[The influence of premedication with diclofenac or pethidine on pain and postop treatment in lumbar discopathy]. / Wplyw premedykacji petydyna lub diklofenakiem na ból i leczenie pooperacyjne u chorych z dyskopatia ledzwiowa.

206 patients scheduled for spinal surgery (lumbar discopathy) were randomly premedicated with diclofenac, pethidine, diazepam or hydroxizine. The frequency of persisted postoperative pain was evaluated from the 3-ed. postoperative day to the end of hospitalisation--as the need for additional concomitant treatment with dexamethasone and intravenous analgesics. The frequency of persisted pain was significantly decreased in patients premedicated with diclofenac (together with diazepam) before spinal surgery (limited to fenestration) in comparison to patients premedicated with pethidine. The pre-emptive analgesic effect of diclofenac was even more evident in patients treated with non-steroidal anti-inflammatory drugs (NSAID) before surgery, but was not observed in patients after more traumatic surgery (laminectomy) premedicated with diazepam. The results are supporting the important role of NSAID given before surgery to decrease the frequency of persisted pain after spinal surgery (limited to fenestration), in patients treated with NSAID.

[Spontaneous intracerebral hematomas in the material of the Department of Neurosurgery of Medical Academy in Lublin]. / Krwiaki sródmózgowe w materiale Kliniki Neurochirurgii AM w Lublinie.

Between 1972 and 1991, 170 patients with spontaneous nontraumatic intracerebral haematomas were treated in the Neurosurgical Department of Medical Academy in Lublin. In 89 (52.5%) patients, the haematomas were caused by ruptured aneurysms; in 14 (8%), by angiomas; 67 (39.5%) haematomas had other etiology. Within the latter group of patients, 27% suffered from hypertension. Hypertension was also found in 15% of the patients with aneurysms and in 7% of the ones with angiomas. 34% of the haematomas were localized in the temporal lobe, 28%-in the frontal lobe, 3%-in parital lobe, 2%-in occipital lobe, 23% of haematomas were multi-lobal, 8% were found in deep brain structures, and in 2% haematomas were found in cerebellum. 128 patients underwent operative treatment, with a mortality rate of 26%, while 42 patients were treated conservatively, with a mortality rate of 19%. Basing on this material, the authors discuss indications for operative treatment of the haematomas.

[Direct effects of the intrathecal administration of normal saline for the brain expansion after the removal of subdural hematoma]. / Bezposrednie skutki dokanalowego podawania fizjologicznego roztworu soli w celu rozprezenia mózgu po usunieciu krwiaka podtwardówkowego.

In a group of 360 patients the effects were studied of various management methods in case of lacking expansion of the brain after removal of chronic subdural haematoma on the therapeutic results. It was found that intrathecal infusion of normal saline was an effective procedure, with small frequency of transient complications, and was followed by a considerably lower number of re-operations than after external or internal drainage of haematoma cavity.

[The early results of surgical treatment of chronic subdural hematomas in computerized tomography imaging]. / Wczesne wyniki leczenia operacyjnego przewleklych krwiaków podtwardówkowych w obrazie tomografii komputerowej.

Since the introduction of computerized tomography (CT) it has been possible to trace the image of the brain after removal of subdural haematoma. Postoperative studies demonstrated often presence of residual haematoma. This raises the problem of establishing indication to reoperation, especially of patients with good clinical condition. The clinical condition and CT images before and after operation were assessed in 20 patients treated surgically for chronic subdural haematoma. A statistically significant correlation was found between the magnitude of the effect of the space occupying lesion in CT image and the severity of the clinical condition. A high-grade mass effect with major ventricular system shifting was more often connected with presence of partly haemolysed haematoma in CT. Subdural haematoma thickness exceeding 20 mm correlated with serious clinical condition of the patient, and increased the likelihood of hemiparesis persisting after the operation. Finding of residual haematoma in postoperative CT should not be an indication to reoperation, if not associated with high-grade mass effect and if the clinical condition is good. In our material out of 15 patients with good clinical condition postoperatively residual haematoma was detected by CT in 12 cases, but only one had to be reoperated because of persistent high-grade mass effect.

[Early results of surgical treatment of chronic subdural hematoma in CT images]. / Wczesne wyniki leczenia operacyjnego przewleklych krwiaków podtwardówkowych w obrazie tomografii komputerowej.

Since the introduction of CT it has become possible to trace the pattern of brain changes after removal of subdural haematoma. Postoperative studies show frequently presence of haematoma residues, and this is connected with the problem of deciding about establishing of indications to reoperation, especially difficult if the patient is in a good clinical condition. The clinical status was compared with CT findings preoperatively and postoperatively in 20 patients subjected to operations for chronic subdural haematomas. A statistically significant correlation was found between the size of the mass effect in CT before and after the operation and the severity of the clinical condition. Major mass effect with high-grade ventricular shifting is more frequently connected with partially haemolysed haematoma in CT. The thickness of subdural haematoma exceeding 20 mm correlated with severe clinical condition, and increased the probability of hemiparesis persistence after the operation. Finding of residual haematoma in CT imaging after the operation, especially when not associated with high-grade mass effect, and with good clinical condition should not be accepted as an indication to repeated operation. In the presented material out of 15 patients with good clinical condition 12 had CT evidence of residual haematoma, and only one had reoperation in view of persisting evident mass effect.

[Results of the treatment of idiopathic hydrocephalus by shunt implantation after computerized cisternography]. / Wyniki leczenia wodoglowia idiopatycznego wszczepieniem zastawki po tomocysternografii komputerowej.

A retrospective study was reported of 19 patients (10 males and 9 females aged from 11 to 65 years) with idiopathic hydrocephalus treated by shunt implantation after qualification for this treatment based on computed tomocisternography. Clinical improvement was noted in 16 patients (84%), and after 2 months the therapeutic results by Black's scale were good in 13 patients (65%).