[Neuroradiologic imaging results suggestive of parasitic cysts in central nervous system in course of neoplastic disorders--cases report]. / Obraz neuroradiologiczny imitujacy torbiele pasozytnicze osrodkowego ukladu nerwowego w przebiegu chorób nowotworowych--opisy przypadków.

Cystic changes within CNS, revealed by computed tomography or magnetic resonance imaging, pose difficult diagnostic and therapeutic problem. We present two patients with primary diagnosis of parasitic cysts of CNS, in whom neoplastic etiology was finally confirmed. Differential diagnosis of cystic foci should from the beginning include not only parasitic infections, but also neoplastic diseases, which are much more frequent in Poland at present and in which prolonged diagnostic process and delayed treatment is highly unfavorable.

The radiological symptoms of lumbar disc herniation and degenerative changes of the lumbar intervertebral discs.

BACKGROUND: The x-ray examination is one of the fundamental diagnostic modalities in patients with low-back-pain. The aim of study was to establish relation between radiological findings and herniation type and its localization. As well, we looked for relation between radiological findings and progression of disc degeneration. MATERIAL/METHODS: The study enrolled 187 individuals operated due to lumbar disc herniation. In each case the x-ray examination of lumbar spine was performed. Herniation was classified as protrusion, prolapse or disc sequestration. According to localization, herniation was defined as central, lateral or intermediate. Removed discs were histologically evaluated to determine degeneration symptoms. The radiological picture was related to the degeneration of the intervertebral discs. RESULTS: The statistical analysis revealed the only one relation -between traction osteophytes and herniation classified as disc prolapse (p<0.05). We found no relations between other radiological findings (narrow intervertebral space, diminished lordosis, scoliosis) and herniation and its localization within the spinal canal. Also there is no relation between disc degeneration and radiological findings. CONCLUSIONS: Classic x-ray examination presents low value in diagnostics of lumbar disc degeneration and its herniation. There is no relation between radiological picture and intensity of degenerative changes within the lumbar discs.

[Vascular proliferation within the herniated lumbar intervertebral discs in surgically treated patients]. / Proliferacja naczyniowa w zmienionych przepuklinowo ledzwiowych krazkach miedzykregowych, bedacych przyczyna leczenia chirurgicznego.

Blood vessels are observed in intervertebral discs of children, and after individuals skeletal maturity the intervertebral discs become avascular structures. According to some opinions, new vessels in the annulus fibrosus can appear in adults as a result of regeneration processes. The lumbar intervertebral discs resected during surgery due to low-back-pain and during autopsies (control group) were evaluated histologically. The vascular proliferation was observed in 35% of surgical specimens in all types of herniation (protrusio, prolapse, and free sequesters). The statistical analysis revealed that proliferation take place mainly in young individuals.

[Autopsy evaluation of the extent of degeneration of the lumbar intervertebral discs]. / Autopsyjna ocena stopnia degeneracji ledzwiowych krazków miedzykregowych.

The aim of study was to evaluate the degree of lumbar intervertebral disc degeneration during post-mortem studies, and its relation to the age and gender of cadavers. The changes of intervertebral disc were classified according to Nachemson [13]. The study included 308 lumbar intervertebral discs taken during autopsy from 57 females (mean age 41.83) and 79 males (mean age 42.06). Two hundred and forty discs showed degenerative changes. The statistic analysis revealed that the degeneration is more pronounced with age (ANOVA p < 0.05). The study demonstrated that in males degeneration occurs a decade earlier than in females, and could be observed in the second decade of life. Similarly, the degeneration of 3rd or 4th grade could be observed a decade earlier in men than in women. The statistical analysis revealed the differences (p < 0.05) in degeneration between upper (levels L2 and L3), and lower (levels L4 and L5) lumbar spine. Analysing the discs as single levels, no statistical differences in degeneration were observed.

[Ageing and degeneration of human lumbar intervertebral discs]. / Starzenie sie i degeneracja ledzwiowych krazków miedzykregowych u czlowieka.

Intervertebral discs undergo serious age-related changes. It is generally accepted that degeneration of discs begins during the second decade of life, and it is well known that other structures of spine do not change as fast as the intervertebral discs. The most extensive degenerative changes occur in the nucleus pulposus, including degradation of proteoglycans aggregates with its fragmentation, dehydration, and loss of viable cells. Data available in literature, suggests that the most critical factor contributing to the degeneration, is increasing volume of the disc due to its growth, resulting in longer nutritional pathways and insufficient nutrition.

[Lumbar intervertebral herniation. The composition of free sequesters--a morphologic study]. / Przepuklina ledzwiowego krazka miedzykregowego--morfologiczna ocena wolnych sekwestrów.

Since 1934 when surgery for lumbar disc herniation was first performed various forms of disc herniation have been described. It is generally accepted that disc herniations can be classified as follows: disc protrusion, disc prolapse, and free sequestration. Histological evaluations of protruded and prolapsed disc have been presented in literature, revealing degenerative changes. No special attention was given to free sequestered disc elements. The aim of this paper was to analyse the frequency of freely sequestered intervertebral disc fragments and to investigate the morphologic nature of sequestered discs. The free sequesters were observed in 15.5% of all operated cases (N = 187). In 16 (55.2%) of these cases the sequester was composed of nucleus pulposus material, in 12 (41.4%) cases end-plate elements were noted and in one case (3.4%) anulus fibrosus elements were found.

[Presence and intensity of the Lasegue sign in relation to the site of lumbar intervertebral disc herniation]. / Obecnosc i nasilenie objawu Lasegue'a a umiejscowienie i wielkosc przepukliny ledzwiowego krazka miedzykregowego.

The manouevre of stretching the sciatic nerve known as the Lasegue test is very useful in the clinical evaluation of patients with suspicion of lumbar disc herniation and has been in use for over 100 years. The relationship between the intensity of the Lasegue test and intraoperative localization of disc herniation is presented. The material comprised 87 cases (54 males and 33 females) aged 47 (+/- 9) years. Duration of symptoms was on average 9 months (+/- 7.5 months). The Lasegue sign was positive in 84 patients and negative in 3 patients (absent in 1 case, and more than 70 degrees in 2 cases). In the investigated group the Lasegue sign was positive at 39 degrees (+/- 22 degrees) on average. The obtained results indicate a strong relation between a positive Lasegue sign and disc herniation leading to direct spinal nerve or nerve sheath compression.

Degenerated lumbar intervertebral disc. A morphological study.

According to many investigators, lumbar disc herniation is formed by the nucleus pulposus displaced to the vertebral canal through the cracks in the annulus fibrosus as a final result of disc degeneration. Specimens obtained during 187 disc surgeries were studied to identify the morphological nature of various forms of disc herniation, especially protrusion and prolapse. In 29% of cases the herniated part was annulus fibrosus and in 21.5% cases the annulus fibrosus was seriously involved. Simultaneously 308 autopsy specimens were studied. On gross examination the signs of degeneration were advanced in 82, and strongly pronounced in 42. In 15 specimens, aged 40 years or older, fibre bundles were reversed to normal convex orientation producing annulus fibrosus bulge. Microscopic examination showed pronounced myxomatous degeneration within the annulus fibrosus. In these circumstances, we believe that general opinion must be verified, because in some herniations the nuclei pulposus are not involved and herniations are solely prolapses of annulus fibrosus. So, the lumbar intervertebral disc herniation should be classified on the basis of histological examinations as a herniation of nucleus pulposus, herniation of annulus fibrosus or as a mixed type herniation where both disc elements are involved.

[The efficacy of intraventricularly administered vancomycin in the case of central nervous system infection caused by enterococcus faecalis]. / Skutecznosc wankomycyny stosowanej dokomorowo w zakazeniu osrodkowego ukladu nerwowego wywolanego przez Enterococcus faecalis.

The case of 40 years old man with subarachnoid hemorrhage with intraventricular bleeding and with consecutive cerebro-meningitis is presented. The bacterial pathogen was Enterococcus faecalis sensitive only to glycopeptide antibiotics. The standard therapy with intravenously administered Vancomycin and Teicoplanin was not effective. Because of the worsening of patient's clinical status and clinical symptoms of sepsis the intraventricular Vancomycin (20 mg/day) was introduced. At the second day of the therapy the gradual patient's recovery was observed. The symptoms typical for meningitis diminished as well as cerebro-spinal fluid (CSF) parameters normalized. There was no bacterial growth in the blood serum and in CSF. As we can observe the intraventricular administration of Vancomycin is efficient method of cerebro-meningitis treatment. In our opinion the blood-brain barrier, even pathologically changed by infection, do not allow antibiotics to penetrate CSF, even in the maximal intravenous doses. In the cases of cerebro-meningitis caused by bacteria sensitive only to glycopeptide antibiotics, the intraventricular administration of the drug might be an alternative way of therapy especially when the doses of intravenous antibiotics need to be reduced.