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.     

Analysis of epileptic pregnant women delivering between 1992-1998 in obstetric departments of the University Medical School in Lublin

Pregnancy in woman with epilepsy arouses several serious medical problems and always belongs to the group of high obstetric risks. The aim of the present clinical study was the evaluation of the antiepileptic treatment efficiency during pregnancy, including risk factor, effects on pregnancy and delivery in epileptic patients. The study group consisted of 84 epileptic pregnant women which delivered between 1992-1998 in Obstetric Departments of University Medical School of Lublin. A randomised group 80 healthy pregnant women constituted the control group. The mean age of the analysed patients was 25 years. 51 epileptic patients were pregnant for the first time, 23 patients for the second time and 10 patients for the third time or more. The mean duration time of the disease was 8.6 years. In our study group: 45 (53.8%) patients experienced primary generalized tonic-clonic seizures and 39 (46.6%) patients experienced partial seizures. 26 patients were treated with monotherapy and the rest with polytherapy methods. The estimation of the seizure frequency during pregnancy in 52 (61.9%) patients did not change, in 13 (15.4%) patients increased. Among obstetric complications: urinary tract infections, hypertonia (EPH-gestosis) were observed. In 4 newborn congenital defects have been noted. Mothers of three of them were treated with Phenydantin (heart lesion, developmental anomaly of fingers). The fourth mother used Convulex (meningoarachnided hernia, hydrocephalus).     

Scintigraphy of hyperfunctioning adrenal tissue after total adrenalectomy

The significance of scintigraphic examination in four patients with hyperfunction of adrenal tissue after total adrenalectomy is described.The scintigraphic examination was done 7–8 days after the injection of 1 mCi of ¹³¹I-19-iodocholesterol using the Jumbo Thoshiba 202 scintillation camera and Informatek SIMIS 3 data processing system.Noticeable concentration of ¹³¹I-19-iodocholesterol occurred in all four patients of, in three cases in the region of the right adrenal gland and in one case in the region of the left one.Scintigraphic examination confirmed the clinical hypothesis that of cushing's syndrome recurred in these patients because of hyperfunctioning adrenal tissue left in the body after the operation. This diagnosis was again confirmed in two cases undergoing repeated operations.The scintigraphic examination allowed accurate localization of the adrenal tissue and facilitated finding it during the next operation. The authors believe that adrenal scintigraphy is at the present time one of the best methods of locating the hyperfunctioning adrenal tissue left in the body during total adrenalectomy.     

Comparison of the FIGO and TNM staging systems for uterine cervix cancer based on classification of 6193 cases

A total of 6193 patients treated for uterine cervix cancer was studied by a collaborative study, aiming to compare the applicability of the TNM versus FIGO clinical staging systems. Retrospective assays of gynecological status were performed. It was found that the FIGO classification system is superior to the TNM system concerning uterine cervix cancer in the aspects of simplicity, recording procedures, and prognostic value.     

Middle ear schwannoma--case report

Schwannoma is one of the common benign middle ear space tumors. The tumors may present with facial nerve paresis or palsy, otologic symptoms and/or parotid mass middle ear schwannomas may originate from the nerves of the tympanic caviti or by extensions from outside the middle ear space. Schwannomas of the facial nerve can occur along any segment, but they frequently involve the geniculate ganglion and extend proximally or distally from there. MRI and CT imaging characteristics are similar to those of vestibular schwannomas. We present the clinical and radiologic features of a middle-space schwannoma originating from facial nerve. The patient underwent middle ear exploration and mastoidectomy. The tumor was of facial nerve origin and was separated from middle ear. The pathologic diagnosis was schwannoma.     

Percutaneous procedures for the repair of iatrogenic occlusion or stenosis of peripheral vessels in children--report of 5 cases

Invasive percutaneous diagnostic or therapeutic procedures are associated with the risk of thrombosis and occlusion of peripheral vessels which are used for vascular access. Data on the transcatheter therapy of vascular complications in children are scarce. We described five children in four of whom percutaneous transluminal balloon angioplasty of occluded peripheral vessels was successfully performed. Technical aspects of this treatment and indications are discussed.     

Planning rehabilitation with elements of active movement for brain-damaged patients

Background. Much research has been done in recent years on optimizing rehabilitation by increasing effectiveness, shortening hospitalization, and reducing cost. One of the more interesting solutions that has been proposed is rehabilitation with elements of active movement, conducted on the basis of strategic planning in cooperation with the patient. The goal of the present study was to evaluate the effectiveness of the strategic approach to the motor rehabilitation of persons with brain damage. Material and methods. We studied 36 brain-damaged patients, divided into two groups paired for age and gender. In the control group of 18 persons, traditional, comprehensive rehabilitation was used. The experimental group was rehabilitated based on an individualized strategic plan with motor elements. Outcome was evaluated by clinical observation, the Polish version of the Functional Independence Measure (FIM), and the Self-Evaluating Scale of Progress in Rehabilitation. Results. Progress was seen in both groups on many FIM parameters, which points to the effectiveness of the techniques used in the standard program; however, the results in Group E were significantly better in terms of functional independence and psycho-social functioning. The patients from Group E were much more satisfied with what they had accomplished than the controls. Conclusions. Rehabilitation planning with elements of active movement maximizes the benefits obtained from the methods used. The strategic approach helps the patient become more independent, increases patient satisfaction, and improves motivation to take an active part in exercises.     

Effect of 12-month therapy with omega-3 polyunsaturated acids on glomerular filtration response to dopamine in IgA nephropathy

BACKGROUND: Omega-3 polyunsaturated acids therapy is efficient in primary IgA nephropathy. It is unknown whether doses of omega-3 smaller than those given previously are still effective. The aim of the study was to examine the effect of omega-3 therapy on renal vascular function in relation to proteinuria and urinary excretion of N-acetyl-beta-D-glucosaminidase (NAG). METHODS: 20 IgA patients aged 36.5 +/- 10.77 with creatinine clearance (Cr(cl)) 105.71 +/- 27.3 ml/min and proteinuria 3.31 +/- 2.01 g/24 h were given orally 810 mg EPA and 540 mg DHA daily for 12 months. Before and at the end of the study, 24-hour proteinuria, serum homocysteine, and Cr(cl) were measured. At the same time, renal vascular function was estimated as dopamine-induced glomerular filtration response (DIR). DIR was measured as: two 120-min lasting Cr(cl) (before and during 2 microg/kg b.w./min i.v. dopamine). RESULTS: The results obtained during follow-up were as follows (baseline vs. after therapy): DIR 14.9 +/- 16.4 vs. 30.3 +/- 14.3% (p < 0.01); urine protein 2.31 +/- 2.01 vs. 1.31 +/- 1.37 g/24 h (p < 0.01); (Cr(cl)) 105.71 +/- 27.3 vs. 103.9 +/- 20.9 ml/min (n.s.); NAG 8.3 +/- 1.8 vs. 6.0 +/- 1.2 U/g(creat) (p < 0.01), and homocysteine 16.2 +/- 3.15 vs. 13.8 +/- 2.6 micromol/l (p < 0.05). The only correlation found was linear correlation between basal DIR and DIR change (r = -0.570; p < 0.010) and basal NAG (r = -0.460; p < 0.50). CONCLUSIONS: Omega-3 supplementation is associated with the improvement of both renal vascular function and tubule function.