Octreotide in the therapy of recurrent medulloblastomas

BACKGROUND: Recurrence of medulloblastoma appears after 30% to 40% of the surgeries. Different from primary medulloblastoma, in which five-year survival rate is 50%, the survival time of relapses much shorter and only 20% of the patients manage to survive a year. There is a logical need for additional methods of treatment of recurrent medulloblastomas. The aim of the study is to determine the effects of intracavitary and long-term subcutaneous application of Sandostatin (octreotide) on the recurrent medulloblastomas. METHODS: Fourteen children aged 4 to 9 years, in which, despite of craniospinal irradiation and chemotherapy came to a recurrence of medulloblastoma during the first 6 months after the surgery, were treated subcutaneously with Sandostatin (octreotide) in a longer period of time. Cerebellar medulloblastomas with a diameter bigger than 20 mm and spinal over 10 mm were removed operatively and octreotide with Beriplast was applied intracavitary. RESULTS: Magnetic resonance of cranioaxis shows that the application of octreotide has caused the disappearance of spinal drop metastases in all 7 patients and the cerebellar metastases smaller than 5 mm in all 4 patients. Subcutaneous application of octreotide combined with intracavitary expresses an antitumoral effect in 2/3 of the relapses. The application of octreotide results with a transformation of Chang's stage M0 into M1 in 71.43% of the patients. CONCLUSION: In the case of in loco or metastatic recurrence of medulloblastomas, intracavitarily and subcutaneously applied octreotide results with a regression of the tumor in a 3 year time within 2/3 of the treated patients

Tracheotomy in children

IntroductionTracheotomy is one of the most urgent procedures in medicine. It is an operative procedure that creates a surgical airway in the cervical trachea.AimTracheostomy refers to a surgical incision made into a trachea. Children are often considered “little people”, however, in medical sense, that is not completely true. The aim of our paper is to review the tracheostomy procedure in children.Materials and MethodsIn this paper, we analysed the tracheostomies in children performed in the Clinical Centre Niš (Serbia) in the five-year period from January 2015 to December 2019 inclusive. At our centre, all tracheostomies were solely performed by otolaryngologists.ResultsA total of 37 tracheotomies were performed in the studied period. There were 25 (67.6%) boys and 12 girls (32.4%). The main reason for this relatively low tracheostomy count in our study is because our practitioners are usually performing tracheostomies only in children that require urgent care. All chronic or complicated cases, if they are stable enough to transport, are referred to a higher specialised institution in Belgrade, Serbia.The youngest was a newborn, not older than 1 hour, and the oldest was 17 years old. We divided them into groups according to the age. There were 5 (13.5%) neonates, 25 (67.6%) infants, 3 (8.1%) preschoolers, 2 (5.4%) school-aged children, and 2 (5.4%) adolescents. This is in concurrence with other studies, where authors reported that the highest number of tracheostomies (around 65–70%) were performed before 1 year of age.In most cases, indication for tracheostomies were upper airway obstructions (n = 35, 94.6%). Prolonged orotracheal intubation (n = 1, 2.7%), and protective tracheostomy (n = 1, 2.7%) were the causes in the other two cases.ConclusionWhile researching the literature for this paper we found that there is little standardisation associated with tracheostomy, even though it is a procedure that is performed regularly all over the globe. There is evidence that there is a disparity in opinions not only among the practitioners in different countries, but in individual countries as well. With the increasing number of patients that require tracheostomy, we find that this topic should be addressed more carefully with the attempt to establish the best way of action for this procedure, and with that, lower the complication and mortality rates

Interpolation and Extrapolation of Precipitation Quantities in Serbia

The aim of this paper is to indicate the problems with filling the missing data in precipitation database using interpolation and extrapolation methods. Investigated periods were from 1981 to 2010 for Northern (Autonomous Province of Vojvodina) and Proper Serbia and from 1971 to 2000 for Southern Serbia (Autonomous Province of Kosovo and Metohia). Database included time series from 78 meteorological stations that had less than 20% of missing data. Interpolation was performed if station had missing data for five consecutive months or less. If station had missing data for six consecutive months or more, extrapolation was performed. For every station with mising data correlation with at least three surrounding stations was performed. The lowest acceptable value of correlation coefficient for precipitation was set at 0,30

Influence of nuclear multiple scattering on axially channeled protons in a bent crystal

The influence of nuclear multiple scattering on axially channeled protons with an energy of 7 TeV through a bent Si crystal, is presented in this paper. The aims of the investigation are the processes correlated to the axial channeling, such as dechanneling, angular distributions and energy loss distribution. The data for these processes are generated via the numerical solution of the proton equations of motion in the transverse plane and the computer simulation method. In the simulations, the crystal thickness is varied from 1 to 5 mm while the bending angle is varied from 0 to 20 μrad. The increasing of the transverse energy of axially channeled protons is due to its multiple scattering by atomic strings and the bending dechanneling mechanism. The analysis of the generated data shows that in the cases we are considering, the dechanneling function, the energy loss spectra, and the angular distributions do not undergo to any significant changes when the effect of nuclear multiple scattering is included in the ion-atom interactions. © 2018, Vinca Inst Nuclear Sci. All rights reserved

ASSESSMENT OF THE INSTRUMENTAL ACTIVITIES OF DAILY LIVING IN MILD COGNITIVE IMPAIRMENT AND DEMENTIA DUE TO ALZHEIMER'S DISEASE: DIAGNOSTIC ACCURACY OF THE SERBIAN VERSION OF THE AMSTERDAM IADL QUESTIONNAIRE

To establish a diagnosis of dementia, it is necessary, in addition to cognitive impairment, to prove the existence of a disorder of instrumental activities of daily living (IADL). The Amsterdam IADL Questionnaire is a reliable instrument translated into different languages. This study aims to assess the diagnostic accuracy of the Serbian version of the Amsterdam IADL Questionnaire. The study  included 75 patients with mild cognitive impairment (MCI) and dementia due to Alzheimer's disease. The questionnaire was scored using the weighted average (WA) and item response theory (IRT) scoring method. Diagnostic accuracy was examined using receiver–operating characteristic (ROC) curves. The area under the curves (AUC) was calculated with 95% confidence intervals (CI). The correlation between IRT and WA scores was strong and significant (r=-0.980, p<0.001). The AUC for the IRT scores of A-IADL-Q  was 0.832 (95% CI: 0.729 to 0.909), while the AUC for the WA scores of A-IADL-Q was 0.848 (95% CI: 0.746 to 0.920). Both were significantly different from the AUC of 0.5 (p<0.001). There  was no significant difference between the AUCs of IRT and WA scoring  (z=1.157; p=0.247). Cutoffs and the highest combination of sensitivity and specificity for the IRT (sensitivity 0.767; specificity 0. 844) and WA (sensitivity 0.744; specificity 0. 844) scores of A-IADL-Q  were calculated. We have shown that A-IADL-Q has moderate diagnostic accuracy in differentiating dementia and MCI. This instrument can be used in combination with cognitive measures to diagnose dementia in its early stages

Breast MRI, digital mammography and breast tomosynthesis: comparison of three methods for early detection of breast cancer

Breast cancer is the most common malignancy in women and early detection is important for its successful treatment. The aim of this study was to investigate the sensitivity and specificity of three methods for early detection of breast cancer: breast magnetic resonance imaging (MRI), digital mammography, and breast tomosynthesis in comparison to histopathology, as well as to investigate the intraindividual variability between these modalities.  We included 57 breast lesions, each detected by three diagnostic modalities: digital mammography, breast MRI, and breast tomosynthesis, and subsequently confirmed by histopathology. Breast Imaging-Reporting and Data System (BI-RADS) was used for characterizing the lesions. One experienced radiologist interpreted all three diagnostic modalities. Twenty-nine of the breast lesions were malignant while 28 were benign. The sensitivity for digital mammography, breast MRI, and breast tomosynthesis, was 72.4%, 93.1%, and 100%, respectively; while the specificity was 46.4%, 60.7%, and 75%, respectively. Receiver operating characteristics (ROC) curve analysis showed an overall diagnostic advantage of breast tomosynthesis over both breast MRI and digital mammography. The difference in performance between breast tomosynthesis and digital mammography was significant (p < 0.001), while the difference between breast tomosynthesis and breast MRI was not significant (p = 0.20)

Peripheral glutamate and TNF-α levels in patients with intracerebral hemorrhage: Their prognostic values and interactions toward the formation of the edemal volume

Objective We aimed to evaluate the prognostic values, contribution and interactions of the peripheral blood plasma glutamate and tumor-necrosis factor-α (TNF-α) levels toward the formation of the perifocal edema in patients with intracerebral hemorrhage (ICH). Methods Fifty patients with ICH and fifty healthy controls were included in the study. The peripheral markers were detected by high-sensitivity ELISA. Results A highly significant differences in plasma glutamate and TNF-α levels with good separation of their values was detected between patients and healthy controls. The two variables correlated with the severity of the symptoms and the initial volume of the ICH at admission. Both peripheral glutamate and TNF-α levels at admission were estimated as significant predictors for the formation of the perifocal edema five days after ICH; nevertheless, it was shown that they independently contribute to the development of the edema, without effects of interaction and regardless the localization of the ICH. Conclusions Our results support the idea for the significance of glutamate and TNF-α as peripheral markers for excitotoxicity and inflammation in ICH patients. The developed multiple regression model for prediction of the development of the edema could be beneficial in decision making between conservative treatment and surgical intervention in the clinical practice

Sensitivity of Radfet for Gamma and X-Ray Doses Used in Medicine

In this paper, the results of radiation sensitive field effect transistors (Al-gate p-channel metal-oxide-semiconductor field effect transistors) sensitivity to gamma and X-ray irradiation are presented. Radiation fields were created using Co-60 source for three dose ranges (0-1 Gy, 0-5 Gy, and 0-50 Gy), as well as X-ray unit of 280 kVp spectrum for a single dose range from 0 to 5 Gy. The sensitivity was characterized by the threshold voltage shift, determined from reader circuit measurements, as a function of absorbed radiation dose. It was shown that for the three dose ranges of gamma radiation, as well as for the X-ray range from 0 Gy to 5 Gy there is approximately a linear dependence between threshold voltage shift Delta V-T and radiation dose D. The application of positive bias of +5 Vat the RADFET gate during irradiation, for these ranges of gamma radiation, also for X-ray dose range, leads to the increase in Delta V-T and also, approximately a linear dependence between Delta V-T and D, is established. Moreover, it was shown that the sensitivity of RADFET is much higher in the case of X-ray irradiation then in the case of gamma-ray irradiation for the same dose range

Influential Factors, Complications and Survival Rate of Primary and Salvage Total Laryngectomy for Advanced Laryngeal Cancer

This is a retrospective review of patients with advanced malignant neoplasms of the larynx treated with total laryngectomy. 387 total laryngectomies for advanced squamous cell carcinoma of larynx performed in the period between 1995 and 2007 were analyzed. Primary total laryngectomy (PRT) was performed in 316 patients, while initial radiotherapy radiotherapy (60–70 Gy) and concomitant chemotherapy (cisplatin-5 fluorouracil) with radiotherapy were applied in totally 71 patients who later received salvage total laryngectomy (STL). All the laryngectomies were performed by four surgeons, using the same routine surgical technique. Postoperative clinical examination was made every three months during five years. We documented the occurrence of: local and general complications, survival rate, residual and recurrent disease, lymph node metastasis, and other changes. Salvage total laryngectomy after previous radiotherapy (STL-pRT) and after chemoradiotherapy (STL-pCTRT) caused more frequent local complications than primary total laryngectomy (PTL). TNM stage and localization of primary laryngeal tumor had significant influence on five year survival rate. It amounted: 61.4% for PTL, 52.6% for STL-pCTRT, and 48.5% for STL-pRT. Incomplete response to initial treatment produced low survival rate. Salvage total laryngectomy caused more frequent local complications, especially after chemoradiotherapy whan compared to primary laryngectomy. Survival rate was increased when chemotherapy is added to radiotherapy. Five year survival rate depended on TNM stage and localization of primary tumor