- Missile injuries are among the most devastating injuries in general traumatology. Traumatic brachial plexus injuries are the most difficult injuries in peripheral nerve surgery, and most ...complicated to be surgically treated. Nevertheless, missile wounding is the second most common mechanism of brachial plexus injury. The aim was to evaluate functional recovery after surgical treatment of these injuries. Our series included 68 patients with 202 nerve lesions treated with 207 surgical procedures. Decision on the treatment modality (exploration, neurolysis, graft repair, or combination) was made upon intraoperative finding. Results were analyzed in 60 (88.2%) patients with 173 (85.6%) nerve lesions followed-up for two years. Functional recovery was evaluated according to functional priorities. Satisfactory functional recovery was achieved in 90.4% of cases with neurolysis and 85.7% of cases with nerve grafting. Insufficient functional recovery was verified in ulnar and radial nerve lesions after neurolysis, and in median and radial nerve lesions when graft repair was done. We conclude that the best time for surgery is between two and four months after injury, except for the gunshot wound associated with injury to the surrounding structures, which requires immediate surgical treatment. The results of neurolysis and nerve grafting were similar.
Glioblastoma multiforme (GBM) is the most common and most aggressive malignant primary brain tumor in humans. Clinically useful molecular markers that help predict response to therapy and prognosis ...are still rare. The research was conducted in 55 patients with GBM, 26 (47.3%) women and 29 (52.7%) men, mean age 62.58 years. On immunohistochemical analysis, primary antibody to CD44 (dilution 1:50) and primary antibody to endoglin (CD105) (dilution 1:250) were used to evaluate neovascularization. Statistical analysis showed negative correlation between CD44 and survival (p=0.023) (higher expression of CD44 was correlated with shorter survival), but there was no correlation between neovascularization determined by CD105 in GBM and patient survival. Thus, significant individual predictors of longer survival were lower expression of CD44 (p=0.004), higher Karnofsky score (p=0.045), and female gender (p=0.017). The results obtained suggested the possible role of CD44 in the progression and tumor neovascularization of GBM.
•Awareness of Global Neurosurgery opportunities is limited in the EANS and a minority have had previous experiences with such activities.•Most training programs and job environments don't encourage ...participation in Global Neurosurgery and mentors are lacking.•However, most European neurosurgeons and trainees remain interested in Global Neurosurgery and are willing to participate.•Junior trainees is the group with the highest rate of interest for Global Neurosurgery.•Barriers exist that may limit participation in Global Neurosurgery, and funding is the most relevant.
Treatment modalities affecting quality of life and survival in elderly brain glioblastoma patients are not well defined. A single-institution data were analyzed during a 3-year period to disclose ...prognostic difference in management related to age. Karnofsky Performance Scale (KPS), overall survival (OS), and adjuvant therapy were evaluated. The case group comprised of elderly patients (>75 years), while the control group included those of younger age (<65 years). The investigated variables were correlated between the groups. Twenty elderly patients and a corresponding number of younger ones were analyzed. Preoperative KPS >70 indicated longer overall survival. Statistically significant correlation was recorded in both the control (p=0.036) and case (p=0.0053) groups. Lower postoperative KPS was significantly correlated with shorter OS in elderly patients (p=0.023). The correlation between the extent of tumor resection and OS was statistically significant in younger patients only (p=0.04). Overall survival was significantly shorter in elderly patients regardless of the extent of tumor resection (p=0.0057). Adjuvant therapy was significantly associated with longer OS in both the case (p=0.032) and control (p=0.013) groups. Elderly population is a more endangered group of surgical brain glioblastoma patients having lower quality of life and shorter overall survival. The management protocol should be personalized for each individual case in this age group of patients to reduce postoperative complications and grant a satisfactory quality of life.
Developmental venous anomalies are cerebral vascular malformations that present
normal venous drainage of cerebral tissue. With increased and accessible usage of modern diagnostic
tools, they are now ...one of the most commonly diagnosed cerebral vascular malformations. Although
developmental venous anomalies are considered to be benign lesions, association with arteriovenous
malformation renders malignant potential to this combined pathology. In the case presented, these
malformations were clinically silent and diagnosed accidentally, so they were not treated either with
surgery, endovascular surgery or radiosurgery, considering the possible complications such as venous
infarction of the brain, and because there was no obvious neurologic deficit related to this pathology.
The patient presents for regular neurosurgical follow up examinations and has been free from symptoms
that were present on admission.
Quality should be in function of users, that is, in function of their satisfaction. The higher education institutions are not exempted from these trends because Bologna model of higher education ...organization devotes an important segment to quality assurance. Numerous reports, analysis and discussions conducted as a part of current reform of the higher education system in Bosnia and Herzegovina indicate that radical changes of the current situation are necessary regarding the organization and improvement of quality of higher education. The importance of permanent maintenance of quality and staff education should not be specifically emphasized, especially in the framework of Total Quality Management. The paper analyzes basic requirements of building effective quality management systems in higher education. Special attention was paid to the analysis and interpretation of Deming's 14 principles of management from the perspective of university institutions.
•Proposed setup to be used with nTMS mappings of writing related cortical areas.•Pen for writing integrated into EMG of nTMS system was developed.•On-line monitoring of EMG and pen related activity ...from hand muscles during writing.•Application of chronometric TMS design and patterned protocol of rTMS.•Stopping and slowing during writing was elicited by mapping premotor cortices.
It has recently been shown that navigated repetitive transcranial magnetic stimulation (nTMS) is useful in preoperative neurosurgical mapping of motor and language brain areas. In TMS mapping of motor cortices the evoked responses can be quantitatively monitored by electromyographic (EMG) recordings. No such setup exists for monitoring of writing during nTMS mappings of writing related cortical areas.
We present a novel approach for monitoring writing during nTMS mappings of motor writing related cortical areas.
To our best knowledge, this is the first demonstration of quantitative monitoring of motor evoked responses from hand by EMG, and of pen related activity during writing with our custom made pen, together with the application of chronometric TMS design and patterned protocol of rTMS.
The method was applied in four healthy subjects participating in writing during nTMS mapping of the premotor cortical area corresponding to BA 6 and close to the superior frontal sulcus. The results showed that stimulation impaired writing in all subjects. The corresponding spectra of measured signal related to writing movements was observed in the frequency band 0–20Hz. Magnetic stimulation affected writing by suppressing normal writing frequency band.
The proposed setup for monitoring of writing provides additional quantitative data for monitoring and the analysis of rTMS induced writing response modifications. The setup can be useful for investigation of neurophysiologic mechanisms of writing, for therapeutic effects of nTMS, and in preoperative mapping of language cortical areas in patients undergoing brain surgery.
Lumbar discectomy is the most common surgical treatment for intervertebral disc extrusion. Postoperative pain is a common clinical problem that greatly affects the length of hospitalization, ...functional status and patient quality of life. Th e aim of this study was to compare the postoperative analgesic effi cacy of paracetamol administered intermittently and through patient-controlled analgesia (PCA) pump following single level lumbar discectomy. Patients who underwent elective lumbar discectomy of intervertebral disc extrusion at the L4-L5 level diagnosed by magnetic resonance of the lumbosacral spine were included in the study. Pain was assessed at regular intervals for 48 hours through a shortened version of McGill pain questionnaire translated in the Croatian language. When pain was monitored as a summarized variable for each measurement, PCA group significantly stood up after 24 hours with better perception of pain compared to the intermittent group (c2-test, p<0.05). Adequate pain relief is an important aspect of postoperative care in spinal surgery patients. Postoperative use of paracetamol through PCA pump achieved better pain control and pain management versuspostoperative use of intermittent paracetamol analgesia after lumbar discectomy.
Bone tissue banks are necessary for collection, production, testing, packaging, storage and delivery of bone transplants. Bone tissue bank is a link between the donor and the recipient by which the ...donation becomes a medium of health improvement for both the donor and the recipient. At the Department of Orthopedics, Mostar University Clinical Hospital, about 200 total hip replacements are performed
per
year. Most patients undergoing total hip replacement surgery (90%) have been diagnosed with osteoarthritis, and they are suitable donors, having in mind their age and comorbidities. In the same Department, around 50 procedures that require bone transplants are performed
per
year. A team of highly competent surgeons are working on an intensive process of adaptation oriented to quality improvement and intensification of the activity, both with the goal of meeting the standards of excellence in orthopedic surgery. The presence of a bone tissue bank has a favorable impact on the quality of health care owing to bone transplant availability, as well as on the scientific role of a highly specialized institution that examines the properties of bone tissue.
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