Risk factors for subdural bleeding in elderly population.

In the elderly, a larger proportion of the intracranial bleeds is related to non-traumatic causes or is caused by slight trauma--such that in a younger patient would not be expected to cause a bleed. In clinical practice, there is a prevailing impression that these bleeds, especially subdural hematomas of chronic and sub-chronic duration with or without acutization (evidence of "fresh" bleeding) are in many cases related directly to the use of anticoagulant therapy. A retrospective survey of medical documentation was performed for patients treated at the Neurosurgery Clinic of KBC Rijeka during the period of 2011 and 2012. Statistical analysis showed a significantly greater incidence of spontaneous SDH (subdural hematoma) in patients taking oral anticoagulation therapy (Fisher exact test, p < 0.01). In the article 3 typical cases of such patients are also presented. This survey confirmed the existence of a relationship between oral anticoagulant therapy and SDH, in particular the subgroup of "spontaneous" SDH. A larger study is planned.

Melanoma sentinel lymph node biopsy: analysis of cases operated on from 1999 to 2008 in The University Hospital Dubrava, Zagreb, Croatia.

TITLE: Melanoma Sentinel Lymph Node Biopsy: analysis of cases operated on from 1999-2008 in the University Hospital Dubrava, Zagreb, Croatia. AIM: To determine how well tumor thickness, ulceration, location and patient age and sex predict a positive sentinel lymph node in the analyzed population. PATIENTS AND METHODS: 321 patients were included in the study. 53% (169) were male and 47% (152) were females. 291 underwent sentinel lymph node biopsy. The median age was 56 years (age range 20-89). Sentinel lymph node biopsy was performed by lymphoscintigraphy using technetium-99m (99mTc)-labeled sulfur colloid and vital dye. RESULTS: Melanomas were similarly distributed on the trunk (154, 48%) and the extremities (145, 45%), a small number was located on the head and neck (12, 4%) and for 10 (3%) there was no record of the location. Positive lymph nodes were detected in 76 (26%) out of 291 patients who underwent sentinel lymph node biopsy. Micrometastases were found in 50 basins (60%), macrometastases were found in 15 basin (18%), one basin contained a metastasis that was spreading beyond the capsule (1%) and in the remaining 18 (21%) positive basins in the identified sentinel lymph nodes contained only isolated tumor cells. The average melanoma thickness of 3.41mm for sentinel lymph node biopsy positive melanomas was significantly greater than 2.47mm for negative melanomas (p=0.006). Proportionally more positive sentinel lymph nodes were found with increasing tumor thickness, (p=0.061). Ulceration was found to be a good predictor of positive sentinel lymph nodes (p<0.001). When comparing upper and lower extremities, sentinel lymph nodes were significantly more positive when the primary melanoma was on the legs (p=0.04). An ulcerated primary melanoma on the extremities was found more likely to have a positive sentinel lymph node (p=0.04). A significantly higher proportion of those older than 50 years old had positive lymph nodes (p<0.001). CONCLUSION: Tumor thickness, ulceration, location (upper vs. lower extremities, on the extremities with ulceration) as well as the age of the patient (>50) were found to be predictors of sentinel lymph node positivity. Clinically negative patients with any of these factors should be considered candidates for sentinel lymph node positivity.