Circulating endothelial progenitor cells are inversely correlated with in-stent restenosis in patients with non-ST-segment elevation acute coronary syndromes treated with EPC-capture stents (JACK-EPC trial).

AIM: Aim of the study was to evaluate the association between circulating endothelial progenitor cells (EPCs) and angiographic outcomes after implantation of GenousTM stent in patients with non-ST-segment elevation acute coronary syndromes (ACS) (NSTE-ACS) undergoing urgent percutaneous coronary intervention (PCI). METHODS: Sixty patients treated with EPC-capture stent (N.=30) or bare metal stents (BMS) (N.=30) receiving 80 mg atorvastatin and dual antiplatelet therapy (DAT) for 12 months. Restenosis was assessed after 6 months by quantitative coronary angiography (QCA) and major acute coronary events (MACE) evaluated after 6 and 12 months. INCLUSION CRITERIA: de novo lesion >70% in native vessel, diameter 2.5-4 mm, lesion length <30 mm. EXCLUSION CRITERIA: diabetes, previous revascularization, significant left main stenosis, chronic total occlusions (CTO) and multivessel disease. RESULTS: Majority of patients in EPC-capture stent and BMS groups presented with NSTEMI (73.3% and 70%, respectively). Mean stent length was 20.1±8 and 19.9±10 mm, diameter 3±0.97 and 3.1±0.88 mm in respective groups. The binary restenosis was significantly lower in GenousTM (13 vs. 26.6%, P=0.04). Risk of MACE after 6 and 12 months were comparable in both groups. There was no stent thrombosis. Numbers of circulating EPCs were significantly approximately 2-fold higher during the ACS than after 6 months. Mobilization of EPCs during acute ischemia was significantly lower in patients who developed restenosis after 6 months (3 vs. 4.5 cells/µL, P=0.002) and it was negatively correlated with late-loss after 6 months (R=-0.42; P<0.03). CONCLUSION: Use of GenousTM stents in NSTE-ACS is associated with lower restenosis rate than BMS at 6 months. There was no ST through 1 year. The number of circulating EPCs is inversely correlated with in-stent late loss (LL).

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.

Endoscopic transsphenoidal treatment of empty sella turcica syndrome using a silastic coil.

An empty sella turcica is due to the presence of an arachnoid diverticulum with its fluid content in the sella turcica, exerting pressure on the pituitary gland. In most cases this condition has an asymptomatic course, and is discovered by accident. Some patients, however, develop empty sella turcica syndrome with headaches, mild dishormonose, dysopsia and, rarely, spontaneous rhinorrhoea. Surgical treatment of empty sella turcica consists of filling the sella, through the transsphenoid route, with tissues collected from the patient or with artificial material. The aim of this report is to present our own experience of endoscopic extradural sella elevation using a silicone spiral, in 4 patients with primary empty sella turcica syndrome. The main indication for surgery was progressing dysopsia. The microinvasive endoscopic transsphenoidal method has been used, based upon the Jho technique with our own modifications. For the elevation of the sella, we used a coiled section of a Pudenz valve intraventricular silicone drain, adjusting its size to the dimensions of the operated sella. Both the implantation of the helix, and the postoperative course were uncomplicated for all surgically treated patients. The follow-up of several months confirmed improvement of the dysopsia in all surgically treated patients. MR examinations confirmed the correct location of the silicone spiral placed in the sella. It seems that the good results achieved are due to a correct indication for surgical treatment. The follow-up period ranges from 12 to 30 months and, so far, the clinical improvement is stable and satisfying both for the patients who underwent treatment and for the neurosurgeons.

Endoscopic transnasal transsphenoidal treatment of pathology of the sellar region.

From October 2001 to the end of November 2002 in Department of Neurosurgery, Silesian University School of Medicine in Katowice 70 explorations of the sella turcica were executed using the endoscopic method. In 63 cases the operation was done because of pituitary gland adenomas. In one case the diagnosis was craniopharyngioma, in 1 chordoma of the clivus, in one glioma of the optic nerve, in 1 the reason for an operation was an empty sella syndrome and in 3 cases the pathological diagnosis was an amorphous masses. Patients were operated using the 4-mm diameter endoscope with 0- and 30-degree angled lenses, using the method according to Jho and Carrau with our own modifications. In all cases of adenomas the total removal of the tumour was obtained in 71.4 %. Permanent diabetes insipidus occurred in 4.3 % of all operated patients. In our series of patients we did not observe any postoperative CSF leak or rhinological complications. One patient died, corresponding to 1.4 % of all cases. We the recommend transsphenoidal transnasal endoscopic approach for use in the cases of sellar region pathology because of the advantages of the method for surgeon and for comfort of the patient.

Validating the use of green fluorescent-marked Escherichia coli O157:H7 for assessing the organism behaviour in foods.

AIMS: Monitoring bacterial kinetics in food is of great importance in food safety. The targeted micro-organism has to be identified accurately among competitive flora. Using green fluorescent protein (GFP)-transformed strains is a possible answer to such issues. However, quantitative studies require that this transformation does not alter the micro-organism behaviour: parent and transformed organisms were thus compared. METHODS AND RESULTS: Three Escherichia coli O157:H7 strains were transformed using a GFP-plasmid expressing. Parent and transformed strains were compared according to their genetic characteristics and serotypes. Growth ability was also assessed in constant and fluctuating temperature profiles. Cardinal values of pH, water activity and temperature were computed. No differences were observed between parent and transformed strains for all these experiments. The plasmid was satisfactorily maintained within transformed strains throughout the studies. Growth was eventually monitored in beef meat. CONCLUSIONS: Using the GFP marker is of great value, as it allows easier enumeration of E. coli O157:H7 in food in the presence of natural microflora. Using transformed strains is legitimate: their behaviour does not differ from that of their parent strains. SIGNIFICANCE AND IMPACT OF THE STUDY: GFP transformation appears to be a valuable and reliable tool for challenge testing studies and predictive microbiology.

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.

[Anorexia as a symptom of cerebral aneurysm in a 14-year-old boy]. / Jadlowstret jako glówny objaw tetniaka mózgu u 14-letniego chlopca.

The authors present a very rare case of a child with anterior communicating artery aneurysm and symptoms of anorexia nervosa. Because of coexistence of subarachnoid haemorrhage and head trauma false diagnosis of temporal and frontal lobe contusion was initially established. Headaches, anorexia and cachexia occurred with aneurysm enlargement. Computed tomography and cerebral angiography allowed to indicate operation. After successful surgery all symptoms disappeared.

[Own experience with the treatment of intracranial aneurysms using "Perneczky" - Zeppelin clips]. / Wlasne doswiadczenia w leczeniu tetniaków mózgu przy zastosowaniu zacisków naczyniowych typu "Perneczky" Zeppelin.

The basic design and the mechanism of clip application have not changed for many years. However in cases of aneurysms located deeply inside brain structure, in narrow spaces, multiple aneurysms or those which require applying of several clips the surgeon may have problems with visual control of the position of the clamping arms on the neck of aneurysm, nearby blood vessels and nerve structures. The above mentioned problems motivated prof. Axel Perneczky to construct a new model of clip with an applying and a removing holder whose mechanism is based on the principle of inverted--spring. Between February and August 1998 in the Neurosurgical Clinic in Katowice, 12 Perneczky's clips were applied in 9 patients. Intraoperative complications were not observed in any of the cases. In two cases of aneurysms located on the bifurcation of the basilar artery, application of two clips enabled precise intraoperative control of clip position.

[Growth of intracranial meningiomas after trauma. A case report]. / Wzrost oponiaków sródczaszkowych po urazach. Opis przypadku.

A case is described of intracranial meningioma development in a woman aged 69 who had craniotomy 28 years earlier. The meningioma grew at the site of previous craniotomy. Documented cases from the literature are quoted in which craniocerebral trauma was unequivocally related to meningioma development, although the coincidence of trauma with meningioma is still controversial.

[A case of arachnoid cyst in vertebral canal]. / Przypadek torbieli pajeczynówki kanalu kregowego.

A rare case of intradural subarachnoid cyst in the vertebral canal was observed in a female aged 52 years. Operation was followed by marked improvement of the neurological condition. The large defect of the dura required grafting of lyophilized dura. The role of MRI in the diagnosis of this case is stressed.

[Two cases of intracranial lipomas]. / Tluszczaki wewnatrzczaszkowe. Opis dwóch przypadków.

The authors report two rare cases of intracranial lipomas recognized in CT of the head. The tumours were situated in the corpus callosum in one case, and in the posterior fossa in the other case. Both cases were thought unsuitable for surgical intervention, and one of the patients was given only anticonvulsant treatment.

[The transseptal approach in transsphenoidal surgery of pituitary neoplasms]. / Dojscie przez przegrode nosowa w operacjach transsfenoidalnych guzów przysadki mózgowej.

The authors described the direct transseptal approach in transsphenoidal surgery for hypophyseal tumors. This route gives a good insight into the area of the sella. The above mentioned method is also less destructive to nasal structures in the nasal cavity, because preserves the anterior nasal septum. It is uniformity of actually views of rhinological school. 20 patients were operated using this method and none of them noticed the changes of nasal airway and the sense of smell.

[Analysis of selected prognostic factors in patients with ruptured cerebral aneurysms operated-on in the early period]. / Analiza wybranych czynników prognostycznych u chorych z peknietym tetniakiem mózgu operowanych we wczesnym okresie.

An analysis of certain clinical and laboratory findings of 80 patients with ruptured intracranial aneurysms was done. All of them underwent an operation in acute stage. The following prognostic factors were analysed: age of patient, sex, number of previous subarachnoid hemorrhages (SAH), clinical status according to the Hunt-Hess scale, CT finding according to Fisher scale, location and number of aneurysms, time of operation, Nimodipine treatment, body temperature, serum sodium level, white blood count just before operation, mean blood pressure, coexistence of heart and kidney disease. A special computer programme was used to analyse the value of the above factors on follow-up and the final results of the ruptured intracranial aneurysms treated surgically in acute stage.

The prognostic value of some clinical and diagnostic factors in traumatic intracranial haematoma.

In order to carry out the analysis of predictive values of some clinical and diagnostic features, 146 patients of the Neurosurgical Clinic of the Silesian School of Medicine, were examined in 1980-1986. All the patients were in coma when admitted while CT findings showed traumatic intracranial haematomas. The examination included neurological diagnosis and CT examination. The analysis of statistical discrimination let us specify the probability of predicting death or survival of every patient. On the basis of 10 prognostic factors applied, the compatibility of prognosis and the real outcome for patients who survived was 78.2% and for those who died 91.2%.

[Aneurysms of the anterior communicating artery and anomalies of the anterior part of the circle of Willis]. / Tetniaki tetnicy laczacej przedniej, a anomalie przedniej czesci kola tetniczego willisa.

Aneurysms of the anterior communicating artery are much more frequently encountered in subjects with developmental anomalies of the anterior part of the Willis circle than in the general population. The most frequent anomaly is hypoplasia of the A1 ACa segment, duplication of the anterior communicating artery or accessory artery of the corpus callosum. In the material of the authors of 130 surgically treated cases of the aneurysm situated in the anterior communicating artery complex developmental anomalies were found in 37.7%.

[2 cases of coexistence of meningioma and glioma]. / Dwa przypadki wspólistnienia oponiaka i glejaka mózgu.

The authors present two cases of a rare coexistence of cerebral meningioma and glioma. In one case meningioma was situated closely to malignant glioma. In the second case in a patient operated on for cerebral glioma a meningioma was removed 20 years later. The meningioma was situated far from the first tumour.

[Post-traumatic posterior cranial fossa hematomas from material of the Department of Neurosurgery, Silesian Medical Academy in Katowice]. / Pourazowe krwiaki tylnego dolu czaszkowego w materiale Kliniki Neurochirurgii SL. AM w Katowicach.

The location of posttraumatic haematomas in the posterior cranial fossa is rare and the correct diagnosis was difficult before the advent of CT. In the years 1976-1989 in the group of 2450 cases of craniocerebellar injuries treated in the Department of Neurosurgery, Silesian Medical Academy 24 patients had posterior fossa haematomas, but only one of them (out of 550 cases of injuries) was diagnosed without CT. In 20 cases surgical treatment was carried out with good and satisfactory results in 16 cases (80%). The authors stress the importance of early CT and surgical intervention.

[Results of the surgical treatment of intracranial aneurysm]. / Wyniki leczenia operacyjnego tetniaków sródczaszkowych.

In the years 1976-1984 in the Department of Neurosurgery, Silesian Medical Academy in Katowice 196 patients were treated surgically for intracranial aneurysms. In the patients with aneurysms in the anterior part of the circulus arteriosus Yasargil's craniotomy was done. In some cases of aneurysms of the posterior cranial fossa suboccipital craniotomy was performed. In 181 cases the aneurysm was isolated by clipping it, in 4 cases it was trapped and in 11 wrapped. Good results were obtained in 60% of cases and bad in 15.9%. Death from extracranial causes occurred in 3 cases. The results of surgical treatment depended on the condition of the patient estimated by the Botterell scale, age, situation of the aneurysm and number of subarachnoid haemorrhages, duration of operation and experience in qualification of patients for surgery and on surgical technique.