-
[show abstract]
[hide abstract]
ABSTRACT: Inspite the new informations about the physiology and biochemistry of pain, it remains true that pain is only partially understood. Cancer pain is often experienced as several different types of pain, with combined somatic and neuropathic types the most frequently. If the acute cancer pain does not subside with initial therapy, patients experience pain of more constant nature, the characteristics of wich vary with the cause and the involved sites. Chronic pain related to cancer can be considered as tumor-induced pain, chemotherapy-induced pain, and radiation therapy-induced pain. Certain pain mechanisms are present in cancer patients. These include inflammation due to infection, such as local sepsis or the pain of herpes zoster, and pain due to the obstruction or occlusion of a hollow organ, such as that caused by large bowel in cancer of colon. Pain also is commonly due to destruction of tissue, such as is often seen with bony metastases. Bony metastases also produce pain because of periostal irritation, medullary pressure, and fractures. Pain may be produced by the growth of tumor in a closed area richly supplied with pain receptors (nociceptors). Examples are tumors growing within the capsule of an organ such as the pancreas. Chest pain occurring after tumor of the lung or the mediastinum due to invasion of the pleura. Certain tumors produce characteristic types of pain. For example, back pain is seen with multiple myeloma, and severe shoulder pain and arm pain is seen with Pancoast tumors.
Acta chirurgica iugoslavica 02/2004; 51(4):9-14.
-
[show abstract]
[hide abstract]
ABSTRACT: Autologous nerve grafting is the most commocommnlynly used operative technique in delayed primary, or secondary nerve repair after the peripheral nerve injuries. The aim of this procedure is to overcome nerve gaps that results from the injury itself, fibrous and elastic retraction forces, resection of the damaged parts of the nerve, position of the articulations and mobilisation of the nerve. In this study we analyse the results of operated patients with transections and lacerations of the peripheral nerves from 1979 to 2000 year. Gunshot injuries have not been analyzed in this study. The majority of the injuries were in the upper extremity (more than 87% of cases). Donor for nerve transplantation had usually been sural nerve, and only occasionally medial cutaneous nerve of the forearm was used. In about 93% of cases we used interfascicular nerve grafting, and cable nerve grafting was performed in the rest of them. Most of the grafts were 1 do 5 cm long (70% of cases). Functional recovery was achieved in more than 86% of cases, which is similar to the results of the other authors. Follow up period was minimum 2 years. We analyzed the influence of different factors on nerve recovery after the operation: patient's age, location and the extent (total or partial) of nerve injury, the length of the nerve graft, type of the nerve, timing of surgery, presence of multiple nerve injuries and associated osseal and soft tissue injuries of the upper and lower extremities.
Acta chirurgica iugoslavica 02/2003; 50(1):47-54.
-
[show abstract]
[hide abstract]
ABSTRACT: Nerve transfer is the only possibility for nerve repair in cases of the brachial plexus traction injuries with spinal roots avulsion. From 1980. until 2000. in Institute of Neurosurgery, Clinical Center of Serbia, nerve transfer has been performed in 127(79%) of 159 patients with traction injuries of brachial plexus, i.e., 204 reinnervation procedures has been performed using different donor nerves. We achieved good or satisfactory arm abduction and full range or satisfactory elbow flexion through reinnervation of the axillary and musculocutaneous nerve using different donor nerves in 143 of 204 reinnervations, which presents general rate of useful functional recovery in 70.1% of cases. Mean values of the rate of useful functional recovery in individual modalities of nerve transfer in our series are 50.1% for intercostal and/or spinal accessory nerve transfer, 64.5% for plexo-plexal nerve transfer, 81.7% for regional nerve transfer, and 87.1% for combine nerve transfer.
Acta chirurgica iugoslavica 02/2003; 50(1):33-46.
-
[show abstract]
[hide abstract]
ABSTRACT: Restoration of upper arm function presents the main priority in nerve repair of brachial plexus traction injuries. The results are predominantly influenced by the level and extent of injury, and the type of surgical procedure. The purpose of this study is to evaluate influence of these factors on final outcome.
Study included 91 surgically treated patients, including 71 patients with avulsions of one or more spinal nerve roots and 20 with peripheral traction injuries. We performed 120 nerve transfers, 25 nerve graftings and 29 neurolyses on different nerve elements depending on the type of nerve damage. Analysis of motor recovery for elbow flexion and arm abduction, isolated or in combination, was done.
Recovery of elbow flexion was obtained in 75% nerve transfers, and in 68,7% nerve graftings in peripheral traction injuries. Recovery of arm abduction was obtained in 78,5% nerve transfers, and in 44,4% nerve graftings in peripheral traction injuries. Neurolysis was successful in all cases. Generally, the quality of recovery was better for the musculocutaneous nerve. Useful global upper arm function was obtained in 49,3% of patients with avulsion of spinal nerve roots, and in 55% of patients with peripheral traction injuries.
Regarding upper arm function the prognosis of surgically treated patients with traction injuries to the brachial plexus is generally similar in cases with central or peripheral level of injury. However, nerve transfers of collateral branches seem to be superior to nerve grafting and may be another possibility for repair in cases with extensive nerve gaps.
Acta Neurochirurgica 05/2002; 144(4):327-34; discussion 334-5. · 1.52 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Radial nerve palsy associated with a fracture of the shaft of the humerus is a relatively common injury. Out of 91 radial nerve injuries, operated upon in the Neurosurgical University Clinic in Belgrade from 1979 to 1988, 37 were associated with fractures of the humeral shaft or their surgical treatment. These fractures were previously treated in other medical units. In all cases a microsurgical reconstruction of the radial nerve was done: an interfascicular neurolysis in 24 cases and interfascicular grafting in 13 cases. A useful functional recovery was obtained in 91.9 per cent of the cases. Timing of nerve exploration and repair, as a main problem, is discussed.
Injury 08/1990; 21(4):220-2. · 1.98 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Malignant gliomas are the most common primary brain tumours in adults. Postoperative radiation therapy significantly improves survival when compared to surgery alone. It is occasionally followed by the adjuvant chemotherapy (CHT). Since this approach carries a significant hazard of local recurrence, new approaches have been tested in order to improve survival figures, hyperfractionated radiation therapy (HFX RT) and recent multiagent CHT.
Fourty eight adult patients with malignant glioma were treated with HFX RT to a total TD of 72 Gy in 60 fractions in 30 treatment days, 1.2 Gy b.i.d. fractions with an interfraction interval of 4.5-6.0 hr. Four weeks after HFX RT, CHT was introduced consisting of BCNU, Vincristine, Procarbazine, and Cisplatin. Six cycles were planned to be administered but CHT was stopped because of tumour progression. Toxicity criteria were made on the basis of joint RTOG/EORTC toxicity criteria.
Median survival time in all 48 patients was 52 weeks, and 1-3 year survival time was 48%, 29%, and 29%, respectively. Median progression-free survival was 30.5 weeks. Patients with AA achieved better results than those with GBM, regarding the overall survival and progression-free survival (p = 0.0000). The univariate analysis revealed that the age, performance status, and extent of surgery were important prognostic factors influencing the overall survival and progression-free survival, as well as tumour location and interfraction interval. The multivariate analysis revealed that the performance status, tumour location, and interfraction interval were independent prognostic factors in patients with GBM. Toxicity of this treatment approach was generally considered as mild, with no late toxicity attributed to HFX RT. CHT-related toxicity was mostly haematological.
The results of this study are in agreement with those using standard and various altered fractionated regimens in malignant glioma. They add evidence that this combined approach is feasible and well tolerated by the patients. Although there is some controversy about dose-escalation in HFX studies in the past, the studies reporting no significant improvement in survival for HFX RT were probably due to somewhat lower total doses used in them. Since this approach contributed to a 3-year survival of 83%, and 3-year progression-free survival of 70% in AA patients (all treated with 4.5 hr interfraction interval), they could serve as a basis for further studies measuring late effects as an endpoint, since there are data showing that aggressive treatment might be hazardous in patients with AA.
Srpski arhiv za celokupno lekarstvo 125(11-12):333-9. · 0.19 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: BOPP chemotherapy regimen was introduced in patients with high-grade astrocytoma after surgery and radiotherapy. There were 10 anaplastic astrocytomas and 19 multiforme glioblastomas. Protocol consisted of BCNU 50 mg/m2, days 1-3, Vincristine 1,4 mg/m2 (max 2 mg), day 1, Procarbazine 50 mg/m2, days 1-7 and Cisplatin 20 mg/m2, days 1-3. All patients received at least three cycles of BOPP chemotherapy. The used toxicity criteria corresponded to ECOG. We observed 12 changes in WBC, 29 changes in haemoglobin, 18 changes in platelets and 11 changes in hematocrite. All patients had nausea and vomiting. We also observed 4 neurologic toxicities. Toxicities we observed responded favourably to standard means of therapy which can suggest either shortening of the interval between the cycles or increasing the dose per cycle.
Srpski arhiv za celokupno lekarstvo 119(9-10):256-8. · 0.19 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Iatrogenic nerve injuries in operative area are undesirable but relatively common complications in relation to the total number of nerve injuries. These injuries are mostly caused by objective factors, especially by the nature of surgical lesion. Unfortunately, the role of surgeon is not irrelevant in large number of cases. The authors analyze a series of 39 iatrogenic surgical nerve injuries and the results of 30 repaired cases.
Srpski arhiv za celokupno lekarstvo 119(7-8):182-4. · 0.19 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The results of peripheral nerve repair have been significantly improved since introduction of the operating microscope. Microsurgical repair enables better fascicular orientation and coaptation with diminished fibrotic reaction on the suture line. The ten-year experience in 421 patients with peripheral nerve injuries is analyzed in the paper. Different surgical procedures (interfascicular neurolysis, direct fascicular repair, interfascicular transplantation or brachial plexus reinnervation) have been performed depending on type of injury, the special attention is paid to the cases with the nerve transection and consecutive interfascicular grafting. The results are analyzed in 182 cases depending on the location of injury, the patient's age, the timing of surgery and the length of nerve grafts.
Srpski arhiv za celokupno lekarstvo 119(1-2):14-7. · 0.19 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: 22 patients with recurrent malignant gliome were treated with "8 drugs in 1 day" chemotherapy protocol. 3 patients achieved partial response, 7 achieved stable disease, while 12 had progressive disease. Median time to tumor progression for all patients was 13 weeks, while median survival time for all patients was 35 weeks. Hematological toxicities were the most common, resulting in treatment refusal in two patients. Other toxicities included gastrointestinal, nephrotoxicity and ototoxicity.
Srpski arhiv za celokupno lekarstvo 122(3-4):73-5. · 0.19 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Extradural haematomas are usually characterized by a rapidly progressing clinical course within several hours. However, an extradural haematoma may have a lucid interval lasting days or weeks. These haematomas are known as chronic or delayed extradural haematomas. Nevertheless, there is little agreement among authors as to when an extradural haematoma should be called chronic. From the practical standpoint they can be divided into a subacute (between the 3rd and 14th day) or a chronic (two weeks or more) group. The authors report a study of 39 extradural haematomas with delayed onset of clinical manifestations treated at the University Neurosurgical Department in Belgrade from 1976 to 1987.
Srpski arhiv za celokupno lekarstvo 117(11-12):717-25. · 0.19 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Between 1980 and 1985 we treated 21 patients with primary spinal cord tumors. There were two diffuse and ten localized ependymoma, six low grade astrocytoma and three malignant glioma. Surgery consisted of total resection in six patients, subtotal resection in three and biopsy in twelve patients. Radiation doses ranged 45-55 Gy. Median age was 55 years (34-70 years), and median follow-up after therapy was 5 years (1-9 years). For patients with localized ependymoma, overall survival and 5-year recurrence-free survival are 80%. Of two patients with diffuse ependymoma, one is alive with no evidence of disease 6 years after the initial diagnosis, while the other is dead. Overall survival and 5 years recurrence-free survival for patients with low grade astrocytoma are 83% and 67%, respectively. All three patients with malignant glioma died of local recurrence (one had diffuse craniospinal metastases, too) one year after the initial diagnosis. Radiotherapy is therapy of choice after surgery in primary spinal cord tumors in adults, although local recurrences remain the major problem.
Srpski arhiv za celokupno lekarstvo 120(5-6):161-6. · 0.19 Impact Factor
