MODIFIED TREATMENT OF HEPATORENAL SYNDROME TYPE I DEPENDING ON THE STAGE OF ACUTE KIDNEY INJURY.

Hepatorenal syndrome is a severe complication of liver cirrhosis which is difficult to treat because of a very fast course and lack of adequate dosing recommendations due to the stage of the disease. In this study we aimed to refine the treatment of hepatorenal syndrome type I by modifying the dose of terlipressin, depending on the stage of acute kidney injury (AKI). Objective - to improve the treatment method of hepatorenal syndrome type I in patients with alcoholic liver cirrhosis by selecting the dose of terlipressin depending on the stage of acute kidney injury. For this study were enrolled 161 patients with diagnosis alcoholic liver cirrhosis, complicated with the hepatorenal syndrome. All patients were were randomly divided into control (group 1) (n=79) and study (group 2) (n=82) groups depending on the treatment received (terlipressin in the standard dosage or modified by the response-guided titration method). If the serum creatinine level decreased less than 25% from the baseline, the dose of terlipressin was gradually increased but did not accede 12 mg/24 hours. The stage of AKI was diagnosed using the criteria of Kidney Disease: Improving Global Outcomes (KDIGO) Clinical Practice Guideline for Acute Kidney Injury, 2012. The risk of short term mortality (within the first 29 days) was prognosed by Model for End-Stage Liver Disease (MELD) score. The kidney function improved better in persons with a modified dose of terlipressin: the complete response rate in them was 81.7%. The response rate in those who received the standard treatment, was 66.7% only (p˂0.05). It was found that the effective dosage of terlipressin is 3 mg/24 for AKI stage I; 6 mg/24 - for AKI stage II; 12 mg/24 - for AKI stage III. The relapse of the disease occurred only in 23.2% patients with modified treatment against 40.1% in the control group (p˂0.05). Short term survival was also significantly higher in the study group - 54.9%, while in the control group it was 37% only (p˂0.05). Thus, correction of terlipressin dosage could improve the results of the treatment and reduce mortality in patients with hepatorenal syndrome type I.

The safety and effectiveness of low field intraoperative MRI guidance in frameless stereotactic biopsies of brain tumours-design and interim analysis of a prospective randomized trial.

The aim of the study was to assess the safety and effectiveness of stereotactic brain tumour biopsy (STx biopsy) guided by low-field intraoperative magnetic resonance imaging (iMRI) in comparison with its frameless classic analogue based on a prospective randomized trial. A pilot group of 42 brain tumour patients was prospectively randomized into a low-field iMRI group and a control group that underwent a frameless STx biopsy. The primary endpoints of the analysis were postoperative complication rate and diagnostic yield, and the secondary endpoints were length of hospital stay and duration of operation. The iMRI group (21 patients) and the control group (21 patients) did not differ significantly according to demographic and epidemiological data. No major postoperative complications were noted in either group. In addition, no significant differences in the diagnostic yield (p = 1.00) and length of hospital stay (p = 0.16) were observed. The mean total OR time was 111 ± 24 min in iMRI and 78 ± 29 min in the control group (p = 0.0001). Usage of iMRI may prolong the time of the procedure but seems to be comparable in safety and effectiveness to the standard frameless STx biopsy.

Hydrotechnical facilities within the Chernobyl nuclear power plant exclusion zone: impacts on hydrologic regime and plant growth patterns of floodplain water bodies of the Pripyat River.

As result of the Chernobyl nuclear power plant accident the territory of the left-bank flood-lands of the Pripyat River have undergone intensive radionuclide contamination. With the purpose of preventing the washing away of radioactive substances, a complex of flood protection dams was constructed. This construction changed the hydrological regime of these territories and caused overgrowth by higher aquatic plants. Absence of a flowing mode of reservoirs, the stagnant phenomena during spring and seasonal high waters on the embank site have caused amplification of eutrophication processes, swamping and, connected with it, increase of water-marsh floristic complex in the structure of the vegetative cover.

[90Sr, 137Cs, 238Pu, 239+240Pu, and 241Am radionuclides in macrophytes within the Krasnensky flood plain: species specificity of concentration and distribution in phytocenosis components]. / Radionuklidy 90Sr, 137Cs, 238Pu, 239+240Pu i 241Am v makrofitakh Krasnenskoi poimy: vidospetsifichnost' kontsentrirovaniia i raspredelenie v komponentakh fitotsenoza.

The analysis of the content of radionuclides 90Sr, 137Cs, 238Pu, 239 + 240Pu and 241Am in water vegetation of flood plain reservoirs has allowed studing features of radionuclide accumulation by various species of macrophytes and revealing bioindicators of radionuclide contamination. Thus species-specificity of radionuclide accumulation can essentially change the contribution of different species to a percentage ratio of the radionuclide content in phytomass of reservoirs in comparison with fund of higher aquatic plants.

[Posttraumatic vasospasm and its treatment with nimodipine]. / Pourazowy skurcz naczyniowy i jego leczenie nimodypina.

The aim of our study was to compare the incidence and the time course of vasospasm as well as outcome of patients with tSAH. In group I there were 15 patients treated with nimodipine. Group II consisted of 20 patients in whom nimodipine was not used. All patients suffered from severe head injury, scored 8 points or less according to Glasgow Coma Scale. The initial CT scan revealed tSAH in all of them. Outcome was evaluated according to Glasgow Outcome Scale (GOS) three months after injury. Results were better (but not significantly) in patients in whom nimodipine was used, time course of vasospasm was less severe and follow-up CT scans did not reveal ischaemic infarcts connected with vasospasm.

[Dysembryoplastic neuroepithelial tumor (DNT)--case report and literature review]. / Dysembrioplastyczny nowotwór neuroepitelialny (DNT)--opis przypadku i przeglad pismiennictwa.

Neuroepithelial dysembryoplastic tumour was first described by Daumas-Duport in 1988 and in WHO classification was included into the group of neuronal and mixed neuroglial tumours. This is a benign and very rare tumor with a good prognosis occurring in children and young adults. The tumour caused characteristic clinical symptoms: epileptic fits, supratentorial, intracortical localisation, most often in temporal lobe and specific nodular architecture with heterogenic cell composition. Oligodendrocyte-like cells, glial and neuronal elements are usually found. The authors present a case of a 24-years old female with partial epileptic sensorial symptomatology. CT examination revealed a tumour in the left parietal lobe. Histological findings showed a typical texture of DNT. The tumour has no tendency for recurrence even in case of incomplete removal and does not require chemotherapy nor radiotherapy which is significantly important for accurate diagnosis, in order to avoid an aggressive therapy in young patients.

The concept of cerebral circulatory-pressure index (CCPI).

The theoretical relations between blood pressure (MABP), intracranial pressure (ICP) and cerebral perfusion pressure (CPP) as well as the new Cerebral Circulation-Pressure Index (CCPI) are presented in the paper. The special nomogram collecting all of these parameters was constructed. CPPI was defined as a quotient of CPP and ICP: [formula: see text] CCPI reflects the relationship between the systemic MABP and ICP and for ensuring the normal conditions of intracranial circulation the MABP must be at least 4 divided by 5 times higher than ICP. The low values of CCPI, if they are not immediately corrected, results on severe brain disability or even death. We didn't find till now what should be the upper limit of CCPI, which overcrossing may be danger for the patient, especially with impaired autoregulation. Based on analysis of patients operated due to intracranial disorders as brain tumours, spontaneous and traumatic haematomas as well as ruptured aneurysms we find that the values of CCPI over 3 have a good prognosis, between 3 and 2 is a field for intensive treatment consisting on decreasing ICP or increasing the systemic blood pressure or both. If CCPI is below 1.5 the prognosis is pessimistic and all the patients died. CCPI together with the nomogram are useful in current evaluation of the state of patients and of the efficacy of treatment and prediction of the treatment results.

[Management of patients with multiple intracranial aneurysms]. / Leczenie pacjentów z mnogimi tetniakami mózgu.

A retrospective analysis of 142 patients with multiple intracranial aneurysms operated on within eight years (1991-1998) was undertaken. In 82 patients multiple aneurysms were clipped during one procedure in the remaining 60 patients operation was performed in two stages. The clinical state of patients according to Hunt-Hess scale at the admission to the department was assessed, as well as the presence of blood on the initial CT scan according to Fisher scale and outcome according to Glasgow Outcome Scale. The operative results patients with multiple intracranial aneurysms are worse, than those with single aneurysm, which is connected with the necessity of wider exposure of cerebral vessels and possibility of bleeding from unclipped aneurysm, when operation is performed in two stages.

[Transcranial doppler ultrasonography monitoring in patients with intracerebral hematoma due to aneurysm rupture]. / Monitorowanie TCD u pacjentów z krwiakiem sródmózgowym w wyniku pekniecia tetniaka.

The aim of the study was to evaluate the influence of intracerebral haematoma due to aneurysmal rupture on vasospasm evaluated by transcranial Doppler ultrasound and outcome according to Glasgow Outcome Scale. 368 patients with ruptured intracranial aneurysm were admitted to the Department of Neurosurgery, Medical Academy in Wroclaw, between January 1, 1995 and June 30, 1998. Patients were divided into two groups. In group I there were 74 patients with subarachnoid haemorrhage and intracerebral haematoma. In group II 294 patients with subarachnoid haemorrhage. Despite intensive monitoring and treatment the outcome of patients with subarachnoid haemorrhage and intracerebral haematoma is worse than in patients with subarachnoid haemorrhage only.

[Experience with nimodipine treatment of vascular spasm after subarachnoid hemorrhage]. / Wlasne doswiadczenia w leczeniu nimodypina skurczu naczyniowego po krwotokach podpajeczynówkowych.

Pathogenesis of vasospasms following subarachnoid haemorrhage and possible therapeutic efficacy of nimodipine (calcium channel blocking agent) are discussed. The authors present their own experience in the treatment of 209 patients with subarachnoid haemorrhage with nimodipine. Collected clinical results suggest the necessity of the combined treatment of vasospasm following subarachnoid haemorrhage with nimodipine, hypervolemia, and hypertensive agents.