[Evaluation of relevance in concussion and damage of health by monitoring of neuron specific enolase and S-100b protein]. / Hodnocení závaznosti otresu mozku a poruchy zdraví pomocí monitorování hladin neuron specifické enolázy a proteinu S-100b v séru.

INTRODUCTION: Proteins released to the circulation from affected glial (neuron specific enolasis, NSE) or ganglial cells (S-100b protein) during traumatic brain injury might be used in diagnosis of traumatic brain injury in cases with negative finding on computer tomography scan (concussion) or in patients where the serious clinical status does not corresponde with mild changes on CT scan (diffuse axonal injury, DAI). Classification of DAI according Gennarelli considered the concussion as lower degree of DAI. MATERIALS AND METHOD: 15 patients were divided into group I of mild conccussion (n=3) with 1-day duration of hospitalisation, group II of serious concussion (n=4) with more days duration of hospitalisation with negative findings on CT scan and group III of patients with diagnosis of DAI (n=8). Blood samples were investigated by immunoanalysis for NSE and protein S-100b (Elecsys 2010, Roche). RESULTS: Values of NSE (16.30 +/- 2.33 vs. 110.48 +/- 34.99 vs. 24.07 +/- 6.29 microg/l), and protein S-100b (0.207 +/- 0.03 vs. 0.945 +/- 0.69 vs. 0.736 +/- 0.36 microg/l) overdrow the reference value in cases of group I, II, and III. We discuss the biomechanics of trauma and the blood brain barrier damage in comparison with values of NSE and S-100b protein. CONCLUSION: [corrected] We proved the significantly higher values of the NSE in group of serious concussion compared to group of DAI. We demonstrated that concussions in some cases lead to serious damage of health.

[Biochemical and immunohistochemical markers of brain injury]. / Biochemické a imunohistochemické markery poskození mozku.

Proteins released to circulation from affected tissues during primary or secondary trauma brain injury might be used as serum markers of glial or ganglial cells damage (neuron specific enolasis and S100 B protein). Other markers of trauma can be proved as relatively specific of diffuse axonal injury by immunohistochemical detectoin (amyloid prekurzor protein, neuron specific enolasis, glial fibrilar acidic protein and superficial antigen receptor CD 68). Some markers are associated with blood brain barrier damage (matrix metaloproteinases (MMP-2, MMP-9) and synthase of nitric oxide (iNOS)). We aimed in our short communication on biomechanics of developed of trauma, primary or secondary kinds of trauma brain injury and use of trauma brain injury markers for clinical diagnostics and management of patients.

The effect of subarachnoid sodium nitroprusside on the prevention of vasospasm in subarachnoid haemorrhage.

OBJECTIVE: The aim of this study was to evaluate the effect of preventive and therapeutic use of subarachnoid sodium nitroprusside (SNP) administration in patients with non-traumatic subarachnoid haemorrhage (SAH). METHODS: All consecutive adult patients admitted in the period 2000-2003 with SAH, Hunt-Hess grade I-IV, indicated for neurosurgical intervention, were enrolled in the study. In the postoperative period they were treated with mechanical ventilation and triple H protocol with nimodipine. Subarachnoid preventive SNP was administred in initial dose of 1 mg by catheter inserted into basal cisterns during the neurosurgical procedure. The timing of following dosage was directed by the changes of respiratory parameters of brain tissue in the region of interest by multiparameter sensor (Codman Neurotrend) and findings of blood flow velocity on the level of circle of Willis were measured by transcranial doppler ultrasonography (TCD). RESULTS: 17 patients were enrolled to study. All patients survived. No brain infarction developed. The increase blood flow velocity was found in three patients. CONCLUSION: Preventive subarachnoid use of SNP in combination with multimodal monitoring might be a possible preventive strategy. Its efficacy has to be proved on a greater group of patients in the future. The therapeutical use of SNP requires an increase in application rate.

Morphometric analysis of early regeneration of motor axons through motor and cutaneous nerve grafts.

Peripheral nerve damage is a frequent consequence of trauma, tumor surgery or diseases. Clinical results of functional reinnervation after the application of cutaneous grafts are still unsatisfactory. Differences in the extracellular matrix are considered to be one of the factors responsible for poor results of motor axon reinnervation through the cutaneous graft. To verify these differences, we compared morphological features of the motor axons regenerating through the graft prepared from the saphenous nerve and the motor branch of the femoral nerve. Eighteen female adult rats (Wistar) were used in experiments. The saphenous nerve, the femoral nerve, and its main motor branch were exposed under deep anesthesia with ketamine and xylazine. The nerve graft (10 mm) prepared from the saphenous nerve was applied between the stumps of the transected motor branch of the femoral nerve in the 6 rats. In the next 6 rats, the nerve graft (10 mm) harvested from the motor branch of the femoral nerve was inserted between stumps of the transected motor branch of the femoral nerve on the contralateral side. All rats were perfused with Zamboni's fixative solution 14 days after grafting. The samples of grafts and the intact motor branch (n = 6) were dissected and embedded in Durcupan ACM. Semithin sections stained with Toluidine Blue were used for morphometric analysis of myelinated axons by means of computer-assisted image analysis system. Ultrathin sections counterstained with uranyl acetate were viewed and photographed in an electron microscope. The number of myelinated motor axons showing early regeneration under conditions of the cutaneous and motor nerve grafts was similar. The diameter of axons and thickness of their myelin sheaths were significantly smaller when the axons regenerated into the saphenous nerve in contrast to the motor graft. Morphometric analysis of early regeneration of myelinated motor axons suggests that the cutaneous and motor branches of the femoral nerve provide different conditions not for the growth but for the maturation of motor axons.

Laminin molecules in freeze-treated nerve segments are associated with migrating Schwann cells that display the corresponding alpha6beta1 integrin receptor.

Isolated acellular nerve segments protected from migration of Schwann cells and the acellular nerve segments joined with the distal nerve stumps were prepared by a repeated freeze-thaw procedure in the rat sciatic nerves. The presence of laminin-1 and -2, as well as alpha6 and beta1 integrin chains, was detected by indirect immunohistochemistry in the sections through acellular nerve segments at 7 and 14 days after cryotreatment. The position of basal laminae and Schwann cells was identified by immunostaining for collagen IV and S-100 protein, respectively. The isolated cryo-treated segment without living Schwann cells (S-100-) did not display immunoreactivity for laminins and integrin chains, while the basal lamina position was verified through the whole segment by immunostaining for collagen IV. The absence of immunostaining for laminin-1 and -2 in cryo-treated nerve segment was verified by Western blot analysis. A crucial diminution of laminin-1 and -2 in the cryo-treated nerve segment of 10-mm length did not abolish the growth and maturation of axons. The greater part of nerve segment connected with the nerve stump displayed no immunohistochemical staining for S-100, corresponding with absence of Schwann cells. The border region of the nerve segment contained Schwann cells (S-100+) migrating from the near-freeze undamaged part of the distal nerve stump. In addition to immunostaining for S-100 protein, the migrating Schwann cells displayed immunostaining for laminins (-1, and -2) and integrin chains (alpha6 and beta1). The results indicate that the presence of laminin molecules in the acellular nerve segments prepared by the repeated freeze-thaw procedure is related with the migrating Schwann cells. The immunostaining for laminins and integrin chains, which constitute one of integrin receptor, suggests an autocrine and/or paracrine utilization of laminin molecules in the promotion of Schwann cell migration.

Acellular nerve graft re-seeded by Schwann cells migrating from the nerve stump can stimulate spinal motoneurons for functional reinnervation of the rat muscle.

The acellular nerve graft was utilised to restore a functional reinnervation of the biceps brachii muscle from the motoneuron pool of the cervical spinal cord. The musculocutaneous nerve stump was sutured to an acellular nerve graft, the opposite end of which was inserted into the cervical spinal cord cranial to the avulsed C5 ventral root. The acellular nerve graft was repopulated by Schwann cells heavily immunostained for NGFr within 90 days. The Schwann cells migrating from the nerve stump reached the spinal cord grey matter, where they stimulated the motoneurons to send axonal sprouts. The functional reinnervation of the biceps brachii muscle was assessed by means of the behavioural (grooming) test and EMG, the presence of myelinated and unmyelinated axons was demonstrated by light and electron microscopy. The axonal reconnection of the musculocutaneous nerve stump was verified by horseradish peroxidase retrograde labelling of the spinal motoneurons. Moreover, the motoneurons on the operated side of the C5 spinal segment displayed increased immunostaining for GAP-43 in comparison to the contralateral side, whereas the pattern of AChE histochemical reaction was similar on both the operated and contralateral side, of the C5 segment 150 days after acellular graft implantation. The regenerated axons bridged a 4-cm long originally acellular nerve graft to reach and reinnervate the biceps brachii muscle. The reinnervation of the neuromuscular junctions was morphologically determined by immunofluorescence for neurofilaments. The number of myelinated axons in the acellular nerve graft was significantly higher than those growing over the cellular graft, but their diameter was smaller. The results of experiments presented here demonstrate functional recovery of the biceps muscle reinnervation through the acellular nerve graft repopulated by migrating Schwann cells. The process of reinnervation by acellular nerve graft is however delayed and worse in comparison with the cellular graft.

[Restoration of vision after surgical treatment of traumatic optic neuropathy of an uncommon type. Case report and literature review]. / Uprava zraku po chirurgické lécbe traumatické optické neuropatie méne obvyklého typu. Kazuistika a prehled literatury.

The paper presents the case of successfully treated traumatic optic neuropathy with complete blindness. The decompression of optical canal was performed together with anterior fossa restoration. The alternative treatment using mega dosage of corticosteroids is discussed.

[Surgical treatment of injuries of the recurrent laryngeal nerve]. / Chirurgická lécba poranení n. laryngeus recurrens.

The authors give an account of the results of suture and decompression of the n. laryngeus recurrence in 15 patients with a mean follow up period of 17,6 months. A total of 12 nerves were sutured, one of them by means of an autograft from the n. suralis. A total of 11 nerves were decompressed. One patients after suture of the nerve and contralateral decompression did not attend a check-up examination. Of 11 sutured and checked nerves the results were very good in ten instances when a remarkable improvement of the voice was recorded as well as of the adduction movement and phonation closure of the vocal cords. In one instance the suture of the nerve failed. After decompression of the nerve in seven instances recovery of the function of the affected vocal cord occurred. After decompression of another two nerves the adduction movement of the vocal cord was restored, the voice became normal and phonation closure occurred. In one instance the nerve decompression failed. EMG examinations were made in three instances after suture of the nerve and in one instance after decompression of the nerve. The EMG examination correlated with the clinical finding. With regard to these results it is possible to recommend after injuries of the n. laryngeus recurrence its revision. The results of suture of the nerve or its decompression within five days after injury are very satisfactory in the group of patients treated by the authors.

[Compression lesions of the chiasmal area from the viewpoint of the ophthalmologist]. / Utlakové léze chiazmatické krajiny z pohledu oftalmologa.

The authors evaluate 100 tumour of the chiasmal region (80 pituitary adenomas, 8 meningiomas, 7 craniopharyngiomas, 5 other tumours) and present their neuroophthalmological findings. In comparison with the findings in pituitary adenomas of the last decade the number of bilateral blindness was lower by 2.4%, the number of the optic atrophy was lower by 48.1% and the number of patients with a vision worse then 1.0 by 60.6%. Before the operation 91.2% patients had defects in the visual fields (monolateral in 5% and bilateral in 86.2%). The authors point out a relatively long period between the first compressive symptoms and the operation, especially in nonsecreting pituitary adenomas (2.1 years). An early diagnosis and an appropriate therapy of the patients suffering from the compressive lesions of the chiasmal region decreases the risk of permanent vision defects.

[The extent of visual field damage in chiasmal lesions--contribution to the selection of methods for visual field examination]. / Rozsah poskození zorného pole u chiazmatických lézí--príspevek k volbe programu vysetrení zorného pole.

The authors analyse 200 visual fields (examine with automatic perimetry) of patients with the chiasmal syndrome. On the basis of their own results they recommend the use of quantitative perimetry for early diagnosis of visual field changes in the range of central visual field (0-30 degrees).