[Preoperative administration of a slow releasing somatostatin analog (SR-lanreotide, BIM 23014) in patients with acromegaly in the course of GH-releasing adenoma]. / Przedoperacyjne zastosowanie analogu somatostatyny o przedluzonym dzialaniu (SR-Lanreotide, BIM 23014) u pacjentów z akromegalia w przebiegu makrogruczolaka przysadki.

To evaluate the therapeutic efficacy of slow releasing analogue of somatostatin (SR-Lanreotide) in the pretreatment for GH-releasing adenomas, especially macroadenomas. During the last four years (between January 1996 and December 1999) the authors carried out 382 transsphenoidal operations for to various lesions. There were 169 acromegalic patients in this group. 82 of them received, as pretreatment, the slow releasing analogue of somatostatin (SR-Lanreotide, BIM 23014) in a dose of 30 mg every 14 days for 3 months (6 injections). There were 55 women and 27 men (range 25-68, mean age 44.8 years, SD +/- 10 years) operated on by one experienced neurosurgeon. The concentrations of serum GH--70.5 micrograms/l (range 5.3-500 micrograms/l, SD +/- 83.9 micrograms/l) and IGF-I--1302 micrograms/l (range 610-2030 micrograms/l, SD +/- 360.7 micrograms/l) were high. Out of these 82 patients 79 had macroadenomas with suprasellar and parasellar extension. The volume of the tumours was calculated according to the formula of Di Chiro-Nelson. The mean volume of the tumour was 4146.9 mm3 (range 213.5-38595.3 mm3, SD +/- 5675.9 mm3). The response to the pretreatment suppression of the serum GH, IGF-I level and shrinkage of the tumours--were evaluated before surgery. Second MR examination was performed in 38 pretreated patients. During the Lanreotide treatment mean serum GH level decreased from 70.5 to 15.6 micrograms/l (p < 0.0001), mean serum IGF-I concentration decreased from 1302 to 787 micrograms/l and mean volume of the tumour decreased from 5662 to 2326 mm3 (p < 0.0001). During surgery, tumours were observed to be softer, had liquid consistency and were easier removed. 57 patient (69.5%) who underwent surgery had GH below 5 micrograms/l and were cured. Transsphenoidal microsurgical resection of pituitary adenomas is the primary treatment for acromegaly. Lanreotide pretreatment significantly decreased mean serum GH and IGF-I level, shrinks the tumour and make it much softer and easier to be removed.

[Intravascular embolization of intracranial aneurysms]. / Embolizacja wewnatrznaczyniowa tetniaków wewnatrzczaszkowych.

UNLABELLED: The paper presents indications for and the technique of the intravascular procedures as well as the results of treating patients with intracranial aneurysms. MATERIAL AND METHOD: Between 1997 and the May 2000, 25 patients (14 women and 11 men) with cerebral aneurysms underwent intravascular embolisation. The aneurysms were embolised with MDS-N BALT with coils. In 5 patients with aneurysm (about 2 cm), the procedure was performed in two or three steps. RESULTS: Aneurysms were embolised successfully in 19 patients. Three patients revealed intra- and postoperative complication manifestations. CONCLUSIONS: Intravascular embolisation of intracranial aneurysms is an affective treatment modality. It carries, though, a certain risk of complication development. Using this method in neurosurgically non-operable cases is a method of choice.

Pyopneumothorax: a complication of Streptococcus pyogenes pharyngitis.

A 20-y-old African-American female with Streptococcus pyogenes pharyngitis presented with tension pyopneumothorax. Her illness began with fever and sore throat that persisted for several days. She then developed a left neck swelling, followed by difficult swallowing and cough. Subsequently, she developed shortness of breath that became severe. On physical examination fever (39.2 degrees C), exudative pharyngitis, tenderness and swelling in the left anterior cervical area were noted. Chest X-ray revealed left side pneumothorax, air-fluid level and near-complete collapse of the left lung with displacement of the heart and trachea to the right. Computed tomography scan of the neck revealed swelling and enhancement of the sternocleidomastoid muscle with loculated fluid collection, inflammation in the left anterior medial neck displacing the trachea extending into the mediastinum and the left apex. Thoracentesis revealed purulent fluid; Gram stain showed Gram-positive cocci in chains; culture yielded pure growth of Streptococcus pyogenes. She was treated with high dose penicillin, several chest tubes and intra-pleural injections of streptokinase with gradual resolution. This complication has not been described previously in Streptococcus pyogenes pharyngitis.

[So-called mirror injuries in severe head trauma]. / Tzw. uszkodzenia lustrzane w ciezkich urazach glowy.

Severe head traumas cause high mortality. It was the reason to analyze such a group of patients, treated in the Neurosurgical Department of the CCH MMA in the years 1980-1990. All cases of mirror injuries were divided into three groups. The lesions of frontal and temporal lobes present brain-stem lesion like syndromes. Personality disorders were associated with lesions of both frontal lobes. The third syndrome is caused by focal lesions according to their location. The authors discuss medical and surgical treatment and stress the importance of early brain protection.

[A case of intrasellar craniopharyngioma with the symptoms of pituitary apoplexy]. / Przypadek sródsiodlowego czaszkogardlaka, przebiegajacego z objawami udaru przysadkowego.

Craniopharyngiomas account approximately for 2.5% of all intracranial neoplasms. They statistically most often arise in Japanese people (8%) and in children (9%). Despite their typical localization in suprasellar region and their close neighbourhood, 10-20% of them occupy intrasellar space, but only very few grow up as intrasellar cysts. Such localization predisposes to hypothalamus-pituitary-axis dysfunction more often, than other localizations. The symptoms of pituitary apoplexy caused by sudden, intrinsic haemorrhage of intrasellar craniopharyngioma are very rare, because the tumour grows very slowly and its vascular supply is usually poor. A very rare localization, extremely atypical course of disease, interesting intraoperative observations and good results of transsphenoidal tumour removal prompted the authors to present this case report.

The effect of bone cement used for endoprosthesis stabilization on the activity of lysosomal enzymes in peripheral blood granulocytes.

The effect of bone cement used for stabilization of hip joint endoprosthesis on the activity of lysosomal enzymes in peripheral blood granulocytes was studied. The operations were carried out under balanced, non-toxic, endotracheal anaesthesia using muscle relaxants. The blood for tests was obtained from an antecubital vein before and during anaesthesia, before application of bone cement, and 10 min., 1 hour and 24, 48 and 72 hours after endoprosthesis implantation using bone cement. The activity of acid phosphatase, acid protease and neutral protease was determined by calculating it in relation to protein level in the studied fractions. During anaesthesia as well as during the operation when bone cement was applied no statistically significant differences were found in the activity of lysosomal enzymes. On the other hand, after the operation statistically significant changes were found in the activity of lysosomal marker enzymes. Lability of lysosomal membranes appeared with permeation of hydrolases into supernatant. These results confirmed the importance of lysosomal proteins in the processes of wound healing and general postoperative course.

Effect of endotracheal anaesthesia on the activity of lysosomal enzymes in peripheral blood granulocytes.

The purpose of this study was to assess the effect of endotracheal anaesthesia on the activity of lysosomal enzymes in peripheral blood granulocytes. The determinations were carried out before anaesthesia, after 1 hour of anaesthesia and 1 hour after awakening. The activity of lysosomal enzymes was assessed on the basis of the activity of marker-enzymes, i.e. acid phosphatase, acid protease and neutral protease. The lysosomal fraction was prepared by Choduker's method and the activity of lysosomal enzymes was calculated for 100 mug of protein. The obtained results showed a statistically not significant rise in the activity of these enzymes in the lysosomes during anaesthesia without a similar rise in the supernatant. The activity of marker enzymes in lysosomes rose to the initial values after the awakening of patients. Such rapid changes in the activity of lysosomal enzymes seem to depend mainly on the mobilization of the reserve pool of granulocytes from other sources than the peripheral blood and, to a lesser extent, on latency and stabilization of lysosomal membranes by anaesthetic agents used in correctly conducted anaesthesia.