Introduction
The pathophysiology, diagnosis, and management of idiopathic normal pressure hydrocephalus (iNPH) remain unclear. Although some prognostic tests recommended in iNPH guidelines should ...have high sensitivity and high predictive value, there is often no positive clinical response to surgical treatment.
Materials and methods
In our study, 19 patients with clinical and neuroradiological signs of iNPH were selected for preoperative evaluation and possible further surgical treatment according to the guidelines. MR volumetry of the intracranial and spinal space was performed. Patients were exposed to prolonged external lumbar drainage in excess of 10 ml per hour during 3 days. Clinical response to lumbar drainage was assessed by a walk test and a mini-mental test.
Results
Twelve of 19 patients showed a positive clinical response and underwent a shunting procedure. Volumetric values of intracranial space content in responders and non-responders showed no statistically significant difference. Total CSF volume (sum of cranial and spinal CSF volumes) was higher than previously published. No correlation was found between spinal canal length, CSF pressure, and CSF spinal volume. The results show that there is a significantly higher CSF volume in the spinal space in the responder group (
n
= 12) (120.5 ± 14.9 ml) compared with the non-responder group (103.1 ± 27.4 ml;
n
= 7).
Discussion
This study demonstrates for the first time that CSF volume in the spinal space may have predictive value in the preoperative assessment of iNPH patients. The results suggest that patients with increased spinal CSF volume have decreased compliance. Additional prospective randomized clinical trials are needed to confirm our results.
In this time of pluralism and effectivness, it is rarely, if ever, in our daily lifes, as just as the broader social circles, spoken of the right upbringing, the virtues and the exemplary behaviour - ...a "role model". While an admirable person presents us the character we can readily look up to, we recognize a call to follow certain values this person idealy-tipically lives by. Regarding that fact, the explicite role models, primarily the people who lived their deep spirituality (for an instance, the saints!) greatly contribute to a healthy development of one's personality and a genuine understanding of ethics.
The perspective of the future that overlooks the dimension of the free, the new, the surprising, and relies only on calculable laws, remains too short, in fact - incomplete. In the modern world - ...because of everything that has been achieved in the rapid process of globalization in the fields of science, technology, economy - for the future, according to Fr Bono Šagi it is imperative to reach an "ethical consensus" - firstly for the common values above all. These are the ideals of “Christian humanism”: dignity of the human person, freedom, justice, peace and love among people and nations.
U kontekstu vremena u kojemu živimo ljudsko se mišljenje i djelovanje razotkriva u svojoj mnogostrukoj destruktivnosti. Destrukcija označava rušenje, razgrađivanje, pustošenje, rasipanje, propadanje, ...uništavanje – zapravo smrt. U raznim antropološkim redukcionizmima danas se udaljavamo od zdrave slike o čovjeku. Razara se čovjek i njegov okoliš. Otvoreno se promiču mržnja i nasilje – »kultura smrti«. U unakrsnoj vatri raznorodnih destruktivnih opasnosti danas se nalaze brak i obitelj. Proživljavaju ozbiljnu krizu i postali su predmetom nepoštedne manipulacije kojoj je cilj umanjiti njihovo značenje i razoriti im bit. Štoviše, mnogi danas vode otvoreni rat protiv braka i obitelji iz političkih, ekonomskih i inih – naročito pak ideoloških uvjerenja (papa Franjo govori o »ideološkoj kolonizacij i«). Posebno se u tome ističu tri ideologije: komunizam, feminizam i genderizam. Uz »ideološke« čimbenike postoje i mnogi drugi »nutarnji« čimbenici koji rastaču brak i obitelj: od ljudske sebičnosti, nespremnosti i nesposobnosti za komunikaciju do bračne nevjernosti i zala različitih ovisnosti.
Poverty is a global problem. Despite of improvement in some areas of standard of living (availability of basic health care and basic education, reduction of illiteracy and child mortality, longer ...life expectancy, etc.), the number of poor in the world today is not decreased. It is therefore not surprising that World Summit for Social Development in Copenhagen in 1995. emphasised three key social problems: poverty, unemployment and social exclusion. On the global level the year 2010 was declared as the Year fighting against poverty... But, is poverty just political and not ethical problem? On what way deontological and consequential (utilitarian) ethics are related to the topic of poverty? Adapted from the source document.
Lumbar spine synovial cysts are benign growths adjoining the facet joints that may induce low back pain, lumbar radiculopathy and neurological deficit. However, they are not well defined concerning ...their origin, cause and pathology, as well as available treatment strategies. The scope of different surgical procedures includes image-guided epidural steroid injection, direct cyst puncture by percutaneous epidural needle, spinal canal decompression and cyst resection, and spinal bone fusion with/without instrumentation. Hereby, we report institutional experience and discuss surgical strategies of lumbar spine synovial cyst treatment. Presenting symptoms, imaging findings and outcomes were retrospectively analyzed in 15 patients with lumbar spine synovial cyst, operated on during a one-year period. The leading presenting symptom was lumbar radicular pain, while the most commonly involved vertebral level was L5-S1. In a great majority of patients, a single-level interlaminectomy and cyst resection were performed. Most patients recovered without postoperative neurological and functional deficit, as well as surgery-related complications. No poor outcome was noticed in our series. Concerning our results and literature review, the optimal management for patients with symptomatic lumbar synovial cyst has to be highly personalized, which is essential to achieve a favorable outcome. Nonetheless, the best treatment strategy has yet to be affirmed. Key words: Lumbar spine synovial cyst; Treatment strategies; Surgical management; Outcome Sinovijalne ciste slabinske kraljeznice benigne su ekspanzivne tvorbe smjestene u blizini fasetnih zglobova koje mogu uzrokovati bol u donjim ledima, lumbalnu radikulopatiju i neuroloski deficit. Medutim, ishodiste i uzroci njihovog nastanka kao i moguce strategije lijecenja ovakvih cista jos su nedovoljno poznati. Raspon razlicitih postupaka kirurskog lijecenja ukljucuje radioskopski navodenu epiduralnu steroidnu infiltraciju, perkutanu punkciju ciste epiduralnom iglom, dekompresiju kraljeznicnog kanala i uklanjanje ciste te spinalnu kostanu fuziju s instrumentacijom ili bez nje. U ovom radu prikazujemo nasa iskustva u lijecenju slabinskih sinovijalnih cista i raspravljamo razlicite strategije njihovog kirurskog lijecenja. Retrospektivno su analizirani simptomi, nalazi dijagnostickih pretraga i uspjesnost lijecenja u 15 operiranih bolesnika sa slabinskom sinovijalnom cistom tijekom jednogodisnjeg razdoblja. Vodeci prezentirajuci simptom bila je slabinska radikularna bol, a najcesce zahvacena razina bila je ona na L5-S1. Jednorazinska interlaminektomija i resekcija ciste ucinjena je u velike vecine bolesnika koji su se uspjesno oporavili bez poslijeoperacijskog neuroloskog i funkcijskog deficita, kao i bez nastanka komplikacija. Temeljem nasih rezultata i pregledom literature zakljucujemo da optimalno lijecenje bolesnika sa sinovijalnom cistom slabinske kraljeznice treba biti usmjereno svakom pojedinom bolesniku kako bi se osigurao uspjesan ishod. Istodobno, najbolja strategija kirurskog lijecenja jos nije dovoljno potvrdena. Kljucne rijeci: Slabinska sinovijalna cista; Strategije lijecenja; Kirursko lijecenje; Ishod
Lumbar spine synovial cysts are benign growths adjoining the facet joints that may induce low back pain, lumbar radiculopathy and neurological deficit. However, they are not well defined concerning ...their origin, cause and pathology, as well as available treatment strategies. The scope of different surgical procedures includes image-guided epidural steroid injection, direct cyst puncture by percutaneous epidural needle, spinal canal decompression and cyst resection, and spinal bone fusion with/without instrumentation. Hereby, we report institutional experience and discuss surgical strategies of lumbar spine synovial cyst treatment. Presenting symptoms, imaging findings and outcomes were retrospectively analyzed in 15 patients with lumbar spine synovial cyst, operated on during a one-year period. The leading presenting symptom was lumbar radicular pain, while the most commonly involved vertebral level was L5-S1. In a great majority of patients, a single-level interlaminectomy and cyst resection were performed. Most patients recovered without postoperative neurological and functional deficit, as well as surgery-related complications. No poor outcome was noticed in our series. Concerning our results and literature review, the optimal management for patients with symptomatic lumbar synovial cyst has to be highly personalized, which is essential to achieve a favorable outcome. Nonetheless, the best treatment strategy has yet to be affirmed.
How do we relate globalisation to other types of mondialisation, such as
communications and economics? The answer should be: any globalisation should be motivated by the general interest of humanity ...and striving to that aim. In practice, this means that international protection of human
rights and environmental rights need not only jurisdictional (legal–political) but also, above all, ethical standards. Without it, a conflict between different types of globalisation could become damaging,
almost dangerous. The very idea of the global village that has so well explained the phenomenon of mondialisation can assist in solving the problems that need to be addressed. One of the features of each village is the intense
connection among the inhabitants. That phenomenon is now present globally, which is the essence of globalisation. That implies a global responsibility that must be implemented on the one hand by communities and the other by individuals, especially those who serve in the service of community — politicians. The crucial question arises, “How to define the responsibility of one and the others?” It is evident that at the top of the pyramid, there are
major planetary problems whose solutions require the cooperation of all
nations and countries. The straightforward phrase “Think globally, act locally”, expresses the rule of the fundamental game of the global world
and its diversity — a possible ethic of sustainable development.
Tillich’s reflections on ethics and morality included reflections on their connection with religion. His conclusion is that morality is the essence of religion, and that theological ethics should be ...present in every part of systematic theology. In this respect, Tillich accentuates the religious dimension of the moral imperative, the religious sources of moral demands, and the religious elements in moral motivation. It can be observed that the application of ethical principles as laid out by Tillich creates a solid network within the social community, and any deviation from the set constellation represents a weakening of that network. We wanted to prove this with our empirical research.
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