TRANSECTION OF INFERIOR ALVEOLAR NERVE IN THE RAT - NEUROANATOMICAL STUDY AND EXPERIMENTAL MODEL.

OBJECTIVE: Experimental lesions in the inferior alveolar nerve (IAN) are used for the study of peripheral and central alterations. The objective of our study was to contribute to a more precise description of the approach to the IAN and creating a lesion. MATERIAL AND METHODS: Twenty-six males of Wistar laboratory rats were used for the study. The animals were divided into three groups: control group (6 rats), experimental group (12 rats - a part of the bone above the mandibular canal was removed under general anaesthesia using extraoral approach, after exposing a part of the IAN, the nerve was excised in a length of 3 mm), and a sham group (8 rats - the nerve was only dissected but not transected). Persisting denervation was verified using surgical revision and histological and immunohistochemical analysis after the observation period (4 weeks). RESULTS: No evidence of re-innervation after 4 weeks. We found no statistically significant differences in mean weight gains between individual groups during the observation period. CONCLUSION: The described technique used in the study is one of the possible ways to create a nerve lesion at the site of the main trunk of the nerve. At the same time, the study provides a more precise description of the anatomical situation and approach to the IAN in the mandibular canal.

Multielemental Chemical Analysis of Elements in Mandibular Bone and Teeth in the Rat.

The purpose of the study was to test the hypothesis of different distribution spaces of elements in the rat mandibular bone and teeth. We used six adult males of Wistar laboratory rats for the study. After killing the animals, we extracted the molars and removed incisor crowns. The mandibular bone was divided into four parts (mesial-central-distal-ridge). Inductively coupled plasma mass spectrometry was used to determine the presence of 41 elements in the bone and tooth. Evidence of 14 elements was found in all samples (incisors-molarsbone). Generally, significant differences between the left and right side were found for K and Rb in the bone locations. As regards statistically significant differences in incisors-molars-bone locations, the elements for which these differences were found for all comparisons are listed as incisors versus individual molars, incisors versus bone locations, and individual molars versus bone locations: a) incisors-molars: Ba, Mn, Mo, Sr, Zn, K, Mg and Rb; b) incisors-bone: Fe, K, Mg, Mn, Na, Zn and Ba; c) molars-bone: Mn, Mo, Na and Mg. Statistically significant differences were also found between molars for Fe, Mg, Mn, and Sr and between bone locations for Ba, Ca, Mn, Sr, K, Rb, Zn, Mo, Mg, and Na. The elements Cu, Ni and Co were without pronounced differences. Twenty-seven elements were below the detection limit. Our results indicate different distributions of some elements in the rat mandibular incisors-molars-bone. We assume that the knowledge of chemical element contents in the laboratory rat bone and teeth will prove useful in experimental research of both these hard tissues.

Multielemental Chemical Analysis of Elements in Mandibular Bone and Teeth in the Rat.

The original article was published in Folia Biologica (Praha) Volume 64, No. 3 (2018), 84-96.

Survived spondyloptosis of the thoracic spine in the Early Middle Ages (Czech Republic).

At a Slavic site Pohansko near Breclav (Czech Republic), at the burial ground around the church (9th-10th century) 757 skeletons (208 males, 159 females, 354 sub-adults and 36 undetermined individuals), were excavated. More or less complete vertebral column was preserved in 109 adults. Among those, in the grave number 403, the skeletal remains of an adult male were found with the deformity of the spine probably caused by severe trauma (spondyloptosis). Due to the poor preservation of the caudal part of the spine, we cannot exclude diagnoses including spondylitis tuberculosa and developmental defects of the spine such as the persistence of neurocentral synchondroses, or the retrosomatic cleft. Considering the first possible diagnosis to be the most probable, it would be the first survived case of spondyloptosis identified in the palaeopathological literature.

Children's cranial lesions from Neolithic.

In skeletal material from the neolithic settlement at Makotrasy, county Kladno, were analysed two children's craniums (identification numbers Ao 8218 and Ao 4184) with pathological cases. Case 1 (Object 127, Ao 8218) is the individual about 4 to 5 years old. There is oval aperture with the diameter 25 x 20 mm in the area of anthropometrical point bregma, with vertical, multiple knurled edges. Bevelled and rounded segment in the left frontal part of the aperture with diameter 10 mm is imitating healing process. We suggest this case is the trephination with the marks of the healing process in the period of 1 to 2 weeks after the surgery took over. Case 2 (Pit 25, Ao 4184) is child with age determined about 4 years old. Cranium was found buried separately. There is oval defect located at os occipitale and os parietale sin and goes through sutura lambdoidea. Caudal part of defect is missing. The edge of the defect is sharp and inward bevelled with exposed diploe. Traces of any vital reaction were not identified. Diameter is around 50 mm. Perimortal trephination leading to death, or postmortal taking of the trephinational amulet must be considered. There were several pathological lesions on the same skull. Defect of oval shape sized 8 x 12 mm is located at the os parietale dex. Defect interferes mostly with lamina externa and less with lamina interna. Exposed diploe is without any vital reaction.

[Anterior skull base reconstruction]. / Plastika báze prední jámy lební.

The reasons for transcranial operative revision of anterior cranial fossa are cerebrospinal fluid (CSF) leakage, pneumocephalus, recurrent meningitis and eventually other causes. The trauma is the most common etiology of previously mentioned pathologic statuses, rarely it can also be long-lasting intracranial hypertension. We retrospectively analyzed our 61 patients, operatively treated at Department of Neurosurgery in Brno-Bohunice between 1997 and 2005, at whom the cranionasal communication must have been treated by means of transcranial neurosurgical repair of anterior fossa skull base. Each year approximately 10-15 operations of this kind were performed. The main goal of operative solution was the water-tight closure of dural defect and cranial base by means of direct dural suture duroplasty with periostal flap, fascial flap or other graft. Each case solution was dependent on actual operative appearance of the operative field. The majority of transcranial repairs of frontal cerebral fossas were performed acutely as a part of frontobasal injury operation with haematoma, calvar impressive fractures and open cerebral injury. The minority of repairs is formed by elective operations for posttraumatic rhinnorhea and meningitis. In our announcement we also mention possible conservative treatment.

Rosai-Dorfman disease: successful long-term results by combination chemotherapy with prednisone, 6-mercaptopurine, methotrexate, and vinblastine: a case report.

Sinus histiocytosis with massive lymphadenopathy (SHML), also known as Rosai-Dorfman disease (RDD), is a rare clinicopathologic entity of unknown etiology. The majority of patients do not require treatment, demonstrating spontaneous resolution or stable disease. However, in some cases the disorder runs a progressive course and/or threatens vital structures and functions, which dictates some form of intervention. It is not clear what constitutes the best approach for those cases. We report on a girl with an extensive and progressive form of the disease who was cured with combination chemotherapy, showing no evidence of recurrence after a follow-up of 5.5 years.

Predictive factors for mild forms of spondylotic cervical myelopathy treated conservatively or surgically.

A prospective 3-year randomized study comparing conservative and surgical treatment of spondylotic cervical myelopathy to establish predictive factors for outcome after conservative treatment and surgery. The clinical, electrophysiological and imaging parameters were examined to reveal how they characterized the clinical outcome. Statistically, pair-wise and multiple comparisons of different were used with the independent t-test and on one-way anova models followed by Tukey multiple-range tests. The patients with a good outcome in the conservatively treated group were of older age before treatment, had normal central motor conduction time (CMCT), and possessed a larger transverse area of the spinal cord. The patients with a good outcome in the surgically treated group had a more serious clinical picture (expressed in mJOA score and slower walk). Patients should rather be treated conservatively if they a spinal transverse area larger than 70 mm2, are of older age, and have normal CMCT. Surgery is more suitable for patients with clinically worse status and a lesser transverse area of spinal cord.

Predictive factors for spondylotic cervical myelopathy treated conservatively or surgically.

A prospective 3-year randomized study comparing conservative and surgical treatment of spondylotic cervical myelopathy to establish predictive factors for outcome after conservative treatment and surgery. The clinical, electrophysiological and imaging parameters were examined to reveal how they characterized the clinical outcome. The patients with a good outcome in the conservatively treated group were of older age before treatment, had normal central motor conduction time (CMCT), and possessed a larger transverse area of the spinal cord. The patients with a good outcome in the surgically treated group had a more serious clinical picture (expressed in mJOA score and slower walk). Patients should rather be treated conservatively if they have a spinal transverse area larger than 70 mm2, are of older age and have normal CMCT. Surgery is more suitable for patients with clinically worse status and a lesser transverse area of spinal cord.

The influence of mild hypothermia on ICP, CPP and outcome in patients with primary and secondary brain injury.

Aim of this study was to examine the hypothesis that only a subgroup of patients with lesser primary brain damage after severe head injury may benefit from therapeutic hypothermia. We prospectively analysed 72 patients with severe head injury, randomized into groups with (n = 37) and without (n = 35) hypothermia of 34 degrees C maintained for 72 hours. The influence of hypothermia on ICP, CPP and neurological outcome was analysed in the context of the extent of primary brain damage. Patients with normothermia and primary lesions (n = 17) values: GCS on admission 5 (median), ICP 18.9 (mean), CPP 73 (mean), GOS 4 (median). Patients with normothermia and extracerebral hematomas (n = 20): GCS 4, ICP 16, CPP 71, GOS 3. Patients with hypothermia and primary lesions (n = 21): GCS 4,62, ICP 10, 81, CPP 78,1, GOS 4. Patients with hypothermia and extracerebral hematomas (n = 14): GCS 5, ICP 13.2, CPP 78, GOS 5. Hypothermia decreased ICP and increased CPP regardless of the type of brain injury. Hypothermia was not able to improve outcome in patients with primary brain lesions but this pilot study suggests that it significantly improves outcome in patients with extracerebral hematomas.

Stereotactic evacuation of spontaneous infratentorial hemorrhage with monitoring of intracerebral pressure.

INTRODUCTION: Based on our experience with stereotactic evacuation of spontaneous supratentorial hematomas this method has also been used for evacuation of spontaneous infratentorial hematoma by the transtentorial approach. MATERIAL AND METHOD: The authors present a series of 6 patients with spontaneous intracerebral hematomas evacuated by the frame-based stereotactic technique, with monitoring of intracranial pressure (ICP) during the stereotactic evacuation. This method was indicated in patients with stable neurological status according to Glasgow Coma Scale (GCS), more than 10. The frame-based stereotaxy with the Riechert-Mundinger apparatus with CT localisation of target and optimal trajectory was used. RESULTS: The presented values after stereotactic evacuation show reduction of the initial intraparenchymal ICP in all patients to values less than 20 mmHg. CONCLUSION: The measuring of the ICP and the analysis of dynamic changes during stereotactic evacuation suggest that this procedure can significantly reduce the ICP performed in connection with ICH and we believe that our results can improve management of patients with spontaneous infratentorial and supratentorial intracerebral hematoma. (Fig. 1, Ref. 21.).

Cerebral perfusion pressure and spect in patients after craniocerebral injury with transtentorial herniation.

We present a group of 29 consecutive head injured comatose patients with the syndrome of transtentorial herniation. All patients had urgent surgery and then continuous monitoring of ICP, CPP, blood pressure and jugular bulb oximetry was instituted. Two postoperative CT and SPECT examinations were performed in each patient. 15 patients had a normal CPP (> 70 mmHg) throughout the postoperative period, 80% of them had a favourable outcome. On the other hand 14 patients had decreased CPP lasting at least one hour and only 36% of them had a favourable outcome (p < 0.05). Similar relationships were found comparing GOS in patients with normal and increased ICP (> 20 mmHg) and normal and decreased SjO2 (< 55%). All but 3 patients had ischaemia on SPECT. Ischaemia improved on the 2nd SPECT in 11 patients and 10 (91%) of them had a favourable outcome. GOS (mean follow up 9 months) is: 12 patients good, 5 moderately disabled, 2 vegetative, 10 died. We conclude that SPECT is able to disclose even reversible ischaemic changes. In these patients all effort has to be made to keep CPP on normal levels. Improvement in cerebral perfusion is related to a better outcome.

The benefit of a temporary vessel occlusion in aneurysm surgery.

OBJECTIVE: Temporary clipping in aneurysm surgery has been used more frequently in last years to increase the efficacy and safety of the neck dissection and obliteration. Experimental studies have shown that neuroprotection using hypertension and mannitol administration diminishes the risk of ischemia during this procedure. However, recent studies show that this method has to be used with caution. METHODS: In 85 aneurysms we used temporary vessel occlusion with neuroprotection described above in 17 patients (20%), ranging from 2 to 35 minutes (mean 9 minutes). The indication was peroperative rupture (3 cases), difficult neck dissection (13 cases) and a giant aneurysm (1 case). RESULTS: Forteen of these patients had a good result, one was severely disabled, the other 2 died. One of them had a large temporal hematoma and was HH=V before the operation, the other one had a premature peroperative aneurysm rupture. Shorter occlusion times were used in patients with a good outcome, in patients with elective use of the clip and in patients with no new ischemia on the postoperative CT scan (t-test, p<0.05). The postoperative infarction rate was similar in the group of patients with (17%) and without temporary clipping (15%). CONCLUSION: We conclude that temporary clipping in aneurysm surgery is a relatively safe procedure which facilitates the aneurysm neck dissection and enables neck obliteration in difficult cases. Better results are achieved with short duration of occlusion. (Fig. 4, Ref. 13.).

Lumbar disc surgery in regional anaesthesia--40 years of experience.

Lumbar disc operations have been performed in Brno since 1952 and from the very beginning they are performed under regional anaesthesia. Since 1965 until 1999 about 16,000 operations for herniated discs have been performed here. The number of operations doubled with the foundation of the second neurosurgical department in Brno in 1992. Lumbar disc surgery represents 25% of the operation spectrum in our department. Epidural anaesthesia is advantageous for less risk of some complications compared with general anaesthesia and enables communication between the surgeon and the patient. Other advantages are: less visible bleeding in the operative field due to the lateral position and the fact that the surgeon can sit during the operation. On a long-term basis we found 4-5% had further surgery for reccurent problems. Objective neurological evaluation 6 weeks after the operation showed improvement in 92% of patients. The patients themselves consider their status as very good or satisfactory in 82% (median 3 years after the operation). Besides a correctly performed operation we emphesize also the role of correct diagnosis (good correlation between the patient's problems and CT scan finding) for a good treatment result.

Treatment of congenital swan neck deformity with dynamic tenodesis of proximal interphalangeal joint.

Congenital swan neck deformities in seven fingers of two patients were treated by transfer of the flexor digitorum superficialis tendon to a tendon graft which was attached the extensor aponeurosis over the middle phalanx. The tendon transfer is protected for at least 2 months by a modified Murphy splint.

[A simple stereotaxic surgical apparatus]. / Jednoduchý stereotaktický operacní prístroj, SOP.

A simple apparatus based on the classical stereotactic method of surgery offers the opportunity to master miniinvasive procedures in neurosurgery and neurotraumatology. This device is particularly helpful in evacuation of intracerebral spontaneous and traumatic haematomas and in stereobiopsies, i.e. the most frequent operations in clinical practice, without the need of general anaesthesia, craniotomy and interference with cerebral tissue. The reliability of the stereotactic apparatus was positively evaluated by three independent surgeons. The apparatus was registered for use in the health services.

Trace elements and the European skeleton through 5000 years.

For our research, one thousand forty-four samples were taken from the femurs of 522 skeletons from 25 sites in Europe from the Neolithic Age (4000-5000 B.C), from La Téne Period, the Roman Era (500 B.C-400 A.D.), the Middle Ages and from contemporary cadavers. We found the following distribution of elements in the longitudional axis of long bones (the femurs and the tibias). The elements Zn, Fe, Ni, Cr, Pb, Mn, Co and Sn cumulated in the epiphysis. On the other hand, we found that Ca, Sr, Na and K prevailed in the central part of the diaphysis. In the central parts of the cross-section the highest concentration of the metal element Pb was in the external layer from the historical femurs. It was the same with cadavers of the recent population. A specific shift from Neolithic farming to agricultural intensification in the Roman Era was also apparent in the skeletons. Special sources of the above mentioned elements were found both in Celtic and Germanic tribes. Meat is the main source of zinc. Zinc is also important for the growth of the skeleton. When we investigated the development of the human skeleton during the last 5000 years we found the highest concetrations of Zn in communities with a good supply of animal food, whereas the lowest concentrations were paralleled with well-developed agriculturists. We assume the Neolithic gracilization, which is in the background for the increase of agricultural populations, is directly linked with the concentration of Zn and other elements essential for growth (Cu, Fe and others). The individuals most vulnerable to zinc deficiency include infants, adolescents during rapid growth phases and women during pregnancy and lactation. Trace elements in the bones of the La Téne period designate two areas of Celtic diet patterns--a "French one" (Roulier, Mont Trote and Acy Romance) and a "Czech one" (Karlov, Radovesice and Jenisuv Ujezd). At Czech sites levels of zinc increased westward towards the Germanic region. Over the Germanic territory in the region of the Saala River there are similar supply trace element sources for bones of the Germanic tribes for a period of more than 1000 years. The dietary customs and environment that formed this development were preserved from 400 B.C. to the period of the Merovingians. A specific ratio of Zn and Sr can be found not only in men, but also in woman and children. At the beginning of our era lead emerged as a civilization element. This element influenced the diet until the 20th century. Since the beginning of the 20th century it occurs much less in the population. On the contrary, we have found significant presence of tin in human bones. Cadavers of the modem population indicate a high content of tin, considerably higher than those in the populations from the beginning of our era (as much as 40 microg.g(-1) bone).

Diet reconstruction in the Roman era.

The samples from the proximal femora were taken from 12 cementeries from the Roman period. The skeletons date from the 1st-4th centuries A.D. Trace element analysis was used in order to reconstruct the basic diet. The sites that best corresponded to the model of Old Germanic diet described by ancient authors "meat, milk and cheese" were found in the Pruszcz Gdanski East Pomerania region close to the Baltic sea as well as in region Halle (Niemberg) and not far from Donau (Sládkovicovo). This diet is characterized by a large amount of protein and consequently of zinc. In the original Old Germanic region in a time period of more than 1000 years (from 400 B.C. to 700 A.D.) there is the same type of trace elements sources for bones and also the same type of the diet. This possibly distinguishes Germanic soldiers (aboriginal) from others groups in Roman legionary camps. It seems that the Donau River is very important for predicting the type of diet in the Roman period. North of the river animal component prevails south of the river vegetal component prevails. The rich agricultural land along the Donau River and in the Pannonian plains affects social arrangement as well as the structure of bones in Germans and Sarmats in the 2nd-4th centuries. Lead became a civilization element. It appeared in the diet of the Greek and Romans. Contamination varied with different social classes. We have found higher lead concentration in the femurs of the Germans than in those of the Sarmatians. The highest concentration we found was in Pannonian towns (Gorsium, Sopianae) and legionary camps (Straubing, Gerulata). In reference to age, the maxima of the highest lead concentrations in Gerulata II are between 11 and 13 years of age and between 40 and 50 years.