Neuroglia - development and role in physiological and pathophysiological processes.

The dynamic development of studies on neuroglia in recent years indicates its previously underestimated role in maintaining proper brain function, both in physiological and pathological conditions. The use of modern research methods such as single-cell techniques as well as in vivo and in vitro models enriched the state of our knowledge. The most important issues regarding the maturation and development of neuroglia include cooperation between glial cell groups and with neurons in neurogenesis, neuroregeneration, (re)myelination and how the early developmental roles of glia contribute to nervous system dysfunction in neurodevelopmental and neurodegenerative disorders. There is still growing evidence emphasizing the importance of astroglia in maintaining the brain physiological homeostasis, regulation of immune response, cerebral blood flow, and involvement in the reactive neurogliosis, precisely adapted to the nature of pathological stimulus and the depth of tissue damage. The important issues related to the function of oligodendrocytes include explanation of the mechanisms of interaction between the glial cells and myelinated axons, important not only in myelination, but also in development of cognitive processes and memory. Further studies are required for understanding the mechanisms of demyelination occurring in several central nervous system (CNS) diseases. An interesting area of research is related with explanation of the NG2 glia function, characterised by significant proliferative potential and ability to differentiate in both in physiological conditions and in pathology, as well as the presence of synaptic neural-glial connections, which are especially numerous during development. The increasing knowledge of microglia comprises the presence of specialised subsets of microglia, their role the myelination process and neurovascular unit functioning. We are only beginning to understand how microglia enter the brain and develop distinct functional states during ontogeny. This review summarises the current state of knowledge on the development and role in the CNS of different, heterogeneous cell populations defined by a common term neuroglia.

Humeral fracture in arm wrestling: bone morphology as a permanent risk factor. Indications for safety measures in arm wrestling.

BACKGROUND: Arm wrestling has been recognized as a popular and potentially dangerous competition. Reports on injuries related to arm wrestling are increasing. The most important of these injuries are humeral shaft fractures. The generally accepted theory states that the shoulder joint is actively internally rotated against the opponent while the elbow is fixed in flexion resulting in enormous violent torque forces across the humeral shaft. METHODS: The reported fracture morphology seems similar so we theorized that the basis of this fracture type is the bone structure. There is no experimental model of the arm wrestling fracture other than a virtual one. We assess morphology of the humeral bone by means of the bone cutting procedures and to verify the theory that the structure of humeral bone is a basis of the arm-wrestling fracture by means of newly developed model on human bones. RESULTS: Results of the study suggest that the humeral shaft fracture morphology during arm wrestling is based on the spiral structure of the bone combined with the direction of the revolving, rotational force during the match. CONCLUSION: The safety rules of the arm-wrestling match based on results of our experimental study and the literature metaanalysis are also formulate.

Posterior urethra rupture: contrast-enhanced computed tomography scan and urethrocystography demonstrations.

In the follow-up study of patients with pelvic fractures, rupture of the posterior urethra is registered in 3-25% of cases (Koraitim et al., 1996). The diagnostic gold standard for the assessment of hemodynamically stable trauma patients is contrast-enhanced CT scan, especially helical CT. Nevertheless, simultaneous suprapubic cystography and ascending urethrograms (the so-called up-and-downogram) are the investigation of choice in assessing the site, severity, and length of urethral injuries. (Carlin and Resnick, 1995) This paper discusses the evaluation and diagnosis of urethral injury in multiple-trauma patient.

Brain SPECT and Neuropsychological Examination in Patients with a History of Minor Craniocerebral Trauma Nine Years after Head Injury.

Focal perfusion deficits disclosed by single photon emission computerized tomography (SPECT) show more diffuse brain dysfunction than computed tomography (CT) examinations in case of head trauma. The aim of the study was to evaluate SPECT as an enhancing and complementary diagnostic method in patients after minor craniocerebral trauma (mCCT) and establish a possible correlation between clinical symptoms and disturbances of cerebral blood flow (CBF). SPECT examination and neuropsychological assessment was performed in seven patients about nine years after head injury, scoring 13-15 points on the Glasgow COMA SCALE and without evidence of structural brain damage. Neuropsychological assessment addressed global cognitive status, verbal and visual memory, working memory, object and space perception, executive function, self-assessment of memory, mood and health-related complaints. A direct relationship was shown between mCCT and the observed CBF disorders, and between the CBF disorders and cognitive dysfunction. Because of its sensitivity, SPECT, should be regarded as a method complementary to CT in mCCT.

Diffuse Axonal Injury: a Brief Review and Examples of the Use of Neurofunctional Imaging (Tc-99m HMPAO SPECT) in Diagnosis and Follow-up.

Diffuse axonal injury (DAI) is a growing problem nowadays as its social and economic costs amount to millions of dollars. DAI is now thought to be the predominant mechanism of injury in almost half the cases of traumatic brain injury connected with loss of consciousness. Computed tomography and magnetic resonance imaging are substantial techniques to diagnose DAI but they have their limitations. Neuropsychological tests used in follow-up disclose persistent disabilities in patients with total regression of CT and MRI changes. In those situations SPECT is appropriate as it shows lesions not disclosed by other imaging techniques. This article describes two cases in which usefulness of SPECT has been proved. A brief review of DAI has been included.

Early brain spect in patients after minor craniocerebral trauma.

A prospective study made 57 measurements of cerebral blood flow (CBF) by Single Photon Emission Computed Tomography (SPECT) in post-traumatic patients. The aim of the investigation was to evaluate CBF in patients after minor craniocerebral trauma (mCCT) to ascertain the clinicotopographic correlation of the CBF changes, and to study SPECT in comparison with computed tomography (CT) findings. In addition, evaluation of the usefulness of SPECT for forensic medicine, assessment of secondary brain injury by SPECT and the predictive value of hypofrontalism were performed. A direct correlation was shown between mCCT and the observed CBF disorders, and between the CBF disorders and clinical symptoms as well as better SPECT sensitivity in comparison with CT. The usefulness of SPECT for forensic medicine purposes was also shown. Secondary brain injuries were disclose and the predictive value of hypofrontalism was confirmed. No correlation between GCS and CBF changes was found.

Evaluation of Gore-Tex graft patency in hemodialysis access.

AIM: The purpose of this retrospective study was to analyze the patency and complications of Gore-Tex grafts used in hemodialysis (HD) access. METHODS: In the last 16 years, 1649 surgical procedures were performed on 655 patients to ensure and maintain permanent HD access. The study group consisted of 64 HD patients on whom 81 vascular synthetic PTFE Gore-tex grafts were performed. There were 28 males and 36 females, 3 of them were children (4.7%). Mean age was 54.2 years (range 15-77). Two types of Gore-Tex prosthesis were used: Diastat and Stretch. All grafts were implanted in the upper extremities. Kaplan-Meier survival curves were calculated to determine primary and secondary patency. Log-rank analysis was used to determine differences between curves. RESULTS: Primary and secondary patency at 12 months was 52.5% and 67.5%, and at 18 months respectively 41.5% and 58.2%. The Diastat graft had a lower primary and secondary patency compared with the Stretch graft (respectively p = 0.02 and p = 0.008). Factors such as gender, coexisting diabetes and hypertension did not determine graft patency. Thrombosis was one of the most frequent complications. The remaining complications included stenosis, pseudoaneurysms, infection, steal syndrome and seroma. CONCLUSION: On the basis of our experience Stretch grafts appear a better option for creating vascular access for HD than Diastat grafts.

Modern approach to management of patients following major trauma.

Trauma remains one of the three main causes of death all over the world. In Poland severe trauma is also an important public health problem which should be fully recognised in the changing system of our health service. There is a growing understanding and interest in the integration of pre-hospital, in-hospital and rehabilitation services taking part in the management of trauma patients. The importance of emergency medicine departments has been found valuable in Western countries and should be promoted by all means in our country. Certain recommendations of treatment of patients following severe trauma have been discussed concerning anti-shock therapy, diagnostic and operative management in polytraumatized patients with major head trauma, thoracic and abdominal trauma and also operative stabilization of fractures of bones. It has been concluded that in our country, especially in bigger cities, patients following major trauma should be treated in specially designed units (centers) integrated with emergency medicine departments providing competent intensive therapy and surgical interventions of well trained trauma teams introducing optimal modern trauma algorithms.

[Selected injury severity scales for practical use in traumatology]. / Wybrane skale ciezkosci obrazen do praktycznego zastosowania w traumatologii.

Measurement of severity of injuries is by all means needed in contemporary traumatology. Objective assessment of several different injuries is helpful in different comparisons concerning different groups of trauma patients. The authors have chosen 4 number scales: Trauma Scale (TS), Abbreviated Injury Scale (AIS), Injury Severity Score (ISS) and APACHE (Acute Physiology and Chronic Health Evaluation) in order to assess their application in traumatological practice. Advantages and disadvantages of number scaling describing of severity of injuries in trauma patients have been discussed.

[Preventable deaths after severe trauma]. / Zgony do unikniecia po ciezkim urazie.

A detailed analysis of 234 trauma patients who died after being admitted to the Department of Trauma Surgery in 1990-1996 has been performed in prospective studies. Among all fatalities multiple injuries have been diagnosed in 86 persons (36.7%) while single injuries have been found in 148 persons (63.3%). The mean Injury Severity Score (ISS) was 18. Consequences of severe head injuries, cardio-pulmonary complications, shock and pulmonary artery embolism have been identified as the main causes of death. All fatal cases have been reviewed by a multidisciplinary panel of physicians and judged as nonpreventable or preventable. In 28 cases errors and deficiencies leading to death have been identified and thus the overall preventable death rate (PDR) was 11.9%. PDR has been much higher among multiply injured patients than in patients with single injuries. Preventable diagnostic errors and deficiencies in management of multiply injured patients have been committed mainly in the early resuscitative phase. A decrease of PDR in fatalities treated lately in our Department has been recorded. Other aspects concerning studies on preventability in trauma patients have been discussed.

[Enzymatic markers in peritoneal lavage fluid for diagnosis of blunt abdominal trauma]. / Oznaczenia enzymatyczne w plynie uzyskanym z diagnostycznego plukania otrzewnej w rozpoznaniu obrazen jamy brzusznej.

Value of Diagnostic Peritoneal Lavage (DPL) in blunt abdominal trauma has been analysed in the studies. The material included 84 patients who were subjected to DPL since 1990 till 1994, and who were treated in the Department of Trauma Surgery Medical University of Gdansk. The enzymatic examination of the lavage perfusate performed in this study revealed that the level of the activity of the aspartic transaminase and the alanine transaminase over 10 IU/L indicate hepatic injury, and the level of the alkaline phosphatase over 3 IU/L point at the injury of the large intestine, small intestine and mesentery.

[A case of large bowel injury with a safety belt in a pregnant woman]. / Przypadek uszkodzenia jelita grubego pasem bezpieczenstwa u kobiety ciezarnej.

The authors present the case of a 24-year-old pregnant woman (9th week of pregnancy) who, due to a traffic accident, suffered transverse colon rupture through a sudden compression of the intestine with a "traditional" safety belt. The authors analyse the mechanism of injury, method of treatment, and on the basis of literature data discuss various body injuries developing as a result of action of safety belts.

The effect of zinc oxide on Staphylococcus aureus and polymorphonuclear cells in a tissue cage model.

The effect of zinc oxide on S. aureus (209 P) was studied in steel net tissue cages implanted subcutaneously in guinea pigs and rabbits. Zinc oxide installed in the tissue cages created high, sustained concentrations of zinc in the cage fluid throughout the study. In a concentration of 22 mmol/l zinc oxide reduced viable counts in tissue cage fluid inoculated with S. aureus. No deleterious effect was observed on polymorphonuclear cell function.

The effect of topical zinc absorption from wounds on growth and the wound healing process in zinc-deficient rats.

An experiment with local application of zinc oxide from a zinc tape to wounds was performed on 80 male Sprague-Dawley rats. Tapes with or without zinc oxide were applied on excisional wounds of both zinc-deficient and zinc-sufficient animals. The reduction in wound area was more pronounced in zinc-tape-treated animals given both a zinc-deficient and zinc-sufficient diet. The operative trauma had a negative effect on the animals' growth rate, although the state of zinc deficiency in the operated rats could be relieved by the local application of zinc. The results of the present study indicate that topically absorbed zinc from wounds promotes both the early wound healing phase and growth in both zinc-deficient and zinc-sufficient rats.