THE ROLE OF FREQUENCY DOUBLING TECHNOLOGY PERIMETRY IN EARLY DETECTION OF DIABETIC RETINOPATHY.

The aim was to assess whether standard automated perimetry (SAP) and frequency doubling technology (FDT) perimetry are able to detect the effect of diabetes mellitus (DM) on retinal function in DM patients in the early stage of disease and to analyze which method is more specific and sensitive. A randomized cross-sectional study was conducted in three different groups of patients to compare the capability of these two methods to examine visual field and to detect the change in light sensitivity. Visual function was assessed in 60 adults with normal retinal finding, 60 adults with DM without clinically detectable retinopathy and 60 adults with DM and non-proliferative diabetic retinopathy but normal visual acuity. FDT perimetry and SAP were performed in all study patients. The presence and severity of diabetic retinopathy was determined by taking and evaluating two 50° field color photographs per eye, macula-centered and disc-centered. The following results were obtained by analyzing parameters in the groups of diabetic patients: sensitivity and specificity of SAP and FDT for medium sensitivity 86.7/33.3 (p<0.061) and 71.7/41.7 (p<0.228), respectively; for medium deficit 41.7/76.7 (p<0.063) and 65/50 (p<0.362), respectively; for loss of variance/pattern standard deviation (LV/PSD) 51.7/61.7 (p<0.536) and 61.7/51.7 (p<0.666), respectively; and for foveal sensitivity 81.7/36.7 (p<0.096) and 23.3/86.7 (p<0.839), respectively. Analysis of parameters between diabetics and control group yielded sensitivity and specificity for medium sensitivity 71.7/61.7 (p<0.001) and 70.8/55 (p<0.002), respectively; for medium deficit 56.7/60 (p<0.058) and 77.5/43.3 (p<0.037), respectively; for LV/PSD 58.3/58.3 (p<0.042) and 33.3/83.3 (p<0.437), respectively; and for foveal sensitivity 82.5/53.3 (p<0.001) and 28.3/85 (p<0.195), respectively. We concluded that neither of these methods was sensitive and specific enough to distinguish diabetics without retinopathy from diabetics with retinopathy. Both of these methods were highly specific and sensitive to distinguish diabetics from healthy subjects, but neither of these methods proved superior.

Transcranial sonography and the pocket smell test in the differential diagnosis between parkinson's disease and essential tremor.

The aim of this study was to determine the specificity and sensitivity of transcranial sonography (TCS) and the Pocket Smell Test (PST) in differing Parkinson's disease from essential tremor. The results were compared with the dopamin transporter scan (DaTSCAN) findings. Based on the DaTSCAN finding we formed a group of patients with essential tremor (51 patients) and a group with the Parkinson's disease (59 patients). The control group consisted of 26 healthy one. To evaluate the olfactory dysfunction the PST was used, whereas by TCS the substantia nigra hyperechogenicity was marked. The sensitivity and specificity of each diagnostic method was statistically calculated. In confirming Parkinson's disease the specificity of TCS was 88.2 % and the sensitivity 94.9 %. The specificity of PST was 80.4 % whereas the sensitivity was 74.6 %. TCS and PST should be performed to evaluate which patients need to be examined by DaTSCAN.

Visual dysfunction in patients with Parkinson's disease and essential tremor.

The aim of this study was to determine the specificity and sensitivity of the Pelli-Robson and Ishihara diagnostic methods in differing Parkinson's disease from essential tremor compared to DaTSCAN (dopamine transporter scan) findings. The intention was to investigate whether visual dysfunction appears in the early state of Parkinson's disease. Therefore, we included patients with the symptomatology of parkinsonism lasting between 6 and 12 months. The study included 164 patients of which 59 (36.0%) suffered from Parkinson's disease, 51 (31.1%) from essential tremor, and 54 (32.9%) healthy patients which presented the control group. The specificity of Pelli-Robson test in confirming Parkinson's disease was 53% and the sensitivity 81.4%. The specificity of Ishihara test in confirming Parkinson's disease was 88.2%, and sensitivity 55.9%. We found that the colour and contrast dysfunction are present as the earliest symptoms of Parkinson's disease. In this study the Pelli-Robson test is highly sensitive and the Ishihara tables are highly specific in the differential diagnosis between Parkinson's disease and essential tremor, but neither of these methods fulfils the criteria for the validity of a test. We suggest performing both of these methods to evaluate which patients are indicated for DaTSCAN.

Clinical manifestation and neuroimaging methods in diagnosing basal ganglia calcifications.

The aim of this case study was to evaluate the clinical symptoms in patients with basal ganglia calcifications and compare the neuroimaging methods used in confirming this state. The clinical status and performed transcranial sonography of basal ganglia structures in patients with brain calcifications found by computed brain tomography was examined. In one of these patients DaTSCAN was performed. A large spectrum of different symptoms was found. Transcranial sonography of basal ganglia showed the hyperechogenicity of nucleus lenticularis in eight out of 10 patients. DaTSCAN, which was performed to one patient with parkinsonian signs and the hyperechogenicity of substantia nigra found by transcranial sonography, was normal. Transcranial sonography is a newly neuroimaging method which can contribute to diagnosing basal ganglia calcifications in patients with different neurological signs. Computed tomography of brain remains the most adequate technique in visualising calcifications.

Six years of following up a glomus jugulare tumor - a case report.

This case report followed up a patient for six years after she had been successfully treated by embolization and gamma knife surgery, while a complete surgical resection was contraindicated because of the high risk of possible mortality outcome. A development of internal hydrocephalus in a subacute postoperative period as a probable postoperative complication related to gamma knife surgery was noted.

Cognitive dysfunction in idiopathic and vascular parkinsonism.

AIM: To evaluate the characteristics of cognitive disturbances in patients with parkinsonism and to point out the need of following up those changes by highly specific tests. METHODS: The first group consisted of patients with Parkinson's disease, and the second group of patients with vascular parkinsonism. The neuropsychological assessments were performed with mini mental state examination (MMSE) and the Raven progressive matrices. RESULTS: The MMSE has shown a higher percentage of patients with vascular parkinsonism who had dementia. For evaluating the nonverbal possibilities, the aim of understanding the complex situation and the visual perception, the Raven's progressive matrices were used showing that in both groups of the patients those specific changes were highly present. CONCLUSIONS: It was concluded that MMSE and Raven's progressive matrices have to be obtained in early phases of the disease, and have to be repeated to follow up the therapy effect.

[Prevalence of acute cerebrovascular disease in Bizovac, Osijek-Baranya county: a door-to-door survey in eastern Croatia]. / Prevalencija akutne cerebrovaskularne bolesti na podrucju opcine Bizovac u Osjecko-Baranjskoj zupaniji: rezultati populacijske studije vrata-do-vrata.

BACKGROUND AND PURPOSE: A door-to-door survey was carried out in Bizovac area, Osijek-Baranya County in east Croatia. A cluster sample of 1899 inhabitants were screened to determine the prevalence of acute cerebrovascular disease (CVD): transient ischemic attacks (TIA) and stroke in this population. METHODS: We used a modified version of the World Health Organization screening instrument. A door-to-door survey of stroke was conducted in five Osijek suburbs, east Croatia. The data obtained were compared with data in personal records of the study subjects. RESULTS: On March 31, 2005, the prevalence of acute CVD was 3370/100.000 (stroke 1948/100,000 and TIA 1422/100,000), of CVD in males 3047/100,000 (stroke 1959/100,000 and TIA 1088/100,000); of CVD in females 3673/100,000 (stroke 1939/100,000 and TIA 1735/100,000); and the prevalence of acute CVD progressively increased with age: in 45-54 age group 1290/00,000 (stroke 942/100,000, TIA 348/100,000); in 55-64 age group 7895/100,000 (stroke 5623/100,000, TIA 2272/100,000); in 65-74 age group 11386/100,000 (stroke 7393/100,000, TIA 3993/100,000); and in 75-84 age group 14035/100,000 (stroke 10001/100,000, TIA 4034/100,000) as the highest figure. CONCLUSION: The study revealed a very high prevalence of acute CVD in the study area and confirmed CVD as one of the leading medical and public health issues in Bizovac area, Osijek-Baranya County, east Croatia.