Serious complication of percutaneous angioplasty with stent implantation in so called "chronic cerebrospinal venous insufficiency" in multiple sclerosis patient.

We report female patient, age 51, with clinically definitive multiple sclerosis (CDMS) since 1998, who underwent two PTA procedures with stent implantation for CCSVI in 2010. Expanded disability status scale (EDSS) worsened since the procedure from 4.5 to 6. Total number of three stents was implanted (two of them in the right internal jugular vein). In six month time, in 2011, patient was referred for independent examination by computer tomography (CT) phlebography for right-sided neck pain. Dislocation of stents on the right side and thrombosis of left sided stent was found. Conservative approach was used so far. Our short report is showing possible complications of PTA and stenting in jugular veins in so called CCSVI and bringing information about neurological state (EDSS) worsening in a subject. Continuation of stent migration in the future is probable, possibly resulting in pulmonary embolism with fatal risk for the patient. We strongly ask for restriction of PTA procedure in so called CCSVI, which concept was not proven to be relevant to MS.

Meningeal carcinomatosis as the first manifestation of malignant carcinomatosis.

Meningeal carcinomatosis (MC) is a malignant infiltration of the leptomeninges and subarachnoid space and can be a devastating complication of a systemic malignancy. Although often found in patients with known metastatic malignancies, MC can also be the initial manifestation of an underlying malignancy. We report four case studies where back pain, dizziness, cognitive decline, headache and headache with the cranial nerve VI palsy were the first signs of MC. In two cases, adenocarcinoma ventriculi was found, in other one, the markers of the gastrointestinal tract malignancy were highly positive but malignity was not found, and in the last one, there was a known breast carcinoma. The diagnosis of MC requires the finding of malignant cells in the cerebrospinal fluid, but sometimes several lumbar punctures are required to establish the diagnosis, and also MRI with gadolinium. Finally, we would like to highlight the fact that markedly decreased glycorrhachia in cerebrospinal fluid (CSF) can also be the first sign of MC (Fig. 6, Tab. 2, Ref. 23).

[Optic neuritis as the first sign of multiple sclerosis]. / Optická neuritída ako prvý prejav sclerosis multiplex.

BACKGROUND: Optic neuritis (ON) is as the initial manifestation of multiple sclerosis (SM) a favourable prognostic factor during the subsequent course. OBJECTIVE: To assess the ratio of ON at the onset of SM in the authors patients and to assess according to clinical criteria the form of disease and degree of functional inability, expressed by Kurtzke s EDSS scale. PATIENTS AND METHODS: In a retrospective analysis of patients with clinically defined and probable SM (Poser s criteria)) hospitalized at the neurological clinic in 1987-2000 the authors investigated the incidence of ON in relation to the course and form of SM. In individual patients they evaluated the age at the onset of the first manifestations of SM, the form, duration and degree of functional inability in EDSS. These findings were compared in groups of patients with incipient ON and without ON at the onset of SM (non-ON). RESULTS: ON as an isolated initial symptom of SM was present in 29 (18.2%) of the total number of 159 patients. The mean age at the time of the initial ON was 27.9 years which is as compared with the non-ON group of SM patients by 2.8 years less. Patients with isolated ON at the onset had the resulting general affection by 2 grades EDDSS lower than the non-ON and it was recorded in 73% cases with a relapse-remitting course of SM. The secondary progressive form of the disease accounted for 27% and the primary progressive form was not found. CONCLUSION: ON as the initial manifestation of SM is a favourable prognostic factor during the subsequent clinical course of the disease.

[Reliability and validition of the Slovak modified version of the Stanford Health Assessment Questionnaire using the functional disability index in patients with rheumatoid arthritis]. / Reliabilita a validita slovenskej verzie a modifikácia Stanfordského dotazníka hodnotiaceho zdravie pomocou indexu disability (HAQ) u pacientov s reumatoidnou artritídou.

BACKGROUND: Functional disability is one of the most important consequences of RA in the patient's daily life. The HAQ has been widely used in its self administered form for the assessment of disability. A sensitive and valid instrument is needed for a Slovak population with RA. OBJECTIVE: To evaluate reliability and validity of the Slovak version of the HAQ in patients with RA and to explore relationships between HAQ score and disease activity and to provide information concerning utilization of this instrument in clinical practice. METHODS: In preparing the Slovak version of the HAQ careful attention has been paid to the translation, in terms of linguistic and conceptual equivalence, in order to preserve the original purpose of the instrument. The wording of some items required adaptation to the current activities of daily living and Slovak lifestyle. The sample consisted of 160 RA-patients, out of which 135 were women and 25 were men. The inclusion criteria were the following: age from 20 to 70 years at the onset of the study, diagnosis of RA according to the ARA criteria. The exclusion criteria were the presence of another serious disease or very disabling RA (stage IV of the Steinbrocker's classification). To analyze the data t-test, correlations, one-way analysis of variance (ANOVA), and principal component analysis (PCA) available in the SPSS/PC+ statistical package were used. RESULTS: The Cronbach's coefficient of reliability alpha for the HAQ total scale was 0.94. The results of PCA showed that the 20 HAQ items loaded on four components for which the eigen values were greater than 1, accounting for 70% of overall interpersonal variability. Orthogonal varimax rotation of the principal components provided factor loadings reflecting the eight dimensions within the HAQ. Validity of the HAQ was examined further by means of known-groups technique. The HAQ was found to be sensitive to differentiate between the Steinbrocker's functional capacity groups, as well as between males and females. Moreover, significant correlations (p < or = 0.01) were found between the HAQ and the C-reactive protein, the ESR, the NHP-pain, the Ritchie articular index, the Steinbrocker's functional capacity (r = 0.31-0.62) and disease duration (p < or = 0.05, r = 0.17). CONCLUSION: The results of the current investigation provide support for reliability and construct validity of the Slovak version of the HAQ in patients with RA. The HAQ has sufficient discriminant ability. The index disability can be used as an criterion of severity of RA, as a criterion of effectiveness in therapeutical trials for patient stratification of the Slovak population with RA.