[A rare case of intracranial hematoma complicating bacterial endocarditis]. / Rzadki przypadek krwiaka wewnatrzczaszkowego w przebiegu bakteryjnego zapalenia wsierdzia--opis przypadku.

Endocarditis is an infectious and inflammatory disease of cardiac valves with other coexisting symptoms affecting heart and other organs and systems. Patients with cardiac valves diseases are in the group of high risk. The authors present a case of successfully treated endocarditis affecting mitral valve prosthesis in the course of staphylococcus septicaemia complicated by intracranial haematoma.

[HELLP syndrome. Case report]. / Zespól HELLP. Opis przypadku.

We present a case of a 40-year-old multigravida with rare combination of HELLP syndrome followed by hemorrhagic complications, DIC, acute renal failure, ARDS. During her stay in intensive care unit total abdominal hysterectomy was performed. Peritoneal dialysis was conducted for two days because of transient acute renal failure. A gradual improvement of her condition was observed after drainage of extraperitoneal haematoma. After forty-two days she was extubated and discharged from intensive care unit.

[Brain barriers. Part II. Blood/cerebrospinal fluid barrier and cerebrospinal fluid /brain tissue barrier]. / Bariery mózgowe. Czesc II. Bariera krew-plyn mózgowo-rdzeniowy i bariera plyn mózgowo-rdzeniowy--tkanki mózgowia.

Brain has its own unique and effective protection system that controls the process of active transport of chemical substances from blood to neurons and cerebrospinal fluid. The above mentioned system is called the blood brain barrier. As far as morphology is concerned the barrier consists of several membranes isolating the following compartments of the intracranial space: brain tissues, blood and cerebrospinal fluids. One of those membranes-blood/brain tissues barrier, has been described in the first part of this work. Structure and function of the blood/CSF barrier and CSF/brain tissues barrier are described in the second part.

[Crucial evaluation of medical management in patients with cranial and brain injuries from the moment of the accident to the end of the diagnostics]. / Krytyczna ocena postepowania lekarskiego u chorych z obrazeniami czaszkowo-mózgowymi od momentu wypadku do zakonczenia diagnostyki.

The aim of the research was to verify the procedures of first-aid and treatment in 100 patients with cranial and brain injuries, admitted to the Intensive Care Unit. Material was estimated using Ambulance and Surgical Ambulatory data and Intensive Care Unit case records. Medical procedure at the place of accident and during transport, duration of the transport to the hospital, duration of the diagnostics and morbidity in studied groups were estimated. Considering the analysed material, it seems that following procedures have significant influence on the final outcome: 1. full resuscitation of the patient at the place of accident; 2. correct protection of the injured person during transport and duration of the transport; 3. time necessary for full and correct diagnostics.

[Midazolam administered orally as premedication in children in the ophthalmology department]. / Midazolam stosowany doustnie w premedykaczji dzieci w oddziale okulistycznym.

The aim of research was using midazolam for preoperational medication in children undergoing diagnostic and minor surgical procedures in ophthalmic surgery and estimation of its properties for deep sedation. We used midazolam in children of both sex, from 2 to 10 years of age. All the patients were considered as I or II grade of ASA scale of perioperational risk. Patients were given midazolam orally at dose 0.5 mg per kg of body weight. Sedation degree was assessed according to Addenbrooke's Hospital Scale of Sedation as well as to changes in systolic (SAP) and diastolic (DAP) arterial pressure, pulse oximetry of capillary blood (SpO2) and heart rate (HR). Sedation in all children subjected to the trial was good and optimal conditions to perform the procedures were achieved. We found the level of sedation satisfactory and safe. Measurement of SAP, DAP, SpO2 and HR revealed stability of circulation in the whole perioperative period. We found the sedative properties of midazolam as excellent in the described range of age and useful for the diagnostics and surgery respectively.

[The effect of cerebrospinal fluid drainage on the permeability of the blood-brain barrier for gentamycin under general anesthesia conditions in the rabbit]. / Wplyw upustu plynu mózgowo-rdzeniowego na przepuszczalnosc bariery krew--mózg dla gentamycyny w warunkach znieczulenia ogólnego u królika.

The aim of the work was to check if cerebrospinal fluid drainage performed under general anaesthesia altered in time the permeability of the blood/cerebrospinal fluid barrier (BCSFB), the part of blood-brain barrier. Twelve adult Chinchilla rabbits were included into the study. The animals were divided into 2 groups: control and investigated. The cerebrospinal fluid drainage was performed in animals from the studied group. Gentamycin was applied as the marker of tightness of BCSFB; under normal circumstances BCSFB prevented or limited the passage of gentamycin to the cerebrospinal fluid after intravenous administration. Heart rate (HR), arterial blood pressure (SAP, DAP, MAP), central venous pressure (CVP), blood-gas analysis (BGA), end-expiratory CO2 pressure (et CO2), hemoglobin, hematocrit, intracranial pressure (ICP) and cerebral perfusion pressure (CPP) were recorded. General anaesthesia was performed under circumstances that excluded the influence of any additional factor on the permeability of the BCSFB and haemodynamic, haematologic and gasometric parameters were stable in all animals. The influence of the cerebrospinal fluid drainage on the permeability of the BCSFB was evaluated using gentamycin concentration levels in blood and cerebrospinal fluid. Mean haemodynamic, haematologic and gasometric parameter values showed no within-group and between-group differences. In the investigated group the cerebrospinal fluid drainage was followed by a decrease in intracranial pressure (Tab. 1, Fig 1.) without changes in cerebral perfusion pressure (Tab. 2, Fig. 2). No significant changes in gentamycin permeability indexes were stated (Tab. 3, Fig. 3). Cerebrospinal fluid drainage performed under general anaesthesia caused no increase of the permeability of the BCSFB. A decrease of the intracranial pressure without changes of the cerebral perfusion pressure followed the cerebrospinal fluid drainage.

[Operation for ruptured abdominal aortic aneurysm without consent for blood transfusion--case report]. / Operacja peknietego tetniaka aorty brzusznej przy braku zgody na transfuzje krwi--opis przypadku.

Successful operation for ruptured abdominal aortic aneurysm (AAA) in a Jehovah's Witness 66-year-old man was presented. The patient was urgently operated for symptomatic AAA. We found during surgery that that aneurysm was ruptured. Bifurcated PTFE aorto-bi-iliac prosthesis was implanted. The patient did not receive any blood or blood-origin products while staying in our Hospital.

[Brain barriers. Part I. Blood-brain tissue barrier]. / Bariery mózgowe. Czesc I. Bariera krew--tkanki mózgowia.

Brain barriers are morphological and functional structures responsible for selective transport of different biological substances between blood and brain. There are three kinds of brain barriers: blood/brain tissue barrier, blood/brain fluid barrier and brain fluid/brain tissue barrier. The blood/brain tissue barrier which consists of brain vascular epithelial cells is thought to play the main role in intracranial homeostasis.