Posterior circulation stroke diagnosis in unselected group of acutely dizzy patients.

BACKGROUNDS: Diagnostics of a posterior circulation ischemia (POCI) in patients with acute vertigo is a challenging task. Recently, the combination of HINTS (Head Impulse, Nystagmus and Test of Skew) exam and ABCD2 has been recommended to identify stroke in these patients. Until now, studies regarding HINTS have mostly been tested on preselected patient groups and their results are only partially applicable to real clinical practice. AIMS: To compare the sensitivity and specificity of HINTS and ABCD2 and their combination in unselected acutely dizzy patients in the emergency department (ED) toward posterior circulation stroke detection. METHODS: A prospective cross-sectional monocentric study in ED patients with acute onset of dizziness lasting less than 72 h. Their clinical characteristics, HINTS, vascular risk factors, ABCD2 scores and neuroimaging data were analyzed. RESULTS: 140 patients were recruited. Acute stroke was identified by MRI in 39 patients. All patients had central pattern nystagmus, skew deviation or further focal neurological finding. The age (≥60) and arterial hypertension clearly distinguished stroke and non-stroke group (p < 0001). The sensitivity of HINTS, ABCD2 and their combination in the unselected group was high (82,1 - 97,4%), but specificity low. After removing patients with inconclusive diagnosis, including transitory ischemic attack, specificity was much higher and comparable to previously published results. CONCLUSIONS: The sensitivity and specificity of HINTS in previously published studies may vary because of their selection criteria. Even though, our study was performed on the unselected patient cohort, combination of HINTS and ABCD2 remained highly sensitive in detecting POCI and outperformed each of these tests alone.

Evaluation of three purely polypropylene meshes of different pore sizes in an onlay position in a New Zealand white rabbit model.

BACKGROUND: The aim of the study was to evaluate the influence of the pore size of a polypropylene mesh on the shrinkage and elasticity of the mesh-tissue complex and the inflammatory reaction to the implant in an open onlay hernia repair. MATERIALS AND METHODS: Twenty-one 10 × 10 cm samples of polypropylene meshes of a different pore size (3.0 × 2.8 mm-PP3, 1.0 × 0.8 mm-PP1 and 0.6 × 0.5 mm-PP.5) were implanted in an onlay position in 21 New Zealand white rabbits. After 90 days of implantation the shrinkage, elasticity and foreign body reaction (FBR) were assessed. RESULTS: The shrinkage of PP3 was 30.6 ± 4.3 %, PP1 49.3 ± 2.9 % and PP.5 49.5 ± 2.6 %. The shrinkage of PP3 was significantly lower (PP3 × PP1 p = 0.007, PP3 × PP.5 p = 0.005), PP1 and PP.5 were similar. The elasticity was similar. The strength of FBR in mesh pores was similar. The width of foreign body granuloma layers at the mesh-tissue interface was significantly reduced with increasing pore size (inner: PP3 10.1 ± 1.2; PP1 12.5 ± 2.9; PP.5 17.4 ± 5.2 and outer: PP3 21.2 ± 2.5; PP1 30.6 ± 6.3; PP.5 60.4 ± 14.9). All differences between the widths of granuloma layers were statistically significant (p < 0.010). One animal (PP1) was excluded because of a mesh infection. CONCLUSIONS: Implantation of polypropylene mesh of a pore size of 3 mm in an onlay position is associated with a significant reduction of shrinkage in comparison to a 1 mm pore lightweight and 0.5 mm pore heavyweight mesh. A pore size increase to 3 mm is not sufficient for an improvement of mesh-tissue complex elasticity in comparison to a 1 mm pore lightweight and 0.5 mm heavyweight mesh. Polypropylene mesh with enlarged pores to 3 mm is associated with a similar strength of FBR in mesh pores and a reduced foreign body granuloma in comparison to a 1 mm pore lightweight and 0.5 mm pore heavyweight mesh.

[Rare internal hernia in the falciform ligament as a rare course of abdominal emergency and infrequent cause of ileus]. / Raritní vnitrní kýla v ligmentum falciforme hepatis jako vzácná prícina náhlé príhody brisní

Intestinal obstruction caused by an internal hernia is considered to be a rare cause of ileus. The rarest of these is herniation through the falciform ligament. In our article we present the case of a 45-year old female patient operated on for small bowel herniation through a defect in the falciform ligament. The loops were laparoscopically repositioned into the free abdominal cavity and the defect was removed by electrocautery. After the operation the patient was stabilised and discharged into outpatient care. Our article also analyses relevant literature and the diagnostic methods because the abovementioned diagnosis is rare and often established as late as postoperatively. Key words: internal hernia - the falciform ligament - iatrogenous defect in the falciform ligament.

[Robotic procedures in the colorectal surgery]. / Robotické výkony v kolorektální chirurgii.

PURPOSE: The da Vinci surgical system (Intuitive Surgical, Sunnyvale, CA, USA) was developed specifically to compensate the technical limitations of laparoscopic instruments, such as two-dimensional vision, misalignment of hands and instruments, limited dexterity of instruments inside the patient, and fixed instrument tips. The da Vinci system provides a stable camera platform, three-dimensional imaging, excellent ergonomics, tremor elimination, ambidextrous capability, motion scaling, and instruments with multiple degrees of freedom. METHODS: These advantages can be applied in the field of colorectal surgery, and that's why we are reporting 45 cases that underwent robotic colorectal surgery. We concluded that the da Vinci system may be useful in surgical procedures, such as splenic flexure takedown, dissection of the inferior mesenteric artery with identification of the nervous plexus, and dissection of a narrow pelvis. The major drawbacks of robotic systems are high cost, and a lack of tactile sensation and tensile feedback to the surgeon, who must depend on visual cues to estimate the tension exerted on tissue by the robotic arms. RESULTS: In conclusion, robotic colorectal surgery can be performed safely and effectively, using the da Vinci surgical system, because this system has more dexterity and flexibility than conventional laparoscopic instruments. However, prospective randomized studies are necessary to evaluate the preservation of sexual and voiding function, as well as the oncological and functional (pelvic floor disorders) outcomes of this approach.

[Interdisciplinary approach to treatment of multiple arterial aneurysms in patient with eighth recurrence of incisional hernia--a case report]. / Interdisciplinární prístup k riesení mnohocetných tepenných aneuryzmat u pacienta s osmou recidivou incizionální kýly--kazuistika.

Vascular surgery is not the only option for arterial aneurysm treatment. Minimally invasive techniques are being increasingly used, especially methods of interventional radiology. We present a case of a 51-year-old man who came to our department in July 2005 because of sonographically diagnosed popliteal artery aneurysm. Simultaneous presence of subrenal abdominal aortic aneurysm, bilateral iliac and femoral artery aneurysms and left popliteal artery aneurysm was found. This patient was operated on for pancreatic pseudocyst in 2000 and then during next three years eight times for incisional hernia and its recurrences. The operations were carried out in other surgical departments. Eighth recurrence of incisional hernia was already present. Because of these facts, the risk of resection was deemed too high. Therefore, we chose stent graft implantation for abdominal aortic aneurysm treatment. The endovascular approach was also used to treat some complications that occurred. In this case report, we would like to present a combination of surgical and interventional radiological approaches to treatment of arterial aneurysms as a typical example of interdisciplinary cooperation.

[Retromuscular mesh repair of a hernia in a scar according to Rives--our first experience]. / Retromuskulární plastika kýly v jizve podle Rivese--nase první zkusenosti.

The authors present a group of 24 patients with hernias in scars operated from February 2004 to January 2005 (12 months) using a retromuscular reconstruction procedure according to Rives. 20 procedure following central laparotomies and 4 procedures following lateral laparotomies were conducted. The defect sizes ranged from 5 to 16 cm. A polypropylene mesh was used which was placed between the rectus abdominis muscle and the posterior leaf of the rectus abdominis sheath. The mesh was covered by the fascia with a minimum overlap of 5 cm in all directions. The mean follow- up period was six months (1-12 months) and no early relapses were recorderd. The complications rate was acceptable--1x secondary wound healing, 2x seroma, 1x non-transmural MI in a patient with a cardiac ischemic disorder. The retromuscular reconstruction procedure according to Rives appears to be an appropriate method for management of large ventral hernias with excellent results and minimum complications.

The laparoscopic ventral and incisional hernia repair.

We retrospectively reviewed the first twenty laparoscopic ventral and incisional hernia repairs performed at the 2nd Department of Surgery, St. Anne's Teaching Hospital, Brno from March 2003 till April 2004. Laparoscopic repairs were performed using Biomesh mesh (Cousin Biotech, France) with a minimum of 3 cm overlap circumferentially with normal fascia and secured with spiraltacks every 3-4 cm and transparietal sutures. All adhesions on the parietal defect are released, using scissors, and whenever possible we attempted to reduce the hernia sac. The mean follow-up period was 7 months with a range of 2 to 13 months. There was no recurrence in the group. There were two hematomas and one seroma in our group, which disappeared without treatment. Two patients experienced transient pain, which was resolved by analgesic treatment over time. By this date, no chronic infection, bowel obstruction, or enterocutaneous fistula have been reported. In conclusion our results are encouraging and suggest that laparoscopic ventral and incisional hernia repair is a safe, feasible, and effective alternative to open techniques. (Ref. 10.)

Paraneoplastic opsoclonus-myoclonus syndrome associated with malignant fibrous histiocytoma: neuropathological findings.

Paraneoplastic syndromes related to soft tissue tumors are very uncommon and an association of paraneoplastic diseases with a malignant fibrous histiocytoma (MFH) has not been reported so far. Opsoclonus-myoclonus is a rare paraneoplastic nervous system syndrome, that was well documented in adult patients with neoplasms particularly of the lung and breast. A 77-year-old woman developed typical opsoclonus-myoclonus syndrome and rapidly progressed to coma. The opsoclonus and generalized myoclonus continued until the patient's death seven months later. An autopsy examination identified a pleomorphic MFH in the retroperitoneum without a metastatic spread. Microscopic examination of the cerebellum revealed an atrophy of the granular layer along with a marked patchy loss of Purkinje cells, and a loss of neurons in the cerebellar nuclei accompanied by distinct peridental demyelination and astrogliosis. A moderate loss of neurons and neuronal chromatolysis were observed also in the inferior olivary nuclei. However, the omnipause neurons of the nucleus raphe interpositus, that are supposed to be responsible for opsoclonus generation under pathological conditions, as well as ocular brain stem nuclei were all intact. We failed to prove the presence of known antineuronal anti-Yo, anti-Hu or anti-Ri autoantibodies in both serum and cerebrospinal fluid (CSF) of the patient. However, the confirmation of the intrathecal IgG synthesis by oligoclonal bands in CSF and the immunohistochemical detection of IgG deposits on membranes of Purkinje cells, neurons of cerebellar granular layer and in cerebellar nuclei in our case support the presumed autoimmune nature of the disease.

Results of therapy of lower extremity ischemic disease by angiosurgery and radiointervention (PTA) methods.

The aim of our work is to evaluate the results of therapy of lower extremity ischemic disease (LEID) in patients treated at 2nd Department of Surgery, St. Anne's Teaching Hospital, Brno, in 2000. According to the therapeutic approach, the patients were divided into two groups: 1. reconstructive angiosurgeries (95 patients), 2. PTA (42 interventions in 36 patients). The short-term follow-up (18 months) has given the following results: in the group of surgical interventions--the patency was 87.37%, in the PTA group it was 83.33%. There was a marked difference between the patency of PTA reconstructions in the region of pelvic arteries (100%) and that in the femoropopliteal region (58.83%). We have found out that in the solution of LEID, angiosurgeries and radiointerventions are equivalent methods and that they complement each other. (Tab. 2, Fig. 3, Ref. 10.).

Efficacy of treatments for posterior canal benign paroxysmal positional vertigo.

OBJECTIVE: This study was performed to determine the relative effectiveness of several passive head maneuvers for treating benign paroxysmal positional vertigo. STUDY DESIGN: This prospective study used 87 subjects diagnosed by their physicians with unilateral benign paroxysmal positional vertigo of the posterior semicircular canal. METHODS: Subjects were randomly assigned to three treatment groups: modified Epley maneuver, modified Epley maneuver with augmented head rotations, and modified Semont maneuver. They were interviewed 1 week after receiving one maneuver. If subjects desired further treatment, they were treated again with the same maneuver, a methodology repeated until subjects desired no further treatment; they were telephoned 3 and 6 months after the last treatment. RESULTS: The groups did not differ significantly, but subjects decreased significantly on vertigo intensity and frequency and improved significantly on independence in activities of daily living. Before treatment, tasks requiring pitch rotations of the head induced vertigo; common comorbid conditions were osteoporosis, cervical spine problems, and head trauma. CONCLUSIONS: These data suggest that augmented head rotations are unnecessary and that the modified Epley and Semont maneuvers are equally effective in the remediation of vertigo in this population.

Effect of 50-Hz electromagnetic field on the retention of toxic radionuclides in rat tissues.

The effect of electromagnetic field (EMF) 50 Hz, 10 mT, on the tissue retention of radiotoxic polonium-210 and thorium-234 was studied in a rat model. Regarding 210Po in the ionic state, small but significant effects were obtained by exposure of rats to EMF either before the intravenous injection of 210Po (pre-exposure) or after the rats had already been injected with 210Po (post-exposure). When compared with control values, pre-exposure to EMF caused a significant 28% decrease in the retention of 210Po in the skin and a 10% decrease in total 210Po retention in the investigated tissues. Relative to controls, post-exposure resulted in a 131% increase in 210Po retention only in the thymus. Regarding carrier-free 234Th in the ionic state, both types of EMF exposure caused a substantial increase in 234Th retention in the liver and spleen and a decrease of 234Th in the bones. A different effect of EMF on the retention of 234Th in the body was obtained when the mass of thorium was increased by adding as carrier 232Th (50 micrograms kg-1 body mass). With pre-exposure, a significant 10% decrease in the high retention of 234Th in the liver (77% of injected radioactivity) was observed. On the other hand, with post-exposure no significant changes in retention of 234Th were found in the tissues.

Developmental effects of magnetic field (50 Hz) in combination with ionizing radiation and chemical teratogens.

The influence of a 50 Hz magnetic field (MF) on avian and mammalian embryogenesis, the MF level and vector, as well as the effect of exposure to MF (50 Hz, 10 mT) in combination with X-rays has been recently reported [2,3]. No significant alterations of chick or rat embryogenesis were found after repeated exposures to 50 Hz MF at 10 mT or 6 microT or with different vectors. However, X-ray chick embryotoxicity was significantly affected by repeated exposures of developing organisms to MF. A strong dependence of effect on the type of interaction was revealed. A decrease of X-ray induced teratogenicity was observed when MF preceded X-ray exposure (indirect interaction), while MF exposure applied immediately after X-ray radiation (direct interaction) non-significantly potentiated adverse developmental effects of ionizing radiation. This study deals with the effects of MF in combination with insulin or tetracycline. Exposure of chick embryos to MF influenced the sensitivity of embryonic morphogenetic systems to the subsequently administered chemical teratogens, insulin and/or tetracycline. A protective effect of MF was detected similarly as in the case of indirect interaction with ionizing radiation.

The influence of a magnetic field on manganese transport into rat brain.

The aim of this study was to detect the effect of a magnetic field on manganese transport into rat brains. An experimental group of Female Wistar rats was given 0.48 mg Mn2+ per kg body weight intratracheally twice a week for 3 months and simultaneously exposed to a magnetic field: B = 10 mT, f = 50 Hz for 1 hr. Rats in one control group of rats received the same dose of manganese as the experimental group but were not exposed to the magnetic field. Rats in a second control group had neither exposure to manganese nor exposure to the magnetic field. After the last dose, all rats were sacrificed and their brains and other tissues were analyzed for manganese content. The results indicated that the magnetic field had a positive effect on increasing the manganese content in the brains of rats in the experimental group relative to those of the control groups. Visual evoked potentials (VEP) measured at the end of the exposure periods on randomly selected experimental and control rats showed a shortened but not statistically significant latency of the P1 peak of VEP in rats that had been exposed to both factors but not in control rats.

Study of the effects of 50 Hz magnetic field on embryonic development: dependence on field level and field vector.

We studied the influence of power frequency and vector of EMF on avian and mammalian embryogenesis at a high level of magnetic induction (10 mT professional exposures and using therapeutic devices of Czech provenance) and at a low level (6 microT-environmental occurrence). No significant alterations of either avian or mammalian embryogenesis were found after repeated exposures to 50 Hz MF at 10 mT or 6 microT, nor with different vectors.

Interaction of MF 50 Hz, 10 mT with high dose of X-rays: evaluation of embryotoxicity in chick embryos.

We studied the combined effects of exposure to magnetic field (MF) 50 Hz 10 mT and X-ray ionizing radiation on developing chick embryos. When chick embryos at early stages were repeatedly exposed to MF prior to X-ray radiation, reduction of X-ray teratogenicity was observed. When MF exposures started immediately after X-ray radiation, the adverse developmental effects of ionizing radiation were potentiated. Embryotoxicity was more pronounced in X-ray irradiated and MF exposed groups. We present a hypothesis about the mechanisms of MF effect based on enhancement of oxidative processes, followed by stimulation of antioxidant systems.

Pulsed magnetotherapy in Czechoslovakia--a review.

Pulsed magnetotherapy has been used in Czechoslovakia for more than one decade. It has been proved that this type of physical therapy is very efficient mainly in rheumatic diseases, in paediatrics (sinusitis, enuresis), and in balneological care of patients suffering from ischaemic disorders of lower extremities. Promising results have also been obtained in neurological diseases (multiple sclerosis, spastic conditions) and in ophthalmology, in degenerative diseases of the retina.

[Agreement between auditory threshold calculated from cortical evoked response audiometry and tone audiometry in occupational hearing loss]. / Sledování shody mezi sluchovým prahem vypocteným z kortikální ERA a tónové audiometrie u profesionální nedoslýchavosti.

In a group of 126 men the authors evaluated the auditory threshold from cortical ERA findings and comparison with their threshold sound audiometry. The mean age of the patients means = 52.5 years (min. = 25 years, max. = 69 years, s = 8.95). Noise exposure means = 16.5 years (min. = 4 years, max. = 30 years, s = 4.5). In 79.3% the men worked as miners in uranium mines, other mining occupations were represented only by small numbers. The arithmetic mean of the total percentage hearing loss (calculated according to Fowler) means = 49.7% (min. = 17%, max. = 100%, s = 15). The cumulative frequency of differences between the auditory threshold of the sound audiogram and cortical ERA: (table; see text) The cumulative frequency of differences in the total percentage hearing loss between sound audiograms and cortical ERA: differences up to +/- 5% hearing loss were recorded in 24.3% of the group, differences up to +/- 10% in 43.9%, differences up to +/- 15% in 58.9%, differences up to +/- 20% in 70.1%. In the group of 126 examined subjects we detected 12 aggravating subjects (9.5%), their mean age being by 6.7 years lower than the mean of the whole group, the mean exposure to noise is by 3.2 years shorter. The differences between the auditory threshold reported by the aggravating men and the cortical ERA are highest in verbal frequencies, on average they are per fr of 2 kHz 27.3 dB, 1 kHz 24.3 dB, 0.5 kHz 20.1 dB, 4 kHz, 10.0 dB. The differences between the total percentage auditory loss calculated from sound audiograms and cortical ERA reaches on average 41.5%.

[The effect of muscle relaxants on the function of the vestibulo-ocular reflex arc]. / Vliv myorelaxancií na funkce vestibulokulárního reflexního okruhu.

Baclofen affects in experiments the reactivity of the vestibuloocular reflex by influencing the time constant of the vestibular nystagmus. The authors compare in three healthy volunteers the reactivity of the vestibular apparatus after administration of Baclofen and a new muscle-relaxant drug tizanidine. The authors evaluate basic parameters of the vestibular and optokinetic nystagmus (gain and time constant), discuss the problem of GABAergic (Baclofen) and monoaminergic (tizanide) receptors kin the area of the vestibular apparatus. As regards the effect on the reactivity of the vestibular system, tizanidine does not affect immediately the response of the vestibuloocular reflex but interferes with processes ensured by the central neuronal integrator.