Chronic hyperglycemia and intracranial meningiomas.

Meningiomas are among the most common primary tumors of the central nervous system. Previous research into the meningioma histological appearance, genetic markers, transcriptome and epigenetic landscape has revealed that benign meningiomas significantly differ in their glucose metabolism compared to aggressive lesions. However, a correlation between the systemic glucose metabolism and the metabolism of the tumor hasn't yet been found. We hypothesized that chronic levels of glycaemia (approximated with glycated hemoglobin (HbA1c)) are different in patients with aggressive and benign meningiomas. The study encompassed 71 patients with de novo intracranial meningiomas, operated on in three European hospitals, two in Croatia and one in Spain. Our results show that patients with WHO grade 2 meningiomas had significantly higher HbA1c values compared to patients with grade 1 lesions (P = 0.0290). We also found a significant number of patients (19/71; 26.7%) being hyperglycemic, harboring all the risks that such a condition entails. Finally, we found a significant correlation between our patients' age and their preoperative HbA1c levels (P = 0.0008, ρ(rho) = 0.388), suggesting that older meningioma patients are at a higher risk of having their glycaemia severely dysregulated. These findings are especially important considering the current routine and wide-spread use of corticosteroids as anti-edematous treatment. Further research in this area could lead to better understanding of meningiomas and have immediate clinical impact.

Surgical removal of metallic foreign body (shrapnel) from the lumbosacral spine and the treatment of chronic osteomyelitis: a case report.

We report a case of a retired soldier who was severely injured by an explosion in 1993 during the war in Bosnia and Herzegovina. Among other wounds, he suffered an explosive wound in the lumbosacral spine with steel foreign body (shrapnel). A year after primary wound treatment, a purulent fistula appeared which was treated and stopped with antimicrobial therapy. Subsequently, fistula which was activated several times after the antibiotic therapy was discontinued, but in the last eight years, the fistula has been continuously present so the patient decided on surgery. During surgery, the shrapnel was removed from the lumbosacral spine and there was debridement of necrotic bone. During two weeks of peri-operative and postoperative period, chronic osteomyelitis was treated by intravenous ciprofloxacin and gentamycin, and after that by a combination of rifampicin and trimethoprim-sulfamethoxazole orally, for six months. The patient did not show any signs of infection after two years of follow-up.

Serum cytokine changes after gastric resection or gastrectomy for gastric cancer.

BACKGROUND/AIMS: Although essential for postoperative recovery, excessive surgical stress response leads to higher rate of serious postoperative complications, such as sepsis and multiple organ disorder syndrome. Exact regulation of surgical stress response is not yet known. Still, our ability to modify surgical stress response severity has led to diminished postoperative morbidity and mortality rates and development of fast-track surgery. In this study we tried to further clarify the roles of several cytokines in surgical stress response regulation. METHODOLOGY: We measured leukocyte count and serum concentrations of C-reactive protein, IL-2, IL-6, IL-10, TNF-alpha, IFN-gamma and cortisol in patients undergoing gastrectomy or gastric resection for gastric cancer. Blood samples were collected preoperatively, 3 hours, 24 hours and 48 hours postoperatively. We also grouped our patients according to operation type and duration and then compared measured values between groups. RESULTS: Elevated postoperative leukocyte count and serum concentrations of IL-4, IL-6, IL-10 and cortisol were measured, all peaking at 3 hours postoperatively. Also, serum IL-6 concentration was higher after longer operations, and leukocyte count was higher after gastrectomy. CONCLUSIONS: The synchronicity of postoperative elevation of IL-4, IL-6 and IL-10 concentrations, each having different role in surgical stress response regulation, might indicate that, in order to determine surgical stress response severity, several cytokines should be measured simultaneously.

Surgical treatment of liver echinococcosis--the role of laparoscopy.

BACKGROUND: The surgical approach to liver echinococcosis is still a controversial issue. This study shows our results of surgical treatment of liver hydatid cysts during a 5-year period. METHODS: A prospective study of 21 patients operated on in a 5-year period (1999-2003), in Dubrava University Hospital in Zagreb, Croatia, with hepatic hydatid cyst. All patients were pre-operatively treated with albendazole. In 12 patients, total pericystectomy without opening the cyst cavity was performed, 9 open and 3 laparoscopic. In the other 9 patients, partial pericystectomy was done, 6 open and 3 laparoscopic. RESULTS: There was no mortality after 5-65 months follow-up, but in 1 patient, in the open partial pericystectomy group, recurrence of the disease occurred after 3 years. When a laparoscopic procedure was done, there were no complications or recurrence. The median operative duration for open surgery was 100.0 min (range 60.0-210.0), and for laparoscopic surgery 67.5 min (range 60.0-120.0). The median length of hospitalisation for open surgery was 8.0 days (range 7.0-14.0), and for laparoscopic surgery 5.0 days (range 4.0-7.0). CONCLUSION: Total pericystectomy without opening the cyst cavity, preceded by pre-operative albendazole therapy is the method of choice for hepatic hydatid cyst treatment. Despite the small group of patients, our first results show laparoscopic total pericystectomy without opening the cyst cavity, in the treatment of hepatic hydatid cyst, as a good alternative to open surgery in selected patients.

War injuries of colon and rectum--results after 10 years.

The aim of our study is to evaluate results of treating war injuries of colon and rectum, after 10 years. During the war in Croatia, 21 wounded, with colon (19) and rectum (2) injuries, were treated in the Department of Surgery at Nova Gradiska General Hospital from August 1991 to April 1992. Bullet wounds accounted for 57% of the injuries. All patients had other associated injuries. Primary repair and proximal derivation was possible in 2 cases (9.5%), while primary resection with intraperitoneal anastomosis was performed in 3 (14.3%) patients. In 2 (9.5%) patients sustained intraperitoneal and extraperitoneal rectal penetrating injury rectum was resected and closed performing temporary sigmoidostomy. When multiple perforations or crush injury of the colon were found, in 8 (38.1%) injured persons resection of the involved segment was combined with proximal end colostomy and aboral mucous fistula. Exteriorization of injured segment of the colon and creating colostomy incorporating the injured colon as the stoma was performed in 6 (28.5%) wounded patients. Four of the wounded (19.0%) died two of them during the operative procedure due to hemorrhagic shock. One injured died after eight days due to pulmonary embolism, and one patient died after thirty days due to sepsis. Reoperation was necessary in two (9.5%) injured due to bowel obstruction four days following initial surgery because of adhesions. Three (14.3%) of the injured had wound infection, one of them died 30 days after injury due to sepsis, and two (9.5%) consequently developed ventral hernia that was operated after 4 and 5 years respectively. Four (19.0%) of the injured are still occasionally experiencing occasional abdominal pain.

Our experience with 2693 wounded treated at the Split University Hospital during the 1991-1995 period.

The authors' personal experience of 2693 wounded treated at the Split University Hospital during the 1991-1995 period is described and compared with the results reported from other recent wars worldwide. Explosive wounds were more frequent than gunshot wounds (N=1490; 55.3% vs N=988; 36.7%), and wounds due to other factors were observed in 215 (8.0%) patients. There were 2494 (92.6%) men and 99 (7.4%) women. A total of 1815 (67.4%) patients were operated on in field war hospitals, and 878 (32.6%) at the Split University Hospital. Recovery and discharge were achieved in 1527 (56.7%) and improvement with the treatment or rehabilitation continued at other institutions in 850 (31.6%) patients. In 240 (8.9%) patients, no definite opinion can yet be given. A lethal outcome was recorded in 76 (2.8%) patients. Rapid transportation from the site of wounding to medical teams was found to be of paramount importance for successful treatment. These teams were placed in field war hospitals placed as close as possible (5-15 km) to the frontline.