Biomedical subjects

Bohdan Huszno

Publications and source records attributed to Bohdan Huszno.

At least 19 recordsLinked to original sources

PubMed2007

Posterior retroperitoneoscopic adrenalectomy: a comparison between the initial experience in the invention phase and introductory phase of the new surgical technique.

BACKGROUND: Today, the posterior retroperitoneoscopic technique has become a standard procedure in adrenal surgery. The procedure allows direct access to the adrenal glands, but it seems to be difficult because of the uncommon anatomic view. This study compares the learning period of the new procedure of "posterior retroperitoneoscopic adrenalectomy" in the primary invention phase and the secondary introductory phase in a different hospital 10 years later. MATERIALS AND METHODS: The analysis included 100 posterior retroperitoneoscopic adrenalectomies (PRA) and involved 50 procedures in each center. Group A consisted of 44 patients (14 males, 30 females; age: 48.7 +/- 14.5 years) undergoing surgery between 07/1994 and 8/1996 (24 right, 26 left; 8 Cushing adenomas, 14 Conn adenomas, 11 pheochromocytomas, 7 nonfunctioning adrenocortical adenomas, 10 ACTH-dependent adrenal hyperplasias). Group B consisted of 50 patients (12 males, 38 females; mean age 59.3 +/- 10.7 years) operated between 01/2004 and 01/2006 (28 right, 22 left tumors; 5 Cushing adenomas, 12 Conn adenomas, 4 pheochromocytomas, 29 nonfunctioning adrenocortical adenomas). All PRAs were performed with the patient in the prone position with 3-4 trocars placed caudally in the region of the 11th and 12th ribs. In group A, the surgical team developed the technique of PRA themselves. Before their first PRA, the surgical team of group B was introduced to the technique by the group A surgeons and afterwards were supervised continuously. RESULTS: No serious intraoperative or postoperative complication occurred in either group. Group A experienced 7 conversions to open surgery, whereas group B had one conversion and one early reoperation due to bleeding (P = 0.03; chi(2)-test). The mean operative time was 117 +/- 41 minutes versus 83 +/- 35 minutes (group A and B respectively; P < 0.001; t-test). Estimated blood loss was similar in the two groups (47.2 +/- 46.2 ml versus 54 +/- 16.3 ml, group A versus B, respectively; P = 0.36; t-test). CONCLUSIONS: The study demonstrates the feasibility, safety, and reproducibility of the new surgical method of PRA both when it is employed in the early phase of invention, as well as when performed by surgeon-learners. After comprehensive training, the operative time and conversion rate are dramatically reduced, allowing for a short learning period.

Adrenal Cortex Neoplasms↗

PubMed2007

Nontraditional atherosclerotic risk factors and extent of coronary atherosclerosis in patients with combined impaired fasting glucose and impaired glucose tolerance.

Partially inconsistent data exist on mutual relations between nontraditional atherosclerotic risk factors, including the magnitude of insulin resistance (IR), as well as on their relevance for atherogenesis in the metabolic syndrome. Subjects exhibiting combined impaired fasting glucose and impaired glucose tolerance (IFG/IGT) are exposed to an exceptionally high risk for atherogenesis and development of type 2 diabetes mellitus. Because of islet Beta-cell dysfunction, the usefulness of commonly used indices of IR is limited in IFG/IGT. Our aim was to assess the relationship between extent of angiographic coronary artery disease (CAD) and nontraditional atherosclerotic risk factors (including IR by a clamp-based golden standard method) in IFG/IGT. Fifty-three subjects (32 men, 21 women; mean age, 55 +/- 11 years) with stable angina, preserved left ventricular systolic function, and IFG/IGT were divided into 3 groups: group A (no coronary stenoses >50%, n = 22), group B (1-vessel CAD, n = 15), and group C (2/3-vessel CAD, n = 16). Insulin sensitivity was quantified by a hyperinsulinemic euglycemic clamp technique and expressed as M. M value, plasma homocysteine (Hcy) level, and asymmetric dimethyl-L-arginine (ADMA)/L-arginine ratio were independent determinants of CAD extent as shown by forward stepwise discriminant function analysis. Compared with group A (M = 32.7 +/- 9.3 micromol/kg fat-free mass [FFM] per minute; Hcy, 8.1 +/- 1.4 micromol/L), lower M and higher Hcy levels were found in group B (M = 16.9 +/- 8.2 micromol/kg FFM per minute, P < .001; Hcy, 11.2 +/- 2.9 micromol/L, P = .003) and C (M = 16.4 +/- 7.8 micromol/kg FFM per minute, P < .001; Hcy, 12.8 +/- 3.9 micromol/L, P < .001). The ADMA/L-arginine ratio was increased in group C (0.0078 +/- 0.0011) compared with group A (0.0063 +/- 0.0013, P = .03) and B (0.0058 +/- 0.0012, P = .01). Multivariate correlates (P < .05) of plasma Hcy concentrations were M (beta = -.34 +/- .12, P = .008), creatinine clearance (beta = -.23 +/- .10, P = .03) and fasting insulin (beta = .25 +/- .12, P = .04). This indicates an additive contribution of IR, plasma Hcy, and elevated ADMA/L-arginine ratio to the extent of angiographic CAD in combined IFG/IGT.

Adult↗

PubMed2006

Technetium-99m-sestamibi subtraction scintigraphy vs. ultrasonography combined with a rapid parathyroid hormone assay in parathyroid aspirates in preoperative localization of parathyroid adenomas and in directing surgical approach.

OBJECTIVE: To determine the sensitivity and positive predictive value (PPV) of subtraction scintigraphy (SS) vs. ultrasonography (US) of the neck combined with rapid intact parathyroid hormone (iPTH) assay in US-guided fine-needle parathyroid aspirates in preoperative localization of parathyroid adenomas and in directing surgical approach. DESIGN: The results of SS for localization of parathyroid adenoma were determined in 121 patients with primary hyperparathyroidism (pHPT) and compared with findings at surgery and with the results of US alone (in patients without nodular goitre) and US in combination with the iPTH assay in US-guided fine-needle aspirates (FNAs) of suspicious parathyroid lesions (in patients with concomitant nodular goitre). PATIENTS: All 121 patients had biochemically documented pHPT; all were referred for first-time surgery. MEASUREMENTS: SS was performed with 99mTc-sestamibi and 99mTc-pertechnetate. High-resolution US of the neck was performed by a single endocrine surgeon and combined with US-guided FNAs of suspicious parathyroid lesions in all patients with nodular goitre (n = 43). RESULTS: The sensitivity and PPV of SS were significantly higher in patients without vs. with goitre (89.3% and 95.7%vs. 74.3% and 76.5%, respectively; P < 0.001). The sensitivity and PPV of US were significantly higher in patients without vs. with goitre (96% and 97.3%vs. 67.7% and 71.9%, respectively; P < 0.001). The iPTH assay of US-guided FNAs of suspicious parathyroid lesions in patients with nodular goitre significantly improved both the sensitivity and PPV of US imaging (90.7% and 100%, respectively), allowing for an accurate choice of surgical approach in 118 (97.5%) of 121 patients. SS was more accurate than US alone in detection of ectopic parathyroid adenomas. However, US alone was characterized by a higher sensitivity in detection of small parathyroid adenomas (< 500 mg) at typical sites (P < 0.01). CONCLUSIONS: Both the sensitivity and PPV of SS and US alone are comparable, with significantly less accurate results obtained in patients with goitre. In cases of equivocal results of US and/or in patients with concomitant goitre, an iPTH assay in US-guided FNAs of suspicious parathyroid lesions may be used to establish the nature of the mass, distinguish between parathyroid and nonparathyroid tissue (goitre, lymph nodes) and improve the accuracy of US parathyroid imaging, allowing for successful directing of surgical approach in a majority of patients.

Adenoma↗

PubMed2006

[Evaluation of the efficacy of long-acting somatostatin analog as adjunctive therapy in patients with active acromegaly].

UNLABELLED: Transsphenoidal surgery is the first-line therapy for patients with acromegaly, but can achieve biochemical control with normalization of somatomedin C in 40-80% of cases. All patients with continued growth hormone hypersecretion after neurosurgery require adjunctive therapy to prevent morbidity and premature mortality. The aim of our study was to evaluate the efficacy of long-acting somatostatin analog--octreotide LAR (OCT-LAR) as adjunctive therapy for patients with persistent disease. 14 adult subjects (age 45 +/- 15 years) were included into the study. All patients were diagnosed as having growth hormone secreting pituitary tumor and underwent transsphenoidal surgery (TSS). Radiotherapy (RT) was used as adjunctive therapy in 7 of investigated persons. In all subjects elevated level of somatomedin C was found, 9 have increased level of growth hormone (hGH) as well. After 6 months therapy with OCT-LAR we noticed drop in somatomedin C and hGH levels in all patients. Mean drop in somatomedin C level was 42.3% (p=0.001), in GH level was 52.3% (p=0.001). We found entire normalization of GH in 12 (85.7%) patients, nearly normalization of somatomedin C (level lower than 110% of normal upper limit) in 8 (57%) patients. We found no significant correlation between decrease in somatomedin C and its level prior to the treatment (p=0.8), but high positive correlation between decrease in hGh level and its initial value (R=0.75, p=0.002). Decreases in both somatomedin C (p=0.7) and hGH (p=0.6) levels were not correlated with patients' age. The therapeutic outcome defined as decrease in somatomedin C level was not significantly different between patients with or without adjunctive radiotherapy in the past (p=0.08) and between patients with intensive or weak isotope collection in the pituitary in 99mTc-octreotide scintiscan (p=0.2). CONCLUSIONS: Octreotide-LAR efficiently reduces somatomedin C and GH levels in patients with active acromegaly. Initial values of somatomedin C as well as age and isotopic imaging findings are not valuable predictor factors for therapeutic outcome.

Acromegaly↗

PubMed2006

[New horizons for increased sensitivity of radionuclide imaging in primary hyperparathyroidism].

The aim of the study was to evaluate the impact of therapy with biphosphonates in patients with primary hyperparathyroidism and negative result of parathyroid scintigraphic imaging on increase of diagnostic sensitivity in repeated scans. Three female patients with diagnosed primary hyperparathyroidism and negative parathyroid imaging with subtraction 99m-Tc-MIBI scintigraphy were included into this prospective study. Patients had been receiving 70 mg of sodium alendronate orally, once a week for 3 months. After this period they were reevaluated with parathyroid subtraction scintigraphy. In all three patients a solitary area of uptake was found in the repeated scans. Patients were qualified for minimally invasive video-assisted parathyroidectomy. In two of them the repeated scans after treatment with biphosphonates were found to be true positive and in those two patients a solitary parathyroid adenoma was removed with video-assisted technique. In one patient a multiglandular disease was revealed intraoperatively basing on intraoperative iPTH assay and in that patient a subtotal video-assisted parathyroidectomy has been successfully completed. All three patients have been eucalcemic within the 6-months follow-up with iPTH serum values within the reference range. In conclusion, treatment with oral biphosphonates in patients with primary hyperparathyroidism and negative result of radionuclide parathyroid imaging, results in increased diagnostic sensitivity of repeated scans. This allows for successful minimally invasive parathyroid surgery in this group of patients with a predominant solitary parathyroid adenoma.

Adenoma↗

PubMed2006

[A case of GH and TSH secreting pituitary macroadenoma].

A case of GH and TSH secreting pituitary macroadenoma is reported. A 45-year-old female presented clinical features of acromegaly (the abnormal growth of the hands and feet, with lower jaw protrusion), diabetes mellitus, hypertension, nodular goiter and hyperthyroidism of unclear origin. NMR pituitary imaging revealed intra and extrasellar tumor. The laboratory examinations showed very high plasma levels of GH and IGF-1 and normal level of TSH coexisting with high plasma levels of free thyroid hormones. Pharmacological pretreatment with somatostatin analogues caused the substantial reduction of GH and TSH plasma levels. Histological and immunohistochemical examination of the tissue obtained at transsphenoidal surgery showed GH and TSH secreting adenoma. The laboratory examinations after surgery showed normal GH and IGF-1 plasma levels and reduced insulin requirement, what indicates radical operation. The very low plasma levels of TSH and free thyroid hormones after surgery and immunohistochemical examination suggest central hyperthyroidism due to TSH secreting pituitary tumor (thyrotropinoma).

Acromegaly↗

PubMed2005

(99m)Tc-HmPAO single photon emission tomography, magnetic resonance proton spectroscopy and neuropsychological testing in evaluation of carbon monoxide neurotoxicity.

There were 10 acutely CO poisoned study patients without CNS history (head traumas, epilepsy, dementia, migraine or alcoholic diseases) in whom (99m)Tc-HmPAO SPET, HMRS and neuropsychological testing were performed. 99mTc-HmPAO SPET and neuropsychological testing were performed twice: in acute phase and at six months post CO exposure. HMRS was carried out at 8 months post CO exposure. A multidimensional analysis of variance (MANOVA) was used to statistical analysis. Regional CBF disturbances in acute phase of CO poisoning were observed in frontal cortex, basal ganglia and parietal cortex respectively. The most reversible, as seen in control (99m)Tc-HmPAO SPET examination, were the changes observed in parietal cortex. Diffuse generalized cortex hypoperfusion, both in acute phase and at 6 months post exposure, was seen only in one the patient. In all of the examined patients different elevation in mobile lipid or/and lactate concentration in frontal lobe or/and basal ganglia was revealed by HMRS evaluation at eight months post acute CO exposure. Results of neuropsychological testing at baseline and at 6 months partially correlated with neuro-imagine techniques applied.

Acute Disease↗

PubMed2005

[Changes in thyroid volume after radioactive iodine therapy in patients with single toxic thyroid nodule].

Radioactive iodine (131I) is a well-established therapeutic modality in the treatment of toxic solitary autonomous thyroid nodules. This method is preferred in patients with small, benign nodules. The aim of our study was to investigate the effects of radioiodine therapy on thyroid size in patients with a solitary toxic thyroid nodule. 22 patients with single nodule in USG and confirmed "hot" nodule in scintigraphy were enrolled in the study. Thyroid and nodule volume were determined by ultrasound before, 3 and 6 months after the administration of 131I. Thyroid function was assessed by TSH level prior to the treatment and 6 weeks after the therapy. Thyroid volume and nodule size decreased significantly within 3 and 6 months after 131I treatment. The mean reduction of thyroid volume within 6 month after treatment was 32%. Reduction in thyroid volume and nodule, size was significantly greater within first 3 months than within next 3 months. Patients with smaller nodules (less than 70% of thyroid volume) were characterized by greater reduction of goiter size than patients with nodules bigger or equal to 70% of thyroid volume.

Dose-Response Relationship, Radiation↗

PubMed2005

[Insulin resistance indices in population-based study and their predictive value in defining metabolic syndrome].

UNLABELLED: In clinical studies insulin resistance, the main factor of the Metabolic Syndrome (MS), is determined directly by metabolic clamp technique, while in epidemiological studies is estimated on the basis of indices calculated from oral glucose tolerance test glycemia and insulinemia. The aim of the study was to find out which insulin resistance indicator best predicts the risk of the MS. MATERIAL AND METHODS: The study population consisted of 2673 inhabitants of Kraków, aged 35-75 years, who participated in the "Polish Multicenter Study on Diabetes Epidemiology". Fasting insulin, HOMA-IR, QUICKI and Matsuda's index were determined for all subjects. Insulin resistance was defined as the cutoff values for the population with normal glucose tolerance and with BMI < 25 kg/m2. RESULTS: All insulin resistance indices were closely correlated (r=0.78-0.98), and the frequency of insulin resistance in the general population was similar (47%-54%), however the highest prevalence of insulin resistance was observed when Matsuda index was used. The risk of insulin resistance, increased with the category of glucose tolerance, and was the highest when Matsuda index was used. The MSWHO was observed in 42% to 45% of the studied population and the predictive value of insulin resistance indices were similar when using WHO criteria. The highest sensitivity in the MSNCEP identification was observed when Matsuda index was used. Matsuda index had also the highest sensitivity to diagnose MSNCEP as compared with the remaining insulin resistance indices. CONCLUSIONS: The study insulin resistance indices have a similar value in predicting the MSWHO while Matsuda index predicts best the MSNCEP. Matsuda index as well predicts best the risk of insulin resistance. This argues in favor of using oral glucose tolerance test to estimate risk for diabetes mellitus and cardiovascular disease.

Adult↗

PubMed2005

(99m)Tc-EDDA/HYNIC-octreotate - a new radiotracer for detection and staging of NET: a case of metastatic duodenal carcinoid.

Somatostatin receptor scintigraphy (SRS) has become a routine imaging method for the diagnostics of neuroendocrine tumours (NET). (99m)Tc-EDDA/HYNIC-octreotate (Polatom, Poland) is a new radiotracer with high affinity for SSTR2 and similar physiological biodistribution to (111)In-Octreoscan. We present a case of a 47-year-old man with disseminated duodenal carcinoid. The patient had been operated due to the tumour mass detected in pancreatic head area. Histopathology revealed carcinoid of the duodenal wall with local lymph node and liver metastases. The patient was qualified for chemotherapy stopped due to severe leucopenia. (99m)Tc EDDA/HYNIC-octreotate scintigraphy was performed for staging and to determine SSTR status of the tumour before planned 90Y-DOTATATE therapy. The multiple metastatic lesions were detected all over the body. The high quality images with high target/non target ratio were obtained. (99m)Tc-MDP scintigraphy confirmed multiple bone metastases. On the basis of SRS result the patient was qualified for 90Y-DOTA-TATE therapy. In conclusion, (99m)Tc EDDA/HYNIC-octreotate can be regarded as a promising tracer for staging and to determine SSTR status of NET.

Bone Neoplasms↗

PubMed2005

[Diagnostic problems with recognition of primary hyperparathyroidism].

The aim of our study was to compare the results of biochemical and imaging investigations with histopathological diagnosis in operated patients with primary hyperparathyroidism. 46 subjects were included into the study, pathologically demonstrated as parathyroid adenoma--23 subjects, parathyroid hypertrophy--16, parathyroid carcinoma--2 and in 5 patients parathyroid gland was not found in resected tissue. The most frequent complications of primary hyperparathyroidism in our group were osteoporosis (87%) and nephrolithiasis (64.1%). 99mTc-MIBI imaging described as a parathyroid adenoma or parathyroid hypertrophy were confirmed pathologically in 52 and 57.1%, respectively. Three typical symptoms of primary hyperparathyroidism assessed in our study (hypercalcemia, hypercalciuria and increased concentration of parathormone) were observed only in about 50% patients with histopathological diagnosis of adenoma and hypertrophy. The lowest average calcium serum level (2.87 mmol/l), urinary calcium level (7.8 mmol/24h) and parathyroid hormone concentration (209.4 pg/ml) were observed in patients with parathyroid adenoma, the highest levels of these parameters were noticed in patients with parathyroid carcinoma (3.41 mmol/l; 14.6 mmol/24h; 687.8 pg/ml, respectively), patients with parathyroid adenoma were characterized by intermediate values (2.98 mmol/l; 9.7 mmol/24h; 285.5 pg/ml, respectively). After parathyroidectomy lowering in average calcium serum level (2.94 vs. 2.16 mmol/l), parathyroid hormone concentration (244.45 vs. 54.15 pg/ml) and increasing in average phosphate serum level (0.81 vs. 1.04 mmol/24h) were observed in our group. Finally, using different biochemical and imaging investigations is necessary for proper recognition of primary hyperparathyroidism due to occurring of oligosymptomatic cases.

Diagnosis, Differential↗

PubMed2005

[Adrenal incidentaloma as essential clinical problem in modern endocrinology].

Adrenal mass discovered during imaging for non-adrenal related causes is called incidentaloma. Adrenal masses can be asymptomatic or can have clinical manifestations related to hormone overproduction. The increasing number of discovered adrenal mass is by no doubt due to quick development of radiology procedures. The aim of study was determination of statistical frequency of different types of adrenal tumours and related clinical symptoms based on retrospective analysis of patients diagnosed in the Department of Endocrinology, Collegium Medicum, Jagiellonian University. There were 271 patients (184 female, 87 male) with incidentaloma confirmed in CT scan from January 2000 to June 2005. Mean patients' age was 56.8 +/- 12.7 years. The most common localisation was right adrenal gland (135 cases), bilaterally in 29 patients. Tumours less than 3 cm in diameter were observed in 58.5% of diagnosed persons, tumours from 3 to 6 cm in 33.3% of cases and tumours bigger than 6 cm in 8.2% patients. Hormone excess associated with adrenal mass was detected in 37 (13.6%) patients. Pheochromocytoma was diagnosed in 20 patients (7.4%). Subclinical hypercortisolism was found in 13 patients (4.8%). Primary hyperaldosteronism was diagnosed in 4 cases (1,4%). In patients with adrenal mass incidentaloma hormone tests should be performed before making therapeutic decisions despite no clinical symptoms.

Adrenal Gland Neoplasms↗

PubMed2004

[Evaluation of accordance between cytological and histopathological findings in selected thyroid tumors].

The thyroid fine-needle aspiration (FNA) is the decisive examination in the preoperative diagnostics of thyroid nodules. Different cytohistologic studies have revealed that the accuracy of FNA for thyroid nodules varied from 69% to 94%. The aim of our study was to compare the results of FNA with regard to final histopathological diagnosis among patients with follicular tumor, Hurthle cell tumor or papillary carcinoma in FNA. We retrospectively analyzed medical documentation of 51 patients (mean age 57.9 years, 49 women and 2 men) from the Endocrinology Department from 1997 to 2002 years. Based on FNA 29 patients were diagnosed as having follicular tumor, 10 as having Hurthle cell tumor and 12 as having papillary carcinoma. Carcinoma was detected histopathologically in 38% of patients with follicular tumor. Follicular carcinoma was detected histopathologically in 10% of patients with Hurthle cell tumor. Cytological diagnosis was confirmed histopathologically in 66.8% of all patients with papillary carcinoma in FNA. In accordance with our results the confirmation of malignant neoplasm can be expected in more than 80% of cases with papillary carcinoma in cytological examination. In case of follicular or Hurthle cell tumors the frequency of malignant neoplasm was less than 40% and 10% respectively.

Adenoma↗

PubMed2004

Evaluation of gastric emptying in patients with chronic renal failure on continuous ambulatory peritoneal dialysis using 99mTc-solid meal.

BACKGROUND: Continuous ambulatory peritoneal dialysis (CAPD) is an alternative to the hemodialysis mode of terminal renal failure treatment. Nutritional status impairment is common among patients with end-stage renal disease, and its laboratory surrogates predict increased morbidity and mortality risk in patients on chronic haemodialysis or peritoneal dialyses. The aetiology of malnutrition is multifactorial and delayed gastric emptying is also considered to be a significant factor. The aim of this study was to estimate the direct influence of indwelled dialysate in the peritoneal cavity on gastric emptying in patients treated with CAPD. MATERIAL AND METHODS: the study group included 20 patients (9 males, 11 females) aged 50,1 +/- 11 years (range: 39-75 years) with chronic renal failure treated with CAPD for 18.4 +/- 14.7 months. All patients were non-diabetic and had no other than chronic uraemia co-morbidity known to influence autonomic nervous system function and gastric motility. The control group included 15 healthy volunteers matched by age, sex and body weight. Dialysis adequacy parameters were calculated based on 24-hour urine and dialysate collections. Gastric emptying was estimated with dynamic abdominal scintigraphy. We compared the results of gastric emptying tests performed in dialysed patients with and without dialysate liquid in the peritoneal cavity and related the values to those of the control subjects. RESULTS: In the study group, weekly values of dialysis parameters were within the ranges considered satisfactory in terms of uraemia control. All parameters of gastric emptying were significantly delayed and prolonged in terminal renal failure patients, but the results have shown no significant differences between those with and without indwelling dialysate. CONCLUSIONS: Based on the results we conclude that gastric emptying in subjects with chronic renal failure treated with CAPD is markedly delayed compared to healthy subjects. There was no significant effect of indwelling dialysate in the peritoneal cavity on gastric emptying rates found, based on the observation that its removal was not associated with any noticeable improvement of gastric emptying. The data strongly contraindicate the theory of peritoneal dialysate volume being the cause of this reversible disorder and indicate that the role of other possible factors leading to the development of gastropathy in those patients should be investigated.

Administration, Oral↗

PubMed2004

Clinical status of carbon-monoxide-poisoned patients and the results of rest 99mTc-MIBI and 99mTc-Amiscan heart scintigraphy performed in the acute phase of intoxication and stress-rest 99mTc-MIBI scintigraphy six month later.

The double tracer (99mTc-MIBI and 99mTc-Amiscan) scintigraphy is an useful technique to imagine cardiac injury due to CO intoxication. Accumulation (retention) of 99mTc-MIBI is dependent on blood flow and cellular and mitochondrial electrical potential of myocytes. The lower tracer accumulation is seen not only in necrotic heart tissue regions, but also in ischemic area of worse metabolic rate and perfusion. 99mTc-Amiscan contrary to 99mTc-MIBI, is accumulated only in regions of early necrosis so it can be can distinguished from transitory ischemia. Mechanisms of cardiac injury due to CO toxicity is different than due to coronary occlusion and the process of the heart damage is usually much longer. Results of control stress-rest 99mTcMIBI scintigraphy, performed after 6 months from CO exposure in relation to the clinical state on admission and results of 99mTc-MIBI and 99mTc-Amiscans scans obtained in acute phase of poisoning are presented in the study. Initial 99mTc-MIBI SPET examination had confirmed transitory myocardial ischemia of different degree in all the examined patients. The mutual dependence between degree of scintigraphic changes and blood lactate level and CK activity was found. 99mTc-Amiscan scintigraphy demonstrated areas of necrosis in myocardium of some patients; they had statistically higher COHb and blood lactate concentration compared to the rest. A control stress-rest 99mTc-MIBI SPET performed 6 months after CO intoxication, confirmed a late consequences of metabolic abnormalities and a necessity of cardiovascular system follow-up controlling.

Acute Disease↗

PubMed2004

Evaluation of regional cerebral perfusion using 99mTc-HmPAO single photon emission tomography (SPET) in carbon monoxide acutely poisoned patients.

Carbon monoxide (CO) poisoning continues to be a significant health problem. An early assessment of organs injury due to carbon monoxide poisoning is even more difficult than confirming the diagnosis of CO poisoning. Numerous neuroimaging techniques have been used to evaluate CO intoxication. The aim of this pilot study was to estimate the regional cerebral perfusion in CO acutely poisoned patients using 99mTc-HmPAO SPET. Disturbances in cerebral perfusion mainly in frontal, parietal cortex and basal ganglia were observed in 17 (85%) of 20 examined CO poisoned patients. 99mTc-HmPAO scintigraphy seems be useful in demonstration of early CNS dysfunction and estimation to what extent perfusion abnormalities influence the brain injury. A further study to evaluate the rCBF in relation to poisoning severity scoring are needed.

Acute Disease↗

PubMed2004

[Difficulties in diagnosis of hepatic encephalopathy in ethanol dependent patients].

As a somatic evaluation by outpatient psychotherapy service for alcoholics is being done very rarely the patients are not informed about health harm related to alcohol having the "false feeling of safety". The aim of the study was to evaluate a functional and morphological liver state of patients served by such a service for minimum 5 years who were sent do the Department of Clinical Toxicology via intervention medicine. The changes in the central nervous system were also considered. The West Haven criteria of altered mental state in hepatic encephalopathy were applied. The Number Connection Test, part A and B, and "100-7" test were used to psychometric evaluation. A significantly higher serum ammonia concentration (p<0.02), AST, ALT and GTP enzymes activity, bilirubin (p<0.02), iron (p=0.005) concentration and significantly lower prothrombin index and albumin concentration were found in the group of ethanol dependent patients as compared to the reference group. A significantly lower RBC and platelets number, lower Ht and significantly elevated MCV compared to the control group were also found. The relationship between West Haven criteria and results of laboratory testing was shown: a worse West Haven criteria a worse metabolic disorders. The pathologic changes in the liver ultrasonography and scintigraphy were significantly higher in the group of ethanol dependent patients. The presented observations indicate on necessity of close co-operation between psychologists, therapeutics and clinical toxicologists in early diagnosing and treatment the organ injury in alcohol addicted patients.

Adult↗

PubMed2004

[Late sequelae of tetraethyl lead poisoning].

In our previous study a tetraethyl lead poisoning due to a rural environmental exposure of four family members was described. A differently intensified OUN dysfunction dominated clinical picture. Cognition status and degree of OUN dysfunction was monitored using generally accepted neurobehavioral test battery. The tests applied were fitted individually to each poisoned family member in accordance to current intensification of symptoms. Basing on the neurobehavioral performance results a consecutive imagine techniques were introduced to full CNS evaluation of intoxicated patients. Results of neuropsychological monitoring in 12 months period were compared to brain CT, SPET 99mTc-ECD used to evaluation of regional brain perfusion disturbances, MRI and MRS and presented in the study.

Adolescent↗