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Abstract: Background. Awake craniotomy is a neurosurgical technique that allows neurophysiological testing with patient cooperation during the resection of brain tumour in regional anaesthesia. This allows identification of vital functional (i.e. eloquent) brain areas during surgery and avoidance of their injury. The aim of the study was to present clinical experience with awake craniotomy for the treatment of gliomas at the University Medical Centre Ljubljana from 2015 to 2019.Patients and methods. Awake craniotomy was considered in patients with a gliomas near or within the language brain areas, in all cases of insular lesions and selected patients with lesions near or within primary motor brain cortex. Each patient was assessed before and after surgery.Results. During the 5-year period, 24 awake craniotomies were performed (18 male and 6 female patients; average age 41). The patient’s cooperation, discomfort and perceived pain assessed during the awake craniotomy were in majority of the cases excellent, slight, and moderate, respectively. After surgery, mild neurological worsening was observed in 13% (3/24) of patients. Gross total resection, in cases of malignant gliomas, was feasible in 60% (6/10) and in cases of low-grade gliomas in 29% (4/14). The surgery did not have important negative impact on functional status or quality of life as assessed by Karnofsky score and Short-Form 36 health survey, respectively (p > 0.05). Conclusions. The results suggest that awake craniotomy for treatment of gliomas is feasible and safe neurosurgical technique. The proper selection of patients, preoperative preparation with planning, and cooperation of medical team members are necessary for best treatment outcome.
Keywords: awake craniotomy, surgery of gliomas, intraoperative neurophysiological testing, primary brain tumours, clinical experiences
Published in DiRROS: 25.07.2024; Views: 245; Downloads: 384
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Abstract: Background. A recent trend in postoperative analgesia for lung cancer surgery relies on regional nerve blocks with decreased opioid administration. Our study aims to critically assess the continuous ultrasound-guided erector spinaeplane block (ESPB) at our institution and compare it to a standard regional anesthetic technique, the intercostal nerve block (ICNB).Patients and methods. A prospective randomized-control study was performed to compare outcomes of pa-tients, scheduled for video-assisted thoracoscopic (VATS) lung cancer resection, allocated to the ESPB or ICNB group. Primary outcomes were total opioid consumption and subjective pain scores at rest and cough each hour in 48 h after surgery. The secondary outcome was respiratory muscle strength, measured by maximal inspiratory and expiratory pressures (MIP/MEP) after 24 h and 48 h.Results. 60 patients met the inclusion criteria, half ESPB. Total opioid consumption in the first 48 h was 21.64 ± 14.22 mg in the ESPB group and 38.34 ± 29.91 mg in the ICNB group (p = 0.035). The patients in the ESPB group had lower numerical rating scores at rest than in the ICNB group (1.19 ± 0.73 vs. 1.77 ± 1.01, p = 0.039). There were no significant differences in MIP/MEP decrease from baseline after 24 h (MIP p = 0.088, MEP p = 0.182) or 48 h (MIP p = 0.110, MEP p = 0.645), time to chest tube removal or hospital discharge between the two groups.Conclusions. In the first 48 h after surgery, patients with continuous ESPB required fewer opioids and reported less pain than patients with ICNB. There were no differences regarding respiratory muscle strength, postoperative compli-cations, and time to hospital discharge. In addition, continuous ESPB demanded more surveillance than ICNB.
Keywords: erector spinae plane block, intercostal nerve block, postoperative analgesia, video-assisted thoracic surgery, thoracic anesthesia
Published in DiRROS: 25.07.2024; Views: 261; Downloads: 250
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Abstract: The term genitourinary syndrome of menopause was first used in 2014 by the North American Menopause Society and the International Society for the Study of Women's Sexual Health to describe conditions previously known as atrophic vaginitis, urogenital atrophy, or vulvovaginal atrophy. It is a complex, chronic, progressive condition characterized by a wide range of signs and symptoms affecting sexual function and the tissues of the urinary and genital tracts. The main cause of genitourinary syndrome of menopause is estrogen deficiency caused by ovarian removal or dysfunction. The most bothersome symptoms are vaginal dryness, decreased vaginal lubrication, and pain during penetration and intercourse. They all have a negative impact on the quality of life. Conclusions: The main goal of treatment is to relieve the symptoms. Treatment modalities are pharmacological or non-pharmacological. The first-line treatment for mild to moderate symptoms is the use of personal lubricants and moisturizers, but the gold standard is estrogen replacement therapy. Hormone therapy may not be an option for women with hormone-dependent cancer.
Keywords: genitourinary syndrome, gynecological malignancies, therapy
Published in DiRROS: 25.07.2024; Views: 233; Downloads: 85
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Abstract: Background. Liver transplantation offers curative treatment to patients with acute and chronic end-stage liver disease. The impact of nutritional status on postoperative outcomes after liver transplantation remains poorly under-stood. The present study investigated the predictive value of radiologically assessed skeletal muscle index (SMI) and myosteatosis (MI) on postoperative outcomes.Patients and methods. Data of 138 adult patients who underwent their first orthotopic liver transplantation were retrospectively analysed. SMI and MI in computer tomography (CT) scan at the third lumbar vertebra level were cal-culated. Results were analyzed for the length of hospitalisation and postoperative outcomes.Results. In 63% of male and 28.9% of female recipients, low SMI was found. High MI was found in 45(32.6%) patients. Male patients with high SMI had longer intensive care unit (ICU) stay (P < 0.025). Low SMI had no influence on ICU stay in female patients (P = 0.544), length of hospitalisation (male, P > 0.05; female, P = 0.843), postoperative complication rates (males, P = 0.883; females, P = 0.113), infection rate (males, P = 0.293, females, P = 0.285) and graft rejection (males, P = 0.875; females, P = 0.135). The presence of MI did not influence ICU stay (P = 0.161), hospitalization (P = 0.771), postoperative complication rates (P = 0.467), infection rate (P = 0.173) or graft rejection rate (P = 0.173).Conclusions. In our study, changes in body composition of liver transplant recipients observed with SMI and MI had no impact on postoperative course after liver transplantation. CT body composition analysis of recipients and uni-formly accepted cut-off points are crucial to producing reliable data in the future.
Keywords: muscle mass, liver transplantation, myosteatosis, skeletal muscle index, GLIM score
Published in DiRROS: 25.07.2024; Views: 262; Downloads: 270
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Abstract: We aimed to identify changes in quality of life after breast cancer treatment and compare them withthe normative population data for the Slovenian population.Patients and methods. A prospective, single-group, cohort design was used. A total of 102 early breast cancerpatients treated with chemotherapy at the Institute of Oncology Ljubljana were included. Of those, 71% returned thequestionnaires after one-year post-chemotherapy. The Slovenian versions of the European Organisation for Researchand Treatment of Cancer (EORTC) QLQ C30 and BR23 questionnaires were used. Primary outcomes were a com-parison of global health status/quality of life (GHS) and C30 Summary Score (C30-SumSc) at baseline and one-yearpost-chemotherapy with the normative Slovenian population. The exploratory analysis evaluated the differences insymptoms and functional scales of QLQ C-30 and QLQ BR-23 between baseline and one-year post-chemotherapy.Results. At baseline and one-year post-chemotherapy, C30-SumSc of patients was lower than the predictedC30-SumSc from the normative Slovenian population by 2.6 points (p = 0.04) and 6.5 points (p < 0.001), resp. On thecontrary, GHS was not statistically different from predicted either at baseline or after one year. Exploratory analysisrevealed that one-year post-chemotherapy compared to the beginning of chemotherapy, patients had statisticallysignificantly and clinically meaningful lower scores in body image and cognitive functioning, and increased symptomscores for pain, fatigue, and arm symptoms.Conclusions. The C30-SumSc is reduced one- year post-chemotherapy. Early interventions should be directed to-ward the prevention of the decline of cognitive functioning and body image, and to alleviate fatigue, pain, and armsymptoms.
Keywords: breast cancer, chemotherapy, quality of life
Published in DiRROS: 25.07.2024; Views: 237; Downloads: 97
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