Standard Lumbar Discectomy Versus Microdiscectomy - Differences in Clinical Outcome and Reoperation Rate.

Microdiscectomy (MD) is accepted nowadays as the operative method of choice for lumbar disc herniation, but it is not rare for neurosurgeons to opt for standard discectomy (SD), which does not entail the use of operating microscope. In our study, differences in disc herniation recurrence and clinical outcome of surgical treatment of lumbar disc herniation with and without the use of operating microscope were assessed. Our study included 167 patients undergoing lumbar disc surgery during a three-year period (SD, n=111 and MD, n=56). Clinical outcome assessments were recorded by patients via questionnaire forms filled out by patients at three time points. Operation duration, length of hospital stay and revision surgeries were also recorded. According to study results, after one-year follow up there was no statistically significant difference between the SD and MD groups in functional outcome. However, we recorded a statistically significant difference in leg pain reduction in favor of the MD group. According to the frequency of reoperations with the mean follow up period of 33.4 months, there was a statistically significant difference in favor of the MD group (SD 6.3% vs. MD 3.2%). There appears to be no particular advantage of either technique in terms of functional outcome since both result in good overall outcome. However, we choose MD over SD because it includes significantly lower recurrent disc herniation rate and higher reduction of leg pain.

Morphometric analysis of collagen and inflammatory cells in periodontal disease.

BACKGROUND/AIM: Periodontal disease affects gingival tissue and supporting apparatus of the teeth leading to its decay. The aim of this study was to highlight and precisely determine his- tological changes in the gum tissue. METHODS: Gingival biopsy samples from 53 healthy and parodontopathy-affected patients were used. Clinical staging of the disease was performed. Tissue specimens were fixed and routinely processed. Sections, 5 µm thin, were stained with hematoxylin and eosin, histochemical Van-Gieson for the collagen content, Spicer method for mast-cells and immunochemical method with anti-CD68 and anti-CD38 for the labelling of the macrophages and plasma-cells. Morphometric analysis was performed by a M42 test system. RESULTS: While the disease advanced, collagen and fibroblast volume density decreased almost twice in the severe cases compared to the control ones, but a significant variation was observed within the investigated groups. The mast-cell number increased nearly two times, while the macrophage content was up to three times higher in severe parodontopathy than in healthy gingival tissue. However, the relative proportion of these cells stayed around 6% in all cases. Plasma-cells had the most prominent increase in the number (over 8 times) compared to the control, but again, a variation within investigated groups was very high. CONCLUSION: Gingival tissue destruction caused by inflammatory process leads to significant changes in collagen density and population of resident connective tissue cells. Although inflammatory cells dominated with the disease advancing, a high variation within the same investigated groups suggests fluctuation of the pathological process.

Embolization of ruptured intracranial aneurysms with detachable coils: case series.

PURPOSE: We present a series of patients with subarachnoid hemorrhage (SAH) from ruptured intracranial aneurysms who were treated with endovascular embolization by detachable coils. MATERIALS AND METHODS: There were 108 patients with SAH treated with endovascular coiling. The efficacy of the endovascular coiling was estimated by initial postembolization angiography and by digital subtraction angiography after 6 months, using the following categories: complete occlusion of an aneurysm (98%-100%), near-complete occlusion (90%-98%), and incomplete occlusion (<90%). RESULTS: In 42 (39%) patients the endovascular coiling was performed during the fi rst 72 h after SAH, and 48 (44%) patients had aneurysms <10 mm in diameter. The most frequent location of ruptured aneurysms was the internal carotid artery (39 patients, 36%). Initially, complete occlusion of the aneurysm was achieved in 87 patients (81%), near-complete in 12 patients (11%), and incomplete in 9 patients (8%). After 6 months, complete occlusion of the aneurysm remained in 84 patients, near-complete in 12 patients, and incomplete in 6 patients; 6 patients were lost to follow-up. CONCLUSION: Endovascular coiling of ruptured intracranial aneurysms is an efficient procedure that should be performed as soon as possible after detection of an SAH.

[Factors influencing general practitioners and specialists of general practice to declare in favor of accepting the role of family doctors].

INTRODUCTION: Protection and promotion of health of an individual, family and society as the whole depends on the organization and efficiency of the public health service. Modern health service is focused on the health prevention and improvement of the family which is the basic unit of society. The life cycle of the family indicates crisis related to development and underdevelopment as well as some expected and unexpected life situations and this is very important when discussing about many somatic and mental diseases. OBJECTIVE: The objective of our project which included 473 specialists of general practice and 355 general practitioners was to determine the factors which influence the positive attitude of the general practitioners about becoming a family doctor. METHOD: A total of 828 doctors in Serbia were required to answer the set of eight questions. Statistical analysis included Pearson chi square test with contingency tables and logistic regression, while dependent variable was doctor's attitude about becoming a family doctor in a certain situation. The answer 'no' or 'I don't know' was scored 1 point and the 'yes' answer was graded 2 points. Eight questions mentioned above were independent variables. RESULTS: Logistic model accounting for 79.3% of dependent variable was obtained. Positive attitude of doctors was very much affected by family problems and great majority of these doctors were specialists of general practice. Other questions were not so important for our results. CONCLUSION: Specialists of general practice, regardless of their working experience and years of practice, gave significantly more positive answers, and the situation was quite opposite with general practitioners. Family medicine supported by modern information systems provides ideal model of comprehensive and complete health prevention with high level of rationalism, quality, efficiency and cost-effectiveness.