Neurol Neurochir Pol
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The current frequency increase of gunshot wounds to the head is directly proportional to the access to firearms and to amount of firearm-related crimes. This risk is increasing especially in population groups that have not been threatened before. Hence the aim of this study was to analyse and resume our experiences in the management of faciocerebral gunshots. ⋯ One patient was dead (GOS Score 1), and 7 (78%) improved to good, independent functional status (GOS Score 4 or 5). The authors emphasize the necessity of multispecialistic initial operative management of faciocerebral gunshots wounds and aggressive pre- and postoperative care (tracheostomy, gastrostomy, treatment of encephalitis), which makes it possible to obtain good and very good outcomes. Furthermore, we stress the role of minimal primary debridement for the sake of frequent secondary reconstructive operations.
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The paper contains a review of reports concerned with how for hormones, epileptic seizures and antiepileptic drugs can be influenced by one another. Hormones influence brain excitability but, on the other hand, both epileptic seizures and antiepileptic drugs may alter hormone secretion and metabolism. Effect of hormones on seizures--Experimental studies revealed the properties which inhibit or stimulate convulsive reactivity of different hormones. ⋯ By induction of hepatic microsomal enzymes, some antiepileptic drugs cause acceleration of hormone metabolism, reducing hormone serum concentrations. Moreover, antiepileptic drugs enhance sex hormone binding globulin SHBG/synthesis, increase binding of these hormones and reduce their active fraction concentration in serum. Recognition of the relationship between epilepsy and hormonal system is necessary to obtain better understanding of this disease.
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Neurol Neurochir Pol · Jan 2000
Factors leading to hydrocephalus after aneurysmal subarachnoid hemorrhage.
The predisposing factors for the development of posthemorrhagic hydrocephalus, requiring shunt implantation, after subarachnoid hemorrhage (SAH) are still not exactly known. Therefore we analyzed the patients with SAH, who were treated in our department with respect to the development of chronical cerebro-spinal fluid (CSF) imbalance, trying to define predictive parameters for this entity. ⋯ Chronic hydrocephalus after aneurysmal SAH is an important complication. The recovery-time of shunt dependent patients is definitely prolonged compared to non-shunted patients. Predictive factors of shunt dependency seem to be length and amount of the external CSF drainage, as well as a high bicaudate index.
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Neurol Neurochir Pol · Jan 2000
Approaches to posterior circulation aneurysms and results of the operations.
Surgical approaches and operative results in 32 operations of aneurysms of the vertebrobasilar system are presented. The orbitozygomatic and temporopolar approach was used for aneurysms of the bifurcation of the basilar artery lying high in the interpeduncular fossa. In aneurysm which neck was located less than 10 mm above or less than 5 mm below the anterior and posterior clinoid processes the pterional transylvian subtemporal and pterional anterior temporal approaches were performed. ⋯ The used approaches made it possible to clip the aneurysms. Good and very good results were obtained in 82 per cent of cases. The perioperative mortality was 9 per cent.
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Mild hypothermia may occur spontaneously or, because of its putative neuroprotective effect, may be induced purposefully during neurosurgical procedures. Though the brain is the organ targeted for the purpose of neuroprotection, little is known about its temperature during general anaesthesia and craniotomy. The purpose of this study was to define the relations between core, skin and brain temperature during craniotomy and to compare two modes of inducing thermal insulation in patients during operative procedures. ⋯ Furthermore tympanic and oesophageal temperature was on average 0.5 degree C higher than brain temperature. In conclusion, temperature measurements obtained in standard sites do not reflect brain temperature reliably during craniotomy and general anaesthesia. This indicates that the direct measurement of intracranial temperature is necessary for correct estimation of brain hypothermia.