The case of low symptoms carotid cavernous fistula.

The authors describe the case of a patient with posttraumatic carotid cavernous sinus fistula with a complex of low clinical syndromes. Attention was drawn to oligosymptomatic fistula causing diagnostic difficulties in maxillofacial surgery practice. The study presents diagnostic and treatment methods and their results.

[Biomechanical investigation of distraction forces appearing in the course of femoral lengthening in rabbits: radiological and histological study]. / Biomechaniczne badania sil dystrakcyjnych wystepujacych podczas wydluzania piszczeli u królików--obserwacje radiologiczne i histologiczne.

This study was conducted in order to determine the values of forces necessary to stretch bony fragments during tibia lengthening in rabbits. The aim of this study was to determine the conditions which lead to complications of the lengthening process related to the rate of distraction. The experiment was conducted on 16 rabbits of New Zealand breed. The construction of the apparatus eliminated tension resulting from the so-called "bending moment". In all rabbits distraction was began on the 5th day after fixing the apparatus. The standard rate of lengthening was 2 x 0.25 mm per day. In 8 rabbits the rate of distraction was regulated. The distraction forces were measured and electronically recorded during the distraction procedure, during the animal's movement and resting position at strictly monitored intervals. Radiological examination of the lengthened tibia was performed once a week. Histological examination was performed in three rabbits after completion of the experiment. We made 328 measurements of the involved distractive forces, collecting a total of 223 MB of data. Graphical representation of the lengthening force and it's performance turned out to be similar for various experimental animals and it's course was typical for every stage of the lengthening process. At the time of distraction of the apparatus the measured force increased on average by 0.87 N (minimum 0.61, maximum 1.1N). Abnormal rates of distraction resulted in a break of the callus continuity in 3 rabbits. Radiological and histological examinations were used to assess to confirm certain observations concerning the technique and rate of distraction.

Power Doppler imaging in the evaluation of extracranial vertebral artery compression in patients with vertebrobasilar insufficiency.

OBJECTIVE: The recent introduction of Power Doppler Imaging (PDI) made a promise for better visualization of blood vessels lying in regions anatomically difficult for ultrasound imaging, i.e. vertebral arteries. The purpose of our study was to assess usefulness of PDI technique in visualization of vertebral artery course and to assess its utility in the detecting spondylotic vertebral artery compression in patients with vertebrobasilar insufficiency (VBI). METHODS: A total of 428 patients with VBI symptoms was evaluated. A total of 282 (66%) patients related their symptoms to a specific head position. Thus, all Doppler examinations were performed in four head positions: hyperextension, flexion and right/left rotation and also in a position reported by a patient to produce symptoms. PDI technique was employed as vertebral artery mapping for precise PW-Doppler range gate placing. RESULTS: Vertebral artery compression was found in 73 (17%) patients: 65 unilateral and eight bilateral. The diagnosis was based on flow decrease or its absence shown on PW-Doppler scans, after a specific head turning. CONCLUSION: Vertebral artery compression, related to a specific head position is relatively frequent in patients with VBI symptoms, especially in an older population commonly suffering from cervical spondylosis. PDI facilitates noninvasive Doppler US diagnosis by showing the real course of vertebral artery, particularly its intertransverse portion.

[The early results of surgical treatment of chronic subdural hematomas in computerized tomography imaging]. / Wczesne wyniki leczenia operacyjnego przewleklych krwiaków podtwardówkowych w obrazie tomografii komputerowej.

Since the introduction of computerized tomography (CT) it has been possible to trace the image of the brain after removal of subdural haematoma. Postoperative studies demonstrated often presence of residual haematoma. This raises the problem of establishing indication to reoperation, especially of patients with good clinical condition. The clinical condition and CT images before and after operation were assessed in 20 patients treated surgically for chronic subdural haematoma. A statistically significant correlation was found between the magnitude of the effect of the space occupying lesion in CT image and the severity of the clinical condition. A high-grade mass effect with major ventricular system shifting was more often connected with presence of partly haemolysed haematoma in CT. Subdural haematoma thickness exceeding 20 mm correlated with serious clinical condition of the patient, and increased the likelihood of hemiparesis persisting after the operation. Finding of residual haematoma in postoperative CT should not be an indication to reoperation, if not associated with high-grade mass effect and if the clinical condition is good. In our material out of 15 patients with good clinical condition postoperatively residual haematoma was detected by CT in 12 cases, but only one had to be reoperated because of persistent high-grade mass effect.

[A case of multiple vascular malformations of brain and liver]. / Przypadek mnogich malformacji naczyniowych mózgu i watroby.

In a woman aged 45 years after a generalized epileptic seizure CT and MRI demonstrated a lesion of the type of vascular malformation of the brain diagnosed as a haemangioma by angiography which demonstrated also presence of an aneurysm of the left pericallosal artery. Abdominal ultrasonography and tomography found also hepatic haemangioma. Both cerebral vascular lesions were managed successfully in one-step operation. The hypotheses for explaining the coexistence of haemangiomas and aneurysms are discussed.

[Spontaneous acute subdural hematoma]. / Spontaniczny ostry krwiak podtwardówkowy.

A rare case of spontaneous acute subdural haematoma is reported. Causes of non-traumatic subdural haematomas are discussed stressing the necessity of rapid surgical intervention.

[Early results of surgical treatment of chronic subdural hematoma in CT images]. / Wczesne wyniki leczenia operacyjnego przewleklych krwiaków podtwardówkowych w obrazie tomografii komputerowej.

Since the introduction of CT it has become possible to trace the pattern of brain changes after removal of subdural haematoma. Postoperative studies show frequently presence of haematoma residues, and this is connected with the problem of deciding about establishing of indications to reoperation, especially difficult if the patient is in a good clinical condition. The clinical status was compared with CT findings preoperatively and postoperatively in 20 patients subjected to operations for chronic subdural haematomas. A statistically significant correlation was found between the size of the mass effect in CT before and after the operation and the severity of the clinical condition. Major mass effect with high-grade ventricular shifting is more frequently connected with partially haemolysed haematoma in CT. The thickness of subdural haematoma exceeding 20 mm correlated with severe clinical condition, and increased the probability of hemiparesis persistence after the operation. Finding of residual haematoma in CT imaging after the operation, especially when not associated with high-grade mass effect, and with good clinical condition should not be accepted as an indication to repeated operation. In the presented material out of 15 patients with good clinical condition 12 had CT evidence of residual haematoma, and only one had reoperation in view of persisting evident mass effect.

[Catheter embolization: parenchyma-preserving therapy of renal bleeding of nonmalignant etiology]. / Katheterembolisation: Die parenchymschonende Therapie der Nierenblutungen nicht-maligner Atiologie.

9 patients with life-threatening renal bleeding of non-malignant origin, including trauma, AV fistulas, pseudoaneurysms and polycystic kidneys, were embolised after angiographic demonstration of the leakage. In all cases, the bleeding was stopped and in one case only nephrectomy was necessary 3 days after the initial embolisation procedure. Transcatheter renal embolisation should be performed as selectively as possible. With this technique most of the renal parenchyma can be saved. Embolisation is a safe and inexpensive procedure which also can be performed in critically ill patients.

[Relation between cerebral blood flow and the changes in perfusion pressure in patients with brain compression processes]. / Zaleznosc przeplywu mózgowego krwi od zmian cisnienia perfuzyjnego u chorych ze sprawami uciskowymi mózgu.

In 20 patients with expanding intracranial lesions the cerebral blood flow was determined by the method of Kety-Schmidt in an own modification with an original device--N2O-meter, with simultaneous continuous measurement of the intraventricular pressure and arterial blood pressure. This made possible determination of the cerebral perfusion pressure and of the effect of its fluctuations on the cerebral blood flow. Lowering of the cerebral blood flow below the normal value occurred when the perfusion pressure fell below 60 mm Hg, but its further fall, even to 20 mm Hg, caused no proportional decrease of the cerebral blood flow.

[Neuropsychological evaluation of the results of treatment of hydrocephalus using a ventriculo-atrial valve]. / Neuropsychologiczna ocena wyników leczenia wodoglowia zastawka komorowo-przedsionkowa.

In 25 patients with hydrocephalus of various grades and aetiology treated by insertion of ventriculoatrial valves neuropsychological investigations were carried out before and after this operation using the method of Luria and certain psychometric tests. The obtained results made possible isolation of three grades of impairment of higher nervous functions: III--afunction--10 patients, II--dysfunction--12 patients, I--eufunction--3 patients. Control neuropsychological examination two weeks after the operation demonstrated improvement of higher nervous functions in 6 cases with grade III and 11 patients with grade II impairment. In these cases radiological investigations demonstrated evidence of normotensive and hypertensive hydrocephalus and this was confirmed by measurements of intraventricular pressure of the cerebrospinal fluid. In 5 cases with grades III and II of damage no improvement was found. Radiograms and measurements of intraventricular pressure suggested in these cases hydrocephalus due to brain atrophy.

[Case of aneurysm of the anterior communicating artery visualized by vertebral angiography]. / Przypadek tetniaka tetnicy laczacej przedniej uwidoczniony droga angiografii tetnic kregowych.

The authors present a case of an aneurysm of the anterior communicating artery which was contrast-filled only from the vertebral artery. The pathogenesis of intracranial aneurysms in cases of developmental anomalies of cerebral arteries is discussed.