Surgical complications of decompressive craniectomy in patients with head injury.

INTRODUCTION: Decompressive craniectomy is an important method for managing refractory intracranial hypertension. Although decompressive craniectomy is a relatively simple procedure, various complications may arise. The aim of our paper was to determine the incidence of complications of decompressive craniectomy in patients with head injury and to analyse their risk factors. METHODS: We retrospectively analysed a group of 94 patients after decompressive craniectomy for head injury between 01 Jan 2014 and 31 Dec 2018. Postoperative complications were evaluated based on clinical examination and postoperative CT scan. The impact of potential risk factors on the occurrence of complications was assessed (age, worse initial clinical condition, any haemocoagulation disorder). RESULTS: Twenty patients died within the first month after surgery. Control CT scan showed one complication in 78 patients (83%), while 46 patients (49%) had more than one complication. We had to reoperate 22 patients (23.4%) due to a complication. The following complications were found: postoperative acute subgaleal/subdural haematoma (30× - 32%), subgaleal/subdural cerebrospinal fluid effusion (29× - 31%), soft tissues oedema (29× - 31%), haemorrhagic progression of brain contusion (17× - 18%), malignant brain oedema (8× - 8.5%), hydrocephalus (8× - 8.5%), temporal muscle atrophy (7× - 7.5%), peroperative massive bleeding ( 6× - 6.4%), epilepsy (4× - 4.3%), syndrome of the trephined (2× - 2.1%), skin necrosis (2× - 2.1%). Patients with a haemocoagulation disorder had a significantly higher incidence of complications (p=0.01). CONCLUSION: Complications of decompressive craniectomy after head injury are frequent. The potential benefit of decompressive craniectomy can be adversely affected by the occurrence of many complications.

[Radiation Necrosis in the Upper Cervical Spinal Cord in a Patient Treated with Proton Therapy after Radical Resection of the Fourth Ventricle Ependymoma]. / Radionekróza horní krcní míchy po protonovém ozárení u nemocné po radikální resekci ependymomu IV. komory mozkové.

BACKGROUND: Radiation necrosis in eloquent areas of the central nervous system (CNS) is one of the most serious forms of toxicity from radiation therapy. The occurrence of radiation necrosis in the CNS is described in a wide range of 3 months to 13 years after radiation therapy. The incidence of this complication covers a wide range of 3-47%. The potential advantage of proton therapy is the ability to reduce dose to normal tissue and escalate tumor dose. Proton beams enter and pass through the tissue with minimal dose deposition until they reach the end of their paths, where the peak of dose, known as the Bragg peak, occurs. Thereafter, a steep dose fall-off is evident. Such a precisely-distributed dose should reduce the toxicity of the treatment. PATIENT: A 23 year-old female patient underwent radical microsurgical resection of anaplastic ependymoma that originated from the floor of the fourth ventricle. The tumor was growing into the foramen magnum dorsally from the medulla oblongata. Taking into account the age of the patient, the localization of the tumor and the required dose of 60 Gy, proton therapy was chosen due to the lower risk of damage to the brain stem. Radiation therapy was performed using pencil beam scanning and one dorsal field. Following this course of treatment, radiation necrosis of the medulla oblongata and the upper cervical spinal cord occurred with fatal clinical impact on the patient. The article analyses possible causes of this complication and a review of the current literature is given. CONCLUSION: Despite the theoretical advantages of proton therapy, no clinical benefit in CNS tumors has yet been proven in comparison with modern methods of photon therapy. Proton therapy is accompanied by many uncertainties which can cause unpredictable complications, such as radiation necrosis at the edges of the target volume. Following proton therapy, there is not only a higher incidence of radiation necrosis but it occurs both sooner and to a higher degree. In cases of high anatomical complexity, the neurosurgeon should cooperate in the creation of the radiation treatment planning to ensure its optimization.Key words: brain tumors - ependymoma - radiation therapy - proton therapy - necrosis - radiation necrosis This work was partially supported by research project MH CZ - DRO (Faculty Hospital in Pilsen - FNPl, 00669806). The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study. The Editorial Board declares that the manuscript met the ICMJE recommendation for biomedical papers.Submitted: 29. 6. 2017Accepted: 25. 7. 2017.

[The clinical, histopathological and imaging methods characteristics of Non-Hodgkin lymphomas in patients with brain involvement]. / Klinické, histopatologické a zobrazovací charakteristiky nonhodgkinských lymfomu u pacientu s postizením mozku.

BACKGROUND: The Non- Hodgkin-lymphoma (NHL) brain infiltration carries a poor prognosis. Because of relatively rare incidence, we decided to share our experience. PATIENTS AND METHODS: Retrospective analysis of patients with NHL brain infiltration dia-gnosed in 2001- 2011 at our university hospital. RESULTS: Twenty -seven patients with median age of 61 (range 42- 82) years were analyzed. The primary diffuse large cell B cell lymphoma of CNS was defined in 22/ 27 (81%) patients, in the others systemic NHL was present. Median positivity of the proliferative marker Ki 67 was 80%, the number of NHL lesions 1 (1- 8), diameter 28 × 30 × 29 (11 × 16 × 20 to 85 × 76 × 65) mm. The fundamental finding in brain lymphoma MRI imaging was lesion with predominantly homogenous contrast enhancement, diffusion restriction and collateral edema. Thirteen out of 27 (48%) patients underwent lumbar puncture, and lymphoma presence in fluid was detected in only two of them. The most frequent symptoms were limb paresis or hemiparesis (55%), bradypsichysm (22%), expressive aphasia (22%), cephalea (18%). Corticosteroid therapy, as a primary treatment option, was indicated in 15% of patients with a median overall survival of one month, CNS radiotherapy in 37% with a median survival of three months, and chemotherapy in 48% patients with a median overall survival 10 (2- 45) months. CONCLUSION: The brain lymphomas are rare and prognostically very unfavorable affection. When specifying brain focal lesions on MRI, it is necessary to consider this etiology and to elect imaging protocols with contrast agents and diffusion weighted sequence. Biopsy should be performed prior to start of corticosteroid therapy. Intensive chemotherapy or radiotherapy indication must be individually considered, and proposed treatment should be initiated immediately with a potential for somewhat prolonged survival.

[The current technical possibilities of the peroperative safety advancement in the microsurgery of cerebral aneurysms - a review article]. / Soucasné technické moznosti zvýsení peroperacní bezpecnosti pri mikrochirurgii mozkových aneuryzmat - souhrnný referát.

The authors present the technical aspects of perioperative safety during the microsurgery of cerebral aneurysms. We evaluated the advantages and disadvantages of the microvascular Doppler ultrasonography, the intraoperative digital subtraction angiography, the intraoperative transit time flowmetry, the intraoperative monitoring - motor evoked potentials and somatosensory evoked potentials, and the ICG videoangiography. The authors, based on their own experience, recommend combining different methods to eliminate the weak points of the individual specific methods. Combining the ICG with the flowmetry and the motor evoked potentials enhances safety during the surgery of cerebral aneurysms with the resultant reduction of the perioperative morbidity/mortality.

[Current microsurgical and neurointerventional therapy of cerebral aneurysms]. / Soucasná mikrochirurgická a neurointervencní terapie mozkových aneuryzmat.

Cerebral aneurysms occur in 5% of the adult population. Their most severe clinical manifestation is subarachnoid haemorrhage occurring in half of the patients. Morbidity and mortality of subarachnoid hemorrhage is relatively high. Stopping blood flow into the aneurysmal sac is the treatment objective. The basic techniques to achieve this are closing the aneurysmal neck with a clip - clipping - and the induction of intraaneurysmal thrombosis using platinum coils - coiling. Fusiform and giant aneurysms represent a technical challenge. The solution for indicated cases is the occlusion of the magistral artery along with a high-flow bypass. A new option is the use of special stents - flow-diverters - in unruptured aneurysms. The authors present the current view on the treatment of both ruptured and unruptured aneurysms. At the same time the authors focus on factors that influence the application of up-to-date knowledge on everyday activities in their departments.

Uncoupling of sexual reproduction from homologous recombination in homozygous Oenothera species.

Salient features of the first meiotic division are independent segregation of chromosomes and homologous recombination (HR). In non-sexually reproducing, homozygous species studied to date HR is absent. In this study, we constructed the first linkage maps of homozygous, bivalent-forming Oenothera species and provide evidence that HR was exclusively confined to the chromosome ends of all linkage groups in our population. Co-segregation of complementary DNA-based markers with the major group of AFLP markers indicates that HR has only a minor role in generating genetic diversity of this taxon despite its efficient adaptation capability. Uneven chromosome condensation during meiosis in Oenothera may account for restriction of HR. The use of plants with ancient chromosomal arm arrangement demonstrates that limitation of HR occurred before and independent from species hybridizations and reciprocal translocations of chromosome arms-a phenomenon, which is widespread in the genus. We propose that consecutive loss of HR favored the evolution of reciprocal translocations, beneficial superlinkage groups and ultimately permanent translocation heterozygosity.

Building a spin quantum bit register using semiconductor nanowires.

This paper reviews recent advances in engineering spin quantum bits (qubits) in semiconductor quantum dots and describes an approach based on top-gated semiconductor nanowire devices. Fast electrical single-spin manipulation is achievable, in principle, using the spin-orbit interaction intrinsic to III-V materials, such as InAs, in concert with AC electric fields. Combined with sub-nanosecond gate control of the nearest-neighbor exchange interaction and spin readout by spin-to-charge conversion, a fully electrical solid-state quantum processor is within reach. We outline strategies for spin manipulation, robust readout and mitigation of decoherence due to nuclear fields that, when combined in a single device, should give a viable multi-qubit testbed and a building block for larger scale quantum devices.

[Osteoplastic decompressive craniotomy--indication and surgical technique]. / Osteoplastická dekompresivní kraniotomie--indikace a operacní technika.

Decompressive craniotomy is usually carried out using decompressive craniectomy (osteoclastic decompressive craniotomy) when the bone flap is removed. In situations when the level of expansion does not call for decomopressive craniectomy, we do not remove the bone flap and we perform osteoplastic decompressive craniotomy. The indication is based on assessment and cross correlation of the following parameters: intracranial pressure,midline shift and the number of pathologies on CT, actual influence of antiedematous therapy, expected cerebral oedema progression and especially according to the size of the dural defect after duratomy. In the course of osteoplastic decompressive craniotomy, decompression is secured by the elevation of the unfixed bone flap during cerebral tissue expansion. After the oedema regression, the elevated bone flap spontaneously drops to its original position and is reattached. The danger of bone plate depression is eliminated with the use of a bevel bone cut using a Gigli saw. Osteoplastic decompressive craniotomy is an effective method of treating brain oedema when the degree of expansion does not require decompressive craniectomy.

[The curative effect of carotid endarterectomy]. / Kurativní efekt karotické endarterektomie.

The preventive effect of carotid endarterectomy in the reduction of ischemic stroke was reliably confirmed. Carotid endarterectomy may also be a curative method, but it has not been confirmed yet. In our case report we illustrate the curative effect of carotid endarterectomy in a patient after a combined embolic and hemodynamic stroke. The administration of intravenous thrombolysis did not have the expected clinical response. Neuroimaging showed ischemia and homolateral hypoperfusion of the brain hemisphere caused by critical internal carotid artery stenosis. On the 8th day after thrombolysis a carotid endarterectomy was performed with beneficial effect. Normalization of hemodynamic in the altered hemisphere was demonstrated by perfusion examination along with the clinical improvement. A curative effect of endarterectomy appears more probable in a hemodynamic ischemic stroke. For the improvement of a neuronal function the existence of penumbra is a condition. While a positive influence of hemodynamic by carotid endarterectomy is confirmed, the possibility of an increase in neuronal activity after repair of vasomotor activity is not documented. The curative effect and it's connection to the timing of the carotid endarterectomy require testing in the further studies.

[Radical surgery and intensive chemotherapy are necessary for successful treatment of osteosarcoma]. / Radikální operacní výkon a intenzivní chemoterapie jsou podmínkou úspesné lécby osteosarkomu.

BACKGROUND: We evaluated the therapeutic results in 44 patients (17 girls and 27 boys) with osteosarcoma from 1997 to 2006.Their average age was 12.8 years (2.5-20.2). 41 patients had localised disease and 3 had primary metastases. PATIENTS AND METHODS: We treated our 44 patients using CCG 7921 POG 9351 INT 0133, the therapeutic protocol of the North American cooperative Children's Oncology Group.The median of the follow up was 5.5 years (2-11 years). RESULTS: 40 patients went into complete remission. 19 patients suffered relapses. Of these, 17 patients died - 15 progressed, 1 died due to treatment-related toxicity, 1 died due to secondary acute myeloid leukaemia. As a whole, the patients had a 5-year overall survival rate (OS) of 58.4% and a 5-year event free survival rate (EFS) of 46.7%. The patients with localised extremity osteosarcoma (n = 40) had a 5-year EFS rate of 51%. The patients with good histological response (n = 22) had a 5-year EFS rate of 63.6%, while patients with poor histological response (n = 18) achieved a 5-year EFS rate of 30.5% (p = 0.009). CONCLUSION: The results of treatment of patients with localised extremity osteosarcoma and patients with good histological response to preoperative treatment were very good. The prognosis of patients with axial localisation and metastatic involvement was poor.

[Intraoperative neuromonitoring, neuroprotection and preventive carotid endarterectomy in patients with increased risk for development of cerebral ischemia indicated for cardiosurgery]. / Postavení peroperacní neuromonitorace, neuroprotekce a preventivní karotické endarterektomie u nemocných se zvýseným rizikem mozkové ischemie indikovaných ke kardiochirurgické operaci.

AIM OF STUDY: To demonstrate the benefit of peroperative electrophysiological monitoring and neuroprotection in cardiac surgery that makes use a cardiopulmonary bypass in patients with a high risk of stroke and to analyze the importance of prophylactic carotid endarterectomy. BACKGROUND: Cerebral ischemia is the most dreaded complication of cardiovascular operations that make use of a cardiopulmonary bypass. It is necessary to select an approach that minimalizes neurological complications. In our treatment strategy we use preoperative electrophysiological monitoring and neuroprotection. Prophylactic carotid endarterectomy performed as part of a combined operation we performed in patients with a high risk of hemodynamic stroke. METHOD: We retrospectively evaluated 86 patients (2004-2008) after cardiac surgery that made use of a cardiopulmonary bypass and synchronous electrophysiological neuromonitoring. After any decrease in neuronal function neuroprotection was used. Combined carotid and cardiac operations were performed under one general anestesia in ten patients with a high risk of hemodynamic stroke. RESULTS: A peroperative decline in electrophysiological responses was noted in 76.5%, of these 54.5% were insignificant alterations, 42.4% significant and in two cases there was a total deletion. After administration of neuroprotection electrophysiological responses partially normalized in 14%, totally normalized in 60% and did not change in 26%. Only one permanent stroke and four temporary encephalopathy were identified after surgery. No morbidity/mortality were detected after combined operations. CONCLUSION: Peroperative electrophysiological neuromonitoring combined with neuroprotection eliminate cerebral ischemic complications in cardiac surgery that makes use of a cardiopulmonary bypass. Selected patients with high risk of hemodynamic stroke profit from carotid endarterectomy.

[Tactical and technical notes for decompression craniotomy--a review]. / Poznámky k operacní taktice a technice dekompresivní kraniotomie--prehledný referát.

The authors present the tactics and technique of the decompression craniotomy (DC). DC is one of the principal neurosurgical procedures in the treatment of intracranial hypertension. Early indication and perfect technical completion of the procedure are the prerequisites for achieving the anticipated decompressive effect. While indications of DC are frequently discussed in the scientific literature, the procedure's tactics and techinque is usually overlooked. The report mentions the DC development and significance from its historical perspective. Decompression craniotomy should be performed as a preventive procedure to prevent secondary brain damage. Four types of craniotomy are used in order to perform decompression: subtemporal, circular, bifrontal and hemispheral. The hemispheral DC best fulfills the essential requirement regarding the brain stem direct compression release. The technical aspect of the hemispheral decompression procedure is described further in the report. The authors discuss some technical aspects, which, provided they are followed, should prevent the surgical method from failure. Incorrect technical performance, especially insufficient extent of the decompression, along with its late indication, is the principal factor discrediting the idea of decompression craniotomy.

Subclasses IgG1--IgG4 in 84 sera with IgG paraprotein.

The distribution of subclasses IgG1-4 was determined in 84 sera with IgG paraprotein. The results were as follows: IgG1--58.3%, IgG2--25%, IgG3--11.9%, IgG4--4.8%. After division into the group of IgG myelomas (n = 47) and the group of non-myeloma IgG paraproteinemias (n = 37), the following distribution was found: IgG1--55.3%, IgG2--25.5%, IgG3--12.7%, IgG4--6.5% and IgG1--62.1%, IgG2--24.3%, IgG3--10.8%, IgG4--2.7%, respectively. The distribution of light chains in the individual subclasses of IgG paraproteins was also studied. In three double IgG and IgA myeloma paraproteinemias, subclass 1 IgG paraprotein was always demonstrated.

Immunochemical and clinical characteristic of series of 516 paraproteinemic patients.

A series of 516 cases of paraproteinemia was analysed. According to the class of paraprotein, there were 336 cases of paraprotein IgG (65.1%), 101 paraprotein IgA (19.6%), 53 paraprotein IgM (10.3%) and 1 case of paraprotein IgD (0.2%); only light chains were found in 15 cases (2.9%) and doubled paraproteins in 10 cases (1.9%). The average age of the series was 64.2 years. Clinically, there were 315 cases of myeloma, 24 cases of Waldenström's macroglobulinemia, 126 cases of facultative paraproteinemia accompanying another disease, 16 cases of paraproteinemia in healthy persons and in 10 cases of paraproteinemia no precise diagnosis was made.

Monoclonal cryoglobulins and pyroglobulins.

In a series of 1182 monoclonal Ig, the authors demonstrated 10 cases with monoclonal cryoglobulin (0.8%) and 5 cases with pyroglobulin (0.42%) in the serum; in two of these cases both thermoproteins were present simultaneously. One observation revealed mixed cryoglobulin consisting of monoclonal IgM-kappa and polyclonal IgG. In 70 Waldenström's macroglobulinemias, monoclonal cryoglobulin occurred in 10%, pyroglobulin in 5.71%. In a subgroup of 744 monoclonal IgG, monoclonal cryoglobulin was demonstrated in 3 cases (0.4%), pyroglobulin in one case (0.13%).

[Our Experience in the Use of BAS-0 Bioactive Glass-ceramic in Orthoses in the Region of the Ankle.]. / Nase zkusenosti s vyuzitím bioaktivní sklokeramiky BAS-0 pri artrodézách v oblasti hlezna.

Extra-articular arthrodesis after Grice is indicated for the treatment of serious pes planovalgus or equinovalgus after the stabilisation of muscular relations in patients with infantile cerebral palsy. The surgical technique itself inspired the authors to use glass-ceramic blocks BAS-0 which were manufactured in co-operation with LASACK. In the period of 1995-1996 they used the glass-ceramic blocks 15times in 14 patients (1 patient operated bilaterally). Thirteen times they used glass-ceramic block in extra-articular arthrodesis, of which in 9 cases in combination with the Young technique, in two cases as part of subtalar arthrodeses. The criterion for the evaluation of the results was the axial alignment between talus and the long axis of the first metatarsus. Excellent and good results were achieved in 9 cases. In these cases the bioactive glass-ceramic block was always encased by bone graft and combined with the surgery after Young. In extraarticular arthrodesis the bones are not in contact. According to authors the glass ceramic block behaves in loading of the neighbouring bone as a "corpus alienum". As a result the ingrowth does not occur. Consequently, the radiograph shows a radioluscent line around the block. Even though the blocks were suitable from the viewpoint of their strength, they did not meet the expectations of authors in this indication. There did not occur a stable incorporation in the surrounding bone. Key words: BAS-0 bioactive glass-ceramics, Grice technique, Young technique, glass ceramic block.

[Ewing's sarcoma in children--current surgical treatment options, evaluation of our patients]. / Ewinguv sarkom u detí--moznosti soucasné chirurgické terapie, zhodnocení naseho souboru pacientu.

PURPOSE OF THE STUDY: Neoplastic diseases continue to arouse much concern in the general population. This also applies to bone tumors. Until recently, these neoplasms, most frequently occurring in children and adolescents, were considered to have the worst possible prognosis with a minimal opportunity for a successful outcome of treatment. This is a likely reason for the still deeply rooted belief that amputation of the affected limb is necessary and disease prognosis is uncertain, which also applies to Ewing's sarcoma. Only lately could these patients be offered a hope of successful treatment including limb salvage. MATERIAL: In the period from 1984 to mid-2003, 78 patients with Ewing's sarcoma were treated in our department. Their age ranged from 3 to 25 years, with the maximum occurrence between 13 and 17 years. We performed 27 reconstructions, 13 amputations or exarticulations and 24 resections without replacements. In 13 patients, the procedure was restricted to diagnostic biopsy only, because the tumor was inoperable. METHODS: The diagnosis was made on the basis of diagnostic biopsy and, subsequently, neoadjuvant chemotherapy was administered. When this resulted in tumor regression, definitive surgery was performed, involving tumor resection and bone replacement either with autograft or allograft, or with an individual prosthesis. When an implant was not necessary for maintaining limb function, a simple resection was carried out. In the patients in whom the tumor failed to regress, amputation or exarticulation was inevitable. Inoperable tumors were managed by megadose chemotherapy and by radiotherapy. The patients after orthopedic surgery receive adjuvant therapy, including bone marrow transplantation in indicated cases. RESULTS: The evaluation of our 78 patients showed that patient survival is not related to the surgical procedure used. In patients with an early diagnosis and a positive response of the tumor to chemotherapy, the reconstruction procedure appeared to be sufficiently radical in terms of cancer control while preserving limb function; these patients showed neither a significant increase in disease recurrence nor metastatic dissemination. Similar outcomes were also recorded in patients with a simple resection. However, amputation and exarticulation cannot completely be avoided and they are necessary in the patients whose tumor failed to respond to chemotherapy or in whom radical removal of the tumor is not possible. The poorest outcome was recorded in the patients with inoperable tumors, in whom it was not possible to carry out a radical orthopedic operation. The time between the onset of pain and initiation of therapy is also an important factor affecting the treatment outcome. Complications of reconstructive surgery for Ewing's sarcoma recorded in our patient group included osteomyelitis and graft fracture in addition to relapse and metastatic dissemination followed by death. DISCUSSION: Reconstructive surgery for Ewing's sarcoma is carried out in our department in patients with a confirmed diagnosis, in whom neoadjuvant therapy has resulted in tumor regression and in whom the extent and site of a tumor permit this sort of procedure. If this is not possible, limb amputation is indicated. If amputation is not possible due to tumor localization, megadose chemotherapy is administered. The results of long-term survival evaluation of our patients undergoing resection and replacement show that the procedure has been sufficiently radical, because no local recurrence or metastatic dissemination followed by death were recorded. Disease recurrence, death, graft osteomyelitis and fracture of a graft inclusive of osteosynthetic material are the complications reported. CONCLUSIONS: This study evaluated the current techniques of treating Ewing's sarcoma, with emphasis on reconstructive surgery leading to limb salvation and maintenance of its full function. The importance of this approach is obvious when we realize that the patients are mostly children and adolescents.

[Carotid microendarterectomy]. / Karotická mikroendarterektomie.

Atherosclerosis of the internal carotid artery with resulting stenosis, threatens the patients by cerebral ischaemia. Patients with high-grade stenosis, who have a high risk of stroke, gain profit from the surgery. The surgeon's decision is based on the clinical picture and on the degree of stenosis. The degree of the stenosis indicated for surgery was determined by international multicentric randomized studies and such indication represents the evidence-based medicine. Carotid microendarterectomy is performed at neurosurgical departments. The microsurgical technique enables perfect endarterectomy, eliminates patching and reduces risk of embolisation and vessel dissection. Cerebral ischaemia is a complex problem and carotid microendarterectomy is a part of the complex management of stroke.

[Allogenic transplantation of bone marrow in childhood]. / Alogenní transplantace kostní drene v detském veku.

BACKGROUND: Bone marrow transplantation has become the therapeutic method in some forms of malignant haemotopoietic diseases, malignant tumours, inborn errors of metabolism and immunodeficiency states. The objective of the presented work is the analysis of 40 allogenic bone marrow transplantations in children made in 1989-1994. METHODS AND RESULTS: Bone marrow transplantation was made in 40 children (26 boys and 14 girls), mean age 10.5 years (range 1.5-17.5 years). Indications were acute lymphoblastic leukaemia in 11, acute myeloid leukaemia in 10, chronic myeloid leukaemia in 6, myelodysplastic syndrome in 2, aplastic anaemia and Fanconi's anaemia in 7, non-Hodgkin lymphoma in 2 and inborn errors in 2 children. The donor was in 33 patients in HLA identical sibling and in seven instances a monozygotic twin, HLA non-identical sibling or relative or unrelated matched donor. Bone marrow engraftment was achieved in 35 (87.5%) patients, in one instance the bone marrow was rejected (2.5%) and in four patients (10%) early death occurred before the bone marrow engraftment. On Aug. 15, 1995 20 patients (50%) survived, a relapse developed in 7 (17.5%) and 13 patients died in conjunction with the transplantation (32.5%). The most frequent cause of death were infectious complications (9 children) either in conjunction with the development of graft versus host reaction (6x) or without signs of this reaction (3x). As a prophylaxis of graft versus host disease 24x Cyclosporine A with corticosteroids was used, 16x with methotrexate. A chronic graft versus host disease developed in 6 of 28 children surviving 100 days after transplantation. The greatest problem are infectious (bacterial and mycotic) complications in the phase of bone marrow aplasia before engraftment of the transplanted bone marrow or in conjunction with a graft versus host reaction which cannot be completely avoided by preventive measures. CONCLUSIONS: Bone marrow transplantation is also in children an effective therapeutic method of some forms of malignant haematopoietic diseases, malignant tumours and immunodeficiency states. The correct indication, suitable donor, preventive measures against the graft versus host reaction and protection against infectious complications are essential for the success of this pretentious treatment.

[Langerhans-cell histiocytosis in children]. / Histiocytóza z Langerhansových bunek u detí.

Histiocytosis from Langerhans cells is a new term for a group of diseases formerly called histiocytosis X. In The Faculty Hospital Motol the authors treated between July 1974 and December 1980 84 children with this disease. Twenty one suffered from the malignant form (formerly Letterer-Siwe and Hand-Schüller-Christian disease) and in 63 patients the diagnosis of eosinophil granuloma was established. In 21 children with unequivocally malignant disease the authors started chemotherapy immediately after establishment of the diagnosis and in six they indicated in addition radiotherapy. Of these 21 children 16 are in complete remission and 5 children died from progression of the disease during treatment. In the group of 63 children with eosinophil granuloma in 44 only excochleation of the focus was performed. Chemotherapy was administered to 12 children, incl. 5 where it was combined with radiotherapy. A relapse of the disease was recorded in 8 children. At present all patients suffering from the disease are in complete remission.