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Legg-Calvé-Perthes disease (osteochondrosis of the femoral head) has been recognized in archaeological material for nearly a century but is extremely rare. We describe two Czech cases from archaeological findings. The first case was diagnosed in the skeleton of a man older than 50 years with the left hip affected. The skeleton was in grave Number 2 of the Langobard cemetery at Luzice (Moravia) and dated to the end of the fifth century and the beginning of the sixth century AD. The second case was described by J. Chochol in 1957 on the left femur and half of the pelvis of a skeleton from an archaeological investigation in Brandýsek (Bohemia), ninth to tenth centuries AD. Using the diagnostic criteria of Ortner and Putschar, we excluded slipped capital femoral epiphysis in both cases. We discuss the differential diagnosis of Legg-Calvé-Perthes disease versus unilateral and bilateral osteochondroses of the femoral head in archaeological and current clinical material. [ABSTRACT FROM AUTHOR]

A prospective randomised 2-year study was performed to compare the conservative and operative treatment of mild and moderate forms of spondylotic cervical myelopathy (SCM). Forty-eight patients presenting with the clinical syndrome of SCM, with a modified Japanese Orthopaedic Association (mJOA) score of 12 points or more, were randomised into two groups. Group A, treated conservatively, consisted of 27 patients, mean age 55.6 +/- 8.6 years, while group B was treated surgically (21 patients, mean age 52.7 +/- 8.1 years). The clinical outcome was measured by the mJOA score, recovery rate (RR), timed 10 m walk, score of daily activities (recorded by video and evaluated by two observers blinded to the therapy), and by the subjective assessment of the patients at 6, 12, and 24 months of the follow-up. There was, on average, no significant deterioration in mJOA score, recovery ratio, or timed 10 m walk within either group during the 2 years of follow-up. In the surgery group there was a slight decline in the scores for daily activities and subjective evaluation. A comparison of the two groups showed no significant differences in changes over time in mJOA score or quantified gait, but there were significant differences in the score of daily activities recorded by video at 24 months, which was a little lower in the surgical group, and also in RR and subjective evaluation, which were both worse in the surgical group at months 12 and 24. However, at month 6, this last parameter was significantly better in the surgical than in conservative group. Surgical treatment of mild and moderate forms of SCM in the present study design, comprising the patients with no or very slow, insidious progression and a relatively long duration of symptoms, did not show better results than conservative treatment over the 2-year follow-up. [ABSTRACT FROM AUTHOR]

Western Eurasia witnessed several large-scale human migrations during the Holocene 1-5 . Here, to investigate the cross-continental effects of these migrations, we shotgun-sequenced 317 genomes-mainly from the Mesolithic and Neolithic periods-from across northern and western Eurasia. These were imputed alongside published data to obtain diploid genotypes from more than 1,600 ancient humans. Our analyses revealed a 'great divide' genomic boundary extending from the Black Sea to the Baltic. Mesolithic hunter-gatherers were highly genetically differentiated east and west of this zone, and the effect of the neolithization was equally disparate. Large-scale ancestry shifts occurred in the west as farming was introduced, including near-total replacement of hunter-gatherers in many areas, whereas no substantial ancestry shifts happened east of the zone during the same period. Similarly, relatedness decreased in the west from the Neolithic transition onwards, whereas, east of the Urals, relatedness remained high until around 4,000 BP, consistent with the persistence of localized groups of hunter-gatherers. The boundary dissolved when Yamnaya-related ancestry spread across western Eurasia around 5,000 BP, resulting in a second major turnover that reached most parts of Europe within a 1,000-year span. The genetic origin and fate of the Yamnaya have remained elusive, but we show that hunter-gatherers from the Middle Don region contributed ancestry to them. Yamnaya groups later admixed with individuals associated with the Globular Amphora culture before expanding into Europe. Similar turnovers occurred in western Siberia, where we report new genomic data from a 'Neolithic steppe' cline spanning the Siberian forest steppe to Lake Baikal. These prehistoric migrations had profound and lasting effects on the genetic diversity of Eurasian populations., (© 2024. The Author(s).)

This paper deals with cases of diffuse idiopathic skeletal hyperostosis (DISH) found at the Late Roman Age necropolis in Pécs, Hungary (4th century AD). The skeletal remains of two male individuals, aged between 60-70 years and 45-55 years, displayed right-sided ossification of the anterior longitudinal ligament with extra-spinal manifestations typical in DISH cases. It is presumed that both male individuals were middle-class citizens. Their social status was supplemented with trace element analysis in order to reconstruct the dietary habits of the urban population. Concentrations of Sr and Zn indicated a predominantly vegetal diet. Potential DISH risk factors and associations were subsequently discussed and compared with our findings.

Three agricultural village homesteads (farmsteads) have been used to describe social development in the course of the 20th century. Distribution of the work, including stratification of prestige and power, is described in detail for the social group living at the farmstead before the World War I and by its end. We used this first period (1901-1918) at the beginning of the 20th century as a model for the social relations outlasting long from the Middle Ages. In the period from the establishment of the First Republic till the end of the World War II (1918-1945) we can witness the replacement of anterior members of the working team (ploughman and senior maid). Due to the lack of farm-hands they are replaced by immigrants from Slovakia. Since 1945 till 1948 the larger family and German prisoners are engaged in the distribution of the work at the farm. In this period of social changes the farmsteads are gradually abolished, which brings about also decomposition of the social group, which was earning its living from the farm. In the development period between 1948 and 1990 we can see the collapse and destruction of the social groups at smaller agricultural farmsteads including larger estates and their replacement by social organisation of agricultural co-operative farms. In the development period lasting from 1990 till the end of the 20th century the agricultural system of smaller farmsteads was partially restored. Thanks to the introduction of new agricultural machines the family alone is able to cultivate the arable land belonging to the farmstead. Specialised companies performing partial works are employed for occasional works. At the majority of farmsteads the traditional farming has not been restored any more.

On the archaeological finds, written reports and in the composition of the bone tissue, we can suppose that social evolution in Hallstatt--La Tène period proceeded through the three following stages. In the Early Iron Age (Hallstatt period) with funerary furnishings of barrows, seldom, also, of burial grounds, we can distinguish only two groups: a ruler and his court with women and servants. Elements of nomadic and pastoral traditions can be distinguished in the ruling stratum. The second class of people living in bondage has agricultural features. At this first stage of social evolution (approximately between the 7th and the 5th centuries B.C.), in the period of princes, we can distinguish only two social groups--the king (prince) with his court on one side and peasants on the other side. This social stratification determines access to land and, at the same time, ownership of mobile wealth--cattle. The elite accumulates wealth coming also from other sources, for example, in an eponymic locality it mines salt and controls its distribution, other elites of the Hallstatt society control key points of trade, in the first place the trade in amber, being the trade proper provided by foreign merchants. In an archaeological context there appear the settlements of the elite of the refugium. The second social stage with military democracy (in the 4th and the 3rd centuries B.C.) is characterised by several factors: 1st Cheaper weapons, due to their manufacture using products with ensured sources of raw material, 2nd overproduction of foodstuffs, 3rd increase of population. Access to the sources has a larger spectrum, this is why the social stratification of the structured unevenness in this period is taking the form of a pyramid. This social pyramid is confirmed by written reports and also appears in the funerary furnishings. Not only are the ruler and his "court" put in the graves, but also all the members of the clan. We suppose that the new social group of priests, who gained a high social prestige both in wartime and in peacetime, took part in this change of mentality and opinions. Due to the rich admission of the dietary elements Sr and Zn, we suppose that it could be garniture 600 in the burial grounds that represents this group. From the result it can be deduced at 5% significance level (p = 0.0519) that also the relations between the garnitures within the social stratification differ consistently with the region. When strontium content in social groups was statistically tested regardless of the region, differences are found at the 5% level of significance (p = 0.0402) between the group II (males with weapons, females with anklets and with 2 bracelets, 54 skeletons with mean content of 198 microg Sr/g of bone) and group IV (males without funerary furniture, children and exceptions, 31 skeletons with mean content of 154.9 microg Sr/g of bone). Also at statistical testing of lead content, regardless of the region, there are differences at the 5% level of significance between group II (48 skeletons with mean content 1.5 microg Pb/g of bone) and group IV (27 skeletons with mean content 0.47 microg Pb/g of bone). Regardless of region there is an apparent difference in consumption of the vegetal component of diet (strontium) and social marker (lead) between the richest elite group II and group IV covering the persons living in bondage on the level of slaves. The third phase of social evolution of the urban type is characterised by the evolution of oppida. Production is fully concentrated here. An oppidum is a market place formed by agricultural villages. Due to the change of the funerary rite towards cremation and the absence of burial grounds, the social structure can only be judged in a mediated manner by means of written reports. A large number of smaller tribal "kingdoms" are concentrated into several larger ones, comprising even several tribes, such as, for example at the king of the Boeotians and of the Taurisks Kritasir in Pannonia and Norik [1]. In these three phases, social evolution lasted for 6 to 7 centuries and headed towards the state system. It was interrupted by the migrations of the Celts and by external pressure from the Romans and the Germans.

In skeletal material from the neolithic settlement at Makotrasy, county Kladno, were analysed two children's craniums (identification numbers Ao 8218 and Ao 4184) with pathological cases. Case 1 (Object 127, Ao 8218) is the individual about 4 to 5 years old. There is oval aperture with the diameter 25 x 20 mm in the area of anthropometrical point bregma, with vertical, multiple knurled edges. Bevelled and rounded segment in the left frontal part of the aperture with diameter 10 mm is imitating healing process. We suggest this case is the trephination with the marks of the healing process in the period of 1 to 2 weeks after the surgery took over. Case 2 (Pit 25, Ao 4184) is child with age determined about 4 years old. Cranium was found buried separately. There is oval defect located at os occipitale and os parietale sin and goes through sutura lambdoidea. Caudal part of defect is missing. The edge of the defect is sharp and inward bevelled with exposed diploe. Traces of any vital reaction were not identified. Diameter is around 50 mm. Perimortal trephination leading to death, or postmortal taking of the trephinational amulet must be considered. There were several pathological lesions on the same skull. Defect of oval shape sized 8 x 12 mm is located at the os parietale dex. Defect interferes mostly with lamina externa and less with lamina interna. Exposed diploe is without any vital reaction.

The reasons for transcranial operative revision of anterior cranial fossa are cerebrospinal fluid (CSF) leakage, pneumocephalus, recurrent meningitis and eventually other causes. The trauma is the most common etiology of previously mentioned pathologic statuses, rarely it can also be long-lasting intracranial hypertension. We retrospectively analyzed our 61 patients, operatively treated at Department of Neurosurgery in Brno-Bohunice between 1997 and 2005, at whom the cranionasal communication must have been treated by means of transcranial neurosurgical repair of anterior fossa skull base. Each year approximately 10-15 operations of this kind were performed. The main goal of operative solution was the water-tight closure of dural defect and cranial base by means of direct dural suture duroplasty with periostal flap, fascial flap or other graft. Each case solution was dependent on actual operative appearance of the operative field. The majority of transcranial repairs of frontal cerebral fossas were performed acutely as a part of frontobasal injury operation with haematoma, calvar impressive fractures and open cerebral injury. The minority of repairs is formed by elective operations for posttraumatic rhinnorhea and meningitis. In our announcement we also mention possible conservative treatment.

A prospective 3-year randomized study comparing conservative and surgical treatment of spondylotic cervical myelopathy to establish predictive factors for outcome after conservative treatment and surgery. The clinical, electrophysiological and imaging parameters were examined to reveal how they characterized the clinical outcome. Statistically, pair-wise and multiple comparisons of different were used with the independent t-test and on one-way anova models followed by Tukey multiple-range tests. The patients with a good outcome in the conservatively treated group were of older age before treatment, had normal central motor conduction time (CMCT), and possessed a larger transverse area of the spinal cord. The patients with a good outcome in the surgically treated group had a more serious clinical picture (expressed in mJOA score and slower walk). Patients should rather be treated conservatively if they a spinal transverse area larger than 70 mm2, are of older age, and have normal CMCT. Surgery is more suitable for patients with clinically worse status and a lesser transverse area of spinal cord.

Introduction: Based on our experience with stereotactic evacuation of spontaneous supratentorial hematomas this method has also been used for evacuation of spontaneous infratentorial hematoma by the transtentorial approach., Material and Method: The authors present a series of 6 patients with spontaneous intracerebral hematomas evacuated by the frame-based stereotactic technique, with monitoring of intracranial pressure (ICP) during the stereotactic evacuation. This method was indicated in patients with stable neurological status according to Glasgow Coma Scale (GCS), more than 10. The frame-based stereotaxy with the Riechert-Mundinger apparatus with CT localisation of target and optimal trajectory was used., Results: The presented values after stereotactic evacuation show reduction of the initial intraparenchymal ICP in all patients to values less than 20 mmHg., Conclusion: The measuring of the ICP and the analysis of dynamic changes during stereotactic evacuation suggest that this procedure can significantly reduce the ICP performed in connection with ICH and we believe that our results can improve management of patients with spontaneous infratentorial and supratentorial intracerebral hematoma. (Fig. 1, Ref. 21.).

Objective: Temporary clipping in aneurysm surgery has been used more frequently in last years to increase the efficacy and safety of the neck dissection and obliteration. Experimental studies have shown that neuroprotection using hypertension and mannitol administration diminishes the risk of ischemia during this procedure. However, recent studies show that this method has to be used with caution., Methods: In 85 aneurysms we used temporary vessel occlusion with neuroprotection described above in 17 patients (20%), ranging from 2 to 35 minutes (mean 9 minutes). The indication was peroperative rupture (3 cases), difficult neck dissection (13 cases) and a giant aneurysm (1 case)., Results: Forteen of these patients had a good result, one was severely disabled, the other 2 died. One of them had a large temporal hematoma and was HH=V before the operation, the other one had a premature peroperative aneurysm rupture. Shorter occlusion times were used in patients with a good outcome, in patients with elective use of the clip and in patients with no new ischemia on the postoperative CT scan (t-test, p<0.05). The postoperative infarction rate was similar in the group of patients with (17%) and without temporary clipping (15%)., Conclusion: We conclude that temporary clipping in aneurysm surgery is a relatively safe procedure which facilitates the aneurysm neck dissection and enables neck obliteration in difficult cases. Better results are achieved with short duration of occlusion. (Fig. 4, Ref. 13.).

We present a group of 29 consecutive head injured comatose patients with the syndrome of transtentorial herniation. All patients had urgent surgery and then continuous monitoring of ICP, CPP, blood pressure and jugular bulb oximetry was instituted. Two postoperative CT and SPECT examinations were performed in each patient. 15 patients had a normal CPP (> 70 mmHg) throughout the postoperative period, 80% of them had a favourable outcome. On the other hand 14 patients had decreased CPP lasting at least one hour and only 36% of them had a favourable outcome (p < 0.05). Similar relationships were found comparing GOS in patients with normal and increased ICP (> 20 mmHg) and normal and decreased SjO2 (< 55%). All but 3 patients had ischaemia on SPECT. Ischaemia improved on the 2nd SPECT in 11 patients and 10 (91%) of them had a favourable outcome. GOS (mean follow up 9 months) is: 12 patients good, 5 moderately disabled, 2 vegetative, 10 died. We conclude that SPECT is able to disclose even reversible ischaemic changes. In these patients all effort has to be made to keep CPP on normal levels. Improvement in cerebral perfusion is related to a better outcome.

Congenital swan neck deformities in seven fingers of two patients were treated by transfer of the flexor digitorum superficialis tendon to a tendon graft which was attached the extensor aponeurosis over the middle phalanx. The tendon transfer is protected for at least 2 months by a modified Murphy splint.

Lumbar disc operations have been performed in Brno since 1952 and from the very beginning they are performed under regional anaesthesia. Since 1965 until 1999 about 16,000 operations for herniated discs have been performed here. The number of operations doubled with the foundation of the second neurosurgical department in Brno in 1992. Lumbar disc surgery represents 25% of the operation spectrum in our department. Epidural anaesthesia is advantageous for less risk of some complications compared with general anaesthesia and enables communication between the surgeon and the patient. Other advantages are: less visible bleeding in the operative field due to the lateral position and the fact that the surgeon can sit during the operation. On a long-term basis we found 4-5% had further surgery for reccurent problems. Objective neurological evaluation 6 weeks after the operation showed improvement in 92% of patients. The patients themselves consider their status as very good or satisfactory in 82% (median 3 years after the operation). Besides a correctly performed operation we emphesize also the role of correct diagnosis (good correlation between the patient's problems and CT scan finding) for a good treatment result.

A simple apparatus based on the classical stereotactic method of surgery offers the opportunity to master miniinvasive procedures in neurosurgery and neurotraumatology. This device is particularly helpful in evacuation of intracerebral spontaneous and traumatic haematomas and in stereobiopsies, i.e. the most frequent operations in clinical practice, without the need of general anaesthesia, craniotomy and interference with cerebral tissue. The reliability of the stereotactic apparatus was positively evaluated by three independent surgeons. The apparatus was registered for use in the health services.

Background: Haemangioblastoma within CNS occurs either as a sporadic tumor or as a syndrome referred to as Morbus Hippel-Lindau (MHL). Since 1993 it has been known that this disease is caused by MHL mutation of the suppressor gene on the chromosome 3p25-p26. The syndrome can include malign tumors of abdominal organs., Material and Methods: We treated 8 patients with CNS haemangioblastoma (5 males and 3 females) during the period of 1998-1999. Two of them were patients with MHL (numerous CNS or retinal haemangioblastomas). All patients were treated by radical extirpation of haemangioblastoma except for one who got ventricular-peritoneal shunt and his tumor was irradiated by linear accelerator. All patients were screened for the presence of abdominal carcinoma., Results: The post-operative course was good in all patients. The screening has not revealed any co-existence of malignant processes., Conclusion: The treatment of haemangioblastoma is only a part of the complex therapy of MHL. The occurrence of carcinomas (especially those of the kidneys) is highly probable, and the mortality of patients with this affliction exceeds that associated with haemangioblastoma owing to its treatment by improved neurosurgical techniques. The patients must be permanently observed in order to reveal the carcinoma as soon as possible, as well as for its potential recurrence or de novo growth of haenangioblastomas. (Tab. 1, Fig. 2, Ref. 17.)

Four out of a group of 5 patients with a colloid cyst located within the III cerebral ventricle were surgically treated by means of a classical microsurgical technique and one of them was treated stereotactically. The preference was given to the frontodorsal transcortical approach. The current CT diagnosis is reliable and by use of MR it is to a certain extent possible to distinguish even the origin of the cyst. Prior to examination we had found out that the cyst was a neuroenteral inclusion and the final surgical result was good in all patients who had been subdued to operation during the initial phase of foramen Monroi enclosure. (Fig. 2, Ref. 10.)

The samples from the proximal femora were taken from 12 cementeries from the Roman period. The skeletons date from the 1st-4th centuries A.D. Trace element analysis was used in order to reconstruct the basic diet. The sites that best corresponded to the model of Old Germanic diet described by ancient authors "meat, milk and cheese" were found in the Pruszcz Gdanski East Pomerania region close to the Baltic sea as well as in region Halle (Niemberg) and not far from Donau (Sládkovicovo). This diet is characterized by a large amount of protein and consequently of zinc. In the original Old Germanic region in a time period of more than 1000 years (from 400 B.C. to 700 A.D.) there is the same type of trace elements sources for bones and also the same type of the diet. This possibly distinguishes Germanic soldiers (aboriginal) from others groups in Roman legionary camps. It seems that the Donau River is very important for predicting the type of diet in the Roman period. North of the river animal component prevails south of the river vegetal component prevails. The rich agricultural land along the Donau River and in the Pannonian plains affects social arrangement as well as the structure of bones in Germans and Sarmats in the 2nd-4th centuries. Lead became a civilization element. It appeared in the diet of the Greek and Romans. Contamination varied with different social classes. We have found higher lead concentration in the femurs of the Germans than in those of the Sarmatians. The highest concentration we found was in Pannonian towns (Gorsium, Sopianae) and legionary camps (Straubing, Gerulata). In reference to age, the maxima of the highest lead concentrations in Gerulata II are between 11 and 13 years of age and between 40 and 50 years.

Cerebral ischemia is a frequent and dangerous consequence of some cerebrovascular diseases. Ischaemia may be used also electively in the course of neurosurgery. Therefore new possible ways are sought how to reduce the danger of ischaemia or to prevent it. In the submitted paper some methods of neuroprotection are described and their potential or actual applicability in clinical neurosurgery are discussed. In addition to influencing the brain cell and pretentious methods in the sphere of molecular biology and genetics the induction of systemic hypertension supplemented alternatively by other methods such as hypothermia, the use of mannitol, haemodilution and hypervolaemia seem natural. A higher blood pressure helps to make leptomeningeal and cortical anastomoses patent and strengthens the collateral circulation from marginal zones of ischaemia, penumbra to the ischaemic centre and to prevent thus cerebral infarction.

The authors investigated a consecutive group of 14 patients treated at the Neurosurgical Clinic on account of traumatic intracranial haemorrhage, admitted with the clinical temporal conus syndrome (GCS 3-5, ipsilateral or bilateral mydriasis, failure of vital functions). All had emergency operations and at the intensive care unit the cerebral perfusion pressure and the saturation in the jugular bulb was monitored continuously. On the first and fifth day after surgery a check-up CT and SPECT examination was made. Only two patients had ischaemia during the first CT check-up, while 11 patients had impaired perfusion on the first SPECT. Improving perfusion on the check-up SPECT was the sign of a favourable prognosis, while ischaemia on the first CT was in both instances fatal. The Glasgow Outcome Score (GOS) six months after the injury was as follows: 9 patients had a good result, 2 patients were moderately disabled 3 patients died. The authors consider the following as basic prerequisites of a favourable outcome: not only early operation but also monitoring and treatment of impaired cerebral perfusion.

Contemporary vascular neurosurgery cannot sometimes avoid electively used focal brain ischemia. In aneurysm surgery, for example, it is sometimes necessary to close temporarily the parent vessel for a safer dissection of the aneurysm sac. Also carotid endarterectomy cannot be done without a temporary closure of the artery. One of possible neuroprotective methods to be used during this controlled focal ischemia is a systemic hypertension. The knowledge of anatomical and functional capabilities of the brain circulation is crucial for understanding the advantages but also the limits of this neuroprotective method.