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Hilotoraks kao komplikacija kirurškog postupka
No full textHilotoraks je rijetka, ali potencijalno smrtonosna komplikacija operativnih zahvata koja se u 80% slučajeva zbrinjava konzervativno i to prvenstveno nutritivnom modifikacijom. U rijetkim slučajevima potreban je agresivniji pristup u vidu pleurodeze, perkutane embolizacije ili disrupcije duktusa toracikusa, limfangiografije sa viskoznim uljem ili kirurškog liječenja. Ključno je odabrati adekvatnu terapijsku metodu liječenja hilotoraksa počevši sa onom minimalno invazivnom. Kroz prikaz liječenja hilotoraksa kod bolesnice koja je operirana zbog tri različita primarna tumora donosimo pregled učinjenih postupaka. Bolesnica je operirana zbog orijaške tumorske tvorbe lijevog prsišta ishodišta Th3-Th4 segmenta kralježnice, prethodno transtorakalnom biopsijom verificirane kao švanom, tipičnog karcinoida lijevog pluća i u drugom aktu zbog karcinoma desnog jajnika. Treći postoperativni dan nakon torakokirurške operacije dolazi do pojave hilotoraksa lijevo. Bolesnica je odmah stavljena na totalnu parenteralnu nutriciju, uvedena je antibiotska terapija, terapija Sandostatinom (oktreotid acetat), postavljeni su i dodatni drenažni sustavi pleurokani radi adekvatne drenaže limfnog sadržaja iz lijevog hemitoraksa. Sekrecija limfnog sadržaja bila je oko 1,5 L/24h, te je vjerojatnost konzervativnog liječenja hilotoraksa bila izrazito niska. Zbog potrebe utvrđivanja točnog mjesta lezije limfnog sustava pod kontrolom UZV-a punktirani su limfni čvorovi obostrano ingvinalno te je aplicirano 12ml viskoznog Lipiodola. Nakon 24h na učinjenom MSCT-u verificira se kompletna transekcija duktusa toracikusa na visini segmenta Th2-Th3 kralješka. Nakon učinjene limfangiografije viskoznim sredstvom došlo je do prestanka sekrecije hiloznog sadržaja, odstranjeni su pleurokani i započeta je peroralna prehrana pripremljena na MCT ulju uz nutritivnu potporu Survimedom OPD 1,5 kcal 1x1. Zbog karcinoma jajnika bolesnica je primila šest ciklusa kemoterapije i dobro se oporavlja. Odabir adekvatnog terapijskog postupka u liječenju hilotoraksa preduvjet je brzog zbrinjavanja ove kirurške komplikacije. Uz konzervativno i kirurško liječenje postoje i drugi terapijski modaliteti koji su učinkoviti u zbrinjavanju hilotoraksa poput limfangiografije viskoznim sredstvom koja je u ovom slučaju dovela do prestanka sekrecije limfnog sadržaja te prevenirala mutilirajuće operativno liječenje. Dobra suradnja kirurga, interventnog radiologa i nutricioniste ključna je u odabiru najboljeg terapijskog postupka u liječenju hilotoraksa
Missed Opportunities in Treating Osteoporosis: What Can We Do for the Secondary Prevention of Osteoporotic Fractures?
No full textU ovom se radu prikazuje problematika sekundarne prevencije osteoporotskih prijeloma kao i strategije sekundarne prevencije prijeloma osobito u starijih bolesnika s kompromitiranim zdravljem kosti. Percepcija rizika za prijelom iz kuta gledanja bolesnika i liječnika često je podcijenjena zato što je osteoporoza tiha bolest sve dok ne nastupi prijelom. Unatoč dostupnosti različitih učinkovitih farmakoloških intervencija i dobro utvrđenih smjernica za prevenciju prijeloma, većina bolesnika koja zadobije niskoenergetske koštane prijelome ne primaju lijekove protiv osteoporoze. Diskrepancija između prethodnoga osteoporotskog prijeloma i niske stope farmakološkog liječenja osteoporoze kod tih bolesnika naziva se jaz prijeloma. Kao odgovor na ovu prazninu unutar skrbi Međunarodna zaklada za osteoporozu (engl. IOF) pokrenula je 2012. godine kampanju „Uhvati prijelom“ (engl. „Capture the Fracture“), kako bi olakšala provedbu multidisciplinarnih modela skrbi za sekundarnu prevenciju prijeloma temeljenih na koordinatorima. Modeli povezivanja s prijelomom (Fracture Liaison Services – FLS) danas se široko zagovaraju kao najprikladniji pristup za pokrivanje svih aspekata sekundarne prevencije prijeloma, uključujući identifikaciju bolesnika, edukaciju, procjenu rizika, liječenje i dugotrajno praćenje. Od velike je važnosti ordinirati pretrage za procjenu rizičnih čimbenika vezano uz osteoporozu i sekundarnu prevenciju prijeloma, kao što su: laboratorijske, denzitometrija skeleta i radiografiju kralježnice. FLS uključuje multidisciplinarni pristup i strukturiranu integraciju liječničke profesije, medicinskih sestara te drugih srodnih djelatnika i same administracije, s ciljem reduciranja posljedičnih rizika za prijelom u bolesnika s nedavnim niskoenergetskim osteoporotskim prijelomom. Zdravstveni sustav počinje sve više davati važnost korisnosti i ostalim dobrobitima sekundarne prevencije osteoporotskih prijeloma i prioritizira sekundarnu naspram primarne prevencije kao i prevenciji padova, u kojima je odnos uloženo-dobiveno u kontekstu zdravstvene skrbi izgledno manji. U ovom radu predstavljamo pivotalni FLS program razvijen u Kliničkom bolničkom centru Sestre milosrdnice u Zagrebu (Hrvatska).This paper outlines the issue of secondary prevention of osteoporotic fractures, especially in the elderly with compromised bone health. The perception of fracture risk from the point of view of patients and clinicians is often underestimated because osteoporosis is a silent disease until a bone fracture occurs. Despite the availability of various effective anti-osteoporosis drugs (AOD) and well-established guidelines for fracture prevention, the majority of patients who sustain low-energy bone fractures do not receive AOD. The discrepancy between the previous osteoporotic fracture and the low rate of AOD in these patients is called the fracture gap. In response to this gap in treatment, in 2012 the International Osteoporosis Foundation (IOF) launched the "Capture the Fracture" program to facilitate the implementation of coordinator-based multidisciplinary healthcare models for secondary fracture prevention. Fracture Liaison Services (FLS) models are now widely advocated as the most appropriate approach to cover all aspects of secondary fracture prevention, including patient identification, education, risk assessment, treatment and long-term follow-up. It is of great importance to prescribe diagnostic tests for the assessment of risk factors such as: laboratory tests, bone densitometry and radiography of the spine. FLS includes a multidisciplinary approach defined and structured by the integration of the medical profession, nurses and other related workers and the administration itself, with the aim of reducing the consequent risks of fractures in patients with a recent low-energy osteoporotic fracture. The healthcare system is beginning to ascribe more importance to its utility and other benefits, and prioritizes secondary versus primary prevention as well as fall prevention, in which the investment-gain ratio in the context of healthcare is apparently smaller. In this work we present a pivotal FLS program developed in the Sisters of Charity University Clinical Hospital in Zagreb (Croatia)
Moderatorski učinak tjelesne visine na povezanost tjelesne mase i onesposobljenosti uzrokovane kroničnom nespecifičnom križoboljom u žena i muškaraca
No full textThe aim of the study was testing the hypothesis that body height has a moderating effect on the association of weight and chronic low back pain (LBP) induced disability, and that this moderating effect is different in women and men. We performed a nested cross-sectional analysis using data collected at baseline in a prospective cohort study conducted in 2008-2009 at a special hospital for medical rehabilitation in Croatia. The outcome was the Roland-Morris Disability Questionnaire (RMDQ) score. The independent variable was body weight. The focal moderators were body height and sex. The moderation analysis was adjusted for seven sociodemographic and clinical covariates. We analyzed data on 72 patients with a median (interquartile range) age of 50 (43-55) years, 36 (50%) of whom were women, treated for nonspecific, chronic LBP. The interaction of sex, body weight and height was a significant predictor of the RMDQ score after adjustments for all covariates (increase of R2=0.13; p=0.001; false discovery rate <5%). In both sexes, the correlation between body weight and the RMDQ score was significantly moderated by body height but in opposite ways. In conclusion, the effects of body weight on physical disability are moderated by body height, but this moderation effect differs between women and men.Cilj je bio testirati hipotezu da tjelesna visina ima moderatorski učinak na povezanost težine i onesposobljenosti uzrokovane kroničnim bolovima u križima (KBK) te da se taj moderatorski učinak razlikuje kod žena i muškaraca. Proveli smo ugniježđenu presječnu analizu koristeći podatke prikupljene na početku prospektivne kohortne studije provedene 2008.-2009. godine u specijalnoj bolnici za medicinsku rehabilitaciju u Hrvatskoj. Ishod je bio rezultat Roland-Morrisova upitnika onesposobljenosti (RMDQ). Neovisna varijabla bila je tjelesna masa. Ciljani moderatori bili su tjelesna visina i spol. Analiza moderacije prilagođena je za sedam sociodemografskih i kliničkih kovarijata. Analizirali smo podatke za 72 bolesnika s medijanom (IQR) dobi 50 (43-55) godina, od kojih su 36 (50%) bile žene, liječenih zbog nespecifične KBK. Interakcija spola, tjelesne mase i visine bila je značajan prediktor rezultata RMDQ nakon prilagodbi za sve kovarijate (porast R2=0,13; p=0,001; stopa lažnih otkrića <5%). U oba spola je korelacija između tjelesne mase i rezultata RMDQ značajno moderirana tjelesnom visinom, ali u suprotnim smjerovima. U zaključku, učinci tjelesne mase na tjelesnu onesposobljenost moderirani su tjelesnom visinom, ali taj se moderatorski učinak razlikuje kod žena i muškaraca
The analysis of the glaucoma screening event results obtained during the World Glaucoma Week in Zagreb, Croatia
No full textPurpose: To report the prevalence of undiagnosed glaucoma, as well as demographic characteristics and risk factors among glaucoma suspects who were detected in a publicly promoted intraocular pressure (IOP) based glaucoma screening event.
Methods: A total of 2468 subjects older than 18 years participated in the glaucoma screening event in Zagreb, in 2014, which included a medical interview and IOP measurement using Icare tonometer. 256 subjects (10.37%) were identified as glaucoma suspects, out of which 125 (5.06%) subjects underwent further detailed ophthalmic examination and were classified into five diagnostic groups.
Results: The prevalence of all types of newly diagnosed glaucoma was 1.175%, while the prevalence of ocular hypertension (OH), primary open-angle glaucoma (POAG), primary angle closure (PAC) and secondary glaucoma (SG) was 0.16%, 0.89%, 0.16% and 0.12%, respectively. The prevalence of newly diagnosed glaucoma in glaucoma suspects was 23.2%. 17.60% of glaucoma suspects were diagnosed as POAG. Older age was statistically significantly associated with POAG (p=0.001) and PAC (p=0.029). At the univariate level, refractive errors were a statistically significant predictor of POAG, and those with hyperopia had more than three times larger odds for POAG. At the multivariate level, none of the predictors reached statistical significance.
Conclusion: Successful cooperation between healthcare institutions and media can be a useful way of increasing awareness and detection of individuals at an increased risk for developing glaucoma
Bilateral Acute Iris Transillumination (BAIT): A Rare Syndrome Possibly Associated with COVID-19 and Moxifloxacin Use. A Report of 2 Cases
No full textBilateral acute iris transillumination (BAIT) is a rare clinical entity, presumed to be associated with preceding upper respiratory tract infection and/or use of certain antibiotics, marked by bilateral acute loss of iris pigment epithelium with pigment dispersion in the anterior chamber and trabecular meshwork, which can cause elevated intraocular pressure and glaucoma, and with iris transillumination and sphincter paralysis which lead to photophobia and blurry vision. We report the first two cases of BAIT in our center which both had a history of preceding COVID-19 (coronavirus disease 2019) and moxifloxacin use. With more awareness, ophthalmologists might diagnose more cases, and thus gain more information regarding the link between COVID-19 and BAIT, which might be underdiagnosed since it is rare or easily misdiagnosed as some more common diseases with similar features
Efficacy and safety of immunochemotherapy in treatment of follicular Nonhodgkin's lymphoma during COVID-19 pandemic: a study of KroHem, the Croatian cooperative group for hematologic diseases
No full textIncreased COVID-19 mortality in patients with lymphoproliferative disorders was observed in this study. Our group of patients had reduced OS and PFS compared to the GALLIUM trial and SARS‐CoV‐2 infection was the most pronounced risk factor for death. Even though in some studies bendamustine has shown to be less toxic and more effective than CHOP in FL, there are some important pandemic aspects that must be considered. Bendamustine exposure seems to be associated with worse outcome in case of the infection with SARS-CoV-2. These intriguing differences could play important role in treatment approach in COVID-19 pandemic. Future studies investigating hematological malignancies in COVID-19 pandemic are warranted
Povezanost meteoroloških varijabla sa subarahnoidnim krvarenjem: iskustvo jednog centra
No full textSpontaneous subarachnoid hemorrhage (SAH) can occur unexpectedly and independently of the classic risk factors. Several different factors could affect intracranial aneurysm (IA) rupture, such as morphological and hemodynamic factors. The aim of this study was to establish the potential association of meteorological data such as temperature, atmospheric pressure, and humidity, and the onset of clinical symptoms preceding hospital admission of patients with acute SAH due to IA rupture. This retrospective study included 130 consecutive patients admitted for non-traumatic SAH with a determinable onset of SAH symptoms. The effects of meteorological parameters of atmospheric pressure, ambient temperature, and relative air humidity on the day of acute SAH onset and 24 hours prior to the onset of symptoms were recorded and analyzed in each patient. Spearman rank correlation analysis was used to assess the risks of incident SAH on the basis of daily meteorological data. Seasonal incidence of acute SAH showed the peak incidence in winter and a trough in summer, with monthly incidence peak in January and December. The circadian rhythm analysis showed the peak incidence of SAH in the forenoon, followed by the evening. Acute SAH incidence showed moderate positive association with daily atmospheric pressure (p<0.05), while no association was found with ambient temperature and relative air humidity. Our results suggested no significant association of changes in ambient temperature and relative humidity with the risk of SAH. Increases in atmospheric pressure were weakly associated with a higher SAH risk. Additional studies are needed to establish in detail both meteorological and morphological factors important to predict IA rupture and SAH.Spontano subarahnoidno krvarenje (SAH) može nastati neočekivano i neovisno o klasičnim čimbenicima rizika. Nekoliko različitih čimbenika može utjecati na rupturu intrakranijske aneurizme (IA), poput morfoloških i hemodinamskih čimbenika. Cilj ovoga istraživanja bio je utvrditi potencijalnu povezanost meteoroloških podataka kao što su temperatura, atmosferski tlak i vlažnost te pojave kliničkih simptoma prije prijma u bolnicu bolesnika s akutnim SAH-om zbog rupture IA. Ova retrospektivna studija uključila je 130 uzastopnih bolesnika primljenih zbog netraumatskog SAH-a s vidljivim početkom simptoma SAH-a. Za svakog bolesnika zabilježeni su i analizirani učinci meteoroloških parametara atmosferskog tlaka, temperature okoline i relativne vlažnosti zraka na dan nastanka akutnog SAH-a i 24 sata prije pojave simptoma. Korelacijska Spearmanova analiza primijenjena je za procjenu rizika od incidentnog SAH-a na temelju dnevnih meteoroloških podataka. Sezonska incidencija akutnog SAH-a pokazala je vrhunac incidencije zimi i pad ljeti, s mjesečnim vrhom incidencije u siječnju i prosincu. Analiza cirkadijanog ritma pokazala je vrhunac incidencije SAH-a u prijepodnevnim satima, a zatim navečer. Učestalost akutnog SAH-a pokazala je umjereno pozitivnu povezanost s dnevnim atmosferskim tlakom (p<0,05), dok nije nađena povezanost s temperaturom okoline i relativnom vlagom zraka. Naši rezultati ukazuju na to da nema značajne povezanosti promjena u temperaturi okoline i relativnoj vlažnosti s rizikom od SAH-a. Povećanje atmosferskog tlaka slabo je povezano s većim rizikom od SAH-a. Potrebne su dodatne studije kako bi se detaljno utvrdili meteorološki i morfološki čimbenici važni za predviđanje rupture IA i SAH-a
Intermittent tramadol vs tramadol administration via patient-controlled pump after lumbar discectomy: a randomized controlled trial
No full textAim: To compare the effect of intermittent tramadol dosing vs tramadol administration via patient-controlled pump on pain after lumbar discectomy.
Methods: This randomized prospective study enrolled 100 patients who underwent elective LIV-LV lumbar discectomy in the neurosurgery department at Sestre Milosrdnice University Hospital Center from May 2016 to July 2017. Patients were randomized to receive either tramadol (600 mg daily) via a patient-controlled analgesia (PCA) pump or intermittently. Pain was evaluated by the Croatian version of Short-Form McGill Pain Questionnaire.
Results: Forty percent of patients were women. The median (interquartile range) age of the patients was 51 (40-61) years. The groups did not differ in pain at 7 pm on the day of discectomy. However, in the morning and evening on the first postoperative day and in the morning and evening of the second postoperative day, the PCA group had significantly lower pain (P=0.023, P<0.001, P<0.001, P=0.026, respectively).
Conclusion: This is the first study that used the Short Form McGill Pain Questionnaire to compare the effect of tramadol administration via PCA pump and intermittent administration on pain after LIV-LV discectomy in a neurosurgery department. Tramadol showed a good analgesic efficacy in lumbar spine surgery; tramadol via PCA controlled pain more effectively than intermittently administered tramadol
Treatment of relapsing multiple sclerosis – recommendations of the Croatian Neurological Society
No full textUntreated multiple sclerosis (MS) irretrievably leads to severe neurological impairment. In European health care systems, patient access to disease modifying therapies (DMT) is often confined to more advanced stages of the disease because of restrictions in reimbursement. A discrepancy in access to DMTs is evident between West and East European countries. In order to improve access to DMTs for people with MS (pwMS) living in Croatia, the Croatian Neurological Society issued new recommendations for the treatment of relapsing MS. The aim of this article is to present these recommendations. The recommendations for platform therapies are to start DMT as soon as the diagnosis is made. If poor prognostic criteria are present (≥9 T2 or FLAIR lesions on the initial brain and spinal cord magnetic resonance imaging [MRI] or ≥3 T1 lesions with postcontrast enhancement on the initial brain and spinal cord MRI or Expanded Disability Status Scale after treatment of the initial relapse ≥3), high-efficacy DMT should be initiated. If pwMS experience ≥1 relapse or ≥3 new T2 lesions while on platform therapies, they should be switched to high-efficacy DMT. Further efforts should be made to enable early and unrestricted access to high-efficacy DMT with a freedom of choice of an appropriate therapy for expert physicians and pwMS. The improvement of access to DMT achieved by the implementation of national treatment guidelines in Croatia can serve as an example to national neurological societies from other Eastern European countries to persuade payers to enable early and unrestricted treatment of pwMS
Global neurosurgery amongst the EANS community: Where are we at?
No full textThe gap between HICs and LMICs in the capability of fulfilling the surgical needs of their population has been fully recognized and quantified in a recent Lancet Commission on Global Surgery (Meara et al., 2015). As regards Neurosurgery specifically, approximately five million people annually are estimated to be left untreated in LMICs for essential neurosurgical conditions that would elsewhere undergo surgical intervention (Dewan et al., 2018). The acquisition of awareness that surgical treatments, including neurosurgical, are an “indivisible and indispensable” component of health, is leading to a series of initiatives aiming to reduce these gaps amongst the different realities (Farmer and Kim, 2008; Johnson, 2013; Ozgediz et al., 2005; J. K; World Health Organization, 2015).
Global Neurosurgery, with its primary purpose of “ensuring timely, safe and affordable neurosurgical care to all who need it” well fits in this so-called “the surgery spring” (Mullan, 2015; Rosseau et al., 2020). Global Neurosurgery initiatives have now broadened their spectrum of action from the initial pioneering surgical camps to provide free surgical care to those in need, which maintain an essential role. These initiatives now include a series of clinical, research and educational activities that go beyond “surgery” strictly speaking. These are represented by, but are not limited to, providing education to local actors, addressing specific issues within the health systems, and developing visiting residencies or fellowships for bilateral neurosurgical transfer of knowledge and competencies (Haglund and Fuller, 2019).
The EANS is a vibrant community that shares the values expressed in the preamble of the Constitution of the World Health Organization which states that “the enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition” (Constitution of the World Health Organization, 1946). Keeping this in mind, the EANS is making all possible efforts to put Global Neurosurgery initiatives amongst the priorities of its agenda. With the commencement of its term of Office in October 2021, the 2021–2023 Board of the EANS, as one of its first actions, approved the formation of a Global and Humanitarian Neurosurgery Committee.
With the aim to better explore energies, efforts and resources, the EANS conducted this survey, with the specific purpose to map awareness, interest and barriers for Global Neurosurgery development amongst its members