[The role of vascular reconstructive surgery in the treatment of cerebrovascular insufficiency]. / Miesto cievnej rekonstrukcnej chirurgie v liecbe cerebrovaskulárnej insuficiencie.

BACKGROUND: Management of cerebrovascular insufficiency (CVI) is one of the greatest medical challenges in our country. Retardation in this field has been causing serious medical and socioeconomic consequences. MAIN PURPOSE AND STARTING POINTS (OBJECTIVES): In spite of existing unfavourable conditions the authors of this paper have managed to standardize their own policy in diagnosis, surgical indications and techniques. This caused substantial improvement of their results, as well as cooperation with the neurologic clinics. In connection with the increasing numbers of operations and improved results, the authors report their recent experience in this field and compare them with the results from previous years. METHODS: The authors compare two series of patients. The first series of 65 consecutive patients surgically treated from 1st Jan. 1987 to 31st Dec. 1990 (69 operations altogether). The 2nd series of 169 consecutive patients surgically treated from January 1st 1993 to December 31st 1994 (191 operations altogether), 149 due of them were subjected to carotid endarterectomy (CEA). Mean age of the first series was 55.3 (35-73), 2nd series 59.7 years (42-86). The authors have studied participation of neurologically and angiographically unstable patients. In the first series the ratio of neurologically stable and unstable patients was 63.4:36.6%, while in the 2nd series it was 75.4:24.6%. The ratio of angiographically stable and unstable patients was in the 1st series 60.2:39.8%, while in the 2nd series it was 50.3:49.7%. In the 2nd series the authors observed also the percent age of ulcerated lesions in the carotid bifurcation and found a surprisingly high number-59.2%. RESULTS: The combined mortality-morbidity index of the first series was 11.6%, of the 2nd series 3.1%. In the first series there were two deaths (2.9%) and 6 brain infarctions. In the 2nd series four patients died from acute myocardial infarction (2.1%) and there were two cases of a perioperative brain infarction, respectively. The necessity of wound revision due to of bleeding was found in two patients (2.9%) in the first series, and in two cases (1%) in the 2nd series. CONCLUSIONS: The authors emphasize the complicated nature of these problems, the necessity to recognize the surgical indications and techniques, and protective measures to prevent serious complications. There is, in their opinion, inevitable to increase bringing the patients in need of surgical reconstruction under control. On the other hand, there is the necessity to increase the accessibility of qualified surgery in the CVI. That means in the first place to increase the number of centers able to accomplish these operations with minimal combined mortality-morbidity index. (Tab. 10, Ref. 37.).

[Changes in carbohydrate metabolism before and after the development of focal cerebral ischemia. III. Function of the diencephalon]. / Zmeny glycidového metabolizmu pred a po vzniku loziskovej ischémie mozgu. III. cast. Funkcia diencefala.

The purpose of the investigation was to assess whether the mechanism of reduced glucose tolerance in focal ischaemia of the brain can be considered a functional disorder of the regulatory brain centres or a manifestation of inadequate glucose utilization due to impaired insulin secretion. The function of centres regulating metabolic processes was tested by the i.v. administration of Pyrifer. It was revealed that after Pyrifer administration a parallel rise of the investigated values does not occur (i.e. number of leucocytes, body temperature, pulse, systolic and diastolic pressure, blood sugar level), the maximum values do not reach the levels of the control group, their rise is retarded, persists twice as long as in the control group and does not return to baseline values in the appropriate time. A pathological constellation of responses was recorded in 85.71% of the cases. A similar trend of changes was found also in a group of arteriosclerotic and hypertonic patients although in a lower percentage. The results confirmed the assumption that in the mechanism of reduced glucose tolerance in the periphery an important part is played by the impaired function of regulating centres in the diencephalon.

[Changes in glucose metabolism before and after the onset of focal cerebral ischemia. I. The intravenous glucose tolerance test]. / Zmeny glycidového metabolizmu pred a po vzniku loziskovej ischémie mozgu. I. cast: Intravenózny glukózotoleracný test.

In a group of 22 patients with focal ischemia of the brain and in 11 patients with cerebral arteriosclerosis and vascular hypertension the tolerance to glucose administered by the i.v. route was investigated. The rate of glucose utilization was expressed by a utilization coefficient. The tolerance to i.v. glucose administration is reduced in the group of arteriosclerotic and hypertensive subjects. As a result of acute focal ischemia of the brain it declines even more, as compared with subjects in the control group. In the mean values of the coefficient of glucose utilization a significant difference was recorded between the group of patients with focal ischemia of the brain, as compared with the control group (p less than 0.001) and the group of arteriosclerotic and hypertonic patients, as compared with controls (p less than 0.005). The authors conclude from the results that the reduced glucose tolerance to orally administered glucose in patients with focal ischemia of the brain and their potential candidates in no causal relationship with the variability of intestinal absorption, as similar changes in glucose tolerance were recorded also after intravenous administration.

[Changes in glucose metabolism before and after the onset of focal cerebral ischemia. II. Production of insulin]. / Zmeny glycidového metabolizmu pred a po vzniku loziskovej ischémie mozgu. II. cast: produkcia inzulínu.

The purpose of the work was to assess the insulin secretion after a glucose load in a group of patients with cerebral infarction and in a group of arteriosclerotic and hypertonic patients, i.e. potential candidates of cerebral infarction. The material comprised 46 patients, incl. 29 with focal cerebral ischaemia and 17 with arteriosclerosis and hypertension. After oral glucose administration plasma insulin was assessed by radiooimmuncassay (IRI). It was revealed that insulinsecretion in the group of hypertonic and arteriosclerotic patients follows the rise of the blood sugar level, the rise is somewhat lower than in the control group but persists longer and returns later to baseline values. Similar but quantitatively more marked changes were refealed also in the group with focal cerebral ischaemia. From the results ensues that a reduced glucose tolerance in patients with cerebral infarction recorded in previous work is not due to an inadequate insulin secretion, i.e. the peripheral glucose metabolism, but indicates rather the ineffectiveness of insulin to restore glucose homeostasis.