The use of three-dimensional reconstruction in neuroroentgenology

The recent advent of spiral computed tomography (CT) and new fast impulse sequences in magnetic resonance imaging (MRI) into diagnostic practice has expanded the range of brain and spinal diseases detected by these techniques. This has also expanded the field of use of three-dimensional images obtained on the basis of mathematical algorithms for processing CT and MRI data. At present, not only neurotraumatology and maxillofacial surgery are the main areas in applying three-dimensional models. Spatial representation of bulky formations of the brain, their mutual location with the adjacent anatomic structures (with ventricles of the brain) may be useful in choosing a surgical access and in planning the scope of a surgical intervention. CT- and MR-angiographies that are now successfully used in diagnosing vascular pathology, providing high-solution angiograms not only can be competitive with direct angiography, but can replace this sophisticated study for vascular stenotic processes in the neck. Moreover, analyzing the internal surface of the vascular wall on the basis of virtual endoscopy may be useful in direct surgical and endovascular interventions. The purpose of this study was to pool long-term experience in using three-dimensional images in the qualitative improvement of diagnostic methods in examining neurosurgical patients and to define the most promising lines of their use in neurosurgery as a whole.     

One-Year Follow-up of Duodenal Ulcers after 1-Wk Triple Therapy for Helicobacter pylori

Objective : to study the ulcer recurrence rate of Helicobacter pylori-positive duodenal ulcers at 1 yr after eradication of the bacteria by triple therapy. Method : Patients with H. pylori-positive duodenal ulcers were randomized to receive either triple therapy for 1 wk plus omeprazole for 4 wk (THple+OMP) (n = 78), or omeprazole alone (OMP) for 4 wk (N = 77). Patients were followed up every 3 months for symptom enquiry. At 1 yr, all asymptomatic patients were invited to attend for gastroscopy. Results : At 8 wk, 16 patients in the OMP group and four in the Triple+OMP group had an ulcer. During the 1-yr period, 12 patients in the OMP group and no patient in the Triple+OMP group developed symptomatic ulcers. At follow-up endoscopy at 1 yr, another 10 ulcers were detected in the OMP group and two in the Triple+OMP group. Fifteen patients in the OMP group and 13 in the Triple+OMP group were lost to follow-up. In total, ulcers were de-tected in 39 of 61 (64%) assessahle patients in the OMP group, and in six of 65 (97o) assessahle patients in the Triple+OMP group after I yr (χ² test: p < 0.001). Of the patients whose H, pytori were successfully eradicated hy Triple+OMP at 8 wk, 90% remained H. pylori negative at 1 yr. Conclusion : Triple therapy for 1 wk eradicates H, pylori infection and significantly reduces duodenal ulcer relapses.     

Potential role of vitamin D deficiency on Fabry cardiomyopathy

Patients with Fabry disease frequently develop left ventricular (LV) hypertrophy and renal fibrosis. Due to heat intolerance and an inability to sweat, patients tend to avoid exposure to sunlight. We hypothesized that subsequent vitamin D deficiency may contribute to Fabry cardiomyopathy. This study investigated the vitamin D status and its association with LV mass and adverse clinical symptoms in patients with Fabry disease. 25-hydroxyvitamin D (25[OH]D) was measured in 111 patients who were genetically proven to have Fabry disease. LV mass and cardiomyopathy were assessed by magnetic resonance imaging and echocardiography. In cross-sectional analyses, associations with adverse clinical outcomes were determined by linear and binary logistic regression analyses, respectively, and were adjusted for age, sex, BMI and season. Patients had a mean age of 40?±?13 years (42 % males), and a mean 25(OH)D of 23.5?±?11.4 ng/ml. Those with overt vitamin D deficiency (25[OH]D?≤?15 ng/ml) had an adjusted six fold higher risk of cardiomyopathy, compared to those with sufficient 25(OH)D levels >30 ng/ml (p?=?0.04). The mean LV mass was distinctively different with 170?±?75 g in deficient, 154?±?60 g in moderately deficient and 128?±?58 g in vitamin D sufficient patients (p?=?0.01). With increasing severity of vitamin D deficiency, the median levels of proteinuria increased, as well as the prevalences of depression, edema, cornea verticillata and the need for medical pain therapy. In conclusion, vitamin D deficiency was strongly associated with cardiomyopathy and adverse clinical symptoms in patients with Fabry disease. Whether vitamin D supplementation improves complications of Fabry disease, requires a randomized controlled trial.     

Efficacy of nimodipine in the prophylaxis of migraine

The efficacy of nimodipine in the prophylaxis of migraine was assessed in a double-blind, placebo-controlled, cross-over study carried out on 33 patients, 20 of whom suffered from classic and 13 from common migraine. Four patients dropped out, but not as a result of the side effects of the drug. The duration of drug treatment was 8 weeks. The dosage used was 30 mg four times daily. Nimodipine proved to be better than placebo, the number of migraine attacks and severity of headache showing a significant reduction. The drug was well tolerated and no marked side effects were noted. The results suggest that nimodipine is a useful new prophylactic drug for migraine, but further studies are needed before its final value can be evaluated.