Namen: Kraniotomija je osnovni nevrokirurški pristop, ki je povezan z zapleti, med katere spada okužba kirurške rane, za pojav katere so dejavniki tveganja še vedno nepopolno definirani. Namen raziskave je bil prepoznati dejavnike tveganja za pojav okužbe kirurške rane pri odraslih bolnikih, operiranih na Oddelku za nevrokirurgijo Univerzitetnega kliničnega centra v Mariboru. Metode: Izvedli smo retrospektivno kohortno študijo, v kateri smo analizirali podatke za obdobje od januarja 2009 do avgusta 2019. Primerjali smo podatke bolnikov, ki so razvili okužbo kirurške rane, s podatki tistih, ki okužbe niso razvili. 66 bolnikov je razvilo okužbo kirurške rane, v kontrolno skupino smo naključno uvrstili 70 bolnikov brez omenjene rane. V raziskavo smo vključili le bolnike, ki so po opravljeni elektivni kraniotomiji potrebovali kirurško zdravljenje okužene kirurške rane. Rezultati: Med 1192 bolniki, ki so v opazovanem obdobju imeli opravljeno kraniotomijo, je 66 (5,5 %) bolnikov razvilo okužbo kirurške rane. Najpogosteje je prišlo do razvoja osteomielitisa (66,7 %) in epiduralnega abscesa (63,6 %), najpogosteje izoliran povzročitelj pa je bil Propionibacterium acnes (54,5 %). V raziskavi so se kot dejavniki, povezani s pojavom okužbe kirurške rane, izkazali uporaba izdelka Surgicel® (p = 0,0019, Fisherjev natančni test), duralni nadomestki (p = 0,0028, Fisherjev natančni test), samolepilna dura (p = 0,0274, Fisherjev natančni test), zapiranje kože s šivi (p = 0,0001, Fisherjev natančni test), opravljena frontalna kraniotomija (p = 0,0328, Fisherjev natančni test) in pooperativno predpisovanje glukokortikoidov (p = 0,04, Fisherjev natančni test). Zaključek: Z našo študijo smo prepoznali določene dejavnike tveganja, povezane s pojavi okužbe kirurške rane, ki jih lahko odpravimo in tako znižamo pojavnost tovrstnega operativnega zapleta oz. zaplet hitreje prepoznamo.
Diffuse leptomeningeal glioneuronal tumour (DLGT) represents a rare type of neoplasm with a limited number of cases and an ambiguous prognosis. It is mainly diagnosed in children, more often in boys. The clinical presentation depends on the area of the central nervous system involved. The diagnostic process must be extremely broad. Currently, no therapeutic guidelines exist. In this report, we present a case of a 26-year-old man diagnosed with DLGT, who at the age of 10, had a pilocytic astrocytoma (PA) that was surgically removed and was afterwards treated with radiotherapy. After 16 years, his neurological condition deteriorated and an extensive diagnostic process was conducted, including molecular genetic testing using the next generation sequencing (NGS), that led to the diagnosis of DLGT. To our knowledge, we present the first reported case of a DLGT, diagnosed in an adult, who as a child was treated for a PA, and was not a case of a malignant transformation, but rather a case of two primary tumours of the central nervous system, in whom neurofibromatosis was excluded.
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