[Infusion test in the selection of patients with hydrocephalus for the shunting]. / Test infuzyjny w kwalifikacji chorych z wodoglowiem do zalozenia zastawki.

The indications for the shunting of the patients with NPH are a matter of discussion. The measurement of the outflow resistance during the infusion test is one of the criteria for shunting. The authors present 38 patients with NPH in whom the lumbar constant-infusion test was carried out. The patients with the outflow resistance more then 13 mmHg/ml/min were selected for shunting. The results at least 4 months after operation are presented.

[Posttraumatic vasospasm and its treatment with nimodipine]. / Pourazowy skurcz naczyniowy i jego leczenie nimodypina.

The aim of our study was to compare the incidence and the time course of vasospasm as well as outcome of patients with tSAH. In group I there were 15 patients treated with nimodipine. Group II consisted of 20 patients in whom nimodipine was not used. All patients suffered from severe head injury, scored 8 points or less according to Glasgow Coma Scale. The initial CT scan revealed tSAH in all of them. Outcome was evaluated according to Glasgow Outcome Scale (GOS) three months after injury. Results were better (but not significantly) in patients in whom nimodipine was used, time course of vasospasm was less severe and follow-up CT scans did not reveal ischaemic infarcts connected with vasospasm.

The concept of cerebral circulatory-pressure index (CCPI).

The theoretical relations between blood pressure (MABP), intracranial pressure (ICP) and cerebral perfusion pressure (CPP) as well as the new Cerebral Circulation-Pressure Index (CCPI) are presented in the paper. The special nomogram collecting all of these parameters was constructed. CPPI was defined as a quotient of CPP and ICP: [formula: see text] CCPI reflects the relationship between the systemic MABP and ICP and for ensuring the normal conditions of intracranial circulation the MABP must be at least 4 divided by 5 times higher than ICP. The low values of CCPI, if they are not immediately corrected, results on severe brain disability or even death. We didn't find till now what should be the upper limit of CCPI, which overcrossing may be danger for the patient, especially with impaired autoregulation. Based on analysis of patients operated due to intracranial disorders as brain tumours, spontaneous and traumatic haematomas as well as ruptured aneurysms we find that the values of CCPI over 3 have a good prognosis, between 3 and 2 is a field for intensive treatment consisting on decreasing ICP or increasing the systemic blood pressure or both. If CCPI is below 1.5 the prognosis is pessimistic and all the patients died. CCPI together with the nomogram are useful in current evaluation of the state of patients and of the efficacy of treatment and prediction of the treatment results.

Tramadol for postoperative analgesia in intracranial surgery. Its effect on ICP and CPP.

An ideal analgesic for patients after craniotomy should neither cause respiratory depression, nor affect intracranial pressure (ICP) and cerebral perfusion pressure (CPP). The aim of the study was to evaluate the effect of Tramadol (T) on ICP and CPP, as well as to determine its analgetic efficacy in patients (pts) after craniotomy. Thirty five pts aged 16 divided by 78 years (mean 46) entered the study. Twelve had GCS (Glasgow Coma Scale) scores < or = 8 and 23 pts had scores > or = 12. Fourteen pts were mechanically ventilated and 21 pts were breathing spontaneously (BS). Tramadol was injected i.v. at a dose of 0.75 mg/kg over 3 minutes in 11 pts (Group 1), 1.0 mg/kg over 5 minutes in 13 pts (Group 2) and 1.0 mg/kg over 10 minutes in 11 pts (Group 3) PaCO2 was measured before T in all pts and at 8 minute after injection in 21 BS pts. Heart rate (HR), mean arterial blood pressure (MBP), ICP, CPP and respiratory frequency (f) were registered before and in the 1st, 3rd, 8th, and 15th minute after T. Analgetic effect was evaluated in 22 conscious pts by comparing the pain intensity before and 30 minutes after T using a five-point verbal response scale. Mean control ICP was 17 mmHg. ICP over 15 mmHg was diagnosed in 15 pts (mean ICP equal 26 mmHg). Mean CPP for all 35 pts was 85 mmHg. There were no statistically significant changes in HR, MBP, ICP, and CPP after T in any particular group, nor were there changes in ICP in subgroups with normal and elevated ICP. No significant changes in PaCO2 and f were found in BS pts. Satisfactory analgesia was obtained in 50% of pts of Group 1, and in 88% of pts of Groups 2 and 3. We conclude that tramadol in doses of 0.75 mg/kg and 1.0 mg/kg i.v. does not affect ICP and CPP in adult postcraniotomy patients and seems to be a safe and effective analgesic at a dose of 1.0 mg/kg for postcraniotomy pain control.

Direct determination of molybdenum in seawater by adsorption cathodic stripping square-wave voltammetry.

A reliable and very sensitive procedure for the determination of trace levels of molybdenum in seawater is proposed. The complex of molybdenum with 8-hydroxyquinoline (Oxine) is analyzed by cathodic stripping square-wave voltammetry based on the adsorption collection onto a hanging mercury drop electrode (HMDE). This procedure of molybdenum determination was found to be more favorable than differential pulse cathodic stripping voltammetry because of inherently faster scan rate and much better linearity obtained through the one-peak (instead of one-of-two peaks) calibration. The variation of polarographic peak and peak current with a pH, adsorption time, adsorption potential, and some instrumental parameters such as scan rate and pulse height were optimized. The alteration of polarographic wave and its likely mechanism are also discussed. The relationship between peak current and molybdenum concentration is linear up to 150 mug l(-1). Under the optimal analytical conditions, the determination limit of 0.5 mug l(-1) Mo was reached after 60 s of the stirred collection. The estimated detection limit is better than 0.1 mug l(-1) of Mo. The applicability of this method to analysis of seawater was assessed by the determination of molybdenum in two certified reference seawater samples (CASS-2 and NASS-2) and the comparison of the analytical results for real seawater samples (study on a vertical distribution of Mo in the seawater column) with the results obtained by Zeeman-corrected electrothermal atomization atomic absorption spectrometry (Zeeman ETAAS). A good agreement between two used methods of molybdenum determination was obtained.

[Management of patients with multiple intracranial aneurysms]. / Leczenie pacjentów z mnogimi tetniakami mózgu.

A retrospective analysis of 142 patients with multiple intracranial aneurysms operated on within eight years (1991-1998) was undertaken. In 82 patients multiple aneurysms were clipped during one procedure in the remaining 60 patients operation was performed in two stages. The clinical state of patients according to Hunt-Hess scale at the admission to the department was assessed, as well as the presence of blood on the initial CT scan according to Fisher scale and outcome according to Glasgow Outcome Scale. The operative results patients with multiple intracranial aneurysms are worse, than those with single aneurysm, which is connected with the necessity of wider exposure of cerebral vessels and possibility of bleeding from unclipped aneurysm, when operation is performed in two stages.

[Transcranial doppler ultrasonography monitoring in patients with intracerebral hematoma due to aneurysm rupture]. / Monitorowanie TCD u pacjentów z krwiakiem sródmózgowym w wyniku pekniecia tetniaka.

The aim of the study was to evaluate the influence of intracerebral haematoma due to aneurysmal rupture on vasospasm evaluated by transcranial Doppler ultrasound and outcome according to Glasgow Outcome Scale. 368 patients with ruptured intracranial aneurysm were admitted to the Department of Neurosurgery, Medical Academy in Wroclaw, between January 1, 1995 and June 30, 1998. Patients were divided into two groups. In group I there were 74 patients with subarachnoid haemorrhage and intracerebral haematoma. In group II 294 patients with subarachnoid haemorrhage. Despite intensive monitoring and treatment the outcome of patients with subarachnoid haemorrhage and intracerebral haematoma is worse than in patients with subarachnoid haemorrhage only.

[Results of postoperative treatment of patients after brain tumor removal based on the cerebral circulatory pressure index (CCPI) in comparison with ICP and CPP]. / Wyniki pooperacyjnego leczenia pacjentów z usunietymi guzami mózgu w oparciu o mózgowy wskaznik krazeniowo-cisnieniowy (CCPI) i w porównaniu z ICP i CCP).

The aim of the study was the assessment of prognostic value of CCPI in relation to the results of treatment of patients with increased intracranial pressure after brain tumour operative treatment. The results of treatment of 107 patients with intracerebral tumours according to neurological state at the introduction of treatment (GCS) and initial values of ICP, CPP and CCPI as well as final results of treatment (GOS) are analysed. A special normogram collecting all of these parameters was constructed, as well as the directions of treatment depending on the areas of MABP, ICP and CPP were established. The CCPI seems to be more a sensitive and earlier signals suggesting the urgency and the direction of treatment than ICP and especially CPP alone. There seems to be a great consistence of the patient state evaluation according to GCS, GOS and CCPI which is also a prognostic factor. All the patients with initial CCPI below 1.5 died while all the patients with CCPI over 3.0 in good and very good neurological state, and all the patients with initial CCPI between 1.5 and 3.0 had neurological deficits.

[Analysis of own clinical material treated by conservative and aggressive control of intracranial hypertension]. / Analiza wlasnego materialu klinicznego przy zachowawczym i agresywnym zwalczaniu nadcisnienia wewnatrzczaszkowego.

These problems arising during the treatment of increased intracranial pressure (ICP) were analysed on the basis of own clinical material with consideration of different therapeutic methods--pharmacological and aggressive. Statistical analysis (contingency tables) showed that the treatment consisting of dexamethason, mannitol and furosemid was the most efficient in the group of patient with increased ICP in the range 15-30 mmHg. In patients with ICP in the range 30-50 mmHg, where other aggressive methods of treatment had failed, the most efficient treatment was cranio-dural decompression.

Plasma selenium concentrations in a Sikh population in Sydney, Australia.

Selenium is essential for humans because it protects the heart against cardiomyopathy. It may also reduce ischaemic heart disease owing to its antioxidant activity. It is known that Indian migrants in a number of countries have high incidences of ischaemic heart disease. In this study, fasting plasma selenium concentrations of Sikh migrants in Sydney (Australia) were measured to investigate whether selenium concentration is reduced in this community. The mean concentration of selenium in plasma (91.8 +/- 15.0 ng ml-1, n = 196) was within the normal range. A significantly higher plasma selenium concentration was demonstrated in males than in females (p < 0.01). This was mainly due to the difference in mean selenium concentrations between genders in vegetarians because no significant difference was observed in non-vegetarian males versus females. The mean concentration of selenium in teetotal males was similar to those who consumed alcohol. Despite significant variations with gender and diet, the selenium concentrations were within the normal range. The results suggest that selenium status is adequate in the Sikh community even though vegetarian diet is common and alcohol use is condones in males.

Comparative determination of Ba, Cu, Fe, Pb and Zn in tea leaves by slurry sampling electrothermal atomic absorption and liquid sampling inductively coupled plasma atomic emission spectrometry.

The comparative determination of barium, copper, iron, lead and zinc in tea leaf samples by two atomic spectrometric techniques is reported. At first, slurry sampling electrothermal atomization atomic absorption spectrometry (ETAAS) was applied. The results of Ba and Pb determination were calculated using the method of standard additions, and results of Cu, Fe and Zn from the calibration graphs based on aqueous standards. These results were compared with the results obtained after microwave-assisted wet (nitric+hydrochloric+hydrofluoric acids) digestion in closed vessels followed by inductively coupled plasma-atomic emission spectrometric (ICP-AES) determination with the calibration by means of aqueous standards. The exception was lead determined after a wet digestion procedure by ETAAS. The accuracy of the studied methods was checked by the use of the certified reference material Tea GBW-07605. The recoveries of the analytes varied in the range from 91 to 99% for slurry sampling ETAAS, and from 92.5 to 102% for liquid sampling ICP-AES. The advantages of slurry sampling ETAAS method are simplicity of sample preparation and very good sensitivity. Slurry sampling ETAAS method is relatively fast but if several elements must be determined in one sample, the time of the whole microwave-assisted digestion procedure and ICP-AES determination will be shorter. However, worse detection limits of ICP-AES must also be taken into the consideration in a case of some analytes.

New method of gold-film electrode preparation for anodic stripping voltammetric determination of arsenic (III and V) in seawater.

A new method of efficient rotating gold-film glassy-carbon electrode preparation prior to the determination of As(III) and As(V) in seawater by anodic stripping voltammetry (ASV) is described. Factors affecting sensitivity and precision including pH, deposition time and potential, rotation and scan rate, and the nature of working electrode were investigated. Electroinactive As(V) was reduced to As(III) by gaseous SO(2) prior to ASV determination. For a deposition time of 4 min the determination limit was approximately 0.19 ppb. Precision of the proposed method was very good (RSD=2-0.6% at 1-5 ppb) and a relatively good accuracy determined by analysis of certified reference seawater (CASS-1) and seawater samples spiked with an arsenic standard solution, was also obtained.

Slurry sampling for hydride generation atomic absorption spectrometric determination of arsenic in cigarette tobaccos.

The development of a slurry sampling hydride generation atomic absorption spectrometric (HGAAS) method for the determination of arsenic in cigarette tobacco samples is described. The method is relatively simple and has been shown to give values of total arsenic close to those obtained using methods requiring total dissolution and decomposition of all vegetable matter before analysis. Pre-treatment of samples slurried in nitric acid by ultrasonication permitted the extraction of about 90% of the total arsenic from tobacco samples. Further improvement in the recovery efficiency (up to 93-94%) was accomplished by the use of an additional step of short microwave-accelerated treatment. L-Cysteine was used as a pre-reduction agent. The accuracy and precision of the slurry sampling HGAAS method were studied using the certified reference material (CRM) CTA-OTL-1 Oriental Tobacco Leaves. Under the optimum conditions, as little as 2.6 ng of arsenic can be detected. The relative standard deviation of the overall procedure was calculated to be below 7.6% at arsenic concentration levels of 0.5-0.9 mg kg-1 and the analytical results obtained for the CRM agreed with the certified value. The main factors that influenced the reliability of the method were sample homogeneity, particle size and slurry concentration.

Selective precipitation separation and inductively coupled plasma mass spectrometric determination of trace metal impurities in high purity silver.

A simple and rapid method for the determination of some trace element impurities in high purity silver, combining the isolation of analytes from the silver matrix with selective precipitation followed by ICP-MS determination was developed. On the basis of an extreme difference in the solubilities of the chlorides of silver and the other accompanying trace elements, silver can be separated completely through the addition of hydrochloric acid. The sample of silver was at first dissolved in 7 M nitric acid followed by addition of hydrochloric acid to remove the silver matrix by formation of a silver chloride precipitate, while leaving the trace element impurities in the solution, which was subsequently analysed by ICP-MS. Eleven elements (Al, Au, Cd, Co, Cu, Fe, Mg, Mn, Ni, Pb and Sn) were determined with good accuracy and precision. The limits of detection (based on the 3 sigma criterion) of these elements were 10(-1)-10(-3) ng g-1. The proposed method was successfully applied to the determination of metal impurities in high-purity silver samples (EM9465 and EM 9343) and validated by the analysis of NIST SRM 8171 (Fine Silver FS 14).

The treatment of persistent night terrors with autogenic training: a case study.

This is a case study of a 16-year-old male with a long history of persistent and severe night terrors. After a comprehensive medical and psychological evaluation, the patient was trained in standard autogenic training exercises and an organ-specific formula. By the end of the eight-week treatment, the nocturnal episodes ceased. Information at 11 weeks and 37 weeks follow-up supported the effectiveness of the treatment.

Propensity for seeking counseling services: a comparison of Asian and American undergraduates.

The authors used the somaticization scale of the Brief Symptom Inventory to study Asian and American college students' propensity for seeking counseling at an American university. They found that the Asian students were more likely than the American students were to report that they would seek counseling services when they experience somatic discomfort. The Asian students scored significantly higher on inclination for seeking counseling than did the American students.

Clinical experiences with nimodipine treatment in patients after SAH and aneurysm surgery.

The authors present their 3-years experiences with nimodipine treatment in patient after subarachnoid haemorrhage (SAH). Nimotop has been used in treatment of SAH in the Department of Neurosurgery since June 1985. During 3-years 220 patients with subarachnoid haemorrhage were admitted to the Department of Neurosurgery in Wroclaw. Till the end of 1989 177 patients with SAH received nimotop therapy. Our results show that intravenous Nimodipine is well tolerated, and we have not observed any discontinuation effects, after we had introduced gradual diminishing doses of Nimotop. Nimotop does not prevent of developing vasospasm in all patients, but their outcome is better. The treatment of vasospasm should be complex (with nimotop and hypervolemic and hypertensive therapy).

[Craniofacial growth under the influence of blood supply. 13. Local biomechanical aspects of bone morphogenesis]. / Kraniofaziales Wachstum unter dem Einfluss der Blutversorgung. 13. Lokale biomechanische Aspekte der Knochenmorphogenese.

The origin of formative forces is to be sought in genetically controlled growth processes. The forces generated by various system components are analyzed. The forces acting in mutual opposition can be illustrated by considering the brain as an intracranial force factor and the temporalis muscle as an external force factor. Apposition and resorption of bone is governed by the interaction between the stresses. The skull's primary growth centres such as the basicranial synchondroses must, like epiphyses of tubular bones, exert growth forces to overcome the restraining forces stemming from surrounding tissues. Growth can be suppressed by excessive counter-pressure, diverted by asymmetrically acting forces, and encouraged by the removal of suppressive forces.