PubMed Health⌕ Search

Biomedical subjects

M Damian

Publications and source records attributed to M Damian.

At least 19 recordsLinked to original sources
PubMed2005

The clinical utility of structural neuroimaging with MRI for diagnosis and differential diagnosis of dementia: a memory clinic study.

OBJECTIVES: The individual contribution to the final comprehensive clinical diagnosis of neuropsychology (NP) and magnetic resonance imaging (MRI), respectively, was quantified in a specialized tertiary care setting to investigate the added clinical value of routine MRI. METHODS: In 106 patients referred to a university memory clinic for the work-up of cognitive disturbances the primary care diagnosis, the initial clinical neuropsychiatric diagnosis, the neuropsychological and MRI diagnoses, and the final comprehensive clinical diagnosis were documented. The neuropsychological investigation was performed using the CERAD test battery. MRI was performed using T1, double echo and FLAIR sequences without contrast medium. The change of the final comprehensive clinical diagnosis in relation to the initial neuropsychiatric diagnosis was used to determine the diagnostic contribution of both, MRI and NP. RESULTS: NP and MRI led to a significant change of the final comprehensive diagnosis in 26% of patients (CI: 0.26 +/- 0.09; p < 0.05). In addition, three cases of secondary dementias, and six cases of vascular encephalopathy without dementia were recognized by MRI. Sensitivity, specificity, and the positive predictive value were higher for NP and MRI, respectively, than for the initial clinical diagnosis alone. CONCLUSION: MRI as well as neuropsychological testing improves early detection and differential diagnosis of dementia and additionally supplies clinically relevant findings. MRI carries added clinical value in the investigation of dementias.

Aged↗
PubMed2005

[Reliability of quantifying vascular white matter brain lesions -- a contribution to reproducible quantitative diagnosis].

PURPOSE: Microangiopathic lesions of the brain tissue correlate with the clinical diagnosis of vascular subcortical dementia. The "experience-based" evaluation is insufficient. Rating scales may contribute to reproducible quantification. MATERIALS AND METHODS: In MRI studies of 10 patients, 9 neuroradiologists quantified vascular white matter lesions (WMLs) at two different points in time for 12 anatomically defined regions with respect to number, size and localization (score). For 9 observers and 10 studies, 90 intra-observer differences were obtained for each of the 12 WML scores. To calculate the inter-observer reliability, rating pairs were formed. Furthermore, 360 differences were computed for each score and rating for 12 anatomically defined WML scores, and the intraclass correlation (ICC) was calculated as a measure of agreement (reliability). RESULTS: As to the intra-observer reliability, the median of the differences was 1.5 for the entire brain as opposed to 0 for defined brain regions. The corresponding values for the inter-observer reliability were 3 and 1, respectively. The mean intra-class correlation coefficient for the 10 studies was 0.88, whereas the mean interclass correlation concerning the inter-observer reliability was 0.70, with the first and second rating being averaged. The rating of each study took about 6 minutes. CONCLUSION: The rating scale with high intra- and inter-observer reliability can dependably quantify WMLs and correlates with the clinical diagnosis of vascular dementia. Using a reliable rating scale, the diagnostic distinction of age-associated physiological vs. pathological size of the WML can make a contribution to the reproducible quantifiable diagnostic evaluation of vascular brain tissue lesions within the framework of dementia diagnostics.

Aged↗
PubMed2005

[Quantification of microangiopathic lesions in brain parenchyma and age-adjusted mean scores for the diagnostic separation of normal from pathological values in senile dementia].

PURPOSE: To quantify microangiopathic lesions in the cerebral white matter and to develop age-corrected cut-off values for separating normal from dementia-related pathological lesions. MATERIALS AND METHODS: In a memory clinic, 338 patients were investigated neuropsychiatrically by a psychological test battery and by MRI. Using a FLAIR sequence and a newly developed rating scale, white matter lesions (WMLs) were quantified with respect to localization, number and intensity, and these ratings were condensed into a score. The WML scores were correlated with the mini-mental state examination (MMSE) and clinical dementia rating (CDR) score in dementia patients. A non-linear smoothing procedure was used to calculate age-related mean values and confidence intervals, separate for cognitively intact subjects and dementia patients. RESULTS: The WML scores correlated highly significantly with age in cognitively intact subjects and with psychometric scores in dementia patients. Age-adjusted WML scores of cognitively intact subjects were significantly different from those of dementia patients with respect to the whole brain as well as to the frontal lobe. Mean value and confidence intervals adjusted for age significantly separated dementia patients from cognitively intact subjects over an age range of 54 through 84 years. CONCLUSION: A rating scale for the quantification of WML was validated and age-adjusted mean values with their confidence intervals for a diagnostically relevant age range were developed. This allows an easy to handle, fast and reliable diagnosis of the vascular component in senile dementia.

Age Factors↗
PubMed2004

[Effects of extended clinical diagnostics on the diagnostic spectrum of an outpatient memory clinic].

OBJECTIVES: In an outpatient memory clinic, the methods of extended clinical diagnostics pertaining to imaging and neuropsychology were changed but the modus of assignment to the clinic remained unchanged at different times. Expected changes in the diagnostic spectrum can be attributed to the changed diagnostics. Consistent with reports from the literature regarding the consequences of such changes, the associated costs have to be taken into consideration as well. METHODS: The clinical final diagnoses of 174 patients referred in 2000/2001 for the diagnostics and differential diagnostics of dementia ("current population") were compared with those of 169 patients who visited the same outpatient clinic in 1998/1999 ("former population"). The diagnostic spectra of the two populations were compared. The diagnoses were differentiated in "no dementia" (XD), "neurodegenerative dementia" (ND), "vascular dementia" (VD), and "dementia of the mixed type" (MIXD). For all patients, the same clinical diagnostic criteria (ICD-10) and laboratory tests were implemented. Only the neuroradiological and neuropsychological methods changed from 1998/1999 to 2000/2001: The current population was examined with MRI instead of CT and underwent an expanded neuropsychological test battery with additional power and speed tests. RESULTS: The diagnoses of the two populations differed significantly in their frequency distribution. A dementia was excluded in 51.1% of the "current" patients vs 19.5% of the "former" patients. The frequencies of the dementia diagnoses were significantly different for the diagnoses ND (29.9 vs 47.9%) and MIXD (1.1 vs 7.7%), but not for VD (13.2 vs 12.4%). Beside other independent modalities, the improvement of imaging with MRI is discussed as recording atrophy size and vascular lesions better than CT. The improvement of the neuropsychological test battery containing additional speed tests is discussed as being able to differentiate even minimal cognitive disturbances. CONCLUSION: Using optimized imaging and neuropsychological methods, the diagnostic spectrum of an outpatient memory clinic changed. The clinical diagnosis was improved by the more sensitive, extended clinical diagnostics. Through optimized differential diagnostic allocation and the exclusion of dementia, expenses can be reduced by early and indication-related medication and by the resulting delay of institutionalized care.

Aged↗
PubMed2004

[Does magnetization transfer ratio (MTR) contribute to the diagnosis and differential diagnosis of the dementias?].

PURPOSE: The magnetization transfer ratio (MTR) is a MR-based neuroimaging procedure aiming at the quantification of the structural integrity of brain tissue. Its contribution to the differential diagnosis of dementias was examined and discussed in relation to the pathogenesis of age-related dementias. MATERIALS AND METHODS: Sixty-one patients from a memory clinic were diagnosed by general physical and neuropsychiatric examination, and underwent neuropsychologic testing and neuroimaging using MRI. Their clinical diagnoses were based on standard operational research criteria. Additionally, the MTR in 10 defined regions of interest (ROI) was determined. This investigation was performed using a T1-weighted SE sequence. Average MTR values were determined in the individual ROI and their combinations and correlated with the age, gender, cognitive impairment and clinical diagnosis. Sensitivity, specificity, positive and negative predictive value were determined, as well as the rate of correct classifications. RESULTS: For cognitive healthy subjects, the MRT values correlate only mildly, though significantly, with age in the hippocampus and with gender in the dorsal corpus callosum. In contrast, the MTR in the frontal white matter correlates strongly and highly significantly with cognitive impairment in patients with dementia. The differential diagnostic assignment of Alzheimer's disease versus vascular dementia by MTR provides a correct classification of approximately 50 % to 70 %. PPV for no dementia vs. vascular dementia or the NPV for vascular vs. Alzheimer's disease are considerably higher exceeding 80 %. For no dementia vs. Alzheimer's disease, the NPV was over 90 %. CONCLUSION: MTR values indicate functional changes in the brain tissue between cognitive healthy and demented patients, and correlate with the cognitive loss, but not with age and gender. In principle, the MTR is suitable for the diagnosis of age-related dementias, but does not contribute substantially to the differential diagnosis of vascular dementia vs. Alzheimer's disease. The present results support the assumption of a synergy between vascular and degenerative components of age-related dementias.

Age Factors↗
PubMed2003

[Microangiopathic lesions of white matter. Quantitation of cerebral MRI findings and correlation with psychological tests].

AIM: The importance of vascular lesions in the white matter of the brain (WML) is viewed differently. Diagnostic evaluation is determined by experience and age-associated normal values are not available. MATERIAL AND METHODS: One hundred fifty-two patients aged 68.8 years (range 50-89) were examined at a memory clinic using a magnetic resonance FLAIR sequence,which is sensitive for WML. The WMLs were entered with respect to size, localization, laterality, and density. The WML scores of 76 clinically and psychologically normal subjects with microangiopathic lesions and 27 patients with vascular dementia were correlated with psychological test results. The contribution of local WML scores to the differentiation between age-associated microangiopathy and vascular dementia was calculated using logistic regression analysis. Nonparametric monotonic regression was used to analyse the age-associated WML scores of both groups, taking individual age into account. RESULTS: The WML scores correlated linearly with the age of psychologically normal subjects but with degree of dementia for those with vascular dementia, and it allowed differentiation between these two groups with an accuracy of up to 88% and specificity of approximately 95% with reference to the right frontal region. The odds ratios of the general and frontal WML scores were significantly different (1,102 and 1,400, respectively). Statistical significance of the age-associated WML scores varied for different age ranges. CONCLUSION: It is possible to differentiate psychologically normal subjects with microangiopathic brain lesions from patients with vascular dementia on MRI when referring to frontal WML scores.

Aged↗
PubMed2003

[Is there a referral bias in the diagnoses of patients of a memory clinic?].

In a recent study addressing the contribution of neuropsychology and neuroradiology to the improvement of the dementia diagnoses of a memory clinic more than 45% of the patients (45 out of 101) did not meet the criteria for dementia. This finding was unexpected because all patients had been referred for the diagnosis and differential diagnosis of dementia. The aim of the present study was to examine whether the proportion of nondemented patients varies with the "modus of referral". This was not found to be true. The frequency of the diagnosis "no dementia" was not significantly different for the two patient groups "general practitioner" vs. "neuropsychiatrist" referred patients (p=0.859). In conclusion, there is no difference between the two groups of physicians in the reliability judging whether a "cognitive complainer" needs to be referred to a specialized memory clinic.

Age Factors↗
PubMed2003

[Evaluation of the contribution of the importance of neuroimaging for the diagnostics of dementias--comparison to the psychological diagnostics].

OBJECTIVE: While psychology is accepted as a necessary component of the dementia diagnostics, the extended clinical diagnostics with neuroimaging is differently estimated. The goal of the study is the quantification of the individual contribution of the two different methods. METHODS: Of 100 patients the diagnosis of entrance, the neurological, the psychological, and the final clinical diagnosis were documented. For both imaging and psychology the sensitivity, specificity, and the positive predictive value were computed. The diagnostic of each method was determined from the change of the final in relation to the initial clinical diagnosis. The neuroradiological investigation took place with MRI, the psychological examination used both usual power and special speed tests. RESULTS: The extended clinical diagnostics led for 26 % of the patients to the change of the clinical diagnosis. Imaging and psychology supplied different own but supplementing contributions. In the case of annihilation imaging contributed with 73.3 %, psychology with 54.1 % to the diagnosis of a neurodegenerative dementia, whereas the contributions to the diagnosis of a vascular dementia were 83.3 % and 70.8 %, respectively. However psychology diagnosed and quantified the dementia. The contribution of neuroimaging consisted in the differential diagnosis of the dementias. Organic causes of symptomatic dementias and vascular encephalopathy without dementia but with consequences for a secondary prophylaxis were additional information also. CONCLUSION: Psychology improves the diagnostic accuracy of dementias. Neuroimaging improves the differential diagnosis of dementias and supplies additional clinically relevant findings. In the qualified diagnostics and differential diagnostics of the dementias both methods are indispensable.

Aged↗
PubMed2001

Treatment of severe hyponatremia: conventional and novel aspects.

Hyponatremia is a frequent electrolyte disorder. A hyponatremia is called acute severe (<115 mM) when the duration has been <36 to 48 h. Such patients often have advanced symptoms as a result of brain edema. Acute severe hyponatremia is a medical emergency. It should be corrected rapidly to approximately 130 mM to prevent permanent brain damage. In contrast, in chronic severe hyponatremia (>4 to 6 d), there is no brain edema and symptoms are usually mild. In such patients, a number of authors have recommended a correction rate <0.5 mM/h to approximately 130 mM to minimize the risk of cerebral myelinolysis. Sometimes it is not possible to diagnose whether a severe hyponatremia is acute or chronic. In such cases, an initial imaging procedure is helpful in deciding whether rapid or slow correction should be prescribed. The modalities of treatment of severe hyponatremia have so far consisted of infusions of hypertonic saline plus fluid restriction. In the near future, vasopressin antagonists will become available. Preliminary experience has already demonstrated their efficiency of inducing a sustained water diuresis and a correction of hyponatremia.

Acute Disease↗
PubMed2000

Comparison of serotyping, ribotyping and pulsed-field gel electrophoresis for distinguishing group A Streptococcus strains isolated in Albania.

Conventional serotyping for T antigens, rRNA gene restriction fragment length polymorphism analysis (ribotyping) and pulsed-field gel electrophoresis were compared for distinguishing among group A streptococci isolated in Albania between 1980-1982 and in 1995. A total of twelve serotypes were identified among seventy GAS strains. Ribotyping revealed eight and eleven distinct patterns after digestion with HindIII and PvuII, respectively. Twenty-three strains of serotype T12 were subdivided in 10 ribotypes and 11 strains of T2 serotype were differentiated in 5 ribotypes. By comparison, PFGE generated 37 patterns after SmaI digestion. The index of discrimination, using the Hunter-Gaston formula, was applied to assess the value of these methods for interpretation of the epidemiological data. For serotyping the value of index was 0.85. The ribotyping system revealed an ID of 0.83 when the combination HindIII and PvuII was used. This index reached 0.97 for PFGE. The methods used were useful to subtype the isolates of GAS.

Albania↗
PubMed1999

Molecular characterization of Mycobacterium bovis BCG: Romanian sub-strain.

The Romanian sub-strain used for BCG vaccine production was characterized by polymorphic GC-rich repetitive sequence (PGRS) restriction profile and IS6110 detection. For comparison, the Pasteur and Moscow Mycobacterium bovis BCG sub-strains, M. bovis AN5, and M. tuberculosis H37Rv were analyzed. The BCG sub-strains showed the same restriction profile for PGRS after Pvu II, BamH I and Sal I digestion. They could be distinguished from the strains M. bovis AN5 and M. tuberculosis H37Rv after Pvu II and Sal I digestion. Sal I can also distinguish between M. bovis AN5 and M. tuberculosis H37Rv. Digestion with Pvu II, Sal I, Sca I, Mlu I and BamH I gave identical profiles of IS6110 hybridization for the Romanian and Pasteur BCG substrains.

Bacterial Typing Techniques↗
PubMed1998

Changes in Vibrio cholerae O1 strains isolated in Romania during 1977-95.

Six hundred and twenty-four Vibrio cholerae O1 strains, 623 serotype Ogawa and one serotype Inaba, isolated in Romania between 1977-95 were tested to detect all changing traits concerning serogroup, serotype, biotype, phage type and resistotype patterns and subsequently, the possible epidemiological relationship among these strains. Biotyping revealed one classical, 580 eltor strains and 43 intermediary variants. When tested with Mukerjee phages, 546 (87%) strains were sensitive and 78 (13%) resistant. One phage type (M4) dominated during 1977-90, two phage types (M4 and M5) exhibited the same high frequencies during 1991, a diversity of types occurred during 1993-4 whereas in 1995, two phage types (M4 and M5) showed similar distributions again. Five patterns of drug susceptibility were successively described during 1977-95. The most prominent changes in Vibrio cholerae O1 strains were noticed during 1993-4: the highest number of non-typable strains and intermediary variants, the widest spectrum of phage types and of multidrug resistance. In 1995, the strains reverted to the previous typable forms but a new drug resistance pattern was noticed.

Bacterial Typing Techniques↗
PubMed1992

Changing pattern of brain hemorrhage during 12 years of computed axial tomography.

BACKGROUND AND PURPOSE: We examined whether the pattern of cerebral hemorrhage changed after the introduction of computed tomography. METHODS: Using a prospective data base we analyzed the case-fatality ratio, early mortality, and the incidences of hypertension and anticoagulant medication in 488 consecutive cases with supratentorial hemorrhage between 1978 and 1989. Blood pressure at admission of all patients for the years 1978-1979 and 1988-1989 and the Mathew and activities of daily living scores for the years 1978-1979, 1982-1983, and 1988-1989 were assessed retrospectively. RESULTS: The case-fatality ratio decreased from 49% in the period 1978-1981 to 31% in 1986-1989 (p = 0.006); early mortality (day 1-4) decreased from 28% to 12% (p = 0.0017). The incidence of hypertension decreased from 78% in the period 1978-1981 to 64% in 1986-1989 (p = 0.01). Systolic and diastolic blood pressure at admission sank (p = 0.09). The decrease of the case-fatality ratio correlated best with a less severe initial disturbance of consciousness (p less than 0.01) and with a higher Mathew score (p = 0.038). The activities of daily living score remained unchanged. CONCLUSIONS: The case-fatality ratio and early mortality decreased after the introduction of computed tomography. This was basically due to a decreased incidence of comatose and stuporous patients with severe neurological deficit paralleled by a decrease of mean systolic and diastolic blood pressure values at admission.

Aged↗
PubMed1990

Age-related spontaneous intracerebral hematoma in a German community.

We investigated incidence, age distribution in relation to etiology, and localization of spontaneous intracerebral hematoma in 100 consecutive cases. Incidence in the total population of the Giessen area was estimated to be greater than 11/100,000 inhabitants/yr and increased with age. There was a trend toward higher incidence in males. Overall mortality was 27%, 22% of 58 patients aged less than 70 years and 33% of 42 patients aged greater than or equal to 70 years. Hypertensive putaminal hematoma showed the highest mortality rate (42%, 10 of 24 cases). Chronic alcoholism and anticoagulant medication influenced the mortality rate unfavourably. We found the following localizations and etiologies to have a specific relation with age: 1) lobar hematomas from vascular malformations, group aged less than 40 years; 2) hypertensive putaminal hematomas and hypertensive thalamic hematomas, group aged 40-69 years; and 3) lobar hematomas, group aged greater than or equal to 70 years. Alcoholism was an additional factor in 38% of the 13 middle-aged men with hypertensive putaminal hematomas. Fourteen cases of spontaneous intracerebral hematoma were possibly due to cerebral amyloid angiopathy. Six of these 14 patients had recurrent lobar hematomas, but only three of the six could be histologically investigated. In these three cases, cerebral amyloid angiopathy was proven.

Adult↗
PubMedDate not supplied

Molecular characterization of Vibrio cholerae O1 strains isolated in Romania.

A collection of 89 Vibrio cholerae O1 strains, isolated in Romania between 1977 and 1994, and 6 strains from the Republic of Moldavia, was characterized by ribotyping, toxin gene restriction pattern (toxinogenotype) and distribution of cholera toxin gene (ctx), accessory toxin gene (ace) and zonula occludens toxin gene (zot). After Bg/I endonuclease restriction of chromosomal DNA, a total of 18 ribotypes and 21 toxinogenotypes were distinguished. Deletions in the core region of the toxin gene cassette were found in 20% of strains; however, with the exception of one strain, all the isolates contained the ctx gene. Used in association, the three methods of molecular typing provided an accurate characterization of V. cholerae O1 isolates.

Bacterial Typing Techniques↗
PubMedDate not supplied

Prevalence of virulence genes in Escherichia coli strains isolated from Romanian adult urinary tract infection cases.

A total of 78 E. coli strains isolated from adults with different types of urinary tract infections were screened by polymerase chain reaction for prevalence of genetic regions coding for virulence factors. The targeted genetic determinants were those coding for type 1 fimbriae (fimH), pili associated with pyelonephritis (pap), S and F1C fimbriae (sfa and foc), afimbrial adhesins (afa), hemolysin (hly), cytotoxic necrotizing factor (cnf), aerobactin (aer). Among the studied strains, the prevalence of genes coding for fimbrial adhesive systems was 86%, 36%, and 23% for fimH, pap, and sfa/foc,respectively. The operons coding for Afa afimbrial adhesins were identified in 14% of strains. The hly and cnf genes coding for toxins were amplified in 23% and 13% of strains, respectively. A prevalence of 54% was found for the aer gene. The various combinations of detected genes were designated as virulence patterns. The strains isolated from the hospitalized patients displayed a greater number of virulence genes and a diversity of gene associations compared to the strains isolated from the ambulatory subjects. A rapid assessment of the bacterial pathogenicity characteristics may contribute to a better medical approach of the patients with urinary tract infections.

Adolescent↗
PubMedDate not supplied

[Lipid metabolism in severely acute diarrheic disease in infants].

In a group of 34 infants with serious acute diarrheic disease, the authors study the total lipids, total and esterified cholesterol, triglycerides and lipidogram, in the acute phase of the disease and at a 10-day-interval from the first determination. Triglycerides have constantly increased values both at admittance and at the second determination, as a consequence of lipid mobilization in acute stage. This process continues due to the hypolipidic and hypocaloric diet. Esterified fraction of cholesterol has initially important decreases, tending to become normal in the interval studies, more evident in the healthy infant. Total lipids are increased in 10.5% of the cases and the lipidogram shows an increase of alpha-lipoproteins and prebeta-lipoproteins in 10.5% and 17.5% respectively of the cases in the first determination.

Acute Disease↗