Diagnosis and Treatment of Pediatric Brain Tumors.

OBJECTIVE: Tumors of the brain and spine make up about 20% of all childhood cancers; they are the second most common form of childhood cancer after leukemia. Brain tumors are the most common solid tumor in children. Symptoms depend on a variety of factors, including location of the tumor, age of child, and rate of tumor growth. The aim of study was to present our experience with the diagnosis and treatment of brain tumors in children. PATIENTS AND METHODS: The aim of this study is to analyze clinicopathological characteristics, treatments, complications, and outcomes in children with brain tumors. This study is a retrospective analysis of 27 consecutive patients younger than 16 years and hospitalized for surgical treatment of brain tumors. Intracranial hypertension, neurological status, radiological computerized tomography (CT) or magnetic resonance imaging (MRI) findings, tumor localization, type of resection, hydrocephalus treatment, histopathology, complications, and outcome were analyzed. RESULTS: Twenty-seven surgeries were performed in patients for brain tumors. There were 9 females and 18 males. The average patient age was 7.8 years. There were 11 (40%) children with astrocytoma; of these, there were 9 (82%) pilocytic astrocytomas and 2 (18%) ordinary histopathological subtypes of high-grade tumors. CONCLUSION: As with any cancer, prognosis and long-term survival vary greatly from child to child. Prompt medical attention and aggressive therapy are important for the best prognosis. Continuous follow-up care is essential for a child diagnosed with a brain tumor.

Clinicopathologic features in a case of intermuscular myopericitoma of thigh.

Myopericytoma is a benign tumor with the most common presentation as a well-circumscribed, slow-growing mass. It is frequently misdiagnosed as a sarcoma. We presented a 23-year-old patient with a history of a sciatic pain of the right leg. A careful physical examination discovered tumor-like mass in the posterior part of the thigh. Neurological finding showed a reduction of myotatic reflexes on the right leg with a weaker muscle strength on the right leg. The right leg musculature was slightly hypotrophic in the range of 2-3 cm comparing to left leg. Initially electrophysiological and radiological diagnostic with magnetic resonance imaging (MRI) of the lumbar spine, pelvis and thighs were normal. Magnetic resonance imaging of the right thigh discovered a slow growing 2.1 × 3.8 cm sized mass that was initially described by radiologist as a neurinoma. Patient was admitted to department of neurosurgery and operated on for a tumor removal. Tumor was located intimately to femur and sciatic nerve and after careful dissection completely removed. Patient was doing well after surgery and discharge after three days from the hospital. In the postoperative period the symptoms disappeared. Histopathology showed a myopericitoma. Postoperative MRI after three months of follow up showed no tumor residues, and after 6 and 12 months there was no tumor recurrence. Myopericytoma behave in a benign fashion, but, because local recurrences and rarely metastases may occur in atypical and malignant neoplasms, a careful follow-up after radical resection is recommended.

The role of fibrin glue polypropylene mesh fixation in open inguinal hernia repair.

UNLABELLED: The aim of this study was to compare two methods of polypropylene mesh fixation for inguinal hernia repair according to Lichtenstein using fibrin glue and suture fixation. MATERIAL AND METHODS: The study included 60 patients with unilateral inguinal hernia, divided into two groups of 30 patients--Suture fixation and fibrin glue fixation. All patients were analyzed according to: age, gender, body mass index (BMI), indication for surgery--the type, localization and size of the hernia, preoperative level of pain and the type of surgery. Overall postoperative complications and the patient's ability to return to regular activities were followed for 3 months. RESULTS AND DISCUSSION: Statistically significant difference in the duration of surgery, pain intensity and complications (p < 0.05) were verified between method A, the group of patients whose inguinal hernia was repaired using polypropylene mesh-fibrin glue and method B, where inguinal hernia was repaired with polypropylene mesh using suture fixation. Given the clinical research, this systematic review of existing results on the comparative effectiveness, will help in making important medical decisions about options for surgical treatment of inguinal hernia. CONCLUSIONS: The results of this study may impact decision making process for recommendations of methods of treatment by professional associations, making appropriate decisions on hospital procurement of materials, as well as coverage of health funds and insurance.

Intracranial meningeoma--ten-year evaluation.

The aim of the study was to analyze the prevalence, occurrence by gender, age, place of residence, location and pathohistological type, focusing on peculiarities of the surgically removed meningiomas in the first post-war decade in Bosnia and Herzegovina. The study was conducted in the region comprising more than 600.000 inhabitants. During the post-war decade 162 patients were surgically treated. Females accounted for 65.4%, convexity meningioma accounted for 43.8%. WHO grade I meningiomas occurred in majority of patients, 60.5%, grade II in 23.5%, and grade III in 16.0% patients. The prevalence of malignant menigeomas was significantly higher in males, 26.8%. Meningiomas were more common during the sixth (33.9%) and seventh (35.2%) decade of life. The somewhat higher prevalence of atypical and malignant meningiomas especially in males requires further analysis that would clarify this phenomenon.

Assessment of depth of anesthesia: PRST score versus bispectral index.

UNLABELLED: Assessment of depth of anesthesia is the basis in anesthesiologists work because the occurrence of awareness during general anesthesia is important due to stress, which is caused in the patient at that moment, and due to complications that may arise later. There are subjective and objective methods used to estimate the depth of anesthesia. The aim of this study was to assess the depth of anesthesia based on clinical parameters and on the basis bispectral index, and determine the part of bispectral monitoring in support to clinical assessment. MATERIAL AND METHODS: Sixty patients divided into two groups were analyzed in a prospective study. In first group (group 1), the depth of anesthesia was assessed by PRST score, and in the second group (group 2) was assessed by bispectral monitoring with determination PRST score concurrently. In both groups PRST score was assessed in four periods, while bispectral monitoring is used continuously. For analysis were used the BIS index values from the equivalent periods as PRST scores. PRST score value 0-3, and BIS index 40-60 were considered as adequate depth of anesthesia. The results showed that in our study were not waking patients during the surgery. In the group where the depth of anesthesia assessed clinically, we had a few of respondents (13%) for whom at some point were present indicators of light anesthesia. Postoperative interview excluded the possibility of intraoperative awareness. In the second group of patients and objective and clinical assessment indicated at all times to adequate depth of anesthesia. CONCLUSION: The use of BIS monitoring with clinical assessment allows anesthesiologists precise decision-making in balancing and dosage of anesthetics and other drugs, as well as treatment in certain situations.

Impact of clinical symptoms on CT ordering policy in minor head injuries.

INTRODUCTION: The aim of our study was to determine the impact of clinical signs and symptoms on CT ordering policy in minor head injuries. PATIENTS AND METHODS: The study encompassed 1830 patients that have sustained minor or mild head injury, as assessed by clinical criteria. Basic clinical variables were recorded and a subset of patients meeting either Canadian or New Orleans criteria were subjected to CT. Outcome in terms of "positive" CT scans and number of patients requiring surgery was recorded. RESULTS: The mean age was 30.4 years (ranging from 10 days to 80 years). 176 patients were subjected to CT scan (based on clinical criteria). CT scan revealed intracranial pathology in 29 patients (16.5% of patients subjected to CT scan) and 19 patients were subsequently subjected to surgery (accounting for 10.8% of patients subjected to CT scan and 1.0% of all patients with mild or minor head injuries). Brain contusions were detected in 10 (5.7%) patients, followed by epidural hematomas (10 patients or 5.7% were found to harbor an epidural hematoma) and subdural hematomas, that were found in 7 patients or 4.0% of patients subjected to CT scan. DISCUSSION: Despite numerous studies that have analyzed the importance of clinical signs and CT in the diagnosis and treatment of minor head injuries, there is still much controversy about the mode of treatment of these patients. Canadian protocol really reduces the need for CT of the brain in relation to the New Orleans protocol, which suggests more observation in hospital patients with minor or mild head injury. CONCLUSION: The authors conclude that minor or mild head injuries should prompt a CT as recommended by Canadian or New Orleans guidelines and that the strongest scientific evidence available at this time would suggest that a CT strategy is a safe way to triage patients for admission.

[Functional status of patients after lumbar disc herniation surgery]. / Funkcionalni status bolesnika nakon operacije lumbalne diskus hernije.

The aim of this study was to determine whether early rehabilitation from the first postoperative day after lumbar disc herniation surgery improved functional status of patients compared to the rehabilitation that started 3 weeks after surgery. Oswestry index was used for functional status assessment before surgery and after rehabilitation in 60 patients divided in 2 groups, i.e., early and control group of rehabilitation strated 3 weeks after surgery, 30 in each. Oswestry index values before surgery and after rehabilitation in the early rehabilitation group were 78.4 +/- 17 and 19.6 +/- 9.9, respectively (p < 0.0001) and in the control group the values were 79 +/- 13 and 37 +/- 14, respectively (p < 0.0001). The difference of Oswestry index before operation and after rehabilitation in the early rehabilitation group was 58.7 +/- 18.9, and in the control group 41.6 +/- 13.2 (p = 0.0001). Onset of rehabilitation from the first post operative day lead to better functional recovery compared to delayed rehabilitation 3 weeks after lumbar disc herniation surgery.

[Spontanious subarachnoidal hemorrhage: report on 67 surgicaly treated patients]. / Spontana subarahnoidalna hemoragija: izvjestaj 67 hirurski tretiranih pacijenata.

PURPOSE: The aneurysmal subarachnoid hemorrhage (SAH) is a syndrom with an extremely complex pathophysiological course. Although treatment outcomes in patients with intracranial aneurysms of the circle of Willis and SAH have improved over time, the mortality and morbidity rates remain unacceptably high. The clinical course and the outcome were evaluated in a group of patients who underwent surgery. METHODS: Patient characteristics, including age, sex, preexisting medical conditions, aneurysm location and size, time to admission, admission neurological status, computerized tomography and angiography findings were analyzed to determine relationship to outcome. A total of 67 patients with the intracranial aneurysms were treated by the microsurgical technique for a direct aneurysm surgery. The data were analyzed in two aspects: the overall management and the surgical results. RESULTS: An occlusion of aneurysm neck was done in 97% and 3% of patients were treated by aneurysm wrapping. There was a significant relationship between the neurological status on admission and the outcome (p < 0.005). Out of 67 patients, 50% had a good result, 16% were moderately disabled, 18% were severely disabled, and 12% were dead at the six month post-SAH evaluation. The results were significantly better according to the better neurological status on admission (p = 0.0001). CONCLUSION: The disastrous natural history of subarachnoid hemorrhage secondary to ruptured intracranial aneurysm has largely remained unaffected by even the best medical and surgical care because of the natural history of the disease, as well as mistakes in diagnosis and delays in treatment. Among the patients who were underwent surgery, 50% returned to their premorbid state, and 12% died. The factors associated with poor results were direct effects of the initial hemorrhage, vasospasm and rebleeding. Although the results of management of patients with ruptured aneurysms seem to be improved with time, there is opportunity for substantial additional improvement.

[Intracranial aneurysms treated by means Guglielmi detachable coil]. / Intrakranijske aneurizme lijecene uz pomoc Guglielmi detachable coila.

AIM: The endovascular treatment of an intracranial aneurysm using the Guglielmi detachable coil (GDC) becomes more and more treatment of choice which is based on aneurysm configuration, aneurysm location, the patient's medical and neurological condition and age, available surgical and interventional abilities at the treatmant center, and patient preference. METHODS: Out of 73 patients with the intracranial aneurysm, 9 were treated by the endosaccular embolization using the Guglielmi detachable coil. Subarachnoid hemorrhage (SAH) occured in 8 patients and a spacio-compressive effect caused epilepsy in one patient. Three patients with multiple aneurysms were treated by the combination of microsurgical clipping and endosaccular embolization. The outcome was obtained after 6-12 months on the basis of Glasgow outcome scale. RESULTS: Out of five patients treated in acute phase of severe subarachnoid hemorrhage (Hunt-Hess grade 4 and 5), one patient died for an inicial hemorrhage, one had a severe disability, and three patients had a good recovery or moderate disability. Two patients with the multiple aneurysms returned to the same quality of life as before the SAH, and one patient had moderate disability. CONCLUSION: Microsurgical clipping of the neck of aneurysm is an optimal way of treatment for the most of ruptured intracranial aneurysms. Endosaccular embolization becomes more and more the treatment of choice in selected cases.