Εν τω βάθει εγκεφαλικός ερεθισμός στην θεραπεία της επιληψίας. Επιλογή του κατάλληλου ανατομικού στόχου, συστηματική ανασκόπηση της βιβλιογραφίας

Εισαγωγή Ο εν τω βάθει εγκεφαλικός ερεθισμός έχει αποδειχτεί ότι μπορεί να περιορίσει τη συχνότητα των επιληπτικών κρίσεων σε ασθενείς με φαρμακοανθεκτική επιληψία, ο ακριβής μηχανισμό δράσης του παραμένει, ωστόσο, άγνωστος. Οι περιοχές στόχοι στους οποίους εφαρμόζεται είναι ο πρόσθιος πυρήνας του θαλάμου (ANT), ο κεντρικός-έσω πυρήνας του θαλάμου (CMT), ο υποθαλαμικός πυρήνας (STN), ο ιππόκαμπος και η παρεγκεφαλίδα. Σκοπός Σκοπός της παρούσας εργασίας είναι η ανατομική περιγραφή των ανωτέρω στόχων και η συστηματική ανασκόπηση της βιβλιογραφίας για διερεύνηση της ύπαρξης ιδανικού στόχου, ανάλογα με τον τύπο των επιληπτικών κρίσεων. Υλικό και μέθοδος Διενεργήθηκε έρευνα μέσω του Pubmed και του MEDLINE, για κλινικές μελέτες που αφορούν την εν τω βάθει εγκεφαλική διέγερση στη θεραπεία της επιληψίας, που είχαν δημοσιευθεί μέχρι 1 Φεβρουαρίου 2019. Μετά από ανάλυση των αποτελεσμάτων, αρχικά με βάση τον τίτλο και την περίληψη, και κατόπιν με βάση το πλήρες κείμενο, προκειμένου να επιβεβαιωθεί η καταλληλόλητα τους για την παρούσα μελέτη, επελέγησαν 67 μελέτες, που αναλύθηκαν εις βάθος και παρουσιάζονται, ταξινομημένες ανά στόχο. Αποτελέσματα Από τις 67 μελέτες που αναλύθηκαν, οι 19 αφορούσαν το πρόσθιο πυρήνα του θαλάμου (ΑΝΤ). Ακολούθως, 12 αφορούσαν τον κεντρικό-έσω πυρήνα του θαλάμου (CMT), 15 τον ιππόκαμπο (HIP), 8 τον υποθαλαμικό πυρήνα (STN), και 13 την παρεγκεφαλίδα (CB). Συμπεράσματα Η εν τω βάθει εγκεφαλική διέγερση σε ασθενείς που πάσχουν από φαρμακοανθεκτική επιληψία είναι μια ασφαλής μέθοδος, η οποία μπορεί να επιφέρει σημαντική βελτίωση όσον αφορά τη συχνότητα και τη βαρύτητα των επιληπτικών κρίσεων. Η ορθή επιλογή του πυρήνα στόχου για τον κάθε ασθενή, με βάση τα αποτελέσματα της ανάλυσης που προηγήθηκε, μπορεί να επιφέρει σημαντική βελτίωση στην κλινική εικόνας καθώς και στην ποιότητα ζωής του ασθενούς.Introduction Deep brain stimulation can effectively decrease the frequency of seizures in patients with drug-resistant epilepsy. However, its exact mechanism of action is still unknown. The main targets of deep brain stimulation, on the treatment of epilepsy, is the Anterior Thalamic Nucleus (ANT), the Centro-Median Thalamic Nucleus (CMT), the Subthalamic Nucleus (STN), the hippocampus, and the cerebellum. Aim Our aim is to describe the anatomy of the targets mentioned above and to identify the identical target, for different types of epileptic seizures, through systematic review of the literature. Material and Method A research was conducted in Pubmed and MEDLINE for clinical trials about deep brain stimulation in patients with epilepsy, until the 1st of February 2019. After carefully reviewing the results, we chose 67 trials. The selected articles ware reviewed and presented classified by anatomical target. Results 19 of the selected articles refer to the Anterior Thalamic Nucleus (ANT), 12 refer to the Centro-Median Thalamic Nucleus (CMT), 15 the Hippocampus, 8 the Subthalamic Nucleus (STN), and 13 the Cerebellum (CB). Conclusions Deep brain stimulation (DBS) is a safe procedure that can significantly help patients with drug-resistant epilepsy, by reducing both the frequency and the severity of the seizures. The right choice of anatomical target for each patient, based on our findings, can lead to noteworthy improvement in their quality of life

GEOTHERMIC STATUS OF THERMOPYLAE - ANTHILI AREA IN FTHIOTIDA PREFECTURE

The purpose of this study was the discovery, identification and evaluation of directly exploitable geothermal fields, in the Thermopylae - Anthili area (100km2 ). After the evaluation and the processing of any preexisting data, followed the surface works, such as further geological mapping, tectonic and stratigraphic correlations and analyses, geothermal impressions, observations at 30 recorded points (springs, drillings, wells) regarding water sampling, chemical analyses, temperature, pH and conductivity measurements, special sampling for Br and isotopes analyses. The in depth works that took place concern geophysical prospecting, loggings, small and large diameter drillings. All the data were digitized and processed in a GIS environment. After correlating all the data collected for the region, a geological - geothermal model was constructed. According to this model, water percolates through permeable formations, joints and faults, gets mixed with the existing salt water, warms up and then ascends to the surface through faults and concentrates on proper reservoirs. Specifically, the region of Damasta where two areas of hot water reservoirs have been identified is of particular geothermal interest. The first, located in Triassic– Jurassic limestones (more than 600m deep), presents the greatest interest in terms of temperature and capacity, while the second (found on the surface and up to 350m deep) is located in Quaternary sediments and the upper formations of the underlying Late Cretaceous limestone

Fibrin glue for pilonidal sinus disease

Background Pilonidal sinus disease is a common condition that mainly affects young adults. This condition can cause significant pain and impairment of normal activities. No consensus currently exists on the optimum treatment for pilonidal sinus and current therapies have various advantages and disadvantages. Fibrin glue has emerged as a potential treatment as both monotherapy and an adjunct to surgery. Objectives To assess the effects of fibrin glue alone or in combination with surgery compared with surgery alone in the treatment of pilonidal sinus disease. Search methods In December 2016 we searched: the Cochrane Wounds Specialised Register; CENTRAL; MEDLINE; Embase and CINAHL Plus. We also searched clinical trials registries and conference proceedings for ongoing and unpublished studies and scanned reference lists to identify additional studies. There were no restrictions with respect to language, date of publication or study setting. Selection criteria We included randomised controlled trials (RCTs) only. We included studies involving participants of all ages and studies conducted in any setting. We considered studies involving people with both new and recurrent pilonidal sinus. We included studies which evaluated fibrin glue monotherapy or as an adjunct to surgery. Data collection and analysis Two study authors independently extracted data and assessed risk of bias. We used standard methods expected by Cochrane. Main results We included four RCTs with 253 participants, all were at risk of bias. One unpublished study evaluated fibrin glue monotherapy compared with Bascom's procedure, two studies evaluated fibrin glue as an adjunct to Limberg flap and one study evaluated fibrin glue as an adjunct to Karydakis flap. For fibrin glue monotherapy compared with Bascom's procedure, there were no data available for the primary outcomes of time to healing and adverse events. There was low-quality evidence of less pain on day one after the procedure with fibrin glue monotherapy compared with Bascom's procedure (mean difference (MD) -2.50, 95% confidence interval (CI) -4.03 to -0.97) (evidence downgraded twice for risk of performance and detection bias). Fibrin glue may reduce the time taken to return to normal activities compared with Bascom's procedure (mean time 42 days with surgery and 7 days with glue, MD -34.80 days, 95% CI -66.82 days to -2.78 days) (very low-quality evidence, downgraded as above and for imprecision). Fibrin glue as an adjunct to the Limberg flap may reduce the healing time from 22 to 8 days compared with the Limberg flap alone (MD -13.95 days, 95% CI -16.76 days to -11.14 days) (very low-quality evidence, downgraded twice for risk of selection, performance and detection bias and imprecision). It is uncertain whether use of fibrin glue affects the incidence of postoperative seroma (an adverse event) (risk ratio (RR) 0.27, 95% CI 0.05 to 1.61; very low-quality evidence, downgraded twice for risk of selection, performance and detection bias and imprecision). There was low-quality evidence that fibrin glue, as an adjunct to Limberg flap, may reduce postoperative pain (median 2 versus 4; P < 0.001) and time to return to normal activities (median 8 days versus 17 days; P < 0.001). The addition of fibrin glue to the Limberg flap may reduce the length of hospital stay (MD -1.69 days, 95% CI -2.08 days to -1.29 days) (very low-quality evidence, downgraded twice for risk of selection, performance and detection bias and for unexplained heterogeneity). A single RCT evaluating fibrin glue as an adjunct to the Karydakis flap did not report data for the primary outcome of time to healing. It is uncertain whether fibrin glue with the Karydakis flap affects the incidence of postoperative seroma (adverse event) (RR 3.00, 95% CI 0.67 to 13.46) (very low-quality evidence, downgraded twice for risk of selection, performance and detection bias and for imprecision). Fibrin glue as an adjunct to Karydakis flap may reduce length of stay but this is highly uncertain (mean 2 days versus 3.7 days; P < 0.001, low-quality evidence downgraded twice for risk of selection, performance and detection bias). Authors' conclusions Current evidence is uncertain regarding any benefits associated with fibrin glue either as monotherapy or as an adjunct to surgery for people with pilonidal sinus disease. We identified only four RCTs and each was small and at risk of bias resulting in very low-quality evidence for the primary outcomes of time to healing and adverse events. Future studies should enrol many more participants, ensure adequate randomisation and blinding, whilst measuring clinically relevant outcomes

Comparison of Karydakis versus midline excision for treatment of pilonidal sinus disease

Pilonidal sinus disease is associated with a high rate of recurrence and complications. The Karydakis (KAR) method, whereby an asymmetric subcutaneous flap obliterates the anal crease, has been shown to be effective in adults. The goal of this study is to assess the efficacy of the KAR procedure in the operative treatment of children with pilonidal sinus disease compared to those treated via a midline excision (ME). Sixty-eight cases of pediatric pilonidal sinus excision were reviewed over the past 10 years. Data abstracted included surgical approach, complication rate and recurrence rate. Student’s t -test or the Chi square test was used for statistical analysis, with P <0.05 being considered significant. An ME was performed in 44 patients; the KAR method was used in 24 patients. Mean age at diagnosis was 14.4±4.2 years for the ME group compared to 15.7±4.3 years for the KAR patients ( P =0.18). Mean operative time was significantly longer with the KAR method (58.7±25.6 min) compared to 46.3±18.6 for the primary ME ( P =0.04). Despite the increased operative dissection, there was no difference ( P =0.42) in early post-operative complication rates between groups (25% in the KAR group compared to 34.8% in the ME group). Initial drainage of an abscess had no significant effect upon the recurrence/complication rate in either group. Recurrence rate alone was lower in patients operated on via the KAR approach 0% versus 11.0% using the ME ( P =0.153). Recurrence and complication rates were lower for those patients with a pilonidal sinus treated by the KAR method compared to the ME, but the results did not reach significance. In conclusion, this study does show a potential benefit for children treated with the KAR method for pilonidal sinus. This study mimics the data obtained in adult patients and suggests that a larger study is likely to achieve significance.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/47167/1/383_2005_Article_1543.pd

Global patient outcomes after elective surgery: prospective cohort study in 27 low-, middle- and high-income countries.

BACKGROUND: As global initiatives increase patient access to surgical treatments, there remains a need to understand the adverse effects of surgery and define appropriate levels of perioperative care. METHODS: We designed a prospective international 7-day cohort study of outcomes following elective adult inpatient surgery in 27 countries. The primary outcome was in-hospital complications. Secondary outcomes were death following a complication (failure to rescue) and death in hospital. Process measures were admission to critical care immediately after surgery or to treat a complication and duration of hospital stay. A single definition of critical care was used for all countries. RESULTS: A total of 474 hospitals in 19 high-, 7 middle- and 1 low-income country were included in the primary analysis. Data included 44 814 patients with a median hospital stay of 4 (range 2-7) days. A total of 7508 patients (16.8%) developed one or more postoperative complication and 207 died (0.5%). The overall mortality among patients who developed complications was 2.8%. Mortality following complications ranged from 2.4% for pulmonary embolism to 43.9% for cardiac arrest. A total of 4360 (9.7%) patients were admitted to a critical care unit as routine immediately after surgery, of whom 2198 (50.4%) developed a complication, with 105 (2.4%) deaths. A total of 1233 patients (16.4%) were admitted to a critical care unit to treat complications, with 119 (9.7%) deaths. Despite lower baseline risk, outcomes were similar in low- and middle-income compared with high-income countries. CONCLUSIONS: Poor patient outcomes are common after inpatient surgery. Global initiatives to increase access to surgical treatments should also address the need for safe perioperative care. STUDY REGISTRATION: ISRCTN5181700

Wolf Management in Dalarna County : A case study on the wolfs' stakeholders attitude

The predators’ management plan is needed for the County Administrative Board to manage the big predators of the county in an efficient way. The wolf is one animal that gets a lot of attention in media, and many people have strong feelings regarding its existence in Swedish nature. The thesis’ purpose is to investigate what different stakeholders feel about the wolf management plan of the Dalarna County. Different stakeholders, that have some kind of relation with the wolves in Sweden, were picked for this study. The stakeholders that were picked were the Swedish Society of Nature Conservation, the Federation of Swedish Farmers, local politicians, the Swedish Association for Hunting and Wildlife Management, and the County Administrative Board of Dalarna. The thesis is based on interviews with these stakeholders. Some of them were negative and some of them had a positive attitude towards wolves. Through that behaviour two different patterns were clearly being noticed that the stakeholders are following. The first pattern includes a positive attitude against wolves and the second one a more negative attitude. A good solution to neutralise the different attitudes seems to be ecotourism, as for example wolf safaris. It is an effective idea that people in Dalarna can easily adapt and use