Neoplastic etiology of intracranial cerebral aneurysm is rare. Yet, the risk of its development is higher in malignant tumor patients receiving radiation therapy. Due to the possible negative effects ...of irradiation on intracranial vessel walls, the risk of aneurysm formation after radiation therapy, which is crucial for some types of breast cancer patients, continues to be a matter of debate. The aim of this study was to evaluate the hazard of multiple intracranial aneurysm development in patients with malignant disease undergoing radiation therapy. It is based on literature review and case report of a 77-year-old female patient who underwent surgery for multifocal invasive hormone-receptor positive ductal breast carcinoma of no special type, followed by chemotherapy, adjuvant radiation and hormone therapy. Her comorbidity included arterial hypertension and type 2 diabetes. Six unruptured intracranial aneurysms of different bilateral locations were diagnosed incidentally by multi-slice computed tomography angiography and digital subtraction angiography of cerebral vessels. Due to the bilateral aneurysm multiplicity, tumor characteristics and prognosis, comorbidity and relatively advanced age, the patient was not selected for active endovascular or microsurgical aneurysm treatment but only periodical clinical, oncologic and radiological follow-up was advised. In conclusion, the risk of multiple intracranial aneurysm formation in patients with breast cancer undergoing radiation therapy is low, but still possible. Long-term follow-up and regular cerebral angiographic check-up studies are necessary in selected malignant patients to decrease such a risk and to evade the worst outcome associated with aneurysm rupture.
This research looks at the connection between psychological stress and the prevalence of hand eczema (HE) among physicians and dentists (surgeons, non-surgeons).
This cross-sectional field study ...involved 185 participants: physicians (surgeons, non-surgeons), dentists (surgeons, non-surgeons) and controls. Hand lesions were examined using the Osnabrueck Hand Eczema Severity Index (OHSI), and participants answered the Nordic Occupational Skin Questionnaire (NOSQ) and Perceived Stress Scale (PSS). Patch tests were performed using commercial contact allergens.
The estimated prevalence of HE (self-reported) was 43.9% (physicians 44.6%; dentists 43.2%). HE was significantly more reported by surgeons than controls (
< 0.004; V = 0.288). Degrees of perceived stress (PSS) did not differ significantly between the groups, though physicians non-surgeons most exhibited high stress (50%), and physicians surgeons most exhibited low stress (22.5%). High stress was associated with 2.5 higher odds for self-reported HE (
= 0.008). Low stress was greater among physicians/dentists who did not report eczema (41.0% vs. 24.6%); moderate stress was more common among those who reported eczema (72.3% vs. 51.8%;
= 0.038; V = 0.210).
Since high stress levels may negatively influence physicians'/dentists' work and quality of life, measures to decrease stress could be introduced into the treatment of healthcare workers who are prone to it.
Parkinsonova bolest druga je najčešća neurodegenerativna bolest (odmah nakon Alzheimerove bolesti), a njezina učestalost raste s godinama starosti. Bolest nastaje složenom interakcijom između genske ...sklonosti i utjecaja čimbenika okoliša koji dovode do propadanja dopaminergičkih neurona u pars compacta substantiae nigrae i posljedične hipoaktivnosti dopaminergičkog sustava. U liječenju Parkinsonove bolesti primjenjuju se lijekovi kojima se pokušava postići kontinuirana stimulacija dopaminergičkih receptora nigrostrijatalnog sustava: levodopa s inhibitorima periferne dopa dekarboksilaze, inhibitori COMT-a i MAO-B, dopaminergički agonisti, amantadin, antikolinergički lijekovi. Osim farmakoterapije, na raspolaganju su i neurokirurške metode liječenja (duboka mozgovna stimulacija (engl. deep brain stimulation – DBS)) i metode fizikalne terapije. Brojne su studije pokazale da različiti oblici vježbanja povoljno djeluju na simptome bolesti i mišićnu funkciju. U ovom su radu prikazani dostupni podaci o povoljnim učincima tjelesne aktivnosti u bolesnika s Parkinsonovom bolešću, s posebnim naglaskom na terapiju plesanjem.
Recent transcranial sonography (TCS) studies showed that disruption of echogenic midbrain line, corresponding to basal limbic system and raphe nuclei (RN) within, might represent functional marker ...for the development of depression. Major depressive disorder (MDD) is one of the most common psychiatric disorders associated with suicidal ideation. We initiated this study to assess the usefulness of TCS recording in a group of MDD patients and in MDD patients who also reported suicidal ideation, on the assumption that TCS might serve as a screening method for differentiating patients at risk of suicide. Altogether 71 subjects: 17 patients with MDD, 14 patients with MDD who also reported suicidal ideation and 40 healthy controls, were studied using TCS by two independent physicians. Reduced raphe echogenicity was found in 8 of 17 (47%) of the patients with MDD but only in 6 of 40 (15%) controls. In patients with suicidal ideations that finding was even more pronounced (12 of 14, 86%) with the highest frequency of completely not visible TCS RN finding (10 of 14, 72%). Data showed that altered echogenicity of the RN is frequent in patients with suicidal ideation. Normal RN echogenicity in MDD patients was associated with less severe depressive symptoms and rarely with the presence of suicidal ideations. As far as we know, these are the first ever obtained results which show that TCS might help differentiating MDD patients with suicidal risk or eventually predict good disease recovery based on the findings of RN hypo- or normoechogenicity.
Sekundarna prevencija obuhvaća liječenje i rehabilitaciju bolesnika koji su preboljeli moždani udar ili tranzitornu ishemijsku ataku (TIA) te identificiranje i liječenje osoba s vrlo visokim rizikom ...od nastanka moždanog udara kako bi se on spriječio. Sekundarnom prevencijom može se produžiti ukupno preživljavanje, poboljšati kvaliteta života, smanjiti potreba za kirurškim zahvatima te smanjiti učestalost budućih moždanih udara i TIA-e. U sekundarnoj prevenciji ishemijskoga moždanog udara najčešće se od antiagregacijskih lijekova propisuje acetilsalicilna kiselina (ASK). Ona inhibira ciklooksigenazu i tako sprečava sintezu tromboksana A2 (TXA2) u trombocitima, ali i sintezu prostaciklina (PGI2) u endotelnim stanicama te tako smanjuje agregaciju trombocita i učestalost kardiovaskularnih i cerebrovaskularnih bolesti. Primjenom ASK prosječno se smanjuje relativni rizik od vaskularnih incidenata oko četvrtine (25%). ASK u svakoj dozi višoj od 50 mg/dan smanjuje rizik od moždanog udara, a više doze povezane su s povećanom učestalošću nuspojava ASK (krvarenje iz probavnog trakta, probavne smetnje, žgaravica, mučnina, povraćanje). Od svih antiagregacijskih lijekova dostupnih na tržištu najjeftiniji je ASK te je u sekundarnoj prevenciji moždanog udara najisplativiji. Međutim, antiagregacijsku terapiju treba prilagoditi svakomu pojedinom bolesniku.
Cognitive dysfunction appears all through the course of multiple sclerosis (MS). Mild and moderate cognitive impairment is present in up to 40% of MS patients and severe cognitive decline affects ...more than 50% of patients in progressive course of the disease. The most common cognitive disorders in MS include diminished information processing speed, compromised word fluency, complex attention deficit and executive dysfunction.
In this mini review, we present the reader with the most common neuropsychological assessments for the evaluation of cognition in MS, addressing the question of cognitive relapse. Source of data presented in this review is PubMed search of the recently published literature on cognitive decline in MS.
Patients with cognitive relapse often fail to meet diagnostic criteria for classical relapse in MS. Although, cognitive decline relates poorly to functional disability in MS, it correlates well with neuropsychological testing and with neuroimaging parameters of the disease.
Cognitive decline might be considered as additional indicator of MS activity, and therefore evaluated routinely, irrespective of clinical presentation. Brief cognitive assessment, with confirmed psychometric qualities, might be useful in detection of cognitive relapse in MS patient.
Stroke is the rapid loss of brain function due to disturbance in the blood supply to the brain causing predominantly motor and sensory symptoms. However, stroke can cause some other symptoms. Post ...stroke dementia and depression are probably the most important non-motor consequences of stroke. Post stroke dementia and depression are important and often overlooked symptoms following stroke. Treatment options for Post stroke dementia and depression are still limited, therefore diagnosis of Post stroke dementia and depression is very important because it could lead to prevention
of dementia and depression by appropriate control of vascular risk
factors. Primary prevention depend on early identification and appropriate control of vascular risk factors, while secondary prevention must include energetic therapy to prevent stroke recurrence.
Parkinsonova bolest (PB) općenito se smatra primarnim poremećajem pokreta, ali većina bolesnika pati i od ne-motornih
oralnih salivarnih simptoma. Najčešći salivarni simptomi, sijaloreja i ...kserostomija, imaju značajan negativan utjecaj na
kvalitetu života bolesnika. Iako su navedeni simptomi potpuno suprotni, oboje značajno narušavaju oralno zdravlje bolesnika.
Sijaloreja se definira kao povećana količina zadržavajuće sline, a povezana je s prekomjernim lučenjem sline ili nedostatnim
odstranjivanjem sline. Za razliku od sijaloreje, kserostomija se subjektivno definira kao suhoća usta i povezana je s nedovoljnim
lučenjem sline. Kserostomija potiče neravnotežu oralne mikroflore i oralnu patologiju koja često dovodi do pothranjenosti
kod bolesnika s PB. Povezana je s autonomnom disfunkcijom ili se može smatrati nuspojavom dopaminergičkih ili
antikolinergičkih lijekova. U PB se za procjenu sijaloreje i kserostomije primjenjuju različite metode procjene, uključujući
standardizirane ljestvice za procjenu ne-motoričkih simptoma i upitnike oralnog zdravlja. Slijedom toga, liječenje salivarnih
simptoma uključuje farmakološki i ne-farmakološki pristup te kirurške intervencije. Multidisciplinarni pristup u kliničkoj
neurologiji i dentalnoj medicini, koji obuhvaća preciznu procjenu salivarnih simptoma te učinkovito liječenje, ukazuje na
uspješno liječenje bolesnika s PB.
Neoplastic etiology of intracranial cerebral aneurysm is rare. Yet, the risk of its development is higher in malignant tumor patients receiving radiation therapy. Due to the possible negative effects ...of irradiation on intracranial vessel walls, the risk of aneurysm formation after radiation therapy, which is crucial for some types of breast cancer patients, continues to be a matter of debate. The aim of this study was to evaluate the hazard of multiple intracranial aneurysm development in patients with malignant disease undergoing radiation therapy. It is based on literature review and case report of a 77-year-old female patient who underwent surgery for multifocal invasive hormone-receptor positive ductal breast carcinoma of no special type, followed by chemotherapy, adjuvant radiation and hormone therapy. Her comorbidity included arterial hypertension and type 2 diabetes. Six unruptured intracranial aneurysms of different bilateral locations were diagnosed incidentally by multi-slice computed tomography angiography and digital subtraction angiography of cerebral vessels. Due to the bilateral aneurysm multiplicity, tumor characteristics and prognosis, comorbidity and relatively advanced age, the patient was not selected for active endovascular or microsurgical aneurysm treatment but only periodical clinical, oncologic and radiological follow-up was advised. In conclusion, the risk of multiple intracranial aneurysm formation in patients with breast cancer undergoing radiation therapy is low, but still possible. Long-term follow-up and regular cerebral angiographic check-up studies are necessary in selected malignant patients to decrease such a risk and to evade the worst outcome associated with aneurysm rupture. Key words: Aneurysms, intracranial, multiple; Breast cancer; Radiation therapy Neoplasticka etiologija intrakranijskih aneurizmi je rijetka. Unatoc tomu, rizik za njihov nastanak povecan je u bolesnika s malignim tumorima koji primaju iradijacijsku terapiju. Poslijeoperacijska iradijacija kljucna je u lijecenju pojedinih tipova karcinoma dojke, ali moe imati negativan ucinak na stijenku intrakranijskih krvnih ila povecavajuci rizik nastanka cerebralnih aneurizmi nakon provedenog zracenja, to je stalni predmet rasprave. Cilj je ovoga rada bio prosuditi rizik nastanka vie-strukih intrakranijskih aneurizmi u bolesnice kod koje je provedeno zracenje u svrhu nastavka lijecenja maligne bolesti. Rad je temeljen na pregledu literature i prikazu slucaja bolesnice u dobi od 77 godina s tumorom dojke koja je operirana zbog nespecificnog tipa multifokalnog, invazivnog, hormonski aktivnog duktalnog karcinoma nakon cega su provedeni kemoterapija, zracenje i hormonska terapija. Bolesnica se je takoder lijecila od arterijske hipertenzije i dijabetesa tipa 2. U bolesnice je pomocu vieslojne kompjutorske tomografske angiografije i digitalne subtrakcijske angiografije modanih krvnih ila dijagnosticirano est nerupturiranih intrakranijskih aneurizmi obostrane lokalizacije. Uzimajuci u obzir smjetaj viestrukiih aneurizmi, kao i osobite znacajke tumora i prognozu maligne bolesti te komorbiditet i relativno visoku ivotnu dob, u bolesnice nije provedeno aktivno endovaskularno ili mikrokirurko lijecenje nerupturiranih anevtrizmi, nego je preporuceno redovito klinicko, onkoloko i radioloko pracenje. Zakljucujemo kako je rizik nastanka viestrukih intrakranijskih aneurizmi u bolesnica s karcinomom dojke podvrgnutih iradijacijskom lijecenju relativno malen, ali ipak moguc. Stoga su dugotrajno klinicko pracenje i redovita angiografska dijagnosticka provjera nuni u selekcioniranih bolesnika kako bi se ovaj rizik umanjio i kako bi se sprijecio nepovoljan ishod lijecenja nastao uslijed moguce rupture cerebralne aneurizme. Kljucne rijeci: Aneurizme, intrakranijske, viestruke; Karcinom dojke; Iradijacijsko lijecenje
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