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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.
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Neoplasias Encefálicas/patología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Biopsia/métodos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Técnicas Estereotáxicas , Adulto JovenRESUMEN
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.
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Aneurisma Intracraneal/patología , Hemorragia Subaracnoidea/patología , Vasoespasmo Intracraneal/patología , Angiografía por Tomografía Computarizada , Humanos , Aneurisma Intracraneal/clasificación , Aneurisma Intracraneal/diagnóstico por imagen , Estudios Prospectivos , Índice de Severidad de la Enfermedad , Hemorragia Subaracnoidea/clasificación , Hemorragia Subaracnoidea/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Vasoespasmo Intracraneal/clasificación , Vasoespasmo Intracraneal/diagnóstico por imagenRESUMEN
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.
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Astrocitoma/patología , Neoplasias Encefálicas/patología , Adolescente , Adulto , Astrocitoma/diagnóstico , Astrocitoma/mortalidad , Astrocitoma/cirugía , Neoplasias Encefálicas/diagnóstico , Neoplasias Encefálicas/mortalidad , Neoplasias Encefálicas/cirugía , Femenino , Humanos , Estado de Ejecución de Karnofsky , Masculino , Persona de Mediana Edad , Pronóstico , Curva ROC , Tasa de Supervivencia , Adulto JovenRESUMEN
INTRODUCTION: Despite the contemporary diagnostics of intracranial aneurysms their treatment is still a great challenge. The decision when and if to apply a surgical or endovascular treatment of intracranial aneurysms should be made by a team of medical specialists which consists of a cerebrovascular neurosurgeon, neuro-radiologist and neuro-anesthesiologist. CASE REPORT: We report a case of a patient aged 16 who was admitted because of a sudden intensive headache followed by sickness, vomiting, and loss of consciousness. On admission the patient was conscious but sleepy. Glasgow Coma Scale score was 14 and the World Federation of Neurological Surgeons Scale grade was I. The computed tomography scan showed a massive subarachnoid haemorrhage. The computed tomography angiography and digital subtraction angiography revealed a ruptured saccular aneurysm in the left vertebral artery. An early treatment with the coiling of the lumen of the aneurysm was performed under general anaesthesia. On the tenth day the boy was discharged in good condition and without any neurological deficits. Six months after the intervention the patient was without symptoms and the control digital subtraction angiography showed the complete occlusion of the aneurysm. CONCLUSION: Intracranial aneurysms in children are more common in males and are predominantly localized in the posterior circulation. In addition, they are frequently of greater size and more complex architecture and they are associated with a lower incidence of clinically manifest vasospasm. According to previous experience, endovascular treatment of intracranial aneurysms in paediatric patients has proven to be a safe and efficient method with a small number of complications.
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Aneurisma Roto/cirugía , Aneurisma Intracraneal/cirugía , Arteria Vertebral , Adolescente , Aneurisma Roto/complicaciones , Aneurisma Roto/diagnóstico por imagen , Angiografía de Substracción Digital , Angiografía Cerebral , Humanos , Aneurisma Intracraneal/complicaciones , Aneurisma Intracraneal/diagnóstico por imagen , Masculino , Hemorragia Subaracnoidea/diagnóstico por imagen , Hemorragia Subaracnoidea/etiología , Tomografía Computarizada por Rayos XRESUMEN
INTRODUCTION: Health care workers often come into conflict situations while performing their daily activities. People behave differently when they come into conflicts and they are usually not aware of their own reactions. The aim of this paper was to establish the presence of conflict styles among health workers and the differences in relation to demographic characteristics (education, working experience, managerial position). MATERIAL AND METHODS: The research was done as a cross-sectional study and through surveys. The conflict handling questionnaire was used as the research instrument. The questionnaire contained 30 statements arranged in five dimensions of conflict styles. The sample included one hundred nurses and fifty-five doctors. RESULTS: The research showed that accommodating was the most often used conflict style. There was no significant difference in styles of managerial and non-managerial staff, but there was a significant difference in the styles adopted by doctors and nurses. It should be noted that nurses used avoiding and accommodating conflict styles much more often. CONCLUSION: It is important to increase the awareness of conflict existence and the possibility of solving the problem constructively in order to achieve more efficient duty performance.
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Conflicto Psicológico , Negociación , Relaciones Médico-Enfermero , Recolección de Datos , Femenino , Humanos , Masculino , Cuerpo Médico de Hospitales , Personal de Enfermería en Hospital , Encuestas y CuestionariosRESUMEN
INTRODUCTION: Collaboration, within and between healthcare teams, facilitates effective healthcare. Internationally, the development of interprofessional education, as a means to facilitate more effective teamwork in health care, has been recognized for over forty years. OBJECTIVE: The aim of this paper is to evaluate students' attitudes toward the influence of interprofessional education on improvement of collaboration and teamwork. METHODS: The research was conducted by interviewing students at the Medical Faculty in Novi Sad in the form of cross-sectional study. The study sample included students from two undergraduate programmes: School of Nursing (n=52) and Integrated Studies of Medicine (n=53). Students admitted to the research had to be exposed to clinical experience. The instrument used in this study was the Readiness for Interprofessional Learning Scale (RIPLS). RESULTS: As many as 93.3% of students indicated that basics of teamwork skills should be obtained prior to graduation, whereas 96.2% considered that interprofessional education would enable them to improve mutual trust and respect. The majority of interviewees indicated that patients would ultimately benefit if healthcare students worked together to solve patient problems. Multivariate procedures MANOVA p < 0.05 and discriminative analysis p < 0.05 of students' attitudes toward teamwork and collaboration showed significant differences between the students of medicine and nursing. CONCLUSION: The students of the Integrated Studies of Medicine and School of Nursing had a positive attitude toward the influence of interprofessional education on the improvement of collaboration and teamwork.
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Conducta Cooperativa , Grupo de Atención al Paciente , Estudiantes de Medicina/psicología , Estudiantes de Enfermería/psicología , Actitud , Humanos , Relaciones Interprofesionales , SerbiaRESUMEN
INTRODUCTION: A gunshot head injury, characterized by a huge intensity of mechanical force, in addition to the direct tissue damage at the location of direct impact, may cause a skull and skull base fracture, distant from the the point of direct impact, which could be further complicated by creating a communication between endocranium and nasal/paranasal cavities. Such cases pose a great diagnostic and therapeutic challenge for every clinician. CASE REPORT: The patient is presented with the history of a perforating gunshot head injury six years ago, with recurrent attacks of meningoencephalitis subsequently, without rhinorrhea. By using high resolution CT scans, previous traumatic skull injury was verified and a fissure in the frontoethmoidal region, far from the point of direct impact, was detected. The patient underwent transnasal endoscopic surgery, in order to seal the communication on skull basis. The patient did not suffer from meningoencephalitis during the next two years. CONCLUSION: In the cases with late occurrence of posttraumatic meningoencephalitis with no signs of rhinorrhea, a possibility of an existing communication between intracranial and nasal cavities should be considered, as well. By applying modern diagnostic and therapeutic procedures such communication should be precisely located and sealed.
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Hueso Etmoides , Fístula/complicaciones , Hueso Frontal , Traumatismos Penetrantes de la Cabeza/complicaciones , Meningoencefalitis/etiología , Cavidad Nasal , Heridas por Arma de Fuego/complicaciones , Adulto , Traumatismos Penetrantes de la Cabeza/cirugía , Humanos , Masculino , Recurrencia , Heridas por Arma de Fuego/cirugíaRESUMEN
BACKGROUND/AIM: Managing of acute postoperative pain should be of great interest for all hospital institutions, as one of the key components of patients satisfaction, which indicates quality, as well as the outcome of treatment. The aim of this study was to assess the quality of nursing care in managing acute postoperative pain and to establish factors which influence patients assessment of the same. METHOD: The investigation was conducted on the sample of 135 patients hospitalized in surgical clinics of the Clinical Centre of Vojvodina in Novi Sad in the form of cross-sectional study, by interviewing patients during the second postoperative day and collecting sociodemographic variables, type of surgical procedure and applied analgesic therapy which were taken from their medical documentation. The modified questionnaire of the Strategic and Clinical Quality Indicators in Postoperative Pain Management (SCQIPP) was used as the instrument of the investigation. The data were processed with suitable mathematical statistics methods such as multivariate analyses of variance (MANOVA), discriminative and other parametric procedures and methods. Roy's test, Pearson's coefficient contingency (X), multiple correlation coefficient (R) were conducted amongst other univariant procedures. RESULTS: The mean score for the individual items of SCQIPP questionnaire was between 2.0 and 4.7 (scale range 1-5) and the percentage of patients answers "strongly agree" ranged from 4.4 to 77%. The smallest number of positive answers were given by the patients for the item "In order to assess pain intensity, some of the staff asked me at least once in the morning, in the afternoon and in the evening to show the number from 0-10". Most of the patients (57%) evaluated severe pain during the previous 24 hours, as moderate pain, which represents significantly greater number of patients which complain of severe pain and mild pain (p < 0.001). The analysis of patients evaluation (MANOVA p < 0.05 and discriminative p < 0.05) indicates the existence of significant difference between the assessment of nursing care quality in managing acute postoperative pain as regards to clinics as the place for pain management, patient's sex and his expectations. Evaluation from "communication" subscale gives the greatest contribution (24.9%) to the difference between the observed clinics, and the greatest contribution (25.7%) to the difference in evaluation of nursing care quality as regards to patients' sex has the evaluations from "procedure" subscale. CONCLUSION: The results of this study show a useful evidence and identify aspects of nursing care in postoperative management of acute pain which are still to be improved. According to the patients' answers the priority should be given to a regular assessment of the intensity of postoperative pain and evaluation of the effects of analgesic therapy.
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Dolor Postoperatorio/terapia , Satisfacción del Paciente , Enfermedad Aguda , Femenino , Humanos , Masculino , Persona de Mediana Edad , Dimensión del Dolor , Encuestas y CuestionariosRESUMEN
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.
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Quistes Aracnoideos/complicaciones , Hematoma Subdural Crónico/cirugía , Adulto , Traumatismos Craneocerebrales/complicaciones , Drenaje , Hematoma Subdural Crónico/complicaciones , Hematoma Subdural Crónico/diagnóstico por imagen , Humanos , Masculino , Radiografía , Recurrencia , Trepanación , Adulto JovenRESUMEN
INTRODUCTION: Traumatic brain injuries have major socio-economic importance due to their frequency, high mortality and serious consequences. According to their nature the consequences of these injuries may be classified as neurological, psychiatric and esthetic. Various lesions of brain structures cause neurological consequences such as disturbance of motor functions, sensibility, coordination or involuntary movements, speech disturbances and other deviations, as well as epilepsy. Psychiatric consequences include cognitive deficit, emotional disturbances and behavior disturbances. CRIMINAL-LEGAL ASPECT OF TRAUMATIC BRAIN INJURIES AND LITIGATION: Criminal-legal aspect of traumatic brain injuries expertise understands the qualification of these injuries as mild, serious and qualified serious body injuries as well as the expertise about the mechanisms of their occurrence. Litigation expertise includes the estimation of pain, fear, diminished, i.e. lost vital activity and disability, esthetic marring, and psychological suffer based on the diminished general vital activity and esthetic marring. COMPETENCE AND TIMING OF EXPERTISE: Evaluation of consequences of traumatic brain injuries should be performed only when it can be positively confirmed that they are permanent, i.e. at least one year after the injury. Expertise of these injuries is interdisciplinary. Among clinical doctors the most competent medical expert is the one who is in charge for diagnostics and injury treatment, with the recommendation to avoid, if possible, the doctor who conducted treatment. For the estimation of general vital activity, the neurological consequences, pain and esthetic marring expertise, the most competent doctors are neurosurgeon and neurologist. Psychological psychiatric consequences and fear expertise have to be performed by the psychiatrist. Specialists of forensic medicine contribute with knowledge of criminal low and legal expertise.