[Developmental anomalies of thoracic and lumbosacral vertebral column with diastematomyelia: case report]. / Anomalie rozwojowe czesci kostnych kregoslupa piersiowego i ledzwiowego w polaczeniu ze zdwojeniem rdzenia kregowego (opis przypadku).

Patient, 37-years old, female, admitted to Department of Neurology, with intensive lower back pain and weakness of right lower extremity. Radiological evaluation showed developmental anomalies of spinal cord and vertebral column, with double spinal cord Th10-S1. The mechanism of described clinical symptoms is due to affixed spinal cord syndrome. According to current literature we presented the mechanism of anomaly development. The above case was classified as the second type of split cord malformations.

[Neural endoscopy in hydrocephalus treatment in a case of tuberous sclerosis]. / Neuroendoskopia w leczeniu wodoglowia w przebiegu stwardnienia guzowatego.

Tuberous sclerosis is a rare, autosomal dominant neurocutaneous disease. The disease can also result from spontaneous mutations. Manifestations of this disease are typically characterized by involvement of the CNS (early childhood seizures, multiple brain tumours), skin (facial angiofibromas, Pringle's birthmarks), kidneys and liver (angiomyolipomas), heart and others. We present a case of 26 years old patient with brain tumour, with clinical and radiological signs of hydrocephalus due to a cystic lesion in the III ventricle. The patient was operated upon using neuroendoscopy, with clinical and radiological improvement.

Flow cytometric analysis of DNA ploidy and proliferative potential in brain tumours.

The proliferative potential and DNA ploidy in 203 brain tumours (27 astrocytomas grade I, 37 grade II, 80 grade III, and 59 grade IV) were investigated using bromodeoxyuridine (BrdUrd) incorporation and flow cytometry. One to three tumour samples from each patient were incubated in vitro for one hour at 37 degrees C with bromodeoxyuridine (BrdUrd) using the high preasure oxygen method. After incubation, fixation and staining, the cell preparations were analysed by flow cytometry. The percentage of BrdUrd-labelled cells (BrdUrd Labelling Index, BrdUrdLI), the predicted potential doubling time (predTpot) and the total DNA content were evaluated. The percentage of unlabelled S-phase cells (SPF) and proliferative index (PI, the percentage of cells in S + G2 phases) were also estimated. DNA aneuploidy was found in 61.1% of high-grade (III-IV) and 50.0% of low-grade (I-II) astrocytomas. The tumours showed variability in the BrdUrdLI values which ranged from 0.2 to 15.8%. Significantly higher mean value for BrdUrdLI was shown in grade III-IV astrocytomas (3.4%), than in grade I-II astrocytomas (1.5%), p = 0.0068. Also significantly shorter mean predTpot was shown in high grade III-IV astrocytomas (28 days) than in low grade I-II tumours (51 days), p = 0.0096. However, no relationship was shown between other cell proliferation parameters and histological grade. The mean intratumoral variability calculated on the basis of BrdUrdLI values on 2-3 samples from each tumour amounted to 31.2% +/- SD 15.9%.

[Endoscopic brain surgery of intracranial cysts: report of 2 cases]. / Torbiele wewnatrzczaszkowe leczone metoda neuroendoskopowa--opis dwóch przypadków.

Two cases are presented of intracranial cystic lesions, which were treated by the neuroendoscopic method. In the two cases the patients' radiological and clinical conditions improved. Neuroendoscopy is a very effective and safe method to treat intracranial cystic lesions.

Ki-67 as a marker of proliferation activity in tumor progression of recurrent gliomas of supratentorial localization. Immunocytochemical quantitative studies.

Quantitative study of labeling index (expressed in per cent of positive cells to all tumor cells) of Ki-67 (Ki-67LI), a marker of tumor proliferation, was performed in a group of 37 primary glial tumors and their recurrences. Three cases were entirely negative (no positive cells were found). Mean Ki-67LI for all primary tumors was 19.2% and for their recurrences-20.1%. There was no significant difference between tumors with longer (exceeding 1 year) and shorter survival between first and second surgery. In 17 cases recurrent tumor was of the same grade and in 16 cases malignancy at second surgery was higher than in primary tumor. Among tumors whose malignancy increased between first and second surgery as well as among tumors with the same grade at first and second surgery there were cases with increased and decreased Ki-67LI comparing samples from primary and secondary (recidiving) tumors. It is however, noteworthy that there was no tumor with markedly (at least twofold) decreased Ki-67LI and increased malignancy. The present findings indicate that there is still no simple answer to the question of prognostic role of Ki-67 in gliomas.

PCNA and protein P53 in recurrent supratentorial glial brain tumors: studies on correlation between morphology and tumor progression.

Thirty seven cases of recurrent gliomas with survival time from 3 month to 13 years were investigated morphologically and immunohistochemically to evaluate progression and transformation of tumors. Using antibodies against PCNA and p53 the proportion of positively marked cells (nuclei) to all tumor cells was assessed at both primary and secondary surgery. This was compared with morphology and survival time between first and second surgery. In 10 cases (27.0%) there were no positively marked cells. In the remaining 27 cases (73.0% of the whole group), the following indices (percents of positive cells) were calculated: for patients with survival below 1 year (mean = 9m) 28.3% PCNA-positive cells and 30.3% p53-positive cells at first operation. For recidiving tumors both indices were lower namely for PCNA 20.9% and for protein p53-26.7%. For patients with survival over 1 year (mean = 4.8y) the index after I operation for PCNA was 25.5% and was higher than found after II operation-22.3%. In contrary, the index for protein p53 was 20.1% after I operation and was lower as compared with the index after II operation-28.2%. Eleven of twelve fibrillary astrocytomas and all five gemistocytic astrocytomas at first operation underwent changes towards malignisation. The immunocytochemical results confirm the high phenotypic differentiation what is reflected in different indices for PCNA and p53 of tumors.

Analysis of morphological changes in recurrent glial tumors after surgery and telegammatherapy.

In 65 cases with supratentorial localized recurrent gliomas the morphological pattern of the tumors from the first and second operation was investigated. Comparison of the tumor tissue obtained for diagnosis from the first and second operation indicated blastic transformation of the tumors observed mainly in the astrocytoma group. It has been found that the transformation proceeds in a longer time since the morphological pattern of the tumors in patients with short survival either did not change or changed only to a minor degree. It was interesting to note at the second operation that tumors with signs of differentiation and clearly defined malignancy did not correlate with survival time. It seems that the primary histological pattern of the tumor determines the survival time after the first operation.

[Diagnosis and treatment of recurrent brain glioma]. / Rozpoznawanie i leczenie wznowy glejopochodnych guzów mózgu.

In the period from Jan 1 1984 to Dec 31 1990 clinical and radiological evidence of brain glioma was found in 120 cases treated previously surgically. The group comprised 55 women (46%) and 65 men (54%). At the time of tumour diagnosis their age was ranged 40 to 60 years. All patients received non-radical surgical treatment, supplemented with Co60 radiation in 104 cases, in 3 cases Co60 treatment was given together with chemotherapy (CCNU) and 12 patients received no complementary treatment. Thirty four patients (28%) had reoperations, in two cases even twice. In 86 cases (72%) treatment was palliative. Three types of secondary tumour regrowth were discerned. Reoperation prolonged survival and its effectiveness was greatest in regrowth type I. The shortest survival till the appearance of regrowth signs and the shortest survival after recurrence were in type II of regrowth.

[Immediate and late results of surgical treatment of hydrocephalus after subarachnoid hemorrhage]. / Bezposrednie i odlegle wyniki leczenia operacyjnego wodoglowia po krwotoku podpajeczynówkowym.

During the period from January 1st 1983 up to the end of April 1989 in the Neurology Department and the Neurosurgery Department 1417 patients were treated due to subarachnoidal hemorrhage. Among these patients in 275 cases the inner hydrocephalus was diagnosed using computer tomography (19.4%). In 17 cases (6.2%) hydrocephalus was treated surgically. In all patients the ventricle-atrial Pudenz valve was implanted; in 15 patients the valve was implanted for low pressure and in 2 for moderate pressure. The diagnostics was based on the computed tomography and angiography of cerebral vessels. In all cases large hydrocephalus was diagnosed (the anterior horn index in the computed tomography was below 3.0). The most frequent clinical symptoms were: urine incontinence (15 cases), disturbances of orientation (8 cases), akinetic mutism (8 cases) and paresis of extremities (7 cases). Above symptoms together with radiologic image presented indication for the valve implantation. Very good and good results were obtained in 13 patients, bad results in 2 cases, 2 patients died. Longer observation showed that 6 patients remain in satisfactory state, 3 patients are in bad state and 3 others died.

Postoperative radiotherapy and radiotherapy combined with CCNU chemotherapy for treatment of brain gliomas.

A prospective, randomized trial evaluates the effects of two postoperative treatment regimens on survival in 198 adult patients with supratentorial gliomas. All patients were irradiated with 6,000 rads after possibly radical removal of tumors. CCNU administration in the doses of 100 mg/sq m of body surface every 6-8 weeks following surgery proved to have no significant effect on the survival of patients. The median survival time in patients receiving radiation therapy alone was 61 +/- 7 weeks, while in those receiving additional chemotherapy was 56 +/- 4 weeks. Tumor histological malignancy and patients age were found to be the only important prognostic factors, irrespective of the treatment modality.