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Biomedical subjects

I Repa

Publications and source records attributed to I Repa.

35 records · Page 2Linked to original sources

[Principles of functional MRI imaging and its possibilities in the study of cerebral cortex activation].

While MR imaging of anatomic structures has long been widely appreciated, the emergence of functional magnetic resonance imaging (FMRI) methods for localising brain activity has emerged in the beginning of the 90s. This new MRI technique produces images of activated brain regions by detecting the indirect effects of neural activity on local blood volume, flow and oxygen saturation, and it is a promising new tool for further understanding of the relationships among brain structure, function and pathology. The information revealed by FMRI is partially overlapping with PET and SPECT, but it is non-invasive and has a better spatial and temporal resolution. The authors briefly summarise the concept and basics of FMRI and demonstrate the first successful FMRI examination performed in Hungary. The potential role of FMRI in the clinical practice is presented.

Animals↗

[Bilateral renal artery stenosis diagnosed during pregnancy].

Bilateral renal artery stenosis was diagnosed noninvasively in the 17th gestational week, in a chronically hypertensive pregnant woman, by renal artery duplex ultrasound examination, MRI and MR angiography. Continuous monitoring of the mother and the fetus was performed. Blood pressure was stabilized by complex antihypertensive therapy, but from the beginning of the third trimester superimposed preeclampsia developed gradually. In the 34th gestational week a 1600-g newborn was delivered by elective cesarean section. The case report draws attention to the significance of the thorough examination of hypertensive women before pregnancy.

Adult↗

[CT-guided percutaneous drainage in the management of psoas abscesses].

The authors review their first experiences in Hungary with the CT guided percutaneous catheter treatment of psoas abscesses. Diagnostic aspiration from abscess was performed in one patient. Percutaneous catheter drainage of psoas abscess were performed in 4 patients. There were 4 patients with unilateral and 1 patient with bilateral psoas abscess. 4 patients had tuberculous spondylodiscitis, 1 patient had staphylococcal vertebral osteomyelitis. One patient following diagnostic aspiration was successfully treated with antituberculoutic drugs. All patient treated with percutaneous catheter drainage received medical antituberculoutic or antibiotic therapy and showed excellent clinical and radiological results. There was no complication and there was no need to open surgical drainage in this series. CT guided aspiration is a valuable tool in the diagnosis of psoas abscesses as well as in the identification of the exact abscess etiology. Percutaneous drainage represents an efficient and attractive alternative to open surgical drainage in the treatment of psoas abscesses.

Aged↗

[Percutaneous transluminal angioplasty of the subclavian artery].

Over a period of 12 years, percutaneous transluminal angioplasty was used to dilate 227 subclavian obliterations (216 stenoses, 11 occlusions) in 208 patients. Immediate success rate was 96%. 152 dilated arteries long-term patency are known. The average follow-up time was 32 months (1-120 months). 14 restenosis occurred. In 7 of the 14 patients redilation were performed. Complication: 3 puncture site thrombosis, 1 haematoma, 4 transient confusion occurred. In 2 patients shoulder pain developed with unknown origin, and last for a few weeks. There were no irreversible neurologic deficit. Percutaneous transluminal angioplasty of subclavian artery stenoses should be the procedure of choice in symptomatic patients.

Adult↗

[The importance of CT-guided needle biopsy in the diagnosis of thoracic diseases].

In the report on 35 CT-guided fine needle transthoracic biopsies the authors show the relevance of invasive radiological methods in tumor diagnostics. The results are compared with those published in the literature. CT-guided transthoracic biopsy is of crucial importance in final diagnosis of certain thoracic diseases.

Biopsy, Needle↗

[The use of endoprostheses (stents) in airway stenosis].

Six patients with obstruction of the trachea were treated with silicone rubber endothracheal stents implanted with flexible bronchoscope. In every case the stent caused significant clinical improvement of the ventilation. At the postintubation stenosis the stent can result a final recovery, at the malignant processes the implantation seems to be a new palliative method.

Accidents↗

[Percutaneous transluminal angioplasty in atypical aortic coarctation in an adult patient].

In the reported case, coarctation of the aortic arch (Coa) was the cause of hypertonia. Coa diminishes the expected lifetime, and operative treatment is required. PTA is contradictory in the treatment of coarctation. In the reported case coarctation was located on the aortic arch, and because of the risk of the operation PTA was performed. The dilatation was successful, hypertension resolved, and there was no significant difference in the blood pressure on the extremities. 16 months after the dilatation the patient is symptomless. The result of this case indicates that PTA of the Coa of the aorta is feasible. More experience is needed to establish its role.

Adult↗

Effects of intravenous streptokinase and CLS 2210 (calcium dobesilate) on the biochemical markers of early acute myocardial infarction: a historic comparison with both studies.

In a previous double-blind, randomized study, CLS 2210 (a new formulation of calcium dobesilate) or placebo was administered by intravenous infusion to 41 patients having their first acute myocardial infarction. In the present study 19 comparable patients were treated intravenously with streptokinase under identical conditions and the results compared with those from the previous study. In all patients administration was begun within three hours of onset of symptoms and continued over seventy-two hours. Blood samples were taken for the measurement of serum activity of creatine kinase and its isoenzyme MB, and the serum and urinary concentrations of myoglobin and glycosaminoglycans were also measured. The purpose of this study was to determine the effects of CLS 2210, placebo, and streptokinase on these biochemical markers of acute myocardial infarction, thereby assessing their actions in limiting myocardial necrosis. In the CLS 2210-treated patients, the levels of serum creatine kinase and serum and urinary myoglobin were significantly lower than in the placebo patients throughout the seventy-two hours (p = 0.01, 0.005, 0.004 respectively). The levels of creatine kinase MB and serum glycosaminoglycan in the CLS 2210 patients were initially higher than in the placebo patients but fell below placebo levels between the fortieth and fifty-fifth hours, respectively (p = 0.89, 0.02). Only the glycosaminoglycan urinary concentrations were higher in the CLS 2210 group than in the placebo group throughout (p = 0.0005). The values for the six variables investigated showed no statistically significant difference between placebo and streptokinase.(ABSTRACT TRUNCATED AT 250 WORDS)

Benzenesulfonates↗

The influence of CLS 2210 on the course of myocardial infarction: a pilot study in man.

To assess the effect of CLS 2210 (a new formulation of calcium dobesilate) on the evolution of acute myocardial infarction, 100 patients presenting their first infarct were distributed, according to their sequential admissions to the hospital, into CLS 2210-treated group (50 patients) or a comparison group (50 patients not receiving CLS 2210). The two groups were similar in age, sex, predisposing factors, and site of infarction. Intravenous infusion of CLS 2210 was begun within six hours of onset of chest pain and continued for seventy-two hours. Thereafter, it was given, as oral capsules, in a dose of 1,000 mg every eight hours throughout the hospitalization. Before and during the trial, blood samples were drawn for the measurements of serum concentrations of creatine kinase (CK), and twelve-lead electrocardiograms (ECGs) were obtained serially in each patient. All objective data were analyzed on a coded basis without reference to the treatment. In the comparison group, thirty-six to forty-eight hours was required for CK to fall to 50% of the baseline value, whereas in the CLS 2210-treated group it reached 50% of the baseline in eighteen to twenty-four hours. For each infarction site, a statistically significant fall was reached earlier in the CLS 2210 group. CK, the ECG index, and the sum of the ST segments showed earlier and more rapid improvement in the CLS 2210 group than in the comparison group. The consumption of narcotic analgesic agents and nitroglycerin was substantially less in the CLS 2210 group than in the comparison group.(ABSTRACT TRUNCATED AT 250 WORDS)

Benzenesulfonates↗

Calcium dobesilate (CLS 2210) protects the myocardium in early acute myocardial infarction: a preliminary randomized, double-blind, placebo-controlled study of its effects on biochemical markers.

To determine the effect of calcium dobesilate (CLS 2210) on biochemical markers of acute myocardial infarction, and thereby assess its action in limiting myocardial necrosis, this compound was administered intravenously by a randomized, double-blind technique to 23 of 41 patients suffering their first infarction. The remaining 18 patients received a placebo. Administration was begun within 3 h of onset of symptoms and continued for 72 h. Before and during treatment, blood samples were taken for measurement of the serum activity of creatine kinase and its isoenzyme MB, and the serum and urinary concentrations of myoglobin and glycosaminoglycans. Serum creatine kinase and serum and urinary myoglobin were significantly lower in the CLS 2210-treated patients than in the placebo patients throughout the 72 h (p = 0.01, 0.005, and 0.004, respectively). Serum creatine kinase MB and serum glycosaminoglycan in the CLS 2210 patients were initially higher than in the controls, but fell below the control levels between the 40th and 55th hours (p = 0.89 and 0.02, respectively). The glycosaminoglycan urinary concentrations alone were higher in the CLS 2210 group than in the placebo group throughout (p = 0.0005). These findings suggest that CLS 2210 reduces myocardial infarct size in human subjects, as it is already known to do in animals.

Acute Disease↗

Myocardial infarction treated with two lymphagogues, calcium dobesilate (CLS 2210) and hyaluronidase: a coded, placebo-controlled animal study.

The effects on the evolution of canine myocardial infarction (MI) of the lymphagogues hyaluronidase (hyaluronate glucanohydrolase) (known to reduce the size of MIs) and calcium dobesilate (calcium, 2,5-dihydroxybenzenesulfonate, CLS 2210) were compared in a coded, placebo-controlled study in 48 dogs, during the first 24 h after coronary occlusion. MI was induced by embolization of the anterior descending branch of the left coronary artery. The animals were given either a placebo, CLS 2210, or hyaluronidase by intravenous infusion begun immediately after embolization and continued for 24h. The volume of myocardial tissue at risk was evaluated at 2 and 24 h by ungated computed tomography (CT), and after necropsy by staining myocardial sections with triphenyl tetrazolium chloride (TTC). Electrocardiography and estimation of serum creatine kinase (CK) activity were also performed. In the 25 animals that survived 24 h, the results of all tests showed that there was less myocardial damage in the animals treated with the two lymphagogues than in those treated with placebo, and less damage with CLS 2210 than with hyaluronidase. The good correlation between the volume of ischemic tissue as assessed by CT in vivo and as assessed by TTC staining after necropsy (r = 0.959) confirms that the CT perfusion phase defect accurately reflects the volume of tissue at risk during the evolution of MI. This study has shown that CLS 2210 is at least as effective as hyaluronidase in reducing myocardial damage due to coronary artery occlusion in dogs.

Animals↗

Thrombogenicity of hydrophilically coated guide wires and catheters.

The thrombogenicities of stainless steel spring guide wires and two hydrophilically coated guide wires were compared. The guide wires were placed in canine femoral arteries for 30 minutes. The guide wires were removed, the thrombi were stripped off, and the clots were weighed. Clot weights obtained with the two hydrophilically coated guide wires were significantly less than those obtained with the stainless steel spring guide wires. The thrombogenicities of hydrophilically coated catheters and noncoated nylon catheters were compared with and without the use of heparin. Carotid arteries, jugular veins, femoral arteries, and femoral veins were used. Catheters were left in place for 45 minutes. The animals were heparinized and killed. The vessels were then removed en bloc with the catheter clamped in place. The vessels were incised, and the clot was removed and weighed. In arterial and venous catheterization, no significant difference in clot deposition was shown between the hydrophilically coated catheters and the noncoated nylon catheters. A striking reduction of thrombogenicity was achieved with heparinization of the catheters in both arteries and veins.

Angiography↗

Mortalities associated with use of a commercial suspension of polyvinyl alcohol.

Two cases of symptomatic neonatal hepatic arteriovenous malformation (AVM) are presented. Both were treated with percutaneous transcatheter embolization and a commercially available polyvinyl alcohol suspension. Both infants died soon after AVM embolization. The results of laboratory examination of particle-size homogeneity of this commercial suspension demonstrate marked inhomogeneity of particle size very probably contributed to the death of these patients. A protocol has been developed to help determine appropriate particle size in individual cases; this may help prevent such catastrophic results during transcatheter embolization.

Arteriovenous Malformations↗

Retrograde left atrial catheterization.

Catheterization of the left atrium can provide valuable information about both congenital and acquired heart disease. The traditional approach to examination of the left atrium has been the transseptal route, which has occasionally been associated with serious complications. A method of retrograde left atrial catheterization has been developed that is performed with a modified standard catheter. The technique was tested in five dogs and was easy and safe to perform.

Animals↗

The importance of separation of prostatic lobes in relief of prostatic obstruction by balloon catheter urethroplasty: studies in dogs and humans.

We performed balloon urethroplasty in six older normal dogs and 10 patients with benign prostatic hypertrophy to establish the mechanism by which this technique results in relief of bladder outlet obstruction. Thirty-millimeter balloon catheters were used in both the animal and human studies. Autopsy studies showed disruption of the anterior prostatic commissure in four of the six dogs, disruption of both anterior and posterior commissures in one dog, and no disruption in the remaining dog. In all 10 patients, cystoscopy and urethrography showed disruption of the anterior commissure. Separation of the prostatic lobes by disruption of the prostatic commissures may be the most important mechanism by which balloon urethroplasty relieves urethral obstruction.

Animals↗

Salvage of ischemic myocardium by CLS 2210 in the dog: a preliminary double-blind study.

To assess whether a cardiac lymphagogue, CLS 2210, would reduce myocardial infarct size after coronary artery ligation, studies were performed in 14 dogs. The left anterior descending coronary artery was ligated in each dog, and the dogs were randomized to either placebo or CLS 2210 treatment, which was carried on for seven days. After seven days the animals were sacrificed and the volume of infarcted myocardium was determined macroscopically on a double-blind basis, supported by histologic examination. CLS 2210 treatment resulted in a highly significant reduction in the volume of infarcted myocardium (p less than 0.001). Since CLS 2210 is chemically and pharmacologically unrelated to hyaluronidase but shares an action with hyaluronidase as a cardiac lymphagogue, the results offer further support for a role of myocardial lymphatics in the evolution of myocardial necrosis following coronary artery occlusion and provide an explanation for the mechanism by which these agents reduce myocardial infarction size.

Animals↗

Influence of a lymphagogue, CLS 2210, on regional cardiac lymphatics and the electrocardiogram after coronary artery occlusion in the dog.

To examine the role of cardiac lymphatic drainage in myocardial infarction, we quantified the effect of a lymphogogue, CLS 2210, on the number and appearance of myocardial lymphatics as well as the electrocardiogram following coronary occlusion in the dog. Thirty minutes and six hours after intravenous administration of the benzenesulfonate compound, (CLS 2210) cardiac lymphatics in the distribution of the left anterior descending coronary artery (LAD) were determined and further delineated by postmortem cardiac lymphangiograms. The results were compared with treated and untreated dogs without and with descending coronary artery ligation including the noninfarcted zone; that is, myocardium within the distribution of left circumflex coronary (LCC) artery. After 30 minutes in dogs receiving CLS 2210 without LAD ligation, number of lymphatics (point count/cm2, see Methods) were respectively--LAD zone: 2.62 +/- 0.11 or 10.9% of left ventricular (LV) surface; LCC zone: 2.87 +/- 0.10, whereas after six hours--LAD zone 8.04 +/- 0.03 or 32.3% LV surface; LCC zone--8.13 +/- 0.06 compared with untreated controls--LAD zone 1.71 +/- 0.11 or 6.6% of LV surface; LCC zone 1.65 +/- 0.12 (p less than 0.0001). At similar intervals in dogs with LAD ligation, the findings were at 30 minutes LAD zone 0.78 +/- 0.07 or 3.1% of LV surface and at 360 minutes was 0.80 +/- 0.08 or 3.3% of LV surface. In conjunction with CLS 2210 administration, however, LAD zone showed at 30 minutes 2.50 +/- 0.12 or 10% of LV surface (p less than .01) and at 360 minutes was 10.34 +/- 0.03 or 35.1% of LV surface.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗