Quantitative and qualitative evaluation tool in planning stroke treatment strategies: the "Safe implementation of treatments in stroke Monitoring Study (SITS MOST)" registry.

A decade ago, stroke was the first leading cause of morbidity and mortality in Croatia. Nowadays, we record reduction in stroke incidence, as well as stroke consequences-invalidity and mortality. These are due to long-term planned actions in the field of public health as well as actions performed by professional organizations. Today, we can be satisfied with improvement in that field, but there are still things we can improve, at the first place improvement of the emergency medicine network due to Croatian-specific topographical characteristics to reduce onset-to-door time. In this paper, we evaluated results from 11 Croatian hospitals in the period 11/2005-11/2012. To find out about the past and present state in applying thrombolytic therapy in Croatia and to plan further actions in light of new studies and efforts in Europe and in the world, all with the aim of improvement in stroke prevention and acute treatment resulting in reduction of stroke morbidity, mortality and symptomatic intracerebral hemorrhage as well as better functional outcome. Our results have shown that we improved stroke treatment in the last decade, but further actions should be performed to raise public stroke awareness and to improve emergency medicine network as well as in hospital protocols.

Increased thyroidal T4 to T3 conversion in autonomously functioning thyroid adenoma: from euthyroidism to thyrotoxicosis.

AIM: The aim was to investigate whether the intrathyroid conversion of T4 to T3 in autonomously functioning thyroid adenoma (AFTA) tissue could influence serum T3 levels and suppression of TSH, especially in patients with borderline thyroid function. PATIENTS AND METHODS: In ten patients with AFTA, thyroidal conversion of T4 to T3 was investigated in nodular and paranodular, TSH-suppressed tissue. All patients had normal serum T4 and suppressed TSH. Serum T3 was normal in six, and borderline or slightly increased in four. AFTA and paranodular tissues were surgically removed and frozen at -70°C, then homogenized in a glass homogenizer, centrifuged at 100,000×g, and particulate fraction collected as a pellet. Analysis mixture consisted of thyroid enzyme suspension in 50 µmol/L TRIS buffer with 5 µmol DTT and 200 µL 1.3 µmol T4. Incubation was performed at 37°C and the generation of T3 measured after 5, 10, 20 and 40 minutes respectively. RESULTS: T3 production (pmol/mg protein) was significantly higher in AFTA than in paranodular tissues (8.8 1.2/Mean ± SE/vs. 1.8 ± 0.2; p<0.01), and excessively high (9.8, 14.1, 14.2 and 15.0) in four patients with borderline or slightly supranormal serum T3. A significant correlation was found between serum T3 concentrations and T3 generation (T4 conversion) in AFTA tissues. CONCLUSION: Results suggest that increased thyroidal T4 to T3 conversion in AFTA tissue could be involved in an increased delivery of T3, increased serum T3 and suppressed serum TSH, particularly in patients with the disease evolving from euthyroid to an early hyperthyroid phase.

Transcranial Doppler sonography in the acute cerebral ischemic disease.

Transcranial Doppler sonography (TCD) is a noninvasive easy-performed method which can be repeated even in critically ill patients. It provides means to diagnose, quantify and monitor individual haemodynamic situation, and, probably, to predict the outcome of stroke. The purpose of this study was to evaluate the usefulness of the TCD in the examination of vascular lesions in the early phase of acute cerebral ischemic disease. The results showed different vascular disturbanies in otherwise homogenous group of patients. The TCD examinations were carried out in 30 patients in the early phase of stroke with presumed lesions in the middle cerebral artery (MCA) irrigation area. CT of the brain showed ischemic lesions of the MCA region in all patients. Additionally, blood flow velocity (BFV) was measured in posterior cerebral artery (PCA), anterior cerebral artery (ACA) and carotid siphon (CS) on both skull sides. On the basis of BFV in MCA, the patients could be apparently divided into three groups. In group I MCA the signal was absent. The patients from group 2 showed severely decreased, moderately decreased or nearly normal BFV in MCA. Group 3 consisted of three patients with increased BFV in MCA. In one of them, in whom a high degree of MCA stenosis was confirmed by angiography, BFV in MCA was extremely increased. The results have shown that TCD examinations in patients with acute stroke could provide additional information about vascular lesions, which are relevant to the course and, probably, the prognosis of the disease.

Transcranial Doppler diagnostic criteria in the evaluations of arteriovenous malformations.

In order to get a better insight in hemodynamic occurrence of intracranial arteriovenous malformations (AVM), 31 patients with AVM, documented by CT and angiography, were investigated by Transcranial Doppler (TDC). Although the angiography provides definite diagnosis of AVM, its size, position, type feeders and involvement of various vascular segments, TCD provides more information about collateral circulation, intracerebral shunts or functional stenosis due to high blood velocities within the blood vessels involved by AVM. The parameters obtained by TCD: mean cerebral blood flow velocities (MCBFV) in middle and internal carotid artery (MCA, ICA), pulsatility index (PI), MCA/ICA ratio and (S-D)/S ratio were introduced. Results have shown that TCD findings in non-feeding arteries were normal in all patients. TCD finding of MCBFV in MCA and ICA, PI and MCA/ICA ratio in feeding arteries has shown a significant difference from normal arteries (p less than 0.01). These parameters are shown to be AVM size dependent. MCBFV in MCA on the feeder side was statistically significant higher in those patients with large AVM (greater than 4 cm) size (p less than 0.01). For assessment of AVM and its improved and advanced analysis the potential advantages of parameters: (S-D)/S ratio and 3D hemodynamic mapping has been emphasised.