[Meningiomas of sella turcica: some clinical aspects]. / Oponiaki guzka siodla tureckiego--wybrane aspekty kliniczne.

The authors present their own experience in the treatment of tuberculum sellae meningiomas. The presented series includes 14 patients operated on during past 7 years. Visual loss was the first symptom in 78% of patients. The period between the onset of symptom and surgical treatment was long and in the majority of patients exceeded 2 years. Monocular blindness was found in 71% of cases prior to surgery. The authors present the results of surgical treatment with special attention directed to visual function after surgery. In conclusion, the authors stress the still unacceptably long period between the onset of symptoms and correct diagnosis. When the size of tumour exceeds 4 cm and compressing of adjacent important neurovascular structures is evident, possibilities of total removal are limited and the chance for visual improvement is low.

A strategy for analyzing multiple parameters with application to aneurysmal SAH patients all of them clipped but treated with and without cyclosporine.

The study evaluated the effectiveness of the combination of nimodipine and cyclosporine A vs nimodipine alone in the prevention of delayed neurologic deficit in 82 (31 plus 51) patients in whom intracranial aneurysms were clipped within 72 h after subarachnoid haemorrhage. The tests performed included examination of the neurological condition before and after operation, angiography of cerebral arteries to visualize vasospasm, and analysis of the distribution and amount of blood in the brain fluids and/or tissue according to Fisher's scale. Inclusion of cyclosporine A in the treatment was clearly beneficial for the neurological condition. While cyclosporine A did not appear to produce a statistically significant improvement as evaluated by the chi-square test, a positive result was obtained following analysis of the correlation coefficients after Pearson in combination with the logistic log-linear regression analysis. The results argue against the utility of the chi-square test for verifying clinical data obtained in a limited number of patients.

Successful prevention of neurological deficit in SAH patients with 2-chlorodeoxyadenosine.

Twenty patients suffering from subarachnoid haemorrhage due to ruptured intracranial aneurysm and operated on within 72 h after SAH were treated with an experimental immunosuppressive drug 2-chlorodeoxyadenosine (2-CDA), dose 0.05 mg/kg/day i.v. for 7 days. The 2-CDA treatment was started immediately after angiographic confirmation of ruptured aneurysm, and the standard pharmacological treatment (nimodipine and steroids) was also given. 50% of patients were severely threatened by "delayed vasospasm" or late neurological deficit (Fisher's score 3 or 4). The neurological outcome (assessed 8-12 weeks after SAH) was good (GOS = 1) in 70%, and fair (moderate disability, GOS = 2) in 25%. A single case of severe disability (GOS = 3), as well as two cases of less than perfect outcome (GOS = 2), were related to unusual pre- or intraoperative complications. We conclude that the low doses of 2-CDA can be considered as a valuable adjunct to the standard pharmacotherapy of SAH patients operated on early.

Urbanization and industrialization versus biological status of human populations.

The paper concerns the biological status of the Polish population. A comparison was made for inhabitants of towns, villages, and areas under different levels of industrialization and environmental pollution. It has been found that urban populations as compared with rural ones were characterized by a smaller number of children within a family, higher natural abortion rate, and higher infant mortality (estimated during the first 24 hours of life). An analysis of birth rate in three groups of birth weight has shown that rural habitats were more suitable for prenatal development than urban habitats, as a higher proportion of newborns had optimum body weight at birth in villages. It has been observed that the biological status of fetus (estimated as the body weight at birth) depended on the socio-economic conditions (a relatively high birth rate with optimum body weight in the first half of the 1970s, and a low birth rate in the years of the social crisis in Poland in 1981-82). Moreover, it has been found that in agricultural areas relatively little polluted (the Suwalki region), birth rate and total mortality were high, respiratory traits reached highest values, and blood pressure was low as compared with values of these traits in other areas of Poland. The inhabitants of industrial centers (Puchaczów, Bukowno) were exposed to heavier environmental pollution than the rural population, and at Puchaczów they were characterized by a short stature and low body weight. The seaside region (Jastarnia) was over-crowded and also affected by the pollution of the Puck Bay. Both these factors could account for a high mortality and emigration rate. Inhabitants of the areas being industrialized (Belchatów) were characterized by a low total mortality, below average for infants, poor development of the respiratory system, but a high psychomotor fitness. In the city of Lódz and in Strzemieszyce, environmental pollution was very high, which was combined with a very high total mortality, and in Lódz also with a high infant mortality. In Strzemieszyce, the values of some physiological traits such as Hb and HR were increased.

Cyclosporine A prevents neurological deterioration of patients with SAH--a preliminary report.

In the present study we found that the neurological outcome in patients anaesthetized for early clipping (up to 72 h after SAH) of a ruptured aneurysm and treated with cyclosporine A was significantly better than the neurological state of control patients without immuno-suppressive treatment. The results justify the presumption that auto-immune reactions are involved in the deterioration of the postoperative neurological state of patients with SAH after rupture of an intracranial aneurysm. Supplementing a standard surgical and pharmacological treatment with cyclosporine A seems to reduce the undesirable neurological consequences of the immunologically, induced vascular disturbance after SAH.

[Post-traumatic intracerebral hematoma]. / Pourazowe krwiaki sródmózgowe.

Fifty-five cases of post-traumatic intracerebral haematomas are analyzed, discussing the diagnostic value of such preliminary methods as plain skull films, EEG, echoencephalography. These methods, together with clinical findings make the diagnosis of intracerebral haematoma likely. The final diagnosis was based on carotid arteriography and computerized tomography of the brain, which provided additional information on traumatic brain damage. The diagnostic sensitivity of CT was higher. The considerable prognostic importance of the degree of consciousness disturbances and their duration is stressed. In the group of patients with lucidum intervallum the mortality was higher. Four patients were treated conservatively since CT demonstrated in them only small haematomas without displacement of the ventricles. The remaining patients were treated surgically removing the haematomas through craniotomy or craniectomy. In 54% of these cases improvement was obtained. The 33% mortality was moderate as compared with previous reports.