Качество жизни пожилых пациентов, больных глиобластомами полушарий большого мозга

Метою дослідження була оцінка динаміки якості життя у пацієнтів похилого віку, прооперованих з приводу гліобластоми півкуль головного мозку. Показано, що у даної групи цацієнтів відбувається зниження якості життя по всіх основних субшкалах. При цьому рівень фізичного дефіциту визначеного за шкалою Карновського корелює з показниками фізичного функціонування та рольового емоційного функціонування шкали MOS SF-36 (r = 0,61 and r = 0,59 відповідно). Впровадження сучасних нейронавігаційних технологій дозволяє покращити якість життя хворих на гліобластоми півкуль великого мозку похилого віку але не впливає на терміни виживання у післяопераційному періоді.The aim of the study was the evaluation of quality of life in elderly patients operated for glioblastomas of cerebral hemispheres. The research was conducted in the clinical departments of RC Institute of Neurosurgery n. a. AP Romodanov NAMS of Ukraine (Kyiv, Ukraine) in 1999-2013. During the observation period were registered 293 cases of intracerebral tumors of the cerebral hemispheres in elderly and senile patients (study group) and 144 cases of surgical treatment of patients 18 to 59 years (control group). Selection of patients was carried out during the period 1999-2013’s. It included all cases of surgical treatment of intracerebral tumors of the cerebral hemispheres in young and middle-aged in the clinic intracerebral tumors each year in a randomized selected month (April). Starting in 2011, used the system of neuronavigation, which included the use of modern methods of medical imaging for preoperative stage, followed by spatial modeling. Preoperative planning included segmentation and Trace Contour tumors, determine the area of perifocal edema spread, building bulk topographic image topography of the cerebral hemispheres, konvexitally located vascular pathways of white matter, lateral ventricles, optimal trajectory and extent of surgical approach. When planning tactics surgery and extent of tumor removal took into account clinical features, topohrafoanatomichne, topographic and functional relationship of the tumor to surrounding anatomical entities. Surgery interventions were performed using the navigation system StealthStation Treon Plus (Medtronic, USA). For noninvasive and more complete removal of the tumor, extending into the functionally important zones and median structure, the method of laser thermal degradation. Surgical resection of the tumor volume was determined by the results of CT and MRI. The functional status of patients evaluated in the dynamics before and after surgery using Karnovsky’s scale. Assessment of quality of life (QOL) was carried out using a questionnaire SF-36 by the standard method before and after treatment. Statistical analysis was carried out using the package Statistica 10.0 (StatSoft Inc., USA). Intracerebral tumors localized in the frontal lobe in 54.8 % of cases, parietal – at 35.0 %, the temporal lobe – at 36.9 %, occipital – 12.7 %. Distribution of PHM on median structures found in 21.7 %. Every second patient was affected by the tumor more than two lobes. In both groups, observations dominated men (study group – 57.0 % control – 59.0 %). The average age of the patients of the main group was 64,62 ± 0,9 years. A pervasive feature of a cohort of elderly patients was a significant incidence of concomitant cardiovascular disease (in 93.8 %). By contrast, in the control group, only 34.1 % were manifestations of diseases of the cardiovascular system without marked functional disorders. The average value of Karnovsky’s index in the main group was at the time of admission to hospital was 61,94 ± 2,2 points, and at discharge – 68,31 ± 1,1 points (p < 0,05). It is shown that in this group of patients, a decrease in the quality of life for all major subscales with a certain level of physical deficits on Karnovsky’s scale correlated with indicators of physical functioning and role-emotional functioning scale MOS SF-36 (r = 0,61 and r = 0,59 respectively). Introduction of modern neuronavigation technologies allows improve the quality of life of senior patients with glioblastomas of hemicerebrums but does not affect the survival in the postoperative period.Целью исследования была оценка динамики качества жизни у пациентов пожилого возраста, прооперированных по поводу глиобластомы полушарий головного мозга. Показано, что у данной группы цациентов происходит снижение качества жизни по всем основным субшкалам. При этом уровень физического дефицита определенного по шкале Карновского коррелирует с показателями физического функционирования и ролевого эмоционального функционирования шкалы MOS SF-36 (r = 0,61 and r = 0,59 соответственно). Внедрение современных нейронавигационных технологий позволяет улучшить качество жизни пожилых пациентов с глиобластомами гемицеребра, но не влияет на выживаемость в послеоперационный период

Acute Upper Gastrointestinal Bleeding in Central Greece: The Role of Clinical and Endoscopic Variables in Bleeding Outcome

The objectives of this work were to portray the incidence of upper gastrointestinal bleeding in central Greece and to define subsets at higher risk of poor outcome or death. Two hundred and sixty-four cases were recorded. The incidence was 116 per 100,000 per year (95% CI: 102-130). Re-bleeding was noted in 7.9% of patients. The case fatality was 7.2% and population mortality 8 per 100,000 per year (95% CI: 4-12). Independently significant risk factors for re-bleeding were stigmata of bleeding at endoscopy (OR: 3.11; 95% CI: 1.06-9.13, P = 0.04), smoking (OR: 3.39; 95% CI: 1.08-10.62, P = 0.03), and the use of anti-coagulant drugs (OR: 2.64; 95% CI: 1.00-7.13, P = 0.05), while the independently significant risk factor for death was re-bleeding (OR: 5.74; 95% CI: 1.40-23.52, P = 0.03). We conclude that patients with stigmata of bleeding at endoscopy and on anti-coagulant therapy should be under close surveillance because of the higher risk of re-bleeding. Smoking also increases the risk of re-bleeding. Patients with re-bleeding episodes must be managed intensively because of the higher risk of death

Alpha-particle physics in the tokamak fusion test reactor DT experiment

A summary is presented of recent alpha-particle experiments on the tokamak fusion test reactor. Alpha particles are generally well confined in MHD-quiescent discharges, and alpha heating of electrons has been observed. The theoretically predicted toroidicity-induced Alfvén eigenmode has been seen in discharges of ≤ 1 MW of alpha power, but only in plasmas with weak magnetic shear. © 1997 IOP Publishing Ltd