Nutrition parameters as hemodialysis adequacy markers.

BACKGROUND AND AIM: The nutritive status has significant role in improving the quality of life of dialysis' patients. The aim of this study was to find out if there is any correlation of the anthropometric parameters and markers of nutrition with the adequacy of HD. METHODS: The investigation was organized as a clinical, cross sectional study. Demographic characteristics, co-morbid conditions, smoking, dialysis duration and blood pressure were recorded. Serum total protein, albumin, ferritin and blood-lipids were measured as biochemical markers of nutritional status.One hundred and forty patients, 82 (58.6%) male, and 58 (41.4%) female, 55±12.59 years, were dividied into two groups. Group A consisted of 44 patients (14 women and 30 men) received the recommended hemodialysis dose (Kt/V ≥ 1.2), while the Group B consisted of 96 patients (69 males and 27 females) received non-adequate hemodialysis dose (Kt/V < 1.2). RESULTS: Patients with adequate hemodialysis had been longer on dialysis in correlation with the group of patients with non-adequate hemodialysis (73 ± 56.4 vs. 44 ± 50.1 months; p: 0.004). Group A and group B presented significant differences in the number of leukocytes (p: 0.027), and hemoglobin (p: 0.047), potassium (p: 0.038) and C-reactive protein level (p: 0.048) as well as in serum total protein (69 ± 4.63 vs. 65 ± 5.74 g/L; p < 0.0001) and albumin (38 ± 2.99 vs. 29 ± 4.4 g/L; p: 0.047). Pearsons correlation of factors that may have impact on hemodialysis adequacy indicated a significant relation between serum total protein and the index of hemodialysis adequacy (r: 0.21; p: 0.0446). CONCLUSIONS: All investigated anthropometric parameters and protein status showed significantly higher values in patients with adequate hemodialysis quality (Group A). The Group B showed higher levels of CRP and lower values of hemoglobin.

Intraventricular textiloma with granuloma formation following third ventricle colloid cyst resection - a case report.

Despite precautions, cotton and gauze pads used for dissection or to achieve haemostasis during neurosurgical procedures can inadvertently be left behind and result in clinically symptomatic or asymptomatic and radiologically apparent mass lesion, sometimes referred to as "textilomas" or "gossypibomas", often mimicking recurrent tumour or abscess on neuroimaging studies. We report the neuroimaging evaluation, including computed tomography (CT), magnetic resonance imaging (MRI) and spectroscopy (H1-MRS), in a case of textiloma developing after the treatment of a third ventricle colloid cyst.

[Comparison of detection of brain lesions in multiple sclerosis in magnetic resonance imaging at magnetic field strength of 1.0 and 3.0 Tesla].

To estimate the relative sensitivity of MR examination for brain lesions in multiple sclerosis at 1.0 Tesla (T) and 3.0 T using identical acquisition conditions. 54 patients with multiple sclerosis were examined both at 1.0T (Siemens Impact Expert) and 3.0T (Philips Intera) using T1-weighted spin echo (T1W-SE) with and without gadolinium contrast injections, T2W SE and fluid attenuated inversion recovery (FLAIR) imaging. Images were examined independently by three experienced neuroradiologists using focal lesion counting. 3.0T scans compared with 1.0T scans demonstrate a 27.3%, increase in the number of detected contrast enhanced lesions and an 22.7% increase in the number of detected lesions on FLAIR MR tomograms. Highfield 3.0T MR imaging demonstrates better sensitivity in the detection of focal brain lesions in multiple sclerosis. This improvement is more apparent in contrast enhanced lesion detection and less noticeable in FLAIR detected lesions.

Uric acid levels in sera from patients with multiple sclerosis.

The levels of uric acid (UA), a natural peroxynitrite scavenger, were measured in sera from 240 patients with multiple sclerosis (MS) and 104 sex- and age-matched control patients with other neurological diseases (OND). The mean serum UA concentration was lower in the MS than in the OND group, but the difference did not reach the level of statistical significance (P = 0.068). However, the mean serum UA level from patients with active MS (202.6 + 67.1 mumol/l) was significantly lower than that in inactive MS patients (226.5 + 78.6 mumol/l; P = 0.046) and OND controls (P = 0.007). We found a significant inverse correlation of serum UA concentration with female gender (P = 0.0001), disease activity (P = 0.012) and duration (P = 0.017), and a trend towards an inverse correlation with disability as assessed by EDSS score, which did not reach statistical significance (P = 0.067). Finally, multivariate linear regression analyses showed that UA concentration was independently correlated with gender (P = 0.0001), disease activity (P = 0.014) and duration of the disease (P = 0.043) in MS patients. These findings suggest that serum UA might serve as a possible marker of disease activity in MS. They also provide support to the potential beneficial therapeutic effect of radical-scavenging substances in MS.

Seizures in multiple sclerosis.

PURPOSE: In patients with multiple sclerosis (MS), epileptic seizures occur more frequently than in the general population. The aim of this study was to analyze clinical characteristics of epilepsy in patients with MS, potential correlation between the semiology of seizures, EEG and magnetic resonance imaging (MRI) findings in these patients, as well as to examine the response to anticonvulsant therapy. METHODS: In a series of 268 consecutive patients with definite MS hospitalized at the Institute of Neurology, Belgrade, we identified 20 (7.5%) patients with seizures or epilepsy. All patients with seizures or epilepsy were submitted to standard EEG and brain MRI with gadopentetate dimeglumine. RESULTS: In four patients, epilepsy occurred 1-5 years before other clinical manifestations of MS. Eight patients had seizures only during MS relapses (provoked seizures). In two of them, seizures were the only manifestations of relapse. In 12 patients, seizures occurred regardless of the phase of MS (chronic epilepsy). In the majority of patients, seizures were partial with secondary generalization. Five patients experienced episodes of status epilepticus, and they all had dementia. Abnormal EEG pattern was found in 11 patients. Brain MRI disclosed cortical-subcortical lesions in nine patients and focal cortical atrophy in one, whereas in the remaining patients, findings were inconclusive. Probable EEG-MRI-seizure type correlation existed in 10 patients. CONCLUSIONS: Our data suggest that epilepsy may represent an initial symptom of MS and a single clinical manifestation of a relapse, and further support the assumption of the existing correlation between the presence of cortical-subcortical lesions and epileptic seizures or epilepsy in patients with MS.

[Sensitivity of criteria for MRI interpretation in patients with multiple sclerosis]. / Senzitivnost kriterijuma za interpretaciju nalaza magnetine rezonancije kod bolesnika od multiple skleroze.

UNLABELLED: Magnetic resonance imaging (MRI) has become the preferred imaging technique in multiple sclerosis (MS). Areas of increased signal (AIS) are detected on T2-weighted (T2W) pulse sequencies in 70-100% of patients with clinically definite MS. However, AIS similar to those seen in MS have also been described in healthy elderly subjects and patients with various neurological disorders including several vasculitises, migraine, and trauma. The aim of this study was to test and compare the sensitivity of different currently used MRI criteria for the diagnosis of MS. METHOD: The study comprised 49 patients wiht clinically definite MS diagnosed according to McAlpine's criteria. Cranial MRI was performed on a 1.5 T Magnetom with spin-echo pulse technique defined by relaxation times: T1W, T2W and proton density. Gadolinium-DTPA was not administred. We interpreted only spin-echo T2W images because they are the most sensitive for MS. The presence, number, size and location of AIS were recorded for all scans. We calculated the sensitivity for the four different sets of criteria (Paty's A and B criteria, Fazekas' criteria and Barkhof's criteria). The presence of four AIS greater than 3 mm was designated as Paty's A criteria, and presence of three AIS, one periventricular, greater than 3 mm was designated as Paty's B criteria. Fazekas' criteria require the presence of at last three AIS and two of the following three features: abutting body of lateral ventricles, infratentorial lesion location, and size = 6 mm. Barkhof's criteria were considered fulfilled if at least eight AIS were present, one infratentorial. RESULTS AND DISCUSSION: Brain MRI revealed normal finding in four (8%) of 49 studied patients with clinically definite MS. Number, size and location of AIS detected in the remaining patients is presented in Table. Characteristic patterns of MRI lesions on T2W images fulfilling different sets of criteria for the diagnosis of MS are presented in Figures 1-3. Using Paty's B criteria, sensitivity of MRI in patients with clinically definite MS was the highest, reaching 92%. Applying Paty's A criteria sensitivity slightly decreased to 88%. Using Fazeka's and Barkhof's criteria led to a further, significant decrease in sensitivity (71% and 57%, respectively; p = 0.045). In 1993, Offenbacher et al. have reviewed 1500 consecutive brain MRI scans for the presence, number, size and location of AIS, and calculated the sensitivity and specificity of Paty's and Fazekas' criteria with respect to clinical evidence for MS. In this study, similar to our results, using Paty's criteria resulted in higher sensitivity (87% for Paty A and 90% for Paty B) than Fazekas' criteria which led to decrease in sensitivity (81%). However, when Fazekas' criteria were used, decrease in sensitivity was associated with highly significant improvement of specificity. In conclusion, according to our and previously published results, Paty's criteria based on the presence of three AIS, one periventricular, or on the presence of four AIS, greater than 3 mm, are the most sensitive for MRI interpretation in MS. Other criteria (greater number of AIS, greater AIS diameter, infratentorial location and gadolinium enhancement) should be used, in order to improve the specificity, only to the MRIs of elderly patients (> 50 years) with suspected MS or patients suspected of MS in whom alternative explanations seem equally similar.