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Midline lumbar fusion (MIDLF) is one promising new surgical technique that has been developed to minimize perioperative damage to the paravertebral stabilizing musculotendinous system. The aim of this study was to assess long-term clinical and radiological effects of MIDLF.This prospective cohort study evaluated patients who underwent MIDLF for degenerative spinal instability. Clinical and radiological examinations were performed before and after surgery. Perioperative and postoperative complications were recorded. Follow-up was 2 years. P ≤ 0.05 was considered statistically significant.The study included 64 patients (mean age 58.9 ± 10.7 years; 41 women [64.1%]). The most frequent indication for MIDLF was degenerative spondylolisthesis grade I (28 cases [43.8%]); the prevalent spinal segment to be fused was L4-L5 (35 cases [54.7%]). Mean duration of surgery was 148.2 ± 28.9 minutes. Relief of low back pain and leg pain was significant and stable in the postoperative period as assessed by visual analog scale (P0.001). Of patients, 86.9% reported fair, good, or excellent outcomes in terms of pain relief based on MacNab score 2 years after surgery. Patients' level of function in activities of daily living improved significantly based on Oswestry Disability Index score: from 66.8 ± 9.8 before surgery to 33.9 ± 16.5 2 years after surgery (P0.001). X-rays and computed tomography at 12 months showed interbody fusion in 46 cases (73.4%), inconclusive results in 13 cases (20.3%), and no fusion in 4 cases (6.3%). No damage to neural or vascular structures and no failure of hardware or screw loosening were recorded.MIDLF is a safe, efficient method for surgical treatment of lumbar spine instability. Its limited invasiveness contributes to better preservation of paravertebral muscles and enhanced postoperative spinal stability.

Reflecting the first wave COVID-19 pandemic in Central Europe (i.e. March 16th–April 15th, 2020) the neurosurgical community witnessed a general diminution in the incidence of emergency neurosurgical cases, which was impelled by a reduced number of traumatic brain injuries (TBI), spine conditions, and chronic subdural hematomas (CSDH). This appeared to be associated with restrictions imposed on mobility within countries but also to possible delayed patient introduction and interdisciplinary medical counseling. In response to one year of COVID-19 experience, also mapping the third wave of COVID-19 in 2021 (i.e. March 16 to April 15, 2021), we aimed to reevaluate the current prevalence and outcomes for emergency non-elective neurosurgical cases in COVID-19-negative patients across Austria and the Czech Republic. The primary analysis was focused on incidence and 30-day mortality in emergency neurosurgical cases compared to four preceding years (2017–2020). A total of 5077 neurosurgical emergency cases were reviewed. The year 2021 compared to the years 2017–2019 was not significantly related to any increased odds of 30 day mortality in Austria or in the Czech Republic. Recently, there was a significant propensity toward increased incidence rates of emergency non-elective neurosurgical cases during the third COVID-19 pandemic wave in Austria, driven by their lower incidence during the first COVID-19 wave in 2020. Selected neurosurgical conditions commonly associated with traumatic etiologies including TBI, and CSDH roughly reverted to similar incidence rates from the previous non-COVID-19 years. Further resisting the major deleterious effects of the continuing COVID-19 pandemic, it is edifying to notice that the neurosurgical community´s demeanor to the recent third pandemic culmination keeps the very high standards of non-elective neurosurgical care alongside with low periprocedural morbidity. This also reflects the current state of health care quality in the Czech Republic and Austria.

The potential to utilize the lower subscapular nerve for brachial plexus surgery has been suggested in many anatomical studies. However, we know of no studies in the literature describing the use of the lower subscapular nerve for axillary nerve reconstruction to date. This study aimed to examine the effectiveness of this nerve transfer in patients with upper brachial plexus palsy. Of 1340 nerve reconstructions in 568 patients with brachial plexus injury performed by the senior author (P.H.), a subset of 18 patients underwent axillary nerve reconstruction using the lower subscapular nerve and constitutes the patient group for this study. The median age was 48 years, and the median time between trauma and surgery was 6 months. A concomitant radial nerve injury was found in 8 patients. Thirteen patients completed a minimum follow-up period of 24 months. Successful deltoid recovery was defined as (1) muscle strength MRC grade ≥ 3, (2) electromyographic signs of reinnervation, and (3) increase in deltoid muscle mass. Axillary nerve reconstruction was successful in 9 of 13 patients, which represents a success rate of 69.2%. No significant postoperative weakness of shoulder internal rotation or adduction was observed after transecting the lower subscapular nerve. The lower subscapular nerve can be used as a safe and effective neurotization tool for upper brachial plexus injury, having a success rate of 69.2% for axillary nerve repair. Our technique presents a suitable alternative for patients with concomitant radial nerve injury.

The world currently faces the novel severe acute respiratory syndrome coronavirus 2 pandemic. Little is known about the effects of a pandemic on non-elective neurosurgical practices, which have continued under modified conditions to reduce the spread of COVID-19. This knowledge might be critical for the ongoing second coronavirus wave and potential restrictions on health care. We aimed to determine the incidence and 30-day mortality rate of various non-elective neurosurgical procedures during the COVID-19 pandemic. A retrospective, multi-centre observational cohort study among neurosurgical centres within Austria, the Czech Republic, and Switzerland was performed. Incidence of neurosurgical emergencies and related 30-day mortality rates were determined for a period reflecting the peak pandemic of the first wave in all participating countries (i.e. March 16th–April 15th, 2020), and compared to the same period in prior years (2017, 2018, and 2019). A total of 4,752 emergency neurosurgical cases were reviewed over a 4-year period. In 2020, during the COVID-19 pandemic, there was a general decline in the incidence of non-elective neurosurgical cases, which was driven by a reduced number of traumatic brain injuries, spine conditions, and chronic subdural hematomas. Thirty-day mortality did not significantly increase overall or for any of the conditions examined during the peak of the pandemic. The neurosurgical community in these three European countries observed a decrease in the incidence of some neurosurgical emergencies with 30-day mortality rates comparable to previous years (2017–2019). Lower incidence of neurosurgical cases is likely related to restrictions placed on mobility within countries, but may also involve delayed patient presentation.

The aim of the present study was to observe visual pathway changes on the contralateral side in optic nerve sheath meningioma (ONSM). The authors present a case report of a 43-year-old patient with OfNSM on the right side. A complex ophthalmic examination was performed, including an assessment of visual functions, an electrophysiology examination and functional and structural MRI examinations. Visual acuity of the right eye after ONSM remained with no light perception, while that of the left side was normal. The visual field of the left eye was normal as was colour perception. An electrophysiology examination using a pattern electroretinogram revealed low amplitude values in the right eye. In the left eye, the finding was at the lower limit of normal results. The pattern visual evoked potential exhibited a bilateral lesion with a larger decrease in response after stimulation of the right eye. The structural MRI revealed intraorbital atrophy of the optic nerve on the right side throughout the whole course, which was accompanied by atrophy of the right half of the optic chiasm. Functional magnetic resonance imaging revealed zero activity after stimulation of the right eye and decreased activity in the visual centre after stimulation of the left eye. The present study demonstrated that unilateral damage to the optic nerve in ONSM is accompanied by significant changes on the contralateral side of the optic pathway.

The leaf area index (LAI) is one of the most common leaf area and canopy structure quantifiers. Direct LAI measurement and determination of canopy characteristics in larger areas is unrealistic due to the large number of measurements required to create the distribution model. This study compares the regression models for the ALS-based calculation of LAI, where the effective leaf area index (eLAI) determined by optical methods and the LAI determined by the direct destructive method and developed by allometric equations were used as response variables. LiDAR metrics and the laser penetration index (LPI) were used as predictor variables. The regression models of LPI and eLAI dependency and the LiDAR metrics and eLAI dependency showed coefficients of determination (R2) of 0.75 and 0.92, respectively; the advantage of using LiDAR metrics for more accurate modelling is demonstrated. The model for true LAI estimation reached a R2of 0.88. info:eu-repo/semantics/openAccess

Leaf area index (LAI) is one of the most important characteristics of forest stands that affects the fundamentals of tree physiological processes, biomass production, and mechanical stability. The LAI results obtained by the semi-direct and indirect methods (the needle technique and an LAI-2000 PCA) in three European beech (Fagus sylvatica L.) stands and one sycamore maple (Acer pseudoplatanus L.) stand were compared with LAI estimated by litter traps during the 2013 growing season. Seasonal LAI was estimated using an LAI-2000 PCA which showed similar trends among the stands and strongly corresponded to phenological phases of deciduous stands in Europe, with the fastest rate of leaf area increment occurring during the first month following bud break. During the growing season, maximum stand LAI value was on June 19th and reached 4.5–5.1, and 4.0 in the beech and maple stands, respectively. The needle technique significantly underestimated (p .05) LAI on average by 15.1% and 5.8% in the beech and maple stands, respectively. All methods for LAI estimation at the stand level could be applicable in deciduous forest stands (beech, maple) with similar site and stand characteristics. However, calibration by direct method is necessary to obtain the required precision.

The present study demonstrates alterations of the contralateral side optic tract to an optic nerve traumatic lesion. Visual acuity of the right eye following Traumatic optic neuropathy (TON) remained at 0 following the injury. Electrophysiological examination using pattern electroretinogram revealed values reduced by 50% in the right eye compared with the left eye. Pattern visual-evoked potential evaluation indicated a bilateral lesion with a higher decrease following right eye stimulation. Magnetic resonance imaging revealed right optic nerve atrophy. Functional magnetic resonance imaging indicated decreased activity of the visual centre during left eye stimulation. The present study revealed contralateral visual tract alterations following unilateral injury, and hypothesize that the ganglion cells of the retina respond initially to glial activation. These changes are, in our view, followed by changes in the visual pathway.

The present study reports a case of a 44-year-old female patient with a large frontal lobe tumor who underwent surgery using a modern navigation system SonoWand that combines the advantages of a non-frame navigation system with intraoperative real-time ultrasound imaging. The right frontal lobe tumor consisted of two morphologically different sections. A diffuse astrocytoma grade II and a glioblastoma grade IV were identified. These tumors were relatively substantially separated. A 17 p deletion, including TP53, was detected in a diffuse astrocytoma but not in a glioblastoma. EGFR and MDM2 amplifications were detected only in a glioblastoma. Detection of these amplifications is typical for primary glioblastomas. These findings support our assumption of two independent tumors. The KRAS, BRAF and EGFR gene mutations were also detected in a glioblastoma. Such an accumulation of molecular mutations is rare in one tumor. Following oncological treatment the patient was cared for in the oncological center and survived for 15 months after the surgery without any signs of a disease. This is an unusual case, and to the best of our knowledge, is not frequently published in literature.

Uvod a cil: Karoticka endarterektomie (CEA) je v soucasne době castým a z hlediska prevence cevni mozkove přihody (CMP) ucinným výkonem. Operace v celkove anestezii jsou provaděny ve větsině připadů za elektrofyziologicke peroperacni monitorace pacienta s využitim somatosenzorických evokovaných potencialů (SEP). Standardně se za monitorace SEP při poklesu amplitudy N20/P25 o vice než 50 % při třech a vice po sobě nasledujicich souborech zavadi zkrat. Operace s použitim zkratu je spojena s vyssim rizikem poskozeni cevni stěny a s možnou centralni embolizaci. Ve snaze minimalizovat pocet pacientů se zavedeným intraluminalnim zkratem jsme modifikovali kriteria nacasovani jeho zavedeni při monitoraci SEP a timto způsobem jsme operovaný soubor vyhodnotili.Metodika: Do studie bylo retrospektivně zařazeno 250 pacientů (171 mužů, 79 žen, průměrný věk 67 let ± 8,55 SD, max. 86 let, min. 45 let) indikovaných k CEA. Zkrat jsme zavaděli až po kompletnim vymizeni odpovědi SEP bez reakce na anesteziologickou intervenci. Vyhodnotili jsme soubor pacientů operovaných s modifikovaným nacasovanim zavedeni zkratu. Byly zaznamenany a porovnany neurologicke komplikace (měřeny změnami v National Institute of Health Stroke Scale [NIHSS]).Výsledky: V nasem souboru bylo operovano 85,51 % pacientů pro symptomatickou stenozu vnitřni karoticke tepny (ICA) s dosaženim 2,80% 30denni mortality a morbidity (2,0% a 0,8%, tedy 5 a 2 pacienti). Tyto hodnoty jsou z hlediska publikovaných výsledků standardni. Nebyl zaznamenan statisticky významný rozdil periooperacnich neurologických komplikaci mezi skupinou SEP pozitivnich a SEP negativnich pacientů (2,9 % v SEP pozitivni skupině vs. 2,7 % v SEP negativni skupině pacientů, p = 0,79). Z tohoto pohledu nejsou SEP jediným faktorem, který dokaže predikovat výsledný neurologický pooperacni nalez. Pokles odpovědi SEP jsme pozorovali u 68 pacientů (27,2 %). Kompletni vymizeni odpovědi s nutnosti zavedeni zkratu jsme zaznamenali v pěti připadech (2,0 %).Zavěr: Operace s modifikovaným nacasovanim zavedeni zkratu vedla ke standardnim výsledkům. Vzhledem k výse uvedeným skutecnostem a riziku, ktere je spojeno se zavedenim zkratu, je vhodne zabývat se v budoucnu podrobněji nacasovanim zavedeni zkratu ve vztahu k monitoraci SEP a přizpůsobit optimalni nacasovani zavedeni zkratu individualnimu průběhu operace.

Misni leze představuje komplikovaný stav spojený se zavažnými nasledky jak pro pacienta, tak pro spolecnost. Regeneracni schopnosti michy jsou znacně omezene. Z tohoto pohledu je důležita rychla diagnostika nasledovana odpovidajici lecbou v zavislosti na přicině leze. Etiologii misni leze lze v zasadě rozdělit na traumatickou a netraumatickou. Traumaticke misni leze jsou nejcastěji spojene s poraněnim pateře. Nadory, degenerativni změny a různe typy krvaceni jsou nejcastějsi přicinou netraumatických misnich lezi. Vcasna dekomprese představuje spolu s odpovidajici konzervativni lecbou v soucasne době jedinou sanci na možne zlepseni klinickeho stavu. U deletrvajici kompletni misni leze je i přes znacne usili na experimentalni urovni prognoza pacientů nepřizniva a zlepseni těžkeho neurologickeho deficitu je spise výjimecne.

Brachial plexus injuries are usually severe and involve the entire brachial plexus, sometimes occurring with root avulsions. Imaging and electrodiagnostic studies are an essential part of the lesion evaluation; however, the results sometimes show a discrepancy. The cutaneous silent period (SP) is a spinal inhibitory reflex mediated by small-diameter A-delta nociceptive fibers. The aim of the study was to determine if cutaneous SP testing may serve as a useful aid in evaluation of brachial plexus injury and/or in the diagnosis of root avulsion.In 19 patients with traumatic brachial plexus injury (15 males, age 18-62 years) we performed a clinical examination, CT myelography and neurophysiological testing. A needle EMG was obtained from muscles supplied by C5-T1 myotomes. Cutaneous SP was recorded after painful stimuli were delivered to the thumb (C6 dermatome), middle (C7) and little (C8) fingers while subjects maintained voluntary contraction of intrinsic hand muscles.Electrodiagnostic and imaging studies confirmed root avulsion (partial or total) maximally involving C5, C6 roots in 12 patients, whereas only in 4 of them the cutaneous SP was partially absent. In the remaining subjects, the cutaneous SP was preserved.In brachial plexopathy even with plurisegmental root avulsion, the cutaneous SP was mostly preserved. This method cannot be recommended as a reliable test for diagnosis of single root avulsion; however, it can provide a quick physiological confirmation of functional afferent A-delta fibers through damaged roots and/or trunks. The clinicians may add this test to the diagnosis of spinal cord dysfunction.

Object Although a number of theoretical and experimental studies dealing with end-to-side neurorrhaphy (ETSN) have been published to date, there is still a considerable lack of clinical trials investigating this technique. Here, the authors describe their experience with ETSN in axillary and musculocutaneous nerve reconstruction in patients with brachial plexus palsy. Methods From 1999 to 2007, out of 791 reconstructed nerves in 441 patients treated for brachial plexus injury, the authors performed 21 axillary and 2 musculocutaneous nerve sutures onto the median, ulnar, or radial nerves. This technique was only performed in patients whose donor nerves, such as the thoracodorsal and medial pectoral nerves, which the authors generally use for repair of axillary and musculocutaneous nerves, respectively, were not available. In all patients, a perineurial suture was carried out after the creation of a perineurial window. Results The overall success rate of the ETSN was 43.5%. Reinnervation of the deltoid muscle with axillary nerve suture was successful in 47.6% of the patients, but reinnervation of the biceps muscle was unsuccessful in the 2 patients undergoing musculocutaneous nerve repair. Conclusions The authors conclude that ETSN should be performed in axillary nerve reconstruction but only when commonly used donor nerves are not available.

A palsy of the brachial plexus elements caused by carrying a heavy backpack is a very rare injury usually occurring in soldiers or hikers, and recovery is usually spontaneous. We describe here the case of male civilian presenting with an isolated serious axillary nerve palsy associated with chronic backpack use. During the surgery, a dumbbell-shaped neuroma-in-continuity was found which was caused by direct pressure from the subscapular artery. After resection of the neuroma, a nerve graft from the sural nerve was used to reconstruct the nerve. Reinnervation was successful and the patient was able to abduct his arm to its full range, with full muscle strength, within 24 months.

Object Nerve repair using motor fascicles of a different nerve was first described for the repair of elbow flexion (Oberlin technique). In this paper, the authors describe their experience with a similar method for axillary nerve reconstruction in cases of upper brachial plexus palsy. Methods Of 791 nerve reconstructions performed by the senior author (P.H.) between 1993 and 2011 in 441 patients with brachial plexus injury, 14 involved axillary nerve repair by fascicle transfer from the ulnar or median nerve. All 14 of these procedures were performed between 2007 and 2010. This technique was used only when there was a deficit of the thoracodorsal or long thoracic nerve, which are normally used as donors. Results Nine patients were followed up for 24 months or longer. Good recovery of deltoid muscle strength was seen in 7 (77.8%) of these 9 patients, and in 4 patients with less follow-up (14–23 months), for an overall success rate of 78.6%. The procedure was unsuccessful in 2 of the 9 patients with at least 24 months of follow-up. The first showed no signs of reinnervation of the axillary nerve by either clinical or electromyographic evaluation in 26 months of follow-up, and the second had Medical Research Council (MRC) Grade 2 strength in the deltoid muscle 36 months after the operation. The last of the group of 14 patients has had 12 months of follow-up and is showing progressive improvement of deltoid muscle function (MRC Grade 2). Conclusions The authors conclude that fascicle transfer from the ulnar or median nerve onto the axillary nerve is a safe and effective method for reconstruction of the axillary nerve in patients with upper brachial plexus injury.

Brachial plexus injuries occur in up to 5% of polytrauma cases involving motorcycle accidents and in approximately 4% of severe winter sports injuries. One of the criteria for a successful operative therapy is the type of lesion. Upper plexus palsy has the best prognosis, whereas lower plexus palsy is surgically untreatable. The aim of this study was to evaluate a group of patients with brachial plexus injury caused by traffic accidents, categorize the injuries according to type of accident, and look for correlations between type of palsy (injury) and specific accidents. A total of 441 brachial plexus reconstruction patients from our department were evaluated retrospectively (1993 to 2011). Sex, age, neurological status, and the type and cause of injury were recorded for each case. Patients with BPI caused by a traffic accident were assessed in detail. Traffic accidents were the cause of brachial plexus injury in most cases (80.7%). The most common type of injury was avulsion of upper root(s) (45.7%) followed by rupture (28.2%), complete avulsion (16.9%) and avulsion of lower root(s) (9.2%). Of the patients, 73.9% had an upper, 22.7% had a complete and only 3.4% had a lower brachial plexus palsy. The main cause was motorcycle accidents (63.2%) followed by car accidents (23.5%), bicycle accidents (10.7%) and pedestrian collisions (3.1%) (p

Decompressive surgery48 h from stroke onset reduces the prevalence of mortality and morbidity from malignant supratentorial infarction. We investigated if utilization of decompressive surgery changed in the Czech Republic (CZ) after the release of new guidelines regarding treatment of malignant brain infarction. The volume of decompressive surgery in 2009 in all centers in the CZ was assessed using the same methodology as in 2006. All neurosurgery departments in the CZ were asked to complete a questionnaire and asked to identify all cases of decompressive surgery for malignant brain infarction through a combination of discharge codes for "brain infarction" and "decompressive surgery" from electronic hospital charts. Data for 56 patients were obtained from 15 of the 16 neurosurgery departments in the CZ. The average age was 53 ± 13; number of males 20; median time to surgery was 48 h (range 24-62); median NIHSS score was 25 (IQR, 20-30); median infarct volume was 300 cm(3) [interquartile (IQR, 250-350)]; mean shift on CT was 10.6 ± 3.6 mm and size of hemicraniectomy was 125 cm(2) (IQR, 110-154). A favorable outcome was achieved in 45% of the patients. The number of procedures increased from 39 in 2,006 to 2,056 in 2009. Based on data from one stroke center, 10% suffered from malignant supratentorial infarction and 2.3% met the criteria for decompressive surgery. In 2009, as compared to 2006, the volume of decompressive surgery carried out moderately increased. However, procedures remained underutilized because only ~10% of those who needed decompressive surgery underwent surgery.

Summary In view of the lack of theoretical information, end-to-side neurorrhaphy is a frequent object of experimental interest. End-to-side neurorrhaphy is based on collateral sprouting of an intact axon. The quantitative assessment of collateral sprouts sent by an intact motor and sensory axon was the goal of the present study. End-to-side neurorrhaphy of the distal stump of transected musculocutaneous nerve (MCN) with intact ulnar nerve (UN) was performed in a rat model. Collateral sprouts were quantitatively evaluated by counting of motoneurons and DRG neurons following their retrograde labeling by Fluoro-Ruby and Fluoro-Emerald applied to the UN and MCN, respectively. The results suggest a comparable capacity of both intact sensory and motor axons to send collateral sprouts into a denervated nerve stump. The ratio of sensory/motor neurons, the axons of which reinnervated distal MCN stumps, was very similar to that of intact UN (6.500 and 6.747, respectively), but different from intact MCN (5.029). This suggests that the pruning process occurred to balance the collateral sprouts at a ratio of sensory/motor neurons for the donor UN, but not according to the number of sensory and motor bands of Bungner available in the distal stump of the MCN. The present experimental study confirms end-to-side neurorrhaphy as a suitable method of nerve reconstruction.

Experimental model based on the C5 ventral root avulsion was used to evaluate the efficacy of brain-derived neurotrophic factor (BDNF) and Cerebrolysin treatment on motor neuron maintenance and survival resulted in the functional reinnervation of the nerve stump. In contrast to vehicle, BDNF treatment reduced the loss and atrophy of motor neurons and enhanced the regrowth axon sprouts into the distal stump of musculocutaneous nerve. However, the axon diameter of the myelinated fibers was smaller than those of control rats. The morphometric results were related to a low score in behavioral test similar to vehicle-treated rats. Cerebrolysin treatment greatly protected the motor neurons against cell death. Moreover, morphometric features of myelinated axons were better than those of rats treated with vehicle or BDNF. The mean score of grooming test suggested better results of the functional motor reinnervation than after BDNF administration. The majority of rescued motor neurons regenerating their axons through nerve graft in both BDNF- and Cerebrolysin-treated rats expressed choline acetyltransferase immunostaining. The results demonstrate that BDNF has more modest effects in preventing the death of motor neurons and functional recovery of injured motor nerve after root avulsion than Cerebrolysin.

In our experimental paradigm we sutured the distal stump of a transected musculocutaneous nerve to an intact ulnar nerve of the rat in an end-to-side fashion. We demonstrated the formation of collateral sprouts from intact afferent and motor axons by application of one type of molecule conjugated by two different fluorophores (Fluoro-Ruby and Fluoro-Emerald). Fluoro-Ruby and Fluoro-Emerald were applied distal to end-to-side suture into fresh cut ends of the ulnar and musculocutaneous nerves, respectively. Formation of collateral sprouts was evidenced by findings of mixed (a yellow to orange color) fluorescence labeling of spinal motoneurons and dorsal root ganglia neurons. Colocalization of two different tracers retrogradely transported to the neurons was verified by the individual green and red fluorescence profiles analyzed by means of the computer-assisted image-analyzing system. Our results unequivocally demonstrate that a nerve stump attached to an intact nerve can induce collateral sprouting of both afferent and motor axons.

The results of 13 patients with end-to-side anastomosis of the axillary nerve to various donor nerves were presented. The results were evaluated by means of functional and electrophysiological methods following avulsion and subsequent reconstruction of the brachial plexus. End-to-side anastomosis of the rat musculocutaneous nerve ( n =12), with the ulnar one, was used in the experimental model. The retrograde tracers were applied to prove the reinnervation. Fair and good results were achieved in neurotization of the axillary nerve in 75% of patients with follow-up longer than 24 months. Electrophysiology proved reinnervation in 100% of the patients. The average muscle strength, according to the muscle test, was 3.80. The functional recovery started within 7–12 months postoperatively. Retrograde staining in the experimental model demonstrated the reinnervation of the rat bicep muscles after 3 months from end-to-side anastomosis, mainly by collateral reinnervation from the ulnar nerve. The ulnar nerve motoneurons (70±13) were able to send off collateral sprouts from their intact axons into the musculocutaneous nerve. Other motoneurons of the same pool (21±4) regenerated axons directly into the musculocutaneous nerve without collateral sprouting, probably due to the axonotmesis of the motor fibers during the preparation of the perineurial window. Our results demonstrated that end-to-side anastomosis of the peripheral nerve might successfully be used for reinnervation procedures of a brachial plexus injury, mainly in cases with insufficient sources of motor nerve fibers from neighboring intact motor nerves.

Purpose To determine whether there is a relationship between seatbelt use and type of brachial plexus injury seen in automobile accidents. Knowledge of such a relationship may help guide the surgical management of these patients. Methods We retrospectively evaluated 43 surgical patients with brachial plexus palsy caused by car accidents. We recorded sex, age, and type of injury for each case. We also obtained data regarding the patients' position in the car at the time of the accident and whether they were wearing a seatbelt. Results We obtained data on 39 men and 4 women. Of the seatbelted patients, 24 (100%) had upper plexus palsy on the side where the seatbelt crossed the shoulder. Of those who were not wearing seatbelts, 17 (86%) had complete plexus injuries. We also found 1 upper and 1 lower plexus injury in the unbelted group. Conclusions We found a relationship between the type of brachial plexus injury sustained by the accident victim and the use and position of the seatbelt. Complete plexus injuries were more common in those who were not wearing seatbelts. We saw upper plexus injuries for those wearing seatbelts. Information about seatbelt use may be useful in clinical practice. When treating an unbelted car accident victim with a brachial plexus injury, it is reasonable to anticipate a more serious form of the injury. Type of study/level of evidence Prognostic IV.

Craniopharyngioma is a rare benign tumour originating from Rathke's pouch. This paper reports a tumour case studied with a set of markers defining protein-carbohydrate recognition. Expression of endogenous lectins and their reactive glycoligands is under differentiation-dependent control in many cell types. These parameters can be related to the degree of cell differentiation in tumours. Therefore, the expression patterns of endogenous lectins, namely galectins-1, -3, and -7, in the craniopharyngioma case were determined. Galectins-1 and -3 were also used to reveal glycoconjugates in cells and extracellular matrices, an approach that has heretofore relied largely on plant lectins. The staining pattern of craniopharyngioma is compared with that of two other types of ectodermally derived tumours, namely basal and squamous cell carcinomas. Clusters of polygonal and flattened cells with morphological characteristics of differentiated cells in the craniopharyngioma and the majority of poorly differentiated cells in squamous cell carcinomas were reactive with galectin-3. No binding of this probe was observed in cells of basal cell carcinomas and the majority of craniopharyngioma cells. In view of the lack of accessible binding in the basal layer of normal squamous epithelia where proliferative cells (including stem cells) are located, galectin-3 binding could be used to distinguish basal from suprabasal cells of squamous epithelial cells.

Background Interruption of antithrombotic treatment before surgery may prevent bleeding, but at the price of increasing cardiovascular complications. This prospective study analysed the impact of antithrombotic therapy interruption on outcomes in non-selected surgical patients with known cardiovascular disease (CVD). Methods All 1200 consecutive patients (age 74.2 ± 10.2 years) undergoing major non-cardiac surgery (37.4 % acute, 61.4 % elective) during a period of 2.5 years while having at least one CVD were enrolled. Details on medication, bleeding, cardiovascular complications and cause of death were registered. Results In-hospital mortality was 3.9 % (versus 0.9 % mortality among 17,740 patients without CVD). Cardiovascular complications occurred in 91 (7.6 %) patients (with 37.4 % case fatality). Perioperative bleeding occurred in 160 (13.3 %) patients and was fatal in 2 (1.2 % case fatality). Multivariate analysis revealed age, preoperative anaemia, history of chronic heart failure, acute surgery and general anaesthesia predictive of cardiovascular complications. For bleeding complications multivariate analysis found warfarin use in the last 3 days, history of hypertension and general anaesthesia as independent predictive factors. Aspirin interruption before surgery was not predictive for either cardiovascular or for bleeding complications. Conclusions Perioperative cardiovascular complications in these high-risk elderly all-comer surgical patients with known cardiovascular disease are relatively rare, but once they occur, the case fatality is high. Perioperative bleeding complications are more frequent, but their case fatality is extremely low. Patterns of interruption of chronic aspirin therapy before major non-cardiac surgery are not predictive for perioperative complications (neither cardiovascular, nor bleeding). Simple baseline clinical factors are better predictors of outcomes than antithrombotic drug interruption patterns.

The presence of laminin-1, and -2, as well as a6 and b1 integrin chains was detected by indirect immunohistochemistry in the sections through acellular nerve segments 7 and 14 days after the cryo-treatment. The position of basal laminae and Schwann cells was identified by immunostaining for collagen-IV and S-100 protein, respectively. The isolated cryo-treated segment without living Schwann cells (S-100-) did not display immunoreactivity for laminins and integrin's chains while the basal lamina position was verified through the whole segment by immunostaining for collagen-IV. The absence of immunostaining for laminin-1 and -2 in cryo-treated nerve segment was confirmed by Western blot analysis. A crucial diminution of laminin-1 and -2 in cryo-treated nerve segment of 10 mm length did not abolish the growth and maturation of axons. The greater part of nerve segment connected with the nerve stump displayed no immunohistochemical staining for S-100 corresponding with absence of Schwann cells. The border region of the nerve segment contained Schwann cells (S-100+) migrating from near freeze-undamaged part of the distal nerve stump. In addition to immunostaining for S-100 protein, the migrating Schwann cells displayed immunostaining for laminins (-1, and -2) and integrin chains (a6 and b1). The results indicate laminin molecules in the acellular nerve segments are related with the migrating Schwann cells. Both immunostaining for laminins and integrin chains suggests an autocrine and/or paracrine utilization of laminin molecules in the promotion of Schwann cell migration.

Summary The acellular nerve graft was utilised to restore a functional reinnervation of the biceps brachii muscle from the motoneuron pool of the cervical spinal cord. The musculocutaneous nerve stump was sutured to an acellular nerve graft, the opposite end of which was inserted into the cervical spinal cord cranial to the avulsed C5 ventral root. The acellular nerve graft was repopulated by Schwann cells heavily immunostained for NGFr within 90 days. The Schwann cells migrating from the nerve stump reached the spinal cord grey matter, where they stimulated the motoneurons to send axonal sprouts. The functional reinnervation of the biceps brachii muscle was assessed by means of the behavioural (grooming) test and EMG, the presence of myelinated and unmyelinated axons was demonstrated by light and electron microscopy. The axonal reconnection of the musculocutaneous nerve stump was verified by horseradish peroxidase retrograde labelling of the spinal motoneurons. Moreover, the motoneurons on the operated side of the C5 spinal segment displayed increased immunostaining for GAP-43 in comparison to the contralateral side, whereas the pattern of AChE histochemical reaction was similar on both the operated and contralateral side, of the C5 segment 150 days after acellular graft implantation. The regenerated axons bridged a 4-cm long originally acellular nerve graft to reach and reinnervate the biceps brachii muscle. The reinnervation of the neuromuscular junctions was morphologically determined by immunofluorescence for neurofilaments. The number of myelinated axons in the acellular nerve graft was significantly higher than those growing over the cellular graft, but their diameter was smaller. The results of experiments presented here demonstrate functional recovery of the biceps muscle reinnervation through the acellular nerve graft repopulated by migrating Schwann cells. The process of reinnervation by acellular nerve graft is however delayed and worse in comparison with the cellular graft.

Summary The application of cutaneous nerve grafts is accompanied by some disadvantages, including insufficient graft material for the reconstruction of a large mixed nerve. Recently, evacuated muscle autografts have been suggested as possible alternatives to cutaneous nerve grafts. In the present paper we have demonstrated a possible preparation of the evacuated muscle graft using an infiltration of Marcaine. The reinnervation of the distal stump of the rat median nerve was evaluated by morphological and morphometric analysis after application of the muscle acellular grafts prepared by three methods: an ordinary freeze-thawed muscle graft, a Marcaine evacuated muscle graft and a Marcaine treated graft with subsequent freezing and thawing. A comparison of the numbers and diameters of the myelinated axons in the distal nerve stumps revealed very similar conditions for axon regrowth and maturation in Marcaine evacuated and freeze-thawed muscle grafts. The best results with myelinated axon numbers and spectrum of their calibres were obtained when the Marcaine treated graft was repeatedly frozen and thawed. The pre-treatment of the muscle graft by Marcaine prevents it from shrinking and fragmenting, the main disadvantage during freeze-thawing of fresh muscle. The present results demonstrate that infiltration of striated muscles with a myotoxic compound, e. g. Marcaine, with subsequent freezing-thawing is the method of choice for the preparation of an acellular muscle graft used in peripheral nerve reconnection in the experimental model.

Although a number of theoretical and experimental studies dealing with end-to-side neurorrhaphy (ETSN) have been published to date, there is still a considerable lack of clinical trials investigating this technique. Here, the authors describe their experience with ETSN in axillary and musculocutaneous nerve reconstruction in patients with brachial plexus palsy.From 1999 to 2007, out of 791 reconstructed nerves in 441 patients treated for brachial plexus injury, the authors performed 21 axillary and 2 musculocutaneous nerve sutures onto the median, ulnar, or radial nerves. This technique was only performed in patients whose donor nerves, such as the thoracodorsal and medial pectoral nerves, which the authors generally use for repair of axillary and musculocutaneous nerves, respectively, were not available. In all patients, a perineurial suture was carried out after the creation of a perineurial window.The overall success rate of the ETSN was 43.5%. Reinnervation of the deltoid muscle with axillary nerve suture was successful in 47.6% of the patients, but reinnervation of the biceps muscle was unsuccessful in the 2 patients undergoing musculocutaneous nerve repair.The authors conclude that ETSN should be performed in axillary nerve reconstruction but only when commonly used donor nerves are not available.

Background Despite high success rate of DREZ lesioning in the treatment of intractable central pain, there is still a significant incidence of patients without satisfactory post-operative effect. The aim of the study was to evaluate the long-term effect of DREZ lesioning using both a subjective assessment using a visual analog scale (VAS) to quantify residual pain and an assessment using the screening tool (painDETECT Questionnaire, PD-Q). Methods DREZ lesioning was performed in 52 patients from a total 441 cases with brachial plexus injury (11.8%) during a 17-year period (1995–2011). The effect of surgery was retrospectively assessed in 48 patients. Results A decrease in pre-operative pain by more than 75% (Group I) was achieved in 70.8% of patients and another 20.8% reported significant improvement (Group II). The surgery was unsucessful in 8.4% (Group III). We found a significant correlation between ‘improvement’ groups from both methods of assessments. Patients from Group I usually complained of residual nociceptive pain according to PD-Q, patients from Group II typically had pain of unclear origin, and all cases those in Group III suffered from neuropathic pain, Cramer’s V = .66, P < .001. Overall, 66.7% of patients had resolved neuropathic pain, 20.8% patients had more serious complaints and may also suffer from residual neuropathic pain, while 12.5% had unresolved neuropathic pain. Conclusion DREZ lesioning is a safe and effective method with success rates of about 90%. PD-Q scores correspond to subjective satisfaction with the surgery and it seems to be a suitable screening tool for finding patients with residual neuropathic pain after surgery.

Background: Many experimental studies have confirmed collateral sprouting of axons after end-to-side neurorrhaphy and its possible clinical application. There is still controversy about how the surgical method should be carried out. The aim of the present study was to quantitatively evaluate collateral sprouting of motor and sensory axons after end-to-side neurorrhaphy with and without the perineurial window. Methods: End-to-side neurorrhaphy of the distal stump of transected musculocutaneous nerve with intact ulnar nerve with or without a perineurial window was performed in a rat model. Collateral sprouts were quantitatively evaluated by counting of motor and sensory neurons following their retrograde labeling by Fluoro-Ruby and Fluoro-Emerald applied to the ulnar and musculocutaneous nerves, respectively. Results: Our results show that significantly more motor and sensory axons sent their collateral branches into the recipient nerve in the group with a perineurial window. Some axons were injured during preparation of the perineurial window; the injured axons reinnervated directly into the recipient nerve to contribute to results of functional reinnervation. Conclusion: The authors conclude that it is necessary to create a perineurial window when using end-to-side neurorrhaphy in clinical practice, especially in brachial plexus reconstruction. (Plast. Reconstr. Surg. 130: 609, 2012.)

Background Vascular endothelial growth factor (VEGF) is not only a potent angiogenic factor but it also promotes axonal outgrowth and proliferation of Schwann cells. The aim of the present study was to quantitatively assess reinnervation of musculocutaneous nerve (MCN) stumps using motor and primary sensory neurons after plasmid phVEGF transfection and end-to-end (ETE) or end-to-side (ETS) neurorrhaphy. The distal stump of rat transected MCN, was transfected with plasmid phVEGF, plasmid alone or treated with vehiculum and reinnervated following ETE or ETS neurorrhaphy for 2 months. The number of motor and dorsal root ganglia neurons reinnervating the MCN stump was estimated following their retrograde labeling with Fluoro-Ruby and Fluoro-Emerald. Reinnervation of the MCN stumps was assessed based on density, diameter and myelin sheath thickness of regenerated axons, grooming test and the wet weight index of the biceps brachii muscles. Results Immunohistochemical detection under the same conditions revealed increased VEGF in the Schwann cells of the MCN stumps transfected with the plasmid phVEGF, as opposed to control stumps transfected with only the plasmid or treated with vehiculum. The MCN stumps transfected with the plasmid phVEGF were reinnervated by moderately higher numbers of motor and sensory neurons after ETE neurorrhaphy compared with control stumps. However, morphometric quality of myelinated axons, grooming test and the wet weight index were significantly better in the MCN plasmid phVEGF transfected stumps. The ETS neurorrhaphy of the MCN plasmid phVEGF transfected stumps in comparison with control stumps resulted in significant elevation of motor and sensory neurons that reinnervated the MCN. Especially noteworthy was the increased numbers of neurons that sent out collateral sprouts into the MCN stumps. Similarly to ETE neurorrhaphy, phVEGF transfection resulted in significantly higher morphometric quality of myelinated axons, behavioral test and the wet weight index of the biceps brachii muscles. Conclusion Our results showed that plasmid phVEGF transfection of MCN stumps could induce an increase in VEGF protein in Schwann cells, which resulted in higher quality axon reinnervation after both ETE and ETS neurorrhaphy. This was also associated with a better wet weight biceps brachii muscle index and functional tests than in control rats.

Background Brachial plexus injury occurs in up to 5% of polytrauma cases involving motorcycle crashes and in approximately 4% of severe winter sports injuries. One of the conditions for the success of operative therapy is early detection, ideally within three months of injury. The aim of this study was to evaluate associated injuries in patients with severe brachial plexus injury and determine whether there is a characteristic concomitant injury (or injuries), the presence of which, in the polytrauma, could act as a marker for nerve structures involvement and whether there are differences in severity of polytrauma accompanying specific types of brachial plexus injury. Methods We evaluated retrospectively 84 surgical patients from our department, from 2008 to 2011, that had undergone brachial plexus reconstruction. For all, an injury severity scale (ISS) score and all major associated injuries were determined. Results 72% of patients had an upper, 26% had a complete and only 2% had a lower brachial plexus palsy. The main cause was motorcycle crashes (60%) followed by car crashes (15%). The average ISS was 35.2 (SD = 23.3), although, values were significantly higher in cases involving a coma (59.3, SD = 11.0). The lower and complete plexus injuries were significantly associated with coma and fractures of the shoulder girdle and injuries of lower limbs, thoracic organs and head. Upper plexus injuries were associated with somewhat less severe injuries of the upper and lower extremities and less severe injuries of the spine. Conclusion Serious brachial plexus injury is usually accompanied by other severe injuries. It occurs in high-energy trauma and it can be stated that patients involved in motorcycle and car crashes with multiple fractures of the shoulder girdle are at high risk of nerve trauma. This is especially true for patients in a primary coma. Lower and complete brachial plexus injuries are associated with higher injury severity scale.

Injury to pelvic nerves during laparoscopy mostly occurs in gynecological and urological procedures. In abdominal surgery, these complications are infrequent. We present a case report of a patient who suffered a rare obturator nerve injury during a laparoscopic hernioplasty caused by clipping the nerve to the edge of the mesh. After revision and release of nerve from the clip and scars tissue, the associated pain rapidly disappeared and thigh adduction strength improved. Now, 4 years later, MRI and EMG show no sign of nerve compression.

Secondary brain injury contributes to poor outcome for patients sustaining brain trauma. Matrix metalloproteinase-9 (MMP-9) is a potential marker, as well as effector of secondary brain injury. This enzyme degrades components of extracellular matrix, and thus it can contribute to blood-brain barrier disruption.We studied dynamics of MMP-9 in jugular venous blood of 15 patients sustaining either an isolated head injury or a head injury as a part of major trauma, and requiring intensive care (Glasgow Coma Scale8 at the time of admission). Blood samples were taken at the 1st, 3rd and 5th day, levels of MMP-9 in plasma were assessed using ELISA. Outcome quality was assessed at the time of discharge from our hospital.Our results show an increase of MMP-9 levels on the 1st day after the brain trauma, followed by a drop on the 3rd day and a rise on day 5. This biphasic time-course was observed in all patients, but no statistically significant differences between each group (major trauma vs. isolated brain trauma, good outcome vs. poor outcome) were found.Initially increased MMP-9 levels in the 1st posttraumatic day is probably related to transient blood-brain barrier dysruption. The decrease of MMP-9 levels observed on the 3rd day can be explained by restoration of blood-brain barrier integrity and its reduced permeability. The second rise of MMP-9 levels observed in the 5th day probably indicates a developing secondary brain injury during which MMP-9 is produced in the brain as a part of an inflammatory response.of our study suggest that MMP-9 could play an important role in pathogenesis of secondary brain injury.

Musculus dorsoepitrochlearis is a typical muscle variation, which, if in full extent, is represented by the muscular or fibromuscular slip detached from the anteroinferior border of the musculus latissimus dorsi. It passes over the axilla under the axillary fascia crossing the medial side of the brachial plexus and continues as a septum intermusculare mediale brachii distally to the medial epicondyle of humerus. Its full extent is rarely developed—the connection into the intermuscular septum being mostly absent. Muscular slips from the musculus latissimus then insert on various structures in the axilla, often on the crest of greater tubercle of humerus or into the musculus pectoralis major (this variation is known as the axillary arch of Langer) or to other neighboring structures (coracoid process, fasciae of muscles). In our observations, 209 patients with traumatic lesions of the brachial plexus underwent surgical procedure. The presence of the musculus dorsoepitrochlearis has been observed. It was found in the form of various slips from the musculus latissimus dorsi in 4 patients. In 3 of those 4 patients, the innervation was derived from the nervus thoracodorsalis. We also presented 2 case reports of patients with clinical symptoms caused by compression of nerves in the axilla by the dorsoepitrochlear strip. Clin. Anat. 22:481–488, 2009. © 2009 Wiley-Liss, Inc.

BACKGROUND: Secondary brain injury contributes to poor outcome for patients sustaining brain trauma. Matrix metalloproteinase-9 (MMP-9) is a potential marker, as well as effector of secondary brain injury. This enzyme degrades components of extracellular matrix, and thus it can contribute to blood-brain barrier disruption. METHODS: We studied dynamics of MMP-9 in jugular venous blood of 15 patients sustaining either an isolated head injury or a head injury as a part of major trauma, and requiring intensive care (Glasgow Coma Scale

The results presented here demonstrate non-specific cholinesterase (nChE) activity in the developing peripheral nerves of chick embryos at stages 25–26 according to Hamburger and Hamilton (1951, J. Morphol. 88, 49–92). Under the light microscope the use of simultaneous staining for nChE activity and silver proteinate impregnation revealed the axons to be surrounded by cells exhibiting nChE activity in the main nerve trunks and in the growing tips of nerves. Nerve branches arising from the main nerve trunks contained cells with positive reaction for nChE activity, too. Electron-dense particles of the reaction product indicating nChE activity were found in the rough endoplasmic reticulum and in the perinuclear envelope of cells in close contact with growing nerve fibers and their growth cones. The same distribution of nChE activity was found in cells which were located near to nerve fasciculi but without direct contact with axons. Surprisingly, the cells in close contact with axons and their growth cones exhibited the end product of nChE activity in the outer part of their plasma membrane. The cells enveloping axons within the nerve trunks were apparently Schwann cells, while those around the growth cones at nerve tips could be identified as Schwann cells and/or mesenchymal cells of the hindlimb. The nChE reaction product was also detected in the axolemma of nerve fibers and their growth cones. The distribution of nChE activity in the developing peripheral nerves of chick embryos suggests that these molecules may influence the process of axonal elongation and locomotion. Several possible mechanisms of nChE action on growing axons can be presumed: 1. (i) intracellular Ca2+ level regulation. 2. (ii) providing an adhesive substrate. 3. (iii) butyrate production affecting the cell metabolism and the distribution of neurotubules and neurofilaments. It is also assumed that nChE molecules are involved in the interactions of nerve fibers with Schwann cells and/or mesenchymal cells as well as in interneuronal interactions.

Localization of dipeptidylpeptidase IV was studied in the spinal cord meninges and peripheral nerve coverings of fetal and postnatal rats. In the same sections, the localization of alkaline phosphatase was monitored. In the prenatal period, dipeptidylpeptidase (DPP) IV activity in the differentiating meninges appeared at the time of cerebrospinal fluid spaces formation (on day 16 in the cervical region and on day 18 in the lumbar region). In adult animals DPP IV was found in cells of those meningeal lamellae which delineated the cerebrospinal fluid spaces (the outer, intermediate and inner lamellae), in the perineurium, in Schwann cells and in some fibroblasts of the bulk of dura mater. It is suggested that DPP IV plays a role in the metabolism of neuropeptides by their interaction with cerebrospinal fluid. Alkaline phosphatase activity was detectable earlier than DPP IV activity. Positivity was first observed in some cells of the meninx primitiva and, later on, in the ectomeninx and also in the differentiating endomeninx where it disappeared postnatally. The developing ectomeninx exhibited activities of both enzymes. Alkaline phosphatase occupied its external layers, while DPP IV was localized in its inner layers. This enzymatic heterogeneity of the ectomeningeal layers suggests that the ectomeninx gives rise not only to dura mater (which in adult animals exhibits alkaline phosphatase activity) but also to the outer arachnoid layer (positive for DPP IV in adult rats).

Objective The aim of this study was to evaluate the effect of preventive and therapeutic use of subarachnoid sodium nitroprusside (SNP) administration in patients with non-traumatic subarachnoid haemorrhage (SAH).

The dorsal root entry zone (DREZ) thermocoagulation for intractable pain after brachial plexus avulsion was performed in 21 patients. Good results in pain relief (relief of more than 75% of preoperative pain) were achieved in 62% of patients, whereby fair results (relief of 25-75% of preoperative pain) in 38% of patients. There was no patient with poor result (relief of less than 25% of preoperative pain). Complication rate was 14%. The whole patient population was subdivided into two groups (Group 1 and Group 2). Direct spinal cord bipolar stimulation and registration with the goal to localize DREZ was performed in the Group 2 consisting of 12 patients (n=12). The point on the spinal cord surface where no response after stimulus of low intensity was obtained was the site (the posterolateral sulcus) we identified as the most suitable point for the placement of radiofrequency thermocoagulation electrode. Comparing with the Group 1 consisting of nine patients (n=9), where the localization of DREZ by evoked potentials was not performed, significantly better effect of pain relief was recorded (P0.05, odds ratio 10). There was no statistically significant difference (P0.7) in complication rate in Group 1 and Group 2. Described electrophysiological technique is very helpful in identifying of DREZ and, in combination with microsurgical technique, can create DREZ thermocoagulation more effective.

Ventral root avulsion results in the loss of motoneurons in the corresponding spinal cord segment. In the present experiments we have tested effects of insulin-like growth factor-I (IGF-I) and Cerebrolysin on survival of avulsed motoneurons after their chronic intrathecal administration in the adult rats. We have found that avulsion of the C5 ventral roots results in significant loss of motoneurons in the same spinal cord segment due mainly to apoptosis. In comparison to the untreated control rats, the amount of motoneuron survival in avulsed ventral horn was significantly higher after 4 weeks intrathecal administration of IGF-I or Cerebrolysin. No significant differences were observed between effects of IGF-I and Cerebrolysin in our experimental model. The results suggest that both IGF-I and Cerebrolysin can reduce avulsion-induced loss of adult rat motoneurons.

Craniopharyngioma is a rare benign tumour originating from Rathke's pouch. This paper reports a tumour case studied with a set of markers defining protein-carbohydrate recognition. Expression of endogenous lectins and their reactive glycoligands is under differentiation-dependent control in many cell types. These parameters can be related to the degree of cell differentiation in tumours. Therefore, the expression patterns of endogenous lectins, namely galectins-1, -3, and -7, in the craniopharyngioma case were determined. Galectins-1 and -3 were also used to reveal glycoconjugates in cells and extracellular matrices, an approach that has heretofore relied largely on plant lectins. The staining pattern of craniopharyngioma is compared with that of two other types of ectodermally derived tumours, namely basal and squamous cell carcinomas. Clusters of polygonal and flattened cells with morphological characteristics of differentiated cells in the craniopharyngioma and the majority of poorly differentiated cells in squamous cell carcinomas were reactive with galectin-3. No binding of this probe was observed in cells of basal cell carcinomas and the majority of craniopharyngioma cells. In view of the lack of accessible binding in the basal layer of normal squamous epithelia where proliferative cells (including stem cells) are located, galectin-3 binding could be used to distinguish basal from suprabasal cells of squamous epithelial cells.

Peripheral nerve damage is a frequent consequence of trauma, tumor surgery or diseases. Clinical results of functional reinnervation after the application of cutaneous grafts are still unsatisfactory. Differences in the extracellular matrix are considered to be one of the factors responsible for poor results of motor axon reinnervation through the cutaneous graft. To verify these differences, we compared morphological features of the motor axons regenerating through the graft prepared from the saphenous nerve and the motor branch of the femoral nerve. Eighteen female adult rats (Wistar) were used in experiments. The saphenous nerve, the femoral nerve, and its main motor branch were exposed under deep anesthesia with ketamine and xylazine. The nerve graft (10 mm) prepared from the saphenous nerve was applied between the stumps of the transected motor branch of the femoral nerve in the 6 rats. In the next 6 rats, the nerve graft (10 mm) harvested from the motor branch of the femoral nerve was inserted between stumps of the transected motor branch of the femoral nerve on the contralateral side. All rats were perfused with Zamboni's fixative solution 14 days after grafting. The samples of grafts and the intact motor branch (n = 6) were dissected and embedded in Durcupan ACM. Semithin sections stained with Toluidine Blue were used for morphometric analysis of myelinated axons by means of computer-assisted image analysis system. Ultrathin sections counterstained with uranyl acetate were viewed and photographed in an electron microscope. The number of myelinated motor axons showing early regeneration under conditions of the cutaneous and motor nerve grafts was similar. The diameter of axons and thickness of their myelin sheaths were significantly smaller when the axons regenerated into the saphenous nerve in contrast to the motor graft. Morphometric analysis of early regeneration of myelinated motor axons suggests that the cutaneous and motor branches of the femoral nerve provide different conditions not for the growth but for the maturation of motor axons.