Traumatski epiduralni hematomi u stražnjoj lubanjskoj jami

Epidural hematoma of the posterior cranial fossa (EHPCF) is a rare complication in head injuries. Furthermore, nonspecific clinical signs and the rare occurrence of this lesion in craniocerebral injuries make the establishment of a diagnosis more difficult. The aim of the paper is to point to the advantages of early diagnosis. During the 1982-2008 period, 18 patients with EHPCF were operated on at University Department of Neurosurgery, Clinical Center of Montenegro in Podgorica. The clinical picture, neuroradiological examination findings and outcome of operated patients were retrospectively analyzed. In our patient series, EHPCF accounted for 0.11% of craniocerebral injuries or 7.9% of epidural hematomas recorded. In 11 cases, the injury was inflicted in traffic accidents and in 7 patients it was caused by fall. Linear fracture of the occipital bone was detected by radiographic investigation in 12, isolated diastasis fracture of lambdoid suture in four, and linear fracture of the occipital bone with diastasis fracture of lambdoid suture in two patients. Glasgow Coma Scale of 8 and less was present in three, 9-12 in seven, and 13-15 in eight patients. The majority of cases (90%) were detected within 24 hours. In all cases, the diagnosis was made by computed tomography. Mortality rate was 11.11%. Early computed tomography of the head in combination with clinical picture and timely surgical intervention could reduce the mortality and morbidity in these lesions.Epiduralni hematom stražnje lubanjske jame (EHSLJ) je rijetka komplikacija kod povrede glave. Nespecifični klinički znaci i rijetkost ove lezije kod kraniocerebralnih ozljeda dodatno otežavaju dijagnozu. Cilj rada je ukazati na prednosti rane dijagnoze. U razdoblju od 1982. do 2008. godine na Neurohirurškoj klinici Kliničkog centra Crne Gore u Podgorici operirano je 18 bolesnika s EHSLJ. Izvedena je retrospektivna analiza kliničke slike, neuroradiološkog ispitivanja i ishoda operiranih bolesnika. U našem nizu bolesnika EHSLJ je utvrđen u 0,11% kraniocerebralnih povreda ili 7,9% u skupini epiduralnih hematoma. U 11 slučajeva ozljeda je nastala u prometnoj nesreći, a kod 7 bolesnika uslijed pada. Radiografskim ispitivanjem otkriven je izolirani linearni prijelom okcipitalne kosti kod 12, linerni prijelom udružen s dijastazom lambdoidne suture u 2 te izolirani dijastatski prijelom lambdoidne suture u 4 bolesnika. Vrijednost Glasgovske ljestvice za komu bila je 8 i manje kod 3, 9-12 kod 7 te 13-15 kod 8 bolesnika. Najveći broj slučajeva (90%) otkriven je unutar 24 sata. Kod svih slučajeva dijagnoza je postavljena kompjutoriziranom tomografijom. Stopa smrtnosti je bila 11,11%. Rana kompjutorizirana tomografija glave u kombinaciji s kliničkom slikom i brzom kirurškom intervencijom mogla bi smanjiti pobol i smrtnost kod ovih ozljeda

Povezanost histopatoloških karakteristika karcinoma usne sa progresijom bolesti

The most common malignancy of the lip is squamous cell carcinoma (SCC). In our population, according to epidemiological data, almost a half of all (45%) SCC of oral mucous tissue spreads over the lower and upper lip. The aim of this study was to estimate prognostic importance of histopathologic characteristics - histologic grade, nuclear grade and tumor size in relation to the appearance of lymph node metastases and relapse in SCC of the lip. Methods. In the retrospective- prospective study 70 cases of lower and upper lip SCC were analyzed. They were diagnosed from 2002 to 2006 in the Clinic of Maxillofacial Surgery, Clinical Center of Montenegro. The data about localization of the carcinomas, histopathologic characteristics and lymph node status were taken from medical files of the patients. The patients were followed up in a 3-year period and the disease relapse or/and metastatic disease appearance were registereds. Results. There was statistically significant difference in tumor size among the patients with and without disease relapse (p = 0.027). Logistic regression analysis showed that the tumor size is a statistically significant factor (R = 0.186; p = 0.011) for the appearance of regional lymph node metastases. Relative risk [exp (B)] for the appearance of regional lymph node metastases in relation to tumor size was 2.807. Conclusion. Histologic and nuclear grade of lip SCC are not prognostic factors for the appearance of the disease relapse and regional lymph node metastases. Tumor size is a predictive factor of the relapse appearance, as well as for lymph node metastases appearance. In clinical practice, tumor size is a factor that classifies patients with lip SCC into the groups of higher and smaller risk of relapse appearance and for lymph node metastases appearance. Our results suggest that, risk for lymph node metastases appearance increases 2.8 times with increasing of the tumor size over 2 cm in diameter.Uvod/Cilj. Planocelularni karcinom (PCC) je najčešće maligno oboljenje usne. Prema epidemiološkim podacima, u našoj populaciji skoro polovina (45%) PCC sluzokože usne duplje zahvata i donju i gornju usnu. Cilj ovog rada bio je utvrđivanje prognostičkog značaja histopatoloških karakteristika PCC usne: histološkog gradusa, nuklearnog gradusa i veličine tumora za pojavu recidiva bolesti i metastaza u regionalnim limfnim čvorovima. Metode. U retrospektivno-prospektivnoj studiji analizirano je 70 bolesnika sa PCC donje i gornje usne, dijagnostikovanim u periodu od 2002. do 2006. godine u Klinici za maksilofacijalnu hirurgiju Kliničkog centra Crne Gore. Podaci o lokalizaciji neoplazmi, životnom dobu i polu bolesnika, kao i o histopatološkim karakteristikama neoplazmi uzeti su iz uputnika za histopatološki pregled. Tokom tri godine, na redovnim postoperativnim kliničkim kontrolama, registrovana je eventualna pojava recidiva i/ili metastatske bolesti. Rezultati. Veličina tumora se statistički značajno razlikovala između ispitanika sa i bez recidiva bolesti (p = 0,027). Logističkom regresionom analizom utvrđeno je da je veličina tumora bila statistički značajan faktor (p = 0,011, R = 0,186) za pojavu metastaza u regionalnim limfnim čvorovima. Relativni rizik [exp (B)] od pojave metastaze u regionalnim limfnim čvorovima u odnosu na veličinu tumora iznosio je 2,807. Zaključak. Histološki i nuklearni gradusi tumora nisu prognostički faktori pojave recidiva i metastatske bolesti PCC usne. Veličina tumora predstavlja prognostički faktor za pojavu recidiva i regionalnih metastaza PCC usne, tj. faktor koji omogućava podelu bolesnika sa karcinomom usne u grupu sa većim, odnosno manjim rizikom od pojave recidiva i/ili metastatske bolesti. Prema našim rezultatima, sa povećanjem veličine PCC usne iznad 2 cm rizik od pojave regionalnih metastaza povećava se 2,8 puta

Prospective Risk Assessment of Medicine Shortages in Europe and Israel: Findings and Implications

Introduction: While medicine shortages are complex, their mitigation is more of a challenge. Prospective risk assessment as a means to mitigate possible shortages, has yet to be applied equally across healthcare settings. The aims of this study have been to: 1) gain insight into risk-prevention against possible medicine shortages among healthcare experts; 2) review existing strategies for minimizing patient-health risks through applied risk assessment; and 3) learn from experiences related to application in practice. Methodology: A semi-structured questionnaire focusing on medicine shortages was distributed electronically to members of the European Cooperation in Science and Technology (COST) Action 15105 (28 member countries) and to hospital pharmacists of the European Association of Hospital Pharmacists (EAHP) (including associated healthcare professionals). Their answers were subjected to both qualitative and quantitative analysis (Microsoft Office Excel 2010 and IBM SPSS Statistics®) with descriptive statistics based on the distribution of responses. Their proportional difference was tested by the chi-square test and Fisher's exact test for independence. Differences in the observed ordinal variables were tested by the Mann-Whitney or Kruskal-Wallis test. The qualitative data were tabulated and recombined with the quantitative data to observe, uncover and interpret meanings and patterns. Results: The participants (61.7%) are aware of the use of risk assessment procedures as a coping strategy for medicine shortages, and named the particular risk assessment procedure they are familiar with failure mode and effect analysis (FMEA) (26.4%), root cause analysis (RCA) (23.5%), the healthcare FMEA (HFMEA) (14.7%), and the hazard analysis and critical control point (HACCP) (14.7%). Only 29.4% report risk assessment as integrated into mitigation strategy protocols. Risk assessment is typically conducted within multidisciplinary teams (35.3%). Whereas 14.7% participants were aware of legislation stipulating risk assessment implementation in shortages, 88.2% claimed not to have reported their findings to their respective official institutions. 85.3% consider risk assessment a useful mitigation strategy. Conclusion: The study indicates a lack of systematically organized tools used to prospectively analyze clinical as well as operationalized risk stemming from medicine shortages in healthcare. There is also a lack of legal instruments and sufficient data confirming the necessity and usefulness of risk assessment in mitigating medicine shortages in Europe. © Copyright © 2020 Miljković, Godman, Kovačević, Polidori, Tzimis, Hoppe-Tichy, Saar, Antofie, Horvath, De Rijdt, Vida, Kkolou, Preece, Tubić, Peppard, Martinez, Yubero, Haddad, Rajinac, Zelić, Jenzer, Tartar, Gitler, Jeske, Davidescu, Beraud, Kuruc-Poje, Haag, Fischer, Sviestina, Ljubojević, Markestad, Vujić-Aleksić, Nežić, Crkvenčić, Linnolahti, Ašanin, Duborija-Kovačević, Bochenek, Huys and Miljković

Correlation between disease progression and histopathologic criterions of the lip squamous cell carcinoma

The most common malignancy of the lip is squamous cell carcinoma (SCC). In our population, according to epidemiological data, almost a half of all (45%) SCC of oral mucous tissue spreads over the lower and upper lip. The aim of this study was to estimate prognostic importance of histopathologic characteristics - histologic grade, nuclear grade and tumor size in relation to the appearance of lymph node metastases and relapse in SCC of the lip. Methods. In the retrospective- prospective study 70 cases of lower and upper lip SCC were analyzed. They were diagnosed from 2002 to 2006 in the Clinic of Maxillofacial Surgery, Clinical Center of Montenegro. The data about localization of the carcinomas, histopathologic characteristics and lymph node status were taken from medical files of the patients. The patients were followed up in a 3-year period and the disease relapse or/and metastatic disease appearance were registereds. Results. There was statistically significant difference in tumor size among the patients with and without disease relapse (p = 0.027). Logistic regression analysis showed that the tumor size is a statistically significant factor (R = 0.186; p = 0.011) for the appearance of regional lymph node metastases. Relative risk [exp (B)] for the appearance of regional lymph node metastases in relation to tumor size was 2.807. Conclusion. Histologic and nuclear grade of lip SCC are not prognostic factors for the appearance of the disease relapse and regional lymph node metastases. Tumor size is a predictive factor of the relapse appearance, as well as for lymph node metastases appearance. In clinical practice, tumor size is a factor that classifies patients with lip SCC into the groups of higher and smaller risk of relapse appearance and for lymph node metastases appearance. Our results suggest that, risk for lymph node metastases appearance increases 2.8 times with increasing of the tumor size over 2 cm in diameter.Uvod/Cilj. Planocelularni karcinom (PCC) je najčešće maligno oboljenje usne. Prema epidemiološkim podacima, u našoj populaciji skoro polovina (45%) PCC sluzokože usne duplje zahvata i donju i gornju usnu. Cilj ovog rada bio je utvrđivanje prognostičkog značaja histopatoloških karakteristika PCC usne: histološkog gradusa, nuklearnog gradusa i veličine tumora za pojavu recidiva bolesti i metastaza u regionalnim limfnim čvorovima. Metode. U retrospektivno-prospektivnoj studiji analizirano je 70 bolesnika sa PCC donje i gornje usne, dijagnostikovanim u periodu od 2002. do 2006. godine u Klinici za maksilofacijalnu hirurgiju Kliničkog centra Crne Gore. Podaci o lokalizaciji neoplazmi, životnom dobu i polu bolesnika, kao i o histopatološkim karakteristikama neoplazmi uzeti su iz uputnika za histopatološki pregled. Tokom tri godine, na redovnim postoperativnim kliničkim kontrolama, registrovana je eventualna pojava recidiva i/ili metastatske bolesti. Rezultati. Veličina tumora se statistički značajno razlikovala između ispitanika sa i bez recidiva bolesti (p = 0,027). Logističkom regresionom analizom utvrđeno je da je veličina tumora bila statistički značajan faktor (p = 0,011, R = 0,186) za pojavu metastaza u regionalnim limfnim čvorovima. Relativni rizik [exp (B)] od pojave metastaze u regionalnim limfnim čvorovima u odnosu na veličinu tumora iznosio je 2,807. Zaključak. Histološki i nuklearni gradusi tumora nisu prognostički faktori pojave recidiva i metastatske bolesti PCC usne. Veličina tumora predstavlja prognostički faktor za pojavu recidiva i regionalnih metastaza PCC usne, tj. faktor koji omogućava podelu bolesnika sa karcinomom usne u grupu sa većim, odnosno manjim rizikom od pojave recidiva i/ili metastatske bolesti. Prema našim rezultatima, sa povećanjem veličine PCC usne iznad 2 cm rizik od pojave regionalnih metastaza povećava se 2,8 puta

Rationale and Design of the ESC Heart Failure III Registry - Implementation and Discovery

Aims: Heart failure outcomes remain poor despite advances in therapy. The European Society of Cardiology (ESC) Heart Failure (HF) III Registry (ESC HF III Registry) aims to characterize HF clinical characteristics and outcomes and to assess implementation of guideline-recommended therapy in Europe and other ESC affiliated countries. Methods and results: Between 01-Nov-2018 and 31-Dec-2020, 10,162 patients with chronic or acute/worsening HF with reduced, mildly reduced, or preserved ejection fraction were enrolled from 220 centres in 41 European or ESC affiliated countries. The ESC HF III Registry collected data on baseline characteristics (hospital or clinic presentation), hospital course, diagnostic and therapeutic decisions in hospital and at the clinic visit; and on outcomes at 12 months follow-up. These data include demographics, medical history, physical examination, biomarkers and imaging, quality of life, treatments, and interventions-including drug doses and reasons for non-use, and cause-specific outcomes. Conclusion: The ESC HF III Registry will provide comprehensive and unique insight into contemporary HF characteristics, treatment implementation, and outcomes, and may impact implementation strategies, clinical discovery, trial design, and public policy. This article is protected by copyright. All rights reserved