Search

Study objectives: Most vestibular schwannomas (VS) grow very slowly, only some of them grow rapidly. Observation is a strategy with selected patients. The aim is to evaluate strategy Wait and Scan. Patients and Methods: In the period 1999-2016, 86 patients with VS were diagnosed. There were 24 patients (28%) were treated surgically, 33 patients (38%) were treated with Leksell Gamma Knife. 29 patients (34%) were indicated for „Wait and Scan" Protocol. Of these 29 patients, 18 patients were monitored for a long time (follow-up period average of 6 years). Reasons for observations included tumour volume, stage I (61%), advanced age (17%), patient preference (17%), poor health condition (5%). Data on one-year monitored VS were evaluated retrospectively. Results: Observations period 2 – 17 years, 6 years in average. 11 patients (61%) were successfully observed without the need for conversion to active treatment, 7 patients (39%) ultimately required active treatment within a mean interval of 3.5 years since diagnosis. 9 tumours (50%) did not grow and 9 tumours (50%) increased their volumes during the observations (2 patients still observed - because of high age and the patient's wishes). The average year-on-year rate of tumor growth during the annual follow-up was significantly higher statistically (p=0.01 and 0.05) in the group requiring conversion to an active approach rather than in the group of observed patients. Significant tumour growth was observed up to 5 years after diagnosis, a later VS growth has not been reported. Conclusion: Observations of VS is a rational strategy for carefully selected patients. The growth rate of the tumour during the annual follow-up was a strong predictor of the potential need for a proactive approach to treatment. Attention should be paidto the identification of fast-growing and progressive VS, as these must be identified in time and possibly indicated them for active treatment. [ABSTRACT FROM AUTHOR]

Aim: To obtain information about the progress and results of treatment of aortic dissection in the present. Methods: We performed a retrospective analysis of 38 patients with aortic dissection who were hospitalized in our department for the last 10 years, from 2003 until the end of 2012. Results: There were 22 patients with type A aortic dissection according to the Stanford classification, with type B dissections 16. The age in both groups was similar 65 or 66 years, males predominated over women. Arterial hypertension clearly dominated of the risk factors in both groups. In one case we recorded an iatrogenic cause. Our patients most often presented with chest pain, in the second group with backache and stomachache as well. Precordial murmur was dominated in physical finding in the first group, while most patients in the second group had no physical findings. Pulse deficits were a rare find. The computed tomography was the most used diagnostic method. Level of D-dimer was high on average, but we recorded low values in patients with symptoms lasting longer than 24 hours. Complications associated with aortic dissection were more common in the first group. 18 patients of 38 died (47%). There were 22 patients who underwent surgery or interventional procedures with 30-day mortality 32%, which was at the time a downward trend. Conclusion: Aortic dissection is currently associated with an acceptable operating decreasing mortality. The predominant clinical sign is sudden pain. The preferred diagnostic method is CT aortography. The recommended biochemical marker is plasma levels of D-dimer with a cutoff value of > 500 ng/ml. A negative value does not exclude aortic dissection. [ABSTRACT FROM AUTHOR]