Koljusisesed verevalumid tõelise polütsüteemiaga haigel kerge trauma järel

Tõelise polütsüteemia diagnoosiga 54aastasel naishaigel kujunesid pärast kerget traumat – omalt jalalt kukkumist – ajusisene ja subduraalne verevalum vasemas ajupoolkeras. Hospitaliseerimise ajal oli haige teadvusel, pareesideta, esines sensomotoorne afaasia. Patsient oli polütsüteemia ravi katkestanud 5 aastat tagasi. Vereanalüüside järgi esines haigel trombotsütopeenia, trombotsüütide funktsiooni häire ja koagulopaatia. Vajalik oli vältimatu operatsioon ja vere hüübivuse parandamiseks manustati haigele värskelt külmutatud plasmat, desmopressiini ja traneksaamhapet. Operatsioon ja operatsioonijärgne periood kulgesid tüsistusteta, kõnehäire taandus. Hematoloogi hinnangul oli haigel polütsüteemia arenenud müelofibroosiks. Edasiseks raviks määrati hüdroksükarbamiid.Eesti Arst 2017; 96(8):474–47

Spontaanse subarahnoidaalse hemorraagia diagnoosimise kiirus ja seda mõjutavad tegurid

Hilinemine spontaanse subarahnoidaalse hemorraagia (SAH) diagnoosimisel suurendab tusistuste riski ja halvendab ravi tulemusi. Eesmärk. Uuringu eesmärgiks oli analüüsida SAHiga patsientide esialgseid diagnoose, diagnostilistele uuringutele jõudmiseks kulunud aega ja haiguse diagnoosimisel tekkinud viivitusi. Uurimismaterjal ja -meetodid. Retrospektiivsesse uuringusse kaasati kõik aastatel 2006–2009 Tartu Ülikooli Kliinikumi hospitaliseeritud SAHi diagnoosiga patsiendid. Esialgsest diagnoosist sõltumatult peeti SAHiga patsientide adekvaatseks käsitluseks patsiendi suunamist täiendavatele diagnostilistele uuringutele või hospitaliseerimist. Tulemused. Uuringurühma kuulus 174 patsienti. Esialgse diagnoosi määramisel oli peaaju verevarustuse häire peale mõeldud 60%-l (n = 104) juhtudest. Esimese ööpaeva jooksul pärast haigestumist jõudis meditsiinilise abini 81,3% haigetest ja diagnostilisele uuringutele 69,7% haigetest. Esmane arstiabi osutamine ei lõppenud patsiendi hospitaliseerimisega 24,7%-l uuritavatest (n = 43). Diagnoosi hilinemise oht oli suurem heas seisundis haigetel ning olulised ebaadekvaatse käsitlusega seonduvad tegurid olid teadvushäire puudumine pärast haigestumist, meessugu ja esmase arstiabi osutamine perearsti poolt (p Eesti Arst 2011;90(8):366-37

Kolmiknärvineuralgiaga patsientide operatsioonijärgse elukvaliteedi muutuse hindamine

Taust ja eesmärgid. Kolmiknärvineuralgia on väga tugevat valu põhjustav ja elukvaliteeti halvendav haigus. Uurisime võrdlevalt selle raviks kasutatava mikrovaskulaarse dekompressiooni (MVD) ja kolmiknärvi ganglioni glütserooliblokaadi (GB) tõhusust ning eeldatavat mõju elukvaliteedile.Metoodika. Tegime kõigile MVDga või GBga 2002.–2013. aastal Eestis ravitud kolmiknärvineuralgia patsientidele, kellega õnnestus ühendust saada, ettepaneku vastata kolmele küsimustikule, et saada teavet nende ravieelse ja -järgse enesetunde ning haiguse mõju kohta elule.Tulemused ja järeldused. Kokku saime uuritud ajavahemikul ravitud 127 patsiendist tagasisidet 79-lt (62,2%). Valutugevus muutus MVD käigus 9,1 pallilt 1,7-ni ja GB puhul 8,3-lt keskmiselt 3,2-ni. MVD puhul kasvas aja möödumisel täielikult valuvabade patsientide osakaal, GB-l sellist mõju ei olnud. Söömis- ja/või rääkimishäire kadus protseduuri järel MVD puhul 66,7%-l ning GB korral 26,3%-l juhtudest, seejuures oli MVD tõhusam ka antikonvulsantide vajaduse vähendamisel. GBst invasiivsem MVD põhjustas patsientide hinnangul oluliselt rohkem nägemis-, kuulmis- ja/või tasakaalu- ning tundlikkushäireid. Emotsionaalse enesetunde küsimustiku 2. versiooni (EEK-2) ja peavalu mõju testi 6 (HIT-6) tulemustes olulisi erinevusi patsiendirühmade vahel esile ei tulnud. Mõlemad meetodid on kolmiknärvineuralgia ravis tõhusad. Haigusest tulenevate kaebuste ravis on vaadeldud võimalustest eelistatum MVD, kuid teatud olukordades tuleb esmavalikuna kaaluda ka ravi GBga.Eesti Arst 2017; 96(6):319–32

Aneurysmal subarachnoid haemorrhage: effect of CRHR1 genotype on fatigue and depression

Background Emotional health disturbances are common after aneurysmal subarachnoid hemorrhage (aSAH) and their causes are largely unexplored. Corticotropin-releasing hormone receptor 1 (CRHR1) is a key factor in stress reactivity and development of mental health disturbances after adverse life-events. Methods We explore the effect of CRHR1 genotype on mental health after aSAH in a retrospective cohort study. One hundred twenty-five patients have been assessed using EST-Q mental health questionnaire. Genotyping of CRHR1 single nucleotide polymorphisms (SNP-s) was performed (Rs7209436, Rs110402, Rs242924). Results Fatigue was present in almost half of aSAH patients, depression and anxiety in one-third. There was a high prevalence of insomnia and panic complaints. Rs110402 minor allele decreased the risk of depression (OR = 0.25, p = 0.027 for homozygotes). Depression was present in 14% vs 41% in minor and major allele homozygotes, respectively. Rs110402, Rs242924 and Rs7209436 minor alleles and TAT-haplotype, formed by them, were protective against fatigue. After Bonferroni correction only the association of Rs110402 with fatigue remained statistically significant (OR = 0.21, p = 0.006 for minor allele homozygotes). Results remained statistically significant when adjusted for gender, admission state, age and time from aSAH. In multiple regression analysis occurrence of fatigue was dependent on anxiety, modified Rankin score and Rs110402 genotype (R2 = 0.34, p <  0.001). Conclusions CRHR1 minor genotype was associated with a lower risk of fatigue and depression after aSAH. Genetic predisposition to mental health disturbances associated with negative life-events could be a risk factor for fatigue and depression after aSAH and selected patients might benefit from advanced counselling in the recovery phase

Aneurysmal subarachnoid haemorrhage: Effect of CRHR1 genotype on mental health-related quality of life

Quality of life (QoL) disturbances are common after aneurysmal subarachnoid hemorrhage (aSAH) both in physical and mental health domains and their causes are not clearly understood. Corticotropin-releasing hormone receptor 1 (CRHR1) is involved in stress reactivity and development of mental health disturbances after negative life-events. We performed a retrospective cohort study of long-term QoL outcomes among 125 surgically treated aSAH patients (2001–2013). QoL was assessed with Short Form Health Survey (SF-36) and compared to an age and gender matched general population. Genotyping of CRHR1 single nucleotide polymorphisms was performed (Rs7209436, Rs110402, Rs242924) and their effect on QoL scores was explored. aSAH patients experienced a reduced quality of life in all domains. CRHR1 minor genotype was associated with higher SF-36 mental health (OR = 1.31–1.6, p < 0.05), role-emotional (OR = 1.57, p = 0.04) and vitality scores (OR = 1.31–1.38, p < 0.05). Association of all studied SNP’s with vitality and Rs242924 with mental health scores remained statistically significant after Bonferroni correction. Mental quality of life scores were associated with physical state of patients, antidepressant history and CRHR1 genotype. Predisposition to mental health disturbances after stressful life-events might be associated with reduced mental QoL after aSAH and selected patients could be provided advanced counselling in the recovery phase

Hõbekuulid vähiteraapias: teel suunatud vähiravi poole

Vähiuuringute üheks keskseks eesmärgiks on vähirakke normaalsetest rakkudest eristavate ravimite väljatöötamine. Kliinilises kasutuses olevate vähiravimite puuduseks on nende vähene selektiivsus ja sellest tingitud kõrvalmõjud normaalsetes kudedes. Artiklis on antud ülevaade suunatud vähiravimite valjatöötamisest ja suundumustest. Suunatud vähiravi põhineb molekulaarsetel erinevustel vähikoe ja normaalsete veresoonte vahel. In vivo faagidisplei meetodi abil on võimalik veresoonte haigusspetsiifilisi molekulaarseid mustreid kaardistada. Selle tulemuseks on peptiidid, mis seostuvad selektiivselt vähiveresoontega. Need kullerpeptiidid nagu ka teised kasvaja veresoontega selektiivselt seonduvad molekulid (antikehad, aptameerid) võimaldavad kasvajasse viia vähiravimeid ja kontrastaineid. Hiljuti avastatud kasvajakude penetreerivad peptiidid põhjustavad vähiveresoonte selektiivset lekkimist. Koos ravimitega manustatuna põhjustavad need peptiidid ravimi väljumist kasvaja veresoontest ja tungimist kasvajakoesse – tulemuseks on ravimi terapeutilise indeksi paranemine.Eesti Arst 2015; 94(5):281–28

Aneurüsmaatilise subarahnoidaalse hemorraagia järgne elukvaliteet, emotsionaalne tervis ja nendega seotud faktorid

Väitekirja elektrooniline versioon ei sisalda publikatsiooneÄmblikvõrkkesta-alune verejooks ehk mittetraumaatiline subarahnoidaalne hemorraagia (SAH) moodustab 5% insultidest. 85%-l patsientidest on SAH põhjustatud ajuarteri aneurüsmi lõhkemisest. Suuremal osal patsientidest leiab aneurüsmaatiline subarahnoidaalne hemorraagia (aSAH) aset keskeas ja sellesse haigestumus on 7.9 juhtu 100.000 elaniku kohta. Esmane ravi haiguse ägedas perioodis on suunatud verejooksu põhjuse likvideerimisele (aneurüsmi mikrokirurgiline klipsimine või versoonesise sulgemine ehk koilimine). Vaatamata sellele, et aSAH-i käsitlus on viimastel aastatel paranenud, on haiguse psühhosotsiaalsed kaugtulemused sageli ebarahuldavad nii patsientide kui ka nende lähedaste jaoks. Enam kui pooltel patsientidel on pärast aSAH-i ägedat perioodi kirjeldatud vähenenud elukvaliteeti. Kuni pooltel patsientidel esineb pärast aSAH-i depressioon ja ärevus, mis võivad püsida rohkem kui 18 kuud. Suhteliselt vähe on uuringutes tähelepanu pööratud aSAH-i põdemisele järgnevate emotsionaalsete häirete ja elukvaliteedi languse seostele ja nende prognostilistele faktoritele. aSAH patsientide retrospektiivse kaugtulemuste uuringu eesmärgid olid: kirjeldada elukvaliteedi langust ja emotsionaalsete häirete esinemist ellujäänute seas, analüüsida emotsionaalsete häirete ja elukvaliteedi omavahelist seost koos neid mõjutavate teguritega, ja uurida CRHR1 genotüübi mõju aSAH kaugtulemustele. Võrreldes samaealiste üldpopulatsiooniga esines aSAH patsientide kohordis elukvaliteedi langus. Samuti oli üldpopulatsiooniga võrreldes pärast aSAH-i kõrge emotsionaalsete häirete, asteenia ja unetuse levimus. Asteenia oli kõige sagedasem patoloogiline seisund, mis mõjutas patsientide nii vaimset kui ka füüsilist seisundit. Ühel kolmandikul patsientidest esines depressiooni ja ärevust, mille sümptomid avaldusid tihti samaaegselt. Olulisel hulgal patsientidest esines surma- või enesetapumõtteid. Emotsionaalsed häired seletasid enam kui poole elukvaliteedi vaimse domeeni hinnete erinevusest ja peaaegu kolmandiku füüsilise domeeni hinnetest Asteenia oli seotud kõikide elukvaliteedi domeenide tulemustega. Depressioon oli seotud elukvaliteedi vaimse domeeni hinnetega. Enam kui kolmandik patsientidest ei suutnud pärast aSAH-i tööle naasta, mis oli seotud emotsionaalsete häirete esinemisega. CRHR1 minoorse genotüübi kandjatel olid oluliselt paremad tulemused elukvaliteedi vaimses domeenis. CRHR1 minoorne genotüüp oli seotud väiksema riskiga asteenia ja depressiooni kujunemiseks.Aneurysmal subarachnoid haemorrhage (aSAH) is an acute neurosurgical disease that is associated with devastating long-term morbidity and socioeconomic burden. aSAH accounts for 5% of all strokes. The incidence of aSAH is around 7.9 per 100.000 patient years. The mean age of aSAH incidence is 55, and survivors have a good life expectancy. Despite recent improvements in the management of aSAH, psychosocial outcomes are still unsatisfactory. More than half of patients report a persistent reduction in their quality of life (QoL). Many patients experience mental health disturbances such as depression, anxiety, and fatigue. Despite the potential benefit associated with timely management of QoL and mental disorders after aSAH, these issues often remain unrecognized and undertreated. Biomarkers are needed to predict, diagnose, and potentially treat the long-term consequences of aSAH. With this long-term retrospective study of aSAH survivors, we aimed to measure survivors’ QoL, describe various emotional disorders that aSAH patients experience, and analyse the associations between emotional disorders and QoL. We also explored the role of the corticotrophin-releasing hormone receptor 1 (CRHR1) genotype as a possible biomarker for emotional maladjustment after aSAH. A strong long-term reduction in the physical, mental, and social domains of QoL occurred in our cohort of aSAH patients in comparison with the general population. There was a high prevalence of emotional disorders, fatigue, and insomnia amongst patients. Fatigue was the most common disorder, which was affected both by the mental and physical state of the patients. One third of the patients scored significantly for depression and anxiety, which coexisted frequently. A substantial number of patients reported frequent thoughts of suicide. Emotional disorders were significantly associated with impaired QoL. Emotional disorders explained more than half of the variance in the mental domain and almost one third of the variance in the physical domain of QoL. Fatigue was significantly associated with all QoL scale results. Depression was significantly associated with all scores in the mental domain of QoL. Carriers of the minor genotype of CRHR1 had significantly better scores in the mental domain of QoL. The CRHR1 minor genotype was associated with a lower risk of fatigue and depression after aSAH.https://www.ester.ee/record=b538525

Association of Head Injury, Neck Injury or Acoustic Trauma on Phenotype of Ménière’s Disease

The aim of the present study was to investigate adverse effects of head injury, neck trauma, and chronic noise exposure on the complaint profile in people with Ménière’s disease (MD). The study used a retrospective design. Register data of 912 patients with MD from the Finnish Ménière Federation database were studied. The data comprised case histories of traumatic brain injury (TBI), neck trauma and occupational noise exposure, MD specific complaints, impact related questions, and the E-Qol health-related quality of life instrument. TBI was classified based on mild, moderate, and severe categories of transient loss of consciousness (TLoC). The mean age of the participants was 60.2 years, the mean duration of the disease was 12.6 years, and 78.7% were females. Logistic regression analysis, linear correlation, and pairwise comparisons were used in evaluating the associations. 19.2% of the participants with MD had a history of TBI. The phenotype of participants with TBI was associated with frequent vestibular drop attacks (VDA), presyncope, headache-associated vertigo, and a reduction in the E-QoL. Logistic regression analysis explained the variability of mild TBI in 6.8%. A history of neck trauma was present in 10.8% of the participants. Neck trauma associated with vertigo (NTwV) was seen in 47 and not associated with vertigo in 52 participants. The phenotype of NTwV was associated with balance problems, VDA, physical strain-induced vertigo, and hyperacusia. Logistic regression analysis explained 8.7% of the variability of the complaint profile. Occupational noise exposure was recorded in 25.4% of the participants and correlated with the greater impact of tinnitus, hyperacusis, and hearing loss. Neither the frequency, duration, or severity of vertigo or nausea were significantly different between the baseline group and the TBI, NTwV, or noise-exposure groups. The results indicate that TBI and NTwV are common among MD patients and may cause a confounder effect

Review of Template-Based Neuroimaging Tools in Neuro-Oncology: Novel Insights

Background: A common MRI reference space allows for easy communication of findings, and has led to high-impact discoveries in neuroscience. Brain MRI of neuro-oncology patients with mass lesions or surgical cavities can now be accurately transformed into reference space, allowing for a reliable comparison across patients. Despite this, it is currently seldom used in neuro-oncology, leaving analytic tools untapped. The aim of this study was to systematically review the neuro-oncology literature utilizing reference space. Methods: A systematic review of the neuro-oncology publications was conducted according to PRISMA statement guidelines. Studies specially reporting the use of the Montreal Neurological Institute (MNI) reference space were included. Studies were categorized according to their type of input data and their contributions to the field. A sub-analysis focusing on connectomics and transcriptomics was also included. Results: We identified only 101 articles that utilized the MNI brain in neuro-oncology research. Tumor locations (n = 77) and direct electrocortical stimulation (n = 19) were the most common source of data. A majority of studies (n = 51) provided insights on clinical factors such as tumor subtype, growth progression, and prognosis. A small group of studies (n = 21) have used the novel connectomic and transcriptomic tools. Conclusions: Brain MRI of neuro-oncology patients can be accurately transformed to MNI space. This has contributed to enhance our understanding of a wide variety of clinical questions ranging from tumor subtyping to symptom mapping. Many advanced tools such as connectomics and transcriptomics remain relatively untapped, thereby hindering our knowledge of neuro-oncology

A Network-Based Approach to Glioma Surgery: Insights from Functional Neurosurgery

The evaluation and manipulation of structural and functional networks, which has been integral to advancing functional neurosurgery, is beginning to transcend classical subspecialty boundaries. Notably, its application in neuro-oncologic surgery has stimulated an exciting paradigm shift from the traditional localizationist approach, which is lacking in nuance and optimization. This manuscript reviews the existing literature and explores how structural and functional connectivity analyses have been leveraged to revolutionize and individualize pre-operative tumor evaluation and surgical planning. We describe how this novel approach may improve cognitive and neurologic preservation after surgery and attenuate tumor spread. Furthermore, we demonstrate how connectivity analysis combined with neuromodulation techniques can be employed to induce post-operative neuroplasticity and personalize neurorehabilitation. While the landscape of functional neuro-oncology is still evolving and requires further study to encourage more widespread adoption, this functional approach can transform the practice of neuro-oncologic surgery and improve the care and outcomes of patients with intra-axial tumors