Biomedical subjects
Publications and source records attributed to M Santa.
The authors present the case of a 0-year-old patient with multiple meninglomatous intracranial foci. They draw attention to the relatively rare occurrence of this condition and its complexity from the diagnostic and therapeutic aspect. The incidence of multiple meningiomas is more typical for advanced age (above 60 years), whereby their size increases with age and the male:female ratio is 1:3.
The authors emphasize the importance of the long-term follow up of intracranial disorders of the CNS by two-dimensional ultrasonic B-visualization in early infancy. They demonstrate the practical results on examinations of four patients with different types of intracranial lesions where "monitoring" by the B-visualization made it possible to follow up the fate of the non-operated focus and in operated patients to visualize the outcome or failure of neurosurgical intervention. The authors prefer ultrasonic examination in early infancy to other neuroradiological methods, in particular because it is unpretentious, simple, safe and the results are easily interpreted.
An account is given of experience recorded from 15 patients who had been surgically treated for head injuries from animal stunning guns. All of them were male patients and were aged from 19 to 66 years. All cases were attempted suicides. Three patients died, including one of pyocephalus and two of injuries of vital structures. Eight patients whose first treatment had been restricted to wound suturing developed dangerous intracranial purulence. Seven patients of this group survived, following treatment of the bullet path. Patients with such injuries can be saved, if wound dressing is accompanied by removal of foreign bodies, bone fragments, blood clots, and devitalised tissue and if the dura mater is sealed watertight.
Mapping the canine lumbosacral spinal cord neurons damaged by ischemia-reperfusion after high thoracic aorta ligation was performed using the Nauta degenerating method. Highly Nauta-positive perikarya of the long ascending projection systems in the 4th to 6th dorsal layer, interneurons in the 7th layer and motoneurons in the 8th and 9th layers in L3-S3 segments subjected to 30 min of ischemia and 30 min of reperfusion were localized and their laminar distribution was specified. Spastic paraplegia fully developed 2 days postoperatively after 30 min of aortic ligation is neurohistopathologically characterized by occurrence of enlarged Nauta-positive boutons with prevailing localization in the 4th to 8th layer of the gray matter.
The authors present an account of successful treatment of a 23-year-old patient with multiple relapsing abscesses of the right cerebral hemisphere of otogenic origin by repeated punctures. They emphasize the importance of computed tomography for assessment of the type of lesions, their localization and follow-up of the disease.
An experimental model for the ischemic damage of the spinal marrow is described by occlusion of the descending thoracic aorta at a level with the 5th or 6th thoracic vertebrae during 30 min. 17 dogs were operated in general anesthesia. The thoracic aorta was clamped by a Pean's clamp in the 1st group (11 animals). One dog was not paralysed, another dog died after thrombosis of the aorta in the locality of clamping. The occlusion was carried out by means of a tourniquet in a 2nd group (6 animals) and pH, blood gas values, and blood pressure in the axillary artery or the common carotid artery were measured. An increase of the blood pressure above the initial value was prevented by slow infusion of nitroprusside. The oxygen pressure in the spinal marrow tissue was measured continuously simultaneously. All these animals survived the operation and a complete damage of the spinal marrow occurred.
The authors compare advantages and disadvantages of CT-scan and two-dimensional echoencephalography in examination of intracranial space of small babies. CT is more precise and complex, but it requires anesthesia and transport (CT-scanners are only in regional centers), moreover the child is endangered by irradiation. Echoencephalography is not so descriptive, but is noninvasive, simple, mobile, cheaper, enables to follow the dynamics of the process, examination in three planes and can be very useful during the operation.
The authors give a report on the results obtained in the implantation of autologous nerves in the cerebral hemispheres of rabbits. In a group of five rabbits they implanted a nerve immediately after its removal, in a second equally large group they implanted a nerve only after seven days of preliminary degeneration. After 12 to 14 weeks of the animals with 10 per cent neutral formalin was carried out and the preparations were impregnated according to the Nauta-Gygax method. In the histological sections they only succeeded in discovering individual fibres, which may be the axons of the cerebral cells growing through into the transplanted peripheral nerves. The authors did not see any differences between the immediately implanted nerves and nerves only implanted after a preliminary degeneration. The results obtained require a maximum of caution in the appraisal of the transplantation possibilities in the central nervous system.
The use of "real-time" ultrasonographic two-dimensional picture in the neurosurgery operation theatre increases and improves the possibility of localization of intracerebral and intraspinal lesions, enables precise needle biopsies, decreases a potential risk of damage to healthy brain tissue, visualizes the results of tumour resection, helps in the localization of catheters into chambers and cysts. The final results of the application of two-dimensional picture in the course of neurosurgery operation is in speeding up the surgical therapy, giving it more precision and safety, while the prolongation of the operation due to the ultrasonography is negligible. The authors document the visualization possibilities of two-dimensional ultrasonographic scanning with linear probe in preoperational recordings of different types of lesions in intracranial and intraspinal space.
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The authors report on a case of hydrocephalus caused by brain abscess in a four-months-old girl. After repeated punctures and antibiotics administration extirpation of abscess was necessary. The child recovered with only slight neurological deficit.
An implantation method of the tibial nerve into the cerebral hemispheres of rabbits is reported. The operations were carried out in 10 adult animals of both sexes of the chinchilla race. All operations were got over well and without any complication within 12 to 14 weeks. 2 female rabbits had brought forth and up healthy animals.
Seven dogs were subjected 30 min to ligation of the thoracic aorta and were then kept alive 6-7 days after the ligature had been removed. Their spinal cord and brain stem were treated by the Nauta-Gygax method and the extent and appearance of preterminal and terminal degeneration of certain ascending spinal systems were analysed. In the medulla oblongata region, marked degenerating fibres from the lower thoracic and lumbosacral cord segments were found in the nucleus tractus spinalis nervi trigemini. Preterminal and terminal degenerating fibres were visualized in the caudal part of the trigeminal nuclear complex. Comparison with the literature showed these to be previously unknown projections with a relationship to the nucleus tractus spinalis nervi trigemini.
The authors report on their experiences in treating 21 patients with intracranial abscesses admitted to the Neurosurgical Department of the Teaching Hospital in Kosice in the years 1982-1987. Suppurative inflammation of the middle ear or of the paranasal sinuses was the most frequent source of infection. Six patients died, five of them in association with the intracranial infection, one female patient died of hemorrhagic necrosis of the pancreas. Two of the survivors suffer from epilepsy, in further three motor derangement of mild or medium degree has persisted on the contralateral side. Therapeutic measures which proved effective were trepanopuncture with pus aspiration, also repeatedly performed if necessary, and administration of antibiotics according to sensitivity of the microorganisms involved. In chronic abscesses with a solid capsule and in intracranial suppuration due to foreign bodies the whole focus as well as the capsule have to be extirpated.
The authors present a report on 9 patients (out of which five were female and four male patients) in the age group ranging from 34 to 55 years, who underwent in the period between 1 January 1982 and 31 December 1987 the revision of three intervertebral spades due to the unilateral lumbo-ischiadic syndrome. Operations of such an extent were performed only exceptionally, in case clinical symptoms and myelographic or CT examination proved the lesion of three intervertebral discs. Ensuing from the control examination performed in November 1988 two patients have been invalided and the rest of them working on a full load (five of them doing their original job and two doing a new one). Almost all of them suffer from occasional pain in sacrum and - but for one exception - also in the lower extremity. Only in one case (a female patient) the condition has not improved after the operation. The recovery of working ability has been in most cases facilitated also by spa treatment.
In a group of seven dogs the thoracic aorta was occluded by means of tourniquet for 30 minutes. After the release of aorta the animals were left living for 6-7 days. The spinal cord and brain stem were treated by Nauta-Gygax method after sacrificing the animals, then the preterminal and terminal degenerations of some ascending spinal systems were analysed. Distinct degenerations in nucleus tractus spinalis nervi trigemini were detected. They originated in lower thoracic and lumbosacral segments of spinal cord. Degenerations were localised in the caudal part of nuclei of trigeminal complex. It looks like the above mentioned projections terminating in nucleus tractus spinalis nervi trigemini are related to tractus spinocerebellaris posterior.
Examinations of both common carotid arteries in men and women divided into three age categories (up to 30 years, from 30 to 50 years, over 50 years) were performed by ultrasonographic B-scan and Doppler technique. The average value of the maximal systolic speed of blood flow was in men 100.55 cm.s-1, in women 99.10 cm.s-1. The average speed of blood flow in men as well as women at the age up to 30 years was 110 cm.s-1; at the age from 30 to 50 years 102 cm.s-1 (-7.2%); at the age over 50 years 86 cm.s-1 (-21.8%). The average diameter D of the right common carotid artery in men was 6.37 mm, of the left 7.0 mm; in women 5.75 mm of the right and 6.0 mm of the left.
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