Hepatitis C treatment uptake and adherence among injecting drug users in the Czech Republic.

BACKGROUND: Injecting drug users (IDUs) represent a major subpopulation of hepatitis C virus (HCV)-infected people in developed countries. Yet their uptake to treatment is generally low despite well-documented effectiveness of HCV treatment among former and active IDUs. The present study represents the first attempt to describe the HCV treatment coverage among IDUs and identify factors that affect treatment uptake in the Czech Republic. METHODS: From January to March 2011, a questionnaire survey was conducted among viral hepatitis treatment centres in the Czech Republic. RESULTS: From a total of 76 identified hepatitis treatment centres existing in the country, 39 provided HCV treatment to (mainly former or abstaining) IDUs in 2010. Most clinicians reported being cautious in initiating HCV treatment in IDUs. Abstinence, a screening phase before treatment initiation, opioid substitution treatment and an external evaluation by a specialist were often prerequisites for skrting treatment. However, HCV treatment centres rarely provided drug-use specific services. Financial constraints were also reported, further limiting the inclusion of IDUs into treatment, as non-users are widely preferred to active drug users. Clinicians reported no difference in treatment uptake and adherence between drug users and non-users, nor between opioid and methamphetamine users. CONCLUSION: A number of system- and provider-related factors limit HCV treatment in IDUs in the Czech Republic, despite permissive national clinical guidelines. Targeting these factors is crucial to reduce HCV prevalence at population level.

Radioisotopic purity and imaging properties of cyclotron-produced 99mTc using direct 100Mo(p,2n) reaction.

Evaluation of the radioisotopic purity of technetium-99m (99mTc) produced in GBq amounts by proton bombardment of enriched molibdenum-100 (100Mo) metallic targets at low proton energies (i.e. within 15-20 MeV) is conducted. This energy range was chosen since it is easily achievable by many conventional medical cyclotrons already available in the nuclear medicine departments of hospitals. The main motivation for such a study is in the framework of the research activities at the international level that have been conducted over the last few years to develop alternative production routes for the most widespread radioisotope used in medical imaging. The analysis of technetium isotopes and isomeric states (9xTc) present in the pertechnetate saline Na99mTcO4 solutions, obtained after the extraction/purification procedure, reveals radionuclidic purity levels basically in compliance with the limits recently issued by European Pharmacopoeia 9.3 (2018 Sodium pertechnetate (99mTc) injection 4801-3). Moreover, the impact of 9xTc contaminant nuclides on the final image quality is thoroughly evaluated, analyzing the emitted high-energy gamma rays and their influence on the image quality. The spatial resolution of images from cyclotron-produced 99mTc acquired with a mini-gamma camera was determined and compared with that obtained using technetium-99m solutions eluted from standard 99Mo/99mTc generators. The effect of the increased image background contribution due to Compton-scattered higher-energy gamma rays (E γ > 200 keV), which could cause image-contrast deterioration, was also studied. It is concluded that, due to the high radionuclidic purity of cyclotron-produced 99mTc using 100Mo(p,2n)99mTc reaction at a proton beam energy in the range 15.7-19.4 MeV, the resulting image properties are well comparable with those from the generator-eluted 99mTc.

Clinical and magnetic resonance features of the classic and akinetic-rigid variants of Huntington's disease.

We studied 32 patients with confirmed Huntington's disease (HD); six (mean age, 31.7 years) had the akinetic-rigid form and 26 (mean age, 46.1 years) had the classic hyperkinetic form. Clinical examination included a count of abnormal involuntary movements, motor self-sufficiency evaluation by the Physical Disability Rating Scale, cognitive function assessment by the Mini-Mental State examination, and a verbal fluency test. Magnetic resonance imaging permitted measurement of bicaudate diameter, a sensitive indicator of caudate atrophy in HD. Patients with the akinetic-rigid form of HD were younger and had earlier disease onset than those with the classic form of HD. All patients with akinetic-rigid HD (group 1) had striatal hyperintensity on T2-weighted magnetic resonance images; seven patients with classic HD (group 2) had a similar abnormality. Groups 1 and 2 were in fact similar in all other respects, except that the number of abnormal involuntary movements was greater in group 2. Groups 1 and 2 together had significantly younger age at onset, lower Mini-Mental State Examination score, more severe motor disability, worse verbal fluency test result, and greater bicaudate diameter than the 19 patients with classic HD without magnetic resonance signal abnormality (group 3) and appear to be a uniform population, distinct from group 3. The abnormalities on magnetic resonance images indicated greater striatal damage in groups 1 and 2, which could be the neuroanatomic substrate of their greater motor and cognitive compromise.

Hallervorden-Spatz disease: clinical and MRI study of 11 cases diagnosed in life.

The diagnosis of Hallervorden-Spatz disease (HSD) has usually been made post mortem, although the recent description of characteristic abnormalities in the globus pallidus has suggested the possibility of an in vivo diagnosis. We present the clinical histories, neurological features and MRI findings of 11 patients, diagnosed as having HSD. Generalized dystonia with predominance of oromandibular involvement, behavioural changes followed by dementia and retinal degeneration were present in all the patients. MRI pallidal abnormalities consisted of decreased signal intensity in T2-weighted images, compatible with iron deposits, and of a small area of hyperintensity in its internal segment ("eye of the tiger" sign). We propose that the combination of these neurological signs with these MRI findings could be considered as highly suggestive of a diagnosis of HSD in living patients.

Intracranial cavernous hemangiomas: neuroradiologic review of 36 operated cases.

Neuroradiologic studies in 36 cases of histologically verified intracranial cavernous hemangiomas were reviewed. Radionuclide brain scans were positive in 17 of 19 examinations. Angiography, performed in 35 cases, usually showed an avascular area with absent or moderate mass effect. Capillary blush and/or early draining veins, often mentioned in single case reports, were observed in only seven cases. Computed tomography (18 cases) usually demonstrated a hyperdense, nodular, or irregular lesion without significant mass effect and always enhancing after contrast injection. The combination of a long clinical history of focal epilepsy with computed tomographic and angiographic findings should suggest the diagnosis of cavernous hemangioma. In all cases of so-called spontaneous hematoma with negative angiography, computed tomography should be repeated after a long interval to exclude the presence of a cavernous hemangioma or other cryptic vascular malformation.

Cavernous hemangiomas of the orbit: value of CT, angiography, and phlebography.

Neuroradiologic studies performed in 18 cases of surgically verified intraorbital cavernous hemangioma are reported. Skull films usually showed enlargement of the orbit and evidence of soft-tissue mass. Phlebography rarely demonstrated filling of the cavernous hemangioma or enlarged draining veins. On angiography, in addition to displacement of vessels, pooling of contrast medium in the cavities of the hemangioma was observed in more than half the cases. Computed tomography (CT) demonstrated a rounded, hyperdense, enhancing lesion usually in the superior segment of the intraconal space. Although CT may be sufficient for planning the surgical approach, in most cases a combination of CT and angiography will give better, more specific preoperative diagnosis.

Hallervorden-Spatz disease: MR and pathologic findings.

PURPOSE: To compare the MR findings of eight cases with clinical diagnosis of Hallervorden-Spatz disease (HSD) with the pathologic findings of two other cases of HSD. MATERIALS AND METHODS: The eight imaged cases were studied with 0.5-T (seven cases) and/or 1.5-T (five cases) units. Six patients also had CT scans. The two other cases with proven HSD had detailed histologic evaluation. RESULTS: The 1.5-T findings showed abnormalities confined to the pallidum, which presented a diffuse low signal intensity in T2-weighted images, and an anteromedial area of high signal intensity (eye-of-the-tiger sign). In 0.5-T studies, low signal intensity was less evident and poorly detectable in spin echo, but gradient-echo images could enhance its demonstration; the area of high signal intensity was always well demonstrated. In three cases (three with 1.5 T, one with 0.5 T) a central spot of low signal intensity was seen in this area. The pathologic cases, in addition to neuroaxonal swellings and iron deposits, exhibited areas of "loose" tissue with vacuolization and lesser amounts of iron in the anteromedial part of the pallidum, in a location corresponding to the area of high signal intensity of the imaged cases. CONCLUSION: Comparison of MR findings with the pathologic studies demonstrates that the low signal intensity in T2-weighted images at 1.5 T corresponds to iron deposits in a dense tissue, and that the high signal intensity of the eye-of-the-tiger sign corresponds to an area of loose tissue with vacuolization. No correlation was found in the two pathologic cases for the central spot of low signal intensity.

Magnetic resonance imaging in progressive supranuclear palsy and other parkinsonian disorders.

High field intensity MRI may demonstrate signal abnormalities consistent with deposits of iron or other paramagnetic substances in several extrapyramidal disorders. Hallervorden-Spatz disease was the only disorder widely known to have iron deposits in the pallidum, that are now easily demonstrated in vivo by MRI. However, lower field intensity MRI may also demonstrate characteristic findings. In progressive supranuclear palsy, definite atrophy of the midbrain and of the region around the third ventricle is seen in slightly more than half of the cases. Minimal signal abnormalities are sometimes seen in the periaqueductal region, but MRI studies remain of little help in establishing the diagnosis of the disease. Asymmetric atrophy in the parietal regions is seen in corticobasal degeneration, as expected from pathological studies. Minimal alterations may be seen in the substantia nigra in Parkinson's disease. The most interesting MRI findings are observed in multiple system atrophies. Variable abnormal signal intensities, depending on the field intensity, are visible in the putamen in striatonigral degeneration and in Shy-Drager syndrome; in this latter condition the abnormalities are due to its striatonigral degeneration component. Atrophy of the pons, middle cerebellar peduncles, and cerebellum, and signal abnormalities in a characteristic distribution are visible in olivopontocerebellar atrophy. A combination of these posterior fossa abnormalities and putaminal alterations may confirm the involvement of the cerebellar and extrapyramidal systems in multiple system atrophies.

Unusual computerized tomography appearance of a carotid-cavernous fistula. Case report.

A case of carotid-cavernous fistula characterized by an unusual computerized tomography (CT) pattern is reported. The CT study showed a hyperdense lesion in the right frontoparietal region, and angiography demonstrated an uncommonly large venous network in the same area. After embolization by a detachable balloon technique, these findings gradually resolved. The CT pattern was probably due to the unusually large venous drainage and to the related ischemia of the brain parenchyma.

[Early diagnosis of stomach cancer: report on 23 cases including 15 patients with an acute hemorrhage or perforation (author's transl)]. / Diagnostic précoce du cancer de l'estomac. 23 cas dont 15 avec complication aiguë d'hémorragie ou de perforation.

Early gastric cancer was detected in 23 patients, 15 of whom had acute complications of either hemorrhage or perforation. Cases with acute complications often have a more favorable prognosis as a carcinoma may be identified while still in its pre-invasive stage. The gravity of the complication should not result in the employ of limited diagnostic procedures (e.g. endoscopy without multiple biopsies) or the use of incomplete therapeutic measures (e.g. simple suture of a perforated ulcer). The treatment of hemorrhagic gastric ulcers and perforated ulcers is discussed in greater detail. The need for a continuous follow-up of these patients with gastric ulcers is emphasized. This should include periodic endoscopy examination and multiple biopsies, even when a gastric ulcer has been apparently cured by medical treatment.

Spinal cord lesion after penicillin gluteal injection.

Penicillin gluteal injection may cause sudden and irreversible paraplegia. In the literature 6 cases have been reported, and spinal infarction was conjectured, the mechanism being obscure. The actual incidence of such a complication is not known. We observed 2 more cases, 6 and 16 years respectively following such an injection. The clinical features suggested that spinal infarction had occurred, and an MRI study in the most severely impaired patient showed marked spinal atrophy, giving further support to the spinal infarction hypothesis. These findings and the pathophysiological considerations suggest that the mechanism might be the accidental injection into the superior gluteal artery, causing its distal spasm and the upstream ascent of the penicillin with ensuing embolic and/or spastic occlusion of the arterior spinal artery.

Gliomatosis cerebri. Report of a case with isolated amnesic disorders.

We describe the case of a female patient with behavioral and memory disorders. A neuropsychological evaluation confirmed the absence of mental deterioration and the presence of the psychometric features of the amnesic syndrome. The clinical diagnosis was supported by MRI and histological examination.