PROGNOSTIC ROLE OF CD44 EXPRESSION AND NEOVASCULARIZATION DETERMINED BY ENDOGLIN (CD105) IN GLIOBLASTOMA PATIENTS

Glioblastoma multiforme (GBM) is the most common and most aggressive malignant primary brain tumor in humans. Clinically useful molecular markers that help predict response to therapy and prognosis are still rare. The research was conducted in 55 patients with GBM, 26 (47.3%) women and 29 (52.7%) men, mean age 62.58 years. On immunohistochemical analysis, primary antibody to CD44 (dilution 1:50) and primary antibody to endoglin (CD105) (dilution 1:250) were used to evaluate neovascularization. Statistical analysis showed negative correlation between CD44 and survival (p=0.023) (higher expression of CD44 was correlated with shorter survival), but there was no correlation between neovascularization determined by CD105 in GBM and patient survival. Thus, significant individual predictors of longer survival were lower expression of CD44 (p=0.004), higher Karnofsky score (p=0.045), and female gender (p=0.017). The results obtained suggested the possible role of CD44 in the progression and tumor neovascularization of GBM.

[Minimally invasive surgery in treatment of lumbar intervertebral disc herniation]

Surgical treatment of lumbar intervertebral disc herniation is one of the most common neurosurgical procedures. Besides conventional surgical techniques, in the last more than 30 years, different methods with minimal damage to neuromuscular spine structures are being developed and introduced, all having the purpose of reducing postoperative back pain. The advantages of the minimally invasive spine surgery include: possibility of performing procedures under local anaesthesia, reduced hospital stay, limited blood loss with consecutively reduced fibrous tissue development. Patients are capable of return to work and everyday activities early after surgery. From the economical point of view, this kind of treatment is considered to be a cost-effective intervention. Three methods that are being used for treatment of lumbar intervertebral disc herniation are: percutaneous laser disc decompression (PLDD), microdiscectomy using tubular retractor system and selective endoscopic discectomy (SED). Conducted prospective studies have shown that minimally invasive methods are adequate alternative to classic surgical procedures.

Complete neurological recovery after surgery for mesencephalic cavernoma: case report

Cavernous malformations are classified as a group of vascular malformations of the central nervous system. Conservative treatment of brainstem cavernomas is accompanied with poor outcome. Surgery ofbrainstem cavernomas still poses a challenge due to the high risk of neurological damage and respectable morbidity. We report a case of complete neurological recovery in a 24-year-old female patient with mesencephalic cavernoma treated surgically. This case highlights that careful microsurgical treatment with the goal of complete cavernoma excision remains the treatment of choice in cases with de novo or recurrent hemorrhage. Intraoperative neurophysiologic monitoring should be used as the gold standard during brainstem cavernoma operations in order to avoid nuclear and long tract damages.

[Guidelines for interventional and invasive treatment in patients with mechanical back pain]

Back pain caused primarily by mechanical disorders is the most common type of back pain and it is usually found in young and middle-aged population, i.e. active population. This is why back pain is one of the most important public health problems. Treatment of pain syndrome affecting spine depends on a variety of factors and generally includes conservative and invasive methods. Relative indication for interventional and surgical procedures is long lasting back pain, the symptoms of which, predominantly pain, cause significant problems for the patient on performing everyday activities. Invasive/surgical treatment is applied after minimally 3 months of unsuccessful conservative treatment. Invasive and surgical procedures comprise a wide spectrum of interventions, from interventional and semi-interventional procedures, minimally invasive procedures to extensive, invasive operations that include instrumentation. The choice of intervention is based on clinical findings, duration and severity of pain and other symptoms, as well as on diagnostic reports. Despite recommendations based on the results of clinical studies, individual approach to each patient is the main principle of successful treatment.

Current status of iodine intake in Croatia--the results of 2009 survey

In 1996, due to persistence of mild to moderate iodine deficiency, new law on obligatory salt iodination with 25 mg of potassium iodide (KI) per kg of salt was implemented in Croatia. Along with a new law, a new program for monitoring of iodine prophylaxis was implemented. Investigations of goiter and iodine intake performed in 2002, demonstrated sufficient iodine intake in Croatia with overall median of urinary iodine concentration (UIC) for schoolchildren in Croatia of 140 microg/L. In 2002, thyroid volumes (TV) measured by ultrasound in schoolchildren from all four geographic regions of Croatia were for the first time within the normal range according to ICCIDD reference values. Nowadays, Croatia is internationally recognized as iodine sufficient country. The aim of the present study was to assess current status of iodine intake in Croatia. The investigation was carried out in 2009. A total of 386 schoolchildren aged 7-10 years from all four major geographic regions of Croatia, 103 euthyroid pregnant women and 36 women of child-bearing age from Zagreb, the capital, were included in the survey. Urinary iodine concentration (UIC) was measured in all participants. Thyroid volumes were measured by ultrasound in schoolchildren from the capital of Zagreb (N = 101) and the village of Rude (N = 56). In the time period 2002-2009, the content of KI was analyzed in 384 salt samples from Croatian salt plants and samples of imported salt. An overall median UIC for schoolchildren in Croatia was 248 microg/L. Median UIC in pregnant women was 159 microg/L, with 50% of samples below and under 150 microg/L. Median UIC in women of child-bearing age was 136 microg/L. Thyroid volumes in schoolchildren were within the normal range according to the new reference values. Mean value of KI/kg of salt in samples from Croatian salt plants was 25.5 mg/kg and 24.9 mg/kg in samples of imported salt. A total of 72/384 (18.8%) of salt samples didn't corresponded to the Croatian law on obligatory salt iodination. Presented data indicate sufficient iodine intake of the Croatian population. Current medians of UIC in schoolchildren in Croatia are significantly higher than medians measured in 2002. This indicates that other potential sources of iodine are present in Croatian diet that may contribute to overall iodine intake. Due to rising medians of UIC in schoolchildren in Croatia, it is important to conduct nutrition studies to identify potential sources of "silent prophylaxis" in order to avoid iodine excess.

Complete resolution of medically refractory temporal lobe epilepsy after arachnoid cyst fenestration

Intracranial arachnoid cysts are congenital lesions that are frequently detected incidentally. About 30% of patients have a symptomatic epileptic seizure as the presenting symptom, occasionally with other focal neurologic signs. A case is presented of a young male patient with medically refractory temporal lobe epilepsy. Following his neurological examination, epileptic zone was defined in the right temporal lobe that correlated with the MRI-detected sylvian arachnoid cyst. Microneurosurgical cyst fenestration with volume reduction was performed, which resulted in a decremental but eventually complete seizure freedom. In conclusion, the arachnoid microsurgical cyst reduction is a safe procedure and may result in complete remission of symptomatic epileptic seizures and favorable outcomes, as reported in other studies.

Postoperative use of radioiodine (131-I): review of recommendations and guidelines

In the management of large number of patients with differentiated thyroid cancer, the radioactive iodine (131-I) administration plays an important role. The guidelines of numerous international and national medical societies regarding the issue of postoperative 131-I administration have been published and updated in the last few years. The guidelines differ in the shape and content, and contain some specific features. The different methods for evaluation and analysis of clinical evidence level and resulting grades of recommendations have been used in line with the very guidelines. The postoperative 131-I administration refers to the radioiodine ablation as a form of adjuvant treatment and radioiodine therapy in the management of patients with recurrent cancer, persistent disease and regional or distant metastases. According to the indications for the postoperative 131-I administration, the patients could be divided into the three risk groups: the very low risk group in which there is no indication for the postoperative 131-I administration, the low risk group in which the indication could be considered, and the high risk group in which there is a clear indication for the 131-I administration. The different criteria for distribution of patients into these three groups are expressed in a certain guidelines. There are different opinions about the necessary dosage of 131-I for the efficient ablation in the low risk group. Moreover, the opinions are also divided regarding the conduction of postoperative (preablative or pretherapeutic) scintigraphy with 131-I. As regards the instructions on preparation of patients for the radioiodine ablation and therapy, all the guidelines recommend the low iodine diet and endogenous or exogenous stimulation of TSH. The endogenous stimulation is accomplished by the withdrawal of thyroid hormones, whereas the recombinant human TSH (rhTSH) is used for exogenous stimulation. For conducting the therapy with 131-I the level of TSH has to be > 25-30 mU/L.

[New techniques and prospects in invasive treatment in vertebrology]

In this article authors outline new techniques and prospects in invasive treatment in vertebrology with emphasis on interventional and semi invasive procedures and minimally invasive surgery for lumbar disc herniation. They describe new approaches in neuroablative procedures for back pain treatment, in spinal fixation and in surgical treatment of scoliosis. Authors also report methods of great expectations which are not yet in use in our clinical practice but are promising like reconstruction of nucleus pulposus by autologous chondrocytes transplantation. New methods in cervical spine surgery are also discussed. The efficacy of each surgical method is pointed out. Apart from being informative, together with the corresponding article on patophysiology, magnetic resonance imaging and conservative treatment, these articles considering recent developments can be used as an aid in decision making when approaching these patients.

Thyroid nodularity--true epidemic or improved diagnostics

The incidence of thyroid nodules has been rising steadily during the last 30 years, since the introduction of new diagnostic methods such as ultrasonography and computerized tomography, thus posing a real challenge in determining the best approach strategy for treatment of this new 'epidemic'. We analyzed and compared data from several studies showing the prevalence of thyroid nodules on autopsy, palpation and ultrasonography to be 13%-60%, 0.5%-6.5% and 13.4%-46%, respectively. This demonstrates that thyroid ultrasonography is a very sensitive and accurate diagnostic tool the use of which, however, entails an increased number of incidentally discovered thyroid nodules without clinical significance. Therefore, ultrasonography of the thyroid should not be performed without clinical indication determined by thyroid specialist.

Iodine supplementation in pregnancy

People of all ages can be affected by iodine deficiency, however, pregnant women and children are especially at a high risk. Because of changes that occur in maternal thyroid hormone economy during pregnancy and the potential unfavorable effects of iodine deficiency on the offspring, an adequate dietary iodine intake throughout the pregnancy is highly important. Therefore, the World Health Organization, United Nations Children's Fund and International Council for the Control of Iodine Deficiency Disorders have proposed that dietary intake of iodine during pregnancy should be 200-300 microg/day to compensate for the augmented T4 requirements in pregnant women. It has been shown that in countries with a longstanding and well-established universal salt iodination program where iodine sufficiency has been reached, there is a fraction of pregnant women that still have low median urinary iodine concentration, which indicates insufficient dietary iodine. Studies performed in such countries emphasize that pregnant women should use multivitamin and/ or mineral tablets specifically prepared for the needs of pregnancy and containing iodine supplements. Only the United States of America and Canada have official recommendations concerning iodine supplementation. In other countries, no such firm decisions have yet been made by medical community and public health authorities. In Croatia, an iodine sufficient country, the situation is the same. There is a need to collect adequate data on iodine supplementation and urinary iodine during pregnancy, along with the universal salt iodination program, so that definitive conclusions can be made.

Pancreatic endocrine tumor of uncertain behavior: a case report

Pancreatic endocrine tumors are rare, and among them large non-functioning tumors of uncertain behavior are extremely infrequent. Non-functioning pancreatic endocrine tumors originate from the endocrine part of the pancreas but are not associated with a distinct hormonal syndrome. A rare case is presented of a 49-year-old woman with a well-differentiated endocrine tumor of uncertain behavior that presented with intermittent pain in the epigastrium radiating to the right subcostal region. Computed tomography showed a well-defined and circumscribed solid mass in the pancreas head. The pancreatic mass was surgically removed and submitted for histopathologic analysis. Microscopically, the tumor had relatively uniform cells with oval nuclei that coated trabecular and pseudoglandular structures, which also showed 1 mitosis per 10 VVP and proliferation activity measured with Ki67 of less than 2%. A focus of intravascular invasion was seen on one slide. Immunohistochemical analyses for NSE, chromogranin and synapthophysin were positive, which along with its size (over 2 cm in diameter) and reported angioinvasion indicated the diagnosis of pancreatic endocrine tumor of uncertain behavior. Although mostly considered as malignant, large non-functioning pancreatic endocrine tumors can sometimes express benign or uncertain behavior; therefore, a large number of factors should always be considered when determining the biological nature of these tumors.