Klinički ishod u bolesnika nakon operacije hernije intervertebralnog diska pomoću proteze za rekonstrukciju defekta anulusa: rezultati dvogodišnjeg praćenja

Annular Reinforcement Device represents a modification of operative treatment of intervertebral disk herniation. It is a prosthesis that is anchored into the body of the vertebra. The intradiscal part of the implant is placed in the inner part of the annulus fibrosus defect. The aim of this technique is to reduce the incidence of reherniation and the degree of intervertebral space collapse, which is the most frequent adverse effect of diskectomy. Clinical outcomes of the treatment group indicated a statistically significant improvement with respect to the control group. Furthermore, over the period of two years, no cases of symptomatic reherniation were recorded. Considering that no serious complications occurred during the procedures, it would appear that this is an implant that, given its encouraging results, should be further verified in carefully designed future studies.Ugradnja proteze za rekonstrukciju defekta anulusa čini modifikaciju operacijskog liječenja hernije intervertebralnog diska. Radi se o protezi koja se ugrađuje (usidri) u korpus kralješka. Intradiskalni dio implantata postavlja se s unutarnje strane defekta anulusa fibrozusa. Cilj navedene tehnike je smanjivanje incidencije rehernijacija te smanjivanje stupnja kolapsa intervertebralnog prostora kao najčešćih neželjenih posljedica diskektomije. Klinički ishod ispitivane skupine pokazao je statistički značajan napredak u odnosu na kontrolnu skupinu. Također tijekom dvije godine nije zabilježen nijedan slučaj simptomatske rehernijacije. S obzirom na to da nije bilo ozbiljnih komplikacija tijekom samog zahvata, smatramo da se radi o implantatu čiji početni rezultati ohrabruju te se moraju potvrditi u slijedećim dobro dizajniranim prospektivnim studijama

Extracranial propagation of glioblastoma with extension to pterygomaxillar fossa

<p>Abstract</p> <p>Background</p> <p>Glioblastoma multiforme is a highly malignant primary brain tumor that shows marked local aggressiveness, but extracranial spread is not a common occurrence. We present an unusual case of recurrent glioblastoma in 54-year old male that spread through the scull base to the ethmoid and sphenoid sinuses, to the orbita, pterygomaxillar fossa, and to the neck.</p> <p>Methods</p> <p>A 54-year old male underwent left temporal resection because of brain tumor of his left temporal lobe. Operation was followed by external beam radiation combined with temozolomide. The tumor recurred eight months after first surgery. The patient developed swelling of left temporal region, difficult swallowing and headache. MRI of head showed recurrent tumor, which invaded orbita, ethmoid and sphenoid sinuses, nasal cavity, pterygomaxillar fossa.</p> <p>Results</p> <p>The patient died ten months after initial diagnosis of glioblastoma multiforme, and two months after his second operation.</p> <p>Conclusions</p> <p>The aggressive surgical operation helped to downsize the tumor mass as much as possible, but did not prolonged significantly the life or improved the life quality of the patient. The current literature is reviewed, and the diagnostic approaches as well as therapeutic options are discussed.</p

Should MS be Treated by Escalation or Induction Therapy?

MS is a chronic, increasingly disabling disease whose long-term outcomes determine the key social, medical and economic impact of this disease. Disease-modifying therapies (DMTs) for multiple sclerosis (MS) are prescribed to delay disease progression and to protect a patient’s functional capability. The concepts of escalation and induction immunotherapy in MS represent different therapeutic strategies for the treatment of MS. Both strategies may be valuable options for patients starting on DMT, however, induction therapy mainly focuses on patients with very aggressive course of MS from the onset. Using a patient unique approach to selection of treatment, MS can be effectively control disease and may delay or even prevent the development of secondary progressive MS

Forensic Efficiency Parameters for the 15 STR Loci in the Population of the Island of Cres (Croatia)

Forensic parameters based on 15 AmpFlSTR Identifiler short tandem repeat (STR) loci (D8S1179, D21S11, D7S820, CSF1PO, D3S1358, TH01, D13S317, D16S539, D2S1338, D19S433, VWA, TPOX, D18S51, D5S818 and FGA) were evaluated in the sample of 122 unrelated, autochthonous, adult individuals from the Island of Cres (Croatia). PCR amplification was performed with the AmpFlSTR Identifiler PCR Amplification Kit and the amplified products were separated and detected using the ABI 3130 DNA genetic analyzer. The agreement with Hardy Weinberg Equilibrium (HWE) was confirmed for all loci (p>0.05). The combined power of discrimination (PD) and the combined power of exclusion (PE) for the 15 tested STR loci were 0.99999999999999997988728679 and 0.999997397, respectively. According to the presented data, D18S51 proved to be the most informative marker followed by markers D2S1338 and D21S11. Interpopulation comparisons in allele frequencies with other East Adriatic Islands revealed significant differences for all analyzed population pairs ranging from 4 loci (Cres vs. Hvar) to 1 locus (Cres vs. Krk). Furthermore, allele frequencies comparisons of Cres and Croatian mainland revealed the lack of statistically significant differences at all studied loci. The results of the current study indicate that the examined fifteen STR loci are useful genetic markers for individual identification and paternity testing in Croatian population from the Island of Cres

Microvascular decompression in supinated position for trigeminal neuralgija treatment

Cilj: Prikazati operacijsku tehniku i učinkovitost mikrovaskularne dekompresije trigeminusa provedene u supinacijskom položaju bolesnika. Bolesnici i metode: Tijekom 2009., 2010. i 2011. godine na Zavodu za neurokirurgiju KB “Dubrava” operirano je 48 bolesnika s neuralgijom trigeminusa; učinjena im je mikrovaskularna dekompresija živca trigeminusa. Operirana su 22 muškarca i 26 žena, prosječne starosti od 56 godina i prosječnog trajanja bolesti 7 godina; kod 16 bolesnika bol je bio lokaliziran u području inervacije jedne grane trigeminusa, kod 25 bolesnika u području inervacije dviju grana, a kod 7 bolesnika u području inervacije svih triju grana trigeminusa. Rezultati: Kod 43 bolesnika nađen je jasan neurovaskularni konflikt. Početni uspjeh operacijskog liječenja (potpuni nestanak bolova ili prisutni značajno blaži bolovi) zabilježen je kod 42 bolesnika. Rasprava i zaključak: Mikrovaskularna dekompresija koja predstavlja jedino uzročno liječenje neuralgije trigeminusa dobra je i učinkovita metoda liječenja te bolesti te se uspješno može provesti u supinacijskom položaju bolesnika.Aim: To describe the operating technique and efficacy of microvascular decompression of trigeminus done in patients in supinated position. Patients and methods: During 2009, 2010 and 2011 in Department of neurosurgery University hospital Dubrava microvascular decompression was performed on 48 patients with trigeminal neuralgia. There were 22 male and 26 female patients with average age 56 years and average duration of pain 7 years. A total of 16 patients had pain distribution in only one trigeminal branch, 25 had pain in two branches and 7 in three branches. Results: A total of 43 patients had a clear neurovascular conflict intraoperatively and 42 patients had initial pain improvement. Discussion and conslusion: Microvascular decompression is the only treatment of trigeminal neuralgia that affects the cause of the illnes and is a good and effective method performed in the supinated position

Tongue somatosensory-evoked potentials in microvascular decompression treated trigeminal neuralgia

Somatosensory-evoked potentials of the tongue (tSSEP) provide useful information about trigeminal-afferent pathway. The aim of this study was to evaluate tSSEP in trigeminal neuralgia (TN) treatment with microvascular decompression. Two patients with trigeminal neuralgia refractory to conservative treatment underwent microvascular decompression of the trigeminal nerve. tSSEP was performed a month prior to surgery and in the month after the surgery in both patients. Pain frequency and tSSEP were analyzed before and after surgery. In both patients, a complete resolution of pain occurred. In patient 1, tSSEP latencies became shorter than before surgery and wave N1 appeared. The intensity of stimulation necessary to reach the threshold was 4 mA before the surgery and 1 mA after the surgery. A complete recovery of tSSEP after the operation was achieved in patient 2. The results of present study demonstrate potential value of tSSEP in pre-surgery evaluation and post-surgery follow-up of TN patients

Targeting CD133 improves chemotherapeutic efficacy of recurrent pediatric pilocytic astrocytoma following prolonged chemotherapy

Quantification of western blot results showing overexpression of pAKT(S473, T308) and pNF-ƙB/p65 in recurrent PAs with chemotherapy, compared to matched primary tumors. (TIF 52 kb

Presentation, management, and outcomes of cauda equina syndrome up to one year after surgery, using clinician and participant reporting: a multi-centre prospective cohort study

Background: Cauda equina syndrome (CES) results from nerve root compression in the lumbosacral spine, usually due to a prolapsed intervertebral disc. Evidence for management of CES is limited by its infrequent occurrence and lack of standardised clinical definitions and outcome measures. Methods: This is a prospective multi-centre observational cohort study of adults with CES in the UK. We assessed presentation, investigation, management, and all Core Outcome Set domains up to one year post-operatively using clinician and participant reporting. Univariable and multivariable associations with the Oswestry Disability Index (ODI) and urinary outcomes were investigated. Findings: In 621 participants with CES, catheterisation for urinary retention was required pre-operatively in 31% (191/615). At discharge, only 13% (78/616) required a catheter. Median time to surgery from symptom onset was 3 days (IQR:1–8) with 32% (175/545) undergoing surgery within 48 h. Earlier surgery was associated with catheterisation (OR:2.2, 95%CI:1.5–3.3) but not with admission ODI or radiological compression. In multivariable analyses catheter requirement at discharge was associated with pre-operative catheterisation (OR:10.6, 95%CI:5.8–20.4) and one-year ODI was associated with presentation ODI (r = 0.3, 95%CI:0.2–0.4), but neither outcome was associated with time to surgery or radiological compression. Additional healthcare services were required by 65% (320/490) during one year follow up. Interpretation: Post-operative functional improvement occurred even in those presenting with urinary retention. There was no association between outcomes and time to surgery in this observational study. Significant healthcare needs remained post-operatively. Funding: DCN Endowment Fund funded study administration. Castor EDC provided database use. No other study funding was received

Effect of orchiectomy on extra orbital lacrimal gland of the rat

Dosadašnja provedena istraživanjima na izvanorbitalnoj suznoj žlijezdi štakora nisu proučavala kako muške spolne žlijezde (testisi) utječu na histološku građu i funkciju izvanorbitalne suzne žlijezde štakora. Cilj ovog istraživanja bio je proučiti morfologiju izvanorbitalne suzne žlijezde štakora, zatim utvrditi kako starenje i orhidektomija utječe na ovu žlijezdu. Tijekom istraživanja korišteni su spolno zreli mužjaci štakora stari tri mjeseca (soja Fisher). Eksperimentalne grupe životinja podijeljene su u tri skupine. Kontrolnoj skupini životinja nije učinjena ni jedna vrsta kiruškog zahvata, lažnoorhidektomiranoj skupini simuliran je operativni zahvat orhidektomije, a orhidektomiranoj skupini životinja učinjena je obostrana orhidektomija. Nakon određenog vremenskog razdoblja (3 dana, 14 dana, 30 dana, 60 dana i 90 dana) životinje su žrtvovane, a njihove izvanorbitalne suzne žlijezde su fiksirane u 5,5 % glutaraldehidu i Bouinu. Tkivo fiskirano u 5,5 % glutaraldehidu je postfiksirano u 1% OsO4 i uklopljeno je u smolu Durcopan i rezano na polutanke i ultratanke rezove, dok je tkivo fiksirano u Bouinu uklopljeno u parafin i rezano na debljinu od 4 μm. Kvalitativna analiza tkiva žlijezde izvršena je uz pomoć binokularnog svjetlosnog mikroskopa Nikon Alphaphot (Nikon, Japan) i transmisijskog elekstronskog mikroskopa JEOL JEM-1400 (JEOL, Japan). Za kvantitativnu (stereološku) analizu na svjetlosnoj mikroskopskoj razini korišten je mnogonamjesni testni sustav po Weibelu s 42 testne točke, a na elektronsko mikroskoposkoj razini korišten je program STEPanizer (Anatomski institut Sveučilišta u Bernu, Švicarska). U elektronskom programu digitalne slike dobivene transmisijskim elektronskom mikroskopom obrađivane se testnim sustavom po Weibelu s 64 testne točke. Žljezdani acinusi izvanorbitalne suzne žlijezde mužjaka štakora su serokmukozni acinusi koji se sastoje od svijetlih i tamnih stanica u svim ispitivanim skupinama životinja. Sa starenjem jedinki dolazi do nakupljanja lipidnih kapljica u citoplazmi stanica acinusa. Tu pojavu nazivamo „harderizacijom“. „Harderizacija“ se ne primjećuje u životinja koje su orhidektomirane. Orhidektomija uzrokuje smanjenje dužine intralobularnih odvodnih kanala žlijezde dok se u kontrolnoj skupini životinja ta promjena ne primjećuje sa starenjem životinje. Orhidektomija također uzrokuje smanjenje volumena jezgre stanica acinusa 30. dana nakon orhidektomije (p< 0,005), dok se volumen jezgri stanica ne mijenja kod životinja unutar prvih 6 mjeseci života. Volumen hrapave endoplazmatske mrežice acinusnih stanica žlijezde orhidektomiranih jedinki pokazuje statistički značajno smanjenje od 14. dana nakon orhidektomije pa sve do kraja eksperimenta (90 dana). Volumen hrapave endoplazmatske mrežice acinusnih stanica žlijezde kontrolnih skupina životinja statistički se značajnije ne mijenja tijekom istraživanja. Volumen sekretnih zrnaca acinusnih stanica žlijezde kontrolne skupine životinja se povećava tijekom istraživanja dok u orhidektomiranih jedinki volumen sekretnih zrnaca istraživane žlijezde je stalan. Volumenska gustoća acinusa se tijekom starenja i nakon orhidektomije statistički značajno smanjuje (p< 0,005 ), međutim pokazuje izrazitu varijabilnost tijekom cijelog istraživanja. Volumen acinusa je u orhidektomiranoj skupini životinja manji nego u kontrolnim skupinama životinja tijekom cijelog istraživanja. Volumenska gustoća vezivnog tkiva izvanorbitalne suzne žlijezde je stalna u kontrolnim skupinama životinja, no u orhidektomiranoj skupini životinja dolazi do statistički značajnog pada 90. dana nakon orhidektomije. Temeljem gore navedenih rezultata može se zaključiti da postoji značajna povezanost između sjemenika i izvanorbitalne suzne žlijezde štakora.Current research did not examine influence of the testicles on the histological appearance and function on the extra orbital lacrimal gland of the rat. Aim of this research was to evaluate the morphology of extra orbital lacrimal gland of the rat and how aging and orchiectomy influence on this gland. For this research we have used male rats of the three months old (Fischer strain). The experimental animals were divided into three experimental groups. Control group was not subjected to any kind of surgical procedure, in false orchiectomy group we have simulated surgical procedure of orchiectomy and in orchiectomy group we performed bilateral orchiectomy. After certain period of time (3 days, 14 days, 30 days, 60 days and 90 days) the animals were sacrificed and their extra orbital lacrimal gland were fixed in 5,5 % glutaraldehide and Bouine. Tissue fixed in 5,5 % glutaraldehide was processed in 1 % OsO4 and embedded in Durcopan resin and cut on half thin and ultra-thin sections, while the tissue fixed in Bouine was embedded into paraffin and sectioned on 4 μm sections. Quantitative analysis of the tissue was performed with the use of light microscope Nikon Alphaphot (Nikon, Japan) and electron microscope Jeol JEM-1400 (JEOL, Japan). For the qualitative stereological analysis of the light microscope pictures we have used Weibel testing system with 42 testing points, and for the analysis of the electronic microscopic pictures we have used STEPanizer program (Institute of anatomy, Bern, Switzerland). In the STEPanizer program the digital images retrieved by the electron microscope were tested with Weibel testing system with 64 testing points. Extra orbital gland acini of the male rat are seromucose acini that are composed of light and dark cells in all examined animal groups. With the aging of the animals we have noticed accumulation of the lipid droplets in the cytoplasm of acini cells. That phenomenon we call harderization. We have not noticed harderization in the group of orchidectomized animals. Orchiectomy is causing shortening the length of the intralobular excretory ducts. This phenomenon is not noticed in control group of the animals and is not induced with the aging of the animals. Orchiectomy also causes decrement of the nucleus volume of the acinar cells 30 days after orchiectomy (p<0,005), while the volume of the nuclei of the acini cells of the control groups of the animals does not change in the first six months of life. Rough endoplasmatic reticulum volume of the acini of the orchiectomy animals showed statistical significant reduction 14 days after orchiectomy and through all days after that. Rough endoplasmatic reticulum volume of the acini of the control group did not show any statistical significant variation. Volume of the secretory granules of the acini of the control group showed significant increment through all experiment while the volume of the secretory granules is stable in orchiectomy group through all experiment. Volume density of the acini has significantly decreased with the aging and after orchiectomy (p<0,005), but it showed pronounced variability during experiment. Volume of the acini of the orchiectomy animals is less then in control group of animals. Volume density of the connective tissue is constant in control group of the animals, but in orchiectomy group shows marked decrement after 90 days after orchiectomy. We have showed with our experiment that there is significant connection between extra orbital lacrimal gland and testicles of the rat