The sitting position during neurosurgical procedures does not influence serum biomarkers of pulmonary parenchymal injury.

BACKGROUND: The sitting position during neurosurgical operations predisposes to air penetration through veins and the movement of the air through the pulmonary circulation. Contact of an air bubble with the endothelium can lead to acute lung injury. The presence of specific pulmonary proteins in the plasma such as surfactant protein D (SP-D) and Clara cell protein (CC16) is a biomarker of damaging processes at the air-blood barrier. The aim of our study was to examine the hypothesis that the level of investigated pulmonary biomarkers in plasma is higher in patients operated on in the sitting position. METHODS: The study included patients undergoing planned neurosurgical operations, who were divided into two groups: the sitting group (40 patients, operated on in the sitting position) and the supine group (24 patients, operated in the supine position). After the operation blood samples were drawn, centrifuged, frozen and stored until analyses were conducted. The determination of the SP-D and CC16 levels was performed using an ELISA test. Air embolism (VAE) was defined as a sudden drop in etCO2 of more than 2 mmHg and the presence of air bubbles in the aspirated blood from the central cannula. In all patients, the number of hospitalization days in the postoperative period was calculated. RESULTS: There were no differences in the average levels of SP-D between the groups (the mean in the sitting group was 95.56 ng/mL and the mean in the supine group was 101.21 ng/mL). The average levels of CC16 were similar in both groups as well (6.56 ng/mL in the sitting group and 6.79 ng/mL in the supine group). There was a statistically significant positive correlation between SP-D and CC16 values in both groups. VAE was diagnosed clinically in 12.5% of cases in the sitting group without a significant increase in SP-D and CC16 levels. On average, patients in both groups were discharged from the hospital within 9 days of surgery. CONCLUSION: The sitting position and intraoperative VAE during neurosurgical procedures do not affect the concentration of plasma biomarkers of pulmonary parenchymal injury such as SP-D and CC16.

[Surfactant protein D as a biomarker for lung injury]. / Bialko D surfaktantu jako biomarker uszkodzenia pluc.

Respiratory distress and the need for mechanical ventilation, have been the most common reasons for ITU hospitalization. Pulmonary pathology is sometimes difficult to diagnose and differentiate; therefore we are on a continuous search for diagnostic tools and markers. It has been suggested that in patients intubated for acute lung injury, lower concentrations of surfactant proteins A and D in bronchoalveolar fluid and higher concentrations in the plasma are associated with more severe lung injury and worse clinical outcomes. Surfactant protein D (SP-D) plays a crucial role in defense mechanisms and immunomodulation, binding with various pathogens such as bacteria, fungi and viruses. SP-D is a valuable marker in ARDS and other specific and non-specific pulmonary pathologies, and may find a place as a valuable marker of the severity of disease.

[Abdominal compartment syndrome as advanced abdominal hypertension]. / Zespól przedzialu brzusznego jako zaawansowana postac nadcisnienia w jamie brzusznej.

The aim of the article is to present the definition and criteria of diagnosis of abdominal compartment syndrome (ACS) due to abdominal hypertension. Epidemiology of ACS is discussed. Secondary ACS is described. There is also an overview of clinical consequences and a scheme for ACS management.

[Multimodal intraoperative electrophysiological monitoring during cerebellopontine angle tumor surgery. Benefit or loss?]. / Wielomodalne sródoperacyjne monitorowanie elektrofizjologiczne w trakcie operacji guzów kata mostowo-mózdzkowego. Zysk czy strata?

In the Neurosurgery Department, Silesian University School of Medicine, continuous monitoring of selected neurophysiological functions of the central and peripheral nervous system was introduced in 1998 as a routine procedure in cerebellopontine angle surgery and some other operations performed in the petroclival region. Such benefits from this method as increased patient safety, availability of information about dynamic changes in the monitored structures, and the possibility of cranial nerves localization using stimulation in the operating area, are quite obvious. The paper presents results of a detailed statistical analysis of the amount of time required for preparation and for operating in 174 cerebellopontine angle tumor surgeries performed in the years 1986-2002 with (group M) and without (group BM, before the year 1998) intraoperative monitoring. Subgroups distinguished according to the histological type of tumor were evaluated. Out of 95 procedures performed in group M, 57 were operations of acoustic neurinoma cases, 15 meningiomas, 8 cases of epidermal cyst, and 15 other growth processes in the cerebellopontine angle region. Among 79 operations in group BM, there were 57 cases of acoustic neurinoma, 4 cases of meningioma, 8 cases of epidermal cyst, and 10 of other types of neoplastic growth. In group M as compared to group BM the pre-op. preparation time was found to be significantly longer in cases of the VIII-th nerve neurinoma, and of other tumors. No statistically significant differences in the amount of operating time in were found between any of the subgroups. Both radicality of tumor removal and facial nerve status have clearly improved since intraoperative monitoring was introduced.

[Endoscopic ventriculostomy of the third ventricle in adults. Own experience]. / Wentrikulostomia endoskopowa komory III u doroslych. Doswiadczenia wlasne.

Only few reports can be found on endoscopic third ventriculostomy (ETV) in the Polish literature, and the majority of other reports concern paediatric or mixed population. This has induced the authors to report their experience with ETV in adults, reporting the results and discussing the usefulness and effectiveness of this procedure, causes of complications and failure. ETV was carried out in 20 patients aged over 18 years in a two-year period, beginning in 1999. In 13 cases (64%) the cause was external compression of CSF system by tumour leading to hydrocephalus. In 3 cases aqueduct stenosis was producing hydrocephalus, in 3 cases arachnoid cyst, perisellar or situated in posterior part of the third ventricle, was the cause, and in one case colloidal cyst of the third ventricle. The outcome were analysed according to clinical and radiological criteria finding that the ETV was successful in 90% of cases by clinical criteria, and in 88% by radiological criteria. Only unimportant clinical complications were reported without major consequences. It is concluded that ETV is a very useful method for hydrocephalus treatment in adults, especially if caused by blockade of CSF pathways by tumour or arachnoid cysts in the vicinity of the third ventricle.