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Biomedical subjects

J Andrychowski

Publications and source records attributed to J Andrychowski.

10 recordsLinked to original sources

Experience with intraoperative high frequency Doppler sonography in neurosurgical practice.

The method of blood flow velocity (BFV) evaluation by intraoperative application of the high frequency Doppler is presented. The device is used to estimate BFV changes in small caliber arteries by direct placement of the probe upon the examined vessel. BFV examinations were performed on the site during aneurysm operations, during transsphenoidal approaches to identify the intracavernous portion of ICA embedded in the tumor mass and in patients after encephalodurosynangiosis evaluated on the outpatient basis. Technical characteristics of the flowmeter used are described and examples of the BFV pictures in cerebral arteries are presented. The device allows a precise BFV evaluation in the selected vessel and detection of changes in BFV patterns particularly useful during aneurysms surgery. This method of identifying cerebral vessels may become applicable in other types of neurosurgical operations.

Blood Flow Velocity

Survival and maturation of heterotopic fetal brain stem xenografts after treatment with 2-chlorodeoxyadenosine and cyclosporine A.

Brain stem halves from fetal rabbits were transplanted to the caudate nucleus area of adult rats. The animals were treated postoperatively with cyclosporine A (CsA) and 2-chlorodeoxyadenosine (CdA) for three days, and with CdA alone for the next 13 days. The treatment started at the day of implantation, and in some animals it was repeated starting at day 36 after grafting (at the time when signs of a light inflammatory reaction appeared in some grafts). Grafts survived and matured histologically, and no signs of acute rejection were observed up to the 90th day. In some grafts we recorded phasic neuronal activities similar to the respiratory-related neural activities characteristic for the adult brain stem. Immunosuppressive with CdA and CsA deserves further evaluation in fetal brain grafting.

Animals

Multiple cerebral cavernous angiomas. Case report.

This 26-year-old woman was admitted to Neurosurgery Department in 1972 for the first time due to increased intracranial pressure and since observed and treated by ventriculo-peritoneal shunt during next twenty years. First symptoms such as visual disturbances, hemiparesis and hemianesthesia appeared 8 years earlier followed 4 years later by epileptic fits. Ventriculography revealed hydrocephalus and the tumor in the region of the third ventricle. CT scan visualized multiple hyperdense foci. Ventriculo-peritoneal shunt provided good improvement. During the next twenty years condition of the patient gradually worsened. Diagnosis of multiple cavernous angiomas was established only at autopsy.

Adult

2-Chloro-2'-deoxyadenosine (2-CdA) combined with cyclosporine A successfully prevents rejection of fetal brain stem allograft in rabbits.

Allografts of brain stem from 20-day-old fetuses to nucleus caudatus of adult rabbits were performed. To prevent graft rejection immunosuppression with 2-CdA and cyclosporine A was transiently induced. Graft survival were assessed by histological and electrophysiological techniques. Both morphological (synaptogenesis, myelinization) and functional (generation of rhythmic neuronal activity) signs of graft maturation were found after nine weeks. The data suggest that transient immunosuppression used is sufficient to induce tolerance to neural graft, and no interference with maturation of implanted fetal tissue occurs.

Animals

Modulation of lymphocyte-fibroblast interactions by 2-chloro-2'-deoxyadenosine (2-CdA) in subarachnoid hemorrhage.

The adherence to monolayers of human fibroblasts of chromium-51 labelled peripheral blood mononuclear cells (PBMC) from normal subjects, and from patients after single or multiple subarachnoid hemorrhage (SAH), and the effect of 2-CdA on cell adhesion have been quantified. The fraction of cells adhering to fibroblasts were the lowest for multiple SAH patients and the highest for normal subjects, which can be explained by depletion of activated lymphocytes from peripheral blood of SAH patients. 2-CdA decreased the fraction of adhering cells isolated from normal subjects, did not change the adherence of cells from single SAH patients and increased the fraction of adhering cells isolated from multiple SAH patients. We conclude that the influence of 2-CdA on the adherence of PBMC to fibroblasts is inversely related to the degree of immune system activation.

Autoimmunity

Successful prevention of neurological deficit in SAH patients with 2-chlorodeoxyadenosine.

Twenty patients suffering from subarachnoid haemorrhage due to ruptured intracranial aneurysm and operated on within 72 h after SAH were treated with an experimental immunosuppressive drug 2-chlorodeoxyadenosine (2-CDA), dose 0.05 mg/kg/day i.v. for 7 days. The 2-CDA treatment was started immediately after angiographic confirmation of ruptured aneurysm, and the standard pharmacological treatment (nimodipine and steroids) was also given. 50% of patients were severely threatened by "delayed vasospasm" or late neurological deficit (Fisher's score 3 or 4). The neurological outcome (assessed 8-12 weeks after SAH) was good (GOS = 1) in 70%, and fair (moderate disability, GOS = 2) in 25%. A single case of severe disability (GOS = 3), as well as two cases of less than perfect outcome (GOS = 2), were related to unusual pre- or intraoperative complications. We conclude that the low doses of 2-CDA can be considered as a valuable adjunct to the standard pharmacotherapy of SAH patients operated on early.

Adult

A strategy for analyzing multiple parameters with application to aneurysmal SAH patients all of them clipped but treated with and without cyclosporine.

The study evaluated the effectiveness of the combination of nimodipine and cyclosporine A vs nimodipine alone in the prevention of delayed neurologic deficit in 82 (31 plus 51) patients in whom intracranial aneurysms were clipped within 72 h after subarachnoid haemorrhage. The tests performed included examination of the neurological condition before and after operation, angiography of cerebral arteries to visualize vasospasm, and analysis of the distribution and amount of blood in the brain fluids and/or tissue according to Fisher's scale. Inclusion of cyclosporine A in the treatment was clearly beneficial for the neurological condition. While cyclosporine A did not appear to produce a statistically significant improvement as evaluated by the chi-square test, a positive result was obtained following analysis of the correlation coefficients after Pearson in combination with the logistic log-linear regression analysis. The results argue against the utility of the chi-square test for verifying clinical data obtained in a limited number of patients.

Adult

Impaired in vitro proliferative response of suppressor lymphocytes in patients with subarachnoid haemorrhage from ruptured intracranial aneurysm.

Proliferative response to mitogens concanavalin A, phytohemagglutinin and pokeweed mitogen, and other chosen indicators of the activity of the immune system were assayed in peripheral blood mononuclear cells isolated from blood of patients with subarachnoid haemorrhage from ruptured aneurysm. Healthy blood donors served as control group. The SAH group displayed impaired response to concanavalin A, which is a mitogen specific for suppressor cells. It is suggested that the impaired activity of suppressor cells pre-existed in patients with subarachnoid haemorrhage, and after intracranial bleeding it might have contributed to the development of late neurological deficits.

Adult

[The usefulness of intraoperative high-frequency doppler flowmetry in surgeries for intracranial aneurysms].

The flowmeter enables estimation of blood flow velocity changes in small calibre arteries. The authors examined blood flow velocity patterns in the vessels during aneurysm operations and blood flow velocity and its disturbances inside aneurysm. Evaluation technique, technical data of the flowmeter use are described and the characteristics of the blood flow velocity picture in cerebral arteries obtained by this method is presented. The presented method enables a very precise estimation of blood flow velocity and detection of changes in flow patterns. The method may become very helpful in identification of the vessels in other types of cerebral surgery.

Equipment Design

[Occipital nerve neuralgia as postoperative complication. Views on etiology and treatment].

Occipital neuralgia might have a various etiology but the most common cause is hypertrophic fibrosis of subcutaneous tissue following trauma to the occipital region, surrounding the occipital nerve. The other important cause of neuralgia is spondylosis of the upper part of the cervical spine (C1-C2). Rare causes are-diabetes, gout and neoplasm. In the presented material we point out the possibility of the occipital neuralgia after surgery in the treatment of the tumours of ponto-cerebellar region and trigeminal neuralgia. We observed the symptoms in two groups of patients and used pharmacological treatment, local blockade and cutting (neuronectomy) of the occipital nerves trunk when the conservative treatment was unsuccessful. We also present the present concepts of occipital neuralgia treatment. In case of severe symptoms, unsuccessful conservative therapy and poor results of the neuronectomy the most indicated therapy is selective posterior rhizotomy.

Cerebellar Neoplasms