Percutaneous transluminal angioplasty of extracranial vertebral artery stenosis--a case report

Due to improvement in intravascular therapeutic procedures significant stenoses of vertebral and basilar arteries can presently be treated by means of percutaneous transluminal angioplasty (PTA). The reported case was a 34-year-old man with symptomatic stenosis of the distal left vertebral artery and hypoplastic right vertebral artery. The patient underwent PTA and the lesion was sufficiently dilated. No complications occurred during or after the procedure. After a year duplex Doppler follow-up examination showed normal blood flow and patency of both vertebral arteries. PTA may prove to be a useful therapeutic option in patients with symptoms of vertebro-basilar insufficiency.     

Skull base surgery techniques in the treatment of pituitary adenomas

The giant pituitary adenoma surgery remains a real challenge to any neurosurgeon. Despite an extensive development of transsphenoidal techniques, open craniotomy procedures still are required in 5-10% of all cases with pituitary adenoma. The skull base surgery techniques not only allow to minimize the surgery-related trauma of the brain, but also improve the access to the operating field. In the years 1998-2001 the authors operated on the total of 395 pituitary adenoma patients, mostly using the transsphenoidal approach (320 cases), with skull base surgery techniques applied in 75 cases (i.e. in 19% of all patients)--in 67 patients the transbasal-subfrontal approach was applied, and in 2 cases--lateral rhinotomy. There were two indications to the transbasal-subfrontal approach: a large size of the tumor causing visual disturbances, and extension of the adenoma to adherent anatomical spaces. In this group of patients the total removal of the tumour was achieved in 88% of cases. In the remaining patients remnants of the tumor were left in the cavernous sinuses. The skull base surgery techniques are most useful in the treatment of selected patients with pituitary adenoma.     

Surgical treatment of posttraumatic lower canaliculus interruption and results of treatment estimation

The authors present the method of surgical treatment of posttraumatic lower canaliculus interruption using intubation through upper lacrimal canaliculus. The lacrimal system was intubated through the upper lacrimal canaliculus with a silicone drainage system for 6 weeks. The results were estimated on a base of dacrocystography and scyntygraphy of lacrimal system after 6 month. The presented surgical treatment is both easy for a beginning surgeon and brings good functional results.     

Biomechanic shear stress in carotid arteries and atherosclerosis development

One of the major hemodynamic forces acting on blood vessels is shear stress, which is, the friction force between the endothelial cell surface and flowing blood. Arterial shear stress within physiologic range (15-70 dyne/cm2) induces endothelial quiescence and an atheroprotective gene expression profile. Low shear stress (< 4 dyne/cm2) stimulates atherogenic phenotype, whereas, high shear stress (> 70 dyne/cm2) induce prothrombotic state.     

Tissue reaction after implantation of Spongostan,as the carrier of xenogenic bone morphogenetic protein. Experimental study

Reconstruction or filling of bone defects, especially in the maxillofacial region, often requires use of biomaterials. An implant should fasten healing of the bone gap or it should replace autogenic bone grafts. The combination of bone morphogenetic proteins with suitable carrier may fulfill these requirements. Proteins causing differentiation of mesenchymal cells in chondroblasts and osteoblasts were called Bone Morphogenetic Proteins--BMPs. The authors extracted BMP from bovine bones and placed it into collagen carrier formed from generally accessible hemostatic sponge--Spongostan. The implants were grafted into rat femoral muscle pouches in order to trace the tissue response. Pathologic examinations were performed 3, 6 and 8 weeks after implantation. On the basis on macroscopic and microscopic examinations it was stated that collagen sponge speckled with BMP caused minimal tissue response and evolved characteristic thin connective tissue capsule formation around the implant. The connective tissue penetrated spongious structure of the implant, filling the spaces, which became growing due to sponge resorption. Characteristic hyalinization and sparse chondroblasts were visible 8 weeks after implantation.     

The review of outcome measures in the shoulder surgery

The article contains the review of outcome measures frequently used in the shoulder surgery. The genesis, structure and scoring of each instrument has been presented. Underlying of advantages and disadvantages should help with selection of clinically useful measure.