Endoscopic third ventriculostomy for hydrocephalus: early and late efficacy in relation to aetiology.

OBJECTIVES: The aim of the study was to analyse the effectiveness and usefulness of treatment of hydrocephalus by Endoscopic Third Ventriculostomy (ETV). We sought to relate rates of failure to the cause of hydrocephalus, distinguishing between early and late outcome. PATIENTS AND METHODS: Between September 1999 and April 2001, 30 patients underwent ETV. In 23 patients hydrocephalus was caused by an expansive mass (tumour). Three groups of patients were distinguished, according to the different aims of ETV. Thus in group T--ETV was carried out to eliminate hydrocephalus prior to the main surgery (53%), in C--ETV was the definite treatment of choice (30%), and in group P--ETV was a palliative treatment (17%). The results were assessed in the early postoperative period and in long term follow-up using clinical relief of symptoms, and radiological criteria (pre- and postoperative computed tomography and/or magnetic resonance scans). RESULTS: In the early postoperative period ETV was rated to be effective by clinical criteria in 29 patients, and by radiological criteria in 27. According to late assessment the method was successful in 25 patients using clinical criteria, and in 21 using radiological criteria. There was no peri-operative mortality. A transient complication (wound CSF leak) occurred in two patients. CONCLUSIONS: ETV is effective in well chosen patients in relieving symptoms of hydrocephalus. It is valuable before a definitive major operation to remove the cause of hydrocephalus, as a palliative treatment, and in itself as a method of definitive management when indications are correct.

[Monitoring of neurophysiologic modalities during surgery for cerebellopontine angle tumors. Personal experiments]. / Monitorowanie neurofizjologicznych modalnosci w trakcie zabiegów operacyjnych guzów kata mostowo-mózdzkowego. Doswiadczenia wlasne.

The purpose of intraoperative monitoring of many modalities is to save some structures of the nervous system being at risk of damaging during surgical procedures. In cerebellopontine angle (cpa) tumour cases these nervous system structures can include cranial nerves (trigeminal, facial, cochlear, accessory), motor and sensory tracts localised within brainstem, and other. Continuous registration of somatosensory and auditory evoked potentials as well as electromyography of masseter muscle, orbicular muscle of eye and trapezius muscle during procedure is the method of brainstem, cochlear tract and cranial nerves status evaluation. Direct stimulation of cranial nerves within posterior fossa using bipolar electrode is the method of facial, trigeminal and accessory nerves localisation, especially in patients with large tumours. In Department of Neurosurgery Silesian University School of Medicine for intraoperative monitoring of many modalities in cpa lesion cases Nocolet Viking IV D unit with special IOM software is employed. Authors presented own experience in such method and effect in treatment of group of 15 patients operated with electrophysiological intraoperative monitoring.

[Usefulness of measuring levels of d-dimer for diagnosis of hospital venous thromboembolism]. / Przydatnosc oznaczania stezenia d-dimeru w diagnostyce szpitalnej zylnej choroby zakrzepowo-zatorowej (z.ch.z.z.).

D-dimer measurement with highly sensitive tests seems useful to rule out pulmonary embolism (PE) and deep vein thrombosis (DVT). However, nonspecific increase in d-dimer is common among inpatients. The aim of our study was to check: 1) whether the frequency of normal DD level in inpatients justifies its assessment as a part of diagnostic strategy for VTE, 2) whether tests that we are using are sensitive enough to exclude PE and DVT. In 27 (47%) out of 58 hospitalised patients evaluated by ultrafast ELISA (VIDAS bioMerieux), but in none of 20/58 patients with confirmed VTE, DD-level was found normal. In 35 of those patients DD was measured also with microlatex tests--Tinaquant and BC d-dimer. In 14/35 patients imaging test confirmed VTE. Sensitivity, specificity and negative predictive value (NPV) respectively were following: VIDAS: 100%, 80%, 100%, Tinaquant: 100%, 48%, 100%, BC d-dimer: 29%, 90%, 70%. Our results suggest that: 1) the relatively high frequency of normal DD-level among inpatients justifies its use in diagnostic strategies involving hospitalised patients, 2) negative VIDAS test confirms its as reliability for excluding VTE while 3) high sensitivity found for Tinaquant test encourages further prospective studies, 4) sensitivity of BC d-dimer is too low to be useful for excluding VTE.

[Own experience with the treatment of intracranial aneurysms using "Perneczky" - Zeppelin clips]. / Wlasne doswiadczenia w leczeniu tetniaków mózgu przy zastosowaniu zacisków naczyniowych typu "Perneczky" Zeppelin.

The basic design and the mechanism of clip application have not changed for many years. However in cases of aneurysms located deeply inside brain structure, in narrow spaces, multiple aneurysms or those which require applying of several clips the surgeon may have problems with visual control of the position of the clamping arms on the neck of aneurysm, nearby blood vessels and nerve structures. The above mentioned problems motivated prof. Axel Perneczky to construct a new model of clip with an applying and a removing holder whose mechanism is based on the principle of inverted--spring. Between February and August 1998 in the Neurosurgical Clinic in Katowice, 12 Perneczky's clips were applied in 9 patients. Intraoperative complications were not observed in any of the cases. In two cases of aneurysms located on the bifurcation of the basilar artery, application of two clips enabled precise intraoperative control of clip position.

CEA, NSE and SCC Ag in bronchial lavage in patients with lung cancer.

CEA, NSE and SCC Ag levels were measured in bronchial lavage (BL) and serum in patients with endobronchial lung cancer (LC) and in patients with nonmalignant lung diseases (NMLD). In both groups of patients 100 ml of normal saline solution was used during the lavage procedure. Tumor markers were detected using radioimmunoassay. CEA levels in BL and in serum were measured in 84 patients with LC and in 94 patients with NMLD. BL CEA levels were significantly increased in patients with LC (97.4 +/- 56.4 ng/ml) in comparison to patients with NMLD (4.2 +/- 6.3 ng/ml). Patients with LC had CEA levels in lavage fluid about 30 times higher than in serum. Significantly increased BL CEA levels in patients with LC were found in the cases with more advanced bronchoscopic tumor and in those with positive bronchial secretion cytology than in other groups of patients with LC. NSE levels were measured in BL and in serum in 21 patients with small cell lung cancer, SCC Ag levels were measured in BL and in serum in 21 patients with squamous cell carcinoma. The control group consisted of 28 patients with NMLD and 8 patients with adenocarcinoma. Determination of CEA levels in BL can be useful additional diagnostic method in patients with LC. The measurement of NSE and SCC Ag levels in BL in LC patients was considered to be not useful because of the low diagnostic sensitivity and specificity.

[Value of neuron specific enolase levels and squamous cell carcinoma antigen in bronchial lavage fluid in patients with lung cancer]. / Wartosc oznaczania stezen neuroswoistej enolazy i antygenu raka plaskonablonkowego w plynie uzyskanym z plukania oskrzeli u chorych na raka pluca.

The aim of the study was to assess a value of NSE and SCC Ag level determination in bronchial lavage fluid in patients with lung cancer. It was found out that NSE levels in bronchial lavage fluid were much lower than in serum and did not differentiate patients with small cell lung cancer from patients with non small cell lung cancer and nonmalignant lung diseases. Bronchial lavage SCC Ag levels were significantly higher than serum SCC Ag levels. Although determination of SCC Ag levels in bronchial lavage was also not helpful in differential diagnosis.

[The value of measuring adenosine deaminase activity in pericardial effusion fluid for diagnosing the etiology of pericardial effusion]. / Wartosc oznaczania aktywnosci deaminazy adenozyny w plynie osierdziowym w diagnostyce etiologii wysieku osierdziowego.

The diagnosis of tuberculous pericarditis is difficult. The cultures of the pericardial fluid for M.tuberculosis are often negative. The determination of ADA activity in pleural fluid in TB patients /PTS/ is very useful. It seemed reasonable to measure ADA activity in pericardial effusion. ADA activity in pericardial fluid of 40PTS/19 women and 21 men/with large pericardial effusion of different etiologies who were treated in our institute in years 1988-1995 was investigated. The median age was 44 years. In each case the pericardiocentesis was performed. PTS were grouped as follows: group I-4 PTS with strongly suspected TB pericarditis, group II-32 PTS with malignancy and group III-4 PTS with miscellaneous diseases. In group I the mean ADA activity was 24U/I(3-60), in group II 18U/I (3-60) and in group III 18U/I (0-37) (with a cutoff value for ADA activity of 40U/I). It was definitive bacteriologic diagnosis of TB pericarditis in PTS of group I. Our observation does not confirm the earlier data about the high ADA activity in clinically suspected TB pericarditis without bacteriologic diagnosis. The value of ADA determination in pericardial fluid is its high specificity (97%) in excluding of TB etiology of pericardial effusion.

[Petronasal fistula caused by the epidermal cyst of the cerebellopontine angle region]. / Przetoka skalisto-nosowa spowodowana torbiela naskórkowa okolicy kata mostowo-mózdzkowego.

The authors report a rare case of the occurrence of the paradoxical CFN rhinerrhea in a three months after epidermal cyst of the cerebellopontine region removal. The good result of the surgical fistula obliteration was reached by using muscle graft and tissue glue.

[Value of determining the concentration of carcinoembryonic antigen in bronchial lavage for diagnosis of lung cancer]. / Wartosc oznaczania stezen antygenu rakowoplodowego w plynie z plukania oskrzeli dla rozpoznania raka pluca.

CEA levels were measured in bronchial lavage in 84 patients with endobronchial lung cancer, undergoing diagnostic bronchoscopy. The control group consisted of 94 patients with nonmalignant lung disease, in whom bronchoalveolar lavage was performed. In both groups of patients 100 ml of normal saline solution was used during the lavage procedure. CEA levels in lavage fluid and in serum were determined with polyclonal (CEA-RIA) and monoclonal antibodies (CEA-EIA). Significantly increased CEA levels in lavage fluid were observed in patients with lung cancer (97.4 +/- 56.4 ng/ml) in comparison to the patients with nonmalignant lung disease (4.2 +/- 6.3 ng/ml). Patients with lung cancer had CEA levels in lavage fluid about 30 times higher than in serum. Determination of CEA levels in bronchial lavage can be a useful additional diagnostic method in patients with lung cancer.

[Usefulness of examining levels of carcinoembryonic antigen in pleural fluid for establishing the cause of pleural effusion]. / Przydatnosc badania stezenia antygenu rakowoplodowego w plynie z jamy oplucnej dla ustalenia przyczyny wysieku.

The levels of CEA in pleural effusion fluid and serum were determined in 132 patients with pleural effusions. Malignancy was the cause of pleurisy in 92 patients, in the remaining 40 patients the cause of pleurisy were non-malignant disorders. CEA levels exceeding 15 ng/ml were found in 42/92 patients with malignancy (45.7%) and in 2 patients with non-malignant disorders (5.0%). The serum CEA levels exceeded the value of 15 ng/ml in 23/92 patients with malignancy (25.0%) and in 1 patient of the remaining group (2.5%).

[The role of pleural needle biopsy and determination of Carcinoembryonic antigen in pleural fluid for diagnosing the etiology of pleural effusion]. / Znaczenie iglowej biopsji oplucnej oraz oznaczania stezenia antygenu karcinoembrionalnego w plynie oplucnowym dla rozpoznawania etiologii wysieku w jamie oplucnej.

Results of histopathological and bacteriological examinations of specimens taken in 213 patients with pleurisy by Abrams' needle biopsy of parietal pleura were presented. Malignant cells were found in histological survey of excisions from pleura in 48/128 patients with final diagnosis of cancer (37.5%). The same examination accompanied by bacteriological survey led to establish proper diagnosis in 41/60 patients with pulmonary tuberculosis (68.3%). In 31 patients with cancer pleural fluid was searched for concentration of the carcinoembryonic antigen (CEA). In this group, in 7/19 patients with negative histological results of pleural biopsy CEA concentrations were markedly increased. This finding strongly supported further searching for malignancy in those cases. Finally, the diagnosis was established due to the pleural needle biopsy in 89/213 patients (41.8%).

[Occupational exposure of workers in chemical factors and selected parameters of the respiratory system]. / Narazenie zawodowe pracowników zakladów chemicznych a wybrane parametry ukladu oddechowego.

Workers employed in chemical factories are chronically exposed to harmful substances present in the air of the occupational environment. The aim of this paper was to find out whether this situation produces adverse effects on the respiratory system despite the observance of admissible concentrations of toxic substances in the air. Spirometric values such as FVC1 and FEV1%FVC were measured in 647 workers. It was found that workers in some departments (power station and polystyrene) showed restrictive and obturative disturbances of ventilation. In other departments workers exhibited less expressed respiratory disorders. Adverse effect of smoking and long period of employment on the respiratory system of workers was also revealed. These results indicate that apart from substances present in the occupational environment there are other factors which affect as well the respiratory system of persons employed in the chemical industry.

[Level of carcinoembryonic antigen, neuron-specific enolase and ferritin in serum of small cell lung cancer patients: correlation with performance status, disease extent and prognosis]. / Stezenie antygenu rakowoplodowego, swoistej enolazy neuronowej i ferrytyny w surowicy chorych na drobnokomórkowego raka pluca: zwiazek ze stanem sprawnosci, rozlegloscia zmian i rokowaniem.

Carcinoembryonic antigen (CEA), neuron-specific enolase (NSE) and ferritin serum levels were assessed before treatment in 109 small cell lung cancer patients. CEA and ferritin serum levels were estimated by immunoenzymatic method: Abbott kits were used. NSE serum level was assessed by radioimmunoassay Pharmacia kits. In 38 patients the disease was localized, in 27 metastases were found in one organ and in 48-in two or more organs. CEA levels above 5 ng/ml were found in 41%, NSE above 12.5 micrograms/l in 86% and ferritin above 250 ng/ml in 41% of patients. The levels of CEA and NSE, but not of ferritin were correlated with the disease extent. The levels of CEA and ferritin, but not of NSE were correlated with performance status of the patients. In the patients with NSE serum levels above 50 micrograms/l and ferritin serum levels above 600 ng/ml the prognosis was significantly worse than in remaining patients.

[Usefulness of monitoring levels of carcinoembryonic antigen, neuron-specific enolase and ferritin in serum of patients with small cell lung cancer for evaluating treatment outcome]. / Ocena przydatnosci monitorowania stezen antygenu rakowo-plodowego, swoistej enolazy neuronowej i ferrytyny w surowicy chorych na drobnokomórkowego raka pluca dla oceny wyników leczenia.

Serum levels of CEA, NSE and ferritin were monitored during cytostatic chemotherapy in 53 small cell lung cancer patients. Complete remission of cancer was correlated with normalization of CEA and NSE but not of ferritin levels. The lack of normalization of CEA and NSE levels, but not of ferritin level were connected with bad prognosis.

Experimental hyperthyroidism enhances the regeneration of central neurites promoted by peripheral nerve grafts in the hippocampus.

The aim of the present paper was to ascertain whether experimental hyperthyroidism promotes the regenerative action of predegenerated peripheral nerve grafts implanted into the transected hippocampus. Hyperthyroidism was induced by subcutaneous injections of T4. Autologous peripheral nerve grafts were implanted immediately, 7 and 35 days following transection of the sciatic nerve. Cells extending their neurites into the grafts were traced by means of horseradish peroxidase conjugated with fluoresceine isothiocyanate (FITC-HRP). Fluorescence microscope examination revealed that experimentally induced hyperthyroidism considerably enhanced the regenerative influence of peripheral nerve grafts. This effect was particularly pronounced in hyperthyrotic animals treated with either nonpredegenerated or 35 day predegenerated nerve grafts.

[Levels of ferritin in serum of patients with lung cancer]. / Stezenie ferrytyny w surowicy chorych na raka pluca.

Serum ferritin levels using the radiometric method were determined in 161 lung cancer patients and in 50 patients with non-malignant pulmonary disorders. Elevated serum ferritin levels were seen more often in lung cancer patients (82%) than in those with the non-malignant disorders (52%). The levels of ferritin were also affected by the extension of the disease. In patients with stage III and IV serum ferritin levels were more pronounced (median 577 ng/ml) in comparison with stage I and II (300 ng/ml). Determination of serum ferritin levels may help in evaluating disease progression and staging, but can not be used as a screening test due to a low specificity.

[Usefulness of simultaneous antigenic determination of carcinoembryonic antigen (CEA), ferritin and orosomucoid levels in diagnosis of lung neoplasms]. / Przydatnosc jednoczesnego oznaczania antygenu rakowo-plodowego (CEA), ferrytyny i orozomukoidu w diagnostyce raka pluca.

Basing on results of tumor marker levels (CEA, ferritin, orosomucoid) in 271 lung cancer patients and 50 with non-malignant pulmonary diseases the authors found that assessment of different tumor markers is clinically more useful than single marker evaluation. Analysing several markers increases the specificity to almost 100% but decreases the sensitivity. Assessing several markers can help differentiating between malignant and non-malignant pulmonary disorders. It may also help in correctly staging the disease. A 12 month survival rate was seen only in 50% of the patients in whom the levels exceeded the cut-off value of two studied markers, whereas 90% survived 12 months if all marker levels were within normal levels. None of the patients with all markers exceeding the normal values survived one year after surgery. Survival rates of patients treated non-surgically were not influenced by the tumor marker levels.

Predegenerated peripheral nerve grafts facilitate neurite outgrowth from the hippocampus.

Autologous predegenerated (10 days after transection) (PD) distal stumps of rat sciatic nerves and nonpredegenerated (NPD) nerves were implanted into the hippocampus. Light microscopic examination of sections treated by hematoxylin-eosin and Nauta-Gygax silver method was performed at 2, 4, 8, and 16 weeks following implantation and revealed that two weeks after surgery PD implants were better connected with the surrounding brain tissue than NPD nerve fragments. Greater differences were observed at the 4th week of the experiment. Predegenerated grafts were better vascularized and contained many fibers bridging the site of anastomosis. At the 8th and 16th week, there were, in the microscopic preparations, no visible differences between PD sciatic nerve grafts and NPD ones.