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Ischemic strokes in vertebrobasilar region, caused by lesions of magistral arteries
Škoda, Ondřej ; Kalvach, Pavel (advisor) ; Šonka, Karel (referee) ; Kemlink, David (referee)
Vertebrobasilar ischemic strokes, caused by lesions of magistral arteries. Background and Purpose Progress in modern non-invasive or minimally invasive diagnostic methods has improved detection and evaluation of pathological changes in the vertebral arterial system. Ischemia in vertebrobasilar circulation, often caused by stenotic processes of vertebral arteries, is considered a severe form of stroke, with a mortality of 20 - 30%. Stenoses of these arteries may be responsible for up to one half of ischemic events in their nutritive region. Although there is no general consensus on treatment of the VA stenoses so far, recent recommendations consider interventions in secondary stroke prevention, when optimal conservative treatment did not prevent recurrent clinical symptoms. With the increasing number of centers providing diagnostics and possible interventional treatment, the objective assessment of these lesions should be available. However, due to a relatively small part of patients, who are indicated to vertebral angioplasty, the diagnostic procedures should be as noninvasive and safe, as possible. The aim of this study was to create the accurate, noninvasive an safe diagnostic algorithm for the detection and evaluation of the VA stenoses and to test its reliability on our own patients group....
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Endocrine and Metabolic Aspects of Various Sleep Disorders
Vimmerová-Lattová, Zuzana ; Anders, Martin (advisor) ; Praško, Ján (referee) ; Šonka, Karel (referee)
Endocrine and Metabolic Aspects of Various Sleep Disorders MUDr. Zuzana Vimmerová Lattová Abstract: Recent epidemiological and experimental data suggest a negative influence of shortened or disturbed night sleep on glucose tolerance. However, no comparative studies of glucose metabolism have been conducted in clinical sleep disorders. Dysfunction of the HPA axis may play a causative role in some sleep disorders and in other sleep disorders it may be secondary to the sleep disorder. Moreover, dysfunction of the HPA axis is regarded as a possible causative factor for the impaired glucose sensitivity associated with disturbed sleep. However, data on HPA system activity in sleep disorders are sparse and conflicting. We studied 25 obstructive sleep apnea (OSA) patients, 18 restless legs syndrome (RLS) patients, 21 patients with primary insomnia and compared them to 33 healthy controls. We performed oral glucose tolerance test and assessed additional parameters of glucose metabolism. The dynamic response of the HPA system was assessed by the DEX-CRH-test which combines suppression (dexamethasone) and stimulation (CRH) of the stress hormone system. Compared to controls, increased rates of impaired glucose tolerance were found in OSA (OR: 4.9) and RLS (OR: 4.7), but not in primary insomnia. In addition, HbA1c...
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Alternative methods in the surgical treatment of mesial temporal lobe epilepsy
Vojtěch, Zdeněk ; Nevšímalová, Soňa (advisor) ; Šonka, Karel (referee) ; Komárek, Vladimír (referee)
Purpose: The aim of the study was to evaluate effectiveness and complications of alternative methods of stereotactic treatment (gamma knife radiosurgery and radiofrequency amygdalohippocampectomy) in mesial temporal lobe epilepsy due to mesial temporal sclerosis. Methods: Both patient groups underwent a standard preoperative epilepsy evaluation. Both procedures were planned according to the individual anatomy of each patient. Between November 1995 and May 1999, 14 patients underwent Leksell Gamma Knife radiosurgical amygdalohippocampectomy with a marginal dose of 18, 20, or 25 Gy to the 50% isodose following. Between April 2004 and October 2009 a group of 51 patients was treated using stereotactic thermo-lesion of the same mesiotemporal structures. Lesions were performed using a string electrode inserted through the occipital approach with a single trajectory. Results: In the radiosurgical group, one patient was classified as Engel Class Ib, three were Engel Class IIc, four were Engel Class IIIa, five were Engel Class IVb and one was Engel class IVc 39 months after treatment. One patient was classified as Engel Class Ib, three were Engel Class IIc, one was Engel Class IIIa, and two were Engel Class IVb in a subgroup of seven patients who were unoperated 2 years prior to the last visit and at least 8...
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Modulation of consequences of ischemia and hypoxia
Nohejlová, Kateryna ; Mareš, Jan (advisor) ; Šonka, Karel (referee) ; Vožeh, František (referee)
Modulation of consequences of ischemia and hypoxia Kateryna Nohejlová (maiden Deykun), MD Abstract It is known from literature that that many types of insults are accompanied by the increase of free radicals level. The models of three pathological states, which are known to be related to the changes in free radicals production, were used for the purposes of the work. These models were also chosen because the intensity of action of pathogenic factor borderlines the threshold of mainly functional CNS disturbances. It was need for the animals to survive the interventions in order use behavioral methods of assessment. For the estimation of the degree of disturbances were used tests of postural motor function and motor learning and spatial orientation. The action of free radicals was evaluated indirectly by application of their scavengers and antioxidants: tempol and melatonin, which act extracellularly as well as intracellularly. Scavengers were administered as prevention, before an insult, and as therapy, after an insult. The results were divided into three sets of experiments: 1. Focal photothrombotic ischemia of sensorimotor cortex: The performance of animals that received tempol treatment did not significantly differ from the animals subjected to plain ischemia in either of tests. Melatonin application...
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Functional imaging of cortical evoked potentials following painful and nonpainful stimulation in healthy volunteers and chronic pain patients
Poláček, Hubert ; Stančák, Andrej (advisor) ; Šonka, Karel (referee) ; Kuba, Miroslav (referee)
A close relationship between painful and non-painful (somatosensory) percepction was noticed already in the past centuries and led into development of many analgesic methods. Only basic neuroanatomical and neurophysiological research using animal models of nociception was able to shed more light on their proper mechanisms until the era of modern non- invasive imaging methods. The main aim of this thesis was to analyze non-invasively, in human volunteers and patients with chronic pain, spatiotemporal relations between brain evoked responses to painful (or aversive) and non-painful stimuli. In next step, to discuss the roles of different engaged mechanisms in found interactions and suggest recommendations for further research of pain. 4 experimental studies (3 in healthy volunteers and 1 in patients with failed back surgery syndrome) are presented. Using high-resolution EEG, phasic electrical stimulation of median, tibial or sural nerve(s), and source analysis of recorded data, modulations of all repersentative components of somatosensory evoked potentials (SEPs) by several interfering conditions were analyzed. In healthy volunteers, effects of heterotopic repetitive heat pain administered to the right side of the body (ipsilateral to electrically stimulated nerve) were tested in Experiment 1 (compared to the...
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Treatment of sleep apnea with continuous positive airway pressure (CPAP) and noninvasive ventilation (BiPAP) during sleep
Jantosová, Nikola ; Šonka, Karel (advisor) ; Pretl, Martin (referee)
(AJ): The thesis focuses on the topic of treatment of sleep apnea with noninvasive ventilation. The research deals with problems of sleep apnea and its role in the pathogenesis of many diseases. This work describes sleep laboratory methodology from baseline until completion of treatment which is ensured by two methods, with the help of sustained pressure. The goal of the research is to highlight the importance of sleep laboratory methodology in the treatment of sleep apnea. The research results confirm that the factors previously known, such as age weight and sex of the patient are responsible for the emergence of apnea. To improve the outcome of the treatment and its tolerance it is important to set the correct pressure.The results do not clearly point to the factor which results in insufficient use of noninvasive ventilation during sleep.
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Specific Shape of the Flow-volume Loop in Patients with Sleep Apnea-pypopnea Syndrome Depending on Oropharyngeal Diagnosis
Drobníčková, Martina ; Špunda, Miloslav (advisor) ; Šonka, Karel (referee)
The theme is a testing of dependency of specific shape of the flow-volume loop in patients with sleep apnea-hypopnea syndrome on the oropharyngeal diagnosis. The work consists of 5 parts: introduction, the theoretical part, practical part, discussion and conclusion. The basic group was a group of 45 patients with specific curve. This specific curve is characterized by saw like dents in the aspiration part of the curve. As a control group, I selected 45 patients with the curve, which characterizes obstructive ventilation failure. This curve is flat in both of the respiratory periods. For all 90 patients to assessed anatomical abnormalities in oropharyng. The evaluation is subjective. This data I transferred this data, and I analysed them by the multidimensional statistical method. On the basis of discriminatory analysis, I found that it is not possible to differentiate the patients, that won't have the specific curve or not according to the 18 variables , which monitor the abnormalities of the upper airway. Classification error is 60%. In its application to the original sample of 90 patients, 45 patients would'be wrong classified, which is unacceptable. It can therefore be noted that only the testing of the anatomical abnormalities is not sufficient for making the decision, whether the patients will or won't...
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Craniofacial Abnormalities in Sleep Apnoea Syndrome
Dostálová, Simona ; Šonka, Karel (advisor) ; Čáp, Jan (referee) ; Peterka, Miroslav (referee)
The thesis is based on a series of cephalometric studies of patients with SAS, acromegalic patients with or without SAS as well as control groups. The studies presented in this thesis produce following results: There are important differences in orofacial skeleton and soft tissue of nasopharynx measured by cephalometry in the patients with sleep apnoea compared to the control group of women and men. Proved skeleton changes (increased lower gonion angle, increased anterior facial heights, decreased depth of the upper face) and elongated soft palate predisposes patients to narrowing of upper airways in oropharyngx, which significantly contributes to development of SAS. Cephalometric differences in the size of the soft palate, the rotation of the mandible and the size of lower gonion angle can be found in men with mild and severe sleep apnoea. We conclude that the severity of the SAS depends on the degree of changes in the orofacial skeleton and adjacent soft tissues. The results, which reveal a significant differences in BMI and in the circumference of the neck between groups with mild and severe SAS, confirm the idea that the most important predisposing factor for SAS is obesity, in particular deposition of adipose tissue in the posteriolateral parapharyngeal space. Patients with acromegaly (of both sexes)...
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Effect of carbamazepine on thyroid hormone homeostasis
Šimko, Julius ; Šonka, Karel (advisor) ; Mareš, Jan (referee) ; Zamrazil, Václav (referee)
8. Summary Introduction: While carbamazepine (CBZ) treatment may affect serum thyroid hormone concentrations it rarely leads to clinically important hypothyroidism. This study was aimed to evaluate an early effect of CBZ on thyroid status in hypothyroid patients with thyroid hormone replacement, as compared with patients without a thyroid disorder. Methods: Twenty-nine patients indicated for CBZ treatment were followed prospectively. Their thyrotropin (TSH), total thyroxine (TT4), free thyroxine (FT4) and antibodies against thyreoperoxidase (TPO- ab) and thyreoglobulin (TG-ab) serum levels were assayed before the start of CBZ medication (150 mg/d increasing to 450 mg/d), and then their TSH, TT4 and FT4 serum levels were assayed at week intervals for 7 weeks. Nineteen patients had no thyroid disorder before CBZ treatment (control group A), whereas 10 patients were treated with L-thyroxine (median 100μg/d ) for hypothyroidism and were stable before CBZ treatment (group B). The fluctuations of thyroid status after the start of CBZ treatment were compared between the groups. Results: In the control group, TT4 was significantly decreased by ca. 15 to 25 %, starting from the 1st week of treatment (Friedman, p<0.001), while FT4 was decreased by only ca. 10 to 15 %, and the significance (p<0.001) was delayed till...
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Hypercapnia impact on vascular and neuronal reactivity in patients before and after carotid endarterectomy
Ostrý, Svatopluk ; Stejskal, Lubor (advisor) ; Šonka, Karel (referee) ; Zvěřina, Eduard (referee)
Indications for carotid endarterectomy (CEA) of symptomatic and asymptomatic internal carotid artery (ICA) stenosis were based on numerous randomised studies. The benefit was rated relative to the lowered risk of ipsilateral stroke relapse. There is evidence that rCBF correlates with brain electrical activity (EEG, SEPs). Somatosensory function is represented by evoked neuronal activity in central region. Can the neuronal activity in primary somatosensory cortex be influenced by hypercapnia-induced increased rCBF or CEA in patients with ICA stenosis or is a change such as that permanent? The aim of the present study was to determine whether CEA in unilateral symptomatic stenosis in the extracranial vascular system had a bearing on neuronal activity in the central region of the cerebral cortex. Material and methods The criteria for enrollment in the study were a history of ischaemic insult (TIA, RIND, minor stroke) less than six weeks before admission and unilateral stenosis of the ICA of 70-99 % measured on the DSA with the NASCET method. Patients were divided inti two groups: Group A (28 men and 13 women) with their initial NIHSS ≤ 2. Group B consisted of 12 men and 5 women, starting NIHSS was from 3 to 8. All patients were examined before CEA, on post-operative days 3-7 and 3 months after CEA. SEPs ans...
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