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Awake surgery for a primary brain tumor
No full textOperacije tumora u elokventnom području mozga u budnom stanju bolesnika izvode se s ciljem maksimalnog odstranjenja tumora i istodobnog očuvanja neurološke funkcije. U ovom radu autori opisuju slučaj bolesnika s primarnim tumorom mozga u području primarne motoričke kore koji je operiran u budnom stanju. Opisani neurokirurško-anesteziološko-neurofiziološki zahvat prvi je takve vrste izveden u Republici Hrvatskoj.Awake brain surgery has been approved as a safe and efficacious operative procedure with the goal of maximal tumor resection and preservation of neurological function. This case report presents the first full awake primary brain tumor surgical procedure performed in Croatia
Sunitinib-induced thyrotoxicosis – a not so rare entity
No full textBackground/Aim: The tyrosine kinase inhibitor (TKI) sunitinib malate is nowadays a standard first-line treatment option for patients with metastatic clear-cell renal cell carcinoma (mRCC). The aim of this study was to evaluate the incidence and clinical course of thyrotoxicosis in our cohort of patients treated with sunitinib. Patients and Methods: Medical records of all patients treated with first-line sunitinib for mRCC at our Institution between November 2008 and March 2014 were retrospectively reviewed. Thyroid function was assessed after every 2 cycles of therapy, during the 2 weeks off period. Results: Out of the 62 included patients, hypothyroidism has developed during therapy in 12 patients (19%) and it was preceded by thyrotoxicosis in 2 (3.2%). Conclusion: Sunitinib-induced thyrotoxicosis (SIT), a not so rare entity, was followed by hypothyroidism. The patterns of occurrence and possible significance of SIT, as predictive marker of better treatment response to sunitinib, need to be validated in further studies
Epiduralna analgezija u porodništvu - proturječja
No full textLabor pain is one of the most severe pains. Labor is a complex and individual process with varying maternal requesting analgesia. Labor analgesia must be safe and accompanied by minimal amount of unwanted consequences for both the mother and the child, as well as for the delivery procedure. Epidural analgesia is the treatment that best meets these demands. According to the American Congress of Obstetrics and Gynecology and American Society of Anesthesiologists, mother’s demand is a reason enough for the introduction of epidural analgesia in labor, providing that no contraindications exist. The application of analgesics should not cease at the end of the second stage of labor, but it is recommended that lower concentration analgesics be then applied. Based on the latest studies, it can be claimed that epidural analgesia can be applied during the major part of the first and second stage of labor. According to previous investigations, there is no definitive conclusion about the incidence of instrumental delivery, duration of second stage of labor, time of epidural analgesia initiation, and long term outcomes for the newborn. Cooperation of obstetric and anesthesiology personnel, as well as appropriate technical equipment significantly decrease the need of instrumental completion of a delivery, as well as other complications encountered in the application of epidural analgesia. Our hospital offers 24/7 epidural analgesia service. The majority of pregnant women in our hospital were aware of the advantages of epidural analgesia for labor, however, only a small proportion of them used it, mainly because of inadequate level of information.Bol kod porođaja smatra se jednom od najjačih boli. Porođaj je složen i individualan proces s različitim željama žena za analgezijom. Analgezija u porođaju mora biti sigurna i s minimalnim neželjenim posljedicama za majku, dijete i za tijek porođaja. Tim uvjetima najbolje udovoljava epiduralna analgezija (EA). Prema American College of Obstetrics and Gynecology i American Society of Anesthesiologists za primjenu EA u porođaju dovoljna je želja rodilje ako ne postoji kontraindikacija. Davanje analgetika ne treba prestati na kraju drugog porođajnog doba, ali se tada preporučuju niske koncentracije lokalnog anestetika te dodavanje adjuvansa. Novije studije ukazuju na to da se EA može primijeniti u najvećem dijelu prvog i drugog porođajnog doba. Bez obzira na dosadašnja iskustva i istraživanja ne postoji slaganje oko učestalosti instrumentalnog dovršenja porođaja, trajanja drugog porođajnog doba uz EA i vremena uvođenja EA te dugoročnog utjecaja na dijete. Dobra suradnja opstetričkog i anesteziološkog osoblja i dobra tehnička opremljenost znatno smanjuju potrebu za instrumentalnim dovršenjem porođaja, kao i druge komplikacije EA. Naša bolnica nudi EA za olakšani porođaj tijekom 24 sata. Većina trudnica je svjesna prednosti primjene EA za vaginalni porođaj, međutim, samo mali broj trudnica iskoristi tu mogućnost, uglavnom zbog nedovoljne obaviještenosti o toj metodi
Adie’s pupil and ANNA-1 associated paraneoplastic neurologic syndromes predict complete response in limited-stage SCLC : a case report
No full textParaneoplastic sensorimotor neuropathy with cerebellar ataxia (PSN CA) is an extremely rare, rapidly progressive, autoimmune disease associated with the development of antibodies against neuronal-specific Hu proteins that are abnormally expressed in small cell lung cancer (SCLC)
The role of neurosonology in diagnosis and treatment of neurological disorders
No full textStroke is a one of the leading causes of morbidity and mortality in the world. Carotid atherosclerosis is recognized as an important factor in stroke pathophysiology and represents a key target in stroke prevention. Multiple randomized trials have shown the efficacy of carotid endarterectomy in secondary and in primary stroke prevention, too
Complete Response of Adult-Onset CNS Langerhans Cell Histiocytosis Documented on 18F-FDG PET/CT
No full textWe report a case of a 49-year-old woman with biopsy-proven multisystemic Langerhans cell histiocytosis (LCH) with hypothalamic involvement documented on 18F-FDG PET/CT. Chemotherapy with a combination of vinblastine, prednisolone, methotrexate, and 6-mercaptopurine was carried out. Two months later, a 90% reduction of the hypothalamic tumor mass was noted on magnetic resonance imaging, but with no signs of pathological 18F-FDG accumulation. The patient died 4 months later, and we found no signs of LCH on autopsy. Our case highlights the need for further studies regarding the role of 18F-FDG PET/CT in the assessment of treatment response in patients with LCH
Prognostic factors and international prognostic index variants in patients with b-large cell lymphoma - an observational study of KroHem, the Croatian cooperative group for hematologic diseases
No full textVitamin D Serum Level, Disease Activity and Functional Ability in Different Rheumatic Patients
No full textBackground: The aim of the study was to determine the serum vitamin D levels in patients with psoriatic arthritis (PsA) and compare it with patients with rheumatoid arthritis (RA) and with osteoarthritis (OA), as well as to explore the relationship of the vitamin D level with indices of disease activity and functional ability in a real-life setting in a South European country. Methods: In a cross-sectional study, 120 adult patients with established diagnosis of PsA, RA and OA were consecutively enrolled. Serum 25-hydroxyvitamin D and intact parathyroid hormone were determined. Parameters of disease activity and functional ability were obtained using standard instruments. Results: Serum vitamin D insufficiency (#75 nmol/L) was found in 74% of patients with PsA, 94% patients with RA and 97% of patients with OA, whereas vitamin D deficiency (#25 nmol/L) was found in 13% of patients with PsA, 39% of patients with RA and in 38% of patients with OA. Compared with RA, patients with PsA had significantly higher serum vitamin D (P 5 0.002), and when controlling for age and gender, their serum vitamin D level was significantly associated with disease activity and functional activity. Conclusions: In the group of rheumatic patients, a high prevalence of serum vitamin D insufficiency/deficiency was found regardless of the type of arthritis. Patients with PsA might have higher levels of vitamin D than patients with RA, and this was associated with disease activity and functional ability. The results of this study indicate that prophylactic supplementation with vitamin D might be recommended for all rheumatic patients
Neurorizično dijete
No full textNeurorizično dijete je ono dijete koje je bilo izloženo prenatalnim, perinatalnim ili postnatalnim čimbenicima rizika. Mjesto i nastanak oštećenja mozga ovisi o gestacijskoj zrelosti novorođenčeta, a objašnjava se postojanjem prijelaznih oblika neuroanatomske organizacije i promjenama prokrvljenosti centralnog živčanog sustava tijekom sazrijevanja. Neurorazvojni ishod djeteta nakon oštećenja ovisi o interakciji: djeteta i okoline, postojećeg oštećenja mozga (tip, opseg i lokalizacija) te kompenzacijskih procesa maturacije i plastičnosti mozga. Klinički ishod može ići u dva smjera: potpuni oporavak ili neurorazvojno odstupanje. Neurorazvojno odstupanje može biti niskoneurorizično ili visokoneurorizično. U ovom radu prikazano je dijete P. L. koje je bilo izloženo prenatalnim, perinatalnim i postnatalnim čimbenicima rizika. Zbog poznatih čimbenika rizika i evidentnog odstupanja tijekom prvog pregleda dječjeg fizijatra odmah je planirana intenzivna stimulacija neuromotoričkog razvoja. Uključen je interdisciplinarni tim stručnjaka kako bi prevenirali stvaranje patoloških obrazaca pokreta i ponašanja.Child at neurorisk is the child who has been exposed to prenatal, perinatal or postnatal risk factors. Place and damage to the brain depends on the gestational age of the newborn, and explains the existence of transitional forms neuroanatomical organization and blood flow changes of the central nervous system during maturation. Child at neurorisk after the damage depends on the interaction: both the child and the environment, the existing brain damage (type, extent and localization) and compensation process of maturation and brain plasticity. Clinical outcome can go in two directions: a full recovery or neurodevelopmental disorders. Neurodevelopmental disorders can be either at low risk or at high risk. In this paper, the child P. L., the subject of interest, has been exposed to prenatal, perinatal and postnatal risk factors. Because of the known risk factors and the evident discrepancies during the first examination of child physiatrist we immediately started planned intensive stimulation of neuromotor development. An interdisciplinary team of experts was involved to help preventing the formation of pathological movement patterns and behavior
Nonelective surgery at night and in-hospital mortality - Prospective observational data from the European Surgical Outcomes Study
No full textBACKGROUND Evidence suggests that sleep deprivation associated with night-time working may adversely affect performance resulting in a reduction in the safety of surgery and anaesthesia.
OBJECTIVE Our primary objective was to evaluate an association between nonelective night-time surgery and in-hospital mortality. We hypothesised that urgent surgery performed during the night was associated with higher in-hospital mortality and also an increase in the duration of hospital stay and the number of admissions to critical care.
DESIGN A prospective cohort study. This is a secondary analysis of a large database related to perioperative care and outcome (European Surgical Outcome Study).
SETTING Four hundred and ninety-eight hospitals in 28 European countries.
PATIENTS Men and women older than 16 years who underwent nonelective, noncardiac surgery were included according to time of the procedure.
INTERVENTION None.
MAIN OUTCOME MEASURES Primary outcome was in-hospital mortality; the secondary outcome was the duration of hospital stay and critical care admission.
RESULTS Eleven thousand two hundred and ninety patients undergoing urgent surgery were included in the analysis with 636 in-hospital deaths (5.6%). Crude mortality odds ratios (ORs) increased sequentially from daytime [426 deaths (5.3%)] to evening [150 deaths (6.0%), OR 1.14; 95% confidence interval 0.94 to 1.38] to night-time [60 deaths (8.3%), OR 1.62; 95% confidence interval 1.22 to 2.14]. Following adjustment for confounding factors, surgery during the evening (OR 1.09; 95% confidence interval 0.91 to 1.31) and night (OR 1.20; 95% confidence interval 0.9 to 1.6) was not associated with an increased risk of postoperative death. Admittance rate to an ICU increased sequentially from daytime [891 (11.1%)], to evening [347 (13.8%)] to night time [149 (20.6%)].
CONCLUSION In patients undergoing nonelective urgent noncardiac surgery, in-hospital mortality was associated with well known risk factors related to patients and surgery, but we did not identify any relationship with the time of day at which the procedure was performed