Impact of haemoglobin A1c on wound infection in patients with diabetes with implanted synthetic graft.

OBJECTIVE: The aim of this study was to assess the relationship between haemoglobin A1c (HbA1c) values and operative wound infection. METHOD: During the period from 2013-2016, consecutive patients with type 2 diabetes were prospectively evaluated. Data were retrospectively analysed. All included patients were admitted for an elective surgical procedure, requiring the use of prosthetic graft in a groin wound. The patients were divided into two groups according to their preoperative HbA1c values. The main outcome was groin wound infection. The association between preoperative long-term glycoregulation and wound infection was evaluated, as well as the impact of postoperative glycaemic values, regardless of the level of HbA1c. RESULTS: Of the 93 participating patients, wound infection occurred in 20 (21.5%). Wound infection occurred in 28.2% of patients with uncontrolled diabetes (HbA1c >7%) and 16.7% of patients with controlled diabetes (HbA1c <7%); however, the difference did not reach statistical significance (p=0.181). In regression modelling, operative time (p=0.042) was a significant predictor of wound infection, while patients' age (p=0.056) was on the borderline of statistical significance. Females had a higher probability for wound infection (odds ratio (OR): 1.739; 95% confidence interval (CI):0.483-6.265), but there was no statistical significance (p=0.397). Patients with elevated levels of HbA1c had a higher chance of wound infection compared with patients with controlled diabetes (OR: 2.243; 95% CI: 0.749-6.716), nevertheless, this was not statistically significant (p=0.149). CONCLUSION: We found no statistically significant correlation between elevated values of preoperative HbA1c and postoperative groin wound infection.

[Morphometric characteristics of neuropeptide Y immunoreactive neurons of human cortical amygdaloid nucleus].

INTRODUCTION: Cortical amygdaloid nucleus belongs to the corticomedial part of the amygdaloid complex. In this nucleus there are neurons that produce neuropeptide Y. This peptide has important roles in sleeping, learning, memory, gastrointestinal regulation, anxiety, epilepsy, alcoholism and depression. MATERIAL AND METHODS: We investigated morphometric characteristics (numbers of primary dendrites, longer and shorter diameters of cell bodies and maximal radius of dendritic arborization) of NPY immunoreactive neurons of human cortical amygdaloid nucleus on 6 male adult human brains, aged 46 to 77 years, by immunohistochemical avidin-biotin technique. RESULTS: Our investigation has shown that in this nucleus there is a moderate number of NPY immunoreactive neurons. 67% of found neurons were nonpyramidal, while 33% were pyramidal. Among the nonpyramidal neurons the dominant groups were multipolar neurons (41%--of which 25% were multipolar irregular, and 16% multipolar oval). Among the pyramidal neurons the dominant groups were the neurons with triangular shape of cell body (21%). All found NPY immunoreactive neurons (pyramidal and nonpyramidal altogether) had intervals of values of numbers of primary dendrites 2 to 6, longer diameters of cell bodies 13 to 38 microm, shorter diameters of cell bodies 9 to 20 microm and maximal radius of dendritic arborization 50 to 340 em. More than a half of investigated neurons (57%) had 3 primary dendrites. DISCUSSION AND CONCLUSION: The other researchers did not find such percentage of pyramidal immunoreactive neurons in this amygdaloid nucleus. If we compare our results with the results of the ather researchers we can conclude that all pyramidal NPY immunoreactive neurons found in this human amygdaloid nucleus belong to the class I of neurons, and that all nonpyramidal NPY immunoreactive neurons belong to the class II of neurons described by other researchers. We suppose that all found pyramidal neurons were projectional.

[Surgical treatment of Arnold-Chiari malformation type I in an adult patient].

BACKGROUND: Herniation of the cerebellar tonsils through the foramen magnum into the cervical spinal canal with obliteration of the cerebellomedullary cistern is the primary feature of Arnold-Chiari type I malformation (ACM I). It is considered to be congenital malformation, although there have been reported cases of an acquired form. CASE REPORT: We presented a female patient, 45-year old, with ACM I without syringomyelia as a rare and unusual clinical image, as well as the effect of decompressive surgery in the treatment of this malformation. The patient was admitted to the Department of Neurosurgery with clinical signs of truncal ataxia worsening during the last six years. Moderate quadriparesis with predominant lower extremity involvement and the signs of the cranial nerves damages occured during the last seven months before admission, with progressive clinical course up to the date of admission. Neurosurgical treatment that included suboccipital medial craniectomy with resection of posterior arch C1 vertebrae and C2 laminectomy resulted in a significant clinical improvement and a much better quality of life. CONCLUSION: Posterior craniovertebral decompression with microsurgical reduction of the cerebellar tonsils and placement of an artificial dural graft is a treatment of choice in severe forms of ACM I without syringomyelia.

Microanatomy of the subependymal arteries of the lateral ventricle.

BACKGROUND: Scarce information about the anatomy of the subependymal arteries (SEAs) is present in the scientific literature. METHODS: Twenty cerebral hemispheres with injected arteries were microdissected, and the magnetic resonance imaging scans of 100 patients with lacunar infarcts were examined. RESULTS: The SEAs were found to range in diameter from 40 to 490 microm (mean, 149 microm) and in number between 3 and 12 (average, 5.2). Of these, numbers from 1 to 3 originated from the anterior choroidal artery (AChA), between 1 and 10 from the lateral posterior choroidal artery (LPChA), 1 from the medial posterior choroidal artery (MPChA), and 1 from the internal carotid artery. The SEAs most often arose from the choroidal branches (90%) and less frequently from the thalamic (30%), caudate (35%), or thalamocaudate twigs (20%). The SEAs of the AChA supplied the walls of the temporal horn (100%), the occipital horn (85%), and the atrium (35%). Those of the LPChA perfused the walls of the occipital horn (15%), the atrium (65%), the body of the ventricle (100%), and partially the frontal horn. The SEAs of the MPChA partially nourished the body and the frontal horn (10%). The SEAs may also occasionally supply the caudate nucleus (20%) and the stria terminalis. The anastomoses involving the SEAs were absent. In spite of this, ischemia in the territory of a single SEA was noticed in only 1% of our patients. CONCLUSIONS: The SEAs are tiny vessels that supply the walls of the lateral ventricle, as well as the caudate nucleus and the stria terminalis occasionally. The obtained anatomic data can have important neurosurgical implications in intraventricular operations.