[Use of autologous veins and streptokinase in vascular complications after replantation of the right forearm]. / Pouzitie autovény a streptokinázy pri cievnych komplikáciach po replantácii pravého predlaktia.

The authors present the case-history of a 20-year-old worker with an amputation of the forearm in the distal third. After shortening of the bone by 2.5 cm and osteosynthesis by means of grooved splints the blood vessels of the forearm were reconstructed by means of three autoveins. After 12 hours venous and arterial thrombosis developed. During reoperation the thrombotic portions of the vessels were resected and were again reconstructed by means of new autovenous grafts. Streptokinase was instilled into the amputate via the ulnar artery. During the subsequent postoperative period no serious vascular complications developed. Lymphorrhea persisted for some two weeks. To achieve satisfactory function of the hand a corrective operation will be necessary.

Electrophysiological monitoring during acoustic neuroma and other posterior fossa surgery.

Techniques used to monitor the function of the seventh and eighth cranial nerves during acoustic neuroma and other posterior fossa surgery are reviewed. The auditory brainstem response (ABR), electrocochleogram (ECochG) and direct recording from the auditory nerve (CNAP) were compared. The best technique is the ECochG, although in many cases, the CNAP should be used as a back-up technique. The CNAP is especially useful for the identification of the auditory nerve. Both can provide real-time feedback on the physiological integrity of the auditory nerve. The ABR may be helpful in monitoring brainstem function. For some procedures, optimal monitoring requires the combined recording of all three techniques. Monopolar constant-voltage intracranial stimulation of the facial nerve is helpful for the identification and preservation of the facial nerve. Audio monitoring of spontaneous electromyographic activity provides real-time feedback on the effect of surgical manipulation of the nerve. Monitoring of ephaptic transmission in the facial nerve during microvascular decompression for hemifacial spasm aids in the identification of the offending vessel.