Hemikraniektomia odbarczająca w udarze niedokrwiennym mózgu

Background and purpose Hemispheric ischaemic stroke complicated by oedema is associated with high mortality. The results of randomized studies showed that decompressive hemicraniectomy performed in this group of patients could be beneficial. First experiences with implementation of hemicraniectomy in patients with brain infarct in our stroke centre are presented. Material and methods Between August 2007 and July 2008, four patients with hemispheric brain infarcts complicated by malignant oedema underwent decompressive hemicraniectomy within 72 hours from symptoms onset. Stroke severity was assessed with the National Institutes of Health Stroke Scale (NIHSS). Clinical outcome was assessed 3, 6 and 12 months after the event using the modified Rankin scale (mRS). Results In the first patient, the neurosurgical procedure included only decompressive hemicraniectomy, whereas in the other three duraplasty was performed additionally. The first patient died 23 days after the stroke onset due to acute respiratory failure. Another died at four months after the event, due to infectious complications. The remaining two patients presented severe functional disability 12 months after the procedure (mRS score 4). Conclusions Decompressive surgery with duraplasty can be a life-saving procedure for patients with brain oedema. To our knowledge, the presented cases are among the first reported cases of hemispheric ischaemic stroke treated with decompressive hemicraniectomy in Poland. Extended follow-up with a larger group of patients is necessary to assess long-term outcome.Wstęp i cel pracy Półkulowy udar niedokrwienny mózgu powikłany obrzękiem mózgu obarczony jest dużą ś miertelnością. Wyniki badań z randomizacją wskazują na skuteczność kraniektomii odbarczającej w tej grupie chorych. W pracy przedstawiono pierwsze doświadczenia z zastosowania kraniektomii odbarczającej u chorych z udarem niedokrwiennym mózgu leczonych w Klinice Neurologii Wieku Podeszłego ŚUM w Katowicach. Materiał i metody W okresie od sierpnia 2007 r. do lipca 2008 r. u 4 chorych z półkulowym udarem niedokrwiennym mózgu powikłanym obrzękiem mózgu przeprowadzono zabieg kraniektomii odbarczającej maksymalnie do 72 godz. od wystąpienia objawów udaru. Stan neurologiczny chorych oceniono, stosując skalę National Institutes of Health Stroke Scale (NIHSS). Oceny stanu funkcjonalnego dokonano przy użyciu zmodyfikowanej skali Rankina w 3., 6. i 12. miesiącu po udarze. Wyniki U pierwszego chorego wykonano jedynie kraniektomię odbarczającą, a u kolejnych 3 dodatkowo plastykę opony twardej. Pierwszy z pacjentów zmarł w 23. dobie od wystąpienia udaru w wyniku niewydolności oddechowej, kolejny w 4. miesiącu z powodu powikłań infekcyjnych. U pozostałych dwóch pacjentów w 12. miesiącu od udaru utrzymywał się duży stopień niesprawności (4 stopień w skali Rankina). Wnioski Kraniektomia odbarczająca może być zabiegiem ratującym życie chorych z obrzękiem mózgu. Przedstawione przypadki są jednymi z pierwszych w Polsce opisanymi przy-padkami zastosowania hemikraniektomii odbarczającej u chorych z półkulowym udarem niedokrwiennym. Konieczna jest dłuższa obserwacja większej grupy chorych, aby ocenić odległe efekty leczenia

Mechanical thrombectomy in acute stroke – Five years of experience in Poland

Objectives Mechanical thrombectomy (MT) is not reimbursed by the Polish public health system. We present a description of 5 years of experience with MT in acute stroke in Comprehensive Stroke Centers (CSCs) in Poland. Methods and results We retrospectively analyzed the results of a structured questionnaire from 23 out of 25 identified CSCs and 22 data sets that include 61 clinical, radiological and outcome measures. Results Most of the CSCs (74%) were founded at University Hospitals and most (65.2%) work round the clock. In 78.3% of them, the working teams are composed of neurologists and neuro-radiologists. All CSCs perform CT and angio-CT before MT. In total 586 patients were subjected to MT and data from 531 of them were analyzed. Mean time laps from stroke onset to groin puncture was 250±99min. 90.3% of the studied patients had MT within 6h from stroke onset; 59.3% of them were treated with IV rt-PA prior to MT; 15.1% had IA rt-PA during MT and 4.7% – emergent stenting of a large vessel. M1 of MCA was occluded in 47.8% of cases. The Solitaire device was used in 53% of cases. Successful recanalization (TICI2b–TICI3) was achieved in 64.6% of cases and 53.4% of patients did not experience hemorrhagic transformation. Clinical improvement on discharge was noticed in 53.7% of cases, futile recanalization – in 30.7%, mRS of 0–2 – in 31.4% and mRS of 6 in 22% of cases. Conclusion Our results can help harmonize standards for MT in Poland according to international guidelines

Diagnosis and Treatment of Cervical Branchial Cleft Cysts Based on the Material from the Department of Cranio-Maxillofacial Surgery, Medical University in Łódź and Literature Review

Cervical branchial cleft cysts are relatively common tumors of the neck that should be distinguished from an epidermoid cyst, hygroma, hemangioma, lymphangioma, lymphadenitis, and metastatic papillary carcinoma of the thyroid gland. Infected cysts might be misdiagnosed as a recurrent abscess. The aim of the study was to present current views concerning diagnosis and treatment of cervical branchial cleft cysts. Material and methods. Data and histopathological results obtained from 49 patients (18 women and 31 men) admitted to the Department of Cranio-Maxillofacial Surgery, due to lateral cervical cysts during the period between 2005 and 2009 were subject to retrospective analysis. Results. Most patients were in their third decade of life. The clinical examination showed a painless, slowly growing tumor on the lateral surface of the neck, more often on the right side, and in 30 cases with a concomitant infection. Initial diagnosis on the basis of the clinical examination, radiology and biopsy was confirmed in 48/49 cases (98%). All patients were subject to surgical treatment. During the 3 to 7 year follow-up period recurrence was not observed. Conclusions. Initial diagnosis of a cervical branchial cleft cyst on the basis of the clinical examination should always be confirmed by means of ultrasonography. In case of suspicion of a coexisting infection, fine-needle aspiration biopsy under ultrasound control is recommended. If there is concern that the lateral neck lesion is not a branchial cyst or its dimension is large, computed tomography of the neck or magnetic resonance should be performed. Complete excision of the tumor under general anesthesia is the treatment of choice, being associated with the low risk of local postoperative complication

Autoerotic death due to electrocution

Autoerotic death is a very rare case in forensic medicine. It is usually caused by asphyxia, but other reasons are also possible. Herein we present a case of autoerotic death due to electrocution caused by a self-made electrical device. The device was constructed to increase sexual feelings through stimulation of the scrotal area

True and Pseudocysts of the Spleen - A Diagnostic and Therapeutic Problem

Splenic cysts are rarely diagnosed lesions. This also includes splenic pseudocysts, which usually develop as a result of a blunt abdominal cavity injury. Splenic cysts are usually diagnosed on the basis of imaging examinations, performed in case of symptomatic patients or those subject to a blunt abdominal cavity injury.Material and methods. The study group comprised six patients with a positive history of blunt abdominal cavity trauma, verified by means of histopathological examinations, which were subject to surgical intervention at the Department of General and Endocrinological Surgery, Medical University in Łódź, during the period between 01.01.2006 and 31.12.2010. Before or during the surgical procedure cystic lesions were diagnosed. The efficacy of the surgical intervention was determined.Results. Splenic pseudocysts were diagnosed in only two of the patients, although in all there was a reasonable suspicion of the above-mentioned lesion. One patient required three operations, due to recurrence of the lesion, which proved to be a primary epithelial cyst. Two of the patients required early explorative relaparotomy. Apart from the above-mentioned, treatment proved uneventful.Conclusions. The diagnosis of a splenic pseudocyst is established in case of suspicion of the above-mentioned lesion. This is evidence that in some patients focal lesions of a different nature are present, being detected by means of diagnostic imaging examinations performed after abdominal cavity injuries

Head and Neck Lymphomas - Diagnostic Difficulties

Malignant lymphomas represent approximately 5% of all malignant neoplasm of the head and neck and may involve nodal or extranodal sites. The head and neck region is the second most frequent anatomical site of extranodal lymphomas (after the gastrointestinal tract). Most are non-Hodgkin lymphomas (NHL) of B-cell lineage. Hodgkin's lymphoma (HL) rarely occurs in extranodal site.The aim of the study was to evaluate head and neck manifestation of lymphoma (both HL and NHL) and emphasize diagnostic difficulties of these pathologies.Material and methods. Retrospective review of medical records of patients diagnosed for lymphomas in our department was performed. Authors analyzed demographic data as well as clinical manifestation and diagnostic trials.Results. 9 patients were included to the study. 7 of them suffered from extranodal NHL and 2 of them from HL (one patient - extranodal and one nodal manifestation). There were diagnostic complications in all cases and final diagnosis was made after surgical material analysis.Conclusions. This data demonstrate low sensivity of fine needle aspiration for identification of lymphoma as well as clinical picture is non characteristic

Sergei Yesenin’s death – a suicide or a murder staged to look like a suicide? An analysis of some selected circumstances of the death and injuries

The article contains some consideration about selected, crucial circumstances of the death of the Russian poet Sergei Yesenin and it also concerns the injuries found in him during the post-mortem examination. The authors have focused on the most important and currently available information which indicates that the true cause of the poet’s death might have been different from the official cause of death. Some facts discredit suicidal hanging and the others suggest a possibility of a murder staged to look like a suicide.Artykuł zawiera rozważania dotyczące wybranych, kluczowych okoliczności śmierci rosyjskiego poety Sergiusza Jesienina oraz stwierdzonych u niego po śmierci obrażeń ciała. Autorzy skupili się na najważniejszych dostępnych dziś informacjach, które wskazują, że faktyczna przyczyna zgonu poety mogła być inna niż oficjalna. Pewne fakty podają bowiem w wątpliwość samobójcze zawiśnięcie w pętli, a inne z kolei sugerują możliwość dokonania zabójstwa z upozorowaniem go na samobójstwo

Damage of Facial Soft Tissues as a Result of Being Bitten by a Dog

Being bitten by a dog can have serious health effects. That is why, never underestimate even the smallest soft tissue injuries inflicted by aggressive animals. This incident may have an impact on the further condition of a patient. From our first aid will also depend the aesthetic and functional effect of the scar on the face. We should pay attention to the use of antibiotic prophylaxis. The aim of the study was to perform the analysis of the soft tissue bitten injuries made by dogs in patients treated in the years 2004‑2009 in the Clinic of Cranio-Maxillo-Facial and Oncological Surgery in Łódź. The most frequent attacked areas were analyzed in the cases of single and multiple face wounds. The dependence of the dog attacks and the alcohol consumption by the victims. The use of an early antibiotic prophylaxis and the number of the infectious complications. Material and methods. The material studied is a group of 26 patients, including 17 women and 9 men. In the majority patients were older than 20 years old. Results. The analysis of our data shows that most of the victims were aged 19-30 and 51-60 years. 14 patients have been mutilated on one area of the face, the remaining patients at least two areas. Most injuries underwent upper or lower lip. In all cases, the initial supply has been applied to the wounds. Antibiotic prophylaxis was used in 23 patients. In one of the other three cases, patient who have not been applied to the prevention of complications in the form of phlegmon face. Half of the attack dogs have been known to the victims. All patients had implemented prevention of tetanus, or held-to-date vaccinations. In eight cases, patients reported that at the time of the event they were under the influence of alcohol. Conclusions. Primary supply of bitten wounds of face at the moment seems to be the standard. In our study, in cases where patients has been treated with an antibiotic, there was no case of infection in the wound. Late complication in the form of phlegmon occurred in one patient who had not used prophylaxis. As the most of the authors note lower lip is the most vulnerable for the bite in the case of adult people. Analysis of our data is consistent with these reports. It has also been found that people under the influence of alcohol are often attacked by unknown dogs

Synthesis and potential cytotoxicity evaluation of carboxymethyl chitosan hydrogels

The aim of the research was to employ radiation to produce flexible carboxymethyl chitosan (CMCS) based hydrogels of uniform structure to characterise their swelling properties and cytocompatibility for potential applications as hydrogel wound dressings. CMCS in aqueous solution was irradiated with an electron beam in the presence of a poly(ethylene glycol) diacrylate (PEGDA) macromonomer as a crosslinker, at 12 different compositions, i.e. 3–20% CMCS, 3 and 5% PEGDA. The obtained hydrogels were subjected to sol–gel analysis. The amount of insoluble fraction (up to 100%) rose with an increase in the PEGDA/polysaccharide ratio. Moreover, the equilibrium degree of swelling, ca. 15 to 200 g of water per g of gel, which was higher for lower content of crosslinker, decreased with the delivered dose, which was associated with an increase in crosslinking density. The in vitro XTT cell viability assay (murine fibroblasts, L929 cell line) showed no significant cytotoxicity of CMCS gels

Attempting to synthesize lasso peptides using high pressure.

Lasso peptides are unique in that the tail of the lasso peptide threads through its macrolactam ring. The unusual structure and biological activity of lasso peptides have generated increased interest from the scientific community in recent years. Because of this, many new types of lasso peptides have been discovered. These peptides can be synthesized by microorganisms efficiently, and yet, their chemical assembly is challenging. Herein, we investigated the possibility of high pressure inducing the cyclization of linear precursors of lasso peptides. Unlike other molecules like rotaxanes which mechanically interlock at high pressure, the threaded lasso peptides did not form, even at pressures the high pressure up to 14 000 kbar