Intracranial region of the vertebral artery: morphometric study in the context of clinical usefulness.

BACKGROUND: The aim of this study was to analyse the morphometry of the intracranial segment of the vertebral artery in the context of clinical usefulness. The results were compared with published data available in full-text archived medical journals. MATERIALS AND METHODS: More than 100 digital subtraction angiography (DSA) and 3-dimensional (3D) angio-computed tomography (CT) examinations were used to measure the following parameters: the whole and partial length of V4 in characteristic anatomical points, the diameter in three places (on the level of foramen magnum, in point of exit to the posterior inferior cerebellar artery, and in the vertebro-basilar junction), the angle of connection to the vertebral arteries, and all anatomical variations including fenestration, duplication, dolichoectasia or absent artery. RESULTS: The left V4 section was predominant over the right artery, which is manifested by length, width, cases of ectasia and fewer cases of hypoplasia. The incidences of V4 ectasia were identified more often than those documented in the accessible literature, and they were found in the natural location of formation of saccular aneurysms. CONCLUSIONS: The presented knowledge of anatomical variation and abnormali-ties of vertebral circulation can improve the accuracy and "safety" of the surgical procedures in this region, help to determine the range of surgical approach and avoid associated complications. The radiological examinations using 3D CT, DSA reveal unlimited observation of anatomical structures in contrast to studies based on cadavers, and can complement the morphometry in anatomical preparations.

Future of the nerve fibres imaging: tractography application and development directions.

Tractography is a tool available in a growing number of centres, to enable planning of neurosurgical interventions. This method has some drawbacks and due to its increasing availability is causing a growing controversy over the possibility of an anatomical mapping of the nerve fibres. This article aims at summarising the application of the diffusion magnetic resonance in contemporary neurosurgery method, showing the usefulness and merits of its performance before surgical procedures, limitation of its application and recommendations for its improvement and more effective use for diagnostic purposes.

Matrix metalloproteinase 7 restrains Helicobacter pylori-induced gastric inflammation and premalignant lesions in the stomach by altering macrophage polarization.

Helicobacter pylori is the strongest risk factor for the development of gastric cancer. Although the specific mechanisms by which this pathogen induces carcinogenesis have not been fully elucidated, high-expression interleukin (IL)-1ß alleles are associated with increased gastric cancer risk among H. pylori-infected persons. In addition, loss of matrix metalloproteinase 7 (MMP7) increases mucosal inflammation in mouse models of epithelial injury, and we have shown that gastric inflammation is increased in H. pylori-infected MMP7(-/-) C57BL/6 mice. In this report, we define mechanisms that underpin such responses and extend these results into a genetic model of MMP7 deficiency and gastric cancer. Wild-type (WT) or MMP7(-/-) C57BL/6 mice were challenged with broth alone as an uninfected control or the H. pylori strain PMSS1. All H. pylori-challenged mice were successfully colonized. As expected, H. pylori-infected MMP7(-/-) C57BL/6 mice exhibited a significant increase in gastric inflammation compared with uninfected or infected WT C57BL/6 animals. Loss of MMP7 resulted in M1 macrophage polarization within H. pylori-infected stomachs, as assessed by Luminex technology and immunohistochemistry, and macrophages isolated from infected MMP7-deficient mice expressed significantly higher levels of the M1 macrophage marker IL-1ß compared with macrophages isolated from WT mice. To extend these findings into a model of gastric cancer, hypergastrinemic WT INS-GAS or MMP7(-/-) INS-GAS mice were challenged with H. pylori strain PMSS1. Consistent with findings in the C57BL/6 model, H. pylori-infected MMP7-deficient INS-GAS mice exhibited a significant increase in gastric inflammation compared with either uninfected or infected WT INS-GAS mice. In addition, the incidence of gastric hyperplasia and dysplasia was significantly increased in H. pylori-infected MMP7(-/-) INS-GAS mice compared with infected WT INS-GAS mice, and loss of MMP7 promoted M1 macrophage polarization. These results suggest that MMP7 exerts a restrictive role on H. pylori-induced gastric injury and the development of premalignant lesions by suppressing M1 macrophage polarization.

Acute phase proteins in serum and cerebrospinal fluid in the course of bacterial meningitis.

We carried out estimations of the following acute phase proteins: C-reactive protein (CRP), alpha-1-antitrypsin (AAT), alpha-1-acid glycoprotein (AAG), alpha-2-ceruloplasmin (CER), and alpha-2-haptoglobin (HPT) in serum and in cerebrospinal fluid (CSF) in patients with bacterial meningitis (BM, n = 30) and viral meningitis (VM, n = 30). We have shown that determinations of concentrations of AAG and CRP in serum and CER in CSF are useful in differentiation between BM and VM. The diagnostic power of these three tests (the areas under their ROC curves equal 0.942, 0.929, and 0.931, respectively) is bigger, though statistically not significantly, than that of traditional parameters of BM in CSF, i.e., total protein concentration and white blood cell count. Determination of AAG, CRP, and AAT in serum is a valuable monitoring marker in the course of BM treatment. Convenience of serum sampling constitutes an advantage over traditional BM parameters in CSF.

[A problem of hospital infection: conclusions from a practice in n German hospitals]. / Problem zakazen szpitalnych w aspekcie wrazen ze stazów w Niemczech.

The aim of this publication is to focus on a worldwide problem of hospital infections, that exists not only in Poland but also in other countries around the world. Authors tried to mention not only an epidemiologic and a financial aspect of hospital infections, but also the possible ways of fighting them. In Germany, problems of a sterilization, disinfection and hospital hygiene are of the same importance as are the diagnostics and medical treatment. About 4.5-12 percent of patients in Germany hospitals are treated because of hospital infections (like in the USA). Authors hope that newly established Polish Society of Hospital Infection will help not only in the exchange of experiences but will also coordinate the measures aimed at the improvement of hygiene status of Polish hospitals.

[Epidemiologic-clinical analysis of purulent meningitis in adults: material from the Clinic of Infectious Diseases AM in Lodz in the years 1990-1991]. / Analiza epidemiologiczno-kliniczna ropnego zapalenia opon mózgowo-rdzeniowych u doroslych: material Kliniki Chorób Zakaznych AM w Lodzi w latach 1990-1991.

Authors have presented 81 cases of bacterial meningitis in adult patients (pts) treated in the Clinic for Infectious Diseases in the years 1990-1991. The aim of the study was the clinical and epidemiological analysis of the bacterial meningitis. Clinical symptoms, time between first symptoms and onset of hospitalisation and treatment, coexisting diseases and their influence on the course of the disease were considered in the analysis. The aetiological agent was found in 21% of cases. In the study group 75.3% were pts 26-65 years old. 77.8% were male pts. In 65.4% pts delay in hospitalisation and therapy exceeded 24 hours, 41.9% was longer than 48 hours. 18% of pts were afebrile. In the study group only 34.6% of pts were free of coexisting diseases.

[Treatment outcome of purulent meningitis in adults from material of the Clinic of Infectious Diseases AM in Lodz in the years 1990-1991]. / Wyniki leczenia ropnego zapalenia opon mózgowo-rdzeniowych u doroslych w materiale Kliniki Chorób Zakaznych AM w Lodzi w latach 1990-1991.

81 patients (pts) with bacterial meningitis hospitalised in the Clinic for Infectious Diseases in the years 1990-1991 were treated according to two therapeutic schedules. First: young pts (under 40 years), without coexisting diseases obtained Penicillin G and aminoglycoside and/or synthetic penicillin. Second: pts over 40 years old with coexisting diseases or cases of recurrent meningitis were treated with third-generation cephalosporins and aminoglycoside and/or synthetic penicillin. The mortality was 16% in the study group. 11 of 13 pts with coexisting diseases died. Neurologic sequelae were found in 23% of pts. The complete recovery was obtained in 34% of pts, more often (35.9%) in a group treated with third--generation cephalosporins comparing to 29.4% with other antibiotic therapy.

[Usefulness of establishing chosen acute phase proteins concentrations in serum and cerebrospinal fluid for differential diagnosis and monitoring of purulent meningitis in adults. I]. / Przydatnosc oznaczania stezen wybranych bialek ostrej fazy w surowicy krwi i plynie mózgowo-rdzeniowym do diagnostyki róznicowej i monitorowania przebiegu ropnych zapalen opon mózgowo-rdzeniowych u doroslych. I. Stezenie bialek ostrej fazy w surowicy krwi.

40 adult patients were examined: 24 with purulent meningitis and 16 with lymphocytic meningitis. The control group consisted of 100 healthy people. In purulent meningitis patients in the 1st, 3rd, 5th, 7th, 14th and 28th day of the disease, concentrations of the following acute phase proteins were measured in serum: C-reactive protein, alpha 1-antitripsin, alpha 1-orosomucoid, alpha 2-ceruloplasmin, alpha 2-macroglobulin and alpha 2-haptoglobin. In lymphocytic meningitis patients concentrations of the above mentioned acute phase proteins were measured only in the 1st day of the disease. Usefulness of establishing alpha 2-haptoglobin, alpha 1-antitripsin, alpha 2-ceruloplasmin and particularly C-reactive protein concentrations for differential diagnosis of purulent and lymphatic meningitis was proved. Evaluation of C-reactive protein and alpha 1-antitripsin concentration kinetics proved to be fully useful for monitoring of seriousness of the course of purulent meningitis, and together with evaluation of the clinical condition of the patient it can constitute a valuable marker of effectiveness of the disease treatment.

[Usefulness of establishing chosen acute phase proteins concentrations in serum and cerebrospinal fluid for differential diagnosis and monitoring of purulent meningitis in adults. II]. / Przydatnosc oznaczania stezen wybranych bialek ostrej fazy w surowicy krwi i plynie mózgowo-rdzeniowym do diagnostyki róznicowej i monitorowania przebiegu ropnych zapalen opon mózgowo-rdzeniowych u doroslych. II. Stezenie bialek ostrej fazy w plynie mózgowo-rdzeniowym.

40 adult patients were examined: 24 with purulent meningitis and 16 with lymphocytic meningitis. In the course of purulent meningitis concentrations of the following acute phase proteins were measured in the cerebrospinal fluid: C-reactive protein, alpha 1-antitripsin, alpha 1-orosomucoid, alpha 2-ceruloplasmin, alpha 2-macroglobulin and alpha 2-haptoglobin in the 1st, 3rd, 5th, 7th, 14th and 28th day of the disease. In lymphocytic meningitis patients concentrations of the above mentioned acute phase proteins were measured only in the 1st day of the disease. Full usefulness of establishing concentrations of all the above mentioned acute phase proteins within the first five days of the purulent meningitis for differential diagnosis of purulent and lymphatic meningitis was proved. Evaluation of concentration kinetics of acute phase proteins in cerebrospinal fluid for monitoring of the course of purulent meningitis is of a limited value.