[A case of subclinical frontal lobe abscess as a complication of sinusitis]. / Przypadek skapoobjawowego zatokowopochodnego ropnia plata czolowego mózgu.

Nowadays suppurative complications of sinusitis are uncommon in orderto widespread treatment with antibiotics. Intracranial complications include bacterial meningitis, encephalitis, brain abscess, epidural or subdural abscess and sinus thrombophlebitis.The 13-40% of all brain abscesses are sinogenic complications. The inflammation process spreads from sinuses by valveless diploic veins of the skull as thrombophlebitis or by direct extension of osteomyelitis. Jatrogenic, posttraumatic or natural fissures in bony walls can also take part in spreading the infection. Diagnostic process includes laryngological and neurological evaluation with the computer tomography scanning or magnetic resonance imaging. Patients with intracranial complications require broad-spectrum antibiotic therapy and surgical treatment in orderto remove the origin of infection in the sinuses. For physicians they are always challenging conditions according to their significantly high mortality. The case of the 24 year old patient with sinogenic brain abscess was shown in this paper. He neglected ambulatory treatment of chronic sinusitis because of lack of the medical insurance. After episode of losing the consciousness he was admitted to the ENT Department with headache, nausea, fever and dehydration. The diagnose was established based on laryngological and neurological examination and visualization of brain abscess on CT scans. He was treated by surgical intervention conducted by team of head and neck surgeons and neurosurgeons. Intensive antibiotic therapy with the Uffenorde operation of frontal sinuses and neurosurgical removal of the brain abscess was performed.The epidemiology, clinical course, diagnostic problems and therapy were described.

[Percutaneous ventriculoatrial shunt: experience with 179 cases]. / Implantacja zastawki komorowo-przedsionkowej z przezskórnym wprowadzeniem drenu dosercowego--doswiadczenia wlasne na podstawie analizy 179 przypadków.

BACKGROUND AND PURPOSE: The aim of the study was to assess the impact of percutaneous placement of a distal catheter on treatment results in patients with hydrocephalus undergoing ventriculoatrial shunt (VA) implantation. MATERIAL AND METHODS: This retrospective study included 184 patients aged 14-80 years (mean: 48 yrs) with hydrocephalus who were treated with VA shunt between 1990-2003. In 179 patients the cardiac catheter was introduced by catheterization of the internal jugular vein, rarely the subclavian or external jugular vein, using the Seldinger technique and standard equipment for central vein catheterization. The mean follow-up time was 64 months. RESULTS: The most frequent complication related to the method used was an incidental puncture of the carotid artery (5% of cases). Pneumothorax was observed in two cases. None of these complications caused permanent sequelae. Early (<6 months) postoperative complications included shunt infection in the neck region (2 cases), impatience of the cardiac catheter (3), disconnection between the outlet and the cardiac catheter with its subsequent migration (1) and kinking of the distal catheter (1). Late (>6 months) complications included infection along the distal catheter (2 cases), occlusion of the cardiac catheter (4) and its disconnection (1). The mean duration of the procedure was 40 minutes. CONCLUSIONS: Percutaneous placement of the cardiac catheter is a safe procedure which shortens the duration of the operation and minimizes tissue traumatization. This method may contribute to a decreased risk of infection. VA shunt with presented modification may be used in those patients for whom implantation of ventriculoperitoneal shunt is contraindicated.

Endodermal cyst of the cervical spinal cord with associated partial fusion of the vertebrae.

A case of a 43-year-old woman with an intradural endodermal cyst at the C4 spinal cord level is presented. The lesion manifested with progressive neck pain and weakness of lower extremities. The presumptive diagnosis of extramedullary benign cystic lesion was established after MRI examination. Coexisting partial fusion of the C5-C6 vertebral bodies was found on X-ray films. The patient was cured by resection of the cyst wall, performed by laminectomy. Pathological examination revealed a cyst wall lined with ciliated cuboidal cells, resembling the respiratory epithelium. Immunohistochemistry demonstrated cytokeratin and epithelial membrane antigen expression in the lining of the cyst. Endodermal cyst should be considered in the differential diagnosis of intraspinal cystic lesions, especially those associated with vertebral anomalies.

Reason and prospects of surgery by transposition of omentum on the brain in patients after ischemic stroke on the basis of 50 cases operated upon

The results of surgery by transposition of omentum on the surface of ischemic brain in 50 patients have been presented and discussed. The reason of such operation is: 1) recent discoveries in omentum biologically active substances taking part in angiogenesis what allows new vascular connections to develop from omentum to the brain and by this way to augment CBF in low perfused areas. 2) the idea that neurons way survive even by long period of time in condition of lowering metabolism provided perfusion in maintained above critical threshold and in condition of increased CBF the normal matabolic and synaptic functions may be restored. 3) encouraging results of such operations perfomed for the first time by Goldsmith in 1978. 4) results of EC-IC Bypass Study Group suggesting failure of arterial bypass to reduce the risk of ischemic stroke. 5) results of catamnestic investigation of 300 patients treated by STA-MCA anastomosis in our Clinic in Bytom in the period 1979-1990 suggesting that in the region of ischemia specially in patients with deep neurological deficit rather creation the new vascular network than bypass formation in reasonable. Patients in the age from 33 to 66 years old were operated upon in the years 1989-1992. They were characterized mainly by deep and stable neurological deficit and in the majority of cases the surgery was pèrfomed 1-4 months after stroke. In postoperative period 4 patients died, 8 were clinically unchanged, 38 regained varying degree, in some patients suprisingly high motor improvement and in lesser degree the speech improvement was observed