Wstęp: W niniejszym badaniu retrospektywnym poddano analizie wyniki badań radiologicznych, postępowanie lecznicze oraz wyniki leczenia chorych z naczyniowłókniakiem młodzieńczym z inwazją wewnątrzczaszkową. Omówiono: częstość szerzenia wewnątrzczaszkowego, jego drogi i wpływ na postępowanie lecznicze. Materiał i metody: Zanalizowano dokumentację medyczną 62 chorych z naczyniakowłókniakiem młodzieńczym. 10 chorych z guzami szerzącymi się wewnątrzczaszkowo włączono do badania. Wszyscy pacjenci to mężczyźni w wieku od 10 do 19 lat. Wyniki: Zgodnie z klasyfikacją Andrewsa, 8 chorych prezentowało stadium IIIb, 1 stadium IVa i 1 stadium IVb. U 8 chorych guz położony był zewnątrzoponowo, natomiast inwazję wewnątrzoponową stwierdzono w 2 przypadkach. 9 osób było leczonych operacyjnie. Najczęściej stosowano łączony dostęp: z dołu podskroniowego i podwargowy. Jednego chorego poddano radioterapii. Okres obserwacji po zakończeniu leczenia wynosił od 8 do 26 lat. U 2 z 9 operowanych chorych (22%) stwierdzono nawrót zewnątrzczaszkowy. Wnioski: U pacjentów z rozległym zajęciem dołu podskroniowego najczęstszą drogą naciekania wewnątrzczaszkowego jest szczelina oczodołowa górna. Ze względu na wysokie ryzyko nawrotów i potencjalnych poważnych powikłań, pacjenci z zaawansowanymi postaciami naczyniowłókniaka młodzieńczego powinni być leczeni przez interdyscyplinarny zespół w ośrodkach referencyjnych trzeciego poziomu z dostępem do nowoczesnych technik diagnostycznych i terapeutycznych.
Introduction: This retrospective study analyzes radiological findings, therapeutic management and outcomes of patients with intracranial extension of JNA. The routes of intracranial spread, incidence of intracranial disease and influence on therapeutic approach are discussed. Material and methods: An evaluation on the records of 62 patients with JNA was performed and 10 patients with intracranial tumors were included in the study. All patients were males aged 10 to 19 years. R esults: According to Andrews’ classification 8 patients presented with stage IIIb, 1 patient stage IVa and another patient stage IVb tumor. Intracranial invasion was extradural in 8 cases and intradural in 2 patient. Surgery was performed in 9 cases and the most common was combined approach: infratemporal fossa and sublabial transantral. One patient was referred for radiotherapy. Follow-up ranged from 8 to 26 years. There was extracranial recurrence in 2 (22%) of 9 operated patients. C onclusions: The superior orbital fissure is the most frequent route of intracranial spread in patients with extensive involvement of the infratemporal fossa. Due to high risk of recurrence and potential serious complications advanced cases of JNA should be managed by experienced multidisciplinary team, preferably in tertiary referral centers, with an access to modern diagnostic and therapeutic modalities.
Introduction. Ischemic strokes (IS) are one of the main causes of death and disabilities around the globe. Therefore, there is a huge need for researching the pathogenesis of IS. The C-reactive protein (CRP) plays a role during inflammatory processes. Results of some studies conducted on animal models indicate that CRP affects the blood-brain barrier (BBB) stability during IS. The presence of S100BB protein can be considered as an indication of BBB injury. Aim. The purpose of this study was to discover the relationship between CRP and S100BB protein. Material and methods. The study looked at fifty four IS patients, with the disease confirmed by computer tomography (CT). The clinical status was evaluated on the 1st, 3rd, 5th, 10th day and 3 months following the onset of IS. Neurological status was estimated using the National Institute of Health Stroke Scale (NIHSS). Patients’ disability level was determined, using Modified Rankin Scale (mRS) and Barthel Index (BI). The volume of ischemic focus was calculated on the 10th day after the stroke, using CT. The levels of CRP and S100BB were evaluated on 1st, 3rd, 5th and 10th day after the stroke onset with usage of ELISA method. Results. The mean level of CRP and its concentration on the 1st, 3rd, 5th and 10th day directly correlates with a deteriorated clinical status, as measured with the use of NIHSS, BI and mRS on day 10 and 3 months after the onset of IS. We found a correlation with the mean CRP level and bigger volume of ischemic injury. The mean CRP level correlated with the mean level of S100BB protein. In the group of patients with low CRP (0.51-24.68 mg/mL) the level of S100BB and the volume of ischemic focus were lower than in the group with a high level of CRP (24.69-209 mg/mL). Conclusions. CRP can be considered as a predictor of a worse clinical outcome after stroke. The relationship between CRP and S100BB protein can suggest the active role of CRP during IS
JavaScript is turned off in your web browser. Turn it on to take full advantage of this site, then refresh the page.