Biomedical subjects
Publications and source records attributed to Z Mariak.
A case of dens fracture with severe dislocation not accompanied by spinal cord injury is presented. Cranial traction has been employed, reduction followed. Orthopedic neck brace has been used for further four weeks. Bony union has been achieved.
The paper contains a review of literature and results of own epidemiological research concerning injuries of cranial nerves II-VI in patients with closed head trauma. Injuries to cranial nerves, especially to the oculomotor nerve, occur more commonly than it could be concluded from routine clinical observation.
Ophthalmological examination was performed in 350 consecutive inpatients with closed head injury, treated in the Neurosurgical Department, Białystok over a period of two years. The group comprised 266 men and 84 women, aged between 16 and 90 years. The purpose of the study was to screen for the symptoms of damage to cranial nerves II-VII. In 12% of cases internal, external or total III nerve palsy was identified. In 2% of cases there were symptoms of damage to the VII nerve, in 1.4% of damage to the V nerve and in 1.1% to the II nerve. In 0.6% of cases damage was observed to the VI nerve. There were no cases of damage to the IV nerve. Thus the III nerve was found to be the most susceptible to damage in head-injured patients.
Brain autopsy was carried out in 12 patients who died within 3 days of closed head injury. A segment of the brain stem with the entire intracranial portions of nerves II-VII was dissected in each case, fixed in formaline and inspected thoroughly under magnification. Injuries to the examined nerves were seen in 9 subjects. The oculomotor nerve was torn out of the midbrain unilaterally in 3 and bilaterally in 2 cases. In one patient only a portion of the superficial fibres on the medial aspect of the nerve was ripped out from the brainstem. In two patients the IV nerve was ruptured. The root of nerve V was contused in one case. Bilateral avulsion of the root of the VIth nerve from the brainstem was found in two cases. The initial segment of the facial nerve was crushed in two subjects. No visible injury to the ophthalmic nerves was found in any of the cases examined. The results suggest that cranial nerves related to the visual system are subject to serious injury in most cases of severe closed head trauma.
The present study was performed to investigate the relationship between noninvasive measurements of core temperature and intracranial temperature measurements in humans. At 2-3 weeks following minor subarachoid haemorrhage, five patients were studied during open brain surgery. All patients were fully conscious and free of neurological symptoms at the time of surgery. During craniotomies in the frontotemporal region, temperatures between the dura and brain surface were on average 0.58 (SD 0.51) degrees C lower than those near the mesencephalon. During the 60-90 min following the initial exposure of the brain surface to the ambient temperature of 24 degrees C, subdural temperature at the convexity decreased by 0.72 (SD 0.43) degrees C and subdural temperature at the basis decreased by 0.36 (SD 0.17) degrees C. During the same period, mesencephalon temperature decreased by 0.22 (SD 0.10) degrees C. The decreases of cerebral temperatures were followed by a similar decrease in tympanic temperature of 0.28 (SD 0.10) degrees C but by an increase in rectal temperature of 0.22 (SD 0.13) degrees C and an increase in oesophageal temperature of 0.20 (SD 0.20) degrees C. The maximal shift of frontal skin temperature during the same period amounted to +0.04 (SD 0.21) degrees C. The findings would seem to support the thesis that a direct relationship does exist between tympanic and brain temperatures in humans and that of the externally accessible body temperatures, tympanic temperatures giving the best approximation of average cerebral temperature.
The authors presented results of extracapsular cataract extraction with IOL implantation performed in 421 eyes using (with) simple removal of the lens nucleus, according to Pears' method. Details of this technique and the value of this way of nucleus removal for the later stages of cataract surgery is discussed.
We measured the temperature of arterial blood within the circle of Willis (T(Willis)) in seven normothermic patients undergoing carotid arteriography. We found this temperature to be lower by 0.13 to 0.30 degrees C than tympanic temperature and by 0.30 to 0.55 degrees C lower than rectal temperature. By imposing this data on calculated cerebral heat balance it can be suggested that the average cerebral temperature of a resting subject is somewhat higher than tympanic temperature. These findings would also support indirectly the thesis that temperature gradients may exist within the brain.
A case of 14-year boy with the optic nerve avulsion from the eyeball is presented. There were no changes in the anterior segment of the eye and pathological findings in the x-ray examination. Diagnostic difficulties and the probable pathomechanism of the injury are discussed.
Increased platelet aggregability is regarded as being a sensitive indicator of the initiation of thrombotic processes. Platelet aggregation was analysed in blood taken from the common carotid artery before and 30 min after its ligation in 3 patients, as well as in the venous blood of 14 patients in the late postoperative period. No tendency towards increasing platelet aggregation was observed in either of the groups investigated.
A series of 17 patients was investigated following common carotid ligation. The period between operation and examination ranged from 2-7 years. Cerebral circulation was estimated by use of the rheoencephalographic method. Statistical analysis of the reg plot was performed by comparing an age-matched normal population with patients. A comparison was also made of the ligated and nonligated sides for the patients. The following results were obtained: a significant decrease in the amplitude of the reg waves, an extension in the anacrotic part of the wave, and a decrease in the angle of its inclination. This was intensified more on the side of the common carotid ligation. These findings may suggest that after common carotid ligation the cerebral circulation is changed for a long period of time. They would also seem to indicate that postoperatively, the cerebral circulation does not return to normal--if it ever does.
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The problem of measurement of intracranial pressure in the epidural space is discussed in the light of the authors' own experience. Three forms of transducers have been used consecutively: (1) a capsular form which slides into the epidural space, (2) a screw-shaped form, fixed firmly in a burr hole and (3) a cylindrical tape, designed to be fixed in a burr hole with the aid of a protective socket. The zero point may be adjusted during measurement. The merits and disadvantages of these three types of transducer, as well as the practical problems connected with their use are discussed.
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