Power and vulnerability: managing sensitive language in organizational communication.

Organizational responsibilities can give people power but also expose them to scrutiny. This tension leads to divergent predictions about the use of potentially sensitive language: power might license it, while exposure might inhibit it. Analysis of peoples' language use in a large corpus of organizational emails using standardized Linguistic Inquiry and Word Count (LIWC) measures shows a systematic difference in the use of words with potentially sensitive (ethnic, religious, or political) connotations. People in positions of relative power are ~3 times less likely to use sensitive words than people more junior to them. The tendency to avoid potentially sensitive language appears to be independent of whether other people are using sensitive language in the same email exchanges, and also independent of whether these words are used in a sensitive context. These results challenge a stereotype about language use and the exercise of power. They suggest that, in at least some circumstances, the exposure and accountability associated with organizational responsibilities are a more significant influence on how people communicate than social power.

Venous thromboembolic and hemorrhagic events after meningioma surgery: A single-center retrospective cohort study of risk factors.

Microsurgical resection of meningiomas in a majority of cases leads to a favorable outcome. Therefore, severe postoperative adverse events are less acceptable. The main purpose of this study was to investigate the incidence of symptomatic venous thromboembolism (VTE) and hemorrhagic complications in patients after operative treatment of intracranial meningiomas and to identify the risk factors in this patient subgroup. Of 106 patients undergoing elective craniotomy for meningioma overall incidence of symptomatic VTE was noted in 5.7% (six patients). For the risk-factor analysis older age (57.20 ± 11.60 vs. 71.00 ± 0.90 years, p < 0.001), higher body mass index (27.60 ± 4.80 vs. 33.16 ± 0.60 kg/m2, p < 0.001), WHO grade II (3.00% vs. 33.33%, p = 0.02), lower intraoperative blood loss (466.00 ± 383.70 vs. 216.70 ± 68.30 mL, p < 0.001), bedridden status and neurologic deficit (0.00% vs. 33.33%, p = 0.003 and 38.00% vs. 100.00%, p = 0.004) were associated with greater VTE risk. No risk factors for hemorrhagic complications were identified on univariate analysis. In conclusion, the incidence of VTE in meningioma patients is not negligible. Identified risk factors should be taken into account in the decision-making process for chemoprophylaxis when the risk of bleeding decreases.

Nocardial brain abscess mimicking lung cancer metastasis in immunocompetent patient with pulmonary nocardiasis: a case report.

Nocardia is a ubiquitous microorganism which can be the cause of local and disseminated infection in humans. Immunocompetent and immunocompromised patients both can be affected and Nocardia cyriacigeorgica was reported as a pathogen isolated in patients worldwide. In most cases, nocardiosis is present as pulmonary infection because inhalation is the primary way of bacterial exposure. Nocardial brain abscess occurs usually secondary to a septic focus elsewhere in the body. Considering the facts that the elderly population is growing, such as the number of immunocompromised patients together with high mortality rate in patients with nocardial infection of the central nervous system, we have to raise awareness of the possibility for this rare but potentially fatal condition. We present a case where nocardial abscesses of lung and brain were initially suspected as lung cancer with brain metastases. The patient was treated with a combination of surgical resection and antimicrobial therapy with good outcome.

SEMIOLOGY OF PATHOLOGICAL CONDITIONS IN PATIENTS INDICATED FOR STEREOTACTIC BIOPSY.

INTRODUCTION: Brain tumors produce symptoms and signs which are often non-specific, and therefore they may occur for more than a few months prior to diagnosis. The aim of this study was to determine the frequency of referent signs and symptoms among patients referred for stereotactic brain biopsy. MATERIAL AND METHODS: In this study, we retrospectively analyzed medical history of 65 patients (67.7% males and 32.3% females) between the ages of 16 and 81 years. The following symptoms and signs were included in the analysis: organic brain syndrome, lateralization of crossed pyramidal tract, cranial nerve dysfunction, speech disorders, cerebellar-vestibular syndrome, nausea, vomiting, headache, the occurrence of at least one epileptic seizure and respondents' physical weakness. RESULTS: Physical weakness was the most frequent symptom to be recogized (76.9%), whereas pyramidal neurological lateralization was the most commonly recognized sign (58.5%). There was a significant correlation between the course of disease and physical weakness (rho = -0.34, p = 0.005), as well as the course of disease and lateralization of the pyramidal tract (rho =0.65, p = 0.00). No significant correlation was found between other clinical signs and symptoms. CONCLUSION: An accurate diagniosis and early recognition of signs and symptoms may be useful in determining indications for stereotactic brain biopsy.

ANAESTHESIA FOR AWAKE BRAIN TUMOUR SURGERY: CASE REPORT.

INTRODUCTION: There is an increasing trend towards performing awake craniotomy procedures. The method is indicated for surgical treatment of brain changes located in functional regions. This technique poses a unique challenge for the anaesthesiologist in view of providing adequate sedation, analgesia, hemodynamic and respiratory stability yet to keep the patient awake and cooperative during the procedure' Case Report. After the adequate preoperative preparation of the patient, the surgical procedure on tumorous change in the left frontoparietal area (Broca's area) was performed. Due to the tumour localization, the surgical treatment was performed in awake condition under intraoperative neurophysiological monitoring of the patient. Analgosedation (Ramsay score 2-3) was provided via continuous infusion. of propofol and reminfentanil. Local infiltration anaesthesia (scalp block) was preformed with levobupivacaine. The surgical procedure proceeded without any major incidents and complications. CONCLUSION: A propofol/remiWentanil combination provided safe and effective analgosedation of the patient.

The Fisher Grade in predicting a degree of cerebral vasospasm in patients after intracranial aneurysm rupture.

Background/Aim: Intracranial aneurysms are pathological enlargement of the wall of cerebral arteries. Intracranial aneurysms rupture is a dramatic event with a significant morbidity and mortality. The Fisher Grade is widely accepted in assessment of the extensiveness of aneurysmal subarachnoid hemorrhage (aSAH) and the presence of other intracranial hemorrhage on the computed tomography (CT) scan. Significant early complication of a aSAH may be a cerebral vasospasm. The aim of this study was to determine the relationship between the extensiveness of aSAH, assessed by the Fisher Grade on admission, with the intensity of cerebral vasospasm in patients with ruptured intracranial aneurysm. Methods: This prospective clinical study included 50 patients with aSAH hospitalized at the Clinic of Neurosurgery, Clinical Center of Vojvodina, Novi Sad, Serbia. All the patients underwent 256-layer cranial CT and CT angiography on admission and on the day 9. Based on native CT scans, they were classified according to the Fisher Grade. On CT angiography images, intensity of cerebral vasospasm was determined. Results: On the basis of admission CT images, 24% of patients were classified into the Fisher Grade group 2, while 34% and 42% were in the groups 3 and 4, respectively. A positive correlation of the Fischer Grade on admission with the intensity of cerebral vasospasm was established, but with no statistical significance (ρ = 0.273, p = 0.160). Conclusion: This study showed that the Fisher Grade is not significant in predicting the intensity of cerebral vasospasm in patients hospitalized with intracranial aneurysm rupture.

The use of the Karnofsky index in the assessment of clinical state in patients with chronic subdural hematoma: the first observation from Vojvodina.

AIM: To evaluate clinical status of patients with chronic subdural hematoma (CSDH) on hospital admission and to predict their outcome after the neurosurgery treatment using Karnofsky index scale (KI). METHODS: Clinical and surgery data of patients with CSDH were collected prospectively. Fifty 50 adults aged over 41 with CSDH diagnosed and hospitalized between November 2010 and April 2012 were investigated. In the analyzed sample there were more CSDHs in males than in females (1.5:1). The diagnosis of CSDH on hospital admission in patients was confirmed by non-contrast computed tomography (CT). Forty-three patients had undergone surgery with Burr-hole drainage and craniotomy, while seven patients were treated conservatively. The KI was used for evaluation of the patient's clinical state before neurosurgery treatment and the quality of survival in all patients, six months after hospital discharge. RESULTS: A statistically significant difference was found between the KI values in patients with CSDHs on hospital admission and KI after the surgical treatment. Six months after, out of 43 patients who underwent surgery in 24 (55.8%) patients KI was between 80-100%, in nine (20.9%) patients KI was between 50-70% and in 10 (23.2%) patients KI was 0-40%. CONCLUSION: Although the elderly with CSDHs are vulnerable because of their age, associated diseases and risk of recurrence of CSDH, their outcome assessed by KI after surgical treatment was good. The Glasgow Coma Scale (GCS) is used for rapid assessment of the state of consciousness in patients on admission and monitoring of the changes in their condition. KI scale could be used as a complementary assessment tool for the general condition of patients with chronic subdural hematoma. This study highlighted that the KI scale had a predictive value for patient's outcome with chronic subdural hematoma.

The evaluation of malignant astrocytoma score (MAS).

BACKGROUND/AIM: At the moment there are few scoring systems for malignant astrocytoma but they are not widely accepted. The aim of this study was to evaluate malignant astrocytoma score (MAS) on a new group of patients with malignant astrocytoma, to compare MAS with other prognostic tools and to describe the use of MAS in everyday practice in neurooncology. METHODS: The study was performed on 124 patients with supratentorial malignant astrocytoma grade III or IV. They were operated on and subsequently irradiated with 50-60 Gy. RESULTS: The mean age of the patients was 57.3 years. The mean Karnofski performance status (KPS) of the functional inpairment was 54. The removal of the tumor > 90% was done in 59.7% of patients. The mean survival was 9.1 months, and 27.4% of patients had a 12-month survival. The area under receiver operating characteristic (ROC) curve (AUC) of the MAS for predicting 6-, 12- and 18-month survival was 0.754, 0.783 and 0.882, respectively. We compared the MAS with the two mostly cited scoring systems. The AUC for the same prediction for medical research council (MRC) was 0.601, 0.693, 0.772 respectively. For the Radiation Therapy Oncology Group (RTOG) the AUC was 0.732, 0.765, 0.827, respectively. CONCLUSION: MAS represents a useful scoring system for determining illness severity and prognosis in patients with malignant supratentorial astrocytoma. It can be helpful in comparing single patients or groups of patients, as well as results of different treatments and in controlling the quality of hospital treatment and so on.

A temporal pattern in the occurrence of aneurysmal subarachnoid hemorrhage in the Province of Vojvodina, Serbia.

BACKGROUND: Numerous studies with conflicting results have tried to prove the influence of seasonal variations or different meteorological factors on the occurrence of aneurysmal subarachnoidal hemorrhage (SAH). The aim of this study was to establish a mathematical model of a series of aneurysmal rupture dates in different patients and verify a temporal pattern in the occurrence of SAH. METHODS: We analyzed a group of 563 patients with the exact aneurysm rupture dates, hospitalized at the Clinic of Neurosurgery, Clinical Center of Vojvodina, Novi Sad, Serbia, between January 1, 1998 and December 31, 2009. After the monthly distributions, we evaluated the period between two subsequent rupture dates. RESULTS: The absolute number of SAH per month varied between 0 and 10. The monthly seasonal indices show a fluctuation of the time series (with the peak in March and nadir in September), but the median values of the number of aneurysm ruptures in a particular month did not differ significantly. The time scale of the aneurysm rupture dates shows that the most frequent interval between subsequent ruptures was 1 day (in 75 cases or 13.34%). Following this period, the number of days between ruptures showed a gradually decreasing pattern that could be approximated by exponential distribution. CONCLUSIONS: The results are a clear confirmation that SAH patients do indeed present in clusters in a restricted population area. This exact clustering in our series is not particularly connected to month or season, yet strongly supports the existence of a temporal pattern in SAH occurrence.

Spontaneous thrombosis of basilar artery aneurysm after subarachnoidal hemorrhage in a patient with thrombophilia and recurrent deep venous thrombosis.

We report a patient with combined thrombophilia--protein C deficiency and mild hyperhomocysteinemia with total spontaneous thrombosis of a basilar tip aneurysm after subarachnoid hemorrhage, without neurological deficit. At admission, the patient had headache, drowsiness, and nausea, with no neurological deficit. Computed tomography (CT) did not show the presence of subarachnoid blood, and magnetic resonance examination revealed discrete remains of a subarachnoid hemorrhage in projections of temporal, frontal and occipital lobes, with no vascular abnormalities. Initial angiography showed a small basilar tip aneurysm and the patient was scheduled for endovascular treatment. A second angiography, performed before the planned endovascular treatment, did not show the aneurysm and complete thrombosis was suspected. A follow-up angiogram, 6 months after this event, showed preserved posterior cerebral circulation with no aneurysm present. The patient was discharged in good condition, without neurological deterioration. We did not find any previous reports of similar conditions.

[Treatment of recurrent chronic subdural hematoma in a patient with arachnoid cyst].

INTRODUCTION: Arachnoid cysts are congenital fluid-filled compartments within the cerebrospinal fluid cisterns and major cerebral fissure, between two layers of the arachnoid membrane. They can develop anywhere within the subarachnoid space, most frequently located within the Sylvian fissure in the middle fossa. In young patients with the arachnoid cyst and history of head trauma chronic subdural hematoma is present up to 4.6%. CASE REPORT: This is a case report of a 21 year old male, with left temporal lobe arachnoid cyst. Three months after minor head injury the patient was admitted to our clinic with chronic subdural hematoma compressing the surrounding tissue. The scull burr-hole trepanation was performed and the hematoma was drained. The control CT scan showed a reduced size of the chronic subdural hematoma with the smaller subdural collection of the fresh blood. Three weeks after the intervention the new CT scan showed the recurrence of the chronic subdural hematoma. The second trepanation was performed and the hematoma was drained. After the second operation, the patient was with no neurological disorders and subjective complaints. Three months after the second intervention, the control CT scan visualized only the arachnoid cyst in the temporal lobe, without the presence of the subdural hematoma. CONCLUSION: We conclude that a chronic subdural hematoma and reccurrent chronic subdural hematoma in patients with the arachnoid cyst in the fossa media should be drained by applying the method of burr-hole trepanation. In the patient with no subjective complaints and neurological disorders, the operative treatment of the arachnoid cyst is not considered necessary.