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Serologic tests are one of the available diagnostic tools in COVID-19. Growing literature highlights their role in the clinical management of the disease. Unfortunately, due to the limited availability of commercial tests and the lack of reliable trials establishing the sensitivity and specificity of the diagnostic method, the clinical application of the test needs to be precisely determined. In this paper, we discuss the utility of anti-SARS-CoV-2 serology testing in a clinical setting and propose diagnostic algorithms that include serological tests in patients with confirmed or suspected COVID-19., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Objective: In order to introduce automated vehicles on public roads, it is necessary to ensure that these vehicles are safe to operate in traffic. One challenge is to prove that all physically possible variations of situations can be handled safely within the operational design domain of the vehicle. A promising approach to handling the set of possible situations is to identify a manageable number of logical scenarios, which provide an abstraction for object properties and behavior within the situations. These can then be transferred into concrete scenarios defining all parameters necessary to reproduce the situation in different test environments. Methods: This article proposes a framework for defining safety-relevant scenarios based on the potential collision between the subject vehicle and a challenging object, which forces the subject vehicle to depart from its planned course of action to avoid a collision. This allows defining only safety-relevant scenarios, which can directly be related to accident classification. The first criterion for defining a scenario is the area of the subject vehicle with which the object would collide. As a second criterion, 8 different positions around the subject vehicle are considered. To account for other relevant objects in the scenario, factors that influence the challenge for the subject vehicle can be added to the scenario. These are grouped as action constraints , dynamic occlusions , and causal chains . Results: By applying the proposed systematics, a catalog of base scenarios for a vehicle traveling on controlled-access highways has been generated, which can directly be linked to parameters in accident classification. The catalog serves as a basis for scenario classification within the PEGASUS project. Conclusions: Defining a limited number of safety-relevant scenarios helps to realize a systematic safety assurance process for automated vehicles. Scenarios are defined based on the point of the potential collision of a challenging object with the subject vehicle and its initial position. This approach allows defining scenarios for different environments and different driving states of the subject vehicle using the same mechanisms. A next step is the generation of logical scenarios for other driving states of the subject vehicle and for other traffic environments.

Purpose: Patients with malignant tumours of the oral cavity require its surgical removal and reconstruction of the bone and soft tissues. The grafts are obtained either from leg (fibula) or pelvis (iliac crest). The removal of grafts from the locomotor apparatus can impair the gait. The aim of this study was to find out how the localization of donor site influences the gait pattern., Methods: Results obtained for 30 patients were analyzed (16 fibula graft, 14 iliac crest graft). Patients underwent instrumented gait analyses three times (VICON system): before surgery, 2-4 month after the surgery, and 4-8 months after the surgery., Results: In both groups several gait parameters were changed. Two parameters changed in both groups: gait speed and cadence. In patients receiving iliac crest graft the changed gait variables were: pelvic rotation, hip range in sagittal plane (operated side), knee range in sagittal plane (operated side), foot dorsiflexion in swing on both sides. In patients receiving fibula flap the changed gait variables were: tilt, range motion of the tilt, minimum hip flexion (operated side), time to maximum knee flexion (non-operated side), GGI (non-operated side) and step length (nonoperated side)., Conclusions: The primary gait deviations occurring after surgery, and the compensatory mechanisms which subsequently arise depend on the localization of graft donor site. The results indicate that the patients in whom fibula flap was used have less problems with gait pattern after the surgery than the patients receiving iliac crest graft.

Background: Surgery for scalp malignancies is aimed at the complete resection and a good aesthetic outcome. The goal was to develop an algorithm for scalp reconstruction based on the authors' surgical experience., Methods: This is a retrospective analysis of 123 procedures of scalp malignancies in 105 patients. Twenty eight procedures were for resection of squamous cell carcinoma, 54 for basal cell carcinoma, and 41 for suspected melanomas., Results: Primary closure (27 procedures), local flap (LF; 19), split-thickness skin graft (SG; 64), rotated LF and SG (9), and free vascularized flaps (4) were used. Complications were partial (4) and total (1) necrosis of SG, free-flap atrophy (1), infection (2), wound dehiscence (1), and death due to cardiovascular complications (1). During follow-up, recurrence occurred in 22 patients (21%) and metastases to lymph nodes in 3 (3%)., Conclusion: Surface area size and the presence of the periosteum as well as a bone infiltration are important factors that can guide selection of a reconstruction method after resection of scalp malignancy.

Background: A small size and difficulties with shaping a medial femoral condyle corticocancellous bone flap are factors limiting its use. The goal of this study was to evaluate range of vascular supply to a medial femoral condyle corticocancellous bone flap to determine whether harvesting of larger flaps and performing a flap osteotomy would compromise the vasculature of a flap's bone., Methods: Twenty-four limbs were dissected and medial femoral condyle corticocancellous bone flaps were harvested with skin paddles. Thirteen of 24 flaps had subperiosteal osteotomies simulating shaping a bone for reconstruction. A pedicle artery was perfused with red latex. Medial femoral condyle corticocancellous bone flap vascularization was evaluated by cutting the bone into 1-cm blocks and assessing the number of Haversian canals filled with red latex., Results: Length of harvested flaps was 7 to 13 cm, thickness was 0.5 to 3 cm, and width was 1 to 3 cm. Pedicle length was between 3.5 and 9 cm (mean ± SD, 6.6 ± 1.6 cm). Red latex filled bone vessels at a distance of 6 to 11.5 cm from the distal end of a flap (8.2 ± 1.4 cm). Skin paddles were filled with latex in all cases., Conclusion: A medial femoral condyle corticocancellous bone flap had sufficient blood supply, allowing for harvesting flaps up to 11 cm long, and subperiosteal osteotomy did not compromise the vasculature of the flap's bone.

Background: Rhabdoid meningioma is rare aggressive meningioma histological subtype that develops predominantly through progression from less malignant tumors. Owing to its low incidence, this tumor's biological background is unknown. The aim of this study was to profile somatic mutations in 4 meningioma samples from the same patient, derived previously from 4 subsequent tumor resections., Case Description: A 58-year-old woman presented with recurrent meningioma progressing from atypical to rhabdoid subtype. Four tumor samples that represent a primary tumor (atypical GII) and 3 recurrent tumors that were subsequently removed (anaplastic GIII, rhabdoid GIII, and anaplastic/rhabdoid GIII) from this patient were subjected to mutational analysis of coding sequences of 952 tumor-related genes. Three mutations were identified in all tumor samples exhibiting a high allelic frequency: ARID1A frameshift deletion, NF2 in-frame deletion, and missense variant of SRSF2. The predicted inactivating effect of ARID1A deletion was confirmed by immunohistochemical staining of tumor sections in which a high proportion of cells lacked protein expression. Additional low-allelic-fraction mutations were observed in all tumor samples, likely representing "passenger," low-effect mutations that reflect a clonal selection of tumor cells through malignant progression of the meningioma., Conclusion: The mutation of ARID1A that encodes the subunit of the SWI/SNF complex represents the most likely driver of the tumor's malignant potential. It also may be involved in the acquisition of the rhabdoid phenotype, given that mutations in chromatin remodeling proteins are the hallmark of atypical teratoid/rhabdoid tumors., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Aim: The goal of this prospective study was to assess the effectiveness of a hypofractionated accelerated regime in treatment of the larynx cancer., Background: Multiple radiotherapy delivery regimes are used for treatment of the larynx cancer. Hypofractionated regimes could provide similar results with reduced use of radiotherapy facilities., Material and Methods: 223 patients with squamous cell carcinoma of the upper or middle larynx have been treated with 63 Gy delivered in 28 fractions of 2.25 Gy during 38 days, 5 fractions per week. The study endpoints were overall survival, progression-free survival, early and late treatment toxicity. Standard and accelerated radiotherapy groups from the study published by Hliniak et al. 20 served as controls., Results: Five-year actuarial overall survival was 87.5% in the study group, 84.5% in the control group receiving accelerated radiotherapy (33 fractions of 2.0 Gy, 6 fractions per week) and 86.2% in the control group (33 fractions of 2.0 Gy, 5 fractions per week). Five-year progression-free survival was 73.6%, 77.2% and 66.2%, respectively. Overall, treatment toxicity and complication rates did not differ between the study group and the control groups., Conclusions: The hypofractionated accelerated radiotherapy protocol using 5 fractions per week reduced the use of radiotherapy facilities. There was no significant difference in overall survival and progression-free survival between the study and control groups treated with accelerated or standard radiotherapy.

INTRODUCTION In numerous countries legislation has been put in place allowing citizens to appoint persons authorized to make medical decisions on their behalf, should the principal lose such decision‑making capacity. OBJECTIVES The paper aimed to prepare a draft proposal of legal regulations introducing into Polish legislation the institution of the health care agent. PATIENTS AND METHODS The draft proposal has been grounded in 6 expertise workshops, in conjunction with several online debates. RESULTS The right to appoint a health care agent should apply to all persons of full legal capacity, and to minors over 16 years of age. Every non-legally incapacitated adult person would be eligible to be appointed a health care agent. Appointment of substitute agents should also be legally provided for. The prerogatives of health care agents would come into effect upon the principals' loss of their decisionmaking capacity, or upon the principals' waiving their right to be provided with pertinent information on their health status. The health care agents would make decisions in all matters pertaining to medical treatment, while remaining under no obligation to perform any hands-on caring duties for their principals. The term of medical power-of-attorney should be discretionary, while its revocation or resignation should be possible at any time. In the event of health care agents' inactivity, or in the event that their actions should appear contrary to the principals' best interests, an attending physician should notify a pertinent court of law whose prerogatives would facilitate revocation of a medical power-of-attorney.  CONCLUSIONS Statutory appointment of a health care agent allows every citizen to appoint in this capacity a person who, to the best of his or her knowledge, would best represent his or her interests in the event that the principal should ultimately lose the capacity to make medical decisions on his or her own behalf.

Introductions: According to clinical observations primary neoplastic lesions in the head and neck are often complicated by infection. The incidence of postoperative complications of cancer lesions of the head and neck, oral cavity, upper airways or larynx is from 19% up to 47% cases but in extensive and long-term operations can reach 80%., Methods: We retrospectively evaluated results of microbiological investigations of 312 clinical specimens collected from patients from Clinical Head and Neck Cancers of On- cology Center in Warsaw in the years 2008 -2012. All samples of clinical materials were plated on the suitable culture media and incubated according to the recommendations., Results: The study has shown that from all collected clinical specimens 491 strains have been isolated. Nearly half of the cultured bacteria were Gram-positive cocci (48.7%), mainly methicillin-sensitive Staphylococcus aureus. Most Gram-negative bacteria isolated from neoplastic lesions in the head and neck belong to Enterobacteriaceae (21%), 23,4% of cultured bacteria grown anaerobically and they were mainly Gram-negative rods., Conclusions: The presence of diverse bacterial flora colonizing the mucous membranes of the mouth and throat may be the reason of difficulties in interpretation of microbiological investigation. It must be remembered that knowledge of colonizing and pathogenic flora of the area of head and neck enables appropriate preoperative prevention and empiric therapy.

Objective: The study focuses on the comparison of tissue reaction to titanium and bioresorbable implants with and without postoperative irradiation on an animal model., Materials and Methods: Thirty-nine LEW/W rats were randomly assigned to experimental or control groups. One titanium and one bioresorbable screw (poly-L-lactide [PLLA] and L- and D-lactide poly-L/D-lactide [PDLLA]) were implanted into the left scapulas of 24 rats. Half of them received 30 Gy to the operation site and the other half received 42 Gy. In the control groups, 3 rats received 30 Gy, and 6 rats received 42 Gy to the scapula area without operation; and 6 rats had implants inserted as in the experimental group, but received no postoperative irradiation. The scapulas were removed 14 or 30 days after irradiation and a histologic analysis was performed., Results: The host tissue reaction to titanium and PLLA-PDLLA screws without postoperative irradiation was of similar intensity. In irradiated animals, the inflammatory tissue reaction was more evident around the titanium screws than around the bioresorbable screws, irrespective of the radiation dose and of the time that elapsed from the irradiation. The reaction was more evident on the 14th day than on the 30th day after the last radiation dose (70 and 86 days after surgery, respectively). The intensity of the inflammatory tissue reaction, irrespective of the implant type, was more intense in the group irradiated with 42 Gy., Conclusions: PLLA-PDLLA implants appear to cause less tissue reaction after irradiation and could be safer reconstructive devices than titanium implants for patients undergoing surgery and adjuvant radiotherapy for cancer., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Background: The purpose of this study was to determine the timing and type of surgical field contamination in 50 consecutive resections for advanced head and neck cancer with same-stage tissue reconstruction and to analyze the relationship between contamination and the surgical site infection., Methods: Swabs from the surgical field and from surgical drapes close to the field were taken every 2 hours (at 0 hour, 2 hours, 4 hours, and 6 hours) and sent for a standard microbiological diagnostic procedure. Results were recorded in Microsoft Excel and analyzed with SPSS., Results: We collected 336 swabs of which 71% were contaminated. Polymicrobial contamination was observed in 153 samples (45%). Twenty-six species of pathogens were found, the most frequent was Streptococcus species. Surgical site infection with positive culture occurred in 3 patients., Conclusion: In head and neck surgery for advanced cancer, standard aseptic procedures do not prevent contamination of the surgical field with physiological bacterial flora of the skin and oral cavity. Although contamination was common, surgical site infection was rare., (© 2013 Wiley Periodicals, Inc.)

In head and neck region leiomyosarcoma is a very rare finding. This tumor is usually located in abdominal cavity. We report a case of 78-year-old man with tumor of the auricle that was resected with 0.7 cm margin. Histological and immunohistochemical analysis revealed the leiomyosarcoma. Adjuvant therapy was not advised. During 3 years of follow-up there are no signs of recurrence. Review of the literature shows that the survival of patients with leiomyosarcoma in head and neck region seems to be similar to other kinds of sarcomas in this localization. It is not clear, how large surgical margins should be to achieve satisfactory local control., (Copyright © 2012 Polish Otorhinolaryngology - Head and Neck Surgery Society. Published by Elsevier Urban & Partner Sp. z.o.o. All rights reserved.)

Mesenchymal chondrosarcoma (MChS) is a rare, high-grade malignant tumor which occurs both in the bone and soft tissue. The extraskeletal location comprises one third of all MChS and in review of the up-to-date literature, about 30 cases of the orbital involvement were found. The authors present clinical, radiological and pathological findings of two cases of MChS of the orbit occurring in young adult females: primary extraskeletal MChS of the orbit and skeletal MChS of the ethmomaxillary complex with secondary orbit involvement. The histopathological examination revealed a characteristic biphasic pattern composed of small round to spindle-shaped cells, mimicking Ewing sarcoma family of tumors, with areas of a haemangiopericytoma-like pattern and admixed cartilage foci. One of the patients had local recurrence 3 years after initial surgical removal. Subsequently, she underwent enucleation followed by chemotherapy. The other patient had a biopsy and debulking resection of the tumor and started chemotherapy. Ten months follow-up of this patient show no evidence of metastasis.

Purpose: Analysis of surgical approaches to primary tumors localized in parapharyngeal space used in Head & Neck Cancer Department, Cancer Center Institute in Warsaw. Description of differences in terminology used to describe fascial compartments of the neck., Material and Methods: Retrospective analysis of medical records of 8 selected patients who had an operation for primary parapharyngeal space neoplasm. Analysis has been done of operation protocols, diagnostic images, tumor size and histopathology., Results: Transcervical, transparotid and transmandibular approaches were used with additional rhinotomy and craniotomy in selected cases. Selection of approach should take into account tumor localization, its size and histopathology., Conclusions: Planning of surgical procedure for parapharyngeal space tumor should be based upon analysis of diagnostic images and selection of the approach depends on tumor localization, size and histopathology. Differences in terminology of superficial and middle cervical fascial compartments can lead to inappropriate clinical decisions.

In the paper the optical diffraction tomographic system for reconstruction of the internal refractive index distribution in optical fiber utilizing grating Mach-Zehnder interferometer configuration is explored. The setup applies afocal imaging. Conventional grating application gives, however, highly aberrated object beam producing incorrect refractive-index reconstructions. The grating inherent aberrations are characterized, its influence on both image projections and refractive index reconstructions is presented. To remove aberrations and enable tomographic reconstruction a novel digital holographic algorithm, correcting optical system imaging, is developed. The algorithm uses plane wave spectrum decomposition of optical field for solving diffraction problem between parallel and tilted planes and enabling correction of imaging system aberrations. The algorithm concept was successfully proved in simulations and the experiment.

Objectives: Juvenile angiofibroma is a benign, non-encapsulated neoplasm, consisting of vascular and connective tissue. Its main feature is a local malignancy. In its clinical course it destroys adjoining structures, without metastasizing. It appears rarely, and is mainly found in boys at puberty. Among theories about the aetiology of juvenile angiofibroma, we must consider a haematoma-like lesion, an angioma with an extended fibrous component, or type of inflammatory allergic polyp. In the development of the lesion the participation of hormonal disorders on the pituitary gland-gonad axis is also suggested. According to the latest research, juvenile angiofibroma is regarded as a developmental defect, affecting the embryonic vascular network surrounding the sphenoid bone., Methods: If the patient or his/her parents refuse blood transfusion and use of blood products, it is necessary to apply modifications in the routine perioperative treatment. In the case of the patient refusing blood and blood products transfusion because of their beliefs, it is possible to get consent to use different, highly processed products like albumins or a cryoprecipitate, as well as applying some blood-saving techniques., Conclusions: 1. Removal of juvenile angiofibroma with minimal bleeding is possible. 2. Applying erythropoietin and iron preparations prior to surgery increases erythropoiesis and reduces the risks in transfusion. 3. Applying intraoperative normovolaemic haemodilution is a safe method and allows avoidance of transfusion of blood-derived products.

Infection rate registered on the basis of clinical symptoms and of microbiological forms in patients treated in Surgery Division, Head & Neck Cancer Department during 2001-2003, was analyzed. Total number of patients treated was 2343. In 664 preoperative microbiological cultures have been obtained from suspected areas and in 52.8% of these a pathogen has been found. Patients undergoing major surgery received a prophylactic antibiotic selected by an infection control team and Microbiology Department. If preoperative cultures showed resistance to standard prophylactic antibiotic, another was selected on the antibiogram basis. Particular attention was paid to all the elements of prophylactic against infection in the ward, examination and dressing rooms, operating theatre. In 48% of patients, mainly those after extensive, prolonged surgery, antibiotics (usually 3rd generation cephalosporins) were used for 5-7 days. During 2001, 2002 and 2003 correspondingly 148, 97 and 58 infections were registered with positive culture and infection with clinical symptoms occurred in 30, 21 and 20 patients (4%, 2,8% i 2,3%). Comparisons of hospital infection rates between different institutions are very difficult, but relatively low rate in our material and decreasing number of infections registered during consecutive years show that persistent and multifaceted prophylactic interventions can result in significant reduction of hospital infections also in patients wits contaminated surgical field.

The authors report the case of 68 year old male operated upon for the branchial cyst of the neck. Histopathological examination showed carcinoma in the wall of the cyst. Ipsilateral tonsillectomy was done and pathology revealed primary focus in the palatine tonsil. Diagnosis of the branchiogenic cancer should be made only when all the criteria defined by Martin in 1950 are met. Patients with carcinoma cells found in branchial cyst should be diagnosed and treated as metastasis from Waldeyer's ring to the lymph nodes of the neck. Ipsilateral tonsillectomy is indicated as blind biopsy. When histopathological examination of the tonsil is negative the patients should be treated as metastasis to the neck from unknown primary focus.

The giant pituitary adenoma surgery remains a real challenge to any neurosurgeon. Despite an extensive development of transsphenoidal techniques, open craniotomy procedures still are required in 5-10% of all cases with pituitary adenoma. The skull base surgery techniques not only allow to minimize the surgery-related trauma of the brain, but also improve the access to the operating field. In the years 1998-2001 the authors operated on the total of 395 pituitary adenoma patients, mostly using the transsphenoidal approach (320 cases), with skull base surgery techniques applied in 75 cases (i.e. in 19% of all patients)--in 67 patients the transbasal-subfrontal approach was applied, and in 2 cases--lateral rhinotomy. There were two indications to the transbasal-subfrontal approach: a large size of the tumor causing visual disturbances, and extension of the adenoma to adherent anatomical spaces. In this group of patients the total removal of the tumour was achieved in 88% of cases. In the remaining patients remnants of the tumor were left in the cavernous sinuses. The skull base surgery techniques are most useful in the treatment of selected patients with pituitary adenoma.

A case of a 44 year-old woman farmer with a total deafness and lack of vestibular function on the left side operated upon the cerebello-pontine cystic neuroma 2.5 x 2.0 x 1.5 cm large via the retromastoidal craniectomy is presented. Despite of the negative audiological tests' results the cochlear nerve flatten on the tumor was cautiously separated. Some time after surgery, she observed "a partial recovery of hearing" in the operated ear confirmed by the tonal (mean 0.5-2 kHz 36 dBHL) vocal SRT 70 dB), BERA and EOAEs tests. The paralysis of the left vestibular function did not recover. In consecutive audiogram a notch at 6 kHz 15 dB deep appeared in the operated ear and one can presume an increased vulnerability of this ear to the noise of the agricultural machines used by then by the patient.

Surgical exposure of internal acoustic meatus via typical suboccipital retrosigmoid craniotomy is limited by inner ear structures that should remain intact if hearing preservation is attempted. Feasibility of supracerebellar-infratentorial approach to the meatus with more medial angle of exposure and with preservation of inner ear structures was studied on fresh cadavers and on computed tomography pictures of temporal bones. Anatomical relationships of internal acoustic meatus and adjacent structures show marked individual variability. When typical retrosigmoid craniotomy is used to expose meatal fundus, significant medial retraction of cerebellar hemisphere is required in 47% of the patients to avoid opening endolymphatic spaces. Internal acoustic foramen and meatus can be exposed via craniotomy situated under transverse sinus, with 10-15 mm downward retraction of cerebellum. Medial extent of craniotomy can be planned on preoperative imaging studies. Infratentorial supracerebellar exposure of internal acoustic meatus allows for more medial angle of surgical approach than standard retrosigmold craniotomy. It can be used when preoperative imaging studies show that anatomical relationships between internal acoustic meatus and inner ear structures would require excessive cerebellar retraction to visualize a whole tumor inside meatus.

Surgery for extensive skull base lesions inevitably creates multiple tissue defects that require reconstruction. In this paper reconstruction methods applied in 41 skull base surgery procedures are presented. Anterior cranial fossa was involved in 13 operations (4 malignant and 9 non-malignant tumours), middle and posterior cranial fossa in 28 (9 malignant and 19 non-malignant). As a rule all the defects were reconstructed in one stage, immediately after tumour removal. Titanium mesh was the only alloplastic material used to cover bone defects in 7 patients. Otherwise only autografts were used. Postoperatively in all the patients in whom excision and repair of dura was necessary, continuous lumbar drainage of cerebrospinal fluid was maintained for 4-6 days. In anterior cranial fossa area large pediculated, vascularized periosteal flap allowed for reliable separation of upper airways from intracranial cavity. Titanium mesh was used to cover orbital wall defects. In the area of middle cranial fossa and temporal bone the most important aspects of reconstruction were watertight closure of the dura, separation of the surgical cavity from nasopharynx with rotated temporalis muscle, and facial nerve reconstruction (the nerve was reconstructed in 7 cases). Additionally in 1 patient hypoglossal nerve was sutured end-to-end. In 2 patients the invaded segment of internal carotid artery was excised and replaced with prosthesis. In 13 patients the surgical procedure was performed in an area that was previously operated upon and/or irradiated. Delayed healing was seen in 6 cases, but none required additional procedures and the wounds were completely healed with local treatment. Reconstruction methods presented in this paper are relatively simple and do not necessitate modern materials. Even in extensive procedures proper wound healing and satisfactory cosmetic result were obtained.

Twenty-three patients with facial nerve paralysis following surgery for a cerebellopontine angle tumour had a facial-hypoglossal anastomosis and simultaneous anastomosis of the cervical ansa with the distal stump of the hypoglossal nerve. In 18 patients, simultaneously with the neural anastomoses, additional transpositions of the temporalis and masseter muscles were performed. At follow-up examination 3-87 months after reconstructive surgery, eight patients had House grade II, ten grade III and five grade IV outcome. The EMG evidence of reinnervation was observed 5-11 months after anastomosis. Combination of the facial-hypoglossal anastomosis with simultaneous myoplasty and with anastomosis of the distal hypoglossal nerve stump to the ansa cervicalis provides the advantage of immediate protection against ophthalmic complications, prevents hemiatrophy of the tongue and gives good functional results when reinnervation of the facial muscles takes place.

Brain abscesses are rare in infants and their clinical presentation is specific for this age group. Seven cases of brain abscess in infants aged 2-11 months are reported. The underlying cause was meningitis in four, sepsis in two, and unknown in one. Gram-negative organisms were cultured in 6 patients. The abscess size was 5 cm or more in five cases; in four there were multiple lesions. Two abscesses were aspirated and irrigated; four particularly large lesions were drained and repeatedly aspirated and irrigated. One craniotomy was done. There were two deaths, one in the postoperative period and the other 6 months after discharge. Follow-up information is available for four children, showing a good result in only one of them. Formation of an abscess should be diagnosed early, and close ultrasound monitoring or CT scanning in infants with bacterial meningitis and sepsis is essential. The prognosis in cases in which large/multiple abscesses develop is poor.

A case of interposed nerve graft repair of an oculomotor nerve damaged during surgery for a laterally growing retrosellar pituitary adenoma is reported. The patient showed partial but functionally useful recovery of nerve function and was able to resume professional work. Only a few reports of end-to-end repair have been published, and they indicate that partial return of nerve function can be expected in such cases.

Twelve children with intracranial cysts of Echinococcus granulosus underwent surgery during a period of 5 years and constituted 19% of all children operated on for intracranial space-occupying lesions. The more common symptoms were raised intracranial pressure (8 cases) and hemiparesis (7 cases). The total number of procedures was 14, with a standard craniotomy approach in 13. In 6 the cysts were removed without puncture or rupture, in 5 puncture and drainage were carried out before removal of capsule, and in 3 the cyst ruptured accidentally. Recurrence of multiple cysts occurred in 1 case and another patient was reoperated on twice for recurrent cysts after an operation in another center. There was no mortality. Non-bacterial meningitis occurred in 2 cases. Although drainage of the cyst contents greatly facilitates removal, it also carries a risk of contamination; thus a traditional approach via a large craniotomy seems to be the safest choice.

An analysis of the clinical data on the intervention and results of treatment of 73 patients operated upon for epilepsy is reported, in whom resection was done of more than one cerebral lobe. They accounted for 17% of all patients treated surgically at this neurosurgical centre for seizures. A characteristic finding in this group was the presence of signs of severe brain damage, such as frequent and variegated seizures, neurological deficits, impairement of mental development, extensive EEG changes. In 50 patients resection of more than two lobes was done, in 22 cases three lobes were removed, and in 1 case even four lobes were removed. The operative mortality was 2.7%. The duration of follow up was 6 years, on the average. Forty-two per cent of the patients are without seizures, isolated seizures occurred in 16.5%, in 18% of cases the frequency of seizures was decreased, in 23.5% there was no improvement. Statistical analysis of the effects of certain elements of the clinical state on the final result of the treatment was carried out and it was found that a significant influence was exerted by: age below 20 years, occurrence of two or more types of seizures, and presence of generalized slow waves in EEG. In these patients the results were worse. On the other hand, the age of disease onset, disease duration, aetiology, intellectual level, changes in neuroradiological investigations, extent of resection were without effect on the final result of the treatment.

The authors describe a group of 9 patients with arteriovenous malformations of the brain operated upon using the microsurgical technique and controlled arterial hypotension. In all cases the malformations were radically removed. In one patient the neck of a coexistent aneurysm of the pericallosal artery was clamped with a clip. Disability in one patient was the effect of haemorrhage, another patient with hemiparesis is being rehabilitated. The remaining patients are feeling well and in only one of them epileptic seizures remained after the operation, they had, been however, present before the operation. The use of the microsurgical technique makes possible reduction of the surgical trauma to the brain tissue and opens greater possibilities of intraoperative evaluation of radical performance of the operation.

The aetiopathogenesis of spasmodic torticollis has not yet been explained. The problem of surgical treatment selection is also at issue. The authors present own observations in 5 cases treated by operations on the peripheral nervous system. In 3 cases a very good therapeutic results was obtained, in 2 cases the results was not satisfactory. A characteristic fact was appearance of ultimate improvement only several months after the operation, similarly as it is observed after stereotactic operations. In the light of own observations and a survey of the literature the authors reach the conclusion that operations on the peripheral nervous system as the first stage of surgical treatment give good results in most cases.

The authors report a patient aged 58 years with a history of two episodes of subarachnoid haemorrhage and with arteriographic finding of four intracranial aneurysms: two on the internal carotid artery, one on the trifurcation of the middle cerebral artery, and one on the anterior communicating artery. Despite rather poor general and local condition (III clinical group) during the operation all four aneurysms were closed with clips. After a stormy postoperative course the condition of he patient improved and 6 months later he was feeling well, had no paresis, and only some memory disturbances remained. This case shows that multiple intracranial aneurysms should be treated in one-step operation, if this can be done from one surgical approach. This is important particularly in these cases in which it is difficult to say which aneurysm is bleeding.

The authors describe 32 cases of hydrocephalus of different aetiology in which the effectiveness of the ventriculoatrial shunt was evaluated by means of repeated computerized axial tomographic (CT) investigations. This investigation made it possible to demonstrate in a way not exposing the patients to any complications that the shunt was effective in 87.4% of cases with reduction of the size of the ventricular system of significant and moderate degree. Simultaneously with reduction of the size of the ventricular system an improvement of the clinical state was observed in these patients with disappearance of the signs of increased intracranial pressure. It was observed that in cases of normotensive hydrocephalus presence of cortical atrophy in CT investigation made the prognosis unfavourable despite treatment with the shunt. The analysis of the presented material demonstrated a high usefulness of CT in the observation of hydrocephalus dynamics in cases of different aetiology treated by means of the shunt.

The authors describe a 54-year-old woman treated surgically 28 years earlier for embryonal haemangioma of the cerebellum and admitted with signs of hypophyseal tumour. Radiological examinations confirmed this suspicion and the patient was treated surgically from the approach through the nose and sphenoidal bone. The previous disease and intraoperative observation suggested the possibility of embryonal angioma in the sella but histological examination demonstrated that the tumour was a chromophobe adenoma.

Two patients are presented in whom repeated subarachnoideal haemorrhages developed 4 and 13 years after operations for intracranial aneurysms including strengthening of aneurysm wall with aneuroplastic. The patients were reoperated on by microsurgery. In both cases it was possible to clip the aneurysm after removing aneuroplastic.

A group of 33 patients with 34 aneurysms of the pericallosal artery and its branches are reported. They were treated in the Department of Neurosurgery, Medical Academy in Warsaw in the years 1965-1981. In 4 patients coexistence of other cerebral vascular anomalies (aneurysms of other location and/or angiomas) was demonstrated. The group comprised 21 men and 12 women aged from 7 to 60 years. Nine patients were not operated on, 8 of them died due to haemorrhagic brain damage and one gave no consent to operation. Out of surgically treated 24 patients in 3 cases the common carotid artery was ligated in 4 cases the wall of the aneurysm was reinforced with plastic mass, and in 17 cases the neck of the aneurysm was closed with a clip. In the clinical group I (Botterell's scale) 7 patients were treated surgically, in group II - 5, in group III - 9 and in group IV - 3. The immediate operative mortality was 8.5% (2 patients). One patient died 2 months after the operation from other disease. Deterioration of the neurological status occurred in 33% of cases (8 patients). Late result of the treatment was known in 16 cases with a mean follow-up of 4 years. Six patients returned to work, five resumed work with restrictions, and five other could not work and required care. The results of surgical treatment depended, in the first place, on the clinical state of the patient and the surgical risk was not greater than in cases of aneurysms of other location.

The authors present a case of a 47 year-old woman admitted to Neurosurgical Clinic with diagnosis of left frontal lobe tumour. At operation, during removal of glioma of the frontal lobe, a parasagital meningioma, 3 cm in diameter, was found and removed. Both tumours were adjacent. Histopatologic examination revealed: grade 1 astrocytoma and fibroblastic meningioma. Some clinical and pathological problems associated with simultaneous occurrence of two tumours of various histologic origin are discussed.

A very unusual case if described of ischialgia coexistent with phantom pains in the amputated extremity. The cause of pain was prolapse of a lumbar intervertebral disc diagnosed only during operation. The case points out the necessity of differentiating between postamputation pains and pains not directly related to amputation. This differentiation may help in successful treatment.