|
|
Atypical intracranial vascular malformations: their behavior, treatment and follow-up
Voldřich, Richard ; Netuka, David (advisor) ; Haninec, Pavel (referee) ; Přibáň, Vladimír (referee)
Therapy and follow-up of patients with atypical vascular malformations are not standardized. The goals of this dissertation are the comparison of relevant treatment and imaging methods, the determination of an optimal follow-up program based on the type of lesion or the character of therapy, and the documentation of the behavior of atypical malformations after incomplete closure. Long-term observation of 195 embolized dural arteriovenous malformations (DAVM) confirmed the high success rate of Onyx embolic material compared to other agents - complete occlusion was achieved in 88% of cases compared to 35% in the control group. A total of 93% of DAVMs treated with Onyx were closed at the last follow-up. The material also proved to be stable in the long term. Recurrence was diagnosed in 1,8% of patients. The recurrences of DAVM occur due to the accentuation of originally negligible vascular fistulas that are not visible on post-interventional digital subtraction angiography (DSA). Prospective comparison of magnetic resonance angiography (MRA) and DSA concluded that patients after complete embolization of dural fistula can be safely followed using only MRA. In the case of carotid-cavernous fistulas (CCFs), imaging and clinical outcomes of traditional and new endovascular materials, as well as...
|
|
|
Porovnanie rôznych prístupov k stanoveniu indexu listovej plochy
Haninec, Pavel
Leaf area index (LAI) is one of the most important characteristics of forest stand affecting fundamentals of tree physiological processes, biomass production or mechanical stability. The aim of this thesis was to compare three different methods (gravimetrical, optical -- LAI 2000 plant canopy analyzer - and needle method) for estimation of LAI. Additionally, the seasonal development of LAI was measured using the LAI 2000 method. Research was conducted in three European beech (Fagus sylvatica L.) and one sycamore maple (Acer pseudoplatanus L.) stands. The age of forest stands was from 13 to 77 years. Seasonal development of LAI followed general pattern typical for broadleaf stands in central Europe, with fastest rate of leaf growth in the first month following budbreak. Maximal LAI was observed in mid-June and July and it was 4.52 -- 5.08 m2m-2 in beech and 4 m2m-2 in maple stand. LAI 2000 underestimated the gravimetrically measured LAI on average by 15.1 % in beech stands and by 5.8 % in maple stand (these differences were not statistically significant). Needle method underestimated gravimetrical LAI in beech on average by 22 % and in a maple stand by 40 % (this difference was significant in three out of four stands). Overall, gravimetrical method is most laborious but provides most accurate results. LAI 2000 slightly underestimates results (albeit not significantly in broadleaf species) but enables multiple measurements of LAI in the course of growing season. Needle method is inexpensive and easy to use but it significantly underestimates LAI. Its use for comparison of multiple species will always require calibration.
|
|
|
Normal pressure hydrocephalus- Complex approach to diagnosis and treatment
Skalický, Petr ; Bradáč, Ondřej (advisor) ; Haninec, Pavel (referee) ; Keller, Jiří (referee)
Normal pressure hydrocephalus (NPH) is an important part of the differential dia- gnosis of the causes of cognitive deficit, gait disorder and incontinence in elderly patients. This is especially true for idiopathic normal pressure hydrocephalus (iNPH), to which this thesis is dominantly devoted. A number of factors contribute to the course of the disease, therefore a comprehensive approach evaluating multiple variables accompanying the disease, comorbid diseases or considered diseases in the differential diagnosis, as well as a comprehensive approach to therapy, which contains much more than just the im- plantation of a derivation system for the drainage of cerebrospinal fluid, can improve, not only, the quality of life of these patients. The mainstay of the dissertation thesis are two first-author articles. The first study deals with morphological parameters obtained during MRI examination and their ability to predict improvement in gait after shunt implantation in iNPH patients. We evaluated the predictive performance of score for evaulating disproportionately enlarged subarachnoid space hydrocephalus (DESH score), callosal angle and cingulate sulcus sign against the reference standard in the form of functional testing - lumbar infusion test (LIT) and external lumbar drainage (ELD). In the...
|
|
|
Predictive value of clinical, imaging and cerebrospinal fluid dynamics examinations in the diagnostic algorithm of the normal pressure hydrocephalus.
Radovnický, Tomáš ; Sameš, Martin (advisor) ; Haninec, Pavel (referee) ; Bartoš, Aleš (referee)
8.SUMMARY By evaluating the effect of treatment of patients with idiopathic normal pressure hydrocephalus (iNPH) indicated for surgery based on positive supplementary tests, we determined their positive predictive value. Both the lumbar infusion test and the tap test have a high positive predictive value for the clinical response to shunt surgery. A patient with a typical symptomatology, a radiological examination finding, and a positive supplementary test will most likely benefit from surgery. Supplementary tests are a valid part of the diagnostic algorithm regardless their invasiveness. Using diffusion tensor imaging on the MRI performed in patients with iNPH prior to surgery, one year after surgery and in healthy controls, we found changes in diffusion parameters in the periventricular white matter. Patients had a higher MD in ALIC, PLIC and CC compared to healthy controls, reflecting a higher degree of axonal degeneration in patients with iNPH. Patients in comparison with healthy controls had higher FA only in a PLIC. This area is affected by compression in patients with iNPH more severe. After the shunt surgery, we recorded a significant decrease in PLIC, which corresponds to the decompression after derivation of the CSF. However, the drop in value was not to the value of healthy controls. In patients...
|
|
| |
|
|
Deriving predictive pathophysiological markers from ICP analysis
Mládek, Arnošt ; Bradáč, Ondřej (advisor) ; Haninec, Pavel (referee) ; Mraček, Jan (referee)
Deriving predictive pathophysiological markers from ICP analysis RNDr. Arnošt Mládek, Ph.D. December 13, 2021 Abstract Intracranial pressure (ICP) is an irreplaceable neurointensive care parameter and is an area under intensive research. The great diagnostic importance of ICP is underlied by two factors: (1) the central nervous system (CNS) is placed in a rigid cranial vault and even small local expansive processes (e.g. tumors, abscesses, bleeding) may lead to intracranial hypertension; (2) a specific property of the CNS is a rather uniform response to various pathological events since many etiologically heterogeneous diffuse injuries of neural tissue lead to oedema elevating ICP. The complexity of ICP monitoring stems from the neurosurgical insertion of the pressure sensor into the intracranial space and the associated risks of bleeding, neuroinfection and brain tissue damage. Intracranial pressure is more than just a number on a bedside monitor, even though in clinical practice this simplification is rather common. Similarly to electrocardiogram (ECG) signals whose information content goes well beyond heart rate calculation, understanding of ICP dynamics can provide us with insight into the current clinical status as well as prediction of further evolution. The mainstay of the dissertation thesis are...
|
|
|
Perineural spread of pelvic tumors: mechanism and diagnosis
Čapek, Štěpán ; Sameš, Martin (advisor) ; Haninec, Pavel (referee) ; Hořínek, Daniel (referee)
Perineural spread of pelvic tumors mechanism and diagnosis Abstract Neoplastic lumbosacral plexopathies are infrequent affections of the lumbosacral plexus. Cases with minimal or non-specific finding on imaging can be particularly puzzling to diagnose. We describe a series of patients with perineural spread from the site of the primary tumor along the visceral autonomous nerves to the lumbosacral plexus and further proximally to the spinal nerves and even intradurally and also distally to the sciatic nerve. On series of 17 patients diagnosed with perineural spread of pelvic malignancy we describe characteristic clinical presentation and imaging finding. In many of these cases a tissue biopsy is necessary to finalize the diagnosis. We describe operative technique of targeted fascicular biopsy of the sciatic nerve and our experience with this procedure. On series of 117 patients, we report the outcome and complication: diagnostic yield was 84.8% and complication rate was 2.7 %. If a tissue sample is needed to conclude the diagnosis, targeted fascicular biopsy does increase the yield at an acceptable complication rate. Perineural spread of pelvic cancer is a new clinical-pathological entity with an unknown natural history or ideal treatment strategy. Based on the imaging finding in this group we present a...
|
|
|
Decompressive craniotomy in craniocerebral injury - evaluation of outcome one year after trauma
Navrátil, Luděk ; Choc, Milan (advisor) ; Náhlovský, Jiří (referee) ; Haninec, Pavel (referee)
The study presents analysis of group of 110 patients treated for craniocerebral trauma by means of decompressive craniotomy between January 1999 and December 2003. The influence of different factors to the outcome of patient one year after injury was evaluated. Among the factors in view we included age, clinical status and its worsenig after admission, accompanying injuries, time period between injury and operation, finding during operation, intracranial pressure and postoparative complications. In addition to evaluation of particular factors to the outcome of patients we followed the correlation between various factors. Results: perimesencephalic cisterns and thickness of subdural hematoma were evaluated. In the subgroup of patients with subdural hematoma (n=63) it was found, that worsening of the outcome correlated with the thickness of subdural hematoma (p = 0.,025) and with the shift in the CT (p = 0.0001). Correlation between shift or width of cinsterns to the outcome of all patinets (n = 110) was not found. The perioperative measurement of dural gap before the duroplasty is the speciality of this work. In all patients (n = 110) the correlation between dural gap and the outcome was not found. In older patients the dural gap was lesser (p = 0.021). But in older patients the subdural hematoma was...
|
|
|
Obstetric brachial plexus palsy
Mencl, Libor ; Haninec, Pavel (advisor) ; Rokyta, Richard (referee) ; Ehler, Edvard (referee)
Obstetrical brachial plexus palsy (OBPP) displays a stable incidence of 0.15 - 3 per 1,000 live births. Most children show good spontaneous recovery, but a recent literature reviews show that a residual deficit remains in 20% to 30% of children. Shoulder dystocia, macrosomia and instrument delivery, forceps or vacuum extraction present the greatest risk for brachial plexus injury. Caesarean section, having a twin or multiple birth mates seems to offer some protection against injury. The resulting nerve injury may vary from neurapraxia or axonotmesis to neurotmesis and root avulsion from spinal cord. In neurapraxia or axonotmetic lesions complete recovery will usually occur over the course of weeks or months. In a neurotmetic injury or in case of root avulsion, the most sever type of lesion, useful regeneration of axons cannot take place. Although we perform electromyography and imaging studies, the final decision of operation relies heavily on the clinical examination. Manual muscle testing system although reliable for examination of motor power in adults is not suited for use with infants. All patients involved in the study were evaluated using the Active Movement Scale (AMS), which greatly increases the ability to detect partial movements. The results of neurophysiological investigations in older...
|
|
|
Cortical electrical stimulation and pain
Rusina, Robert ; Rokyta, Richard (advisor) ; Haninec, Pavel (referee) ; Paleček, Jiří (referee)
The aim of the study was to examine effects of sensorimotor cortex stimulation on pain in animal. A behavioral model investigated pain thresholds in deafferentated rats depending on cortex stimulation and two neurophysiological models studied different components of the jaw opening reflex (JOR) and tooth pulp evoked potentials (TPEPs) following cortical stimulation. The behavioral model used 18 deafferentated (dorsal root rhizotomy) rats and 14 controls. Pain thresholds were measured before and after cortical stimulation using plantar test and tail-flick latencies. In the neurophysiological model, rats were implanted with tooth pulp, cerebral cortex, and digastric muscle electrodes. 15 animals were divided into three groups, receiving 60 Hz, 40 Hz and no cortical stimulation, respectively. TPEPs were recorded before, one, three and fi ve hours after continuous stimulation. 10 other rats were submitted to recordings after a single tooth pulp stimulation, while in 5 more rats we administrated conditioning and test stimulation. TPEPs and digastric EMG were simultaneously recorded. A multiresolution denoising method was used for signal processing. Our results show a similar effect of the stimulation in man and experimental animals despite the differences in the organization of the cerebral cortex. Our results...
|
guest ::
RSS feed.