[Morphologic analysis of the coexisting anomalies of the arteries of the cerebral base and aneurysms: clinical study].

During operations of the aneurysms showing anatomical details is the means that leads to the aim, and it is not only a purpose in itself. Data on details that the surgeons come across during their work and which sometimes represent difficulties during interpretations of angiographic findings and planning operations, as well as the intraoperative orientations and identifications of the elements . Frequency of occurrence of such anatomical details and anomalies may be completely different from the one that autopsy series show. Knowledge of this makes the work of surgeons easier and gives a necessary feeling of confidence during operations. Thus, we decided to conduct a clinical, morphological study based on angiographic and surgical analyses of the explored segments of the Wilson circle. The study included 344 patients from the Institute for Neurosurgery, during the period of 2 years; the patients had complete angiographic diagnosing and operative exploration. Our findings confirm differences in localization of aneurysms according to sex. Aneurysms on the front communicant complex are to a great extent associated with anomalies of the front part of the Wilson circle.

[New trends in neuromonitoring patients with with aneurysmal subarachnoid haemorrhage].

Neurointensive care of patients with subarachnoid haemorrhage is based on the theory that clinical outcome is the consequence of the primary haemorrhage and a number of secondary insults in the acute post haemorrhage period. Several neuromonitoring techniques have been introduced or accomplished into clinical practice in the last decade with the purpose of monitoring different but related aspects of brain physiology, such as cerebral blood flow (CBF), pressure within the cranial cavity, metabolism, and oxygenation. The aim of these techniques is to obtain information that can improve knowledge on brain pathophysiology, and especially to detect secondary insults which may cause permanent neurological damage if undetected and untreated in "real time", at the time when they can still be managed. These techniques include intracranial pressure (ICP) measurements, jugular venous oxygen saturation, near-infrared spectroscopy, brain tissue monitoring, and transcranial Doppler. The available devices are limited because they measure a part of complex process indirectly. Expense, technical difficulties, invasiveness, limited spatial or temporal resolution and the lack of sensitivity add to the limitation of any individual monitor. These problems have been partially addressed by the combination of several monitors known as multimodality monitoring. In this review, we describe the most common neuromonitoring methods in patients with subarachnoidal hemorrhage that can assess nervous system function, cerebral haemodynamics and cerebral oxygenation.

[Results of the operative treatment of the ruptured aneurysm: prospective clinical study].

Aneurysmal subarachnoid hemorrhage (SAH) is a dramatic, frequently fatal event. With the incidence of 10 to 15 in 100 000 and a total mortality which even today is 40-50%, it represents a significant problem. Early surgical care for the hemorrhaging aneurysms has, without doubt, an importance in prevention of the rupture, however different series show different results as regards surgical timing and they are very different as regards giving advantage to the early or delayed time of the operation. Our aim was to perceive the results of the treatment in our group of 197 consequently operated patients for ruptured aneurysms with a special attention to the time of operation. This was a prospective clinical study and it was carried out at the Institute for Neurosurgery in Belgrade. Mortality of the operative treatment was a total of 15.74% in the entire group. According to operative intervals from the early to the delayed mortality the range is 35.71%, 22.22%, 11.63% and 8.88% respectively. The results of the treatment are in direct connection with the seriousness of the clinical picture. Being in the group graded from 1-3 decreases the probability of a fatal outcome, and graded from 1-2 decreases probability of morbidity. Early operated patients who in our group included also the most serious cases, life endangered ones, although with higher mortality do not have higher morbidity.

[Neurosurgical treatment of patients with supratentorial cavernoma].

The aim of this study is to present the principal clinical manifestations and neurosurgical results of the treatment of patients with supratentorial cavernoma and epilepsy. The retrospective study included 14 patients with supratentorial lesion on MRI and CT scan of the brain that manifested with epileptic seizures. All patients were surgically treated and pathophysiologic evaluation in all patients confirmed that cavernoma was in question. Results were analyzed and compared with data from the literature. Epileptic seizures are the most frequent clinical manifestation found in supratentorial cavernoma and neurosurgical treatment gives excellent result as regards the control of epilepsy, with a very low incidence of morbidity and mortality. A complete resection of all cavernomas in this study was confirmed by postoperative neurosurgical diagnosing. 12 patients did not have any more epi seizures in the postoperative period, and in 2 patients we found decrease in the occurrence of epilepsy seizures.

Blood and plasma selenium levels and GSH-Px activities in patients with arterial hypertension and chronic heart disease.

The purpose of this study was to examine the relationship between arterial hypertension (HTN), chronic heart disease (CHD), and selenium (Se) status. Blood and plasma Se concentrations and Se-dependent GSH-Px activities were determined in 40 patients (HTN = 20; CHD = 20) and 17 healthy volunteers aged 41 to 66 years. Whole blood and plasma Se concentrations were significantly lower in the patients with HTN (19.1% and 26.3%, respectively) and CHD (33.1% and 29.4%, respectively) compared with the values obtained in the controls. The hypertensive patients had lower plasma Se-GSH-Px (26.7%), and those with CHD had both lower whole blood (19.5%) and plasma Se-GSH-Px activities (30.2%). A significant positive correlation between plasma Se-GSH-Px activity and ejection fraction (EF) was found in patients with CHD. There were significant correlations between plasma and whole blood Se concentration, plasma Se concentration and Se-GSH-Px activity, and whole blood Se and Se-GSH-Px activity. Our results showed that hypertensive patients and those with CHD had lower Se levels compared with controls. We conclude that low Se content might be a risk factor for development of HTN and CHD.