Intraoperative C-arm fluoroscopy-based 3D navigation for intraventricular endoscopic intervention.

The authors present the technique of retained ventricular catheter removal by means of fluoroscopy-guided neuronavigation. A disconnected free-floating intraventricular catheter is an unusual shunt complication, and in case of shunt infection it should be removed immediately. The operative procedure described here is the first such imaging technique and original approach to retained ventricular catheter endoscopic surgery. The real-time fluoroscopy-guided neuroendoscopy seems to make 3D intraoperative navigation possible.

Endolymphatic sac tumours and von Hippel-Lindau disease - case report, molecular analysis and histopathological characterization.

Endolymphatic sac tumours (ELST) are aggressive papillary tumours of the temporal bone. The name was finally determined after the endolymphatic sac was determined as the site of their origin. They should be considered in patients with tumours eroding the petrous part of the temporal bone, extending to the cerebellopontine angle or other adjacent structures. These very rare tumours in the general population have much higher prevalence in von Hippel-Lindau disease. Hence molecular analysis of the VHL gene should be performed in patients with ELST and their relatives. The purpose of this study is to present a case report, histopathological characterization of endolymphatic sac tumours, their association with von Hippel-Lindau disease and use of molecular analysis.

[Saliva pH and galvanic current ways in mouth tissues and liquids].

In the group of 290 human having metal artificial limbs in an oral cavity, decrease in average value pH the mixed saliva in comparison with the persons who are not having metal inclusions was due to increase of percent of persons with sour reaction of saliva. Thus the degree of decrease the mixed saliva pH did not depend up on size of galvanic currents and presence of galvanic symptoms. The hypothesis was put forward, that decrease of saliva pH and development of galvanism was connected with local changes in a biofilm contacting to metal artificial prosthetic devices. Galvanic currents extended both on a surface of oral mucous membrane and in tissue. Clinical symptoms of galvanism we more expressed when galvanic currents flow manly in oral tissue.

Maternal tetrahydrobiopterin deficiency: the course of two pregnancies and follow-up of two children in a mother with 6-pyruvoyl-tetrahydropterin synthase deficiency.

No reports are available about the course of pregnancies in women with tetrahydrobiopterin (BH(4)) deficiencies or the effects of treatment with BH(4), L-dopa/carbidopa and 5-hydroxytryptophan (5-OHTrp) on fetal development. We present for the first time the case of a mother with late-diagnosed mild form of 6-pyruvoyl-tetrahydropterin synthase (PTPS) deficiency, the course of her two subsequent pregnancies and clinical evaluation with follow-up of two offspring. In both pregnancies neurotransmitter precursors, as well as BH(4) dosages were increased proportionally to the mother's weight gain. To prevent maternal phenylketonuria (MPKU) syndrome, special attention was paid to increasing BH(4) dosages. Both pregnancies were complicated by threatened premature labour, by the mother's nicotinism and additionally, in the first pregnancy, by gestational diabetes mellitus and vaginitis. The first child was born in the 31st week of pregnancy with the symptoms of moderate intrauterine growth retardation (IUGR) and brain malformation in the form of right sided closed-lip schizencephaly with absence of septum pellucidum. Although the girl demonstrates mild left-sided hemiparesis, her psychological development at the age of 8 years is above average. The second child was born in the 37th week of pregnancy without brain anomalies and at the age of 5 years his psychomotor development is appropriate for the age. As the cause of brain malformations resulting in physical impairment in the first child is unknown, more data are essential to verify conclusions about the influence of the mother's BH(4) deficiency and the safety of her treatment for fetal development.

Interleukin-10 (IL10) and tumor necrosis factor alpha (TNF) gene polymorphisms in Parkinson's disease patients.

Recent studies revealed that inflammatory processes might play an important role in the pathogenesis of Parkinson's disease (PD). We hypothesized that genetically determined differences in the immune response, especially in anti- and pro-inflammatory cytokines production might influence the risk for the development and/or onset of sporadic PD. In the present study, we investigated the genetic polymorphisms of the IL10 (-1082 and -519) and TNF (-308) genes in relation to the risk of PD, and their associations with age of PD onset in a group of 316 patients, divided into two subgroups: Group 1: patients with early onset PD (EOPD), i.e. before 50 years of age (102 patients), and group 2: patients with onset of PD after 50 years of age comprising 214 subjects. Control samples were obtained from 300 randomly selected healthy individuals from the same geographical region with no signs of Parkinsonism as evaluated by a neurologist. PCR-RFLP methods were used for genotyping. No statistically significant differences between PD patients and controls were found in the frequency of a single locus of IL10 promoter. We found TNF -308A allele significantly more frequent in EOPD patients compared to the controls (p=0.007). The overrepresentation of the A allele was reflected by a significant increase in AA homozygous individuals in EOPD patients compared to the controls (p=0.0021). The results from our study revealed that the TNF -308AA genotype might increase the risk of early onset of PD.

Treatment of acute ischemic brain infarction with the assistance of local intraarterial thrombolysis with recombinant tissue-type plasminogen activator.

BACKGROUND: Cerebral infarction is usually due to arterial occlusion. Prompt treatment with thrombolytic drugs can restore blood flow and improve recovery from an infarct. PURPOSE: To evaluate the clinical efficacy and safety of local intraarterial thrombolysis with recombinant tissue-type plasminogen activator (rtPA) in patients with acute middle cerebral artery (MCA) infarctions within 6 hours of the onset of symptoms. MATERIAL AND METHODS: Sixteen patients (10 females and six males) aged from 42 to 61 years, with acute MCA territory infarcts were selected for treatment with local i.a. rtPA up to 6 hours after the onset of symptoms. Patient selection was based on clinical examination, computed tomography (CT), and digital subtraction angiography (DSA). A clinical evaluation was performed before treatment, at the time of discharge, and 90 days post-procedure on the basis of modified Rankin and NIHSS scores. Controls (n = 16, nine females and seven males) aged from 51 to 70 years were treated only with intravenous anticoagulation using i.v. heparin infusion. The control group was evaluated with multidetector CT (MDCT) angiography performed on entry to the study and at 2-4 hours afterwards. RESULTS: Eight patients (50%) achieved a modified Rankin score of 2 or less as the primary outcome after 90 days follow-up. The secondary clinical outcome at 90-day follow-up was as follows: NIHSS score < or =1, three (19%) of the patients; NIHSS score > or =50% decrease, nine (56%) of the patients. A recanalization rate of 75% was achieved in 12 of the 16 treated patients, but only 12.5% in two of the 16 patients in the control group. Intracerebral hemorrhage occurred in two (12.5%) of the patients in the treatment group, but in only one patient (6%) in the control group. There were no deaths in the treated group after thrombolysis up to the time of discharge; however, during the 90-day follow-up, two patients died compared to three patients in the control group (19% vs. 12.5% mortality rate). CONCLUSION: Patients with cerebral infarction who were treated within 6 hours of onset using intraarterial rtPA thrombolysis had a significantly improved clinical outcome 90 days after the procedure compared to patients treated only with intravenous anticoagulation.

The effect of stem cell mobilisation with granulocyte colony-stimulating factor on the morphology of the haematopoietic organs in mice.

The cellular mobilisation of mice with granulocyte colony-stimulating factor (G-CSF) results in an egress of haematopoietic stem/progenitor cells from the bone marrow and an increase in their level in the peripheral blood. While the mobilisation process with different agents is widely studied, little is known about the morphology of the murine haematopoietic organs during the mobilisation. The purpose of this study was to examine the morphology of the bone marrow, spleen and liver in mice mobilised with G-CSF. To address this issue mice were injected subcutaneously with G-CSF for 6 consecutive days. Morphological analysis revealed an increase in the number of mature neutrophils close to the wall of sinusoids in the bone marrow as well as hypertrophy of the red pulp in the spleen. At the same time no morphological changes were noticed in the livers of G-CSF-mobilised mice. In conclusion, G-CSF induces discrete ultrastructural changes in the bone marrow, which intensify the transendothelial traverse of haematopoietic stem and progenitor cells from it. The changes in the spleen are related to repopulation of this organ by mobilised early haematopoietic cells circulating in the peripheral blood. We also noticed that the process of migration of haematopoietic cells from the bone marrow into the peripheral blood began on day 2 and was most pronounced on day 4 after stimulation with G-CSF.

Emergency Use of Stent and rtPA with Mechanical Cloth Defragmentation for a Thromboembolic Complication during GDC Coil Treatment of an Acutely Ruptured Basilar Tip Aneurysm.

Thrombotic occlusion of both posterior cerebral arteries occurred during embolization of an acutely ruptured basilar tip aneurysm. Intracranial stenting and continuous superselective infusion of rtPA was administered combined with mechanical clot fragmentation to reestablish normal vessel flow. DSA disclosed that normal vessel patency was achieved within 30 min. There were no adverse events related to rtPA administration and the patient recovered from the embolization with minor neurologic deficit as present before the procedure.

An unusual stab wound of the cervical spinal cord: a case report.

STUDY DESIGN: A rare case of a laterally directed stab wound injury of the cervical spinal cord is reported. OBJECTIVE: To describe the unusual mechanism of injury of this case and its clinical features. The surgical indications for penetrating injuries of the spinal cord are discussed. SUMMARY OF BACKGROUND DATA: Spinal stab wound injuries are rare, and the literature on the subject is scant. There has been only one large clinical review from South Africa, published in 1977. The clinical features and the injury mechanism of a laterally directed stab wound to the cervical spine have not been previously described. METHODS: An 18-year-old man was stabbed in the right side of the neck at C1-C2. The blade penetrated the spine laterally and went through the ligaments without affecting the bony structures. On admission the patient had tetraplegia and was in respiratory failure. Radiologic investigation showed the retained blade passing through the cord but showed no bony or vascular injuries. RESULTS: Before extraction, the knife was followed to its tip with careful dissection. Because no cerebrospinal fluid leak was noted in the area, the dura was not exposed. After surgery, magnetic resonance images showed a complete transection of the spinal cord at C1-C2. The patient was neurologically unchanged in follow-up examinations. CONCLUSION: Laterally directed horizontal stab wounds of the spine are particularly dangerous because the blade can pass between two vertebrae to transect the cord. The neurologic injury that results is irreversible. The more common stab wounds, inflicted from behind, usually produce incomplete cord damage.

[Brain stem auditory evoked potentials in brain death state]. / Sluchowe pniowe potencjaly wywolane w stanie smierci mózgu.

The authors studied auditory brainstem evoked potentials (BAEP) in 27 organ donors aged 40 to 68 years treated in neurosurgery units in Szczecin and Grenoble. Abnormal results were found in all cases. In 63% of cases no evoked action potentials were obtained, in 34% only the 1st wave was obtained, and in two cases evolution was observed with activity extinction. The authors believe that in the process of shaping of BAEP morphotic extinction begins from the later waves to earlier ones in agreement with the rostrocaudal direction of extinction of the functions or brain midline structures, and in a single study various findings may be obtained.

[Spinal reflexes in the determination of brain death]. / Odruchy rdzeniowe w przypadkach z rozpoznana smiercia mózgu.

The authors present the results of spinal cord function evaluation in organ donors by examination of reflexes. The knee reflex and ankle jerk, as well as abdominal reflex and foot withdrawal reaction were tested in 31 donors. At least one of the above was seen in 25 individuals. It is suggested on the basis of data obtained not to hamper the transplant procedure in cases of tested reflex persistency when brain death is revealed on relevant examination.

On the origin of mitosing cells. 1967

A theory of the origin of eukaryotic cells ("higher" cells which divide by classical mitosis) is presented. By hypothesis, three fundamental organelles: the mitochondria, the photosynthetic plastids and the (9+2) [9(2)+2] basal bodies [kinetosomes] of flagella [undulipodia] were themselves once free-living (prokaryotic) cells. The evolution of photosynthesis under the anaerobic [anoxic] conditions of the early atmosphere to form anaerobic bacteria, photosynthetic bacteria and eventually blue-green algae (and protoplastids) is described. The subsequent evolution of aerobic metabolism in prokayotes to form aerobic bacteria (protoflagella [undulipodia] and protomitochondria) presumably occurred during the transition to the oxidizing atmosphere. Classical mitosis evolved in protozoan-type cells millions of years after the evolution of photosynthesis. A plausible scheme for the origin of classical mitosis in primitive amoeboflagellates [amoebomastigotes] is presented. During the course of the evolution of mitosis, photosynthetic plastids (themselves derived from prokaryotes) were symbolically acquired by some of these protozoans to form the ["eukaryotic" deleted] algae and the green plants. The cytological, biochemical and paleontological evidence for this theory is presented, along with suggestions for further possible experimental verification. The implications of this scheme for the systematics of the lower [smaller] organisms is discussed.