[Estimation of efficacy of the octreotide LAR administration in the patients with somatotropinoma]. / Ocena skutecznosci stosowania oktreotydu LAR u pacjentów z guzami przysadki typu somatotropinoma.

Acromegaly is caused by excessive secretion of growth hormone by a hypophyseal adenoma type of somatotropinoma. IGF-I is formed in the liver and mediates most biological actions of GH. Treatment of adenomas, which secrete GH, involves pharmacotherapy followed by surgery. Modern pharmacotherapy leaning is based on somatostatin analogues (factor restrictive secretion GH): octreotide, octreotide LAR and lanreotide. The aim of our study was estimation of efficiency of octreotide LAR in the patients with somatotropinoma prepared to neurosurgery intervention. We examined 16 patients (10 of women and 6 men) with the features of active acromegaly. In all cases the increased concentration of HGH and IGF-I were observed. The presence of pituitary adenoma in all patients was confirmed by MRI. The patients were treated with octreotide LAR monthly in dose 20 mg and 30 mg respectively. Before and after application of somatostatin analogues the concentration HGH, IGF-I, PRL in serum were marked. The concentration of GH before octreotide LAR therapy in all patients increased remarkable and ranged from 15.6 to 78.6 ng/ml, mean: 31.20 +/- 16.84 (norm: 0-10 ng/ml), also, in all cases the serum IGF-I level was increased and ranged from 451 to 1107.6 ng/ml, mean: 801.75 +/- 207.82 (norm: 100-400 ng/ml). The prolactin concentration ranged from 7.4 to 49.9 ng/ml, mean: 22.8 +/- 13.7 (norm: 2-20 ng/ml) and in 8 (50%) cases the increased of PRL concentration in serum was observed. After the administration of octreotide LAR the level of: GH [mean: 12.99 +/- 17.16 ng/ml (p < 0.001)], of IGF-I [mean 422.8 +/- 229 ng ml (p < 0.01)] statistical important decreased and prolactin in 8 with increased concentration [mean: 12.45 +/- 5.57 (p < 0.01)] were observed. Long acting somatostatin analogues--octreotide LAR is particular efficient in lowering of growth hormone and IGF-I in patients with somatotropinoma and shows efficiency in normalization of increased prolactin concentration. Because of extreme effectiveness of octreotide LAR, it should be used the routine treatment at the patients suffering from active acromegaly and preparing to neurosurgical treatment.

Short-term pre-surgical treatment with somatostatin analogues, octreotide and lanreotide, in acromegaly.

Eighteen patients with symptoms of active acromegaly were treated with somatostatin analogues for 4 weeks before surgery. Both before and after the treatment, levels of growth hormone (GH), prolactin (PRL), insulin growth factor -I (IGF-I), luteotropin (LH), folliculostimulin (FSH) and subunit alpha of glycoprotein hormones were estimated. Glucose tolerance test, magnetic resonance imaging (MRI) examination, sight acuity and field of vision tests were also performed. The same tests were performed on ten control patients with clinically and biochemically active acromegaly, subjected to surgery but not treated with somatostatin analogues. In six patients treated with somatostatin analogues GH levels decreased significantly to less than 5 ng/ml and in two patients remained elevated while in 10 patients GH level decreased and ranged from 6.1 to 42.9 ng/ml. In 13 patients we observed a decrease in IGF-I to normal levels (<400 ng/dl) and in 3 patients we noted a decrease to levels slightly higher than normal. There was also a slight decrease in alpha subunit concentration. In the glucose inhibition test 4 patients demonstrated normalized GH levels. In patients with elevated PRL and TSH levels, treatment with somatostatin analogues induced their decrease. No changes were observed in levels of LH and FSH. After therapy MRI examination disclosed a decrease in tumor volume in two patients (by 20 and 25%, respectively) and no changes in tumor size in 16 patients. The two patients with a decreased tumor volume also showed normalized glucose tolerance tests. All patients manifested an improved clinical condition. Neurosurgeons disclosed a decreased tumor consistency which greatly facilitated surgical procedure. Our studies documented favourable effects of somatostatin analogues on the assayed hormone levels, and on the general condition of the patients as well as on the course of the surgical procedure itself.

[The proliferative potential of human pituitary macroadenomas on the basis of morphometric analysis of nucleolus organizer regions]. / Potencjal proliferacyjny makrogruczolaków przysadki na podstawie analizy morfometrycznej srebrochlonnych bialek obszarów transkrypcyjnych jaderek.

Cell kinetic information is an important adjuvant to histological typing and grading of human brain tumours. In the current study detection of the proliferating potential of adenomas was attempted using silver colloid technique for argyrophilic protein associated with nucleolar organizer regions (AgNORs). The expression of nucleolar organizer regions was assessed on paraffin sections in 28 pituitary macroadenomas which included all the main types. Nucleolar organiser regions have been quantified with computer-aided image analysis system in order to evaluate the mean area of AgNORs and their number relative to an internal reference, the number and areas of clusters of AgNORs and the area of the nucleus. In the pituitary macroadenomas there were 1.48 +/- 0.30 (mean +/- SEM) AgNORs per cell nucleus and corrected values were 1.66 +/- 0.27 (mean +/- SEM) AgNORs. The mean nucleus area was 867.18 +/- 203.91 pixels. The mean AgNORs size was 54.50 +/- 34.80 pixels. Correlation of nucleus area/AgNORs area was: r = 0.7085. On the number of the AgNORs it was possible to distinguish 3 subgroups of macroadenoma with different proliferative potential: low < = 1.367 (1.479); medium 1.367-1.733 (1.479-1.864) and high > 1.733 (1.864) AgNORs per cell nucleus and corrected number of AgNORs per cell nucleus respectively. Thus, this method provides useful information about the proliferative potential of human pituitary adenoma.

[Conservative treatment of cerebral arteriovenous malformations. Follow-up study of 31 cases]. / Leczenie zachowawcze naczyniaków tetniczo-zylnych mózgu. Badanie katamnestyczne 31 przypadków.

The clinical course of 31 patients with conservatively treated intracranial arteriovenous malformations (AVM's) was followed-up. The average follow-up period was 8.2 years, 75% of patients were followed up for more than 5 years. The initial symptom was intracranial bleeding in 21 patients (68%), seizure in 5 (16%), neurological deficit in 2 (6.5%), headache in 2 (6.5%) and intracranial hypertension in 1 (3%). The prognosis was more favourable for patients presenting with seizures than for patients presenting with haemorrhage. Patients in the haemorrhage group had 29% incidence of haemorrhage causing 14% mortality in this group. Of the 31 patient's 20 (64.5%) had a good clinical outcome, 4 (13%) had a fair outcome and 2 (6.5%) poor, 5 patients died, with one not due to AVM. There was no correlation between pregnancy and bleeding.

[Post-traumatic cerebrospinal rhinorrhea managed surgically. Clinical analysis of cases]. / Analiza kliniczna przypadków pourazowych plynotoków nosowych leczonych operacyjnie.

47 patients was treated surgically for posttraumatic cerebrospinal fluid rhinorrhea between 1977 and 1996 in the Department of Neurosurgery in Poznan. Cerebrospinal fluid fistula developed after road accident, less often because of assault, fall etc. Frontobasal fracture usually caused rhinorrhea and was verified by plain X-rays, computed tomography and magnetic resonance. Indications to early surgery were rhinorrhea coexisting with intracranial haematoma or pneumocephalus, optic nerve lesion, the persistent or recurrent rhinorrhea and meningitis. The authors present surgical methods and postoperative complications. Good outcome was in 86%.

[Central neurocytoma of the right parietal and occipital lobe. Case report]. / Nerwiak zwojowokomórkowy osrodkowy w placie ciemieniowym i potylicznym prawej pólkuli mózgu. Opis przypadku.

Central neurocytoma is a rare tumour of the CNS. It typically occurs in intraventricular location in young adults. The authors describe central neurocytoma in a 17-year-old woman, which was situated unusually for this type of tumour in the brain parenchyma. In this paper radiological and histopathological picture is presented.

[Factors contributing to recurrence of intracranial meningiomas and indications to postoperative radiotherapy]. / Czynniki sprzyjajace odrostowi oponiaków wewnatrzczaskowych i wskazania do pooperacyjnej radioterapii.

The incidence of various histological subtypes of intracranial meningiomas and recurrences was examined in 565 patients with surgically treated meningiomas in the Department of Neurosurgery in Poznan, between 1960-1992. Approximately 60% of the tumours were located on the convexity (39.5%) and parasagitally (23%). Histological diagnosis in 88% of the patients was endotheliomatous (61%), fibroblastic (17%) and angiomatous (10%) meningiomas. The incidence of recurrence after complete removal of the meningioma was 7% for all sites, but much higher after partial removal. Among the recurrences, there was a higher degree of malignant and angiomatous subtypes. Surgery is the accepted form of treatment for meningiomas but it may prove insufficient as the only method of therapy in certain situations. Implications for the potential role of postoperative radiation therapy are discussed.

[Central nervous system trauma in children. Clinical analysis of 782 cases]. / Urazy centralnego ukladu nerwowego u dzieci. Analiza kliniczna 782 przypadków.

A series of consecutive 782 children with severe head trauma and spinal cord injury who were managed surgically or conservatively in the Department of Neurosurgery, Medical Academy in Poznan during 31 years was analysed. The clinical history, severity of injury (scales AIS, ISS), outcome of head and spinal cord injuries are reviewed. Factors important in predicting a poor outcome included the presence of brainstem contusion, intracranial haematomas and complete and severe partial spinal cord lesions.

[Surgical management of pituitary adenomas by transsphenoidal approach]. / Chirurgiczne leczenie gruczolaków przysadki mózgowej z dojscia przez zatoke klinowa.

In the years 1976-1993 we have performed 90 transsphenoidal approaches for pituitary adenomas. This paper presents a detail report concerning 23 cases, operated in the last 2 years, with CT and NMR documentation. A preoperative visual deficit was very common in this group of patients. In the postoperative period the dramatic improvement of the vision was observed in 86% of cases. In our opinion the transphenoidal approach is very useful for the operation of the tumors with suprasellar expansion.

[Clinical analysis of 27 cases of primary lymphoma of the central nervous system]. / Analiza kliniczna 27 pierwotnych chloniaków osrodkowego ukladu nerwowego.

Clinical analysis of 27 patients with primary central nervous system lymphoma--Out of 4397 patients with intracranial neoplasms treated in the Department of Neurosurgery Medical Academy in Poznan between years 1956-1990, 27 patients i.e. 0.6% had primary central nervous system lymphoma. The patients age ranged from 15 to 63 years. In most patients the tumour was located in the temporo-parietal region. All patients were treated surgically, and then some received radio and/or chemotherapy. In spite of combined therapy the results of treatment are unsatisfactory, the median survival time is between 2 and 4 months.

[Multifocal oligodendroglioma. A case report]. / Wieloogniskowy skapodrzewiak. Opis przypadku.

A case of multifocal oligodendroglioma was described in a 51-year-old woman. Tumours were located in the parietal lobe of the right cerebral hemisphere and in the frontal lobe of the left cerebral hemisphere. Multifocal character and type of the neoplasm were determined by using computerized+ tomography and fine-needle biopsy with the patient alive. Histologic examinations of the surgical and autopsy materials confirmed multifocal development of oligodendroglioma.

[Evaluation of n-butyl 2-cyanoacrylate for the reconstruction of the arteries in dogs. II. Morphological evaluation]. / Ocena przydatnosci kleju do tkanek 2-cyjanoakrylanu n-butylu do rekonstrukcji uszkodzonych tetnic u psa. II. Ocena morfologiczna.

The microscopic examinations of 56 arteries anastomosed or dressed by 2-cyanoacrylate n-butyl tissue adhesive revealed prolonged inflammation of a foreign body type. The reaction was noticeable even after 93 days. Small parts of adhesive on the arterial surface were surrounded by fibromatosed granulation. However, inside some vessels parietal clots caused by an inaccurate anastomosis and too thick adhesive layer, were found. The long lasting inflammation doesn't eliminate the usefulness of the adhesive as remedy for the facilitation of the small vessels anastomosis.

[Evaluation of n=butyl 2-cyanoacrylate for the reconstruction of the arteries in dogs. I. Clinical evaluation]. / Ocena przydatnosci kleju do tkanek 2-cyjanoakrylanu n-butylu do rekonstrukcji uszkodzonych tetnic u psa. I. Ocena kliniczna.

The results of the experiments with 2-cyanoacrylate n-butyl adhesive used in arterial reconstruction at dog's were presented. The operations were performed on 56 carotid or femoral arteries of 14 dogs. Longitudinal 5-6 mm long arterial incisions and transversal incisions of the half of the circumference were treated with tissue adhesive only. Transsected arteries were anastomosed both with sutures and tissue adhesive applying the invagination method or end-to-end anastomosis. For 32 arteries with partial injury normal patency was stated, both in early and subsequent period after the operation in 32 cases. Partial occlusion was observed in 5 cases only. When the investigation method was applied to arterial anastomosis, the occlusion appeared in all 14 cases. For 10 arteries anastomosed by the end-to-end method, partial or complete occlusion appeared in 3 cases. The investigations prove that in slight arterial injuries the application of sutures and tissue adhesive, and in some cases exclusively adhesives, ensures the sufficient tightness and patency, and simplifies the surgical technique.

[Congenital carotid-sinus cervical-sagittal fistula]. / Wrodzona przetoka tetniczo-zatokowa; szyjno-strzalkowa.

The reported case presented an unusual form of congenital carotid-sagittal communication. Clinical findings included: except vascular murmur over the skull a characteristic syndrome consisting of of epleptic seizures, hemiparesis, aphasia and dementia. The communication was excised radically in its central and peripheral parts. The segment corresponding to the main trunk of the middle cerebral artery was narrowed by means of bipolar coagulation. Postoperative angiography and disappearance of most neurological signs after the operation showed that the chronically ischaemic parts of the brain resumed their functions.

[Aneurysm situated within the optic nerve]. / Tetniak umiejscowiony wewnatrz nerwu wzrokowego

A case of carotid-ophthalmic aneurysm of unusual location in the optic nerve is reported. The development of the disease was sudden: pain in the eye was followed by unilaternal blindness and manifestations of subarachnoid haemorrhage. The optic nerve was dilated balloon-like, cyanotic and vigorously pulsating. It was divided longitudinally and the aneurysmatic sac was exposed from the nerve. A vascular clip was put on its peduncle communicating with the cervico-ophthalmic portion of internal carotid artery. Despite preserved patency of the ophthalmic artery and partial continuity of the optic nerve, the vision of the eye didn't improve.