[The Cracow Physicians Society and the medical faculty of Jagiellonian University--the past and the present]. / Towarzystwo Lekarskie Krakowskie a Wydzial Lekarski Uniwersytetu Jagiellonskiego--przeszlosc i terazniejszosc.

The Cracow Physicians Society (CPS) since inception in 1866, maintain close liaison with the Faculty of Medicine of the Jagiellonian University by the person of president, board members and ordinary members of the Society who are also employees of the University. They share a number of common initiatives. Many distinguished professors are honorary members of the Society. CPS annually rewards outstanding doctoral and postdoctoral works award named professor Sych, and also awards diplomas and medals to deserving individuals for professional, scientific and organizational work. CPS cooperates with the Association of Graduates of the Medical Faculties of the Jagiellonian University, Polish Academy of Learning and the Division of Krakow Polish Academy of Sciences and numerous specialized medical societies in the medical integration and to focus physicians around deontological and ethical problems, basic sciences, medical diagnostics, therapeutics, medical history and culture.

[History of Jagiellonian University Clinic for Nervous and Mental Diseases in 100 anniversary]. / Zarys historii Kliniki Neurologiczno- Psychiatrycznej w 100 rocznice powstania.

In the paper there have been presented the creation and activities of the Clinic of Neuropsychiatry in the period of 1914-1950 and the scientific and organizational work of professor J. Piltz (1870-1930).

Morphological aspects of the traumatic chronic subdural hematoma capsule: SEM studies.

The morphology of the outer and inner membranes of traumatic chronic subdural hematomas (CSDHs) surgically removed from eight patients was investigated by scanning electron microscopy (SEM). Hematomas were divided into three groups based on time that had passed from the initiation of trauma to surgery. Structure of the CSDHs showed gradual morphological changes of the developing hematoma capsule. They initially included angiogenic and aseptic inflammatory reactions followed by progressive involvement of fibroblasts-proliferating and producing collagen fibrils. Numerous capillaries suggesting formation of new blood vessels were observed mainly in young hematomas removed between 15 and 21 days after trauma. In "older" hematomas (40 days after trauma), more numerous capillaries and thin-walled sinusoids were accompanied by patent, larger diameter blood vessels. Within the fibrotic outer membrane of the "oldest" hematoma capsules (60 or more days after trauma), especially in the area over the hematoma cavity, blood vessels were frequently occluded by clots. The results suggest dynamic changes in cellular and vascular organization of traumatic CSDH capsules paralleling the progression in hematoma age.

Autonomic system disturbances in patients with increased intracranial pressure caused by brain tumors evaluated by heart rate variability.

Most of the disturbances of autonomic system (AS) activity seen in clinical practice result from head injury are due to development of increased intracranial pressure (ICP). It has been described that cerebral lesions produce hypersympathetic states mediated mostly by sympatho-adrenal discharge. Aim of the study was to evaluate effects of ICP on heart rate variability (HRV) in patients with brain tumors. We studied 24 patients, which were divided on two groups: with increased ICP before neurosurgery treatment caused by brain tumors with symptoms and without symptoms with treated ICP. Our results provided evidence that all patients with increased ICP had the autonomic system disturbances. The heart rate variability and cardiovascular reflexes are useful in identification of autonomic system dysfunction.

[The role of computerized rheoencephalography in the assessment of normal pressure hydrocephalus. Preliminary report]. / Wartosc badania reoencefalograficznego w ustalaniu wskazan do leczenia operacyjnego pourazowego wodoglowia normotensyjnego. Doniesienie wstepne.

BACKGROUND AND PURPOSE: It is generally agreed that the positive result of lumbar cerebrospinal fluid (CSF) withdrawal offers a reliable means for selection of patients likely to respond to shunting in normal pressure hydrocephalus (NPH). However the studies of cerebral hemodynamics in NPH are performed Routinely only in few neurosurgical centers. We therefore studied the effect of CSF withdrawal on cerebrovascular autoregulation (CVA) in this condition by means of computerized rheoencephalography [REG]. MATERIAL AND METHODS: The study group consisted of 27 patients with presumed posttraumatic NPH. In each patient both the tap test and infusion test were performed. Psychometric tests and rheoencephalographic examinations were made twice: before and after CSF withdrawal. The obvious restoration of the functional state of CVA after CSF withdrawal was considered as a positive result of the tap test. RESULTS: Fourteen patients with a positive tap test and/or with resistance to CSF outflow (Rout) of more than 11 mmHg/ml/min were shunted. The improvement was obtained in 10 of them. Only one patient with a positive tap test did not improve. CONCLUSIONS: Our study suggests that restoration of CVA after CSF withdrawal is associated with high likelihood of shunt success, but not vice versa. Evaluation of CVA using REG seems to offer a new diagnostic tool in selecting patients likely to respond to shunting. Further studies are necessary to optimize the amount of CSF withdrawal, the delay between CSF withdrawal and control examinations and methodology of neuropsychological examinations.

[Prognostic value of computerized rheoencephalography in chronic posttraumatic subdural hematoma: a preliminary report]. / Znaczenie prognostyczne badania reoencefalograficznego w przewleklym pourazowym krwiaku podtwardówkowym--doniesienie wstepne.

BACKGROUND AND PURPOSE: The results of treatment of chronic subdural hematoma (CSDH) are still regarded as unsatisfactory. Measurements of cerebral hemodynamics are increasingly used to elucidate the pathophysiology of mental disturbances and hemiparesis in CSDH. On the other hand the clinical studies of cerebrovascular autoregulation in this condition are almost nonexistent. This study was therefore conducted to assess the cerebral artery compliance and the status of the autoregulatory reserve in CSDH as well as their effect on the neurological outcome. MATERIAL AND METHODS: Ten patients with posttraumatic CSDH were studied. The status of cerebrovascular autoregulation and compliance of arteries were investigated using computerized rheoencephalography (REG). A classification of the pulse waveform (REGpw) has been devised according to the number of inflection points in the ascending branch. The normal cases have corresponded with only one inflection point (category I). The presence of three or more inflection points was thought as characteristic for regressive changes of the arterial wall (category II). The capacity of autoregulatory reserve was estimated by studying the changes in amplitude of REGpw as a response to upper body-down tilting. RESULTS: In all patients the REG examination revealed a reduction in autoregulatory reserve. In 3 patients with the worst clinical result of treatment bilateral impairment of cerebrovascular autoregulation was found. The reduction in compliance of arteries was revealed in 6 patients. CONCLUSIONS: Our preliminary results indicate that bilateral impairment of the cerebral blood flow and the decrease in arterial compliance are of prognostic significance in patients with CSDH.

[Effects of intracranial hypertension on gastric myoelectrical activity evaluated by using clinical and radiological symptoms]. / Wplyw wzmozonego cisnienia sródczaszkowego ocenianego przy pomocy objawów klinicznych i radiologicznych na aktywnosc mioelektryczna zoladka.

BACKGROUND AND PURPOSE: Acute and chronic increases in intracranial pressure (ICP) cause a dramatic autonomic dysfunction. The aim of the study is to evaluate effects of acute and chronic ICP on gastric myoelectrical activity. MATERIAL AND METHODS: We studied 80 patients hospitalized in the Department of Neurotraumatology of the Jagiellonian University Medical College. The control group included 16 healthy volunteers matched with gender and age. Gastric myoelectrical activity was captured with cutaneous electrodes and Synectics (Sweden) system of storing and analyzing the data. RESULTS: Results of the study were analyzed in the Department of Pathophysiology of the Jagiellonian University Medical College. Most significant changes on gastric myoelectrical activity were observed in patients after a severe head injury with acute intracranial hypertension (Glasgow Coma Scale: 4-7 points). The percentage of bradygastria timing increased up to 50%. In this group of patients the increase in amplitude of the signal was observed. Significant dysrhythmias up to 40% occurred in patients with chronic increase of intracranial pressure caused by brain tumors. CONCLUSIONS: Most significant changes on gastric myoelectrical activity were observed in patients after a severe head injury with acute intracranial hypertension (Glasgow Coma Scale: 4-7 points). The percentage of bradygastria timing increased up to 50%. Gastric dysmotility was caused by stimulation of both arms of the autonomic nervous system.

[Circadian rhythms of melatonin of patients with severe traumatic brain injury]. / Badania rytmu dobowego melatoniny u chorych po ciezkim urazie czaszkowo-mózgowym.

The study was performed on a group of 5 patients with severe traumatic brain injury and in 2 healthy volunteers as the controls. The examination began 2-5 days after injury. The management of the patients and controls did not affect the natural melatonin circadian rhythm. The first result obtained was the characteristic nocturnal increase of the melatonin level in the healthy subjects. In a group of 5 patients with the severe traumatic brain injury the differences between the day and night time were insignificant. The results of the present study indicate that the severe brain injury gives rise to serious disturbances of the melatonin secretion in the acute posttraumatic period. These disturbances are characterized by the absence of the natural melatonin circadian rhythm. Despite the small number of patients, the obtained results justify further studies.

Nitric oxide as a prognostic marker for neurological diseases.

The potential value of the nitric oxide (NO) level as a prognostic marker in human brain diseases is investigated. Cerebrospinal fluid (CSF) collected from neurological patients was examined for NO content using electron paramagnetic resonance (EPR) spectroscopy. In adult patients with meningitis, the level of NO was higher than that in other groups of brain disorders, such as brain traumas and brain tumors. Very high levels of NO in the CSF appeared to be correlated with a high incidence of fatal outcomes. In children with meningitis, it was possible to differentiate between viral and bacterial origin of the disease as evidenced by the EPR analysis of the CSF. The results indicated that NO levels in the CSF can be a useful prognostic marker in neurological diseases.

Gastric myoelectrical activity and intracranial hypertension.

BACKGROUND: The aim of the study was to evaluate altered patterns of gastric myoelectrical activity in patients with high intracranial pressure due to severe craniocerebral injury producing intracranial hematomas, or to neoplastic processes in the central nervous system. MATERIAL/METHODS: The study population consisted of 50 patients admitted to the Department of Neurotraumatology, Jagiellonian University College of Medicine. The controls were 16 healthy volunteers matched for gender and age. Gastric myoelectrical activity was recorded with standard cutaneous electrodes using the Synectics (Sweden) system of data storage and analysis. RESULTS: The most significant changes in gastric myoelectrical activity were observed in patients after severe head injury with increased intracranial pressure (Glasgow Coma Scale score 4-7). The percentage of bradygastria increased to 46.5 in these patients, and the signal amplitude was also increased. Significant dysrrhythmias occurred in patients with increased intracranial pressure due to brain tumours. The percentage of tachygastria increased to 36.5. CONCLUSIONS: The greatest changes in gastric myoelectrical activity were found in patients with increased ICP and coma (GCS score 4-7) due to head injury. Bradygastria was found in 46.5% of cases.

Gastric myoelectric activity in patients with closed head brain injury.

BACKGROUND: Traumatic brain injury (TBI) constitutes a major public health problem. Most of the acute disturbances of autonomic nervous system activity seen in clinical practice resulting from head injury are due to increased intracranial pressure (ICP), which precipitates a complex set of changes causing lack of food tolerance. The aim of our study was to evaluate the effects of TBI on gastric myoelectric activity in coma patients. MATERIAL/METHODS: 24 patients (23 male, 1 female; mean age 43.6 +/- 7 yr.) hospitalized for TBI in the Department of Neurotraumatology were included in the study. Gastric myoelectric activity was recorded using the Synectics system (Sweden) on the 1st and 2nd day after injury. The control group consisted of healthy volunteers matched for age and gender. RESULTS: In the control group, electrogastrography (EGG) showed the percentage of time with bradygastria, normogastria and tachygastria to be 9.7 +/- 6.4, 88.3 +/- 7.6 and 2.0 +/- 3.5 respectively. The amplitude of the signal was 181 +/- 11.5 [micro V2]. In TBI patients, the percentage of time with bradygastria and tachygastria increased to 46.5 +/- 21.8 (p=0.03) and 5.5 +/- 11.8 (p=0.001) respectively, while the duration of normogastria decreased to 47.2 +/- 20.4 (p=0.001). Highly significant changes were observed in signal amplitude, which increased to 766 +/- 550 [micro V2] (p=0.0007). There was positive correlation between GCS and normogastria (r=0.66, p<0.001) and negative correlation between GCS and bradygastria (r=-0.77, p<0.001). CONCLUSIONS: In patients with brain trauma and coma, the functional brain-gut link is altered, causing gastric dysrrhythmias and intolerance to feeding. Prokinetics during enteral feeding are recommended.