1. Awake craniotomy for operative treatment of brain gliomas - experience from University Medical Centre LjubljanaTilen Žele, Tomaž Velnar, Blaž Koritnik, Roman Bošnjak, Jasmina Markovič Božič, 2023, izvirni znanstveni članek Povzetek: 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.
Ključne besede: awake craniotomy, surgery of gliomas, intraoperative neurophysiological testing, primary brain tumours, clinical experiences
Objavljeno v DiRROS: 25.07.2024; Ogledov: 66; Prenosov: 43
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2. Crystalloids vs. colloids for fluid optimization in patients undergoing brain tumour surgeryJasmina Markovič Božič, Božidar Visočnik, Polona Mušič, Iztok Potočnik, Alenka Spindler-Vesel, 2022, izvirni znanstveni članek Povzetek: Background. This randomised, double-blinded, single-centre study prospectively investigated the impact of goal directed therapy and fluid optimization with crystalloids or colloids on perioperative complications in patients un-dergoing brain tumour surgery. Main aim of the study was to investigate the impact of fluid type on postoperative complications.Patients and methods. 80 patients were allocated into two equal groups to be optimised with either crystalloids (n = 40) or colloids (n = 40). Invasive hemodynamic monitoring was used to adjust and maintain mean arterial pressure and cerebral oxygenation within the baseline values (± 20%) and stroke volume variation (SVV) ≤ 10%. Postoperative complications from different organ systems were monitored during the first 15 days after surgery. Hospital stay was also recorded.Results. Crystalloid group received significantly more fluids (p = 0.003) and phenylephrine (p = 0.02) compared to colloid group. This did not have any significant impact on perioperative complications and hospital stay, since no dif-ferences between groups were observed. Conclusions. Either crystalloids or colloids could be used for fluid optimization in brain tumour surgery. If protocol-ised perioperative haemodynamic management is used, the type of fluid does not have significant impact on the outcome.
Objavljeno v DiRROS: 25.07.2024; Ogledov: 66; Prenosov: 17
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3. The urokinase plasminogen activator and its inhibitors PAI-1 nad PAI-2 in primary cutaneous melanomaJasmina Markovič Božič, Borut Štabuc, 2003, izvirni znanstveni članek Povzetek: Background. We investigated the differences in urokinase plasminogen activator(uPA) and its inhibitors type-1 and 2 (PAI-1/2) concentrations in clinically suspected nevi, primary cutaneous melanoma and normal skin and correlations with histopathological prognostic factors of primary melanoma. Patients and methods. Fifty-one patients were enrolled. The tissue concentrations of uPA, PAI 1 and PAI2 were quantified by enzyme-linked immunosorbent assay (ELISA). Results. Mean uPA and PAI-1 concentrations in melanomas were higher than in normal surrounding skin (uPA: 1.08; vs. 0.48 ng/mgp; PAI-1: 14.07 vs. 2.07 ng/mgp; p < 0.001), uPA and PAI-1 concentrationswere higher in melanomas than in nevi, and higher in nevi than in normal surrounding skin (uPA: p > 0.05; PAI-1: p = 0.02). PAI-2 concentration was higher in normal surrounding skin than in nevi and melanomas(p > 0.05). Melanoma uPA, PAI-1 and PAI-2 concentrations correlated significantly with normal skin (r= 0.73, 0.54, 0.38 respectively). PAI 1 was significantly lower in melanomas of Breslow thickness < 0.75 mm, Clark invasion of O+I, without microscopic ulceration, without vascular invasion (p < 0.01) than in melanomas of Breslow thickness > 0.75 mm, Clark invasion > II,with ulceration and vascular invasion. Conclusions. Determination of uPA and PAI-1 can provide significant additional prognostic information for melanoma patients.
Objavljeno v DiRROS: 06.02.2024; Ogledov: 272; Prenosov: 65
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