Analiza statystyczna zabiegów wewnątrzczaszkowych przeprowadzonych w Polsce w latach 2008–2009

Background and purpose Quantitative and qualitative analysis of neurosurgical procedures provides important data for assessment of the development and trends in the field of neurosurgery. The authors present statistical data on intracranial procedures (IPs) performed in Poland in 2008–2009. Material and methods Data on IPs come from reports of the National Health Fund, grouped according to the system of Diagnosis-Related Groups, group A – nervous system diseases. Data concerning the year 2009 include all IPs performed in Poland. Data from the second half of 2008 to 2009 (18 months) come from 35 neurosurgical centers in Poland, divided by provinces. We analyzed the number of IPs, the cost of procedures, duration of hospitalization and deaths. Results 20 849 IPs were performed in Poland in 2009. The most common procedure was A12 (6807; 32.65%), and the rarest was A04 (96; 0.46%). The annual cost of all IPs was 228 599 956 PLN. Average cost of the procedure ranged from 1578 PLN (A14) to 47 940 PLN (A03). Duration of the hospitalization ranged between 3 days (A14) and 12 days (A12). The highest percentage of deaths was reported for A01 (n = 1050, 19.06%). Reports from 35 neurosurgical centers in the second half of 2008 and 2009 showed the highest number of IPs per 100 000 population in Kujawsko-Pomorskie (93) and the lowest in Wielkopolskie (27) and Podkarpackie (27). The highest number of IPs (1669) was performed in neurosurgical center Ml (Małopolskie), and the lowest (99) in W1 (Wielkopolskie). Conclusions A significant disparity in the number of IPs performed in different centers in Poland was observed. There are no data in the literature on the number of neurosurgical procedures performed in Poland in other periods.Wstęp i cel pracy Analiza ilościowa i jakościowa procedur neurochirurgicznych dostarcza istotnych danych dotyczących rozwoju oraz trendów w dziedzinie neurochirurgii. Autorzy pracy przedstawiają dane statystyczne dotyczące procedur wewnątrzczaszkowych (PW) wykonywanych w Polsce w latach 2008–2009. Materiał i metody Dane dotyczące PW pochodzą z raportów Narodowego Funduszu Zdrowia i były grupowane wg systemu Jednorodnych Grup Pacjentów dla grupy A – choroby układu nerwowego. Dane z 2009 r. uwzględniają wszystkie PW wykonane w Polsce, dane z drugiej połowy 2008 i 2009 r. (18 miesięcy) pochodzą z 35 ośrodków neurochirurgicznych w Polsce podzielonych według województw. Analizowano liczbę PW, koszty procedur, czas hospitalizacji i liczbę zgonów. Wyniki W 2009 r. w Polsce wykonano 20 849 PW. Najczęstszą procedurą była A12 (6807; 32,65%), a najrzadszą A04 (96; 0,46%). Roczny koszt wszystkich PW wyniósł 228 599 956 PLN. Średni koszt procedury wahał się od 1 578 PLN (A14) do 47 940 PLN (A03). Czas hospitalizacji wahał się od 3 dni (A14) do 12 dni (A12). Największy odsetek zgonów odnotowano dla procedury A01 (19,06%; n = 1050). Analizowano raporty 35 ośrodków neurochirurgicznych w Polsce. W ciągu 18 miesięcy (druga połowa 2008 i 2009) najwięcej PW na 100 tys. mieszkańców wykonano w kujawsko-pomorskim (93), natomiast najmniej w wielkopolskim (27) i podkarpackim (27). Najwięcej PW (1669) wykonano w ośrodku M1 (małopolskie), najmniej (99) w W1 (wielkopolskie). Najczęściej raportowana była procedura A12. Wnioski Obserwowano znaczną dysproporcję w liczbie PW wykonywanych w różnych ośrodkach w Polsce. Brakuje danych w piśmiennictwie dotyczących liczby procedur neurochirurgicznych wykonywanych w Polsce we wcześniejszych okresach

Stymulacja kory ruchowej w leczeniu bólów neuropatycznych

Background and purpose Despite the rapid development of neuropharmacotherapy, medical treatment of neuropathic pain (NP) still constitutes a significant socioeconomic problem. The authors herein present a group of patients treated with motor cortex stimulation (MCS) for NP of various types and aetiologies. Material and methods Our cohort included 12 female and 11 male NP patients aged 53 ± 16 treated with MCS. Eleven patients were diagnosed with neuropathic facial pain (NFP), 8 with hemi-body neuropathic pain (HNP), and 4 with deafferentation pain (DP). Prior to surgery, 16 out of 23 patients were treated with repetitive transcranial magnetic stimulation (rTMS), with a positive response in 10 cases. Pain intensity in our group was evaluated with the visual analogue scale (VAS) one month before and three months after MCS implantation. Results Improvement on the VAS was reported in the whole group of patients (p < 0.001). The best results were reported in the NFP group (p < 0.001) while the worst ones were noted in the DP group (p = 0.04). Anamnesis duration positively correlated with outcome. Infection forced the authors to permanently remove the system in one case. There were no other complications in the group. Conclusions Minimally invasive, safe neuromodulative treatment with MCS permits neuropathic pain control with good efficacy. The type of neuropathic pain might be a prognostic factor.Wstęp i cel pracy Pomimo dynamicznego rozwoju neurofarmakoterapii, leczenie bólów neuropatycznych stanowi istotny problem socjoekonomiczny. Autorzy przedstawiają grupę chorych leczonych metodą stymulacji kory ruchowej (motor cortex stimulation – MCS) z powodu bólów neuropatycznych o różnym obrazie klinicznym i etiologii. Materiał i metody W grupie 12 kobiet oraz 11 mężczyzn w wieku 53 ± 16 lat zastosowano MCS z powodu bólu neuropatycznego. U 11 chorych rozpoznano neuropatyczne bóle twarzy, u 8 chorych połowiczy ból neuropatyczny, a u 4 chorych – ból deaferentacyjny. U 16 chorych przeprowadzono próbną przezczaszkową stymulację magnetyczną, uzyskując przejściową poprawę u 10 z nich. Nasilenie dolegliwości bólowych oceniano z wykorzystaniem wzrokowej skali analogowej (visual analogue scale – VAS) miesiąc przed implantacją oraz w trzecim miesiącu po implantacji MCS. Wyniki U wszystkich chorych w grupie stwierdzono poprawę mierzoną VAS (p < 0,001). Najlepsze efekty leczenia bólu neuropatycznego zaobserwowano w grupie chorych z neuropatycznym bólem twarzy (p < 0,001), a najsłabsze u chorych z rozpoznanym bólem deaferentacyjnym (p = 0,04). Długość wywiadów korelowała dodatnio z wynikami leczenia. U jednego chorego ze względu na zakażenie usunięto system i nie podejmowano próby ponownego wszczepienia. Innych powikłań w grupie nie stwierdzano. Wnioski Wykorzystanie minimalnie inwazyjnych technik neuromodulacyjnych, w tym MCS, pozwala na skuteczne i bezpieczne zmniejszenie nasilenia bólów neuropatycznych. Rodzaj bólu neuropatycznego może mieć znaczenie rokownicze

Higher efficacy of oral nitrendipine admininstration in comparison with sublingual route. Pharmacokinetic and pharmacodynamic evaluation in hypertensive urgencies

Wstęp Istnieje opinia, że leki hipotensyjne podawane w stanach podwyższonego ciśnienia drogą podjęzykową powodują skuteczniejsze obniżenie ciśnienia niż preparaty podawane drogą doustną. Celem badania była ocena stężeń w surowicy oraz efektu działania: redukcji ciśnienia tętniczego po podaniu drogą podjęzykową [SL], doustną [PO] oraz podjęzykową i doustną [SL + PO] 5 mg nitrendipiny. Materiał i metody Nitrendipinę w kroplach w dawce 5 mg podawano 12 chorym z podwyższonym ciśnieniem tętniczym (średnia wartość 167 &plusmn; 9/108 &plusmn; 9 mm Hg), w wieku 55 &plusmn; 9 lat, o masie ciała 81 &plusmn; 13 kg, w sposób randomizowany, z zastosowaniem placebo, drogą podjęzykową [SL] (utrzymanie leku w jamie ustnej przez 20 min i usunięcie pozostałości), doustną [PO] (połknięcie) oraz podjęzykową i doustną [SL + PO] (utrzymanie leku w jamie ustnej przez 20 min i połknięcie). Wartości ciśnienia rejestrowano za pomocą 24-godzinnej automatycznej rejestracji (SpaceLabs 90207), pomiary wykonywano co 10 minut. Stężenia nitrendipiny oznaczano w 16 próbkach krwi pobieranych w ciągu 8 godzin od podania leku metodą chromatografii cieczowej (HPLC), czułość wynosiła 2 ng/ml. Wyniki Najwyższe stężenia nitrendipiny stwierdzono po podaniu PO: Cmax 32,8 &plusmn; 9 ng/ml (tmax 1,0 h) i po podaniu SL + PO: 33,8 &plusmn; 8 ng/ml (tmax 0,96 h) vs. SL: 15,1 &plusmn; 4 ng/ml (tmax 0,53 h). Porównywano stężenia i biodostępność nitrendipiny podanej 3 metodami po 15 min (0,25 h), gdyż późniejsze różnice wynikały z faktu wchłonięcia po podaniu SL w ciągu 20 minut tylko 2,81 mg leku (56,2% podanej dawki). Stężenia nitrendipiny po 0,25 h od podania wyniosły po podaniu PO: 14,4 &plusmn; 71 ng/ml, SL + PO: 10,1 &plusmn; 6,9 ng/ml, a po SL: 7,3 &plusmn; 3,4 ng/ml. Wartości AUCcałk po podaniu PO wynosiły: 90,5 &plusmn; 35 ng.h/ml (AUC po 0,25 h: 1,5). Wartości AUCcałk po podaniu SL + PO: 60,0 &plusmn; 29 ng.h/ml (AUC po 0,25 h: 0,9). Pole pod krzywą stężenie&#8211;czas po podaniu SL wyniosło tylko 12,8 &plusmn; 7 ng.h/ml (po 0,25 h: 1,1). Wchłanianie leku z przewodu pokarmowego było szybsze niż ze śluzówki jamy ustnej. Redukcja ciśnienia skurczowego [SBP] po 15 minutach wyniosła w porównaniu z placebo, odpowiednio, po podaniu PO: 7,1 mm Hg (p < 0,05), po podaniu SL + PO: 3,2 mm Hg (ns), a po podaniu SL: 5,5 mm Hg (ns). Istotna redukcja SBP wystąpiła po podaniu PO przez okres 0,25&#8211;10 h (maks. w 3 h, &#8211;17,2%) , po podaniu SL + PO przez okres 1&#8211;10 h (maks. 2,5 h, &#8211;14,9%). Redukcja powyżej 10% SBP wystąpiła po 1 h u wszystkich pacjentów po podaniu PO i SL + PO. Po podaniu drogą SL nie stwierdzono istotnej redukcji SBP. Wnioski Wchłanianie nitrendipiny zachodziło szybciej z przewodu pokarmowego po połknięciu leku w porównaniu z podaniem SL. Tylko po podaniu leku PO oraz SL + PO występowało większe i dłużej utrzymujące się obniżenie ciśnienia. W praktyce nie istnieje czysta droga podjęzykowa podania leku: przy poleceniu utrzymywania leku pod językiem jedynie część jest wchłaniana ze śluzówki jamy ustnej, reszta jest połykana i wchłonięta z przewodu pokarmowego.Background In management of hypertensive urgencies the common opinion exists, that antihypertensive drugs given sublingually are more efficacious than administered orally. The aim of the study was to assess plasma concentrations and effect (blood pressure reduction) after sublingual [SL], oral [PO] and sublingual and oral [SL + PO] administration [adm] of 5 mg nitrendipine [NIT]. Material and methods NIT drops, dose 5 mg, were administered to 12 moderate hypertensive patients with mean initial blood pressure 167/108 (&plusmn; 9/9) mm Hg, mean age 55 &plusmn; 9 years, body mass 81 &plusmn; 13 kg. Patients were given NIT randomly in comparison with placebo: sublingually (keeping drops 20 minutes in the mouth and then removing the rest), orally (swallowing drops), and combined (keeping drops in the mouth for 20 min then swallowing). BP was recorded for 24 hrs using ambulatory BP monitoring (SpaceLabs 90207), readings every 10 min. NIT levels were measured in 16 blood samples drawn for 8 hrs after drug intake by HPLC method (sensitivity 2 ng/ml). Results Highest NIT concentrations were measured after POadm: Cmax 32.8 &plusmn; 9 ng/ml (tmax 1.0 h) and after SL + PO: 33.8 &plusmn; 8 ng/ml (tmax 0.96 h) vs. SL 15.1 &plusmn; 4 ng/ml (tmax 0.53). The concentrations and bioavailability of NIT after 3 ways of administration were compared after 15 min (0.25 h), because latter differences were due to low absorption after SL administration within 20 minutes: 2.81 mg only (56.2% given dose). NIT concentrations after 0.25 h were for PO administration: 14.4 &plusmn; 7 ng/ml, SL + PO: 10.1 &plusmn; 6.9 ng/ml and SL: 7.3 &plusmn; 3.4 ng/ml. Total AUC after PO administration was 90.5 &plusmn; 35 ng.h/ml (AUC after 0.25 h: 1.5 ng.h/ml). Total AUC after SL + PO was 60.0 &plusmn; 29 ng.h/ml (AUC after 0.25 h: 0.9). And finally: total AUC after SL administration was only 12.8 &plusmn; 7 ng.h/ml (after 0.25 h: 1.1). This indicated that absorption from GI tract was faster than from oral mucosa. Systolic blood pressure reductions [SBP] after 0.25 was, respectively, for PO administration: 7.1 mm Hg (p < 0.05), SL + PO: 3.2 mm Hg (ns), and for SL: 5.5 mm Hg (ns). Significant SBP reduction was observed after PO administration for 0.25&#8211;10 hrs (max after 3 h, &#8211;17.2%), after SL + PO for 1&#8211;10 hrs (max after 2.5 h, &#8211;14.9%). In all patients 1 h after PO and SL + PO administration > 10% reduction of SBP was registered. After SL no significant reduction of SBP was observed. Conclusions Study demonstrated the faster absorption of NIT from gastro-intestinal tract than from oral mucosa. Only after PO and SL+PO administration greater and prolonged reduction of SBP was observed. The pure sublingual administration does not exist in practice: only small part of drug is absorbed from oral mucosa and most part of drug after swallowing is absorbed from gastro-intestinal tract

Corticotroph Aggressive Pituitary Tumors and Carcinomas Frequently Harbor ATRX Mutations

Context: Aggressive pituitary tumors (APTs) are characterized by unusually rapid growth and lack of response to standard treatment. About 1% to 2% develop metastases being classified as pituitary carcinomas (PCs). For unknown reasons, the corticotroph tumors are overrepresented among APTs and PCs. Mutations in the alpha thalassemia/mental retardation syndrome X-linked (ATRX) gene, regulating chromatin remodeling and telomere maintenance, have been implicated in the development of several cancer types, including neuroendocrine tumors. Objective: To study ATRX protein expression and mutational status of the ATRX gene in APTs and PCs. Design: We investigated ATRX protein expression by using immunohistochemistry in 30 APTs and 18 PCs, mostly of Pit-1 and T-Pit cell lineage. In tumors lacking ATRX immunolabeling, mutational status of the ATRX gene was explored. Results: Nine of the 48 tumors (19%) demonstrated lack of ATRX immunolabelling with a higher proportion in patients with PCs (5/18; 28%) than in those with APTs (4/30;13%). Lack of ATRX was most common in the corticotroph tumors, 7/22 (32%), versus tumors of the Pit-1 lineage, 2/24 (8%). Loss-of-function ATRX mutations were found in all 9 ATRX immunonegative cases: nonsense mutations (n = 4), frameshift deletions (n = 4), and large deletions affecting 22-28 of the 36 exons (n = 3). More than 1 ATRX gene defect was identified in 2 PCs. Conclusion: ATRX mutations occur in a subset of APTs and are more common in corticotroph tumors. The findings provide a rationale for performing ATRX immunohistochemistry to identify patients at risk of developing aggressive and potentially metastatic pituitary tumors.Peer reviewe

Endoscopic transnasal surgery for skull base chondrosarcomas

Introduction: Skull base chondrosarcomas are low-grade, malignant tumors arising from cartilage tissue. Intracranial chondrosarcomas are rare tumors comprising only 0.1-0.2% of all brain neoplasms. In skull base 2 out of 4 pathologic subtypes occur: conventional chondrosarcoma and mesenchymal chondrosarcoma. Although distant metastases are rare, tumors often invade surrounding bone and compress critical anatomical structures including internal carotid artery or cranial nerves. Treatment involves surgery and adjuvant radiation therapy. Endoscopic transnasal surgery (ETS) gives the most direct approach to the tumor in this region

A Rare Case of a Primary Leiomyoma of the Clivus in an Immunocompetent Patient and a Review of the Literature Regarding Clival Lesions

Leiomyomas are common lesions that are usually located in the genitourinary and gastrointestinal tracts. Primary leiomyomas at the skull base are uncommon. They are composed of well-differentiated smooth muscle cells without cellular atypia. The diagnosis of a leiomyoma has to be confirmed by immunohistochemistry. The tumor tissue is immunoreactive for SMA, S100 and cytokeratin. Leiomyomas mainly occur in immunocompromised patients. Most tumor tissues are positive for EBV. The presented case is that of a 56-year-old immunocompetent woman with a tumor on the clivus. The radiological images suggested chordoma or fibrous dysplasia. Transnasal transsphenoidal surgery was performed. The tumor tissue consisted of well-differentiated smooth muscle cells with elongated nuclei. Immunohistochemistry revealed a positive reaction for desmin, SMA and h-Caldesmon and a negative reaction for S100, beta-catenin, PGR and Ki67. The leiomyoma diagnosis was subsequently established. To the best of our knowledge, the case of a primary leiomyoma on the clivus of an immunocompetent patient is the first to be described. We also extensively reviewed the literature on the immunohistopathological and radiological differential diagnosis of clival lesions

Influence of the Cable Accessories Installing Method on the Partial Discharge Activity in Medium Voltage Cables

This article proposes a method to modify the construction of a medium voltage (MV) heat shrinkable cable termination in cases of atypical damage to the shields of cross-linked polyethylene (XLPE) insulated cables. The proposed solutions include a modified method of assembling electric field control coating. An attempt was made to check the effect of such damage to the shields of MV cables with XLPE insulation on the level of occurrence of partial discharges within the cable termination. The investigations included testing the XRUHAKXS 1 × 240/25 cable type using the electric method (ME) and high frequency (HF) method with sinusoidal AC test voltage. As a result of the measurements, the values of total charges in the period and phase-resolved partial discharge (PRPD) patterns were obtained. The presented experimental results show the influence of the damage of the semiconducting coating surface on the occurrence of a defect in the cable termination without a modified method of control mantissa pinning. We suggest new methods of assembling MV cable accessories in the case of the presented coating damage in MV cable insulation

Evaluating the risk of endometriosis based on patients’ self-assessment questionnaires

Abstract Background Endometriosis is a condition that significantly affects the quality of life of about 10 % of reproductive-aged women. It is characterized by the presence of tissue similar to the uterine lining (endometrium) outside the uterus, which can lead lead scarring, adhesions, pain, and fertility issues. While numerous factors associated with endometriosis are documented, a wide range of symptoms may still be undiscovered. Methods In this study, we employed machine learning algorithms to predict endometriosis based on the patient symptoms extracted from 13,933 questionnaires. We compared the results of feature selection obtained from various algorithms (i.e., Boruta algorithm, Recursive Feature Selection) with experts’ decisions. As a benchmark model architecture, we utilized a LightGBM algorithm, along with Multivariate Imputation by Chained Equations (MICE) and k-nearest neighbors (KNN), for missing data imputation. Our primary objective was to assess the model’s performance and feature importance compared to existing studies. Results We identified the top 20 predictors of endometriosis, uncovering previously overlooked features such as Cesarean section, ovarian cysts, and hernia. Notably, the model’s performance metrics were maximized when utilizing a combination of multiple feature selection methods. Specifically, the final model achieved an area under the receiver operator characteristic curve (AUC) of 0.85 on the training dataset and an AUC of 0.82 on the testing dataset. Conclusions The application of machine learning in diagnosing endometriosis has the potential to significantly impact clinical practice, streamlining the diagnostic process and enhancing efficiency. Our questionnaire-based prediction approach empowers individuals with endometriosis to proactively identify potential symptoms, facilitating informed discussions with healthcare professionals about diagnosis and treatment options

The Expression of Cell Cycle-Related Genes in <i>USP8</i>-Mutated Corticotroph Neuroendocrine Pituitary Tumors and Their Possible Role in Cell Cycle-Targeting Treatment

Protein deubiquitinases USP8 and USP48 are known driver genes in corticotroph pituitary neuroendocrine tumors (PitNETs). USP8 mutations have pleiotropic effects that include notable changes in genes’ expression. Genes involved in cell cycle regulation were found differentially expressed in mutated and wild-type tumors. This study aimed to verify difference in the expression level of selected cell cycle-related genes and investigate their potential role in response to cell cycle inhibitors. Analysis of 70 corticotroph PitNETs showed that USP8-mutated tumors have lower CDKN1B, CDK6, CCND2 and higher CDC25A expression. USP48-mutated tumors have lower CDKN1B and CCND1 expression. A lower p27 protein level in mutated than in wild-type tumors was confirmed that may potentially influence the response to small molecule inhibitors targeting the cell cycle. We looked for the role of USP8 mutations or a changed p27 level in the response to palbociclib, flavopiridol and roscovitine in vitro using murine corticotroph AtT-20/D16v-F2 cells. The cells were sensitive to each agent and treatment influenced the expression of genes involved in cell cycle regulation. Overexpression of mutated Usp8 in the cells did not affect the expression of p27 nor the response to the inhibitors. Downregulating or upregulating p27 expression in AtT-20/D16v-F2 cells also did not affect treatment response