 1-year follow-up, 81.1% at 3 years, and 57.5% at 5 years. All patients were alive at 1-year followup. OS was 90.5% at 3-year follow-up and 78.8% at 5-year follow-up.
CONCLUSIONS: Despite some limitations, our study demonstrates that aggressive surgical treatment achieving a gross total removal is a positive predictive parameter for RFS as well as a good clinical outcome (KPS score >80) and is related to a longer OS
Prikaz bolesnice sa sekundarnim oblikom sistemske amiloidoze i primarnim hiperparatireoidizmom
No full textNove smjernice u liječenju psorijaze
No full textPsorijaza je bolest sa znatnim utjecajem na kvalitetu života i zbog toga su smjernice u postavljanju realističnih ciljeva, liječenja i praćenja tih bolesnika, ključne za postizanje uspjeha. U svjetlu sve učinkovitijih terapijskih opcija, ciljevi koje postavljamo, postaju sve ambiciozniji. Uz impresivne rezultate liječenja, koji su samo unatrag nekoliko godina bili nezamislivi, u fokusu nam je sve više poboljšanje kvalitete života. Danas se u evaluaciji liječenja najčešće primjenjuje PASI-indeks (engl. Psoriasis area and Severity Index) u objektiviziranju stanja kože, i to: kao relativni PASI-odgovor (%) u odnosu na početno stanje, ili sve češće apsolutni PASI, kojim se definira ciljna vrijednost. Prilikom subjektivne procjene bolesnika, najčešće se primjenjuje DLQI-indeks (engl. Dermatology Life Quality Index). No, i nadalje postoji potreba za boljim instrumentima procjene, koji bi uzeli u obzir i neke druge elemente, kao što su vidljivost lezija, funkcionalnost te socijalni i psihološki aspekt bolesti, kao i muskuloskeletne simptome. Upravo prema tim aspektima uspješnosti liječenja (PASI i DLQI) Europskim konsenzusom iz 2011. godine, postavljene su prve smjernice temeljene na sistematiziranom definiranju težine psorijaze. Od tada su obzirom na nove dostupne terapijske opcije, PASI 90 ili PASI 100, kao i uvođenje ciljnog apsolutnog PASI-zbroja <2 postali realnost. Stoga je Europski centar za razvoj smjernica u sklopu Europskoga dermatološkoga foruma, uz pomoć međunarodnih ekspertnih timova, izdao nove preporuke i smjernice u liječenju vulgarne psorijaze, tzv., "EuroGuiDerm guideline on the systemic treatment of psoriasis vulgaris“. Ove preporuke i smjernice dobar su temelj za izradu nacionalnih smjernica
Elective surgery cancellations due to the COVID-19 pandemic : global predictive modelling to inform surgical recovery plans
No full textBackground: The COVID-19 pandemic has disrupted routine hospital services globally. This study estimated the total number of adult elective operations that would be cancelled worldwide during the 12 weeks of peak disruption due to COVID-19.
Methods: A global expert response study was conducted to elicit projections for the proportion of elective surgery that would be cancelled or postponed during the 12 weeks of peak disruption. A Bayesian β-regression model was used to estimate 12-week cancellation rates for 190 countries. Elective surgical case-mix data, stratified by specialty and indication (surgery for cancer versus benign disease), were determined. This case mix was applied to country-level surgical volumes. The 12-week cancellation rates were then applied to these figures to calculate the total number of cancelled operations.
Results: The best estimate was that 28 404 603 operations would be cancelled or postponed during the peak 12 weeks of disruption due to COVID-19 (2 367 050 operations per week). Most would be operations for benign disease (90⋅2 per cent, 25 638 922 of 28 404 603). The overall 12-week cancellation rate would be 72⋅3 per cent. Globally, 81⋅7 per cent of operations for benign conditions (25 638 922 of 31 378 062), 37⋅7 per cent of cancer operations (2 324 070 of 6 162 311) and 25⋅4 per cent of elective caesarean sections (441 611 of 1 735 483) would be cancelled or postponed. If countries increased their normal surgical volume by 20 per cent after the pandemic, it would take a median of 45 weeks to clear the backlog of operations resulting from COVID-19 disruption.
Conclusion: A very large number of operations will be cancelled or postponed owing to disruption caused by COVID-19. Governments should mitigate against this major burden on patients by developing recovery plans and implementing strategies to restore surgical activity safely
Reliable predicting factors for post-stroke dysphagia – Our experience
No full textDysphagia affects more than 50 % of stroke survivors. The most common consequences of post-stroke dysphagia are malnutrition, dehydration, aspiration pneumonia, choking, limited quality of life, increased mortality and morbidity rate. Patients with post-stroke dysphagia should be identified as soon as possible so that special measures can be taken to avoid these consequences. The objectives of our study were to evaluate the prevalence of post-stroke dysphagia in a tertiary care hospital, to analyse the reliability of predicting risk factors for dysphagia and to determine the stroke locations and brain regions respectively connected with post-stroke dysphagia. We included 207 patients who presented with acute stroke and were admitted to Department of Neurology – Stroke Unit from September 2016 to September 2017. Forty-three percent of patients had poststroke dysphagia. We investigated patient’s age, gender, arterial hypertension, diabetes mellitus, atrial fibrillation, previous statin therapy, severity of stroke and localisation of stroke as possible predicting factors for poststroke dysphagia. Our results showed that the only reliable predicting factor for post-stroke dysphagia was the location of the brain lesion, which according to our study were Brodmann areas 4, 8, 24, 30 and pons lesions
Case report: The role and importance of child physiatrist in recognition of prenatal and perinatal risk factors and achievement a good neurodevelopmental outcome in infant
No full text
Plasma Brain-Derived Neurotrophic Factor (BDNF) Concentration and BDNF/TrkB Gene Polymorphisms in Croatian Adults with Asthma
No full textBrain-derived neurotrophic factor (BDNF) and its tropomyosin-related kinase B (TrkB) receptor might contribute to normal lung functioning and immune responses; however, their role in asthma remains unclear. Plasma BDNF concentrations, as well as BDNF and NTRK2 (TrkB gene) polymorphisms, were investigated in 120 asthma patients and 120 healthy individuals using enzyme-linked immunosorbent assay and polymerase chain reaction, respectively. The genotype and allele frequencies of BDNF Val66Met (rs6265) and NTRK2 rs1439050 polymorphisms did not differ between healthy individuals and asthma patients, nor between patients grouped according to severity or different asthma phenotypes. Although plasma BDNF concentrations were higher among healthy subjects carrying the BDNF Val66Met GG genotype compared to the A allele carriers, such differences were not detected in asthma patients, suggesting the influences of other factors. Plasma BDNF concentration was not affected by NTRK2 rs1439050 polymorphism. Asthma patients had higher plasma BDNF concentrations than control subjects; however, no differences were found between patients subdivided according to asthma severity, or Type-2, allergic, and eosinophilic asthma. Higher plasma BDNF levels were observed in asthma patients with aspirin sensitivity and aspirin-exacerbated respiratory disease. These results suggest that plasma BDNF may serve as a potential peripheral biomarker for asthma, particularly asthma with aspirin sensitivity
Suvremeno endovaskularno liječenje inficirajućih intrakranijskih aneurizma distalnih ogranaka: prikaz slučaja i uvid u literaturu
No full textInfected intracranial aneurysms are a rare type of inflammatory vascular lesions that occur due to infection of intracranial arterial wall. Brain aneurysms of distal arterial branches are equally rare and frequently multiple, including those situated at the peripheral middle cerebral artery segments. Although both types represent a small percentage of all intracranial aneurysms, they may bring about high mortality in case of rupture. The management of such aneurysms includes conservative treatment with broad-spectrum antibiotics, and microsurgical or endovascular treatment, which is gaining more prominence for both asymptomatic and ruptured aneurysms. Herein, we present a case of a 61-year-old male patient with a history of cardiac infective disease and multiple bilateral aneurysms of infected distal branch middle cerebral arteries, discussing the efficacy of available endovascular treatment modalities and reviewing the literature. In conclusion, selective endovascular coiling is a preferable method in the current management of distal branch infected ruptured intracranial aneurysms, which may bring a favorable outcome.Inficirajuće intrakranijske aneurizme rijedak su tip inflamatorne vaskularne bolesti koji nastaje uslijed upalnih promjena arterijske stijenke moždanih krvnih žila. Aneurizmatske tvorbe distalnih arterijskih ogranaka podjednako su rijetke i učestalo višestruke, uključujući i one nastale na završnim odsječcima srednje moždane arterije. Iako oba tipa predstavljaju mali postotak u učestalosti intrakranijskih aneurizma, one mogu biti uzrokom povećane smrtnosti u slučaju rupture. Liječenje ovakvih aneurizma sastoji se od primjene antibiotika širokog spektra djelovanja, kao i od mikrokirurškog ili raznih oblika endovaskularnog liječenja, koje je sve zastupljenije u slučaju asimptomatskih i rupturiranih aneurizma. U ovom radu dajemo prikaz bolesnika u dobi od 61 godine s opsežnim komorbiditetom uključujući i upalnu bolest srca, koji je liječen zbog višestrukih obostranih inficirajućih aneurizma distalnih ogranaka srednje moždane arterije. Također raspravljamo o učinkovitosti postojećih endovaskularnih metoda liječenja te donosimo uvid u relevantnu literaturu. Zaključujemo kako je selektivna endovaskularna embolizacija zavojnicama preporučljiva metoda suvremenog liječenja rupturiranih inficirajućih aneurizma distalnih intrakranijskih arterijskih ogranaka, koja može rezultirati povoljnim ishodom