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BACKGROUND: Although the number of educated women and physicians, and especially neurosurgeons, is increasing worldwide, the educational opportunities, careers, and beliefs concerning female neurosurgeon's status and abilities are undermined. To date, reported studies have focused on the conditions of the work environment, work-life balance, and the academic career of female neurosurgeons. In this study, we aimed to report the patients' viewpoint and how they choose spine physicians. METHODS: We conducted an international survey based on 19 questions in four languages (Bulgarian, Greek, English, and German). The responses of 413 individuals, unrelated to the medical field (sex, 315 female and 115 male individuals; one individual did not answer the question regarding the gender), were obtained. Except for the question regarding the patient's preference for the physician sex, the survey aimed to examine the factors that might be contributing to this choice, including education, age, heard/read recommendations/advertisements, knowledge regarding the work of the neurosurgeons/orthopedists, and their difference regarding spine surgery. RESULTS: The majority of the participants responded that they prefer male surgeons to treat their spine. The results showed a significant correlation between the choice of a male spine surgeon and heard/read advertisements/recommendations and knowledge regarding the work of the neurosurgeon. Despite the fact that education was not related to physician selection, it was an indirect factor that led to the final choice. CONCLUSION: Women in surgery, mainly in neurosurgery, are being treated by society in an unequal way. Female surgeons are still discriminated because of their gender. The most patients prefer female physicians to talk to, but still believe that they are incapable to perform spine surgery. We cannot stop this until we change our mindset and perception of reality.
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Patients with active cancer are at high risk of recurrent venous thromboembolism (VTE). Usual treatment includes low molecular weight heparin (LMWH), while vitamin K antagonists (VKAs) have also been used as substitutes for LMWH. Direct oral anticoagulants (DOACs) are considered a beneficial alternative to the usual treatment but are accompanied by an increased rate of bleeding compared to LMWH. We conducted a meta-analysis to evaluate the benefits and harms under a common denomination, namely the net clinical benefit (NCB), between DOACs and usual anticoagulation. The primary outcome was NCB-1, defined as non-fatal VTE, major non-fatal bleedings, and all-cause mortality). Co-primary outcomes were 1) NCB-2 (i.e., NCB-1 and clinically relevant non-major bleedings) and 2) NCB-3 (i.e., fatal or non-fatal VTE and major bleedings). A random-effects model was used to calculate outcome risk ratios and 95% confidence intervals (CI). Prospective Register of Systematic Reviews identification number CRD42021284238. We selected 8 studies (n = 4,4461 patients; mean follow-up, 6 months). The NCB-1 and -2 were not different between DOACs and usual anticoagulation, while the NCB-3 showed a reduction of 28% (95% CI, 10-42%), favoring DOACs. Recurrent VTE was reduced by 40% (95% CI, 25-53%) with DOACs than the usual treatment. Different bleeding outcomes and all-cause mortality were not different between treatments. All primary outcomes did not differ between DOACs and LMWH, while NCB-2 and NCB-3 were reduced with DOACs than VKAs. The NCB of DOACs was similar or more favorable to usual anticoagulation in patients with active cancer due to a substantial reduction of VTE and no bleeding excess.
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Neoplasias , Tromboembolia Venosa , Humanos , Heparina de Baixo Peso Molecular/uso terapêutico , Tromboembolia Venosa/complicações , Anticoagulantes/efeitos adversos , Hemorragia/induzido quimicamente , Hemorragia/tratamento farmacológico , Neoplasias/complicações , Neoplasias/tratamento farmacológico , Administração OralRESUMO
INTRODUCTION: Glioblastoma cases are often treated with aggressive resection. Recent studies have suggested that extended surgical resection could improve survival. Improved extent of resection could be afforded by the use of fluorescence during surgery. We aimed to examine the effect of fluorescence on the results of gross total resection (GTR) and its impact on the overall survival (OS) and progression-free survival (PFS) rates. METHODS: We performed a literature search of studies published between 2000 and 2021. The study followed the PRISMA guidelines and focused on newly-diagnosed glioblastoma cases. The collected data were divided into two groups according to the fluorescence use: Group A (standard white-light use) and Group B (fluorescent-light use). RESULTS: The results showed a superiority of the fluorescence use during surgery for newly diagnosed glioblastoma cases concerning the procurement of GTR. Additionally, we highlighted the importance of GTR on the OS but not on the PFS rate. We found that the use of 5-aminolevulinic acid resulted in better OS rates compared to fluorescein sodium. CONCLUSION: GTR is a significant factor leading to improved OS; nevertheless, it was an apparently unrelated factor for estimating the PFS rate. Fluorescence use during surgery could lead to higher rates of complete resection and better OS rates.
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Neoplasias Encefálicas , Glioblastoma , Ácido Aminolevulínico , Neoplasias Encefálicas/cirurgia , Fluoresceína , Glioblastoma/diagnóstico , Humanos , Taxa de SobrevidaRESUMO
BACKGROUND: Unfavorable anatomy is one of the major limitations of endovascular aortic aneurysm repair (EVAR) with specifically adverse proximal neck morphology excluding many patients from receiving the standard endograft devices. Thoracic tube endografts have been used to overcome the issue of wide infrarenal necks, either as a sole device (single tubes or double tubes using the trombone technique) or as the proximal part of a bifurcated device fixed to the aortic bifurcation or infrarenally oriented. However, custom-made large proximal diameter bifurcated endograft designs have never been used. METHODS: We present the case of a 56-year-old man with Marfan syndrome, suffering abdominal aortic aneurysm (AAA) enlargement from a type Ib endoleak after previous EVAR with 2 Endofit tube endografts (trombone technique). He was considered unfit for open surgery while possible alternatives such as fenestrated endovascular AAA repair and chimney technique were excluded. RESULTS: The patient was treated with a custom-made 44-mm proximal diameter, bifurcated Bolton Medical Treovance device with technical and clinical success. No immediate or perioperative complications were noted. Follow-up after 6 months showed graft patency and no endoleak of any type. CONCLUSIONS: This alternative technique for hostile proximal neck management is promising and needs long-term follow-up; an issue which is discussed within the broader context of custom-made device regulations.
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Aneurisma da Aorta Abdominal/cirurgia , Implante de Prótese Vascular/instrumentação , Prótese Vascular , Endoleak/cirurgia , Procedimentos Endovasculares/instrumentação , Síndrome de Marfan/complicações , Falha de Prótese , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Aneurisma da Aorta Abdominal/etiologia , Aortografia/métodos , Implante de Prótese Vascular/efeitos adversos , Angiografia por Tomografia Computadorizada , Endoleak/diagnóstico por imagem , Endoleak/etiologia , Procedimentos Endovasculares/efeitos adversos , Humanos , Masculino , Síndrome de Marfan/diagnóstico , Pessoa de Meia-Idade , Desenho de Prótese , Resultado do TratamentoRESUMO
We report the case of a 79-year-old man who was admitted to our department with acute limb ischemia due to the occlusion of the left iliac limb of an Endurant endograft. The admission computed tomography angiography revealed also a type IIIa endoleak due to modular disconnection of the iliac extensions from the right iliac limb of the endograft main body. Interestingly, during the 4-year post-endovascular aneurysm repair period, an increased kinking of the right limb has been observed leading to an almost cross-limb configuration of the limbs at the time of complications. To our knowledge, this is the first case in the literature of the simultaneous presence of limb thrombosis and late type IIIa endoleak with this particular device. The ischemia was treated with a femoro-femoral cross-over bypass, and the endoleak was corrected with the position of 2 Endurant iliac limb extensions bridging the dislocated endograft pieces.
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Aneurisma da Aorta Abdominal/cirurgia , Implante de Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/instrumentação , Prótese Vascular/efeitos adversos , Endoleak/etiologia , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/instrumentação , Migração de Corpo Estranho/etiologia , Oclusão de Enxerto Vascular/etiologia , Artéria Ilíaca/cirurgia , Isquemia/etiologia , Idoso , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Aortografia/métodos , Angiografia por Tomografia Computadorizada , Endoleak/diagnóstico por imagem , Endoleak/cirurgia , Migração de Corpo Estranho/diagnóstico por imagem , Migração de Corpo Estranho/cirurgia , Oclusão de Enxerto Vascular/diagnóstico por imagem , Oclusão de Enxerto Vascular/cirurgia , Humanos , Artéria Ilíaca/diagnóstico por imagem , Isquemia/diagnóstico por imagem , Isquemia/cirurgia , Masculino , Desenho de Prótese , Resultado do TratamentoRESUMO
OBJECTIVE: Spinal arteriovenous malformations (AVM) manifest in the pediatric population very differently from the ones in adulthood. Despite that fact, the treatment strategy is quite the same, which provokes a question - whether some of the therapies have an advantage and if so, in which age group. METHODS: For this reason, the authors searched the world literature between 1989 and 2018 for spinal AVM in children and further categorized the studies into two age groups: < 12 and ≥12. RESULTS: The total number of included studies in this meta-analysis is 35. Seventeen of them are on the subject of AVM and 15 on the subject of arteriovenous fistula. Three studies encompass both types of lesions. CONCLUSION: After processing the data, we observed that there is no relationship between age group and the utilized management, except for the endovascular AVF in children less than 12 years of age. Because of this, it should be strongly considered in further management planning.
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Fístula Arteriovenosa/cirurgia , Malformações Arteriovenosas/cirurgia , Procedimentos Endovasculares , Medula Espinal/anormalidades , Medula Espinal/cirurgia , Adolescente , Fatores Etários , Fístula Arteriovenosa/terapia , Criança , Pré-Escolar , Embolização Terapêutica/métodos , Procedimentos Endovasculares/métodos , Humanos , Lactente , Recém-Nascido , Medula Espinal/irrigação sanguíneaRESUMO
(1) Self-regulation of driving is a means of maintaining one's driving identity. The purpose of this study was to investigate the extent to which older drivers with Mild Cognitive Impairment (MCI) are metacognitively aware of the requirements of specific demanding driving conditions and whether this awareness is linked to subjective assessments of cognition. (2) One hundred seventeen (117) older MCI drivers participated in a telephone survey in which they reported their metacognitive experiences in nine driving conditions, listed as an aim of self-regulation. The analyses included the participants' subjective cognitive assessments, both in terms of their cognitive state and their perceived driving self-efficacy. (3) The analyses pointed out a direct and negative effect of age on the formation of the metacognitive feeling of certainty. Furthermore, an indirect effect of sex through driving self-efficacy was established. This effect was negative in the case of the metacognitive feeling of difficulty and the estimation of effort and positive in the case of the metacognitive feeling of certainty. (4) This position points out the need to establish appropriate levels of the perceived self-efficacy of older drivers with MCI, and it raises issues when it moves to fictitious levels.
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Frontotemporal dementia (FTD) is a neurodegenerative disorder characterized by progressive impairments in behavior, executive function, and language, primarily affecting individuals under the age of 65. This disorder is associated with expressive and receptive anomia, word comprehension deficits, and behavioral symptoms such as apathy, loss of empathy, and disinhibition, all of which closely correlate with functional impairment in daily activities. Despite substantial efforts, research on occupational therapy (OT) interventions has yet to demonstrate clear benefits in managing the disease. The aim of this study is to investigate OT interventions and assess their efficacy, with a specific focus on individuals suffering from FTD. We systematically conducted searches on two databases, namely Medline and Science Direct, spanning a ten-year period from 2003 to 2023, in accordance with the PRISMA guidelines. Eleven studies met the inclusion criteria. OT interventions targeted both patients and caregivers and yielded significant positive improvements in their lives. A key focus of these interventions was to teach acceptable alternatives to the behaviors exhibited by FTD patients, as these behaviors are strongly influenced by the disease itself. OT contributes positively to enhancing the quality of life of FTD patients and alleviating the caregiving burden experienced by those providing long-term care to these patients.
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Demência Frontotemporal , Terapia Ocupacional , Doença de Pick , Humanos , Demência Frontotemporal/terapia , Qualidade de Vida , CuidadoresRESUMO
Management of glioblastoma should be aggressive and personalised to increase the quality of life. Many new therapies, such as active immunotherapy, increase the overall survival, yet they result in complications which render the search for the optimal treatment stra-tegy challenging.
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Neoplasias Encefálicas , Glioblastoma , Neoplasias Encefálicas/terapia , Quimiorradioterapia , Glioblastoma/terapia , Humanos , Imunoterapia Ativa , Qualidade de VidaRESUMO
Brain tumours are a heterogenic group, a subtype of which is arising from glial cells. Pediatric low-grade gliomas are the most common primary CNS tumour group in childhood, representing 25% to over 30% of pediatric CNS tumours. Pediatric high-grade gliomas are relatively rare and have a poor prognosis. Epidemiological studies have reported various potential risk factors, such as demographics, ionizing and nonionizing radiation, allergic conditions, and infections, immunologic, parental, genetic, and developmental risk factors. These risk factors are relatively unclear and understudied; thus, this narrative review aims to summarize all studies connecting risk factors and pediatric gliomas.
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Neoplasias Encefálicas , Glioma , Neoplasias Encefálicas/epidemiologia , Neoplasias Encefálicas/patologia , Criança , Glioma/epidemiologia , Glioma/etiologia , Humanos , Prognóstico , Fatores de RiscoRESUMO
INTRODUCTION: Cancer patients are usually subjected to numerous surgeries during their course of treatment. Recent studies suggest that anesthetic drugs such as propofol, benzodiazepines, and opioids are linked to cognitive impairment. AIM: The aim of the study was to show and compare the cognitive function of oncology patients who have undergone surgery and have been sedated with propofol, fentanyl and benzodiazepines. MATERIALS AND METHODS: In order to determine whether the cognition of oncological patients is being impaired, a mini-mental state examination (MMSE) test was obtained 6 to 24 hours pre- and postoperatively for the duration of one month from 8 eligible oncological patients and 7 non-oncological ones. Afterwards, the data were statistically processed with SPSS version 25.0 (Chicago, Ill. the USA). RESULTS: The analysis shows that there is statistically significant difference in the preoperative MMSE scores between oncological and non-oncological patients. CONCLUSIONS: Oncological patients compound a sensitive group for cognitive dysfunction, and indeed, MMSE test could be useful for cognitive evaluation. The present sample, however, is small, and the results could not be generalized. Therefore a more extensive study is needed.
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Neoplasias , Benzodiazepinas , Humanos , Testes de Estado Mental e Demência , Prognóstico , Propofol , Oncologia CirúrgicaRESUMO
OBJECTIVE: Brain trauma and its burden is becoming a significant cause of permanent damage and deterioration. Prioritization at the place of the incident and calculation of mortality are leading factors for the final management, but all of them are obtained from living patients. When the autopsies are made there is no actual score system to guide the forensic scientists in their conclusions. Should all of the cadavers with traumatic brain injury (TBI) have been dead? Therefore, we aim to present a score system-brain trauma mortality score scale (BTMSS), aiming to evaluate postmortem the actual risk of mortality. METHODS: We established a score scale, which could be used on cadavers for the evaluation of the events. Afterwards, we applied this score scale on the reports of the cadavers who suffered blunt force TBI for a 10-year period of time between 2007 and 2016. Thereafter, the results were processed with SPSS version 25. RESULTS: The outcome showed that there is a significant difference between the scores of the cadavers who died at the place of the incident and those who died in hospital thus approving that the BTMSS works well, as well as the importance of level I trauma center. CONCLUSION: Every score system could show something useful for the management of the TBIs. The solution and improvement in the outcome of the current study would be a level I trauma center with a qualified neurosurgical department.
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OBJECTIVE: Traumatic brain injury (TBI) due to transport accidents is a serious cause of death and disability. In every case, however, quick response and a proper health care are required. MATERIALS AND METHODS: We collected 10-year data retrospectively from the laboratory of forensic science and toxicology in Montana, Bulgaria with the intention to show the importance of neurosurgical care in the traumatology and its connection to mortality rate. RESULTS: 124 cadavers were included with significant male predominance. The data analysis shows that the mortality rate at the hospitals without neurosurgical facilities and the mortality at the scene of the accident is the same for traffic brain injuries. Furthermore, we found that the age has no correlation with the mortality rate. CONCLUSION: Road injuries are the most common type of brain injury. We believe that the outcome of these TBIs depends on the availability of a neurosurgical unit.
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Acidentes de Trânsito/mortalidade , Lesões Encefálicas Traumáticas/mortalidade , Acessibilidade aos Serviços de Saúde , Mortalidade Hospitalar , Procedimentos Neurocirúrgicos , Adulto , Fatores Etários , Idoso , Autopsia , Lesões Encefálicas Traumáticas/epidemiologia , Lesões Encefálicas Traumáticas/cirurgia , Bulgária/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Mortalidade , Neurocirurgia , Estudos Retrospectivos , Adulto JovemRESUMO
INTRODUCTION: Patients with gastrointestinal cancer are at high risk of developing thrombosis and postoperative infection. Antico-agulation therapy for such patients is provided by low molecular weight heparin (LMWH) and elastic stockings. The latter, however, is linked to immunoregulatory activities and immunosuppression in vivo and in vitro. AIM: Therefore, the present study aimed to examine the link between LMWH and infection in patients with gastrointestinal cancer. MATERIALS AND METHODS: The study is a retrospective report of 51 patients operated on at the Second Department of Surgery at Metaxa Cancer Hospital. The sample was divided into groups based on the presence or absence of diabetes and preoperative anticoagu-lation therapy. Afterwards, the data were statistically analysed. RESULTS: The results of the study show a statistically significant correlation between LMWH and infection. Moreover, the risk of infec-tion increases by 13.3% for each day of heparin intake. The theory of this correlation is explained in detail. CONCLUSIONS: The findings of the present study raise an essential question about postoperative management of cancer patients. How-ever, the study sample size is rather small so further studies with larger sample size are required to give greater credence to results.
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Procedimentos Cirúrgicos do Sistema Digestório/efeitos adversos , Neoplasias Gastrointestinais/cirurgia , Heparina de Baixo Peso Molecular/efeitos adversos , Infecção da Ferida Cirúrgica/induzido quimicamente , Idoso , Anticoagulantes/efeitos adversos , Feminino , Seguimentos , Humanos , Masculino , Estudos Retrospectivos , Infecção da Ferida Cirúrgica/epidemiologiaRESUMO
OBJECTIVE: Brain trauma is an extremely important economical and social issue with increasing daily incidence. It is important to observe and report brain trauma, in order to provide better conditions for improvement of the trauma prevention and management. METHODS: A ten-year retrospective observational analysis was performed on 292 (fatal and non-fatal) incidents of traumatic brain injury among 2,847 totally examined cases in the records of the laboratory of forensic sciences at Democritus University of Thrace between January 1, 2007 and December 31, 2016. The results were further analyzed and classified into pertinent categories associated with the purpose of the study. RESULTS: The average age was estimated at 47.24 years with an obvious male domination. The most common cause of TBI, according to the results, is transport accidents (61.85%) followed by trauma inflicted by blunt instrument (22.49%), fall from height (11.65%) and occupational accidents (4.02%). Mortality rates were evaluated for each type, revealing extremely disturbing numbers. Regarding the anatomical localization on the skull, the most common region of cranial fractures is the cranial base (16.48%), followed by the frontal (12.87%), occipital (11.29%) and parietal bones (11.06%). In the majority of the cases, there were associated injuries. CONCLUSION: The management of traumatic brain injuries is difficult and sometimes impossible. Better prevention measures are required to minimize as much as possible the incidence of brain trauma.
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OBJECTIVE: Penetrating brain trauma (PBT) caused by gunshot is one of the most lethal traumatic brain injuries (TBIs) and its management and confrontation is of great importance. METHODS: The authors searched retrospectively the archives from 2 similar autonomous laboratories of forensic science and toxicology in the Balkan peninsula for a 10-year period of time and included only fatal penetrating brain injuries. RESULTS: The study is conducted in 61 cadavers with gunshot PBT. All of the cadavers were victims of suicide attempt. The most common anatomical localization on the skull were the facial bones, followed by skull base, temporal and parietal bone, conducting a trajectory of the gunshot. Additional findings were atherosclerosis of the blood vessels and chronic diseases such as chronic obstructive pulmonary disease, cancer and fatty liver. CONCLUSION: PBI has a high mortality rate. There are factors and findings from the collected data differing between the 2 aforementioned nations. Either way, better preventative measures, gun control and healthcare system are highly necessary.
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OBJECTIVE: Brain atrophy and brain herniation are gaining a lot of attention separately, but a limited amount of studies connected them together, and because of this, we are going to review and examine the subject in the current meta-analysis. METHODS: The authors collected data reporting brain atrophy of alcoholic and schizophrenic cause, as well as data on control patients, all of which was published on MEDLINE between 1996 and 2018. The included 11 articles were processed with a statistical program. RESULTS: We found that the pericerebral space is unequal among the groups, while the intracranial volume is strongly correlated to the biggest foramen of the body. The effect of this inequality, however, is expressed in emergency cases, where the patients with brain atrophy will have more time before the final stage of brain herniation. CONCLUSION: The current study raises a controversial issue that requires careful investigation and high attention from the health care personnel.
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OBJECTIVE AND CONCLUSION: Neurosurgery is probably the most constantly developing specialty of all times. Its dimension is enormous and its history, Ancient. The evolution of neurosurgery from the Mayan and Egyptian periods to the Renaissance and the 21st century was the result of many physicians and patients whose experiences lead to the revolution of modernization. Today, the field of neurosurgery is continuously expanding, aiming to introduce knowledge and technologies that could provide a new futuristic wave of medicine. METHODS: Given this background, our team selected relevant data from Medline published between 1936 and 2017. RESULTS: We included 91 articles on this topic, all of them providing enough information about the revolution and progress of brain surgery through the centuries as well as its potential expansion in the future.