Endoscopic transsphenoidal treatment in recurrent and residual pituitary adenomas--first experience.

AIM OF THE STUDY: The aim of the study has been the assessment of the endoscopic method in the surgical management of recurrent and residual pituitary adenomas, as concerns treatment efficiency, substantial complications, and its possible advantages for the operating surgeon and patient. MATERIAL AND METHODS: In Department of Neurosurgery, Silesian University School of Medicine in Katowice, between October 2001 and June 2004, 125 patients underwent endoscopic surgery due to pituitary adenoma. The analysis comprised 20 patients, who were operated on due to recurrent adenomas or residual tumour not completely removed during the first surgical procedure. The group of patients was composed of 9 women and 11 men. The youngest patient was 32 years of age, the oldest 79. The average age was 53.9 years. The analysed group had 14 non-functioning adenomas, 4 GH-secreting adenomas, 1 PRL-secreting adenoma and 1 ACTH-secreting adenoma. 19 of them were macroadenomas while 1 was a microadenoma. 11 of the 20 adenomas infiltrated the cavernous sinuses. The surgical procedures were performed by a stable team, composed of 2 neurosurgeons, a laryngologist and an anaesthesiologist. The surgery method was based upon the technique developed by Jho and Carrau, with own modifications of the operators. A rigid neuroendoscope having the diameter of 4 mm with 0 degrees and 30 degrees optics by Storz was used. The follow-up period after surgery was between 12 and 42 months, 24.2 months on average. RESULTS: Of the 20 cases, complete recovery was achieved in 40% of patients undergoing secondary surgical procedures. In the group of 11 patients with adenomas not infiltrating the cavernous sinuses, recovery was reported for 8 of them, that is 73%. No fatalities occurred. 7 cases of liquorrhoea occurred during operation, requiring reconstruction and sealing of the sella by means of tissue glue and artificial dura or freeze-dried human dura. In 1 case, despite the application of post-operative lumbar drainage, rhinorrhoea occurred one month after the procedure, which required endoscopic reconstructive treatment. In the same patient, a pneumoencephalocele was observed. The average time of the repeat surgical procedure using endoscopic techniques was shorter by 18 minutes than the repeat procedure using microscopic techniques. CONCLUSIONS: The endoscopic method is a safe, hardly invasive and efficient surgical technique in the treatment of recurrent and residual pituitary adenomas. Advantages which add to its attractiveness are also reduction of the procedure duration, very good visualisation of the operative field, absence of serious complications, less pain experienced after the surgery.

Solar photocatalytic oxidation of pretreated wastewaters: laboratory scale generation of design data for technical-scale double-skin sheet reactors.

Batchwise heterogeneous photocatalytic oxidation of model wastewater (solutions of the azo dye "Acid Orange 7" in tap water) has been performed in a laboratory-scale stirred vessel reactor with non-submerged UV-A lamps using titanium dioxide "P25" as photocatalyst. Comparison to results of solar pilot-scale Plexiglass double-skin sheet reactor (DSSR) experiments indicates that the lab-scale method may predict area demand for technical-scale DSSR design. Characteristic UV-A fluences leading to TOC or COD reduction to e(-1) of the initial concentrations were determined in lab-scale stirred vessel experiments for treated effluents of seven different industrial branches, secondary municipal effluent and biologically treated greywater. Predicted areas for solar photocatalytic oxidation of these effluents in DSSRs yielding mineralization of 95% of organics in 100 m3 of the respective effluents for a TiO2 concentration of 2 g l(-1) and a sky and solar radiation of 3.9kWh m(-2) d(-1) within one day greatly varied from below 6,000 m2 (biologically treated lubricating oil refinery effluent) to more than 100,000 m2 (highly saline biologically treated effluent of chemical industry). Especially municipal and refinery effluents (except oil reclaiming) have been identified as promising candidates for reuse after solar photocatalytic oxidation. Mineralization efficiency was decreasing with increasing alkalinity of effluents. This was interpreted by competition of hydrogen carbonate anions with organics for binding sites on photocatalyst surface and by OH radical scavenging by hydrogen carbonate. Dependence on alkalinity was superimposed by salinity influence as some effluents with high alkalinity also exhibited high salt concentrations (especially chloride).

Cerebral aneurysms in childhood.

OBJECTS: The aim of this work was to ascertain any clinical and anatomical factors allowing differentiation between aneurysms of childhood and those occurring in adults by comparing both groups. METHODS: Results obtained in a total of 17 children and adolescents aged up to 18 who had been operated on for cerebral aneurysm in our department from 1989 to 1997 (3% of all patients treated for subarachnoid haemorrhage resulting from ruptured cerebral aneurysm in this period) were compared with those in the adult group operated on in our department. In contrast to the situation in adults, there was a male predominance in our population. In children we found only 1 case of middle cerebral aneurysm and 1 case of multiple aneurysms. We also found a high rate of rebleeding in the paediatric group. CONCLUSIONS: We suggest that the very good outcome (100% very good results in patients operated on early) obtained and the high risk of rebleeding in children with cerebral aneurysm allow the recommendation of early surgery in children with ruptured cerebral aneurysms.

[Neurovascular compression within posterior cranial cavity]. / Konflikt naczyniowo-nerwowy w obrebie tylnej jamy czaszki.

30 years ago Janetta proposed neurovascular compression as an etiology factor of trigeminal neuralgia. Neuroanatomical, neurophysiological studies and observations during neurosurgical operations seems to confirm Janetta's suggestions. The conception of neurovascular compression was accepted also as an etiology factor in hemifacial spasm. There are more diseases of unknown etiology described in literature in which neurovascular compression as an etiological factor is suspected. The results of initial treatment of these diseases performed by neurovascular decompression were presented. We are described the methods of contemporary diagnostics of neurovascular compression syndrome. The difficulties with correct diagnostics were underlined. MRI and neurophysiological examinations were pointed out as the most useful in an evaluation of neurovascular compression syndromes.

[Neurovascular compression as a reason for neurogenic hypertension]. / Konflikt naczyniowo-nerwowy jako przyczyna powstania nadcisnienia neurogennego.

30 years ago Janetta proposed neurovascular compression as an etiological factor of trigeminal neuralgia. Neuroanatomical, neurophysiological studies and observations during neurosurgical operations seem to confirm Janetta's suggestion. The conception of neurovascular compression is accepted also as an etiological factor in hemifacial spasm. In literature a neurovascular compression is suspected as an etiological factor in many diseases of unknown etiology. The results of neurovascular decompression performed as initial treatment of these diseases were presented. The methods of contemporary diagnostics of neurovascular compression syndromes and difficulties with correct diagnosis were described. MRI and neurophysiological examinations were pointed out as the most useful in the evaluation of neurovascular compression syndromes.

Surgery or conservative treatment in children with traumatic intracerebral haematoma.

In contrast to the case of extracerebral haematomas, the criteria for operative treatment of traumatic intracerebral haematoma (TIH) are not clear. The purpose of this study was to find factors that would be helpful in reaching a decision for surgical or conservative treatment of TIH. We performed a retrospective analysis of 31 consecutive cases of TIH treated in our department. The following factors were estimated: age, mechanism of injury, initial GCS or CCS score, neurological deficits, coexistence of arterial hypotension and respiratory disturbances, and localisation and size of the haematoma. The outcome was evaluated according to a modified GOS. Treatment was surgical for 20 patients and conservative for 11. Patients with GCS or CCS scores of 3-8 were treated surgically significantly more often than those with higher scores. The other factors did not correlate with type of treatment. It seems, then, that the clinical status of the patient, especially the level of consciousness according to the GCS or CCS score, is the most important predictor of the need for surgery in children with TIH.

[A case of sarcoidosis with massive pleural and pericardial effusion]. / Przypadek sarkoidozy przebiegajacej z duza iloscia plynu w oplucnych i w osierdziu.

A rare case of sarcoidosis with massive pleural and pericardial effusion in 30-year-old female patient was presented. Diagnosis was established on the basis of the specimen examination of bronchial mucosa and lymph nodes. Suspicion of heart sarcoidosis was supported by radioisotopic examination. Following steroid therapy, fast disappearance of the pathological changes was observed.