Diffusion tensor tractography imaging in pediatric epilepsy – A systematic review

Purpose Recent years brought several experimental and clinical reports applying diffusion tensor tractography imaging (DTI) of the brain in epilepsy. This study was aimed to evaluate current evidence for adding the DTI sequence to the standard diagnostic magnetic resonance imaging (MRI) protocol in pediatric epilepsy. Material and methods Rapid and qualitative systematic review (RAE, Rapid Evidence Assessment), aggregating relevant studies from the recent 7 years. The PubMed database was hand searched for records containing terms “tractography AND epilepsy.” Only studies referring to children were included; studies were rated using “final quality of evidence.” Results Out of 144 screened records, relevant 101 were aggregated and reviewed. The synthesis was based on 73 studies. Case-control clinical studies were the majority of the material and comprised 43.8% of the material. Low ‘confirmability’ and low ‘applicability’ referred to 18 and 17 articles (29.5% and 27.9%), respectively. The sufficient quality of evidence supported performing DTI in temporal lobe epilepsy, malformations of cortical development and prior to a neurosurgery of epilepsy. Conclusions The qualitative RAE provides an interim estimate of the clinical relevance of quickly developing diagnostic methods. Based on the critical appraisal of current knowledge, adding the DTI sequence to the standard MRI protocol may be clinically beneficial in selected patient groups with childhood temporal lobe epilepsy or as a part of planning for an epilepsy surgery

Recurrence-associated chromosomal anomalies in meningiomas: Single-institution study and a systematic review with meta-analysis

•WHO grade II or III and loss of heterozygosity (LOH) on 1p, and 14q are responsible for recurrence of a sporadic meningioma.•WHO grading has greater impact on further tumour behaviour than molecular findings.•Sparse reporting of the rate of resection prevents full meta-analysing

Romantic Name for a Deadly Condition: Kissing Aneurysms of the Pericallosal Artery – A Case Report

Background: Kissing aneurysms are two independent but adjacent aneurysms protruding from two contralateral arterial locations. This report describes a successfully treated case of kissing aneurysms at the Department of Neurosurgery, Medical University of Gdansk. Case: A 45-year-old asymptomatic woman was diagnosed with unruptured bilateral aneurysms located in the pericallosal-callosomarginal division. Her medical history included a previous intracranial aneurysm and arterial hypertension. The patient underwent a successful treatment by surgical clipping and was discharged in good condition; neither disability nor neurologic deficit was noticed upon discharge. Surgical wound healing was complicated by an infection and resulted in a reoperation for the patient. Conclusion: The etiology of kissing aneurysms is still unknown and the best treatment method stills remains unclear. Thus, every case has to be carefully and individually assessed by an interdisciplinaryteam. As a result, patient transfer to an experienced neurosurgical center could be beneficial

The challenges of hypervolemic therapy in patients after subarachnoid haemorrhage

Purpose The triple-H therapy is widely used for cerebral vasospasm (CV) prevention and treatment in patients after subarachnoid haemorrhage (SAH). However, this practice is based on low level evidence. Aim of this study was to evaluate errors in fluid administration, fluid balance monitoring and bedside charts completeness during a trial of triple-H therapy. Materials and methods An audit of the SAH patient charts was performed. A total of 508 fluid measurements were performed in 41 patients (6 with delayed cerebral ischaemia; DCI) during 14 days of observation. Results Underestimating for intravenous drugs was the most frequent error (80.6%; 112), resulting in a false positive fluid balance in 2.4% of estimations. In 38.6% of the negative fluid balance cases, the physicians did not order additional fluids for the next 24h. In spite of that, the fluid intake was significantly increased after DCI diagnosis. The mean and median intake values were 3.5 and 3.8l/24h respectively, although 40% of the fluid balances were negative. The positive to negative fluid balance ratio was decreasing in the course of the 14 day observation. Conclusions This study revealed inconsistencies in the fluid orders as well as mistakes in the fluid monitoring, which illustrates the difficulties of fluid therapy and reinforces the need for strong evidence-based guidelines for hypervolemic therapy in SAH

THE BRIEF ASSESSMENT OF COGNITION IN AFFECTIVE DISORDERS - NOVEL TOOL IS THE NEUROPSYCHOLOGICAL ASSESSMENT IN MOOD DISORDERS - POLISH TRANSLATION

Mood disorders are chronic disorders accompanied by cognitive impairment. They impair the adaptability and daily functioning of patients, also during remission and justify implementing pharmacological treatment and psychotherapeutic interactions in these patients to improve their quality of life. The recommended method for assessing the charcter of cognitive deficits in affective disorders is the BAC-A (Brief Assessment of Cognition In Affective Disorders) test battery. This scale is a short, simple instrument of the "paper-and-pencil test" type, based on the BAC (Brief Assessment of Cognition) inventory and the Short Scale for Assessment of Cognitive Functions in Schizophrenia (BAC-S). The BAC-A consists of eight subtests measuring: verbal memory and learning, affective control, working memory, motor functions, verbal fluency, executive functions. This paper presents the Polish version of the BAC-A along with instructions about its use and interpretation. The BAC-A scale is a method designed to monitor the cognitive functioning of people with mood disorders, enabling early detection of existing deficits to improve the effectiveness of the diagnostic and treatment process

The correlation of clinical and chromosomal alterations of benign meningiomas and their recurrences

Meningiomas (MGs) are the frequent benign intracranial tumors. Their complete removal does not always guarantee relapse-free survival. Recurrence-associated chromosomal anomalies in MGs haves been proposed as prognostic factors in addition to the World Health Organisation (WHO) grading, tumor size and resection rate. The aim of this study was to evaluate the frequency of deletions on chromosomes in sporadic MGs and to correlate them with the clinical findings and tumor behaviour. Along with survival, the tumor recurrence was the main endpoint. Chromosomal loss of heterozygosity (LOH) was studied. 46 benign MGs were subjected to the analysis, complete tumor resection was intended and no early mortalities were observed. Incomplete removal was related to parasagittal location and psammomatous hisptopathology (p<0.01). Chromosomal alterations were present in 82.6% of cases; LOH at 22q (67.4%) and 1p (34.8%) were the most frequent and associated with male sex (p=0.04). Molecular findings were not specific for any of the histopathologic grade. Tumor recurrence (14 of 46) correlated with tumor size (≥35mm), LOH at 1p, 14q, coexistence of LOH at 1p/14q, 10q/14q, ‘complex karyotype’ status (≥2 LOHs excluding 22q), patient age (younger <35), and Simpson grading of resection rate (≥3 of worse prognosis). The last 3 variables were independent significant prognostic factors in multivariate analysis and of the same importance in recurrence prediction (Receiver Operating Characteristic curves comparison p>0.05). Among the cases of recurrence, tumor progression was observed in 3 of 14. In 2 cases, LOH on 1p and/or coexistence of LOH 1p/14q correlated with anaplastic transformation

INTERNET SEARCHES FOR “SUICIDE”, ITS ASSOCIATION WITH EPIDEMIOLOGICAL DATA AND INSIGHTS FOR PREVENTION PROGRAMS

Background: Literature demonstrates that analysis of internet search data is a useful tool in predicting the occurrence of illnesses and health-related behaviors. The aim of the study was to quantitatively present the trends in Google searches for the keyword “suicide” and to analyze its correlation with the number of suicides in Poland. Subjects and methods: We used the Google Trends tool to compile data for years 2004-2016. Statistical analysis was performed for annual, monthly, daily and hourly data. Official data on suicide in Poland were obtained from the Central Statistical Office and the General Police Headquarters of Poland. Results: A gradual decrease in Google Relative Search Volume of the keyword “suicide” was observed in years 2004-2014, despite the significant increase of suicide rate in Poland (R=-0.24). Reverse correlation was also found between regional suicide coefficients and search volume (R=-0.22). The highest search volumes were recorded in winter months, first days of the week and at night hours (p<0.001). Conclusions: Presented results may contribute to more effective suicide prevention programs. By specifying the time intervals in which searching suicide information is the highest, it will become easier get to individuals at risk

Patient satisfaction with the perioperative care by anesthesiologists: pilot study at four surgical departments

Background: The aim of this pilot study was to measure the outcomes of perioperative care by anesthesiologists and patient satisfaction at four surgical departments. Methods: We designed an original 25–item questionnaire and used it to complete structured interviews of 80 consenting, alert, adult surgical patients during their 1st to 3rd post–operative day. Results: Although >70% were satisfied with the information sharing, 43% patients were unsure or not informed about the possible complications of anesthesia. Similarly, >75% positively rated the anesthesiologists' bedside manner; however 69% were either unsure or sure that an anesthesiologist did not visit them after surgery. Interestingly, this lack of continued care had no overall effect on patient satisfaction. Majority reported receiving immediate post–operative analgesia (65%). The Oncological Surgery patients reported highest (and the Orthopedic patients the lowest) satisfaction with their postoperative nausea and pain management. Majority of responders were overall satisfied with their care. Conclusions: Our data indicate a high level of patient satisfaction with nearly all aspects of perioperative anesthesiology care. However, anesthesiologists need to more thoroughly inform patients about possible complications of anesthesia. A larger survey is needed to fully assess the patient care and satisfaction trends discussed above