Children's cranial lesions from Neolithic

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.

[Anterior skull base reconstruction]

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.

Rosai-Dorfman disease: successful long-term results by combination chemotherapy with prednisone, 6-mercaptopurine, methotrexate, and vinblastine: a case report

Sinus histiocytosis with massive lymphadenopathy (SHML), also known as Rosai-Dorfman disease (RDD), is a rare clinicopathologic entity of unknown etiology. The majority of patients do not require treatment, demonstrating spontaneous resolution or stable disease. However, in some cases the disorder runs a progressive course and/or threatens vital structures and functions, which dictates some form of intervention. It is not clear what constitutes the best approach for those cases. We report on a girl with an extensive and progressive form of the disease who was cured with combination chemotherapy, showing no evidence of recurrence after a follow-up of 5.5 years.

Predictive factors for mild forms of spondylotic cervical myelopathy treated conservatively or surgically

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.

Predictive factors for spondylotic cervical myelopathy treated conservatively or surgically

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. 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 have 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.

The influence of mild hypothermia on ICP, CPP and outcome in patients with primary and secondary brain injury

Aim of this study was to examine the hypothesis that only a subgroup of patients with lesser primary brain damage after severe head injury may benefit from therapeutic hypothermia. We prospectively analysed 72 patients with severe head injury, randomized into groups with (n = 37) and without (n = 35) hypothermia of 34 degrees C maintained for 72 hours. The influence of hypothermia on ICP, CPP and neurological outcome was analysed in the context of the extent of primary brain damage. Patients with normothermia and primary lesions (n = 17) values: GCS on admission 5 (median), ICP 18.9 (mean), CPP 73 (mean), GOS 4 (median). Patients with normothermia and extracerebral hematomas (n = 20): GCS 4, ICP 16, CPP 71, GOS 3. Patients with hypothermia and primary lesions (n = 21): GCS 4,62, ICP 10, 81, CPP 78,1, GOS 4. Patients with hypothermia and extracerebral hematomas (n = 14): GCS 5, ICP 13.2, CPP 78, GOS 5. Hypothermia decreased ICP and increased CPP regardless of the type of brain injury. Hypothermia was not able to improve outcome in patients with primary brain lesions but this pilot study suggests that it significantly improves outcome in patients with extracerebral hematomas.

Stereotactic evacuation of spontaneous infratentorial hemorrhage with monitoring of intracerebral pressure

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.).

The benefit of a temporary vessel occlusion in aneurysm surgery

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.).

Cerebral perfusion pressure and spect in patients after craniocerebral injury with transtentorial herniation

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.

Lumbar disc surgery in regional anaesthesia--40 years of experience

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.

Treatment of congenital swan neck deformity with dynamic tenodesis of proximal interphalangeal joint

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.

[Colloid cysts in the 3rd cerebral ventricle]

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.)

[Central nervous system hemangioblastoma: its role in von Hippel-Lindau disease]

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.)

Precision grip with congenital hypoplasty or hypofunction of the thumb

We tested the grip in four patients with congenital defects of the hand and either a hypoplastic thumb or a thumb with impaired inervation. Small objects were taken by a scissors grip between the fingers. In a hand with radial duction in the manus vara congenita, during strengthening of the wrist, the grip from the ulnar side between the fourth and fifth fingers was changed to the radial side between the second and third fingers. Large objects were gripped by all the three-phalanx fingers into the palm in a horizontal position. In case 4 with hypoplasia of the thumb grade IIIC by the classification of Blauth and Buck-Gramcko, we describe a transposition of the index finger to the site of the thumb and the hypoplastic thumb to the site of the index finger. It is obvious that the precision grip is affected by the thumb length and strengthening of the ulnar side of the wrist. We assume that the scissors grip is the earliest precision grip in the evolution of the primate hand.

[A simple stereotaxic surgical apparatus]

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.

Diet reconstruction in the Roman era

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 and neuroprotection from the viewpoint of the neurosurgeon]

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.

[Traumatic intracranial hemorrhage with a clinical temporal conus syndrome]

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.

[Anatomic and functional basis for the effect of systemic hypertension on focal cerebral ischemia]

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.

Congenital contracture of the superficial flexor of the hand

The authors describe a case of an inborn contracture of the superficial flexors of the three-phalangeal fingers in a 15-year-old girl and treatment of the condition. For clinical purposes a classification on congenital deformities in the proximal part of the flexor complex was proposed in which the described case is included. The classification was derived from the ontogenetic development of flexor tendons. There are three types of deformities: S1--the muscular belly of the superficial flexor of the fingers is only in the palm; S2--the muscle is attached to the area between the wrist and medial epicondyle; S3--the palmaris longus of the fingers is on the medial epicondyle, however the m. palmaris longus is lacking; Pl-1 the superficial flexor exists only in the form of a proximal muscular belly of varying length; Pl-2--the palmaris longus is on the wrist and the insertion tendon may be thinner than on the contralateral side. The described contracture deformity was classified as type S2.

Environmental pollution and the occurrence of congenital defects in a 15-year period in a south Moravian district

We have made a simple 15-year retrospective epidemiological study of a part of South Moravia, district Breclav, on the basis of genetic documentation of 245 congenital defects and 28 spontaneous abortions. The whole area was worked up by computer-geographical methods, and the occurrence of congenital defects was compared both in areas of severe chronic air pollution and in less contamined areas. There were three municipal areas, Mikulov, Breclav-Postorná, Velké Bilovice and their surroundings, in which an increased number of congenital defects was recorded. In the municipal area of Breclav-Postorná there was also a greater occurrence of organic solvents and phosphoric acid and a significantly higher occurrence of spontaneous abortions and at the same time a higher occurrence of heart defects.

[Cerebral blood flow measurement]

A cerebral blood flow measurement is an important part of studying various brain pathologies, particularly brain ischemia. The methods of measurement are still improving, although the physical substance of many of them, like Fick's or Doppler's principles, outlasts further. A change in quality in last several years came with the use of isotopes and a computer technique. New options in imaging of circulatory changes with the help of magnetic resonance technology seem to be particularly perspective. If there were no economical obstacles, this method, which is able to disclose non-invasively a brain perfusion disorder in the very beginning, would be certainly immediately applied in the broad clinical practice.

[Development of European medicine to the time of Vesalius (16th century)]

Mythical Greece, Egyptian Alexandria and ancient Rome were the cradle of ancient medicine where the beginnings of anatomy and physiology were combined with nature philosophy of great personalities such as Hippocrates and Galen. A modern contribution i.e. medical chemistry, to European medicine was made by Arab physicians Rhazes and Avicena. Only when clerical dogmatism was overcome, after the discovery of the New world and the development of universities the road to scientific progress ws opened on which started the great surgeon and physician Andreas Vesalius.

[Minimally invasive treatment of traumatic cerebral hematoma. Further experience with stereotaxic evacuation]

The authors summarise their experience with 16 post-traumatic cerebral haematomas which they evacuated using stereotactic technique. Based on the achieved results they reached the conclusion that stereotactically aimed treatment of haematomas is an advance, for the patient's benefit. The evacuation cannula is safely inserted to its target from a transcutaneous drill hole of the skull and thus the patient is spared the surgical trauma associated with craniotomy and further brain damage. If necessary, the focus of haemorrhage can be reached again by puncture via the channel in the bone which navigates the cannula. Surgery under local anaesthesia is rapid and the results of promising. Extension of the new method depends, however, on the availability of simple stereotactic equipment which starts to play a part in the surgery of traumatic haematomas.

Reconstruction of paralyzed biceps brachii muscle by transposition of pedicled latissimus dorsi muscle: report of two cases

The biceps brachii muscle was reconstructed in two patients with inveterate injuries of the brachial plexus. The latissimus dorsi muscle was transferred on the thoracodorsal neurovascular bundle into the regio brachii anterior and sutured to the long head of the m. biceps brachii. The distal part of the latissimus dorsi muscle was sutured above the tuberositas radii along with the insertion tendon of the biceps brachii muscle. Both patients achieved very satisfactory restoration of flexion in the elbow joint 12 and 16 months after surgery.

Inveterate lesions of the collateral ligaments of the thumb joints

Inveterate lesions 2-18 months following injury to the collateral ligaments of the metacarpophalangeal (MP) joint of the thumb and pollicised proximal interphalangeal (PIP) joint were replaced by a tendinous transplant from the palmaris longus muscle. The group comprised three patients, 34-46 years old, with a post-traumatic injury of the ulnar collateral ligament of the MP joint of the thumb and a seven-year-old child with an congenital defect of the radial collateral ligament. Lateral 30-degree instability indicates injury of the collateral ligament. On examination the range of instability in the investigated group was between 45 and 90 degrees. The authors recommend comparison with the contralateral thumb.

Treatment of a maxillary defect following resection of carcinoma

A group of 37 oncological patients with tumours of the head and neck where extensive resection of the face, maxilla or mandible or calva was necessary, comprised five patients with a typical defect after resection of part of the maxilla including half of the palate and exenteration of the orbit. This extensive defect causes discomfort to the patient and his environment--functional i.e. impaired speech, and cosmetic. A satisfactory solution during reconstruction of the maxilla without the need of skeletal reconstruction is microsurgical transplantation of a narrow flap of the latissimus dorsi, usually with two cutaneous islands--one to close the palate and the other to close the orbit and face.

[Surgical findings in stereotaxic therapy of spontaneous cerebral hemorrhage]

Observation of stereotactic evacuation of haematomas in the deep structures of the brain in 41 patients and in the white matter of the cerebral lobes in 33 patients revealed that in the surgical technique and results no substantial difference can be found. The tactics of the intervention in deep hypertensive haemorrhages call however for greater care to avoid a new haematoma and also a greater effort to crush possible blood clots.

[Present possibilities for dura mater substitutes]

Since 1995, we have been using the Neuro-Patch--a fibrillar microporous polyesterurethane produced by B. Braun Surgical GmbH Melsungen. We have compared the Neuro-Path with the until very recently used autologous and homologous tissues from June 1995 to December 1996. According to the results of study, Neuro-Path appears to be the most suitable replacement material for duraplasty for both practical (no inflamation, CSF fistula appeared) and ethical reasons.

Circular stereotactic callosotomy: a preliminary report. Technical note

The authors propose a new method for performing stereotactic callosotomy, which they have named circular callosotomy. The operating device is the original Riechert-Mundinger's string electrode, which can be protruded through a side window and by rotating the probe it is possible to cut the commisural pathways to the extent required. The anatomical results of the operation can be checked using MRI scanning.

[Stereotaxic therapy of post-traumatic cerebral hemorrhage]

The authors present five case-histories pertaining to stereotactic evacuation of lobar traumatic cerebral haematomas and indicate new ways of their treatment. It ensure already from initial observations of the authors that stereotactic operation of these haemorrhages is justified and useful in haematomas affecting several cerebral lobes simultaneously or in case of symmetrical haematomas.

[Spastic complications in free flap transfers]

The authors follow up spastic reactions in free flap transplantations. In experiments on rats groin flaps were transplanted and during their preparation models of four types of spasms were made--segmental spasms of the afferent artery of the flap, spasms of the whole artery, spasms in the flap and tissue shock of the flap. The authors discuss possibilities of influencing and preventing spasms under experimental conditions and in clinical practice.

[Replantation of traumatically amputated parts of extremities-- indications and nomenclature]

The authors submit a brief report on replantation activities during the past five years and discuss the problem of indications and terminology of traumatic amputations. The paper contains instruction regarding communication by telephone between the attending surgeon and a specialized microsurgical department. There are also instruction how to handle the amputated portion of the limb and how to transport the patient and the amputated portion of the limb. The authors discusses traditional procedures in replantation surgery on the basis of his own experience with 292 replantations or revascularizations.