RESUMEN
BACKGROUND: The increasing endeavors to make inpatient treatment processes more effective leads to a reduction of the length of stay in hospital and minimization of postoperative monitoring. Therefore, the aim of our study was to determine potential postoperative complications for neurosurgical patients undergoing elective surgery with respect to assessment of the relevance for intensive medical care. Furthermore, our approach was compared with the standard of postoperative care of such patients in Germany. METHODS: All 499 patients scheduled for elective craniotomy at our institute from 2010-2013 could be included corresponding to various treatment criteria for vascular diseases, such as aneurysms, arteriovenous malformation (AVM) and cavernous hemangioma as well as supratentorial and infratentorial tumors, transsphenoidally operated pituitary adenomas and stereotactic biopsies. All complications could be collated and categorized according to major and minor complications. Furthermore, a survey was conducted among 155 neurosurgical hospitals and departments with respect to the preferred postoperative monitoring strategy for the named treatment categories. RESULTS: The numbers of major complication were in accordance with data from other studies and although minor complications (13.4% in our collective) are rarely recorded in the literature, they do however indicate an adequate postoperative inpatient monitoring. The results of the survey showed a broad preference for intensive care unit monitoring of patients undergoing elective craniotomy in Germany. CONCLUSION: The undisputed gold standard of postoperative monitoring of neurosurgical patients undergoing elective surgery is still the intensive care unit. Although more flexible surveillance modalities are available, a cost-driven restructuring of postoperative monitoring and in particular reduction of the length of stay in hospital must be subjected to detailed scrutinization.
Asunto(s)
Craneotomía/efectos adversos , Craneotomía/normas , Procedimientos Quirúrgicos Electivos/efectos adversos , Procedimientos Quirúrgicos Electivos/normas , Adulto , Anciano , Anciano de 80 o más Años , Neoplasias Encefálicas/cirugía , Trastornos Cerebrovasculares/cirugía , Cuidados Críticos , Femenino , Alemania/epidemiología , Humanos , Tiempo de Internación , Masculino , Persona de Mediana Edad , Monitoreo Fisiológico , Cuidados Posoperatorios , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/terapia , Reoperación/estadística & datos numéricosRESUMEN
OBJECTIVE: Preoperative differentiation between primary central nervous system lymphoma (PCNSL) and high grade astrocytoma (HGA) on conventional magnetic resonance imaging (MRI) can be difficult and even impossible. However, differentiation is important to guide therapeutic strategy. Several authors have reported the leakage pattern in dynamic susceptibility-contrast (DSC)-MRI in PCNSL. It describes the shape of the signal intensity curve which does not return to the baseline after the first pass of the bolus of contrast agent but crosses above it and sometimes even slopes up. In this retrospective study, our goal was to define the sensitivity and specificity of this sign. MATERIAL AND METHODS: Patients with first ever diagnosed PCNSL and HGA who were treatment naive and received DSC-MRI were included. In all patients, a histological specimen was available. Patients did not receive corticosteroids prior to imaging and were HIV negative. The presence of a leakage pattern was assessed by two neuroradiologists working in consensus and correlated with the histological diagnosis. RESULTS: Nine patients with PCNSL (2 women, 7 men, age 59 ± 10 years) and 14 patients with HGA (3 women, 11 men, age 58 ± 17 years) were included. Six of the patients with PCNSL exhibited a leakage pattern, while only two patients with HGA did (P = 0.0227, Fischer's exact test). Sensitivity was 0.67, and specificity was 0.86. DISCUSSION: Although the leakage pattern does not prove PCNSL, it is an important diagnostic clue and can be easily assessed.
Asunto(s)
Astrocitoma/diagnóstico , Neoplasias del Sistema Nervioso Central/diagnóstico , Medios de Contraste , Linfoma/diagnóstico , Imagen por Resonancia Magnética/métodos , Adulto , Anciano , Astrocitoma/epidemiología , Astrocitoma/patología , Neoplasias del Sistema Nervioso Central/epidemiología , Neoplasias del Sistema Nervioso Central/patología , Diagnóstico Diferencial , Femenino , Humanos , Linfoma/epidemiología , Linfoma/patología , Imagen por Resonancia Magnética/normas , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Adulto JovenRESUMEN
AIM: The endothelial nitric oxide (eNOS) gene T-786C polymorphism may influence as a genetic risk factor cardiovascular diseases and shows association with cardiovascular mortality. We hypothesized that this polymorphism may lead to increase mortality and morbidity after cardiac surgery with cardiopulmonary bypass (CPB). METHODS: In 500 patients who underwent cardiac surgery with CPB we investigated the eNOS T-786C polymorphism by DNA-sequencing. The patients were grouped according to their genotype in three groups (TT, TC, and CC). RESULTS: The overall genotype distribution of T-786C polymorphism was TT=41.6%, TC=51.2%, and CC=7.2% respectively. The groups did not differ in age and gender. No significance was shown in preoperative risk factors, excluding peripheral disease (P=0.03). No difference was shown in Euroscore, APACHE II, and SAPS II. The usage of norepinephrine (P=0.03) and nitroglycerine (P=0.01) was significant higher in TC allele carrier. The mortality was quite uniform across elective and urgent subgroup. However, we found a significant difference concerning mortality and emergency cardiac procedures in homozygous C-allele carrier (P=0.014). CONCLUSION: The present study demonstrates that this polymorphism contributes to a higher prevalence of postoperative mortality after emergency cardiac surgery. Thus, the eNOS T-786C polymorphism could serve as a possibility to differentiate high risk subgroups in heterogeneous population of individuals with cardiac diseases who need cardiac surgery with CPB.
Asunto(s)
Procedimientos Quirúrgicos Cardíacos/mortalidad , Puente Cardiopulmonar/mortalidad , Óxido Nítrico Sintasa de Tipo III/genética , Polimorfismo Genético , Anciano , Femenino , Frecuencia de los Genes , Predisposición Genética a la Enfermedad , Homocigoto , Mortalidad Hospitalaria , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Fenotipo , Estudios Prospectivos , Medición de Riesgo , Factores de RiesgoRESUMEN
AIM: We performed 123I-(S)-2-hydroxy 3-iodo-6-methoxy-N-[(1-ethyl-2-pyrrolidinyl)methyl]benzamide (123I-IBZM)-scintigraphy to evaluate one usefulness of this radiopharmaceutic agent for the diagnosis of malignant melanomas. METHODS: We performed whole body scintigraphies after intravenous application of 123I-IBZM in 20 patients and compared the scintigraphic findings with the results of other imaging methods. RESULTS: In four patients no melanotic lesions were detectable, neither by 123I-IBZM-scintigraphy nor by other imaging procedures. A scintigraphic detection of cutaneous or subcutaneous lesions was possible in our of ten patients. 123I-IBZM-scintigraphy showed pathological findings in five of ten patients with lymph node metastases. Two patients had brain metastases, in four patients lung localizations were present. None of these organic manifestations was discovered by scintigraphic means. Amelanotic lesions never showed an accumulation of 123I-IBZM. It was not possible to detect any "new" lesions, i.e. lesions not visualized by other imaging procedures. CONCLUSION: 123I-IBZM-scintigraphy did not present additional information important for the therapy of patients with malignant melanoma.