Functional assessment of posterior cordotomy in patients with bilateral vocal fold paralysis

Surgical treatment of bilateral vocal fold paralysis must be undertaken if such a condition lasts 6-12 months or longer and causes dyspnoea. The purpose of the procedures is to assure proper airflow through the glottis and to preserve good voice and unimpaired swallowing. Modern endoscopic surgery of the glottis is performed with CO2 laser. The following paper presents results of laser posterior cordotomy performed in 17 patients aged 19-73 years suffering from bilateral vocal fold paralysis. Results and conclusions: In 7 patients the range of vocal fold resection had to be expanded. 3 individuals developed post-operative granulation in subglottal region. Spirometry and electroglottography were performed before and after the operation to assess the patients' laryngeal functions: respiration and voice quality. The results indicate that laser cordectomy was effective in the discussed group of patients.     

Health hazard for medical staff exposed to nitrous oxide

The paper briefly reviews available data on occupational exposure to nitrous oxide and health consequences in medical staff. Special attention is paid on causes of nitrous oxide contamination in occupational environment and monitoring its concentrations. On the basis of the epidemiological studies it was ascertained that nitrous oxide exerts multiple deleterious effects on human organism, especially on fertility, pregnancy, central nervous system and bone marrow.     

Serum resistin levels in women taking combined oral contraceptives containing desogestrel or gestodene

Resistin is a hormone secreted by adipose tissue that could be involved in the development of insulin resistance. Previous studies confirmed that endogenous sex steroids may influence serum resistin concentration in women. The aim of our study was to investigate the influence of combined oral contraceptives containing desogestrel or gestodene on circulating levels of resistin. Fifty-three women were enrolled in the study. Thirteen patients received 20 μg ethinylestradiol/150 μg desogestrel, 15 women were treated with 20 μg ethinylestradiol/75 μg gestodene, 11 with 30 μg ethinylestradiol/150 μg desogestrel and 14 with 30 μg ethinylestradiol/75 μg gestodene. Blood samples for estimation of serum resistin and insulin levels were drawn before administration of oral contraceptive and after 6 cycles of therapy. We found that serum resistin level remained unchanged in women receiving ethinylestradiol/desogestrel and was reduced in women treated with formulations containing gestodene. We conclude that ethinylestradiol combined with desogestrel or gestodene is unlikely to induce insulin resistance through resistin pathway.     

Age-dependent effects of 5,7-dihydroxytryptamine on serotonin transporter in different brain areas in the rat

In the present study, we investigated the [(3)H]citalopram binding using a quantitative autoradiography following intracerebroventricular injection of 5,7-dihydroxytryptamine (5,7-DHT) in neonatal and adult male Wistar rats. One group of animals was injected with 5,7-DHT at 3 days after birth while the second group received the neurotoxin at 3 months after birth. Control group was injected with saline. Afterwards, all rats were examined at 4(th) months after birth to determine the serotonin (5-HT) and catecholamines concentrations using the liquid chromatography with electrochemical detection HPLC system and distribution and density of [(3)H]citalopram binding sites in the brain using the quantitative autoradiography. A marked depletion of brain 5-HT was observed in rats lesioned either in postnatal or adult period of life. Rats lesioned in their adult period of life showed dramatic reduction of 5-HT transporter in all investigated brain areas (i.e.the frontal cortex, entorhinal cortex, hippocampus, caudate-putamen, nucleus accumbens and ventral tegmental area). On the other hand, administration of 5,7-DHT to newborn rats failed to reduce 5-HT transporter sites in the ventral tegmental area, and produced only slight or moderate reduction in the nucleus accumbens. Thus, it appears that the mesolimbic ventral tegmental area-nucleus accumbens systems are relatively more resistant to 5,7-DHT neurotoxicity in the early postnatal period.     

Effects of ischaemia and hypoxia on the development of the nervous system in acardiac foetus

The twin-reversed arterial perfusion (TRAP) sequence and development of an acardius are rare and severe complications in monozygotic twin pregnancy. Haemodynamic disturbances in placental perfusion via abnormal vascular anastomoses allow inter-twin transfusion to occur. Because of blood perfusion, one of the twins is poorly oxygenated and contains metabolic waste products. Retrograde placental perfusion leads to the formation of a non-viable malformed acardiac foetus. We studied the effects of haemodynamic disturbances in acardiac foetus on the development of the nervous system. The acardius was a product of a 32-weeks pregnancy. Caesarean section yielded a skin covered ovoid mass (size, 10 x 8 cm; weight, 220 g). The dissection of the acardiac twin showed a skin with hair and appendages, rudimentary lower limbs, vertebral column and brain mass. The rudimentary brain tissue was considerably disorganised structurally. We distinguished two main morphological forms of various appearances. In the centre, we observed a scarcely vascularised mass of tissue containing mature and immature neurones, glial cells and randomly distributed fibres. The mass of tissue appeared poorly differentiated, although there were some arrangements reminiscent of cerebral structures. Clusters of neurones provided a slight suggestion of nuclear or fibre structure. The cerebellar cortex was the only well recognisable structure. In the other fragment of the tissue, we found a slit cavity with ependymal outline and well-developed choroid plexus, which seemed to represent the 3rd ventricle. The scarcely vascularised disorganised tissue was surrounded by the highly vascularised one. It included many thin-walled sinusoid vessels. In some places, they were so concentrated that they resembled cavernous haemangioma. The spinal cord appeared comparatively well organised with a slightly dilated central canal. The morphological picture of the rudimentary brain tissue was similar to the picture of the cerebrovasculosa area. The effect of ischaemia in the presented case is the anomalous formation of the cerebral structures. The morphological features imply that the failure occurred after neurulation and before the prosencephalic began to grow. The failure of neural tube formation occurred on the 22nd-25th day of gestation. The malformed formation of the nervous system might be caused by impaired induction due to altered gene expression or to the interference of exogenous agents that interrupt normal development. The haemodynamic abnormal placental circulation, which induced lack of oxygen supply and nutritional deficiency, implies the morphological pattern of the anomaly.     

An attempt to use Gore-Tex surgical membrane in lumbar disc surgery

BACKGROUND: Peridural fibrosis developing after lumbar discectomy may be responsible for as much as 20% of all Failed Back Surgery Syndrome. A variety of biological and non-biological materials have been used as a barrier to invasion of fibrous tissue into the vertebral canal. AIM: The purpose of this study was to evaluate the use of expanded polytetrafluoroethylene (ePTFE) surgical membrane (Gore-Tex membrane) to inhibit peridural fibrosis and reduce FBSS symptoms after lumbar discectomy. MATERIAL AND METHODS: In a prospective study we compared postoperative results in 20 patients who had an ePTFE membrane implanted during lumbar discectomy with the results in 20 patients in whom no material was implanted. The outcomes were evaluated using a questionnaire on activities of daily living according to the Low Back Outcome Score, pain grading scale -- Visual Analog Scale, assessment of Lasegue sign and MRI 18-24 months after the operation for all patients. RESULTS: The authors found no evident positive clinical and radiological effects of using ePTFE surgical membrane during lumbar discectomy. CONCLUSIONS: 1. It is impossible to prove that ePTFE membrane used during lumbar discectomy essentially prevents postoperative peridural scar formation. 2. The use of ePTFE membrane does not improve the outcome of the surgical treatment of lumbar disc herniation.     

Surgical treatment of tumors of the central region of brain in children: analysis of own material and review of the literature

AIM OF THIS PAPER: Is to present our results of surgical treatment of central region tumors in children and to determine prognostic factors for patients' survival. METHOD: Retrospective analysis of medical records, radiographies and histopathological specimens of patients treated at the Dept. of Neurosurgery with the diagnosis of central region tumor and review of questionnaires mailed to the patients' parents. The statistical analysis was performed using the "Statistica.pl" software. MATERIAL: From January 1980 to March 2003, 114 such children were treated (mean age--8.05 years, mean follow-up time--38.4 months). In the subgroup of benign tumors (n=70), 70% of children are still alive 21.4% are dead and no data are available for the remaining 8.5% (mean survival time--23 months). In the subgroup of malignant tumors (n=12), 33.3% of patients are still alive and 66.6% are dead (mean survival time--14.2 months). In the group treated surgically (total or partial resection) (n=35), 71.4% of children are still alive, 17.1% are dead and no data are available in 11.4% of cases (mean survival time--24 months). In the group of children who underwent palliative procedures only (n=47), 59.5% are still alive, 27% are dead and no data are available for the remaining 12.7% (mean survival time--18.3 months). The statistical analysis revealed highly significant differences in the survival of children dependent on the tumor grade (p=0.00059) and the extent of resection (p=0.00825). CONCLUSIONS: Tumors of the central region of brain in children are highly heterogenous, so in every case the histological diagnosis should be obtained. Prognostic factors are the degree of histologic malignancy and the extent of surgical resection. In every case surgical resection should be considered.     

Application of solubilizing properties of the products of oxyethylenated fatty alcohols of the Brij type in relation to simvastatin

Investigation of 3-hydroxy-3-methyl-glutaril-coenzyme A inhibitors (statins) has influenced considerably the process of treatment of dislipidemy; now they belong to the most frequently prescribed hypolipemizing medicines. As it has been proved through randomized clinical examination, it is believed to be related to their complex pharmacological action that statins cause certain clinical effects such as a decrease in the morbidity and mortality rate resulted from vessel diseases referred to artheriosclerotic changes. It has been also proved the statine's beneficial influence during the primary and secondary preventive treatment for ischaemic heart disease, ischaemic stroke in the case of patients with diagnosed changes in the vascular system. Moreover, it has been proved the clinical usability in the preventive treatment for osteoporotic changes in bones [4]. The aim of the preformulary examination is to determine solubilizing properties of oxyethylenated fatty alcohols of the Brij type in the relation to simvastatin. Estimation of pharmaceutical accessibility of simvastatin in model form of drug made it possible to establish the influence of supportive substances on the process of equilibrial solubilization of biologically active substance in the recipe liquid--0.1n HCl.