Kolmiknärvineuralgiaga patsientide operatsioonijärgse elukvaliteedi muutuse hindamine

Taust ja eesmärgid. Kolmiknärvineuralgia on väga tugevat valu põhjustav ja elukvaliteeti halvendav haigus. Uurisime võrdlevalt selle raviks kasutatava mikrovaskulaarse dekompressiooni (MVD) ja kolmiknärvi ganglioni glütserooliblokaadi (GB) tõhusust ning eeldatavat mõju elukvaliteedile.Metoodika. Tegime kõigile MVDga või GBga 2002.–2013. aastal Eestis ravitud kolmiknärvineuralgia patsientidele, kellega õnnestus ühendust saada, ettepaneku vastata kolmele küsimustikule, et saada teavet nende ravieelse ja -järgse enesetunde ning haiguse mõju kohta elule.Tulemused ja järeldused. Kokku saime uuritud ajavahemikul ravitud 127 patsiendist tagasisidet 79-lt (62,2%). Valutugevus muutus MVD käigus 9,1 pallilt 1,7-ni ja GB puhul 8,3-lt keskmiselt 3,2-ni. MVD puhul kasvas aja möödumisel täielikult valuvabade patsientide osakaal, GB-l sellist mõju ei olnud. Söömis- ja/või rääkimishäire kadus protseduuri järel MVD puhul 66,7%-l ning GB korral 26,3%-l juhtudest, seejuures oli MVD tõhusam ka antikonvulsantide vajaduse vähendamisel. GBst invasiivsem MVD põhjustas patsientide hinnangul oluliselt rohkem nägemis-, kuulmis- ja/või tasakaalu- ning tundlikkushäireid. Emotsionaalse enesetunde küsimustiku 2. versiooni (EEK-2) ja peavalu mõju testi 6 (HIT-6) tulemustes olulisi erinevusi patsiendirühmade vahel esile ei tulnud. Mõlemad meetodid on kolmiknärvineuralgia ravis tõhusad. Haigusest tulenevate kaebuste ravis on vaadeldud võimalustest eelistatum MVD, kuid teatud olukordades tuleb esmavalikuna kaaluda ka ravi GBga.Eesti Arst 2017; 96(6):319–32

Peaaju difuussete astrotsütaarsete glioomide loomupärane invasiivsus

Inimese astrotsütaarsetele glioomidele iseomane invasiivne käitumine on üheks peamiseks probleemiks neuroonkoloogias. Astrotsütoomirakkude migratsioon on aluseks nende kasvajate ulatuslikule levikule närvisüsteemis, mis raskendab oluliselt kasvaja piiride kindlaksmääramist diagnostikas ning viib sageli kirurgilisele ja adjuvantravile vaatamata kasvajahaiguse retsidiveerumisele. Invasioonimehhanismide mõistmine on oluliseks ja ehk ka peamiseks eelduseks leidmaks potentsiaalseid ravistrateegilisi ründepunkte astrotsütaarse rea kasvajate efektiivseks käsitlemiseks lähitulevikus. Eesti Arst 2003; 82 (10): 699–70

Seljaajusong ja hüdrotsefaalia: üldine ülevaade ning 30 aastat registriandmete kogumist Eestis

Seljaajusong ja hüdrotsefaalia on kesknärvisüsteemi arenguhäired, mis tekivad lootel varajase embrüonaalse arengu käigus. Haiguste summaarne esinemissagedus on üle maailma keskmiselt 1–2 juhtu 1000 elussünni kohta. Teadaolevalt on neuraaltorudefektidel valdavalt mitmeteguriline etioloogia, hõlmates nii geneetilisi variante kui ka keskkonnategureid. 1985. aastal Tallinna Lastehaigla lastekirurgia osakonna baasil loodud Eesti Seljaajusonga ja Vesipeahaigete Seltsi register on võimaldanud saada ülevaate Eesti neuraaltorudefektidega patsientidest. 2017. aasta alguse seisuga oli Eestis elus 127 seljaajusonga ja 234 hüdrotsefaaliaga haiget ning viimase 30 aasta registriandmete põhjal on leitud vastavad sünniprevalentsid. Siiani kogutud andmete analüüsimise ja eelkõige geneetiliste uuringutega sidumise põhjal tuleb rõhutada foolhappe profülaktilise tarvitamise vajadust. Registriandmed on aidanud laiendada ka teadmisi haigustega kaasnevatest probleemidest ning suunata tähelepanu lapseeast täiskasvanuteks sirgunud haigete ravivõimaluste parendamise vajadusele. Lisaks uutele teadmistele neuraaltorudefektide olukorrast Eestis on oluline laiendada teadmisi nende harvikhaiguste suhtes ka rahvusvahelistes uuringutes

Hõbekuulid vähiteraapias: teel suunatud vähiravi poole

Vähiuuringute üheks keskseks eesmärgiks on vähirakke normaalsetest rakkudest eristavate ravimite väljatöötamine. Kliinilises kasutuses olevate vähiravimite puuduseks on nende vähene selektiivsus ja sellest tingitud kõrvalmõjud normaalsetes kudedes. Artiklis on antud ülevaade suunatud vähiravimite valjatöötamisest ja suundumustest. Suunatud vähiravi põhineb molekulaarsetel erinevustel vähikoe ja normaalsete veresoonte vahel. In vivo faagidisplei meetodi abil on võimalik veresoonte haigusspetsiifilisi molekulaarseid mustreid kaardistada. Selle tulemuseks on peptiidid, mis seostuvad selektiivselt vähiveresoontega. Need kullerpeptiidid nagu ka teised kasvaja veresoontega selektiivselt seonduvad molekulid (antikehad, aptameerid) võimaldavad kasvajasse viia vähiravimeid ja kontrastaineid. Hiljuti avastatud kasvajakude penetreerivad peptiidid põhjustavad vähiveresoonte selektiivset lekkimist. Koos ravimitega manustatuna põhjustavad need peptiidid ravimi väljumist kasvaja veresoontest ja tungimist kasvajakoesse – tulemuseks on ravimi terapeutilise indeksi paranemine.Eesti Arst 2015; 94(5):281–28

Aju venoossete siinuste tromboos

Aju venoossed siinused on kõvakelme lestmete vahel moodustunud urked, mis koguvad verd suuraju veenidest ja suubuvad sisemisse kägiveeni. Venoossed siinused võivad tromboseeruda erinevatel lokaalsetel ja süsteemsetel põhjustel, kusjuures haigus võib avalduda äärmiselt heterogeense kliinilise sümptomaatikaga. Siinustromboosi diagnoosihüpotees vajab tõestust radioloogiliste uuringute abil ja õigeaegse diagnoosimise korral saab siinustromboosi edukalt ravida üle 90%-l juhtudest. Artiklis käsitletakse siinustromboosi kliinilist pilti, diagnoosimist ja ravi ning esitatakse andmed TÜ Kliinikumi neuroloogiaosakonnas ravitud juhtude kohta. Eesti Arst 2007; 86 (12): 897–90

Subacute administration of both methcathinone and manganese causes basal ganglia damage in mice resembling that in methcathinone abusers

An irreversible extrapyramidal syndrome occurs in man after intravenous abuse of "homemade" methcathinone (ephedrone, Mcat) that is contaminated with manganese (Mn) and is accompanied by altered basal ganglia function. Both Mcat and Mn can cause alterations in nigrostriatal function but it remains unknown whether the effects of the 'homemade' drug seen in man are due to Mcat or to Mn or to a combination of both. To determine how toxicity occurs, we have investigated the effects of 4-week intraperitoneal administration of Mn (30 mg/kg t.i.d) and Mcat (100 mg/kg t.i.d.) given alone, on the nigrostriatal function in male C57BL6 mice. The effects were compared to those of the 'homemade' mixture which contained about 7 mg/kg of Mn and 100 mg/kg of Mcat. Motor function, nigral dopaminergic cell number and markers of pre- and postsynaptic dopaminergic neuronal integrity including SPECT analysis were assessed. All three treatments had similar effects on motor behavior and neuronal markers. All decreased motor activity and induced tyrosine hydroxylase positive cell loss in the substantia nigra. All reduced I-123-epidepride binding to D2 receptors in the striatum. Vesicular monoamine transporter 2 (VMAT2) binding was not altered by any drug treatment. However, Mcat treatment alone decreased levels of the dopamine transporter (DAT) and Mn alone reduced GAD immunoreactivity in the striatum. These data suggest that both Mcat and Mn alone could contribute to the neuronal damage caused by the 'homemade' mixture but that both produce additional changes that contribute to the extrapyramidal syndrome seen in man.Peer reviewe

Increased striatal VMAT2 binding in mice after chronic administration of methcathinone and manganese

Intravenous use of a psychostimulant drug containing methcathinone (ephedrone) and manganese causes an irreversible extrapyramidal syndrome in drug abusers. We aimed to reproduce the syndrome in mice to evaluate dopaminergic damage. C57/B6 mice were intraperitoneally injected once a day with the study drug or saline for a period of 27 weeks. Motor activity was recorded in an automated motility-box. After 13 and 27 weeks of treatment, ex vivo digital autoradiography was performed using [11C]dihydrotetrabenazine ([11C]DTBZ). After 27 weeks of treatment [11C]DTBZ autoradiography demonstrated a significant increase in the striatum-to-cerebellum binding ratio compared with saline treated controls. At the same time point, there was no evident change in motor activity. Increased [11C]DTBZ binding may indicate vesicular monoamine transporter type 2 (VMAT2) function is altered. The lack of extrapyramidal symptoms in animals could be attributed to low dosing regimen or high metabolic rate

Acute effects of methcathinone and manganese in mice: A dose response study

An intravenously injectable illicit drug made by mixing pseudoephedrine, potassium permanganate, vinegar and water, yielding methcathinone (Mcat) and manganese (Mn), induces an extrapyramidal syndrome with parkinsonism, dystonia, gait and balance disorders similar to manganism. Although the cause of the syndrome is largely attributed to Mn, the interaction of the drug's individual components is not known and the role of Mcat is possibly underestimated. Aim of the present study was to analyze dose-dependent behavioral effects of the mixture and its two main active components Mcat and Mn in an acute setting and determine the lethal doses of each substance. Three groups of C57BL/6 mice were injected intraperitoneally with (1) the drug mixture containing 10, 25, 50, 100 or 150 mg of Mcat and respectively 1.6, 3.8, 6.9, 17.1 and 22.6 mg of Mn per kilogram of body weight; (2) 10, 25, 50, 100, 150, 200 or 300 mg of racemic Mcat/kg of body weight; (3) MnCl2 10, 25 or 50 mg/kg of body weight. Locomotor activity of the animals, various signs and time of death were recorded. Lower doses (10 and 25 mg/kg) of Mcat had a clear motor activity stimulating effect and this was clearly dose-dependent. High doses of Mcat produced epileptic seizures in 74% of the animals and became lethal with the highest doses. Similarly, the mixture had a clear dose-dependent stimulating effect and the higher doses became lethal. The LD50 of the pseudoephedrine mixture was 110.2 mg of Mcat/kg and for pure Mcat 201.7 mg/kg. Mn did not prove to be lethal in doses up to 50 mg/kg, but had a strong dose dependent inhibitory effect on the animals’ behavior. Our data reveal that both Mn and Mcat have a significant role in the toxicity of the mixture

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Carotid cavernous fistula after elective carotid endarterectomy: Case report

Carotid cavernous fistula (CCF) is a rare complication of surgical procedures. Single case reports have been published in association with carotid endarterectomy (CEA). We hereby present a case of a 75 years old woman who was admitted to our hospital with complaints of intense headache, bilateral visual disturbance and proptosis one month after elective CEA. CT angiography demonstrated a right side CCF. Digital subtraction angiography (DSA) showed a direct high-flow fistula with subtotal vascular steal phenomenon on the right side. Initial endovascular occlusion was partial but gave almost total relief of all symptoms. A few weeks later a second procedure was necessary due to recurrence of ocular symptoms and headache. This time complete occlusion of the fistula was achieved. The patient had episodic headaches at follow-up 9 months later. Follow-up DSA demonstrated a complete fistula occlusion and normal filling of distal cerebral vessels. This is a case to illustrate a rare complication of carotid artery surgery. The patient had atherosclerotic vessel damage of ICA visible on earlier CT scans. This combined with abrupt increase of transmural pressure due to the revascularization procedure could possibly lead to arterial wall rupture and fistula formation