Intracranial temperature in many clinical situations can significantly differ from core trunk tem... more Intracranial temperature in many clinical situations can significantly differ from core trunk temperature. Little is known about temperature relations in these locations in brain death. The oesophageal and rectal temperatures were monitored in 52 comatose (GCS score: 3-9) patients after head trauma or haemorrhagic stroke. Brain temperature was recorded in 44 patients who had been treated surgically. In 8 patients treated conservatively only tympanic temperature was monitored. Signs of brain death appeared in 27 patients. In patients who were unconscious but without signs of brain death, the brain and trunk temperature run parallel in time, the former being somewhat higher than the latter. The tympanic temperature matched well the temperature of the brain. With brain death symptoms all core temperatures fell by 2 to 4 degrees C during 6 to 12 hours. Most notably, the decrease in brain temperature far exceeded that of trunk temperature. As a result, intracranial temperature establishe...
Polski Merkuriusz Lekarski Organ Polskiego Towarzystwa Lekarskiego, Jul 1, 2006
The aim. Despite adhibition of new, improved enhancing agents some subjective signs during cerebr... more The aim. Despite adhibition of new, improved enhancing agents some subjective signs during cerebral angiography are notified. This suggests that cerebral blood flow might be influenced by this procedure. The validity of transcranial color doppler sonography (TCCS) in cerebral blood flow evaluation is already proved and this method was selected for blood flow parameters estimation before and after cerebral angiography. 33 subjects (17 female and 16 male) aged 50 +/- 13 were diagnosed by cerebral angiography. Before and immediately after angiographic examination cerebral blood flow parameters were evaluated in middle cerebral arteries by transcranial, sektor 2.5 MHz probe of Toshiba Aplio SSA 770A system. In comparison to pre-angiographic TCCS examination middle cerebral artery systolic velocity decreased about 3 cm/s (p<0.05). Mean and end-diastolic velocity in MCA insignificantly increased about 1 and 2 cm/s respectively (p>0.05). Impedance index values significantly decreased (Wilcoxon test, p<0.05) after angiography. Change of flow parameters in the middle cerebral artery prove increase of cerebral blood flow after diagnostic angiography.
OBJECT Distal coil or stent migration is a rare, but potentially morbid complication of intracran... more OBJECT Distal coil or stent migration is a rare, but potentially morbid complication of intracranial aneurysm embolization. At present, there is no established standard of surgical evacuation of displaced material-in particular, there is no consensus on the optimum time for such intervention. The authors report their positive experiences with an ultra-early surgical evacuation of 2 migrated coils and a flow-diverter stent. METHODS Uncontrolled coil or stent migration occurred in 3 (0.75%) of approximately 400 patients treated between 1999 and 2012 in the authors' institution. In all 3 cases, the materials moved from their intended position to the middle cerebral artery (MCA). Surgical evacuation was started immediately (within half an hour) after a futile attempt of removing them via intraarterial route, under the same anesthesia and with no active reversal of heparinization. RESULTS No excessive bleeding was observed. Displaced coils were extracted through an incision of a branch of MCA-the anterior temporal artery, the stent was removed through a direct incision of MCA. Recombinant tissue plasminogen activator (rtPA) was injected to the stem of the internal carotid artery toward the end of the procedure, with no discernible adverse effects. Two patients were discharged with no deficit (Glasgow Outcome Scale [GOS] Score 5); the other patient was conscious with mild hemiparesis (GOS Score 4) at discharge. CONCLUSIONS The experiences of these 3 cases suggest that immediate removal of a migrated stent/coil is feasible and may be effective. Indirect access to the MCA through its branch helps to shorten the time of temporary clipping of the artery to a minimum. Maintaining active heparinization and direct intraarterial injection of rtPA are helpful in promoting blood flow in the MCA.
Although much is known about cytokines and adhesion molecules during an active course of multiple... more Although much is known about cytokines and adhesion molecules during an active course of multiple sclerosis (MS), there is limited information about their serum levels during remission. This study aimed to (1) compare peripheral levels of tumor necrosis factor-α (TNF-α), soluble interleukin-2 receptor α (sIL-2Rα), soluble intercellular adhesion molecule-1 (sICAM-1), and soluble E-selectin (sE-selectin) in MS patients during clinical remission with those of healthy controls and (2) explore possible relationships between the levels of these cytokines and adhesion molecules and neurological impairment. Initially, 92 patients with relapsing-remitting multiple sclerosis (RRMS) who were in clinical remission and 30 healthy controls were recruited for this study. The severity of neurological impairment was assessed with the Expanded Disability Status Scale (EDSS). Serum concentrations of TNF-α, sIL-2Rα, sICAM-1, and sE-selectin were determined using the sandwich enzyme-linked immunosorbent...
Colour-coded duplex sonography is a handy, cost-effective method of screening for stroke-endanger... more Colour-coded duplex sonography is a handy, cost-effective method of screening for stroke-endangered subjects through reliable measurement of blood flow velocity within the internal carotid artery (ICA). The purpose of this investigation was to analyze the effect of age and sex on blood flow velocity and side-to-side differences in the ICAs. Three hundred forty-three healthy volunteers (215 women and 128 men) were divided into 3 age groups: group I < 40 years, group II 41-60 years, and group III > 60 years. Blood flow velocities in the ICA were examined with a Toshiba scanner Aplio SSA 770A, endowed with a linear 7.5 MHz probe. Blood flow velocities in the ICA (mean +/- SD, cm/s) were as follows. In men (group I/group II/group III): peak systolic (PSV) - 64.0 +/- 18.2/58.6 +/- 14.4/60.3 +/- 18.2, mean (MV) - 36.0 +/- 8.3/34.1 +/- 8.5/33.8 +/- 9.3, end diastolic (EDV) - 24.7 +/- 6.2/22.9 +/- 6.8/20.1 +/- 5.5. In women (group I/group II/group III): PSV - 77.2 +/- 16.9/66.5 +/- 20...
Assessment of quality of life, especially from the psychological point of view, is likely to be s... more Assessment of quality of life, especially from the psychological point of view, is likely to be strongly influenced by the degree of acceptance of one's own illness and the resultant negative emotional reactions associated with the illness itself. The aim of the present study was to determine the relationship between quality of life and the degree of acceptance of illness in diabetic patients with and without peripheral diabetic neuropathy. 59 patients with diabetes were included in the study; they consisted of patients both with and without peripheral diabetic neuropathy. The degree of acceptance of illness was assessed using the Acceptance of Illness Scale (AIS) and quality of life (HRQOL - health-related quality of life) was measured using the SF-36v2. Quality of life in people with diabetes was reduced and related to their levels of illness acceptance. Factors affecting illness acceptance in patients with peripheral diabetic neuropathy included feelings of being a burden to ...
Medical science monitor: international medical journal of experimental and clinical research
Epilepsy is a disease which manifests itself with recurrent dysfunction of the brain. Epilepsy th... more Epilepsy is a disease which manifests itself with recurrent dysfunction of the brain. Epilepsy thus becomes a serious social problem and it is therefore necessary to introduce more and more up-to-date methods of its diagnostics. Examinations were performed on 85 patients with partial epileptic attacks. The study group included 43 women and 42 men who had suffered from epilepsy for 2 to 40 years. CT and MR examinations were performed in the interparoxysmal period. In MRI, T1-weighted images before and after contrast administration, T2- and PD-weighted images, and FLAIR images were analyzed. Agreement between the location of lesions in CT and EEG was evaluated with the kappa test and amounted to 0.29. Low compatibility was also found between MR and EEG and amounted to 0.33. However, compatibility between the location in CT and MR reached the level of 0.62. The most common abnormalities were asymmetry of the lateral ventricles (most often temporal horns), cortical scars, mesial tempora...
The index of mean blood flow velocity (V) in the middle cerebral artery (MCA) divided by respecti... more The index of mean blood flow velocity (V) in the middle cerebral artery (MCA) divided by respective velocity in the ipsilateral internal carotid artery (ICA), or V(MCA)/V(ICA) index, is commonly used as a marker of vasospasm, although reference values are not established. We sought to provide reference data for these velocities and index. Transcranial color-coded duplex and carotid duplex sonography was performed in 335 healthy volunteers (211 women, 124 men; mean age +/- SD, 42 +/- 18 years; range, 18-86 years). Age analyses were based on three groups: I, <40; II, 40-60; and III, >60 years. The V(MCA)/V(ICA) index was calculated based on angle-corrected blood flow velocities determined in the MCA and extracranial ICA. Mean flow velocities in the MCA and ICA diminished with increasing age, most pronounced in those subjects >40 years. The V(MCA)/V(ICA) index increased significantly (1.67 + 0.005 [age]; P < .05) with age in women, but not in men. In women, reference values...
We report the case of a 54-year-old woman with a right intracavernous internal carotid artery ane... more We report the case of a 54-year-old woman with a right intracavernous internal carotid artery aneurysm treated endovascularly with MDS coils. During the procedure, one of the coils migrated to the middle cerebral artery (MCA), resulting in left hemiplegia. The attempt to remove the migrated coil endovascularly failed and the patient had emergency front-temporal craniotomy. After the dissection of the Sylvian fissure, the M1 portion of the MCA was exposed with the coil visible through the distended wall of the artery. Because it was feared that the M1 arteriotomy could tear the MCA, the coil was removed through the anterior temporal artery, a small branch of the M2 segment. Hemiplegia gradually resolved and the patient recovered completely. This case depicts an alternative route via a distal arteriotomy to remove the migrating coil. Additionally, it implies that endovascular procedures in neurosurgical patients should be performed by the interventional neurosurgeon (neurosurgeon trai...
Accurate localization and adequate visualization of the superiorly or inferiorly located subperio... more Accurate localization and adequate visualization of the superiorly or inferiorly located subperiosteal orbital abscesses or intraorbital abscess is difficult with transnasal endoscopic approach. Sonography is a well-known and effective tool for evaluation of orbital pathologies but no paper documenting intraoperative application of this method in orbital abscess surgery has been published to date. We present a series of 12 patients in whom orbital abscesses were drained endoscopically with an aid of neuronavigation and intraoperative ultrasonography. The abscesses were localized subperiosteally in the medial (n=6), superior (n=2) or inferior (n=1) part of the orbit whereas in 3 patients the abscess was localized in the intraconal space. According to intraoperative sonographic imaging complete drainage of the abscess was achieved in 11 out of 12 patients and no complications occurred. Intraoperative sonography helped to limit opening of the orbital wall in the medial subperiosteal abscesses, enabled check-up for completeness of drainage of the far extending pouches in the superior and inferior subperiosteal abscesses and enabled visualization of the tip of surgical instrument when reaching deeply located intraorbital abscesses. Intraoperative ultrasonography facilitates the endoscopic management of orbital abscesses, especially those which are difficult to reach due to subperiosteal location in the superior and inferior parts of the orbit, or abscesses localized intraorbitally.
Medical science monitor : international medical journal of experimental and clinical research, 2007
Vascular reactions after cerebral angiography have not been hitherto extensively explored due to ... more Vascular reactions after cerebral angiography have not been hitherto extensively explored due to the lack of a simple, easily available, and safe method for the measurement of cerebral circulation. We attempted to study cerebral circulation with color Doppler transcranial sonography (TCCS) in consecutive patients before and immediately after digital subtraction angiography (DSA). TCCS examination of the major cerebral arteries was carried out in 52 patients (25 females and 27 males), mean age 50.3+/-11.5 years, before and 10-20 minutes after cerebral angiography. A Toshiba Aplio SSA 770A system with a 2.5-MHz sector transducer was used. In general terms, there was a tendency after DSA towards a slight decrease in peak systolic blood velocity and an increase in mean and end-diastolic velocity in all the major cerebral arteries which, in turn, led to a decrease in the impedance index (pulsatility index, PI). In 19 patients, the impedance index as measured in the middle cerebral artery decreased after DSA, in 29 it did not change, while in 4 patients PI increased. Discriminant analysis showed that the factors predisposing individuals to these adverse reactions were a low score on the Glasgow Coma Scale, etiological diagnosis of intracerebral bleeding, and a high value of the impedance index prior to the procedure. Contrast cerebral angiography may affect the tonus of cerebral vessels. In the majority of patients it caused vasodilatation to varying degrees and in a small sub-group vasoconstriction.
To prospectively determine the accuracy of transcranial color-coded duplex ultrasonography (US) u... more To prospectively determine the accuracy of transcranial color-coded duplex ultrasonography (US) used alone and in conjunction with carotid artery US for diagnosis of middle cerebral artery (MCA) spasm, with intraarterial digital subtraction angiography (DSA) used as the reference standard. The institutional ethics committee approved the study. Each patient, or members of the patient&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s family, gave informed consent. One hundred twenty consecutive patients (64 women, 56 men; mean age, 45.5 years +/- 13.6 [standard deviation]) were routinely referred for DSA after subarachnoid hemorrhage. Vasospasm was graded as mild (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; or =25% reduction in vessel diameter), moderate (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;25% to 50% reduction), or severe (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;50% reduction). US was performed 2 hours or less before angiography. The ratio of flow velocity in the middle cerebral artery (V(MCA)) to flow velocity in the ipsilateral extracranial internal carotid artery (V(ICA)) was calculated. Diagnostic accuracy was evaluated by calculating the area under the receiver operating characteristic curve (Az). The significance of the difference between the two Az values (for US vs DSA) was determined by using the z test with correction for correlated data. Nine of 120 patients were excluded because of inadequacy of acoustic windows in the squama of temporal bones. Spasm was mild in 17, moderate in 16, and severe in only nine of 222 arteries studied. Arteries with moderate or severe vasospasm were combined in one group. The best-performing parameters were peak systolic velocity and V(MCA)/V(ICA) ratio. Az values for these two parameters in diagnosis of moderate-to-severe vasospasm were 0.93 and 0.95, and in diagnosis of mild vasospasm, 0.90 and 0.91. Accuracy of the V(MCA)/V(ICA) ratio calculated on the basis of end-diastolic velocity for diagnosis of mild MCA narrowing was significantly better than that of end-diastolic MCA velocity alone (Az = 0.88 vs 0.84, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .05). The stepwise approach with use of the V(MCA)/V(ICA) ratio after flow velocity measurements in the MCA resulted in a decreased number of false-negative findings in both vasospasm subgroups. The thresholds of highest efficiency were at a mean velocity of 94 and 108 cm/sec and a peak systolic V(MCA)/V(ICA) ratio of 3.6 and 3.9 for diagnosis of mild and moderate-to-severe vasospasm, respectively. Transcranial color-coded duplex US alone or in conjunction with carotid artery US has excellent accuracy for angiographic detection of vasospasm. Use of MCA velocity measurements and V(MCA)/V(ICA) ratio can increase the accuracy of Doppler US.
Reduced cerebral blood flow after severe head injury results in an increased risk of ischemic bra... more Reduced cerebral blood flow after severe head injury results in an increased risk of ischemic brain damage. Blood flow should therefore be monitored with a simple, reliable method. Transcranial color-coded Doppler sonography (TCCS) is an accepted tool for the diagnosis of cerebral vasospasm; however, its usefulness in evaluating patients with head injury has not been proven. Cerebral blood-flow velocity in the middle, anterior, and posterior cerebral arteries was measured with a 2.5 MHz probe (Aplio SSA 770A, Toshiba, Japan) in 36 subjects with moderate or severe head injury. Serial measurements of resistance index (RI), peak-systolic, end-diastolic, and mean velocity in the middle cerebral arteries were performed 2-24 h after head trauma and in the subsequent days during hospitalization. Immediately after head trauma, increased RI values, and unusually decreased blood-flow velocity (mainly in MCA) were observed. Microcirculation disturbances were suspected because the end-diastolic velocity had substantially diminished. Changes in blood-flow parameters correlated with the clinical state, and in most cases, a poor prognosis. In some patients, blood-flow velocity increased above the normal reference limit and this implied poor prognosis. Transcranial color-coded Doppler sonography is a reliable, repeatable, and accessible tool that provides information about cerebral blood-flow disturbances and may hold diagnostic and prognostic importance.
Intracranial temperature in many clinical situations can significantly differ from core trunk tem... more Intracranial temperature in many clinical situations can significantly differ from core trunk temperature. Little is known about temperature relations in these locations in brain death. The oesophageal and rectal temperatures were monitored in 52 comatose (GCS score: 3-9) patients after head trauma or haemorrhagic stroke. Brain temperature was recorded in 44 patients who had been treated surgically. In 8 patients treated conservatively only tympanic temperature was monitored. Signs of brain death appeared in 27 patients. In patients who were unconscious but without signs of brain death, the brain and trunk temperature run parallel in time, the former being somewhat higher than the latter. The tympanic temperature matched well the temperature of the brain. With brain death symptoms all core temperatures fell by 2 to 4 degrees C during 6 to 12 hours. Most notably, the decrease in brain temperature far exceeded that of trunk temperature. As a result, intracranial temperature establishe...
Polski Merkuriusz Lekarski Organ Polskiego Towarzystwa Lekarskiego, Jul 1, 2006
The aim. Despite adhibition of new, improved enhancing agents some subjective signs during cerebr... more The aim. Despite adhibition of new, improved enhancing agents some subjective signs during cerebral angiography are notified. This suggests that cerebral blood flow might be influenced by this procedure. The validity of transcranial color doppler sonography (TCCS) in cerebral blood flow evaluation is already proved and this method was selected for blood flow parameters estimation before and after cerebral angiography. 33 subjects (17 female and 16 male) aged 50 +/- 13 were diagnosed by cerebral angiography. Before and immediately after angiographic examination cerebral blood flow parameters were evaluated in middle cerebral arteries by transcranial, sektor 2.5 MHz probe of Toshiba Aplio SSA 770A system. In comparison to pre-angiographic TCCS examination middle cerebral artery systolic velocity decreased about 3 cm/s (p&amp;amp;amp;amp;amp;amp;amp;amp;lt;0.05). Mean and end-diastolic velocity in MCA insignificantly increased about 1 and 2 cm/s respectively (p&amp;amp;amp;amp;amp;amp;amp;amp;gt;0.05). Impedance index values significantly decreased (Wilcoxon test, p&amp;amp;amp;amp;amp;amp;amp;amp;lt;0.05) after angiography. Change of flow parameters in the middle cerebral artery prove increase of cerebral blood flow after diagnostic angiography.
OBJECT Distal coil or stent migration is a rare, but potentially morbid complication of intracran... more OBJECT Distal coil or stent migration is a rare, but potentially morbid complication of intracranial aneurysm embolization. At present, there is no established standard of surgical evacuation of displaced material-in particular, there is no consensus on the optimum time for such intervention. The authors report their positive experiences with an ultra-early surgical evacuation of 2 migrated coils and a flow-diverter stent. METHODS Uncontrolled coil or stent migration occurred in 3 (0.75%) of approximately 400 patients treated between 1999 and 2012 in the authors&amp;amp;amp;amp;#39; institution. In all 3 cases, the materials moved from their intended position to the middle cerebral artery (MCA). Surgical evacuation was started immediately (within half an hour) after a futile attempt of removing them via intraarterial route, under the same anesthesia and with no active reversal of heparinization. RESULTS No excessive bleeding was observed. Displaced coils were extracted through an incision of a branch of MCA-the anterior temporal artery, the stent was removed through a direct incision of MCA. Recombinant tissue plasminogen activator (rtPA) was injected to the stem of the internal carotid artery toward the end of the procedure, with no discernible adverse effects. Two patients were discharged with no deficit (Glasgow Outcome Scale [GOS] Score 5); the other patient was conscious with mild hemiparesis (GOS Score 4) at discharge. CONCLUSIONS The experiences of these 3 cases suggest that immediate removal of a migrated stent/coil is feasible and may be effective. Indirect access to the MCA through its branch helps to shorten the time of temporary clipping of the artery to a minimum. Maintaining active heparinization and direct intraarterial injection of rtPA are helpful in promoting blood flow in the MCA.
Although much is known about cytokines and adhesion molecules during an active course of multiple... more Although much is known about cytokines and adhesion molecules during an active course of multiple sclerosis (MS), there is limited information about their serum levels during remission. This study aimed to (1) compare peripheral levels of tumor necrosis factor-α (TNF-α), soluble interleukin-2 receptor α (sIL-2Rα), soluble intercellular adhesion molecule-1 (sICAM-1), and soluble E-selectin (sE-selectin) in MS patients during clinical remission with those of healthy controls and (2) explore possible relationships between the levels of these cytokines and adhesion molecules and neurological impairment. Initially, 92 patients with relapsing-remitting multiple sclerosis (RRMS) who were in clinical remission and 30 healthy controls were recruited for this study. The severity of neurological impairment was assessed with the Expanded Disability Status Scale (EDSS). Serum concentrations of TNF-α, sIL-2Rα, sICAM-1, and sE-selectin were determined using the sandwich enzyme-linked immunosorbent...
Colour-coded duplex sonography is a handy, cost-effective method of screening for stroke-endanger... more Colour-coded duplex sonography is a handy, cost-effective method of screening for stroke-endangered subjects through reliable measurement of blood flow velocity within the internal carotid artery (ICA). The purpose of this investigation was to analyze the effect of age and sex on blood flow velocity and side-to-side differences in the ICAs. Three hundred forty-three healthy volunteers (215 women and 128 men) were divided into 3 age groups: group I < 40 years, group II 41-60 years, and group III > 60 years. Blood flow velocities in the ICA were examined with a Toshiba scanner Aplio SSA 770A, endowed with a linear 7.5 MHz probe. Blood flow velocities in the ICA (mean +/- SD, cm/s) were as follows. In men (group I/group II/group III): peak systolic (PSV) - 64.0 +/- 18.2/58.6 +/- 14.4/60.3 +/- 18.2, mean (MV) - 36.0 +/- 8.3/34.1 +/- 8.5/33.8 +/- 9.3, end diastolic (EDV) - 24.7 +/- 6.2/22.9 +/- 6.8/20.1 +/- 5.5. In women (group I/group II/group III): PSV - 77.2 +/- 16.9/66.5 +/- 20...
Assessment of quality of life, especially from the psychological point of view, is likely to be s... more Assessment of quality of life, especially from the psychological point of view, is likely to be strongly influenced by the degree of acceptance of one's own illness and the resultant negative emotional reactions associated with the illness itself. The aim of the present study was to determine the relationship between quality of life and the degree of acceptance of illness in diabetic patients with and without peripheral diabetic neuropathy. 59 patients with diabetes were included in the study; they consisted of patients both with and without peripheral diabetic neuropathy. The degree of acceptance of illness was assessed using the Acceptance of Illness Scale (AIS) and quality of life (HRQOL - health-related quality of life) was measured using the SF-36v2. Quality of life in people with diabetes was reduced and related to their levels of illness acceptance. Factors affecting illness acceptance in patients with peripheral diabetic neuropathy included feelings of being a burden to ...
Medical science monitor: international medical journal of experimental and clinical research
Epilepsy is a disease which manifests itself with recurrent dysfunction of the brain. Epilepsy th... more Epilepsy is a disease which manifests itself with recurrent dysfunction of the brain. Epilepsy thus becomes a serious social problem and it is therefore necessary to introduce more and more up-to-date methods of its diagnostics. Examinations were performed on 85 patients with partial epileptic attacks. The study group included 43 women and 42 men who had suffered from epilepsy for 2 to 40 years. CT and MR examinations were performed in the interparoxysmal period. In MRI, T1-weighted images before and after contrast administration, T2- and PD-weighted images, and FLAIR images were analyzed. Agreement between the location of lesions in CT and EEG was evaluated with the kappa test and amounted to 0.29. Low compatibility was also found between MR and EEG and amounted to 0.33. However, compatibility between the location in CT and MR reached the level of 0.62. The most common abnormalities were asymmetry of the lateral ventricles (most often temporal horns), cortical scars, mesial tempora...
The index of mean blood flow velocity (V) in the middle cerebral artery (MCA) divided by respecti... more The index of mean blood flow velocity (V) in the middle cerebral artery (MCA) divided by respective velocity in the ipsilateral internal carotid artery (ICA), or V(MCA)/V(ICA) index, is commonly used as a marker of vasospasm, although reference values are not established. We sought to provide reference data for these velocities and index. Transcranial color-coded duplex and carotid duplex sonography was performed in 335 healthy volunteers (211 women, 124 men; mean age +/- SD, 42 +/- 18 years; range, 18-86 years). Age analyses were based on three groups: I, <40; II, 40-60; and III, >60 years. The V(MCA)/V(ICA) index was calculated based on angle-corrected blood flow velocities determined in the MCA and extracranial ICA. Mean flow velocities in the MCA and ICA diminished with increasing age, most pronounced in those subjects >40 years. The V(MCA)/V(ICA) index increased significantly (1.67 + 0.005 [age]; P < .05) with age in women, but not in men. In women, reference values...
We report the case of a 54-year-old woman with a right intracavernous internal carotid artery ane... more We report the case of a 54-year-old woman with a right intracavernous internal carotid artery aneurysm treated endovascularly with MDS coils. During the procedure, one of the coils migrated to the middle cerebral artery (MCA), resulting in left hemiplegia. The attempt to remove the migrated coil endovascularly failed and the patient had emergency front-temporal craniotomy. After the dissection of the Sylvian fissure, the M1 portion of the MCA was exposed with the coil visible through the distended wall of the artery. Because it was feared that the M1 arteriotomy could tear the MCA, the coil was removed through the anterior temporal artery, a small branch of the M2 segment. Hemiplegia gradually resolved and the patient recovered completely. This case depicts an alternative route via a distal arteriotomy to remove the migrating coil. Additionally, it implies that endovascular procedures in neurosurgical patients should be performed by the interventional neurosurgeon (neurosurgeon trai...
Accurate localization and adequate visualization of the superiorly or inferiorly located subperio... more Accurate localization and adequate visualization of the superiorly or inferiorly located subperiosteal orbital abscesses or intraorbital abscess is difficult with transnasal endoscopic approach. Sonography is a well-known and effective tool for evaluation of orbital pathologies but no paper documenting intraoperative application of this method in orbital abscess surgery has been published to date. We present a series of 12 patients in whom orbital abscesses were drained endoscopically with an aid of neuronavigation and intraoperative ultrasonography. The abscesses were localized subperiosteally in the medial (n=6), superior (n=2) or inferior (n=1) part of the orbit whereas in 3 patients the abscess was localized in the intraconal space. According to intraoperative sonographic imaging complete drainage of the abscess was achieved in 11 out of 12 patients and no complications occurred. Intraoperative sonography helped to limit opening of the orbital wall in the medial subperiosteal abscesses, enabled check-up for completeness of drainage of the far extending pouches in the superior and inferior subperiosteal abscesses and enabled visualization of the tip of surgical instrument when reaching deeply located intraorbital abscesses. Intraoperative ultrasonography facilitates the endoscopic management of orbital abscesses, especially those which are difficult to reach due to subperiosteal location in the superior and inferior parts of the orbit, or abscesses localized intraorbitally.
Medical science monitor : international medical journal of experimental and clinical research, 2007
Vascular reactions after cerebral angiography have not been hitherto extensively explored due to ... more Vascular reactions after cerebral angiography have not been hitherto extensively explored due to the lack of a simple, easily available, and safe method for the measurement of cerebral circulation. We attempted to study cerebral circulation with color Doppler transcranial sonography (TCCS) in consecutive patients before and immediately after digital subtraction angiography (DSA). TCCS examination of the major cerebral arteries was carried out in 52 patients (25 females and 27 males), mean age 50.3+/-11.5 years, before and 10-20 minutes after cerebral angiography. A Toshiba Aplio SSA 770A system with a 2.5-MHz sector transducer was used. In general terms, there was a tendency after DSA towards a slight decrease in peak systolic blood velocity and an increase in mean and end-diastolic velocity in all the major cerebral arteries which, in turn, led to a decrease in the impedance index (pulsatility index, PI). In 19 patients, the impedance index as measured in the middle cerebral artery decreased after DSA, in 29 it did not change, while in 4 patients PI increased. Discriminant analysis showed that the factors predisposing individuals to these adverse reactions were a low score on the Glasgow Coma Scale, etiological diagnosis of intracerebral bleeding, and a high value of the impedance index prior to the procedure. Contrast cerebral angiography may affect the tonus of cerebral vessels. In the majority of patients it caused vasodilatation to varying degrees and in a small sub-group vasoconstriction.
To prospectively determine the accuracy of transcranial color-coded duplex ultrasonography (US) u... more To prospectively determine the accuracy of transcranial color-coded duplex ultrasonography (US) used alone and in conjunction with carotid artery US for diagnosis of middle cerebral artery (MCA) spasm, with intraarterial digital subtraction angiography (DSA) used as the reference standard. The institutional ethics committee approved the study. Each patient, or members of the patient&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s family, gave informed consent. One hundred twenty consecutive patients (64 women, 56 men; mean age, 45.5 years +/- 13.6 [standard deviation]) were routinely referred for DSA after subarachnoid hemorrhage. Vasospasm was graded as mild (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; or =25% reduction in vessel diameter), moderate (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;25% to 50% reduction), or severe (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;50% reduction). US was performed 2 hours or less before angiography. The ratio of flow velocity in the middle cerebral artery (V(MCA)) to flow velocity in the ipsilateral extracranial internal carotid artery (V(ICA)) was calculated. Diagnostic accuracy was evaluated by calculating the area under the receiver operating characteristic curve (Az). The significance of the difference between the two Az values (for US vs DSA) was determined by using the z test with correction for correlated data. Nine of 120 patients were excluded because of inadequacy of acoustic windows in the squama of temporal bones. Spasm was mild in 17, moderate in 16, and severe in only nine of 222 arteries studied. Arteries with moderate or severe vasospasm were combined in one group. The best-performing parameters were peak systolic velocity and V(MCA)/V(ICA) ratio. Az values for these two parameters in diagnosis of moderate-to-severe vasospasm were 0.93 and 0.95, and in diagnosis of mild vasospasm, 0.90 and 0.91. Accuracy of the V(MCA)/V(ICA) ratio calculated on the basis of end-diastolic velocity for diagnosis of mild MCA narrowing was significantly better than that of end-diastolic MCA velocity alone (Az = 0.88 vs 0.84, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .05). The stepwise approach with use of the V(MCA)/V(ICA) ratio after flow velocity measurements in the MCA resulted in a decreased number of false-negative findings in both vasospasm subgroups. The thresholds of highest efficiency were at a mean velocity of 94 and 108 cm/sec and a peak systolic V(MCA)/V(ICA) ratio of 3.6 and 3.9 for diagnosis of mild and moderate-to-severe vasospasm, respectively. Transcranial color-coded duplex US alone or in conjunction with carotid artery US has excellent accuracy for angiographic detection of vasospasm. Use of MCA velocity measurements and V(MCA)/V(ICA) ratio can increase the accuracy of Doppler US.
Reduced cerebral blood flow after severe head injury results in an increased risk of ischemic bra... more Reduced cerebral blood flow after severe head injury results in an increased risk of ischemic brain damage. Blood flow should therefore be monitored with a simple, reliable method. Transcranial color-coded Doppler sonography (TCCS) is an accepted tool for the diagnosis of cerebral vasospasm; however, its usefulness in evaluating patients with head injury has not been proven. Cerebral blood-flow velocity in the middle, anterior, and posterior cerebral arteries was measured with a 2.5 MHz probe (Aplio SSA 770A, Toshiba, Japan) in 36 subjects with moderate or severe head injury. Serial measurements of resistance index (RI), peak-systolic, end-diastolic, and mean velocity in the middle cerebral arteries were performed 2-24 h after head trauma and in the subsequent days during hospitalization. Immediately after head trauma, increased RI values, and unusually decreased blood-flow velocity (mainly in MCA) were observed. Microcirculation disturbances were suspected because the end-diastolic velocity had substantially diminished. Changes in blood-flow parameters correlated with the clinical state, and in most cases, a poor prognosis. In some patients, blood-flow velocity increased above the normal reference limit and this implied poor prognosis. Transcranial color-coded Doppler sonography is a reliable, repeatable, and accessible tool that provides information about cerebral blood-flow disturbances and may hold diagnostic and prognostic importance.
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Papers by Jan Kochanowicz