Biomedical subjects
Publications and source records attributed to R Mrówka.
The orbitozygomatic craniotomy was presented in resection of giant tumour of maxillary-ethmoidal region, orbital cavity and anterior cranial fossa. As a result of this approach the possibility of whole tumour resection was obtained. Also, easy closure of anterior fossa and avoidance of the facial deformation was achieved.
A case of giant osteoma of paranasal sinus passing into anterior cranial fossa was presented. The frontal craniotomy in order to removing this tumor was applied. In any case of such tumor the CT seems to be a necessary examination.
The role of intra-operative pathological diagnosis increases along with a development of minimally invasive neurosurgery, especially stereotactic and endoscopic techniques. The authors present their own experience with the cytological method and evaluate its usefulness in intra-operative diagnosis of brain tumors. Brain tumor biopsy specimens obtained during craniotomy from 217 patients were examined. The cytological preparations (smears) were stained with 1% toluidin blue and/or with May-Grünwald-Giemsa stain. In 199 cases (92%) the cytological diagnosis was consistent with the histopathological one. A 99% sensitivity and 69% specificity were obtained. The histogenesis of gliomas was correctly established in 90% and their grade in 73% of cases. The most frequent diagnostic errors were: undergrading of gliomas (20), incorrect assessment of their histogenesis (10), diagnosis of low grade astrocytoma in a case of gliosis (3) and diagnosis of glioblastoma multiforme instead of metastatic carcinoma (2 cases). The most important advantages of cytological examination are rapidity, simplicity and relatively high diagnostic efficacy. Even very tiny specimens, especially of soft consistency are suitable for this technique, which is extremely important in operations of brain tumors localized in functionally important brain areas. In the authors' opinion this method still merits wider popularization in neurosurgical centers.
Two cases of cerebral secretory meningioma, occurring in 57 and 33-year-old females are reported. The tumors were located in the tentorial and frontotemporal region, respectively. The general histologic appearance of the tumors was of meningothelial meningioma (case 1) and meningioma with microcystic and angiomatous features (case 2). The most striking histological finding in both tumors were numerous pseudopsammoma bodies, localized chiefly around blood vessels. The inclusions were slightly eosinophilic, stained strongly with PAS method and were differing in size from 3 to 30 microns. Tumor cells containing or surrounding pseudopsammomas were immunopositive for cytokeratin and epithelial membrane antigen. In the first case, individual pseudopsammomas were strongly positive for carcinoembryonic antigen. Some diagnostic aspects of this antigen and problems regarding differential diagnosis in secretory meningioma are briefly discussed.
Expression of CD44 (m.w. 80-95 kD) in 48 metastatic brain tumors was examined using monoclonal antibody on paraffin sections. The CD44 expression was found in 48% of studied tumors. The most constant expression of CD44 was observed in metastases from thyroid, skin and breast cancer. The brain metastases were characterized by quite heterogenous distribution of CD44 glycoprotein--the most pronounced expression was seen in individual neoplastic cells embedded in abundant stroma and in the vicinity of preserved neural tissue. Such a topographical distribution of CD44 supports its role in interactions of cancer cells with extracellular matrix components of the tumor stroma as well as of neural tissue.
The clinical, angiographic and computed tomography (CT) examinations of 19 patients aged from 12 to 30 years with signs of ischaemic brain syndrome are presented. On the basis of these examinations and data obtained from literature it is supposed that in a majority of patients the disease is caused by basal arteriopathies + i.e. pathological changes in the wall of cerebral arteries, mainly of the circulus Willis. The features distinguishing this syndrome from ischaemic disease in adults are presented and discussed. These are first of all: sudden onset connected with physical effort, deep neurological deficit, narrowing or occlusion of basal cerebral arteries seen in angiography and signs of ischaemia within deep cerebral structures visible in CT. The methods of treatment are discussed, mainly STA-MCA anastomosis used in most cases. The results of treatment are discussed. Finally the problem of the cerebral ischaemic syndrome in young people is presented from the point of view of haemodynamics, principally in the aspect of haemodynamic reserve of cerebral blood flow.
There is presented the case of a patient with an ischaemic stroke of the right cerebral hemisphere who was treated surgically by the transposition of omentum to the affected area of the brain. This type of operation is carried out with increasing frequency in countries of the Far East and in arousing more interest over the whole world because of the discovery in recent years that the omentum contains biologically active substances taking part in neurotransmission and having angiogenic and neurotropic action.
From 250 patients suffering from cerebral ischemia who were subjected to microsurgical anastomosis STA-MCA between 1979 and 1986 there was chosen a group of patients who were examined retrospectively at a period of 1-7 years after surgery. Some patients were examined clinically at average post-operation periods of 10-20 days, several months, 1.5 year and 4 years. Results of angiography and CT examination both before and after operation were also taken into consideration. From patients examined in this way there was selected a group with less severe forms of the disease, mainly Prolonged Reversible Ischaemic Neurological Deficit, with a Completed Stroke, and next a group of patients who showed worsening of the neurological condition after operation--transient or permanent and a group of patients who died some time after operation. The results of examination were subjected to statistical analysis. On the base of this the author attempts to answer the question whether, with present diagnostic technique limited to clinical examination, angiography and CT examination, groups of patients can be selected in which operative risk will be reduced to a minimum and the result of operation will be advantageous to the patient.
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Developmental narrowing of the spinal canal in the lumbar region is one of the most controversial subjects from the point of view of the significance of the neurological syndrome, the value of spondylometric assessment and methods of treatment. Among 1,196 patients operated on in our neurosurgical centre during the last 18 years because of symptomatic sciatica the authors diagnosed developmental narrowing of the spinal canal in 29 cases (2.4%). The diagnosis was made mainly on routine X-ray plates, functional X-rays, X-ray contrast examination and tomograms with indicator of known size placed at the level of the spinal canal. Among operative methods we used laminectomy and fenestration. The choice of a suitable method for a given case depended mainly on the condition during operation but the extent of the operation depended on myelography. The results of treatment during a 10 years following-up were assessed as satisfactory.
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Considering the lack of complete agreement of viewpoints concerning the heterogeneity of ABB indices of CSF at various levels along the cerebrospinal axis, an attempt was made to elucidate this problem. For this purpose 82 patients suffering from diseases causing increased intracranial pressure and spinal pain were examined. A total of 262 samples of CSF was taken from cisterna magna and from the lumbar region of the subarachnoid space. In accordance with the degree of severity of clinical symptoms resulting from increased intracranial pressure, the patients examined were divided into five groups. The results of examination show irregular differentiation of samples of CSF which is related to the clinical state of the patients examined. On the basis of the authors experience and data from medical literature an attempt was made to explain this phenomenon so complicated in its aetiology.
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Results of the examination of the acid-base balance and the concentration of enzymes - mannosidase, b-galactosidase and b-glucosidase in 61 patients with cerebral contusion are presented. Examination was carried out on an average 11, 15 and 39 days after injury in groups of patients characterised by various clinical states. Examination showed that, in contradistinction to the acid-base balance, enzymal changes in CSF are less evident than in blood. On the base of the results presented it would appear that the level of b-glucosidase in CSF changes in accordance with the level in the blood whereas the other enzymes show a certain autonomy of the CSF in this field.
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