[Vasospasm. Part II -- Onset time, localization, etiology. Proposed management algorithm in vasospasm]. / Skurcz naczyniowy, cz. II--Czas wystepowania, lokalizacja i etiologia. Propozycja algorytmu postepowania w stwierdzonym skurczu.

Time course of vasospasm in man has a big impact on clinical pisture, it also has an influence on the decision of surgery. The presence of acute stage of vasospasm is still under discussion. Many authors deny its existence. It is well known that positive decision about early operating has a crucial role in case of vasospasm Another problem is the aetiology of vasospasm. Inspite of many clinical and experimental investigations the aetiology of vasospasm remains unclear. The main problem is still the adequate therapy. This paper contains the updated knowledge about vasospasm, with the main accent on aetiology diagnosis and therapy.

[Vasospasm, part I: clinical symptomatology and differential diagnosis]. / Skurcz naczyniowy, cz. I--objawy kliniczne i róznicowanie.

Vasospasm is the most dangerous and common complication of subarachnoid haemorrhage (SAH) from ruptured brain aneurysms. The frequency of vasospasm is between 11 to 72% of SAH cases. One of the consequences of vasospasm is delayed neurological deficit (DND). Clinical diagnosis of vasospasm can course many diagnostic and therapeutic problems. This paper reviews the current developments concerning history, clinical picture and differential diagnosis of vasospasm.

[Surgical treatment of lateral extraforaminal lumbar disc herniation]. / Leczenie operacyjne bocznych zewnatrzkanalowych przepuklin jadra miazdzystego w odcinku ledzwiowym kregoslupa.

Extraforaminal lumbar disc herniations with spinal nerve compression are a well-recognised entity. The diagnosis is difficult although the clinical syndrome is quite characteristic. Myelography fails to disclose these lesions, while CT, MRI or discography are helpful. The best approach to the extreme-lateral lumbar disc herniation is microsurgical decompression of the spinal nerve via the intertransverse muscle, ligament and fascia. With this approach, there is no facet destruction and satisfactory nerve root decompression is safe and effective in relieving radicular pain.

[Repeated operations for recurrent lumbar disc herniations]. / Wielokrotne operacje przepuklin jadra miazdzystego w odcinku ledzwiowym.

A study of 73 patients who underwent reoperation for persistent or new complaints following initial lumbar discectomy is presented. 32 patients showed true recurrence of disc herniation (6 on the contralateral side) and 41 at a different level. 14 patients needed 3rd operation. Final results were evaluated using the Functional Economic Rating Scale elaborated by Prolo. Mean score for group operated on twice was 8.1 according to Prolo and 7.1 for group operated on 3 times.

[Polish School of Medicine at the University of Edinburgh, in the years of World War II. (50th anniversary of closure)]. / Polski Wydzial Lekarski Uniwersytetu w Edynburgu, w latach II wojny swiatowej.

Half a century ago the activity of the Polish School of Medicine at the University of Edinburgh came to an end. It seems a good occasion to recall its beginnings and recognise its merits for Poland and for medical education. The school was a Scottish-Polish academic enterprise, unique in the history of universities, presenting an example of international academic co-operation. It was then the only legal Polish medical school in the years of World War II. The founders of it were: Lt.Col. Professor Francis A. E. Crew, Commanding Officer of the Military Hospital at Edinburgh Castle, who conceived the idea of a Polish medical school as a part of the University of Edinburgh, the Dean of the Medical Faculty, Professor Sidney Smith, who along with Sir Thomas Holland, the Principal of the University put the idea into motion through the University authorities on the Scottish side-and the Commander in Chief of the Polish Forces and Prime Minister General Wladyslaw Sikorski, who gave his whole-hearted support and Lt.Col. Dr Antoni Jurasz, Professor of Surgery at the University of Poznan, who became the main organiser and first dean of the Faculty-on the Polish side. It was an independent Polish academic institution being simultaneously an integral part of the University. The medical training underwent 337 undergraduates, 227 out of whom obtained the degree M.B.Ch.B. and 19 degrees of Ph.D. after submission of doctoral thesis. The majority of them had served in the Polish troops being referred by the Military authorities and many of them took later part in the war campaigns. Much emphasis is put on the activity of Wiktor Tomaszewski, Associate Professor of medicine, ex-Senior Lecturer of the School, explorer of historical bounds between two nations, and above all, the organiser of the anniversary celebrations, so much animated by a passion for unceasing memory of the school. He was honored by granting F.R.C.P. (Ed.) and honorary doctorship of the University.

[Epidural gas aggregation in the course of gaseous degeneration of lumbar intervertebral disk as a cause of foot paresis]. / Obecnosc zewnatrzoponowego gazu sródkanalowo w przebiegu gazowego zwyrodnienia jadra miazdzystego w odcinku ledzwiowym jako domniemana przyczyna niedowladu prostowników stopy.

The finding of gas within the vertebral disc space ("vacuum phenomenon") is relatively common. Degenerative spine disease, gaseous degeneration of the intervertebral disc, and epidural gas were disclosed on imaging study. The epidural gas could be attributed to gaseous disc degeneration. The nerve root in presented patient was compressed by epidural gas. Following surgery the clinical syndrome including foot drop has thoroughly resolved.

Meningiomas of the lateral ventricles of the brain in children.

Meningiomas of the lateral ventricles of the brain are rare tumours, accounting for approximately 0.5-5% of all intracranial meningiomas. Their natural history and symptomatology and the possibilities of early diagnosis are presented. The intraventricular location of the slow-growing benign mass provides a compensatory mechanism in the form of reserve space, which contributes to the delay in clinical demonstration of symptoms and signs. This makes the choice of diagnostic procedure an essential problem. CT and MRI are useful in detecting these masses, and magnetic resonance angiography (MRA) has also proved to be of great value in demonstrating the vascular supply of the tumour. This paper deals with two cases. In case 1 CT, MRI and MRA and in case 2 CT examination proved to be very useful. The tumours were removed by a transcortical approach in the posterior area.

Posterior fossa tumors in children--indications for ventricular drainage and for V-P shunting.

A clinical analysis of 95 patients with posterior fossa tumors treated in the Department of Neurosurgery of the Medical University in Gdansk over a period of 16 years (1979-1995) is presented. The following preoperative factors were studied: localization, size and suspected type of tumor, size of the ventricular system, and presence or absence of the "halo" symptom. The indications for ventricular drainage (Fisher) versus V-P shunting as a preliminary treatment are discussed. Finally, the advantages of each of these procedures are emphasized.

Meningiomas of the lateral ventricles of the brain.

Meningiomas of the lateral ventricles of the brain are rare tumours with an approximate incidence of 0.5-4.5% among all intracranial meningiomas. Four cases of intraventricular meningioma arising from the trigone are presented. In 1-st case the calcified mass was visible on straight radiographs. In 2-nd and 3-rd cases CT and angiography was performed. In 4-th case MRI and MRA proved to be very useful. The tumours were removed by transcortical approach in the posterior parietal area. The available literature on intraventricular meningiomas has been discussed.

[Antithrombotic prophylaxis in neurosurgical patients]. / Profilaktyka przeciwzakrzepowa w neurochirurgii.

Thromboembolic complications are common in patients with risk factors, undergoing general surgery, as well as in patients after neurosurgery. Among the methods used to prevent thromboembolic complications after surgery low molecular weight heparins are especially recommended, although the time of the beginning as well as the method of prophylaxis should be carefully chosen especially in neurosurgical patients.

[Lateral extra-canalicular lumbar disc herniation]. / Boczna zewnatrzkanalowa przepuklina jadra miazdzystego.

A case of 60 years old female with far-lateral disc herniation within lumbar spine is presented. The herniated disc has been excised from the lateral muscle splitting approach with the use of microscope.

[Intracranial epidermal cysts (true cholesteatoma) dermoids]. / Sródczaszkowe torbiele naskórkowe (perlaki prawdziwe, epidermoidy).

Three cases of intracranial epidermoids treated surgically are reported. Typical course, histological appearance, diagnostic value of radiological investigations and surgical procedure are presented. In differential diagnosis dermoids and cholesterol granulomas (cholesteatomas) are widely discussed.

[Multiple venous air embolism during cerebellar tumor surgery. Case report]. / Wielokrotny zylny zator powietrzny podczas operacji guza mózdzku.

A case of successfully treated multiple venous air embolism occurred in a man aged 41 operated on for cerebellar tumour. Postoperatively exceptionally serious complication developed in the form of neurogenic pulmonary oedema. Attention is called to a number of aetiological factors in this case. The anaesthesiological management in such cases should include careful monitoring of end-tidal CO2 concentration and insertion of catheter into right atrium.

[Spontaneous chronic spinal epidural haematoma in a 14-year-old boy. Case report]. / Przewlekly samoistny krwiak nadtwardówkowy w odcinku piersiowym kregoslupa u 14-letniego chlopca.

An unusual case of a 14-year-old boy with spontaneous chronic spinal epidural haematoma treated surgically with full success is reported. The clinical presentation and aetiology are discussed. The result of treatment depends mainly on the time of duration of neurological deficit. Immediate transfer to neurosurgical department gives a chance of good recovery.

[Evaluation of the results of the treatment of cerebral hematoma in relation to its volume using the "best fit" method]. / Próba oceny wyników leczenia krwiaków sródmózgowych w zaleznosci od objetosci obliczanej metoda "najlepszego dopasowania".

A method is described in which the volumes of intracerebral haematomas were retrospectively measured by a method of best-fitting circles, in 173 consecutive patients. 173 patients were operated on and 41 were treated conservatively. Prognosis in supratentorial haematomas of the volume up to 65 ml is better by 20% when they are treated conservatively. It seems that surgical treatment should be reserved for patients with haematomas over 65 ml presenting progressive deterioration of neurological condition. On the other hand, patients with infratentorial haematoma over 14 ml of volume should be operated on as quickly as possible.

[Use of somatosensory evoked potentials for prognostic evaluation of patients with intracerebral hematoma]. / Próba zastosowania somatosensorycznych potencjalów wywolanych do oceny rokowniczej chorych z krwiakami sródmózgowymi.

Evoked somatosensory potential (SEP) was studied in 15 patients with intracerebral haematomas comparing the obtained results with those in healthy subjects. In all studied patients the diagnosis was based on clinical picture and on computerized tomography. In 6 patients normal symmetrical records of SEP or records with slight differences of latency, amplitude or symmetry of various components between the ipsilateral and contralateral side in relation to the pathological focus were obtained. The postoperative course in this group was good. In 9 patients SEP on the ipsilateral or contralateral side (in relation to the pathological focus) was absent or deformed. The postoperative course in this group was unfavourable, and all patients died despite intensive treatment.

[Electrophysiological analysis of the degree of damage and regeneration of the facial nerve in tumors of the cerebellopontile angle]. / Analiza elektrofizjologiczna stopnia uszkodzenia oraz przebiegu regenerachji nerwu twarzowego w guzach kata mostowo-mózdzkowego.

In 7 patients with peripheral facial nerve paralysis during the development of pontocerebellar angle tumor or caused by damage to the nerve during surgical removal of the tumour the blink reflex and the peripheral nerve conduction were studied. Additionally, in 5 of these cases clinical and electrophysiological follow-up was carried out after operations of anastomosing of the hypoglossal nerve to the facial nerve. In all these cases the blink reflex was absent after the operation. On the other hand, from the third month on after the anastomotic operation a return was observed of the conduction in the facial nerve. Complete condution never returned despite evident clinical improvement in some case. Muscle atrophy, involuntary movements or associated movements in the facial muscles on the side of the anastomosis, which are frequent during spontaneous regeneration, were never observed.

Immunological and immunohistochemical studies in brain tumours.

The authors have studied different brain tumours with immunohistochemical technique using fluorescence and peroxidase methods. On frozen sections reactions for fibronectin (FN), prostaglandin E2 (PGE2), carcinoembryonic antigen (CEA) with polyclonal antibodies and for lymphocyte subpopulations B, NK and Pan-T with monoclonal antibodies have been investigated. Both primary and metastatic tumours contained fibronectin in various intensity and showed increased reactions with PGE2 antibodies comparing with surrounding tissues. A well developed FN positive fibrillary network in tumour tissue confirmed the presence of angiogenesis and visualised abnormalities of the vessel walls with focal disruptions. The intracytoplasmatic location of PGE2, more intense than in surrounding tissues revealed in this study, may indicate that tumour cells are capable of its production. Since prostaglandin inhibits lymphocyte cytotoxicity against tumour cells in vitro, this may be suggestive for its activity in tumour defence reaction. CEA was not found in primary brain tumours by immunohistochemical procedure, either fluorescence or peroxidase method. It has been detected only in metastatic carcinomatous tumours in moderate intensity. Immunostaining for subpopulations of lymphocytes in tumour slices with monoclonal antibodies showed only small number of cells, in some specimens. The reasons for this failure are discussed. The meaning of all these findings mentioned above for clinical purposes is considered. The application of immunohistochemical staining may be useful in diagnosing tumour of vague or doubtful microscopic appearances.