Stenotic occlusive lesions of internal carotid artery in diabetic patients.

Diabetes deteriorates atherosclerotic changes in the arteries. The aim of the study was to assess the prevalence and localization of stenotic atherosclerotic lesions of the internal carotid artery (ICA) in patients with diabetes. A prospective analysis of angiography findings was carried out in 150 diabetic and 150 non-diabetic patients with symptoms of cerebral ischemia using double-blind angiogram readings by two independent investigators. The degree of stenosis was determined using the North American Symptomatic Carotid Endarterectomy Trial (NASCET) criteria. Stenoses of the proximal arterial segment accounted for the majority of extracranial ICA stenoses, being more frequent in diabetic (left ICA 50.7%, right ICA 58.0%) than in the non-diabetic patients (left ICA 29.3%, right ICA 32.7%). Diabetic patients revealed a more significant rate of unilateral tandem ICA stenoses (14.0-21.3%), as well as a statistically significantly higher prevalence of intracranial ICA stenoses (left ICA 24.0% and right ICA 17.3%) than did non-diabetic patients (left and right ICA 3.3% each). Our results confirm that there is a morphological basis in ICA for increased incidence of ICA lesions in patients with diabetes as compared to those without it. Data on the incidence of stenotic ICA lesions in diabetes suggest the importance of assessing overall ICA status using digital subtraction angiography. Such an assessment is a precondition for an optimal therapeutic approach, especially in diabetic patients who are at an increased risk of cerebrovascular disease.

[Role of 0.5 T magnetic resonance and duplex ultrasonography in the imaging of stenotic and oblitertive changes in the carotid arteries]. / Uloga magnetskog rezonatora 0.5 T i dupleks ultrasonografije u prikazu stenoticko-obliterativnih promjena arterije karotis.

The aim of the study was to determine diagnostic value of magnetic resonance angiography (MRA) of the carotid artery, performed with less expensive machine of 0.5 T, and value of duplex ultrasonography (DU) in the same patients. Diagnostic values of MRA and DU were examined by comparison with the results of digital subtraction angiography (DSA) or with the operative finding. All MRA examinations were performed in the same diagnostic center, but DU diagnostic procedures were performed in five different centres. In total, we examined 70 arteries in 37 patients. Among them, 66 arteries in 33 patients were compared with DSA and four arteries in four patients with operative findings. All patients were referred to DSA after MRA and DU. In four patients four carotid arteries were operated without DSA due to previous allergic reaction to iodinated contrast agent. The positive result in present examination was stenosis of the carotid artery more than 70% of the arterial lumen. Such stenosis is considered as an indication for active therapeutic approach using vascular surgery or transluminal angioplasty. Results indicate more true positive results for MRA (21 patients) than for DU (20 patients). Also, we found more true negative results for MRA (45 patients) than for DU (44 patients). MRA had one false positive and three false negative results, and DU two false positive and 4 false negative results. Sensitivity of MRA in our group of patients was 88% and specificity 98%. In the same group DU had sensitivity 83% and specificity 96%. Our results showed that neither MRA nor DU separately could replace DSA in diagnosis of high grade carotid stenosis. Because of high specificity, negative MRA or DU can exclude significant stenosis and avoid DSA. In the case of similar positive results of MRA and DU, the number of DSA can be reduced.

[Diagnostic results of the carotid artery duplex ultrasonography performed in the private offices in Zagreb]. / Dijagnosticki rezultati dupleks ultrasonografije arterije karotis u privatnim ordinacijama grada Zagreba.

The purpose of the investigation was to evaluate the diagnostic value of duplex ultrasonography (DU) of the cerebral arteries in the patients with cerebrovascular insufficiency performed in private offices in Zagreb town. The investigation was performed for all patients referred to digital subtraction angiography (DSA) after DU examination performed in one of private offices (in total, 12 offices) during the period of three years. During mentioned period 127 patients were examined (100 male, 67 female, age 28-79 y, mean 62 y) according to DU exams performed in private offices. Other patients, who had DU examinations in offices other than private, were not examined in present investigation. The method of investigation was prospective comparison between DSA and DU findings, where DSA was used as the gold standard. The investigation was performed by three radiologists prospectively. They did not know DU findings before performing DSA. The pathological findings of the supraaortal arteries and especially significant stenoses (70%-99%) of the extracranial part of the carotid arteries, obliteration and ulcerated plaques were examined. For the significant stenoses of the carotid arteries, which are indication for operative treatment, DU showed sensitivity of only 63%, specificity 79%, positive predictive value 60% and negative predictive value 81%. The diagnostic difference between occlusion and subtotal stenosis of the carotid artery was also very important. DSA showed 18 occluded arteries, while DU presented 20, nine of them false positive and seven false negative (sensitivity 36%). DU diagnosed ulcerated plaque in only three out of 37 patients, including two false positive and 36 false negative results. According to results presented here, DU of the carotid arteries performed in analysed practices are not reliable and the price of DU presents expense without benefit. The insufficient education of the doctors and defective regulations of the private practices are the possible reasons for such results.

C-reactive protein level in severe stenosis of cerebral arteries.

BACKGROUND: C-reactive protein (CRP) as a non-specific inflammatory biomarker has been demonstrated to actively contribute to all stages of atherogenesis. The aim of this study was to investigate the relation between CRP concentrations and the severity of stenosis of cerebral arteries. METHODS: Lipid parameters and CRP levels were measured in the sera of 119 patients with stenosis of the extracranial cerebral arteries established by angiography and compared with the control group, with a normal appearance of the cerebral arteries on ultrasound examination. CRP concentrations were determined by a high-sensitivity assay. RESULTS: CRP concentrations showed a statistically significant difference in the group of patients with cerebrovascular stenosis of more than 70% compared to the control group (median value 3.4 vs. 1.5 mg/l in the control group, p < 0.05). At logistic regression analysis, CRP was significantly associated with stenosis of more than 70%. CONCLUSION: In addition to traditional biochemical risk markers, an elevated CRP level measured on automated analysers using a high-sensitivity assay may be useful in the detection of patients with severe stenosis of the cerebral arteries.

Ultrasound assessment of detrusor muscle thickness in children with non-neuropathic bladder/sphincter dysfunction.

OBJECTIVE: To measure detrusor muscle thickness in children with non-neuropathic bladder/sphincter dysfunction (NNBSD), and to evaluate the difference between children with various bladder dysfunctions and those with normal urodynamics. MATERIALS AND METHODS: In 139 children the urodynamic study was performed, and the detrusor of the anterior bladder wall was measured using high-frequency ultrasonography (US). Children were categorized into five groups, according to urodynamic findings. Differences in detrusor thickness between groups were tested by one-way ANOVA with post hoc Scheffé test. RESULTS: Forty-six children (33.1%) had normal urodynamics, and mean (+/-S.D.) detrusor thickness 1.3 +/- 0.5 mm (range 0.5-3.0). Fifty-two (37.4%) had urge syndrome, with detrusor thickness of 2 +/- 0.7 mm (1.0-3.6). Thirty-three (23.7%) had dysfunctional voiding, with detrusor thickness of 2.6 +/- 0.5 mm (1.5-3.6). Four (2.9%) had lazy bladder, with detrusor thickness of 0.9 +/- 0.1 mm (0.8-1.0), and four had anatomical infravesical obstruction, with detrusor thickness of 4.4 +/- 0.3 mm (4-4.6). The mean detrusor thickness in all children with NNBSD was 2.2 +/- 0.7 mm (range 0.8-3.6). Multiple comparisons showed significant difference between all groups, except between children with normal urodynamics and children with lazy bladder. CONCLUSION: There is statistically significant difference in mean detrusor thickness between children with normal urodynamics and children with NNBSD. However, due to the overlap of measured values, it is not possible to determine the cut-off value that could be used to distinguish children with and without NNBSD.

Biochemical risk factors in angiographically established stenosis of cerebral arteries.

AIM: To determine the significance of the association between biochemical risk factors for cerebrovascular atherosclerosis (lipid parameters, lipoprotein(a), total homocysteine, total antioxidant status, trace elements, and electrolytes) and the degree of stenosis of cerebral arteries scored by digital subtraction angiography. METHODS: The study included 35 patients with angiographically established < 50% stenosis of cerebral arteries and 55 patients with > or =50% stenosis of cerebral arteries, including obliteration. The control group consisted of 51 patients with normal cerebral arteries on ultrasound examination. Biochemical parameters were measured in all participants according to the standard laboratory protocols. RESULTS: Logistic regression analysis showed two independent and significant biochemical risk factors associated with the severity of cerebrovascular stenosis: lipoprotein(a) for patients with different degrees of stenosis, and total antioxidant status for patients with severe stenosis of more than 50%. Univariate statistical evaluation showed significantly higher homocysteine levels in the group of patients with > or =50% stenosis than in the control group (median 14.84 micromol/L vs median 12.40 micromol/L, p < 0.05). CONCLUSION: Increased lipoprotein(a) and low total antioxidant status values seem to be the most significant independent biochemical risk factors for the development of cerebrovascular stenosis. Mild hyperhomocysteinemia seems to be an additional discriminating indicator of the severe cerebrovascular stenosis. These factors may be useful for early identification and recognition of patients with cerebrovascular atherosclerosis.