-
[show abstract]
[hide abstract]
ABSTRACT: Objective
Five different
calliper methods for assessing the
degree of carotid artery stenosis
and visual estimation (eyeballing)
of postmortem carotid arteriograms
were compared with the
planimetric gold standard of the
area reduction at the site of the
stenosis.
Methods
During autopsy
53 carotid specimens were removed
in toto from 31 neurological patients.
Carotid arteries were ligated
and redistended to a physiological
degree for standardised three–plane
arteriography. Afterwards, the entire
specimen was filled with an
embedding medium under the
same conditions and sectioned.
Slices at the site of stenoses were
histologically processed. Computerised
planimetric analysis of the
lumen area reduction was performed
and compared with the arteriographic
findings. Arteriograms
were evaluated by two independent
observers by means of linear Common
Carotid Artery (CC), the European
Carotid Surgery Trial (ECST)
and the North American Symptomatic
Carotid Endarterectomy
Trial (NASCET), and squared measurements
(NASCET2, ECST2) after
applying the r2 function. Further,
three independent observers performed
eyeballing of the degree of
stenosis from the postmortem arteriographies.
Results
Planimetry was
carried out in 29 internal carotid
artery (ICA) and 17 common
carotid artery (CCA) stenoses ranging
from 8.5 to 100%. The smallest
mean differences of the degree of
stenosis in % between planimetry
and arteriography were –0.5 and
0.6%. The narrowest 95 %–limits of
agreement covered a range of 24.1
and 26.3% of stenoses, and the
highest correlation coefficients
were both 0.9 for the CC and ECST2
techniques, respectively. By eyeballing,
the degree of stenosis was
underestimated by 13.5 to 15.8%
on average. The narrowest limits of
agreement between two observers
for eyeballing covered a range of
35%.
Conclusion
Three–plane arteriography
has only a moderate accuracy
and reproducibility in detecting
and measuring carotid
artery stenosis independent of the
technique of measurement used.
Journal of Neurology 04/2005; 252(5):575-582. · 3.47 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Pathologic processes affecting the brain vessels may damage cerebral vasodilatory capacity. Early detection of cerebral dysfunction plays an important role in the prevention of cerebrovascular diseases. In recent decades acetazolamide (AZ) has frequently been used for this purpose. In the present work the mechanism of action and the previous studies are reviewed. The authors conclude that AZ tests are useful in cerebrovascular research. Further investigations are recommended to prove how impaired reserve capacity and reactivity influence the stroke risk in patients and whether these tests may indicate therapeutic interventions.
European Journal of Neurology 12/2003; 10(6):609-20. · 3.69 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Neuroimaging of a 75-year-old lady demonstrated the characteristic pathological features of the Marchiafava-Bignami disease (MBD), which develops usually in chronic alcoholics. The onset of the neurological symptoms and signs were abrupt and similar to those seen in common ischemic vascular lesions. Our patient denied that she had consumed alcoholic beverage during her life. Laboratory results showed her liver enzymes were not elevated and a subsequent abdominal ultrasound examination revealed no liver pathology. The attack responded fairly well to anti-ischemic therapy and a complete recovery was observed within a week. In this sense, her pathology cannot be considered as a true MBD in spite of the presence of the CT and MRI findings of MBD. Our case seems to show that the CT and MRI findings in MBD are not specific because new imaging procedures reveal edematous, necrotic lesions that may have the appearance of MBD.
European Journal of Radiology 10/2001; 39(3):151-4. · 2.61 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The aim of the present work was to investigate the impact of gender on resting cerebral blood flow velocity and cerebrovascular reserve capacity among diabetic patients. Middle cerebral artery mean blood flow velocity (MCAV) was measured in 72 patients suffering from type 1 diabetes mellitus at rest and 5, 10, 15 and 20 min after intravenous administration of 1 g acetazolamide. Cerebrovascular reserve was calculated as the maximal percent increase in MCAV after acetazolamide. Resting MCAV and cerebrovascular reserve capacity were compared between males and females. Resting cerebral blood flow velocity was higher in diabetic females than in males (men, 55.0+/-17.0 cm/s; women, 64.4+/-12.6 cm/s, p=0.0094). Cerebrovascular reserve capacity was similar in diabetic women and men (men, 44.0%+/-18.6%; women, 52.6%+/-32.9%, p=0.17). Comparing MCAV and cerebrovascular reserve capacity among the diabetic subgroups with disease duration < or = 10 years and >10 years, we did not detect any differences between women and men. Duration of diabetes was an important factor in determining cerebrovascular reserve capacity in both sexes: long-term diabetic women and men showed lower CRC values than diabetics with < or = 10 years disease duration. Cerebrovascular reserve capacity is similar in diabetic women and men. Taking into consideration that cerebrovascular reserve is normally higher among women, our finding indicates a relatively more serious worsening of cerebral vasodilatory responses in women suffering from type 1 diabetes.
Acta Diabetologica 01/2001; 38(3):107-12. · 2.78 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Twenty carotid bifurcations were examined. During autopsy, carotid bifurcations were removed in toto. Unfixed carotids were ligated and cannulated for injection of an angiographic contrast medium followed by injection of a tissue-embedding medium at physiologic pressure and temperature. The carotid bifurcation was frozen and cut manually in 3-mm cross-sections. Photographs were then taken of every slice. Angiography, filling with tissue-embedding material, and sectioning were successful in all cases. In the macropathologic sections, the extent, configuration and location of atherosclerotic lesions could be identified.
CardioVascular and Interventional Radiology 01/2000; 23(4):312-4. · 2.09 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Cerebrovascular disease is a major public health problem in Eastern European countries. A Hungarian post-stroke population was examined to estimate the rate of dementia, the risk factors for cognitive impairment, and the applicability of a recently established Canadian diagnostic checklist in this cohort. Chronic cerebrovascular outpatients were screened for cognitive impairment with a combined checklist: the Diagnostic Checklist for Vascular Dementia established by the Consortium of Canadian Centres for Clinical Cognitive Research using the Mini Mental State Examination instead of the detailed neuropsychological part of the Checklist. Of the 247 consecutive patients at a cerebrovascular outpatient unit, 176 had cerebrovascular disorder diagnosed either by computed tomography (CT; n=126) or by the clinical signs. Of these, 15% were cognitively impaired and 5% fulfilled the criteria of dementia. The mean age of the patients with cognitive impairment was significantly higher than that of patients with normal cognition (68.2+/-10.2 and 60.5+/-10.5 years, P<0.001). The Barthel index was significantly lower in the cognitively affected group than in non-affected patients (92.4+/-16.0 and 97.1+/-8.7, P=0.027). Diabetes and more than two subcortical infarcts on CT or magnetic resonance imaging were more frequent in patients with cognitive loss (P=0.043 and P=0.013, respectively). Cognitive performance was also influenced by the level of education. Higher age, diabetes, motor deficits, and multiple subcortical infarcts are risk factors for cognitive impairment after stroke. The combined checklist appears to be a practical screening test for cognitive impairment in patients with chronic cerebrovascular diseases.
Psychiatry and Clinical Neurosciences 02/1999; 53(1):39-43. · 2.13 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The cerebral glucose metabolism in eight patients with systemic lupus erythematosus (SLE) and in five healthy controls were examined by positron emission tomography (PET) using 18-F-labeled deoxy-glucose (FDG) as tracer. One of the eight patients had no abnormality by magnetic resonance imaging (MRI), three of them had cerebral atrophy and four patients had multiple white matter hyperintensities and vascular infarcts in the striatum as assessed by MRI. With FDG-PET, inhomogeneous multifocal cerebral glucose hypometabolism was detected, more frequently in the temporal lobe of right hemisphere. The PET findings did not correlate always with the neurological symptoms. Abnormalities in brain metabolism can be detected more frequently by PET, than morphological changes by MRI, indicating the involvement of the central nervous system.
Orvosi Hetilap 09/1997; 138(31):1947-52.
-
[show abstract]
[hide abstract]
ABSTRACT: We investigated the cervical level of carotid bifurcation, diameter of common carotid artery (CCA) and internal carotid artery (ICA) in 147 Japanese patients (150 arteries, range of age 31-79) and in 490 Hungarian patients (517 arteries, range of age 12-77). The cervical level of carotid bifurcation was determined by comparison with cervical vertebra. The carotid bifurcation of Japanese was most frequent at the lower part of 3rd cervical vertebra but in Hungarian the bifurcation was most frequent at the middle part of 4th cervical vertebra. Japanese carotid bifurcation was high-positioned compared with Hungarian. The mean CCA diameter in Japanese was 7.47 mm in male and 7.07 mm in female, in Hungarian 9.24 mm in male and 7.80 mm in female. The mean ICA diameter in Japanese was 4.96 mm in male and 4.83 mm in female, in Hungarian 8.56 mm in male and 7.66 mm in female. CCA and ICA diameter were larger in male than in female. The diameter of CCA had a significantly positive correlation with age (p < 0.002) but ICA had no similar correlation.
Nō to shinkei = Brain and nerve 07/1997; 49(7):633-7.
-
L Trón,
O Esik,
K Borbély,
B Clemens,
L Csernay,
T Csépány,
L Csiba,
I Degrell,
P Halász,
A Holló,
A Illés, J Kollár,
Z Kószegi,
G Németh,
L Novák,
I Nyáry,
L Pávics,
J Sikula,
S Szakáll,
B Gulyás
[show abstract]
[hide abstract]
ABSTRACT: Diagnostic investigations commenced on the 28th of June 1994 in Hungary's and Central Europe's first PET Centre at the University Medical School of Debrecen. The Centre is equipped with a GE 4096 Plus whole body PET scanner. A metabolic tracer, 18F-deoxy-D-glucose (FDG), was used in the investigations. During the first 15 months 249 PET investigations were made in the Centre of which 242 were diagnostic and 7 normal subjects served as control for the patient studies with brain scans. The number of oncological indications (intra- and extracranial tumours, Hodgkin's lymphomas) was n = 105 (43.4% of the 242 diagnostic examinations), neurological investigations (without intracranial tumours) formed the dominant group (n = 117; 48.3%), whereas the number of cardiological indications was 20 (8.3%). The oncological studies included those of intracranial tumours (n = 76; 31.4%); thyroid tumours (n = 9; 3.7%); Hodgkin's lymphomas (n = 7; 2.9%) and other extracranial tumours (n = 13; 5.4%). The distribution of different neurological and psychiatric investigations was as follows: localization of focal epileptogen zone (n = 60; 24.8%); differential diagnosis of dementias (n = 30; 12.4%); exploration of cerebrovascular diseases (n = 10; 4.1%); and other neurological diseases (n = 17; 7.0%). The main objective of the cardiological PET investigations was the exploration of viable myocardium. The present paper overviews both the procedures (including administrative issues, as well) and the results of the first 249 FDG-PET investigations.
Orvosi Hetilap 03/1997; 138(5):259-69.
-
[show abstract]
[hide abstract]
ABSTRACT: The level of carotid bifurcation, frequency of the kinking of the internal carotid artery, correlation between the diameter of carotid arteries and the age of the Hungarians was examined. The cervical level of carotid bifurcation, diameter of extracranial carotid arteries, frequency of kinking of internal carotid arteries were measured on conventional carotid angiograms in 490 Hungarian patients (517 arteries, age range 12-77 yr). The cervical level of the carotid bifurcation was determined by comparison with cervical vertebra. The most frequent level of carotid bifurcation was found at the middle part of 4th cervical vertebra. The position shifted higher with ageing. The mean common carotid artery diameter was 9.24 +/- 1.58 mm in males and 7.80 +/- 1.10 mm in females. The mean internal carotid artery diameter was 8.56 +/- 1.84 in males and 7.66 +/- 1.39 in females. The mean external carotid artery diameter was 5.53 +/- 1.11 mm in males and 4.76 +/- 0.91 in females. The diameter of the common carotid artery has a significantly positive correlation with age (p < 0.05) but internal carotid artery and external carotid artery had no similar correlation. The kinking of internal carotid artery was observed frequently in patients who had higher level of carotid bifurcation.
Orvosi Hetilap 07/1995; 136(29):1551-4.
-
[show abstract]
[hide abstract]
ABSTRACT: During the planning of implantation the CT method helps in determining the location of the implant and aids in choosing the right implant. It provides the following measurable information about the jaw-bones: height and width; exact location of bone deficiencies; the orovestibular shape of the alveolar process; the course of the mandibular canal; the location of the mental foramen; the location and size of the canalis incisivus; the area of the nasal cavity and the maxillary sinus; the quality of the bones and the relationship between cortical and spongious bone. In comparison to the X-ray examinations possession of these informations increase significantly the safety of planning before surgery.
Fogorvosi szemle 06/1995; 88(5):169-72.
-
[show abstract]
[hide abstract]
ABSTRACT: The difficulties of differential diagnosis between intra- and suprasellar tumours resp. inflammatory processes are discussed, based on three personal cases. In all three computed tomography (CT) and magnetic resonance imaging (MR) had demonstrated a tumour, but the clinical signs with discrepancies between radiological and clinical findings were pointing to an inflammatory process. The correct diagnosis of an inflammation was achieved by co-operation between neurologist, neurosurgeon, otologist and ophthalmologist. An unnecessary neurosurgical operation was avoided and the patients were cured by otological intervention and antibiotic therapy.
Acta Neurochirurgica 02/1995; 137(1-2):54-7. · 1.52 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: A case presentation is given of a 40 years old woman with acute ischemic cerebrovascular lesion in the territory of the left middle cerebral artery caused by embolization from a myxoma in the left atrium. The tumor was diagnosed by transthoracic echocardiography. Histological examination after cardiac surgery revealed a benignant myxoma. In the six-month-long postoperative follow up gradual improvement of the neurological signs was observed. The most important morphological and clinical characteristics of myxomas are summarized. The necessity of detailed cardiological examination of each young patient with stroke is emphasized.
Orvosi Hetilap 10/1994; 135(36):1981-5.
-
[show abstract]
[hide abstract]
ABSTRACT: Via statistic methods, the authors examine the capability of Ceolat tablet in improving the diagnostic efficacy of plain abdominal films, US and CT examinations. It has been proved on the basis of self-control examinations that by decreasing the amount of intestinal gas, Ceolat improves the quality of the images in all the three methods examined.
Orvosi Hetilap 02/1994; 135(4):177-9.
-
[show abstract]
[hide abstract]
ABSTRACT: Dynamic cerebral scintigraphy was performed on 41 patients with cerebrovascular disease. The diagnostic value of parametric images formed by a computer was correlated to angiographic findings and clinical sings, respectively. Having the appropriate software these examinations can be performed with traditional gamma-cameras. Analysis of parametric pictures increases the reliability of the method. Analysis of cinematic display of serial images had the highest sensitivity and accuracy, while time-of-maximum pictures had the highest specificity. In departments, where digitized subtraction angiography, single photon emission computed tomography or positron emission tomography is not available, the non invasive dynamic brain scintigraphy is a useful screening method, its application is proposed by the authors.
Orvosi Hetilap 03/1990; 131(6):297-301.
-
-
[show abstract]
[hide abstract]
ABSTRACT: Depressive symptoms can often be observed after stroke. We prospectively evaluated patients at a stroke unit in order to determine the occurrence and severity of depressive symptoms in the acute phase of stroke in 82 patients 7 +/- 2 days after admission to the stroke unit. Severity of stroke was evaluated by the Scandinavian and Orgogozo scales and the Barthel index. Severity of depressive symptoms was measured by the 13-item Beck scale. Mean age of the patients was 65.8 years. No gender difference was observed in the severity of stroke or depressive symptoms. DSM-IV criteria of adjustment disorder with depressed mood were fulfilled by 27% of the patients. In this group, stroke was significantly more severe by the Barthel, Orgogozo, and Scandinavian scales (p < 0.001). Whereas Beck score was at least 10 in 19.5%, severe depressive symptoms (Beck score > or = 15) occurred in less than 5% of patients with acute stroke. Those who could not walk by themselves or who were aphasic had significantly higher mean Beck scores (6.3 +/- 5.1 vs 2.4 +/- 3.1, p < 0.001, and 7.0 +/- 5.8 vs 3.4 +/- 3.9, p = 0.002). Significant correlation was found between the severity of stroke and that of the depressive symptoms (r = -0.56, -0.58, and -0.54 for the Scandinavian, Orgogozo, and Barthel scales, p < 0.001).
General Hospital Psychiatry 21(2):116-21. · 2.74 Impact Factor
