The Value of Stereotactic Biopsy in Improving Survival and Quality of Life for Malignant Brain Glioma Patients

The purpose of the study was to investigate possible differences in the survival and outcome of malignant brain glioma patients when treated by two different methods of surgery. During a 3-year period, 32 glioma patients underwent surgery and oncological protocol afterwards. The patients were divided into two groups according to the surgical method applied. The case group comprised 11 patients in whom a stereotactic biopsy was performed, while the control group consisted of 21 patients who were operated on by radical surgery (craniotomy and maximal reduction of the tumor mass). All survived patients were clinically examined at follow-ups (one year and 2 years following the surgery). The monitored variables for both groups were the tumor pathohistology (the tumor type), the survival rate (time between surgery and follow-up), and the outcome assessed by The Extended Glasgow Outcome Scale. Data statistical analysis was done to compare various investigated variables in two different groups of patients. The majority of patients treated by a stereotactic biopsy survived for more than 2 years following the procedure. The great part of patients treated by radical surgery died or was severely disabled at follow-up examination. The survival and outcome for the patients in whom a stereotactic biopsy was performed were notably better comparing to the patients who were treated by radical surgery. Consequently, it appears that a stereotactic biopsy is surgical option for primary treatment of selected patients with malignant brain glioma when the survival and quality of life are concerned

The Value of Stereotactic Biopsy in Improving Survival and Quality of Life for Malignant Brain Glioma Patients

The purpose of the study was to investigate possible differences in the survival and outcome of malignant brain glioma patients when treated by two different methods of surgery. During a 3-year period, 32 glioma patients underwent surgery and oncological protocol afterwards. The patients were divided into two groups according to the surgical method applied. The case group comprised 11 patients in whom a stereotactic biopsy was performed, while the control group consisted of 21 patients who were operated on by radical surgery (craniotomy and maximal reduction of the tumor mass). All survived patients were clinically examined at follow-ups (one year and 2 years following the surgery). The monitored variables for both groups were the tumor pathohistology (the tumor type), the survival rate (time between surgery and follow-up), and the outcome assessed by The Extended Glasgow Outcome Scale. Data statistical analysis was done to compare various investigated variables in two different groups of patients. The majority of patients treated by a stereotactic biopsy survived for more than 2 years following the procedure. The great part of patients treated by radical surgery died or was severely disabled at follow-up examination. The survival and outcome for the patients in whom a stereotactic biopsy was performed were notably better comparing to the patients who were treated by radical surgery. Consequently, it appears that a stereotactic biopsy is surgical option for primary treatment of selected patients with malignant brain glioma when the survival and quality of life are concerned

Snodgrass’ Urethroplasty in Hypospadias Surgery in Clinical Hospital Mostar – Preliminary Report

Amongst the various methods of reconstructing the hypospadic urethra such as the MAGPI, Mathieu’s and Preputial island flap urethroplasty method and the Snodgrass method, the latter is being used more frequently nowadays in patients with the urethral meatus located in the proximity of the penis. In the Pediatric ward at Mostar Clinical Hospital, we have recently adopted the Snodgrass method when reconstructing the hypospadic urethra. We herewith present our research regarding the successful results in adopting the aforementioned method. Success was evaluated according to the frequency of post-operative complications, as well as the patients’ satisfaction with the functional and the cosmetic result of the urethra reconstruction. The conclusions relating to our research result in an addition basis from which to evaluate whether the Snodgrass method should receive privileged preference in future operative treatment of the hypospadias over others methods, as can be seen from our research

Abdominal Pain Patient Referrals to Emergency Surgical Service: Appropriateness of Diagnosis and Attitudes of General Practitioners

This study evaluate the need for general practitioners referrals and self referrals of acute abdominal pain patients to emergency surgical service, the appropriateness of GP referral diagnosis and their attitudes dealing with abdominal pain. In three months period all acute abdominal pain patient referrals to our hospital emergency surgical service were audited. Data on final diagnosis, surgical treatment, admission to hospital and surgery performance were recorded. Self referral or GP referral, referring GP diagnosis, referral letters indicating presenting complaint or history, axillar and rectal temperature measurement, laboratory checking and abdominal radiography checking by GP were recorded as well. Also, GPs examination details as palpation, auscultation and digit-rectal checking were recorded. We calculated sensitivity, specificity, positive and negative predictive value (PV) for referring diagnosis. Self referrals and GP referrals differences were evaluated. During the study 318 patients were admitted. A total of 163 (51.25%) referrals were deemed inappropriate; 102 (52.6% of GP referrals) and 61 (49.2% of self referred) (p<0.05). There were no differences in general treatment, hospital admission and operative treatment in self referred and GP referred groups (p<0.05 for all three categories). Sensitivity, specificity, positive and negative predictive values for most frequent GP referral diagnoses were: abdominal colic/abdomen in observation 0.78; 0.66; 0.74; 0.70; acute appendicitis 0.37; 0.92; 0.44; 0.90; acute abdomen/peritonitis 0.30; 0.97; 0.54; 0.92; constipation 0.95; 0.98; 0.85; 0.99; and ileus 0.83; 0.97; 0.50; 0.99. Data on GP including clinical examination, patient history and running basic diagnostics were poor. Our results suggest that a general agreement within the profession about what constitutes a »necessary« hospital referral is necessary. GP consultation quality must be improved by booking more time per patient and by giving more medical/technical attention to patients

Laparoskopska holecistektomija u cirotičnih bolesnika

In the beginning, liver cirrhosis was considered a contraindication for laparoscopic cholecystectomy, mostly for the same reasons as for other surgical procedures, i.e. mild to severe bleeding tendency, prolonged wound healing due to hypoproteinemia, and various metabolic disorders. The effect of CO2 pneumoperitoneum on the cirrhotic liver was also discussed. Results obtained by laparoscopic cholecystectomy in 24 liver cirrhosis patients are presented. The experience acquired since the introduction of laparoscopic procedures at our unit is briefly described. The index of conversion was 4.16% (1/24) and mortality rate 0. The mean length of hospital stay was 2.9 days. The use of laparoscopic cholecystectomy for gallstone disease is proposed in patients with liver cirrhosis as the first choice operative method of treatment.U početku razvoja laparoskopskih operacija žučnjaka ciroza jetre opisivala se kao jedna od kontraindikacija, uglavnom iz istih razloga kao i za druge kirurške zahvate kao što su sklonost krvarenju, produženo cijeljenje rana zbog hipoproteinemije, te razni metabolični poremećaji. Neki autori su prikazali i djelovanje CO2 pneumoperitoneuma na cirotičnu jetru. Ovdje su prikazani rezultati i iskustvo stečeno primjenom laparoskopske holecistektomije u 24 bolesnika s cirozom jetre. Nije bilo smrtnog ishoda. U jednoga je bolesnika učinjena konverzija zbog krvarenja. Prosječeno vrijeme hospitalizacije bilo je 2,9 dana. Na osnovi iskustva laparoskopska se holecistektomija preporuča kao metoda izbora u liječenju simptomatske holelitijaze u bolesnika s jetrenom cirozom

ACCURACY OF MODIFIED ALVARADO SCORE, ESKELINEN SCORE AND OHMANN SCORE IN DIAGNOSING ACUTE APPENDICITIS

Introduction: By processing the data of a large number of patients with abdominal pain, diagnostic scores whose implementation attempts to facilitate acute appendicitis diagnostics were developed. Modified Alvarado score, Ohmann score and Eskelinen score are used as assistance when setting the diagnosis and making a decision to undertake surgery. Aim: To assess accuracy of Alvarado score, Ohmann score and Eskelinen score in diagnosing acute appendicitis and to establish connection of total score of these scoring systems with histopathological degree of appendicitis. Subjects and methods: A cross-sectional study was conducted at the Department of Surgery of University Clinical Hospital Mostar. The study included 70 patients who underwent appendectomy and were scored before surgery. All tested persons were examined by experienced surgeon who took anamnesis, physical status and ordered laboratory diagnostic tests. Appendicitis was excluded or confirmed by means of histopathological diagnostics, and the degree of appendicitis was determined. Results: According to accuracy parameters (sensitivity, specificity, negative and positive predictive value), the score which was of highest value was Ohmann score, followed by Eskelinen score, while the lowest value was the one of modified Alvarado score. Total score in all three scoring systems follows the degree of appendicitis, but statistical significance was proven only for Ohmann and Eskelinen scores. Conclusion: Ohmann and Eskelinen scores can be useful in diagnosing acute appendicitis, predicting the degree of appendicitis, as well as assistance when making decision to undertake an operative procedure. Modified Alvarado score in our subjects did not prove sufficient value. Diagnostics of acute appendicitis still must be led by contemporary algorithms in which diagnostic scoring is implemented

A Randomised Two-way Comparison of Mastectomy Performed Using Harmonic Scalpel or Monopolar Diathermy

The purpose of this study was to perform an overall evaluation and comparison of the success rate of modified radical mastectomy by harmonic scalpel and monopolar electrocauter. The prospective study included all of the patients that were planned for and mastectiomized because of breast carcinoma during July 1st 2008 until December 21 st 2008 at the Department of Surgery and Urology, University Hospital Mostar. Duration of the surgical procedure, intraoperative blood loss and operational drain secretion was measured and registered. Leukocyte number (Le), interleukin 6 (IL-6), C-reactive protein (CRP) and erythrocyte sedimentation rate was tested and registered out of peripheral venous blood before the operation, 4 hrs after it, as well as on the first, second and third day after the operation. Every patient was tested for postoperative pain intensity, amount of administered analgesics during hospital stay, number and types of postoperative complications; also the time needed for return to everyday activities was registered. 61 patients were included in the study. 31 patients were operated with the harmonic scalpel, and 30 of them with the monopolar electrocauter. There is no statistically significant difference between the operation time in the two groups: 78.50±17.50 minutes by harmonic scalpel and 82.50±18.50 minutes by electrocauter (p=0.796). The smaller amount of intraoperative blood loss is statistically significant in the group of patients mastectomized by harmonic scalpel 78±31 ml compared to 256±112 ml in the group mastectomized by electrocauter (p<0.001); as is the total operational drain secretion: patients mastectomized by harmonic scalpel 540±390 mL compared to 960±710 mL in patients mastectomized by electrocauter (p<0.001). There is no statistical difference in the number of leukocytes in blood after modified radical mastectomy using the harmonic scalpel or electrocauter (p=0.957), or in erythrocyte sedimentation rate (p=0.114), CRP (p=0.071) and IL-6 (p=0.082). The duration of postoperative hospital stay does not differ statistically between the two groups, nor does the postoperative pain intensity, amount of administered analgesics, number or types of postoperative complications, as well as the time needed for return to everyday activities. Therefore using the ultrasound harmonic scalpel in comparison to monopolar electrocauter brings certain advantages, which however do not contribute significantly to the total success rate of the operation

Comparative Outcome Analyses of Differently Surgical Approaches to Lumbar Disc Herniation

Lumbar disc herniations (LDH) occur in the lower back, most often between the fourth and fifth lumbar vertebral bodies or between the fifth and the sacrum. It is evident lack of studies dealing with comparative analysis of the surgical outcomes of the spine operation techniques. In this paper we analyzed and compared outcomes of the LDH standard techniques (laminectomy and hemilaminectomy), and contemporary operation techniques (interlaminectomy, and microdiscectomy). Adult patients (18–75 years of age) surgically treated on the Neurosurgery Department of the University Clinical Hospital Mostar – Bosnia and Herzegovina between January 1998 and December 2007 were sampled as subjects. We analyzed and compared, number of the LDH surgically treated patients; age, patient’s satisfaction with postoperative status, postoperative recurrence of the LDH; incidence of the postoperative complications, and duration of hospitalization. In conclusion, modern operating methods have to be considered as superior over traditional operating types mostly because of smaller violations of forms and integrity of lumbar spine

The Advantages of End-to-Side Arteriovenous Anastomosis over the Other Two Types of Arteriovenous Anastomosis in Dialysis Patients

The functional duration of vascular access in dialysis patients depends on the emergence of threatening complications. Discussions are constantly being held in an attempt to discover their causality and decrease their emergence. In 260 patients undergoing haemodialysis, we have studied the potential existence of a cause-and-effect relation between the emergence of complications in the vascular access and the applied type of arteriovenous (av.) anastomosis in the arteriovenous (AV) fistula. We have observed the incidence of all complications, both that of the thrombosis incidence as well as the primary and secondary fistula patency (survival). The complications – The examinees with the end-to-end anastomosis showed the incidence of 8.08%, 6.15% of the patients with the end-to-side anastomosis and 7.31% of the patients with the side-to-side anastomosis. The differences regarding incidences are statistically significant ( 2-test = 29.25; P=0.0001). Thrombosis – it has been found that thrombosis was the most frequent complication developing in 30.00 % patients with the end-to-end av. anastomosis, in 2.31% patients with end-to-side av. anastomosis and in 5.56% patients with side-to-side av. anastomosis. The difference between the highest and the lowest assessment is 27.69%, and it is statistically relevant ( 2-test = 33.920; P=0.0001). The »primary patency« (primary survival): within a 6-month interval following the establishment of vascular access, the first complications arose in 62.50% of patients with end-to-end av. anastomosis, 10.76% in those with end-to-side av. anastomosis and 18.88% in those with side-to-side av. anastomosis. The difference between the highest and the lowest assessment is 51.74%, which is statistically significant ( 2-test = 49.009; P=0.0001). The secondary patency: 24 months subsequent to the establishment of vascular access, the AV-fistula was still functional in 52.50% of the patients with end-to-end av. anastomosis, 89.23% in those with end-to-side av. anastomosis and 81.11% in those with side-to-side av. anastomosis. The difference between the highest and the lowest assessment is 36.73%, which is also statistically significant ( 2-test = 26.579; P=0.0001). According to our research, the end- -to-side type of av. anastomosis in vascular access provides better results both in relation to the duration as well as the maintenance of the functionality of the Av-fistula and in the lower incidence of the complications than the other types, and hence it shows a definite advantage

Prognostička vrijednost radioloških deskriptivnih pokazatelja u prosudbi oporavka bolesnika s primarnim intracerebralnim krvarenjem

Uvod: Spontano intracerebralno krvarenje definirano je kao krvarenje unutar moždanog parenhima, predstavlja za život ugrožavajuće stanje i povezano je s visokim morbiditetom i mortalitetom. Primarno oštećenje mozga uslijed ovakvog krvarenja proizlazi iz karakteristika samog hematoma, kao što su njegova lokalizacija i volumen, što utječe na funkcionalni oporavak bolesnika i ishod liječenja. Cilj: U retrospektivnom preglednom istraživanju ispitati povezanost lokalizacije i volumena hematoma te prodora krvi u moždane klijetke s oporavkom i prognozom liječenja bolesnika s primarnim spontanim intracerebralnim krvarenjem. Metode: Tijekom petogodišnjega retrospektivnog istraživanja provedenog u Sveučilišnoj kliničkoj bolnici Mostar na uzorku od 267 odraslih bolesnika sa spontanim intracerebralnim krvarenjem statistički su analizirani demografski podaci i osnovne prediktivne varijable radioloških deskriptivnih pokazatelja. Provjeravana je povezanost lokalizacije i volumena hematoma te intraventrikulskog krvarenja s ishodom liječenja. Razina statističke značajnosti iznosila je p > 0,05. Rezultati: Razlika u lokalizaciji hematoma između preživjelih i umrlih bolesnika nije bila statistički značajna (p = 0,226). Razlika u volumenu hematoma između istraživanih skupina bila je visoko statistički značajna (p < 0,001), kao i razlika u odnosu na prodor krvi u moždane klijetke (p = 0,001). Zaključak: Rezultatima provedenog istraživanja potvrđeni su radiološki deskriptivni pokazatelji volumena hematoma s prodorom krvi u moždane klijetke kao pouzdani negativni prediktori oporavka bolesnika s primarnim spontanim intracerebralnim krvarenjem