[Endothelin in the plasma and cerebrospinal fluid of patients after head injury]. / Endotelina w osoczu i plynie mózgowo--rdzeniowym chorych po urazie glowy.

UNLABELLED: Endothelin (ET) is identified as a potent vasoconstrictor peptide. It can cause a cerebral vasospam after subarachnoid hemorrhage. Its long-lasting vasoconstricting activity has been well documented. The role of ET in response to head injury is not clear. ET can participate in astrocyte activation and oxidative stress after trauma. The aim of this presentation was to investigate ET in the plasma and cerebrospinal fluid of patients after head injury and estimation of relation between the ET csf level and clinical condition of the patients and also relation of ET csf level and changes in the CT-scan and usefulness of ET as independent prognostic factor. We examined 30 patients at Day 1 after trauma (28 male, 2 female, aged 19-34 y, mean 30, 4, GCS ranged 8-15). CT-examination showed post-traumatic changes in 19 cases (11 with brain edema only, 8 with brain contusion). We measured ET by immunoenzymatic method using standard kits (Biomedica). The ET plasma level reached 1.12 +/- 0.63 fmol/ml (in the control group--0.44 +/- 0.19 fmol/ml) and c ET csf level 1.03 +/- 0.49 (in the control group--0.07 +/- 0.09 fmol/ml). W confirmed the correlation between the ET level and patients consciousness (by GCS) (p < 0.01). The ET csf level was highest in the patients with brain contusion in CT-scan (p < 0.02). Using multivariate analyses, we showed that ET can be used as a prognostic factor of results of treatment (p < 0.02). CONCLUSIONS: The ET level is elevated in the plasma of patients after head injury. ET is also present and strongly elevated in the cerebrospinal fluid of the same patients. The ET level in cerebrospinal fluid is associated with clinical condition of patients and elevated in cases with brain edema and structural brain damage. The ET level in cerebrospinal fluid is related to post-traumatic changes of the brain such as oedema and structural damage present in the CT-scan. ET can be used as a prognostic factor of results of treatment.

[Von Willebrand factor in patients with subarachnoid hemorrhage]. / Czynnik von Willebranda u chorych z krwotokiem podpajeczynówkowym.

UNLABELLED: Von Willebrand factor (vWF) plays an important role in the coagulation system. It affects platelet aggregation in the place of vessel endothelium damage. The importance of vWF in cerebrovascular disease is not clear. The aim of this presentation was to evaluate the vWF level in the plasma and cerebrospinal fluid of patients after subarachnoid hemorrhage including cases with cerebral vasospasm and cerebral infarct. We investigated 66 patients (38 persons graded I-III H&H and 28 persons graded IV H&H). The control group consists of 8 subjects. VWF was measured by ELISA method using standard kit Asserachrom (Boehringer). The vWF level in the plasma reached 288.81 +/- 99.66% (in the control group, 98.84 +/- 14.53%) without significant differences regarding clinical condition of patients. In the cerebrospinal fluid the vWF level was significantly different in I-III H&H patients and in IV H&H patients (1.21 +/- 0.52% and 9.18 +/- 7.58%, respectively, p < 0.001) and in the control group (0.13 +/- 0.33%). Our data indicate that there is correlation (Pearson, p < 0.01) between the level of vWF and neurological condition (GCS) of patients. There is also correlation (p < 0.01) between the level of VWF and the presence of clinical disorders (cerebral vasospasm, delayed neurological deficit (DIND) and cerebral infarct). Based on multivariate analysis, we confirmed that vWF is an independent prognostic factor of cerebral vasospasm (p < 0.01) and ischemic complications (p < 0.02). CONCLUSIONS: vWF is elevated in the plasma of patients after subarachnoid hemorrhage in early stage of the disease. VWF is present in the cerebrospinal fluid of patients with SAH and its level is higher in patients with poor neurological condition. The VWF elevation in csf is correlated with clinical condition of patients and also the presence of cerebral vasospasm and cerebral infarct. VWF can be used as an independent prognostic factor of cerebral vasospasm and ischemic complications.

Cerebrospinal meningitis with the presence of Acinetobacter spp.

The study was conducted on 16 strains of Acinetobacter sp. which were isolated from cerebrospinal fluid. The diagnostic material was analysed with the use of automatic BacT/Alert system (Organon Teknika). The analysis was performed in the Department of Microbiology, Medical University in Bydgoszcz. API 20NE system (bioMérieux) enabled the identification of 14 strains (87.5%) as A. baumannii, 1 strain as A. haemolyticus and 1 strain as A. lwoffii. The micro-organisms were isolated from patients whose age ranged between 4 and 66 years. These patients were treated in the departments of Neurosurgery (75.0%), Neurology (18.8%) and Intensive Therapy (6.2%). The infection of cerebrospinal fluid was caused by injury and subsequent exposure to the bacteria present in external environment. Antibiotic-sensitivity of these micro-organisms was evaluated with the help of disc-diffusion method, observing standardisation conditions outlined by NCCLS. All the strains proved sensitive to carbapenems, 15 strains were sensitive to netilmicin, 7 strains--to tobramycin and 7 strains--to amikacin. All the strains displayed multiple resistance. The only exception was A. haemolyticus. The use of two-discs allowed for the detection of ESBLs in 7 A. baumannii strains. Positive results were most frequently obtained after the combination of sublactam and aztreonam. Due to microscopic resemblance between Acinetobacter spp., and bacteria of Neisseria, Moraxella and Haemophilus genus, microbiological diagnostics should not be restricted to microscopic assessment of cerebrospinal fluid and quick serological tests evaluating the antigens of the most frequent aetiological factors. Considering multiple resistance of Acinetobacter spp. to antibiotics, the treatment should be based on sensitivity tests and the ability of a given antibiotic to penetrate into cerebrospinal fluid. In our opinion, both reasonable antibiotic policy as well as observing the principles of hygiene and monitoring infections play equally important roles in the prevention of infections with Acinetobacter spp. Such combined measures may help to prevent the spreading of multiple resistant strains in hospital environment.

Rhinospirography in evaluation of respiratory disorders in patients with central nervous system tumors.

The aim of the study was to define respiratory disorders caused by central nervous system tumors. We investigated 51 patients (31 men, 20 women, mean age 58). They were divided into the following groups: patients with supra-, infratentorial and cranio-vertebral junction lesions. We analyzed: the localization of tumors based on CT and MRI examinations and intraoperative observation, the status of consciousness by GCS scale, neurological status and histological findings. For the estimation of dynamics of the respiratory changes, rhinospirography examination was repeated several times in the course of observation. The alterations of respiration were clearly visible in many cases. We have confirmed that respiratory disorders found by rhinospirography provide a source of important clinical information on the effect of the treatment and prognosis. We have also confirmed that changes in respiration are observed earlier than changes of consciousness.

Surgical treatment of pathologiesof the craniocervical functions.

Spinal fractures at the craniocervical function require surgical treatment. Surgical can be preceded by direct traction of the cranium in order to set the fragments prior to fixation. This paper presents various methods of fixation from the posterior titanium loops.

Fixation of high thoracic spine fractures. A case report.

Fractures of the thoracic spine are very frequently accompanied by spinal cord compression syndromes, including symptoms that would indicate complete severance of the spinal cord. The indicates a very small reverse of space, especially in the upper and middle segments of the thoracic spine. Even a few millimeters of dislocation among the fragments of broken vertebrae can disrupt the proper anatomical relations and produce neurological deficits. Early intervention - in the form of complete immobilization of the damaged spinal segment, the administration of Solu-Medrol in a dosage consistent with the NASCIS II recommendations, and early surgical treatment with full decompression of the nerve elements - can lead to improvement. Despite the natural splinting provided by the ribs and the sternum, the thoracic spine requires good fixation after the decompression operation, followed in short order by intensive rehabilitation.

[Cases of cavernous hemangioma discovered in patients with post traumatic intracerebral hematoma]. / Przypadki haemangioma cavernosum ujawnione u chorych z pourazowym krwiakiem sródmózgowym.

Cavernous haemangioma has various forms. The cases with spontaneous intracerebral haemorrhage are most common, but post-traumatic intracerebral haematoma was not reported. The aim of this report is to present cases of cavernous haemangioma with unusual clinical course. In seven patients with post-traumatic intracerebral haematoma, fragments of histologically confirmed cavernous haemangioma tissue situated in the place of haematoma were found. In one case, delayed intracerebral haematoma twenty four hours after trauma and initial CT-scan was observed. On the initial CT-scan in this patient only traumatic changes in the brain without haematoma or tumour were present. In our cases, cavernous haemangioma was situated most frequently in frontal and temporal region, shown as haematoma usually 24 hours after trauma, mainly in men in age range 30-44 years with disorders of consciousness (GCS 11). As the result of operation, the majority of patients (6 out of 7) were discharged as self-independent. The authors reviewed the literature for cavernous haemangioma. The tumour may be present in any region of the brain including infratentorial region. The lesion is disclosed most frequently in children as spontaneous brain haemorrhage and rarely as seizures or intracranial hypertension. Final diagnosis is based on cerebral angiography or MRI. CT-scans are not typical and before the appearance of haematoma do not suggest the presence of tumour. Surgical removal of haematoma with tumour fragments is the main method of therapy, but radiation is possible in order to diminish the mass. The authors conclude that in each patient with post-traumatic intracerebral haematoma, the presence of cavernous haemangioma is possible.

[Advances in diagnostic procedures and treatment of spinal neoplasms]. / Postepy w diagnostyce i leczeniu nowotworów kregoslupa.

In the years 1958-1995 in the Department of Neurosurgery in Bydgoszcz we treated operatively 160 patients (100 men and 60 women aged 5-81 yrs) with spinal tumours causing spinal cord compression. Our material was useful in estimating the evolution in diagnostic procedures, treatment and limit of contraindications to surgery. We utilized previously analyzed patients' data from the years 1958-1987 (100 patients) and compared this with results from the years 1988-1995 (60 patients). In the years 1988-1995 we operated on twice as many patients per year than in the period 1958-1987 owing to better diagnostic and operative procedures and decrease of contraindications to treatment. In about 60 percent of patients the tumours were totally and subtotally removed. In recent period we performed 10 initial procedures of transpedicular stabilization. In most cases the extensiveness of tumours did not reach the level of three spinal segments. We confirmed good early results of treatment, particularly in cases with total resection of tumours, in about half the patients with spinal neoplasm, although the most common histological diagnoses were carcinoma (89 cases). In thirty percent of cases with carcinoma only pain was diminished.

[Cases of posterior inferior cerebellar artery aneurysms]. / Przypadki tetniaków tetnicy mózdzkowej tylnej dolnej.

The authors described two cases of aneurysms of the posterior inferior cerebellar artery (PICA) successfully operated on. The possibilities of surgical approaches and methods of obliteration of the aneurysm and review of PICA aneurysms in the literature are presented.

[Tissue plasminogen activator (T-PA) and tissue plasminogen activator inhibitor (PAI-1) in patients after head injury]. / Tkankowy aktywator plazminogenu (T-PA) i inhibitor aktywatora plazminogenu (PAI-1) u chorych po urazach czaszkowo-mózgowych.

The following factors of fibrinolysis: tissue plasminogen activator (t-PA) and tissue plasminogen activator inhibitor-1 (PAI-1) play an important role in patients after trauma. Their possible mechanisms in head-injured patients remain unknown. We studied the maintenance of those markers of fibrinolysis in the plasma and cerebrospinal fluid of 19 patients after severe head injury (initially GCS less than 8 p) without intracranial haematoma. We measured changes of the level of t-PA antigen and PAI-1 activity in days 0-3, 4-6 and later. T-PA antigen level in the plasma was higher than normally (4-8 ng/ml). T-Pa was present in the cerebrospinal fluid, but its level reached only 30% of the plasma level. In the days following injury the t-PA antigen level decreased. The PAI-1 activity in the plasma was normal (0-15 IU/ml). However, its activity in csf was high and reached, 80% of the plasma level and systematically increase in the following days particularly in patients who died. PAI-1 activity can be connected with the presence of damaged brain tissue and its necrosis and its increase can be a marker of poor prognosis.

[Cases of "delayed" subdural posttraumatic hygromas]. / Przypadki "odroczonych" pourazowych wodniaków podtwardówkowych.

The authors present 6 cases of uni- or bilateral subdural hygromas that appeared a few weeks following severe head injury. Such hygromas were named by the authors as "delayed" ones. Surgical evacuation of hygroma resulted in patient's status improvement in all 6 cases, based on well-known theories of posttraumatic hygromas origin, the authors try to explain patomechanism of the "delayed" hygromas.

[Otoneurological syndromes after cervical injuries]. / Zespoly otoneurologiczne po urazach kregoslupa szyjnego.

The aim of the work was the examination of vestibular and visual disturbances in patients after whiplash injury of the neck. The authors are of the opinion, that estimation of peripheral and central vestibular disorders are useful for defining of the clinical state of these patients.