Incidence of pressure ulcers in intensive care units and direct costs of treatment: Evidence from Iran

Background and objective

Pressure ulcer (PU) is one of the important and frequent complications of hospitalization, associated with high treatment costs. The present study was conducted to determine the incidence of PU and its direct treatment costs for patients in intensive care unit (ICU) in Iran.

The MTT assay for chemosensitivity testing of human tumors of the central nervous system

In this study we assessed the influence of patient- and drug-specific parameters in the short-term MTT-chemosensitivity assay in 150 primary cell cultures derived from human brain tumors. In 45 patients the MTT assay was directly compared with the CFA (Colony Forming Assay). Resistance was 10-20% higher in the MTT assay than in the CFA, but there was a good agreement in both assays, that more malignant gliomas had a higher in vitro chemosensitivity against ACNU and BCNU. Overall the results demonstrate, that there is no uniform correlation between the in vitro chemosensitivity and the histopathological classification of the tumors, which corresponds well to the clinical situation. On the basis of this study we suggest prospective clinical trials with the MTT assay in human brain tumors.     

Diagnosis and surgery of brachial plexus injuries

The surgical outcome of traumatic injuries of the brachial plexus (BP) depends on the following parameters: 1) accurate preoperative diagnosis of cervical root avulsion; 2) time interval between injury and surgery; 3) delicate handling of the nerve tissue; and 4) postoperative physiologic training. This report is based on a 15-year experience in brachial plexus surgery and is supported on the grounds of two major studies. In a prospective study, the authors controlled for the reliability of preoperative radiologic diagnosis by myelo-CT and MRI scans for 40 patients, to evaluate the integrity of the intraspinal cervical roots after brachial plexus injury. Surgical inspection via a cervical hemilaminectomy proved the accuracy of 85 percent and 52 percent of CT myelography and MRI, respectively. Retrospective statistical analyses were carried out of the long-term surgical results of 54 patients with traumatic injuries of the BP who received a grafting procedure between cervical roots C5 or C6 and the musculocutaneous nerve. Patients operated on up to 6 months after trauma showed a better result than patients operated on later than 12 months after trauma (p<0.05). In contrast, grafting between cervical root C5 or C6 and the use of different sural-graft sizes to reconstruct the musculocutaneous nerve demonstrated no statistically significant difference in the final outcome.     

Classification of ADHD and BMD patients using visual evoked potential

Objectives

Children with Bipolar Mood Disorder (BMD) and those with Attention Deficit Hyperactivity Disorder (ADHD) share many clinical signs and symptoms; therefore, achieving an accurate diagnosis is still a challenge, especially in the first interview session. The main focus of this paper is to quantitatively classify the ADHD and BMD patients using their Visual Evoke Potential (VEP) features elicited from their Electroencephalogram (EEG) signals.

Methods and materials

In this study, 36 subjects were participated including 12 healthy ones, 12 patients with ADHD and 12 ones with BMD. The age of ADHD patients was 16.92 ± 6.29 and for the BMD ones was 17.85 ± 3.68. Their scalp EEG signals in the presence of visual stimulus were recorded using 22 silver electrodes located according to the 10–20 international recording protocol. To extract their VEP, first a preprocessing step was executed to remove the power line and movement artifacts. Afterward, the wavelet denoising and synchronous averaging were applied to the preprocessed trials in order to elicit the P100 component. To obtain interpretable features from the evoked patterns, amplitude and latency were extracted and applied to the 1-Nearest Neighbor (1NN) classifier due to the locally scattered distribution of the VEP features.

Results

The evaluation was performed according to leave-one(subject)-out method and the experimental results were led to 92.85% classification accuracy which is a fairly promising achievement to distinguish the BMD, ADHD, and healthy subjects from each other.

Conclusion

From the physiological point of view, this result point out to the existence of significant difference in the neural activities of their visual system in the ADHD, BMD, and healthy subjects in response to a periodic optical stimulus.     

Intraindividual comparison of histopathological diagnosis obtained by stereotactic serial biopsy to open surgical resection specimen in patients with intracranial tumours

Background

There are concerns in the literature about the accuracy of histopathological diagnosis obtained by stereotactic biopsy in patients with brain tumours. The aim of this study was to analyse intraindividually the histopathological accuracy of stereotactic biopsies of intracerebral lesions in comparison to open surgical resection.

Materials and methods

Between 2007 and 2011 a total of 635 patients underwent stereotactic serial biopsy in our department. Among these patients we identified 51 patients, who underwent magnetic resonance (MR) based stereotactic biopsy and subsequent open resection within 30 days. Mortality and morbidity data as well as final histopathological diagnoses of both procedures were compared with regard to tumour grade and tumour cell type. Patients with discrepancies between the histological diagnosis obtained by biopsy and open resection were classified into three subgroups (same cell type but different grading; same grading but different cell type and different grading as well as different cell type).

Results

The mean number of tissue samples taken by stereotactic serial biopsy from each patient was 12 (range 7–21). Minor morbidity was 6% and major morbidity was 14% after open surgery compared to no morbidity after stereotactic biopsy. Mortality was 2% after stereotactic biopsy (one patient died after stereotactic biopsy as a result of a fatal bleeding) compared to 0% in the resection group. Silent bleeding rate without any clinical symptoms was 8% in the biopsy group. A complete correlation of histopathological findings between the biopsy group and the resection group was achieved in 76% and was increased to 90% by analyzing clinical and neuroradiological information. In patients with recurrence the correlation was higher (94%) than for patients with primary brain lesions (67%). The discrepancies between the open resection group and biopsy group were analysed.

Conclusion

Stereotactic MR guided serial biopsy is a minimal invasive procedure with low morbidity and high diagnostic accuracy for diagnosis and grading of brain tumours. Diagnostic accuracy of stereotactic biopsy can be enhanced further by careful interpretation of neuroradiological and clinical information.     

The effect of systemic erythropoietin and oral prednisolone on recent-onset non-arteritic anterior ischemic optic neuropathy: a randomized clinical trial

Graefe's Archive for Clinical and Experimental Ophthalmology - To evaluate the effect of systemic erythropoietin, as well as oral steroids, in the management of recent-onset non-arteritic...