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Neurological manifestations of Fabry disease
Reková, Petra ; Kemlink, David (advisor) ; Karetová, Debora (referee) ; Kešnerová, Petra (referee)
Neurological manifestations of Fabry disease Abstract The presented thesis deals with cerebrovascular manifestations of a rare X-linked disease, Fabry disease (FD). Screening programs can detect unrecognized disease and increase awareness of the disease with the goal of early diagnosis and initiation of therapy before developing an irreversible organ damage. Identifying vascular abnormalities and the influence of comorbidities on the cerebrovascular phenotype of FD patients may help to promote the knowledge of the pathophysiology of cerebrovascular involvement. The main objectives of the studies underlying this thesis were to determine the prevalence of FD and to evaluate the relevance of FD diagnosis in an at-risk group of patients with acute ischemic stroke, to analyse the cerebrovascular phenotype of patients with FD using ultrasound, and to identify predictors of significant cerebrovascular involvement. In this thesis we showed a relatively high prevalence of FD in adult patients with acute stroke, proposed to reclassify the G325S variant, and identified a novel R30K variant. We noted that the combination of aseptic meningitis with lacunar stroke in a young person should lead to suspicion of FD. We further demonstrated multiple differences in neurosonological parameters between patients with FD and a...
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Preclinical atherosclerosis of peripheral arteries and its relation to venous thrombosis in patiens with thrombophilias
Auzký, Ondřej ; Piťha, Jan (advisor) ; Karetová, Debora (referee) ; Vaverková, Helena (referee)
The aim of our study was to evaluate association between venous disorders and preclinical atherosclerosis and its risk factors. The study was particularly focused on the association between cardiovascular risk factors and preclinical atherosclerosis with venous diseases represented by venous thromboembolism and/or symptoms of chronic venous disease evaluated by standard protocol. In our first study we evaluated the association between preclinical atherosclerosis and prevalence of venous thromboembolic events in patients with thrombophilias. Preclinical atherosclerosis might increase through its procoagulative action the risk of venous thromboembolism. Presence of preclinical atherosclerosis in common carotid and femoral arteries measured by ultrasound was assessed by Belcaro score (based mainly on presence of plaques) and by measurements of intima media thickness in the same location in 109 patients (43 men, mean age 41.5 ± 13 years) with established thrombophilias. Other parameters under study were age, presence of traditional cardiovascular risk factors, anthropometric and clinical data including blood pressure measurements and medication. The differences between 4 patients with (n = 47) and without (n = 62) thromboembolic events were assessed by paired t-test and chi square tests. In patients with a...
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The Value of FDG PET/CT in the Diagnosis of Cardiovascular Inflammation.
Zogala, David ; Kubinyi, Jozef (advisor) ; Karetová, Debora (referee) ; Řehák, Zdeněk (referee)
1 Abstract Aim: To evaluate the diagnostic performance of FDG PET/CT in the detection of stent graft infection (SGI) with the use of visual and semiquantitative interpretation, to compare it with standalone CT analysis, to verify the transferability of the experience with FDG PET/CT in surgical prosthesis infection and to define the role of the method in the diagnostic algorithm of SGI. Subjects and Methods: In this retrospective study, two nuclear medicine physicians have independently analyzed 21 FDG PET/CT examinations performed in 20 subjects (16 men, 66 ± 8 years) between 2010 and 2019 for clinical suspicion of SGI. Six subjects examined from other reasons without signs of infection constituted a control group. The images were evaluated for the uptake pattern and intensity, and by the maximum standard uptake value (SUVmax), the target-to-background ratio with blood pool (TBRBP) and liver uptake (TBRhep) as a reference. The SGI was defined as the presence of focal hyperactivity with an intensity exceeding hepatic uptake. CT images were independently assessed for signs of SGI. Clinical review of all further patients' data served as the standard of reference. Results: Twelve cases were established as SGI by the clinical review. PET/CT correctly diagnosed SGI in eight and yielded a sensitivity of 92 % and...
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The relationship between lower extremity arterial properties and aortic stiffness and their effect on cardiovascular risk
Wohlfahrt, Peter ; Cífková, Renata (advisor) ; Karetová, Debora (referee) ; Bulvas, Miroslav (referee)
The ratio of systolic blood pressure at the ankle to arm systolic pressure (ankle- brachial index - ABI) is used in the diagnosis of peripheral vascular disease. While its reduced value suggests obstruction of the arterial lumen, an abnormally elevated value is due to incompressibility of lower extremity arteries. While increased stiffness of the aorta, measured as carotid-femoral pulse wave velocity, is able to predict cardiovascular risk, increased pulse wave velocity of the leg arteries has no independent predictive value. Despite that, incompressibility of lower extremity arteries, diagnosed using ABI measurement, is independently associated with increased cardiovascular risk. The aim of our study was to determine the relationship between the characteristics of lower limb arteries and aortic stiffness, and their impact on cardiovascular risk. Our study showed that the results of oscillometric and Doppler ABI measurement methods are not interchangeable, because the oscillometric method systematically overestimates low values and underestimates high ABI values. Therefore, the diagnosis of lower limb arteries incompressibility should be based on the Doppler method of ABI measurement. Furthermore, we showed that age and cardiovascular risk factors have only a small effect on lower extremity arteries, but a...
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The Value of FDG PET/CT in the Diagnosis of Cardiovascular Inflammation.
Zogala, David ; Kubinyi, Jozef (advisor) ; Karetová, Debora (referee) ; Řehák, Zdeněk (referee)
1 Abstract Aim: To evaluate the diagnostic performance of FDG PET/CT in the detection of stent graft infection (SGI) with the use of visual and semiquantitative interpretation, to compare it with standalone CT analysis, to verify the transferability of the experience with FDG PET/CT in surgical prosthesis infection and to define the role of the method in the diagnostic algorithm of SGI. Subjects and Methods: In this retrospective study, two nuclear medicine physicians have independently analyzed 21 FDG PET/CT examinations performed in 20 subjects (16 men, 66 ± 8 years) between 2010 and 2019 for clinical suspicion of SGI. Six subjects examined from other reasons without signs of infection constituted a control group. The images were evaluated for the uptake pattern and intensity, and by the maximum standard uptake value (SUVmax), the target-to-background ratio with blood pool (TBRBP) and liver uptake (TBRhep) as a reference. The SGI was defined as the presence of focal hyperactivity with an intensity exceeding hepatic uptake. CT images were independently assessed for signs of SGI. Clinical review of all further patients' data served as the standard of reference. Results: Twelve cases were established as SGI by the clinical review. PET/CT correctly diagnosed SGI in eight and yielded a sensitivity of 92 % and...
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The relationship between lower extremity arterial properties and aortic stiffness and their effect on cardiovascular risk
Wohlfahrt, Peter ; Cífková, Renata (advisor) ; Karetová, Debora (referee) ; Bulvas, Miroslav (referee)
The ratio of systolic blood pressure at the ankle to arm systolic pressure (ankle- brachial index - ABI) is used in the diagnosis of peripheral vascular disease. While its reduced value suggests obstruction of the arterial lumen, an abnormally elevated value is due to incompressibility of lower extremity arteries. While increased stiffness of the aorta, measured as carotid-femoral pulse wave velocity, is able to predict cardiovascular risk, increased pulse wave velocity of the leg arteries has no independent predictive value. Despite that, incompressibility of lower extremity arteries, diagnosed using ABI measurement, is independently associated with increased cardiovascular risk. The aim of our study was to determine the relationship between the characteristics of lower limb arteries and aortic stiffness, and their impact on cardiovascular risk. Our study showed that the results of oscillometric and Doppler ABI measurement methods are not interchangeable, because the oscillometric method systematically overestimates low values and underestimates high ABI values. Therefore, the diagnosis of lower limb arteries incompressibility should be based on the Doppler method of ABI measurement. Furthermore, we showed that age and cardiovascular risk factors have only a small effect on lower extremity arteries, but a...
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Local and systemic pathological processes in diabetic foot diasease and their management
Dubský, Michal ; Jirkovská, Alexandra (advisor) ; Rušavý, Zdeněk (referee) ; Karetová, Debora (referee)
Local tissue factors, ischemia and infection (which are often the cause of re-ulceration) are the main pathogenetic factors for diabetic foot disease (DFD). Neuropathic bone metabolism disorder leads to Charcot osteoarthropathy (CHOA). The aim of this dissertation was to assess experimentally the effectiveness of new skin substitutes, evaluate local vasculogenesis in different types of cell therapy of DFD, the role of infection in recurrence of DFD and scintigraphic parameters of activity of CHOA. Our studies concerning local pathological processes in DFD experimentally proved that gelatine nanofibers accelerate wound healing and can be suitable scaffolds for cell transfer and skin regeneration and also that acellular porcine dermis is more effective in healing of chronic wounds then xenotransplants. Our studies concerning therapeutic vasculogenesis confirmed that efficacy of stem cells (SC) harvested from bone marrow is similar in efficacy to SC separated from peripheral blood after stimulation. We found no evidence for systemic vasculogenesis by means of a significant increase of pro-angiogenic cytokines, which confirms the paracrine effect of injected SC. We proved a significant correlation between angiogeneisis inhibitor (endostatin) and the number of injected SC, which could be an indicator of...
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Preclinical atherosclerosis of peripheral arteries and its relation to venous thrombosis in patiens with thrombophilias
Auzký, Ondřej ; Piťha, Jan (advisor) ; Karetová, Debora (referee) ; Vaverková, Helena (referee)
The aim of our study was to evaluate association between venous disorders and preclinical atherosclerosis and its risk factors. The study was particularly focused on the association between cardiovascular risk factors and preclinical atherosclerosis with venous diseases represented by venous thromboembolism and/or symptoms of chronic venous disease evaluated by standard protocol. In our first study we evaluated the association between preclinical atherosclerosis and prevalence of venous thromboembolic events in patients with thrombophilias. Preclinical atherosclerosis might increase through its procoagulative action the risk of venous thromboembolism. Presence of preclinical atherosclerosis in common carotid and femoral arteries measured by ultrasound was assessed by Belcaro score (based mainly on presence of plaques) and by measurements of intima media thickness in the same location in 109 patients (43 men, mean age 41.5 ± 13 years) with established thrombophilias. Other parameters under study were age, presence of traditional cardiovascular risk factors, anthropometric and clinical data including blood pressure measurements and medication. The differences between 4 patients with (n = 47) and without (n = 62) thromboembolic events were assessed by paired t-test and chi square tests. In patients with a...
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Diagnosis of deep vein thrombosis with ultrasonography
Pinka, Jiří ; Karetová, Debora (advisor) ; Chochola, Miroslav (referee)
This thesis is retrospective study group of patients who visited the internal medicine clinic at hospital in Vyškov during the year 2010 with a suspected thrombotic closure of limb veins. As a source of information were used outpatient and inpatient discharge and sonographic reports. A total of 1000 patients were examined, of whom were 379 men and 621 women. Thanks to graphical process groups were formed, which included examined patients with common causes of thrombosis, clinical symptoms, sonographic findings, and lateral extent of disability thrombosis. These groups were subjected to statistical evaluation and comparison to identify traits and patterns of side differences in the limb affection, the clinical problems related to the extent of thrombotic disability, the relationship of embolization risk of thrombotic events to the extent of thrombotic disability. There was available sonographic machine Toshiba Nemio SSA-550A year of manufacture 2002 with a linear probe for vascular investigations and it was equipped with color Doppler. The source of information was anamnestic data obtained during an outpatient consultation or hospitalization. In the in-hospital reports were objective clinical examinations, numerous laboratory data characterizing the extent of the inflammatory response, affected...
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