Search PubMed⌕ Search

Biomedical subjects

J Wroński

Publications and source records attributed to J Wroński.

At least 19 recordsLinked to original sources
PubMed2001

Possibilities of spatial imaging of carotid arteries pathologies in Power-Doppler US.

The aim of the study was to assess the value of Power-Doppler US spatial reconstructions in examining pathologies of carotid arteries for determining its role in the diagnostic algorithm. 3D Power-Doppler US reconstructions were performed in 19 patients with pathologies of carotid arteries qualified for surgical treatment on the basis of Color-Doppler examinations. Digital data of 2D US sections secondarily gave spatial pictures. Most frequently, 14 times, different degrees of carotid artery stenosis were found, in 3 cases critical, and complete impatency was observed twice. The narrowings were caused by both atheromas and parietal clots. In 3 cases the internal carotid artery formed an angular refraction. Spatial pictures also determined the geometry of division of common carotid arteries. It was found that Power-Doppler 3D US perspectively visualizes the configuration of carotid vessels and the range of their pathology facilitating understanding of the extent of changes and mutual topographic relationships. Spatial imaging let visualize atheromas and ulcerations of their surfaces besides the degree of carotid arteries narrowing.

Algorithms↗
PubMed2001

Arterial to end-tidal carbon dioxide difference during craniotomy in severely head-injured patients.

Clinical data suggest that cerebral blood flow (CBF) can be abnormally low within the first four to eight hours after severe head injury (SHI). An aggressive hyperventilation can additionally worsen CBF and provoke cerebral ischemia. Therefore an accurate PCO2 monitoring in SHI patients (pts) is necessary. PetCO2 failed to reflect PaCO2 in SHI pts treated in neurosurgical ICU. Up to now, the validity of PetCO2 monitoring in estimating PaCO2 during an acute posttraumatic craniotomy has not been studied. Forty five adult SHI pts operated on because of an acute intracranial posttraumatic haematoma within 8 hours after head trauma entered the study. The standard anaesthetic protocol included N2O/O2, fentanyl and pancuronium bromide anaesthesia, and mechanical ventilation with respiratory rate 10 divided by 12 bpm and tidal volume in mL = body weight (kg) x 10 - 100. After obtaining a stable PetCO2 arterial blood sample was taken for PaCO2 measurement and P(a-et)CO2 = PaCO2 - PetCO2 was calculated. P(a-et)CO2 ranged -9 divided by 20 mm Hg (5 +/- 6; mean +/- SD). P(a-et)CO2 between 2 mm Hg and 6 mm Hg was found in 17 (38%) patients only. A negative P(a-et)CO2 was stated in 20% of patients. No relationships between P(a-et)CO2 and pts age and mean arterial pressure were found. P(a-et)CO2 was higher in normocapneic pts than in hyperventilated ones and tended to decrease with an increase in heart rate. We can conclude that during an acute craniotomy in SHI pts, PetCO2 does not reflect accurately PaCO2 and the monitoring of adequacy of ventilation should be based on repeated or continuous measurements of an arterial PCO2.

Adult↗
PubMed2000

Cerebral vasospasm detection by TCD after supratentorial brain tumours surgery.

Serial transcranial Doppler ultrasonography (TCD) studies were carried out in 61 patients, who had been operated due to supratentorial brain tumours. Among 61 cases have been 26 gliomas, 19 meningiomas and 16 metastases. The Mean Flow Velocity (MFV) exceeding 120 cm/s in Middle Cerebral Artery (MCA) and 90 cm/s in Anterior Cerebral Artery (ACA) has been admitted as pathognomonic for vasospasm. The vasospasm has been stated in 14 cases (23%)--10 gliomas and 4 meningiomas out of 61 patients. The vasospasm has been more intense in ACA on the operated (lesion) side than in MCA and on the non operated (opposite) side.

Adolescent↗
PubMed2000

Tramadol for postoperative analgesia in intracranial surgery. Its effect on ICP and CPP.

An ideal analgesic for patients after craniotomy should neither cause respiratory depression, nor affect intracranial pressure (ICP) and cerebral perfusion pressure (CPP). The aim of the study was to evaluate the effect of Tramadol (T) on ICP and CPP, as well as to determine its analgetic efficacy in patients (pts) after craniotomy. Thirty five pts aged 16 divided by 78 years (mean 46) entered the study. Twelve had GCS (Glasgow Coma Scale) scores < or = 8 and 23 pts had scores > or = 12. Fourteen pts were mechanically ventilated and 21 pts were breathing spontaneously (BS). Tramadol was injected i.v. at a dose of 0.75 mg/kg over 3 minutes in 11 pts (Group 1), 1.0 mg/kg over 5 minutes in 13 pts (Group 2) and 1.0 mg/kg over 10 minutes in 11 pts (Group 3) PaCO2 was measured before T in all pts and at 8 minute after injection in 21 BS pts. Heart rate (HR), mean arterial blood pressure (MBP), ICP, CPP and respiratory frequency (f) were registered before and in the 1st, 3rd, 8th, and 15th minute after T. Analgetic effect was evaluated in 22 conscious pts by comparing the pain intensity before and 30 minutes after T using a five-point verbal response scale. Mean control ICP was 17 mmHg. ICP over 15 mmHg was diagnosed in 15 pts (mean ICP equal 26 mmHg). Mean CPP for all 35 pts was 85 mmHg. There were no statistically significant changes in HR, MBP, ICP, and CPP after T in any particular group, nor were there changes in ICP in subgroups with normal and elevated ICP. No significant changes in PaCO2 and f were found in BS pts. Satisfactory analgesia was obtained in 50% of pts of Group 1, and in 88% of pts of Groups 2 and 3. We conclude that tramadol in doses of 0.75 mg/kg and 1.0 mg/kg i.v. does not affect ICP and CPP in adult postcraniotomy patients and seems to be a safe and effective analgesic at a dose of 1.0 mg/kg for postcraniotomy pain control.

Adolescent↗
PubMed2000

The concept of cerebral circulatory-pressure index (CCPI).

The theoretical relations between blood pressure (MABP), intracranial pressure (ICP) and cerebral perfusion pressure (CPP) as well as the new Cerebral Circulation-Pressure Index (CCPI) are presented in the paper. The special nomogram collecting all of these parameters was constructed. CPPI was defined as a quotient of CPP and ICP: [formula: see text] CCPI reflects the relationship between the systemic MABP and ICP and for ensuring the normal conditions of intracranial circulation the MABP must be at least 4 divided by 5 times higher than ICP. The low values of CCPI, if they are not immediately corrected, results on severe brain disability or even death. We didn't find till now what should be the upper limit of CCPI, which overcrossing may be danger for the patient, especially with impaired autoregulation. Based on analysis of patients operated due to intracranial disorders as brain tumours, spontaneous and traumatic haematomas as well as ruptured aneurysms we find that the values of CCPI over 3 have a good prognosis, between 3 and 2 is a field for intensive treatment consisting on decreasing ICP or increasing the systemic blood pressure or both. If CCPI is below 1.5 the prognosis is pessimistic and all the patients died. CCPI together with the nomogram are useful in current evaluation of the state of patients and of the efficacy of treatment and prediction of the treatment results.

Adolescent↗
PubMed1997

[A case of frontal sinus osteoma with unusual clinical course].

The case of frontal sinus osteoma causing exophtalmus and brain compression was presented. The osteoma was removed surgically. The information connected with histopathological and clinical features of the tumor were shown. The review of literature was presented.

Adult↗
PubMed1995

[Pneumocephalus following facial injury].

Pneumocephalus or intracranial air its commonly detected following serious head injury and posterior fossa surgery. In laryngology the frequent reason of its appearance is also herniation of air through a break in the wall of skull due to advanced benign and malignant tumors. The pathophysiology involves the presence of craniodural fistula allowing ingress of air. A ballvalve mechanism may allow air to enter not exit the cranium or like in turned upside down bottle leak permit air entrance as fluid leaves the intracranial space. The presence of air is usually asymptomatic but caries a potential risk of increased intracranial pressure or meningitis which require an immediate therapy. Although various ways of treatment were reported prevention and early diagnosis are the most important. We report 3 cases of cerebral air that occurred secondary to the head trauma. The diagnosis every time promptly confirmed by skull roentgenogram or CT.

Adult↗
PubMed1990

Clinical experiences with nimodipine treatment in patients after SAH and aneurysm surgery.

The authors present their 3-years experiences with nimodipine treatment in patient after subarachnoid haemorrhage (SAH). Nimotop has been used in treatment of SAH in the Department of Neurosurgery since June 1985. During 3-years 220 patients with subarachnoid haemorrhage were admitted to the Department of Neurosurgery in Wroclaw. Till the end of 1989 177 patients with SAH received nimotop therapy. Our results show that intravenous Nimodipine is well tolerated, and we have not observed any discontinuation effects, after we had introduced gradual diminishing doses of Nimotop. Nimotop does not prevent of developing vasospasm in all patients, but their outcome is better. The treatment of vasospasm should be complex (with nimotop and hypervolemic and hypertensive therapy).

Adolescent↗
PubMed1980

[Giant aneurysm of the internal carotid artery, stimulating parasellar tumor].

The authors report a case of a giant aneurysm of the internal carotid artery filling from the left internal carotid artery below the site of branching-off of the posterior communicating artery. The initial neurological, and ophthalmological signs and plain films of the skull suggested presence of an Erdheim's tumour. It is worth stressing that the onset of the clinical manifestations was at the age of 15 years, particularly in the form of progressing binasal hemianopsia with sparing of the lower temporal quadrant. The efficiency of the cerebral circulation was tested using Mathas' test, electroencephalography, ophthalmodynamometry and angiography. It was decided to ligate the left carotid artery although Mathas' test during angiography was not as positive. The boy tolerated the operation well. Ophthalmological examination demonstrated after 18 months normal visual fields and normal visual acuity. Further follow-up during 8 years demonstrated normal psychosomatic development of the boy.

Adolescent↗
PubMed1980

[Diagnosis of blood flow disorders in the common carotid arteries by the ultrasonic Doppler method].

The aim of this work was evaluation of the usefulness of the Doppler ultrasound method for detection of blood flow disturbances in carotid arteries. The investigations were done in 110 patients with symptoms of cerebral circulatory disorders. In 45 patients carotid arteriography was done. In 30 cases arterial reconstructive operations were performed. The curves of blood flow velocity in the common carotid arteries were recorded with a UDP-10 ultrasound blood flow detector. The obtained curves were subjected to morphological analysis and the mean momentary velocity of the systolic and diastolic flow wave was calculated. In 80% of cases with impaired patency of the carotid arteries demonstrated by angiography abnormal curves of blood flow velocity in the common carotid arteries were obtained. The method of ultrasound recording of blood flow velocity is non-invasive and safe and it is very useful for establishing indications to angiography and for postoperative control.

Adult↗