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Biomedical subjects

T Trojanowski

Publications and source records attributed to T Trojanowski.

At least 19 recordsLinked to original sources
PubMed2003

Cerebrospinal fluid and blood propofol concentration during total intravenous anaesthesia for neurosurgery.

BACKGROUND: The aim of this paper is to compare the propofol concentration in blood and cerebrospinal fluid (CSF) in patients scheduled for different neurosurgical procedures and anaesthetized using propofol as part of a total intravenous anaesthesia technique. METHODS: Thirty-nine patients (ASA I-III) scheduled for elective intracranial procedures, were studied. Propofol was infused initially at 12 mg kg(-1) h(-1) and then reduced in steps to 9 and 6 mg kg(-1) h(-1). During anaesthesia, bolus doses of fentanyl and cis-atracurium were administered as necessary. After tracheal intubation the lungs were ventilated to achieve normocapnia with an oxygen-air mixture (FI(O(2))=0.33). Arterial blood and CSF samples for propofol examination were obtained simultaneously directly after intracranial drainage insertion and measured using high-performance liquid chromatography. The patients were divided into two groups depending on the type of neurosurgery. The Aneurysm group consisted of 13 patients who were surgically treated for ruptured intracranial aneurysm. The Tumour group was composed of 26 patients who were undergoing elective posterior fossa extra-axial tumour removal. RESULTS: Blood propofol concentrations in both groups did not differ significantly (P>0.05). The propofol concentration in CSF was 86.62 (SD 37.99) ng ml(-1) in the Aneurysm group and 50.81 (26.10) ng ml(-1) in the Tumour group (P<0.005). CONCLUSIONS: Intracranial pathology may influence CSF propofol concentration. However, the observed discrepancies may also result from quantitative differences in CSF composition and from restricted diffusion of the drug in the CSF.

Adult↗
PubMed2001

Continuing education--the EANS concepts.

Continuing Medical Education (CME) is becoming to be an important part of professional conduct of neurosurgeons in the member countries of EANS. It is therefore a task for the EANS to harmonize various systems of CME and to offer a compatible programme of continuing education that would meet the expectations and needs of the neurosurgeons. It should help choose fields in which updating knowledge is indispensable, offer teaching and training opportunities and provide systems of evaluation and certification of progress in neurosurgical CME.

Curriculum↗
PubMed2001

Intensive care management of head-injured patients in Europe: a survey from the European brain injury consortium.

OBJECTIVES: (a) to describe current practice in the monitoring and treatment of moderate and severe head injuries in Europe; (b) to report on intracranial pressure and cerebral perfusion pressure monitoring, occurrence of measured and reported intracranial hypertension, and complications related to this monitoring; (c) to investigate the relationship between the severity of injury, the frequency of monitoring and management, and outcome. METHODS: A three-page questionnaire comprising 60 items of information has been compiled by 67 centres in 12 European countries. Information was collected prospectively regarding all severe and moderate head injuries in adults (> 16 years) admitted to neurosurgery within 24 h of injury. A total of 1005 adult head injury cases were enrolled in the study from 1 February 1995 to 30 April 1995. The Glasgow Outcome Scale was administered at 6 months. RESULTS: Early surgery was performed in 346 cases (35%); arterial pressure was monitored invasively in 631 (68%), ICP in 346 (37%), and jugular bulb saturation in 173 (18%). Artificial ventilation was provided to 736 patients (78%). Intracranial hypertension was noted in 55% of patients in whom ICP was recorded, while it was suspected in only 12% of cases without ICP measurement. There were great differences in the use of ventilation and CPP monitoring among the centres. Mortality at 6 months was 31%. There was an association between an increased frequency of monitoring and intervention and an increased severity of injury; correspondingly, patients who more frequently underwent monitoring and ventilation had a less favourable outcome. CONCLUSIONS: In Europe there are great differences between centres in the frequency of CPP monitoring and ventilatory support applied to head-injured patients. ICP measurement disclosed a high rate of intracranial hypertension, which was not suspected in patients evaluated on a clinical basis alone. ICP monitoring was associated with a low rate of complications. Cases with severe neurological impairment, and with the worse outcome, were treated and monitored more intensively.

Adult↗
PubMed2001

[Assessment of p53 dependent apoptosis in glia-derived tumors of the brain].

There are conflicting reports in connection with the association of the p53 tumour suppressor gene mutation with the clinical and histopathological progression of gliomas. Glia-derived neoplasms frequently show mutational changes in the p53 gene which result in enhancement of tumorigenesis. The aim of the paper was an assessment of the frequency of mutations in the exon 8 of this gene. The specimens from 14 patients operated for glial tumors were investigated by polymerase chain reaction-assisted--single strand conformation polymorphism (PCR-SSCP). We found aberrant bands in 64.3% of specimens. The percentage of mutations was similar in patients with benign and malignant tumours. There was no correlation between the alteration of the gene and intensity of necrosis in histological examination in patients with glioblastoma. Changes in activity of the p53 gene were more frequent in younger patients and in males when compared to women.

Adolescent↗
PubMed2001

[Expression of bcl-2 gene in glia-derived tumors of the brain].

Bcl-2 gene is an important factor in regulation of apoptosis as an inhibitor of this process. Its increased expression is observed in numerous neoplasms, what points out on importance of this gene in the process of oncogenesis. The aim of this paper was to assess the expression of bcl-2 gene in the cells of the glia-derived tumours of the brain. The method of Chomczyński and Sacchi with guanidine tiocyanate was applied to isolate a whole cellular RNA. Expression of bcl-2 gene was measured with a reverse transcription method by a synthesis of cDNA and amplification of gene fragment with specific oligonucleotides in polymerase chain reaction (RT-PCR). The expression of bcl-2 gene was found in cells of all examined glial tumours at the level of transcript. We carried out the discussion of the results and an attempt to explain the importance of bcl-2 gene expression of these neoplasms.

Adult↗
PubMed2001

[The application and evaluation of TachoComb in repair of lacerations of dural sac].

The opening of dural sac (deliberate or accidental) during operation of the spine should be watertightly closed because of the risk of cerebro-spinal fluid leakage and infectious complications. Suturing the dural sac is sometimes difficult and time-consuming in cases of dural sac lacerations in a narrow confined space or in the proximity of radices. This occurs particularly in the case of reoperation in presence of scar involving the dural sac, that increases the risk of laceration. The aim of this paper is to asses the usefulness of a new sealing and haemostatic material--TachoComb in a watertight closure of the dural sac during spinal operation. We compared the frequency of complications related to closing of the dural sac in patients operated before and after introduction of TachoComb. The results indicate that the rate of liquorrhoea and infections is lower in the postoperative period with addition of TachoComb. Addition of TachoComb allows to shorten the time of operation, while its application is relatively easy.

Adolescent↗
PubMed2000

The value of the "worst" computed tomographic scan in clinical studies of moderate and severe head injury. European Brain Injury Consortium.

OBJECTIVE: Computed tomographic (CT) scanning can reveal the pattern and severity of structural brain damage after head injury. With the proliferation of CT scanners in general hospitals, and with improvements in patient transport, the interval from injury to the first CT scan is decreasing. The potential result is an "admission" scan missing an evolving and potentially operable lesion. Furthermore, the literature is confusing regarding the timing and coding of CT findings. We sought to establish the frequency of deterioration in CT appearance from an admission scan to subsequent scans and the prognostic significance of such deterioration. METHODS: In a survey organized by the European Brain Injury Consortium, data on initial severity, management, and subsequent outcome were gathered prospectively for 1005 patients with moderate or severe head injury admitted to one of 67 European neurosurgical units during a 3-month period in 1995. The findings of the initial and the final ("worst") CT scan were classified according to the Traumatic Coma Data Bank system and were related to outcome as assessed using the Glasgow Outcome Scale 6 months after injury. RESULTS: Data on an initial and a final CT scan were available for 897 patients; of these, 724 patients were assessed using the Glasgow Outcome Scale at 6 months. The initial CT findings were classified as a diffuse injury for 53% of the cohort, with 16% of these diffuse injuries demonstrating deterioration on a subsequent scan. In 56 (74%) of 76 deteriorations, the change was from a diffuse injury to a mass lesion. When the initial CT scan demonstrated a diffuse injury without swelling or shift, evolution to a mass lesion was associated with a statistically significant increase in the risk of an unfavorable outcome (62% versus 38%). When the initial scan demonstrated evidence of swelling or shift, there was a nonsignificant trend in the opposite direction, although the numbers were limited. CONCLUSION: When an admission CT scan demonstrates evidence of a diffuse injury, follow-up scans should be performed, because approximately one in six such patients will demonstrate significant CT evolution. In studies comparing series of head-injured patients, correspondence of timing of CT scans is necessary for valid comparison.

Brain Injuries↗
PubMed1999

The European Brain Injury Consortium survey of head injuries.

To provide a picture of contemporary practice, a survey was carried out of severely and moderately head injured patients admitted to 67 'neuro' centres in 12 European countries. 1,005 adult head injuries were recruited over a three month period. Sixty items of information on demography, clinical features, investigations, management and early complications were captured on a simple, two-page questionnaire and, information on outcome at six months on a third page. The median age of the subjects was 38 years, 74% were male and 51% injured in road traffic accidents; 57% of patients were transferred to the 'neuro' centre from another hospital. Assessment of clinical responsiveness was limited by the use of sedation and intubation and information from four early time points (pre-hospital, arrival at the Accident and Emergency department, post-resuscitation, and arrival at the 'neuro' unit) was combined to stratify the subjects as severe (58%), moderate (17%) or intermediate (19%). In 48% of patients classified the CT scan showed features of a 'mass lesion' and in 40% showed a subarachnoid haemorrhage. Fifty-five centres provided the data on outcome for 94% of the cases recruited in these centres six months after injury. 31% died, 3% were vegetative, 16% severely disabled, 20% moderately disabled and 31% had made a good recovery. Comparison of the data from different parts of Europe showed differences in the frequency of secondary transfer, cause of injury, occurrence of major extracranial injury, CT scan findings, intracranial operation, clinical severity of injury and utilisation of the components of intensive care and the occurrence of a favourable outcome, although the latter difference was not statistically significant when variations in the initial severity of injury were taken into account. The findings in the present survey are compared with newly analysed information for three previous large series: the International Data Bank involving the UK, the Netherlands and the USA, the North American Traumatic Coma Data Bank, and data from four centres in the UK. The comparisons showed substantial similarities and also differences that may reflect variations in policy for admission of the head injury to 'neuro' units, and evolution in methods of assessment, investigation and management. The effects of these differences on outcome requires further, rigorous prospective study.

Adolescent↗
PubMed1992

Neurosurgical publications in European journals.

The number of papers published in European neurosurgical journals during the last decade (1980-90) was analysed using online databases. Thirteen journals devoted to neurosurgery were published in Europe at that time. In five of them neurosurgery appears together with other specialties. Almost 50% of all European neurosurgical journals are written in English. They published 68% of all papers by neurosurgeons appearing in the European neurosurgical journals during the last decade. Together with the American neurosurgical journals English was used in about 80% of all neurosurgical publications. Other languages used are German and French (9% each), Russian (5%), Czech or Slovak (4%), Polish (3%), Rumanian (2%). Most papers by European neurosurgeons originate from England, followed by Germany, France, Italy and Sweden. Of the East-European countries Polish neurosurgeons contributed with 782 publications, followed by Czechoslovakia (568), Hungary (501), USSR (470) and East Germany (452). The proportion of papers published in neurosurgical journals by European neurosurgeons to those in the journals devoted to other neurosciences varied from 99% in the USSR to 12% in Austria with an average of 38%. Citation analysis indicates that only a few of the journals have a large impact on neurosurgical publications, while the others have a rather limited influence.

Cross-Cultural Comparison↗
PubMed1992

[Factors affecting the quality of life of patients treated by a combined method for poorly differentiated supratentorial glioma].

The quality of life of patients treated for brain tumours and the length of survival are important factors making possible the evaluation of treatment effectiveness. Changes of life quality evaluated by the Karnofsky scale were analysed in a group of 56 patients who have received combined treatment for poorly differentiated supratentorial gliomas. Life quality changes were evaluated after completion of surgical and radiological treatment in relation to preoperative status. The influence of various clinical factors on life quality changes was evaluated. Surgical treatment and tumour site had a significant effect on the stabilization or slight improvement of life quality. The direction and extent of life quality changes were related to surgery, with further change after radiotherapy.

Adolescent↗
PubMed1992

[Brachytherapy of brain gliomas].

Radiotherapy is considered presently the most advantageous supplementary method after surgical treatment for gliomas. The limitations of classical teletherapy cause that interstitial radiation may become preferable. The authors present the theoretical principles and practical application of brachytherapy in 10 cases of glioma. Closed radioactive sources were used in form of I125 implanted stereotactically into brain tumours for a period sufficient for providing therapeutic radiation dose to the border of the tumour. The doses received by tumour borders ranged from 812 to 4560 cGy, and the mean dose was 2064 cGy. Five patients were given additionally 6000 cGy by teleradiotherapy.

Adolescent↗
PubMed1990

Percutaneous stereotactic brain tumour biopsy and cyst aspiration with a non-invasive frame.

A non-invasive Stereoadapter was used for stereotactic CT-guided percutaneous brain biopsy in 18 patients with 16 solid tumours and four cysts. The Stereoadapter was mounted on the patient's head using ear plugs and a nasion support. After the CT study, the Stereoadapter was detached. The target was simulated on a phantom base and a probe carrier attached to the Stereoadapter. For surgery, the Stereoadapter with the probe carrier was remounted to the patient's head. Local anaesthesia was mainly used. Tissue samples were aspirated with a 2 mm diameter Sedan-Nashold biopsy cannula, introduced through a twist drill hole. Conclusive histological/cytological diagnosis was obtained in 16 of the 20 lesions. The new method proved to be reliable and quick. Since the imaging study and the surgery could be separated in time and place, the biopsy procedure was less time-consuming than previous methods of stereotactic biopsy using an invasive frame.

Adolescent↗
PubMed1989

Quality of survival of patients with brain gliomas treated with postoperative CCNU and radiation therapy.

This prospective randomized clinical trial compared the effectiveness of combined treatment with CCNU and radiation therapy to the use of radiation therapy alone for the postoperative management of supratentorial brain gliomas (67% anaplastic) in 198 patients. The results were evaluated with the aid of a specially developed weighted neuropsychological test battery providing single-value estimation of "life quality" of patients, as well as with a clinical performance scale. Based on these methods, it was established that patients improved within 6 months following therapy. This improvement was maintained in surviving patients during the 2-year follow-up period. The patients led a relatively normal life, but when their condition deteriorated their decline was rapid. The median survival time of patients treated with radiotherapy did not differ significantly from that of patients receiving chemotherapy in addition. Nor did the analysis of life quality and of changes in clinical performance show any benefit in supplementing surgery and radiation therapy with CCNU chemotherapy at the dosage used.

Adolescent↗
PubMed1988

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.

Adolescent↗
PubMed1984

Early effects of experimental arterial subarachnoid haemorrhage on the cerebral circulation. Part I: Experimental subarachnoid haemorrhage in cat and its pathophysiological effects. Methods of regional cerebral blood flow measurement and evaluation of microcirculation.

Studies of pathophysiological changes, regional cerebral blood flow (rCBF) and cerebral microcirculation were performed in cats subjected to arterial subarachnoid haemorrhage (SAH). An original method for SAH imitating aneurysm rupture was developed. The bleeding was induced by puncturing of the internal carotid artery approached tranpresphenoidally and followed by immediate closure of the skull opening. It was found, that arterial subarachnoid bleeding elevates intracranial pressure and results in a transitory fall in cerebral perfusion pressure which is not prevented by elevation of arterial blood pressure (Cushing reflex). A depression in brain electrical activity and respiration rate were present in the course of subarachnoid haemorrhage.

Animals↗