Percutaneous Radiofrequency Disc Decompression: A Study of 27 Patients.

BACKGROUND: Percutaneous radiofrequency nucleoplasty is a true minimally invasive technique for treatment for radiculopathy caused by contained disc protrusions. This minimally invasive procedure uses controlled thermoablation for reducing the intervertebral disc and decompressing the lumbar nerve root. Material and Methods: Our study is a prospective analysis of 27 patients aged from 30 to 64 years with lumbar disc protrusion who were treated with percutaneous radiofrequency disc decompression (PRFD) between May 2018 and May 2019. Clinical follow-up was reported at 1 month, 3 months, and 6 months. The outcomes were assessed using a visual analog scale (VAS) and MacNab score. RESULTS: Of the 27 patients, 14 were female and 13 were male. Their mean age was 53 ± 2 years. In all 27 patients, percutaneous radiofrequency nucleotomy was performed. An excellent outcome as reflected by MacNab score was observed in 17 patients (63%), a good outcome in 8 patients (29.7%), and a poor outcome in 2 patients (7.3%). Prior to treatment, the average back and leg VAS scores were 7.95 and 7.82, respectively. At sixth month follow-up, the back and leg VAS scores were reduced to 3.17 and 3.04, respectively. Patients with a poor outcome developed early recurrent disc prolapse and required endoscopic discectomy. CONCLUSION: PRFD is a safe and effective treatment of contained disc protrusion. PRFD is a good alternative to surgery. These procedures significantly increase quality of life in patients with lumbar radiculopathy.

Significance of the Ki-67 proliferation index in the assessment of the therapeutic response to cisplatin-based chemotherapy in patients with advanced cervical cancer.

OBJECTIVE: The purposes of this study were to examine the therapeutic response of advanced cervical cancer to Ki-67 proliferative index (Ki-67 PI) dependent cisplatin chemotherapy, and to determine Ki-67 PI referential value that is expected to provide a satisfactory therapeutic response of cervical cancer to cisplatin chemotherapy. PATIENTS AND METHODS: This prospective study enrolled 59 patients treated for cervical cancer at Clinic for Oncology, Clinical Center Nis, Serbia. According to the obtained Ki-67 PI values, patients were divided into three groups, and all the patients received the same cytostatic, cisplatin. Therapeutic response to chemotherapy was evaluated in relation to disease progression presence or absence and progression-free survival after a year follow-up since the first chemotherapy. RESULTS: Survival rate increases with an increase of Ki-67 PI by Kaplan-Meier survival analysis, meaning that survival rate is statistically significantly shorter in the group of patients with Ki-67 PI < 40% in comparison to patients from other two groups (p=0.010). Mann-Whitney test confirmed a statistically significant increase in survival rate among the groups of patients formed according to Ki-67 PI (p<0.05). Kaplan-Meier survival analysis confirmed that the mean survival rate in the group of patients with Ki-67 PI values over 60% is statistically significantly longer in comparison to patients with Ki-67 PI values below or equal 60% (p<0.001). CONCLUSIONS: Advanced cervical cancer with a high Ki-67 PI expression responds better to cisplatin-based chemotherapy, thus resulting in a longer survival rate. The values of Ki-67 PI were determined: high Ki-67 PI (≥ 60%), moderate Ki-67 PI (40-60%), and low Ki-67 PI (≤ 40%).

Can oral anaerobic bacteria cause adverse pregnancy outcomes?

AIM: Maternal periodontal infection has been recognized as a risk factor for premature and low birthweight infants. It is suspected that pathogens causing periodontal disease may translocate to the amniotic cavity and so contribute to triggering an adverse pregnancy outcome. The aim of this study was to evaluate whether the presence of specific periodontal pathogens may influence the incidence of preterm labor and premature birth. MATERIAL AND METHODS: This study was designed as a hospital-based case-control study. A total of 70 pregnant women, aged 18-40 with single live pregnancy were recruited from the Departement of Gynecolgy and Obstetrics at a General hospital in Sibenik, Croatia, between March 2013 to March 2014. The case group: 30 pregnant women who were hospitalised with signs of premature labor. CONTROL GROUP: 40 patients with normal pregnancy post-delivery up to 48 hrs, who had given birth at term, and the baby had a weight of more than 2500 gr. These women had undergone microbiological examination at the time of recruitment, microbial samples, paper point subgingival swabs were obtained in both groups and processed by anaerobic culturing. Standard procedures were used for culture and identification of bacteria. Information was collected on demographics, health behaviors, and obstetric and systemic diseases that may have influence the premature delivery. RESULTS: The levels of periodontal pathogens tended to be higher in the premature (case group) labor compared to the term deliveries (control group). Levels of Porphyromonas gingivalis, Fuscobacterium nucleatum, Actinomyces actinomycetecomitans were statistically significantly higher in premature births as compared to term deliveries, adjusting for baseline levels. The joint effects of red and orange microbial clusters were significantly higher in the premature group compared to the term group. CONCLUSIONS: The study shows a significant association betwen periodontal anaerobic infection and adverse pregnancy outcome. High levels of periodontal pathogens during pregnancy are associated with an increased risk for preterm delivery. Further studies elucidating the role of the microbial load and maternal immune response as related to pregnancy outcome seem merited.

IL-17 and glutamate excitotoxicity in the pathogenesis of multiple sclerosis.

Immunoinflammatory-mediated demyelination, the main pathological feature of multiple sclerosis (MS), is regularly accompanied by neurodegenerative processes, mostly in the form of axonal degeneration, which could be initiated by glutamate excitotoxicity. In the current study, the relationship between Th17-mediated inflammatory and excitotoxic events was investigated during an active phase of MS. Cerebrospinal fluid (CSF) of patients with MS and control subjects was collected, and IL-17A and glutamate levels were determined. IL-17A level was significantly higher in patients with MS; whereas no statistically significant changes in glutamate concentrations were found. There was a direct correlation between IL-17A and glutamate levels; IL-17A levels were also associated with the neutrophil expansion in CSF and blood-brain barrier disruption. However, IL-17A level and the number of neutrophils tended to fall with disease duration. The results suggest that Th17 cells might enhance and use glutamate excitotoxicity as an effector mechanism in the MS pathogenesis. Furthermore, Th17 immune response, as well as neutrophils, could be more important for MS onset rather than further disease development and progression, what could explain why some MS clinical trials, targeting Th17 cells in the later stage of the disease, failed to provide any clinical benefit.

Safety and efficacy of addition of bevacizumab to oxaliplatin-based preoperative chemotherapy in colorectal cancer with liver metastasis- a single institution experience.

PURPOSE: To evaluate the safety and efficacy of the addition of bevacizumab to oxaliplatin-based preoperative chemotherapy in metastatic colorectal cancer (mCRC) patients. METHODS: Between August 2008 and December 2011, 51 patients with histologically documented CRC and liver metastases were treated with first-line oxaliplatin-based therapy plus bevacizumab: FOLFOX 4 (oxaliplatin, folinic acid and 5-FU) plus bevacizumab or OXFL mod.Mayo (folinic acid, oxaliplatin and 5-FU) plus bevacizumab. RESULTS: The mean patient age was 59.69+ 9.38 years (range 38-78) and 34 (66.67%) were male. Complete response (CR) was achieved in 7 (13.73%) patients, partial response (PR) in 29 (56. 86%) and stable disease (SD) in 6 (11.76%); progressive disease (PD) was registered in 9 (17.65%) patients. Disease control rate was 82.36% (42 patients). Liver resections were performed in 37 (72.55%) patients vs those without resection (p<0.01). The same regimen without bevacizumab was administered postoperatively to 18 (42. 86%) patients. The mean progression free survival (PFS) was 9.90±7.07 months (range 3-26) and was significantly longer in patients with postoperative therapy (p<0.001). Treatment-related toxicity appeared in 28 (54. 90%) patients vs those who did not (p<0.001) Independent of grade, nausea (19.61%), leucopenia (17.65%) and peripheral neuropathy (17.65%) were the most frequent toxicities. Chemotherapy was postponed in 9 (17.65%) patients due to grade 3-4 toxicities. The most frequent grade 3 or 4 toxicities were leucopenia (5.88%) and hypertension (3.92%). CONCLUSION: Bevacizumab plus oxaliplatin-based treatment is safe and efficient as preoperative treatment of mCRC with primarily unresectable liver metastases. Liver resection could offer a possibility for long-term survival in these patients.

Prognostic value of peritumoral edema and angiogenesis in intracranial meningioma surgery.

PURPOSE: In a series of 78 consecutive patients we analyzed the influence of peritumoral edema (PTE) and angiogenesis (vascular endothelial growth factor/ VEGF expression) on the prognosis of morbidity and postoperative complications after intracranial meningioma surgery. METHODS: A retrospective analysis was performed of clinical, neuroradiological and histological data of 78 microsurgically treated patients with intracranial supratentorial meningioma, with follow-up period of at least one year. RESULTS: The severity of PTE showed significant correlation with VEGF expression, and all patients with large PTE (>40 mm) had strong VEGF expression (>50%). Treatment outcome was significantly better in patients with low VEGF expression (p<0.05). All of the monitored postoperative complications were more frequent in the group with PTE.The duration of intensive care treatment in the group with PTE (mean 6.85 days) was significantly longer than in the group without PTE (mean 3.68 days) (p=0.003). In the group without PTE, the outcome was significantly better than in patients with PTE (p<0.01). CONCLUSION: PTE in intracranial meningiomas has significant influence on the prognosis in surgically treated patients in terms of increased risk of morbidity and postoperative complications. VEGF expression is strongly correlated with PTE formation, which also affects the outcome in the management of patients with intracranial meningioma.

Correlation of nuclear morphometry of primary melanoma of the skin with clinicopathological parameters and expression of tumor suppressor proteins (p53 and p16(INK4a)) and bcl-2 oncoprotein.

PURPOSE: To determine the correlation of nuclear morphometry of primary cutaneous malignant melanoma (CMM) with clinicopathological parameters and the expression of p53, p16INK4a, and bcl-2. METHODS: Image analysis and computerized nuclear morphometry were used in a series of 53 primary CMM (nodular melanoma/NM, N=33, and superficially spreading melanoma/SSM, N=20). The clinicopathological parameters determined for each tumor were histological type, maximal tumor diameter, Breslow thickness, Clark level, ulceration, mitotic index (MI) and pathological disease stage. Measured nuclear features included size, shape and optical density (OD). The results were correlated with the expression of p53, p16INK4a and bcl-2. RESULTS: Significant differences between NM and SSM were found for the nuclear area, OD, and perimeter (p<0.05). MI showed significant correlations with nuclear area, perimeter and Feret diameter (p<0.05). In relation to the Clark level, significant differences were found for OD (p<0.01) and circularity of nuclei (p<0.05) between levels II and IV, while the Breslow thickness was not significantly correlated with nuclear morphometric variables. Significantly negative correlations were observed between OD and the expression of p53 and bcl-2, while significant positive correlation was found between the nuclear circularity and p53 immunoreaction intensity. There was no significant correlation between the expression of p16INK4a protein and karyometric variables. CONCLUSION: OD and circularity are significantly correlated with p53 and bcl-2, and nuclear area with MI. These karyometric variables may determine a more aggressive phenotype of melanoma cells.

Role of smoking in periodontal disease among diabetic patients.

OBJECTIVE: The objective of the study was to analyse the effect of smoking on periodontal disease in diabetic patients. METHODS: One hundred and fifty patients participated in the study Fifty patients with Type 1 diabetes mellitus (DM) and periodontal disease were the first group; 50 patients with Type 2 DM and periodontal disease were the second group, and 50 non-diabetic patients with periodontal disease were the third group. After anamnesis was taken, the variable in the analysis was smoker/non-smoker The status of the oral hygiene and periodontal condition was recorded using Plaque index, Supragingival calculus index, Subgingival calculus index, Gingival index, Periodontal Disease Index and Community Periodontal Index of Treatment Needs, by the periodontologist. RESULTS: Except Gingival index, mean values of all investigated indices were higher in smokers in all investigated groups. CONCLUSION: Periodontal disease is more advanced in diabetic smokers compared to diabetic non-smokers. It can be concluded that smoking negatively affects the course of diabetic periodontal disease and increases the risk of attachment loss. Diabetic smokers are at high risk for poor periodontal prognosis, and they should be included in careful periodontal treatment.

[Surgical treatment of degenerative cervical spine diseases: analyses of 90 patients clinical study]. / Hirursko lecenje degenerativnih oboljenja cervikalne kicme: analiza klinicke serije od 90 pacijenata.

The effect of degenerative cervical spine surgery depends on good understanding of the pathogenesis and clinical course of disease with a detailed neurological and neuroradiological examination. Surgical approach should be considered separately for each pathological substrate in order to avoid additional morbidity. The aim of our study is to present the results of treatment through analysis of large clinical series focusing on anterior surgical approach with iliac crest graft fusion without cervical plating. The retrospective analysis of 90 patients operated on Neurosurgery of CHC Zemun, from 2008 to 2011, was done. In 81 patients cervical disc herniation was found in one or two levels, and 9 patients had spinal canal stenosis with polydiscopathy. Preoperatively 50 patients had cervical myelopathy, and 40 patients had radiculopathy as dominating clinical sign. Anterior cervical approach was performed in 79 patients, and 11 patients were operated by posterior approach. The treatment outcome was as follows: good outcome 16 (16.8%) patients, improved condition 65 (72.2%), without improvement 6 (6.7%), bad outcome 3 (4.3%). The anterior cervical approach with iliac crest autologous graft fusion, and without additional cervical plating, is reliable treatment option with results comparable to reported clinical series with sintetic graft placement and anterior cervical plate stabilisation.

Simplified scoring system predicting HER-2 status in patients with breast carcinoma.

PURPOSE: The existing scoring systems HERSI (Kajo 2007) and DIVER (Taucher 2003) are based on the assumption that tumor grade, estrogen (ER) and progesterone receptors (PR) equally affect HER-2 status. Our idea was to propose a simplified scoring system (SIMPLY) which employs tumor characteristics according to their significance. METHODS: A total of 621 cases of invasive breast carcinoma with determined tumor grade, size, histological type, ER, PR, lymph node metastasis, lymphovascular invasion, age and HER-2 status were included in the study. The main features of the proposed system were simplicity in the scoring of ER and PR and emphasizing the role of tumor grade as the most important predictor of HER-2. RESULTS: The percentage of cases for which HER-2 assessment could be postponed was 33.98% for HERSI, 42.51% for DIVER, 53.62% for SIMPLY (score 5), and 66.34% for SIMPLY with a subgroup (score 3.5-5), when all scoring systems were applied to the same data set. CONCLUSION: In the SIMPLY group with the highest score, HER-2 assessment could be delayed, since the results from HER-2 assessment were not expected to affect patient management. SIMPLY could be helpful in improving patient care in countries lacking financial resources.

A feasibility study of realtime telemedicine in Croatia using Internet videoconferencing.

We explored the feasibility of realtime telemedicine in Croatia using Internet videoconferencing. A 33 kbit/s link was established between a team of specialists in the General Hospital 'Sveti Duh' in Zagreb and a general practitioner's clinic in Selca, on the island of Brac. During a two-week study, 16 patients (median age 51 years) were studied. Twenty-one teleconsultations (seven initial and 14 follow-up visits) were conducted, 13 with a specialist in internal medicine, six with a surgeon and two with a neurologist. In 18 cases (86%) telemedicine successfully replaced hands-on examination. The mean duration of the teleconsultations was 7.2 min (initial visits 7.4 min, follow-up visits 7.1 min). Each computer system cost about US$700. The total connection cost for the study was US$4.95. The teleconsultations saved the patients US$272 in travel costs. We suggest forming a permanent on-line specialist service connected to networked clinics via the Internet to improve access to health-care in Croatia.

[Parental behavior during the most common childhood diseases]. / Ponasanje roditelja u situacijama najcescih decjih bolesti.

The paper analyzes certain aspects of parental behaviour in situations of the most frequent children's diseases: their reactions, habits and some medical knowledge concerning antipyretics and antibiotics. An anonymous self-report questionnaire was applied. Five questions assessed demographic and seven the studied characteristics. 160 parents from the city and surrounding villages participated during period May - June 1993 in the offices of The Children and Adolescent Health Service in Krusevac. Most parents follow up the state of their children and/or try to help on their own before visiting the doctor. Only a small percentage decide to apply antibiotics. Those from villages and those with lower education are more likely to panic. Parents have habits of keeping antipyretics, tea and alcohol in home pharmacies in high percentage. They usually buy drugs or keep them from the previous children's disease. About half of them follow the instructions of doctor at what time the drug is to be applied. The rest take the advice of pharmacists, or act according to previous experience or drug declaration. 53.8% think that raised temperature should be lowered immediately when higher than 37 degrees C. About half of them connect the meaning of antibiotics with infection, but only 17.8% specifically with bacterial infections. It can be concluded that a parent is still an unreliable partner of a doctor for his often medically unjustified behaviour. It is specially characteristic for parents with elementary or secondary education, those from villages and unemployed parents.

The effects of parabiotic union with a normal partner on the blood tissue of the b/b rat suffering from an inheritable anemia.

The parabiotic union of a b/b rat, suffering from a red blood cell anemia, with a normal partner will restore to normal the functioning of this type of blood cell. The effect of parabiotic union is evident for several weeks following the separation of the parabiotic partners. It would be logical to conclude that the normal partner supplies a factor absent in the anemic animal needed for normal functioning of the red cell.

Inheritable precocious opening of the vagina in laboratory rats exposed to 300 R and 200 R of X-rays on day 6 of their intrauterine life.

A highly significant inheritable advancement in opening of the vagina in laboratory rats has been induced by the X-ray application to pregnant females of different filial generations origination from the X-irradiated FO embryos. The reaction to X-rays has so far been followed through 9 filial generations.