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V Smrcka

Publications and source records attributed to V Smrcka.

At least 19 recordsLinked to original sources
PubMed2005

The influence of mild hypothermia on ICP, CPP and outcome in patients with primary and secondary brain injury.

Aim of this study was to examine the hypothesis that only a subgroup of patients with lesser primary brain damage after severe head injury may benefit from therapeutic hypothermia. We prospectively analysed 72 patients with severe head injury, randomized into groups with (n = 37) and without (n = 35) hypothermia of 34 degrees C maintained for 72 hours. The influence of hypothermia on ICP, CPP and neurological outcome was analysed in the context of the extent of primary brain damage. Patients with normothermia and primary lesions (n = 17) values: GCS on admission 5 (median), ICP 18.9 (mean), CPP 73 (mean), GOS 4 (median). Patients with normothermia and extracerebral hematomas (n = 20): GCS 4, ICP 16, CPP 71, GOS 3. Patients with hypothermia and primary lesions (n = 21): GCS 4,62, ICP 10, 81, CPP 78,1, GOS 4. Patients with hypothermia and extracerebral hematomas (n = 14): GCS 5, ICP 13.2, CPP 78, GOS 5. Hypothermia decreased ICP and increased CPP regardless of the type of brain injury. Hypothermia was not able to improve outcome in patients with primary brain lesions but this pilot study suggests that it significantly improves outcome in patients with extracerebral hematomas.

Adult↗
PubMed2005

Predictive factors for spondylotic cervical myelopathy treated conservatively or surgically.

A prospective 3-year randomized study comparing conservative and surgical treatment of spondylotic cervical myelopathy to establish predictive factors for outcome after conservative treatment and surgery. The clinical, electrophysiological and imaging parameters were examined to reveal how they characterized the clinical outcome. The patients with a good outcome in the conservatively treated group were of older age before treatment, had normal central motor conduction time (CMCT), and possessed a larger transverse area of the spinal cord. The patients with a good outcome in the surgically treated group had a more serious clinical picture (expressed in mJOA score and slower walk). Patients should rather be treated conservatively if they have a spinal transverse area larger than 70 mm2, are of older age and have normal CMCT. Surgery is more suitable for patients with clinically worse status and a lesser transverse area of spinal cord.

Adult↗
PubMed2005

Predictive factors for mild forms of spondylotic cervical myelopathy treated conservatively or surgically.

A prospective 3-year randomized study comparing conservative and surgical treatment of spondylotic cervical myelopathy to establish predictive factors for outcome after conservative treatment and surgery. The clinical, electrophysiological and imaging parameters were examined to reveal how they characterized the clinical outcome. Statistically, pair-wise and multiple comparisons of different were used with the independent t-test and on one-way anova models followed by Tukey multiple-range tests. The patients with a good outcome in the conservatively treated group were of older age before treatment, had normal central motor conduction time (CMCT), and possessed a larger transverse area of the spinal cord. The patients with a good outcome in the surgically treated group had a more serious clinical picture (expressed in mJOA score and slower walk). Patients should rather be treated conservatively if they a spinal transverse area larger than 70 mm2, are of older age, and have normal CMCT. Surgery is more suitable for patients with clinically worse status and a lesser transverse area of spinal cord.

Adult↗
PubMed2005

Rosai-Dorfman disease: successful long-term results by combination chemotherapy with prednisone, 6-mercaptopurine, methotrexate, and vinblastine: a case report.

Sinus histiocytosis with massive lymphadenopathy (SHML), also known as Rosai-Dorfman disease (RDD), is a rare clinicopathologic entity of unknown etiology. The majority of patients do not require treatment, demonstrating spontaneous resolution or stable disease. However, in some cases the disorder runs a progressive course and/or threatens vital structures and functions, which dictates some form of intervention. It is not clear what constitutes the best approach for those cases. We report on a girl with an extensive and progressive form of the disease who was cured with combination chemotherapy, showing no evidence of recurrence after a follow-up of 5.5 years.

Adolescent↗
PubMed2004

Stereotactic evacuation of spontaneous infratentorial hemorrhage with monitoring of intracerebral pressure.

INTRODUCTION: Based on our experience with stereotactic evacuation of spontaneous supratentorial hematomas this method has also been used for evacuation of spontaneous infratentorial hematoma by the transtentorial approach. MATERIAL AND METHOD: The authors present a series of 6 patients with spontaneous intracerebral hematomas evacuated by the frame-based stereotactic technique, with monitoring of intracranial pressure (ICP) during the stereotactic evacuation. This method was indicated in patients with stable neurological status according to Glasgow Coma Scale (GCS), more than 10. The frame-based stereotaxy with the Riechert-Mundinger apparatus with CT localisation of target and optimal trajectory was used. RESULTS: The presented values after stereotactic evacuation show reduction of the initial intraparenchymal ICP in all patients to values less than 20 mmHg. CONCLUSION: The measuring of the ICP and the analysis of dynamic changes during stereotactic evacuation suggest that this procedure can significantly reduce the ICP performed in connection with ICH and we believe that our results can improve management of patients with spontaneous infratentorial and supratentorial intracerebral hematoma. (Fig. 1, Ref. 21.).

Aged↗
PubMed2002

Cerebral perfusion pressure and spect in patients after craniocerebral injury with transtentorial herniation.

We present a group of 29 consecutive head injured comatose patients with the syndrome of transtentorial herniation. All patients had urgent surgery and then continuous monitoring of ICP, CPP, blood pressure and jugular bulb oximetry was instituted. Two postoperative CT and SPECT examinations were performed in each patient. 15 patients had a normal CPP (> 70 mmHg) throughout the postoperative period, 80% of them had a favourable outcome. On the other hand 14 patients had decreased CPP lasting at least one hour and only 36% of them had a favourable outcome (p < 0.05). Similar relationships were found comparing GOS in patients with normal and increased ICP (> 20 mmHg) and normal and decreased SjO2 (< 55%). All but 3 patients had ischaemia on SPECT. Ischaemia improved on the 2nd SPECT in 11 patients and 10 (91%) of them had a favourable outcome. GOS (mean follow up 9 months) is: 12 patients good, 5 moderately disabled, 2 vegetative, 10 died. We conclude that SPECT is able to disclose even reversible ischaemic changes. In these patients all effort has to be made to keep CPP on normal levels. Improvement in cerebral perfusion is related to a better outcome.

Adolescent↗
PubMed2002

The benefit of a temporary vessel occlusion in aneurysm surgery.

OBJECTIVE: Temporary clipping in aneurysm surgery has been used more frequently in last years to increase the efficacy and safety of the neck dissection and obliteration. Experimental studies have shown that neuroprotection using hypertension and mannitol administration diminishes the risk of ischemia during this procedure. However, recent studies show that this method has to be used with caution. METHODS: In 85 aneurysms we used temporary vessel occlusion with neuroprotection described above in 17 patients (20%), ranging from 2 to 35 minutes (mean 9 minutes). The indication was peroperative rupture (3 cases), difficult neck dissection (13 cases) and a giant aneurysm (1 case). RESULTS: Forteen of these patients had a good result, one was severely disabled, the other 2 died. One of them had a large temporal hematoma and was HH=V before the operation, the other one had a premature peroperative aneurysm rupture. Shorter occlusion times were used in patients with a good outcome, in patients with elective use of the clip and in patients with no new ischemia on the postoperative CT scan (t-test, p<0.05). The postoperative infarction rate was similar in the group of patients with (17%) and without temporary clipping (15%). CONCLUSION: We conclude that temporary clipping in aneurysm surgery is a relatively safe procedure which facilitates the aneurysm neck dissection and enables neck obliteration in difficult cases. Better results are achieved with short duration of occlusion. (Fig. 4, Ref. 13.).

Aneurysm, Ruptured↗
PubMed2001

Lumbar disc surgery in regional anaesthesia--40 years of experience.

Lumbar disc operations have been performed in Brno since 1952 and from the very beginning they are performed under regional anaesthesia. Since 1965 until 1999 about 16,000 operations for herniated discs have been performed here. The number of operations doubled with the foundation of the second neurosurgical department in Brno in 1992. Lumbar disc surgery represents 25% of the operation spectrum in our department. Epidural anaesthesia is advantageous for less risk of some complications compared with general anaesthesia and enables communication between the surgeon and the patient. Other advantages are: less visible bleeding in the operative field due to the lateral position and the fact that the surgeon can sit during the operation. On a long-term basis we found 4-5% had further surgery for reccurent problems. Objective neurological evaluation 6 weeks after the operation showed improvement in 92% of patients. The patients themselves consider their status as very good or satisfactory in 82% (median 3 years after the operation). Besides a correctly performed operation we emphesize also the role of correct diagnosis (good correlation between the patient's problems and CT scan finding) for a good treatment result.

Adult↗
PubMed2000

Conservative treatment versus surgery in spondylotic cervical myelopathy: a prospective randomised study.

A prospective randomised 2-year study was performed to compare the conservative and operative treatment of mild and moderate forms of spondylotic cervical myelopathy (SCM). Forty-eight patients presenting with the clinical syndrome of SCM, with a modified Japanese Orthopaedic Association (mJOA) score of 12 points or more, were randomised into two groups. Group A, treated conservatively, consisted of 27 patients, mean age 55.6 +/- 8.6 years, while group B was treated surgically (21 patients, mean age 52.7 +/- 8.1 years). The clinical outcome was measured by the mJOA score, recovery rate (RR), timed 10 m walk, score of daily activities (recorded by video and evaluated by two observers blinded to the therapy), and by the subjective assessment of the patients at 6, 12, and 24 months of the follow-up. There was, on average, no significant deterioration in mJOA score, recovery ratio, or timed 10 m walk within either group during the 2 years of follow-up. In the surgery group there was a slight decline in the scores for daily activities and subjective evaluation. A comparison of the two groups showed no significant differences in changes over time in mJOA score or quantified gait, but there were significant differences in the score of daily activities recorded by video at 24 months, which was a little lower in the surgical group, and also in RR and subjective evaluation, which were both worse in the surgical group at months 12 and 24. However, at month 6, this last parameter was significantly better in the surgical than in conservative group. Surgical treatment of mild and moderate forms of SCM in the present study design, comprising the patients with no or very slow, insidious progression and a relatively long duration of symptoms, did not show better results than conservative treatment over the 2-year follow-up.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed2000

[A simple stereotaxic surgical apparatus].

A simple apparatus based on the classical stereotactic method of surgery offers the opportunity to master miniinvasive procedures in neurosurgery and neurotraumatology. This device is particularly helpful in evacuation of intracerebral spontaneous and traumatic haematomas and in stereobiopsies, i.e. the most frequent operations in clinical practice, without the need of general anaesthesia, craniotomy and interference with cerebral tissue. The reliability of the stereotactic apparatus was positively evaluated by three independent surgeons. The apparatus was registered for use in the health services.

Humans↗
PubMed2000

[Colloid cysts in the 3rd cerebral ventricle].

Four out of a group of 5 patients with a colloid cyst located within the III cerebral ventricle were surgically treated by means of a classical microsurgical technique and one of them was treated stereotactically. The preference was given to the frontodorsal transcortical approach. The current CT diagnosis is reliable and by use of MR it is to a certain extent possible to distinguish even the origin of the cyst. Prior to examination we had found out that the cyst was a neuroenteral inclusion and the final surgical result was good in all patients who had been subdued to operation during the initial phase of foramen Monroi enclosure. (Fig. 2, Ref. 10.)

Brain Diseases↗
PubMed2000

[Central nervous system hemangioblastoma: its role in von Hippel-Lindau disease].

BACKGROUND: Haemangioblastoma within CNS occurs either as a sporadic tumor or as a syndrome referred to as Morbus Hippel-Lindau (MHL). Since 1993 it has been known that this disease is caused by MHL mutation of the suppressor gene on the chromosome 3p25-p26. The syndrome can include malign tumors of abdominal organs. MATERIAL AND METHODS: We treated 8 patients with CNS haemangioblastoma (5 males and 3 females) during the period of 1998-1999. Two of them were patients with MHL (numerous CNS or retinal haemangioblastomas). All patients were treated by radical extirpation of haemangioblastoma except for one who got ventricular-peritoneal shunt and his tumor was irradiated by linear accelerator. All patients were screened for the presence of abdominal carcinoma. RESULTS: The post-operative course was good in all patients. The screening has not revealed any co-existence of malignant processes. CONCLUSION: The treatment of haemangioblastoma is only a part of the complex therapy of MHL. The occurrence of carcinomas (especially those of the kidneys) is highly probable, and the mortality of patients with this affliction exceeds that associated with haemangioblastoma owing to its treatment by improved neurosurgical techniques. The patients must be permanently observed in order to reveal the carcinoma as soon as possible, as well as for its potential recurrence or de novo growth of haenangioblastomas. (Tab. 1, Fig. 2, Ref. 17.)

Adult↗
PubMed2000

Diet reconstruction in the Roman era.

The samples from the proximal femora were taken from 12 cementeries from the Roman period. The skeletons date from the 1st-4th centuries A.D. Trace element analysis was used in order to reconstruct the basic diet. The sites that best corresponded to the model of Old Germanic diet described by ancient authors "meat, milk and cheese" were found in the Pruszcz Gdanski East Pomerania region close to the Baltic sea as well as in region Halle (Niemberg) and not far from Donau (Sládkovicovo). This diet is characterized by a large amount of protein and consequently of zinc. In the original Old Germanic region in a time period of more than 1000 years (from 400 B.C. to 700 A.D.) there is the same type of trace elements sources for bones and also the same type of the diet. This possibly distinguishes Germanic soldiers (aboriginal) from others groups in Roman legionary camps. It seems that the Donau River is very important for predicting the type of diet in the Roman period. North of the river animal component prevails south of the river vegetal component prevails. The rich agricultural land along the Donau River and in the Pannonian plains affects social arrangement as well as the structure of bones in Germans and Sarmats in the 2nd-4th centuries. Lead became a civilization element. It appeared in the diet of the Greek and Romans. Contamination varied with different social classes. We have found higher lead concentration in the femurs of the Germans than in those of the Sarmatians. The highest concentration we found was in Pannonian towns (Gorsium, Sopianae) and legionary camps (Straubing, Gerulata). In reference to age, the maxima of the highest lead concentrations in Gerulata II are between 11 and 13 years of age and between 40 and 50 years.

Archaeology↗
PubMed1999

[Cerebral ischemia and neuroprotection from the viewpoint of the neurosurgeon].

Cerebral ischemia is a frequent and dangerous consequence of some cerebrovascular diseases. Ischaemia may be used also electively in the course of neurosurgery. Therefore new possible ways are sought how to reduce the danger of ischaemia or to prevent it. In the submitted paper some methods of neuroprotection are described and their potential or actual applicability in clinical neurosurgery are discussed. In addition to influencing the brain cell and pretentious methods in the sphere of molecular biology and genetics the induction of systemic hypertension supplemented alternatively by other methods such as hypothermia, the use of mannitol, haemodilution and hypervolaemia seem natural. A higher blood pressure helps to make leptomeningeal and cortical anastomoses patent and strengthens the collateral circulation from marginal zones of ischaemia, penumbra to the ischaemic centre and to prevent thus cerebral infarction.

Brain↗
PubMed1999

[Development of European medicine to the time of Vesalius (16th century)].

Mythical Greece, Egyptian Alexandria and ancient Rome were the cradle of ancient medicine where the beginnings of anatomy and physiology were combined with nature philosophy of great personalities such as Hippocrates and Galen. A modern contribution i.e. medical chemistry, to European medicine was made by Arab physicians Rhazes and Avicena. Only when clerical dogmatism was overcome, after the discovery of the New world and the development of universities the road to scientific progress ws opened on which started the great surgeon and physician Andreas Vesalius.

Europe↗