AWAKE SURGERY FOR A PRIMARY BRAIN TUMOR

Operacije 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 efficaceous 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

Operacija primarnog tumora mozga u budnom stanju bolesnika [Awake surgery for a primary brain tumor]

Awake brain surgery has been approved as a safe and efficaceous 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

AWAKE SURGERY FOR A PRIMARY BRAIN TUMOR

Operacije 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 efficaceous 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

Sex difference and intra-operative tidal volume: Insights from the LAS VEGAS study

BACKGROUND: One key element of lung-protective ventilation is the use of a low tidal volume (VT). A sex difference in use of low tidal volume ventilation (LTVV) has been described in critically ill ICU patients.OBJECTIVES: The aim of this study was to determine whether a sex difference in use of LTVV also exists in operating room patients, and if present what factors drive this difference.DESIGN, PATIENTS AND SETTING: This is a posthoc analysis of LAS VEGAS, a 1-week worldwide observational study in adults requiring intra-operative ventilation during general anaesthesia for surgery in 146 hospitals in 29 countries.MAIN OUTCOME MEASURES: Women and men were compared with respect to use of LTVV, defined as VT of 8 ml kg-1 or less predicted bodyweight (PBW). A VT was deemed 'default' if the set VT was a round number. A mediation analysis assessed which factors may explain the sex difference in use of LTVV during intra-operative ventilation.RESULTS: This analysis includes 9864 patients, of whom 5425 (55%) were women. A default VT was often set, both in women and men; mode VT was 500 ml. Median [IQR] VT was higher in women than in men (8.6 [7.7 to 9.6] vs. 7.6 [6.8 to 8.4] ml kg-1 PBW, P < 0.001). Compared with men, women were twice as likely not to receive LTVV [68.8 vs. 36.0%; relative risk ratio 2.1 (95% CI 1.9 to 2.1), P < 0.001]. In the mediation analysis, patients' height and actual body weight (ABW) explained 81 and 18% of the sex difference in use of LTVV, respectively; it was not explained by the use of a default VT.CONCLUSION: In this worldwide cohort of patients receiving intra-operative ventilation during general anaesthesia for surgery, women received a higher VT than men during intra-operative ventilation. The risk for a female not to receive LTVV during surgery was double that of males. Height and ABW were the two mediators of the sex difference in use of LTVV.TRIAL REGISTRATION: The study was registered at Clinicaltrials.gov, NCT01601223

Bug or no bug: challenges in diagnosing cutaneous mycobacterial infections

Cutaneous mycobacterioses are rare in Germany. Nevertheless, early diagnosis and subsequent effective treatment requires awareness of these conditions. Moreover, mycobacterial infections are on the differential diagnosis list of many skin diseases. Diagnoses of cutaneous mycobacterioses are based on clinical features, but also on laboratory investigations, including bacterial culture, histopathology and PCR-based methods. Knowledge about the opportunities and limitations of theses laboratory tests is pivotal to reasonable clinical decision-making. In this paper, we review the current diagnostic options when suspecting a case of cutaneous mycobacterial infection