Enhanced lipid peroxidation processes in patients after brain contusion.

Erythrocyte superoxide dismutase (SOD-1) activity and cerebrospinal fluid (CSF), blood plasma low-density lipoprotein (LDL) and erythrocyte thiobarbituric acid reactive substance (TBARS) concentrations were determined in 30 patients with brain contusion and in 37 control patients with low back pain due to noninflammatory degenerative lumbar disc disease. In comparison to controls, during 10-day follow-up patients with brain contusion had significantly increased erythrocyte SOD-1 activity and CSF, blood plasma (LDL), and erythrocyte TBARS concentrations. The highest CSF TBARS concentrations were observed in five patients who died 2, 7, or 8 days following head injury. A significant negative correlation was found between erythrocyte SOD-1 activity or TBARS concentrations, in the blood plasma LDL fraction and erythrocytes, and The Glasgow Coma Scale score. These results suggest that enhanced lipid peroxidation processes, which seem to correlate with the severity of head injury, accompany brain contusion.

Stabilometric evaluation of equilibrium in patients with damage to the cervical spine.

The purpose of the present article is the stabilometric evaluation of patients with disorders of the cervical spine. The research involved 106 persons with spinal damage in the cervical segment due either to degenerative disease or traumatic injury. The examinations, performed on a Freyss stabilometric platform, involved the evaluation of particular parameters of platform movement. Head torque was also measured by using a special attachment. Improvement in posture coordination was demonstrated in the period from one month to one year after surgical fixation of the spine, as was the negative impact of an orthopedic collar on vestibulospinal reflexes. The results here recorded are associated with changes in cervical proprioception, reliably evaluated by comparing traditional platform movement results with the parameters used to evaluate shifts is head position.

Functional evaluation of treatment outcome in fractures of the cervical spine.

Introduction. Fractures of the cervical spine are becoming more and more frequent, which is causing the number of disabled persons to increase. Proper handling of the patient on the scene of the accident, proper transport to the hospital, and the correct interpretation of indications for surgical intervention can contribute to reducing the number of complications and improving treatment outcome.
Material and method. Our research involved 132 patients, 86 men and 46 women, operated as a result of traumatic injury to the spine and spinal cord with neurological deficits of varying degree. The patients were evaluated neurologically before surgery and divided into three groups on the deficits discovered. Their functional status was tested by means of the Functional Independence Measure (FIM) before surgery (Exam I), one week after surgery (Exam II), and approximately 6 months after surgery (Exam III).
Results. Improvement occurred in our patients in all the measured parameters, depending on the preoperative status of the patient. The greatest improvement in respect to functional independence was gained by those patients who prior to surgery presented with the largest neurological deficits; however, due to the very low preoperative level of functioning exhibited by these patients their condition, even after considerable improvement, was less than fully satisfactory. Somewhat less improvement took place in the patients with a moderate level of neurological deficit, while the least improvement occurred in the patients who presented with minimal neurological deficits. The condition of the patients in this last group was close to normal.
Conclusions. The proposed surgical method in many cases facilitated a rapid return to health; within only a few days after surgery these patients obtain more complete sphincter control, greater motor capability, more self-sufficiency, and better social functioning. The treatment outcomes are dependent on the patient's preoperative status.

[Cerebral aneurysms and current methods of treatment]. / Tetniaki tetnic mózgowych i nowoczesne metody ich zaopatrywania.

The authors discuss briefly aneurysms cerebral arteries. In the light of the pertinent literature the hypotheses of their development are reviewed. These aneurysms are probably lesions acquired by individuals with special predispositions, acquired or inborn. The problems of aneurysm diagnosis are reviewed and the methods are discussed of their management, both surgical and intravascular (embolization). Both methods are tentatively compared. In certain cases each method may be an excellent alternative for the other, and in other cases they are mutually complementary extending thus the range of therapeutic possibilities.

[Electronystagmographic and videonystagmographic studies in cerebello-pontine angle tumors]. / Diagnostyka elektronystagmograficzna i videonystagmograficzna w guzach kata mostowo-mózdzkowego.

Otoneurological investigations were carried out in 24 patients with cerebello-pontine angle tumors demonstrated in computed tomography. Standardized history taking was followed by electronystagmographic and videonystagmographical tests. In no case correct electrophysiological results were obtained. Eye-tracking test and gaze nystagmus were most frequently abnormal and together with other data these abnormalities indicated the location of the process. A more extensive use of videonystagmography was postulated.

Fixation of the cervical spine using a titanium plate.

Surgery of the cervical spine has been developing since the early twentieth century, but significant progress began with the appearance of the anterior approach, thanks to Bailley, Bedgley and Cloward, who developed a special set of instruments to facilitate operations using the anterior approach. In 1967 Haftek became the first surgeon to perform this operation in Poland; since that time the anterior approach has come to be in more and more general use. The first goal of the operation is to remove fragments of bone and intervertebral discs compressing the spinal cord; the second goal is to achieve good fixation of the operated segment of the cervical spine. In the earlier period external immobilization was applied, using campolite collars, Florida collars, Schanz collars, or HALO stabilizers. Currently immobilizing is done with titanium plates, which are well suited to the purpose of internal fixation of the spine.

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.

Problems in treating bedsores in patients with significantly limited motor activity.

Bedsores are a treatment problem often encountered in patients with spinal injuries and other bedridden patients. It may occur in patients who do not receive proper nursing care. Failure to observe nursing standards may result in neglect, potentially leading to the death of the patient. The authors describe the pathomechanism of bedsores, preventive measures against bedsores in daily nursing practice, and methods of treatment.

[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.