1,721,246 research outputs found
Polimorfizam promotorske regije gena inhibitora aktivatora plazminogena-1 u bolesnika s moždanim udarom
Get PDFStroke (MU) is the leading cause of disability in modern society. In developed countries, the MU is in second place among the causes of mortality and in Croatia leading causes of death. Due to changing lifestyles and reducing risk factors, better management of patients with stroke, the incidence of stroke in developed countries declined, and mortality is reduced. Yet the treatment of stroke is far from satisfactory. In the last decade MU is finally recognized as emergency in medicine.
Furthermore, treatment of stroke, primary and secondary prevention and rehabilitation in the specialized departments, have proven to be effective methods. In recent years several recommendations for the treatment of stroke were published. The goal of primary prevention is to reduce the risk of stroke in asymptomatic individuals. Lifestyle and certain diseases have been identified as a risk factor for stroke. The most common risk factors include inadequate diet, alcohol consumption, smoking, reduced physical activity, hypertension, diabetes, elevated cholesterol levels, myocardial infarction, atrial fibrillation and carotid stenosis. Stress, taking high amounts of oral contraceptives, polymorphism 4G/5G as a risk factor for lacunar stroke, while the incidence of 4G/4G mentioned as a protective factor in the elderly. Therefore, the gene polymorphism 4G/5G could be useful in identifying individuals at risk for developing cardiovascular disease, and dosing of patients fibrinolytic agents, like t-PA
CORRELATION OF BDNF, IL-6 AND OXIDATIVE STRESS MARKERS IN DEMYELINATING DAMAGE
No full textBDNF, IL-6 i biljezi oskidacijskog stresa nedvojbeno imaju utjecaj na demijelinizacijski proces umultiploj sklerozi. Točni mehanizmi utjecaja na upalnu i neurodegenerativnu fazu nisu upotpunosti razjašnjeni. U ovo istraživanje je uključeno 60 ispitanika (19 muških i 41 ženskih)koji zadovoljavaju kriterije relapsno remitentne multiple skleroze (RRMS), i 66 zdravihkontrola (24 muških, 42 ženskih). Srednja dob oboljelih i zdravih je 43,5 godina. Iz krviispitanika određena je razina neurotrofina BDNF-a (proBDNF i mBDNF) i IL-6 ELISA testom,a biljega oksidacijskog stresa (MDA, GSH, katalaze i karboniliranih proteina)spektrofotometrijskom metodom, te ih se dodatno koreliralo s brojem demijelinizacijskihT1,T2/FLAIR i gadolinij imbibirajućih lezija. Utvrđena je i korelacija omjera navedenihfizioloških parametara sa stupnjem onesposobljenosti (EDSS), kognitivnim (MoCA test) idepresivnim deficitom (BDI-II upitnik). Dokazana je statistički značajna (P<0,001) negativnakorelacija serumskih razina biljega oksidacijskog stresa glutationa (GSH) na razvoj kognitivnihpromjena ispitanika s RRMS-om ispitanih MoCA testom. Ovo je prvo istraživanje ispitanika sRRMS-om temeljeno na istraživanju serumske razine glutationa na stupanj kongitivnogoštećenja ispitanog MoCA testom. Na razvoj kognitivnih promjena u ovom istraživanjuverificiranih MoCA testom, je statistički pozitivno značajno utjecao broj MR lezija(T1,T2,FLAIR) stupanj depresije, stupanj neurološke onesposobljenosti verificirane EDSSskalom, dob, te vrijednosti GSH. Ispitanici s višim vrijednostima MoCA testa su bili mlađi,imali manji stupanj neurološke onesposobljenosti, bili manje depresivni i imali su manjevrijednosti glutationa i manje demijelinizacijskih lezija na MR-u. Glutation bi mogao bitipotencijalni biljeg progresije kognitivnog deficita kod bolesnika s RRMS-om.BDNF, IL-6 and oxidative stress markers have a distinct role on the process of demyelination in multiple sclerosis. Distinct mechanisms of influence on inflammatory and neurodegenerative phase are not clarified. 60 subjects meeting the criteria for RRMS (19 men and 41 women) and 66 healthy control subjects (24 men, 42 women) were included in the study. The average age of patients and healthy people is around 43,5 years. The levels of the neurotrophin BDNF (proBDNF and mBDNF) and IL-6 were determined from the blood of the subjects by an ELISA test and oxidative stress markers (MDA, GSH, catalase and carbonylated proteins) were determined from subjects by the spectrophotometric method and correlated with the number of demyelinating T2/FLAIR lesions and gadolininium enhanced lesions. The correlation of the ratio of the mentioned physiological parameters with the degree of disability (EDSS), cognitive (MoCA test) and depressive deficit (BDI-II questionnaire) was determined. A statistically significant (P<0.001) negative correlation of serum markers of oxidative stress levels of glutathione (GSH) on the development of cognitive changes in subjects with RRMS tested with the MoCA test was shown. This is the first study of subjects with RRMS that performed the mentioned research of serum glutathione levels on the degree of congitive damage tested by the MoCA test. The development of cognitive changes in this study, verified by the MoCA test, was statistically significantly influenced by the positive number of MR lesions (T1, T2, FLAIR), degree of depression, EDSS, age, and GSH values. Subjects with higher MoCA test values were younger, had a lower degree of neurological disability, were less depressed and had lower glutathione values and fewer demyelinating lesions on MRI. Glutathione could be a potential marker of cognitive deficit progression in patients with RRMS
The role of thyroid hormones in carotid wall remodeling and lipid metabolism
Get PDFAteroskleroza je kronična bolest s progresivnim tijekom, razvoj koje počinje već u djetinjstvu,
a obuhvaća čitav niz zbivanja koja rezultiraju zadebljanjem krvožilne stijenke, smanjenjem
njezine elastičnosti i razvojem plaka. Kada taj proces zahvati karotidne arterije, dolazi do
razvoja subkliničkih promjena na stijenkama arterije, koje se mogu kvantificirati mjerenjem
debljine karotidnoga IMT-a uporabom ultrazvuka. Hormoni štitnjače utječu na
kardiovaskularni sustav, no točni mehanizmi njihova utjecaja na razvoj ateroskleroze nisu u
potpunosti jasni. U ovo je istraživanje bilo uključeno 100 žena, kojima su određene serumske
koncentracije fT4, TSH, CRP-a, ukupnoga kolesterola, triglicerida, HDL-a, LDL-a i njegova
podtipa sdLDL-a (za koji se smatra da ima izrazito proaterogeno djelovanje), te debljina
karotidnoga IMT-a uporabom obojenoga doplera. Rezultati istraživanja potvrdili su hipotezu
da ispitanice sa subkliničkom hipotireozom imaju poremećen metabolizam masti s povećanjem
triglicerida, omjera kolesterol/HDL, sdLDL-a i karotidnog IMT-a u usporedbi s eutireoidnom
skupinom ispitanica. Na temelju ovih rezultata može se zaključiti da je potreban probir,
praćenja i eventualno liječenje osoba koje pokazuju rane, subkliničke znakove disfunkcije štitne
žlijezde, te je potrebno, uz konvencionalne čimbenike rizika, provesti mjerenje i sdLDL-a.Atherosclerosis is a chronic progressive disease, which develops in childhood, and which
encompasses a whole range of processes that result in carotid wall thickening, reduction of its
elasticity and development of plaque. When this process affects the carotid arteries, there is a
development of subclinical changes on the arterial wall, which can be quantified by measuring
the thickness of IMT with an ultrasound. Thyroid hormones affect the cardiovascular system,
but the precise mechanisms of their effects on the development of atherosclerosis are not
entirely clear. This research included 100 women whose serum concentrations of fT4, TSH,
CRP, total cholesterol count, triglycerides, HDL, LDL and its subtype sdLDL (previously
suggested to have highly atherogenic properties), as well as carotid IMT thickness using colour
Doppler, have been determined. The results of this research confirmed the hypothesis that
subjects with subclinical hypothyroidism have an imbalanced lipid metabolism with increased
triglycerides, cholesterol/HDL ratio, sdLDL and carotid IMT, when compared with the
euthyroid group. Based on these results we can conclude that there is a need to screen, track
and eventually treat people showing early, subclinical signs of thyroid gland dysfunction, and
that it is necessary, along with conventional risk factors, to measure sdLDL
Cerebrovascular disease as a cause of pseudobulbar paresis
No full textGlavni patologijski uzrok uključen u okluzivnu ekstrakranijalnu cerebrovaskularnu bolest je ateroskleroza, koja približno tvori 90% svih slučajeva. Aterogenetski rizični faktori su: hiperkolesterolemija, hipertenzija, imunokompleks, virusne infekcije i pušenje.
Masne lezije okružene tankom kapsulom imaju tendenciju pucanja uslijed utjecaja krvne struje i vibracije tokom turbulencije.
Takve forme mogu poslužiti kao objašnjenje patogenetskog mehanizma bolesti. Moždani udar je jedan od najvažnijih problema u današnjoj neurologiji, a multipli lakunarni infrakti koji nastaju kao posljedica moždane mikroangiopatije, a zahvaćaju kortikospinalni i kortikolubularni put, najčešći su uzrok pseudobulbarne pareze. Novije neinvazivne dijagnostike tih aterosklerotičnih promjena su nezamjenjive u klasifikaciji, prevenciji, prognozi i praćenju cerebrovaskularnih bolesti. Ekstrakranijsko Duplex Doppler razmatranje i Color Doppler Flow Imaging omogućuju direktan pogled u morfologiju krvne struje, eventualno prisustvo plaka, strukturu, veličinu i površinu, a Transcranial Doppler (TCD) predstavlja probitak u neurološkoj neinvazivnoj dijagnostici. Obzirom da bolesnici s kliničkom slikom pseudobulbarne pareze često imaju potrebe za stomatološkim zahvatima, a imaju poteškoća s otvaranjem usta i teže su pokretni neophodno je važno da stomatolog zna prepoznati probleme i suočiti se s njima.The main pathologic entity involved in the occlusive extracranial cerebrovascular disease is atherosclerosis, which accounts for approximately 90 percent of all cases. Atherogenetic risk factors are the following: hypercholesterolemia, hypertension,
immunocomplex, viral infection, and tobacco smoke. The lipid lesions surrounded by a thin capsule tend to rupture easily under the influence of blood flow forces and vibration due to turbulence. Such forms may serve as an explanation for the embolic pathogenetic mechanism of the disease. Brain stroke is one of the major problems in today’s neurology and multiple lacunar strokes developing as a result of microangiopathy, spreading to the corticospinal and corticobulbar tract, are the most common causes of pseudobulbar paresis. Early noninvasive diagnostics of these atherosclerotic changes is indispensable in classification, prevention, prognosis and monitoring of cerebrovascular diseases. Extracranial Duplex Doppler evaluation and Color Doppler Flow Imaging provide direct insight into blood vessel morphology, possible presence of plaques, their composition, size and surface. Relatively recently introduced Transcranial Doppler (TCD) evaluation was a real breakthrough in neurological noninvasive diagnostics. Since patients with the clinical picture of pseudobulbar paresis often need stomatological intervention and have difficulty opening the mouth and walking, it is very important for the stomatologist to be able to recognize these problems and deal with them
Cerebrovascular disease as a cause of pseudobulbar paresis
No full textGlavni patologijski uzrok uključen u okluzivnu ekstrakranijalnu cerebrovaskularnu bolest je ateroskleroza, koja približno tvori 90% svih slučajeva. Aterogenetski rizični faktori su: hiperkolesterolemija, hipertenzija, imunokompleks, virusne infekcije i pušenje.
Masne lezije okružene tankom kapsulom imaju tendenciju pucanja uslijed utjecaja krvne struje i vibracije tokom turbulencije.
Takve forme mogu poslužiti kao objašnjenje patogenetskog mehanizma bolesti. Moždani udar je jedan od najvažnijih problema u današnjoj neurologiji, a multipli lakunarni infrakti koji nastaju kao posljedica moždane mikroangiopatije, a zahvaćaju kortikospinalni i kortikolubularni put, najčešći su uzrok pseudobulbarne pareze. Novije neinvazivne dijagnostike tih aterosklerotičnih promjena su nezamjenjive u klasifikaciji, prevenciji, prognozi i praćenju cerebrovaskularnih bolesti. Ekstrakranijsko Duplex Doppler razmatranje i Color Doppler Flow Imaging omogućuju direktan pogled u morfologiju krvne struje, eventualno prisustvo plaka, strukturu, veličinu i površinu, a Transcranial Doppler (TCD) predstavlja probitak u neurološkoj neinvazivnoj dijagnostici. Obzirom da bolesnici s kliničkom slikom pseudobulbarne pareze često imaju potrebe za stomatološkim zahvatima, a imaju poteškoća s otvaranjem usta i teže su pokretni neophodno je važno da stomatolog zna prepoznati probleme i suočiti se s njima.The main pathologic entity involved in the occlusive extracranial cerebrovascular disease is atherosclerosis, which accounts for approximately 90 percent of all cases. Atherogenetic risk factors are the following: hypercholesterolemia, hypertension,
immunocomplex, viral infection, and tobacco smoke. The lipid lesions surrounded by a thin capsule tend to rupture easily under the influence of blood flow forces and vibration due to turbulence. Such forms may serve as an explanation for the embolic pathogenetic mechanism of the disease. Brain stroke is one of the major problems in today’s neurology and multiple lacunar strokes developing as a result of microangiopathy, spreading to the corticospinal and corticobulbar tract, are the most common causes of pseudobulbar paresis. Early noninvasive diagnostics of these atherosclerotic changes is indispensable in classification, prevention, prognosis and monitoring of cerebrovascular diseases. Extracranial Duplex Doppler evaluation and Color Doppler Flow Imaging provide direct insight into blood vessel morphology, possible presence of plaques, their composition, size and surface. Relatively recently introduced Transcranial Doppler (TCD) evaluation was a real breakthrough in neurological noninvasive diagnostics. Since patients with the clinical picture of pseudobulbar paresis often need stomatological intervention and have difficulty opening the mouth and walking, it is very important for the stomatologist to be able to recognize these problems and deal with them
Diferencijalna dijagnostika neuralgije n. trigeminusa
No full textTrigeminalna neuralgija je kompleksno kraniofacijanlo bolno stanje koje stomatologu u njegovoj svakodnevnoj praksi može zadati brojne dijagnostičkoterapijske poteškoće. Stomatolog je najčešće prva osoba kojoj se javlja bolesnik s orofacijalnom boli, potrebno je diferencijalno dijagnostički uzeti u obzir i pojavu trigeminalne neuralgije, pogotovo ako se radi o intenzivnijim i dugotrajnijim
bolovima. U ovom radu iznesen je pregled anatomskih područja koja su zahvačena bolnim senzacijama, opis kliničke slike bolesti te način liječenja bolesnika. S obzirom da je etiologija bolesti još uvijek nepoznata opisana je i diferencijalna dijagnostika kao i
dijagnostički postupci koji pomažu pri postavljanju točne dijagnoze trigeminalne neuralgije.Trigeminal neuralgia is a complex craniofacial neurophatic disorder of the trigeminal nerve. Because of its coplex and yet unknown natural history it represents a large diagnostic and therapeutic challenge in dentists' everyday practice. A dentist is often the first person whom the patient with orofacial pain refers to, it is of great importance to consider trigeminal neuralgia as one of potential diagnoses, especially in cases of long and intensive pain. This thesis provides an overview of anatomical regions caught in pain sensation, description of clinical picture and treatment strategies of the patient. Since this condition has no clear natural history, it is often misdiagnosed. This thesis provides a brief description of differential diagnoses of the disease and diagnostic procedures that lead us towards the right diagnosis
Visual evoked potentials in patients with pineal gland cyst
No full textCilj ovog rada je istražiti vidne evocirane potencijale (VEP) kod ispitanika s cistično promijenjenom pinealnom žlijezdom. Hipoteza istraživanja je: patološki promijenjenim vidnim evociranim potencijalima (VEP) se može detektirati kompresivan učinak cistično promijenjene pinealne žlijezde na okolne strukture mozga koje su dio vidnog puta. Učinjen je VEP kod 68 ispitanika (46 žena i 22 muškarca, srednje dobi 28,5 ± 17,7 godina) s cistično promijenjenom pinealnom žlijezdom opisanom na MR mozga (ispitivana skupina) te 68 kontrolnih ispitanika s urednim nalazom MR mozga (kontrolna skupina). Prikupljeni su podaci o amplitudi i latenci vala P100 na VEP sa pet registracijskih elektroda. Nalazi VEP su grupirani kao: 1.uredan nalaz, 2. prehijazmalne promjene, 3. posthijazmalne promjene te 4. prehijazmalne i posthijazmalne promjene. Nalaz VEP se značajno razlikovao između ispitivane i kontrolne skupine (p<0.001), većinom radi veće učestalosti posthijazmalnih promjena u ispitivanoj skupini. Patološki nalaz VEP je značajno veći kod ispitanika s većim volumenom cistično promijenjene pinealne žlijezde (p=0,001) te kod ispitanika s opisanim kompresivnim učinkom cistično promijenjene pinealne žlijezde na gornje kolikule (p=0,024). Ovo istraživanje pokazuje da je VEP korisna dijagnostička metoda za utvrđivanje funkcionalnog oštećenja vidnog puta kod ispitanika s cistično promijenjenom pinealnom žlijezdom.The aim of this study is to investigate the visual evoked potentials (VEP) in patients with pineal gland cyst. The hypothesis is that patological changes of VEP can be used to detect compressive effect of pineal gland cyst on surrounding brain structures which are part of the visual pathway. Pattern-reversal checkerboard VEPs (PSVEP) were recorded in 68 patients (46 female and 22 male, mean age 28,7 ± 17,6 years) with pineal gland cyst detected on MR of the brain (subject group) and 68 control subjects with normal MR of the brain (control group). Amplitudes and P100 latencies were collected and afterwards grouped as: 1.) normal VEP, 2.) prechiasmal, 4.) postchiasmal and 3.) prechiasmal and postchiasmal VEP disfunction. VEP findings differed significantly between subject and control group (p<0,001), mainly due to the postchiasmal disfunction frequency in the subject group. VEP findings differed significantly according to the volume of the pineal gland cyst (p=0,001) with more frequent pathological VEP findings among subjects with larger pineal gland cysts. Pathological VEP findings were significantly more frequent in patients with described compression of pineal gland cyst on surrounding brain structures (p=0,024). This study shows that VEP serve as a useful method to determine the functional impairment of visual pathway in patients with pineal gland cyst
Dugotrajno neurološko i kognitivno praćenje prvoga i drugoga dvojajčanoga blizanca
Get PDFIntroduction brings perinatal mortality of twins and other consequences of premature labor
and low birth weight which influence the incidence of cerebral pulsy and mental retardation as
well as incidence of cognitive impairment and behavioral disorders. The basic elements of
cognitive and social development in twins are described and causes of retarded speech
development explained. Introduction contains review of psychological difficulties in twins and
etiology of attention deficit hyperactivity disorder (ADHD) as well as its diagnostic criteria.
The main aim of this work was to analize the final intellectual development and behavior of
dizygotic twins compared to control singletons born from single pregnancies as well as between
themselves. Specific aims included analysis of epilepsy and ADHD occurrence and observed
frequency of other neurolological diseases. Hypothesis of this research expected in twins more
frequent disturbances in intellectual functioning, more frequent occurrence of ADHD and
neurological diseases with inferior final cognitive development and inferior academic achievements
when compared with control examinees.
Examinees and methods. 36 pairs of dizygotic twins took part in this research and all of
them participated in the first research of their neurological development 25 years ago when they
were in preschool and early school age. Responding rate of previous control singletons for this
research was significantly lower and new smaller control sample of 27 examinees was created for
this research which included partially new controls. All examinees, twins and controls were born
in the same period from 1981. until 1985. in the same Maternity Hospital in Zagreb and were
chosen by the lottery method. The data were collected by 7 Questionnaires including ones used in
the first research, basic Questionnaire about general health, “ASQ-Attachment style questionnaire,
“ The adult ADHD Self - Report Scale”, “PBI-Parental Bonding Instrument” and “Beta II- revised
Beta examination- second edition ” as well as by clinical neurological examination. The data
processing was done on personal computer with IBM SPSS Statistics (version 25) Programe
support in modeling of data base and statistical interpretation. All P values lower than 0,05 were
thought and interpreted as statistically significant in further analysis.Results of this research confirmed the hypothesis only partially. The first group of results is
related to the pregnancy and perinatal outcomes. The following differences between twins and
controls were statistically significant (P<0,001): the gestational age in twins was shorter, twin
pregnancies were more complicated, more deliveries were terminated by Cesarian section in twins,
twin perinatal complications were more frequent, birth weight and birth length in twins were
smaller and Apgar scores in first and fifth minute after delivery were in twins lower than in controls
(P<0,001). The second group of results reports about speech development, intelectuall functioning,
learning difficulties and problematic behaviors with special interest in ADHD frequency in twins
and controls in childhood and in adult age. It is interesting that first born twins had statistically
significant higher ADHD frequency in childhood (P=0,034) while there is no difference in adult
age between themselves as well as between twins and controls. First born twins had also
statisctically significant higher frequency of speech difficulties (P=0,045). Except for speech
retardation (P=0,033) and lower education level (P=0,045) in twins what made statictically
significant difference compared to control examinees all other observed parameters including
occurrence of epilepsy and other neurological diseases didn’t show statistically significant
difference between compared samples.
Discussion analizes the results in attempt to interpret and compare them with the results
from the literature. The subject of discussion is risk for appereance of neurological and cognitive
damage in children with very low birth weight what happens more often in prematurely born
children, especially frequent in twins. The retarded development of speech found in twins in this
research is compared with the similar findings in recent literature. The discussion turns back to
evolution of ADHD through adolescence to adult age trying to explain the differences in its
frequency in twins in childhood and in adult age. The need and importance of further ADHD
research is emphasized suggesting that this disorder should be rather understood as extreme
behavior which genetically varies through entire population than as disorder limited only to
persons who fulfill clinical criteria. Conclusions include the following facts: there is no statistically significant difference
between twins and controls in intelectuall functioning, frequency of ADHD and other problematic
behaviors in adult age as well as no difference in frequency of epilepsy and other neurological
diseases between what was expected by hypothesis. The research confirmed statistically significant
lower educational level in twins what can be explained by higher frequency of ADHD
symptoms in twins, lower levels of their verbal functioning, more frequent learning difficulties
and psychological problems than in controls although all followed parameters didn’t show
statistically significant difference
Novel ultrasound diagnostic index in confirmation of carpal tunnel syndrome
No full textUVOD: Kao komplementarna metoda u evaluaciji sindroma karpalnoga kanala (SKK) u kliničkoj
primjeni sve je zastupljenija procjena medijanog živca ultrazvukom (UZV). Unatoč brojnim
dosadašnjim istraživanjima s ciljem pronalaska optimalnog UZV parametra, do sada nije
istraživana mogućnost konstrukcije parametra veće složenosti koji bi imao bolja dijagnostička
svojstva. Cilj ovog istraživanja je utvrditi pruža li kompleksni indeks značajnu dijagnostičku
prednost u usporedbi s jednostavnijim parametrima.
METODE: U studiju je uključeno 88 pacijenata s SKK te 78 kontrolnih ispitanika. Svi pacijenti
podvrgnuti su kliničkom pregledu, neurofiziološkom testiranju te ultrazvučnom pregledu. U
sklopu UZV pregleda, medijani živac je mjeren na četiri anatomske razine. Iz pojedinačnih mjera
izvedeni su dvokomponentni parametri. Regresijskom analizom izračunat je i multikomponentni
indeks te su upotrebom ROC krivulja i vrijednosti AUC za sve parametre procijenjena njihova
dijagnostička svojstva.
REZULTATI: Između jednostavnih ultrazvučnih parametara CSA-I, CIR-I i CSA-O su imali najbolji
AUC (0.969, 0.958 i 0.934; p < 0.001), osjetljivost (89,8%, 90,9% i 84,1%; p < 0.001) i specifičnost
(96,2%, 91% i 88,5%; p < 0.001). Analiza dvokomponentnih parametara rezultirala je najvećim
AUC-om za IOM (0.984; p < 0.001) s dobrom osjetljivošću i odličnom specifičnosti (100%, p <
0.001). Kompleksni indeks utemeljen na regresijskim metodama imao je marginalno veći AUC
(0.989; p < 0.001) u usporedbi s prethodno spomenutim parametrima. ZAKLJUČAK: Prosječna transkarpalna površina presjeka (IOM) jednostavan je i pouzdan
parametar u potvrdi SKK. Složeni multikomponentni indeks utemeljen na regresijskim
metodama (UDICTS) pružio je još bolje dijagnostičke karakteristike u komparaciji s IOM u našem
uzorku. Zbog kompleksnosti izračuna UDICTS je vremenski zahtjevan, čineći time IOM
optimalnim parametrom za potvrdu sindroma karpalnoga kanala. ZAKLJUČAK: Prosječna transkarpalna površina presjeka (IOM) jednostavan je i pouzdan
parametar u potvrdi SKK. Složeni multikomponentni indeks utemeljen na regresijskim
metodama (UDICTS) pružio je još bolje dijagnostičke karakteristike u komparaciji s IOM u našem
uzorku. Zbog kompleksnosti izračuna UDICTS je vremenski zahtjevan, čineći time IOM
optimalnim parametrom za potvrdu sindroma karpalnoga kanala.INTRODUCTION: Ultrasound (US) is becoming an increasingly widespread complementary method in
evaluation of carpal tunnel syndrome (CTS) in a routine clinical practice. Although a large number of
studies have been done in order to find an optimal US parameter, to our knowledge, a possibility of
constructing a complex US parameter with potentially improved diagnostic value has not yet been
adressed. The aim of this research was to construct such a parameter and to compare it to previously
used US parameters to assess its potential diagnostical advantage.
METHODS AND PATIENTS: Eighty eight patients with CTS and 78 asymptomatic participants were
enrolled in the study. All participants went through clinical, neurophysiologic and ultrasound
examination. During US examination, median nerve (MN) was measured on 4 anatomical levels. Twolevel
parameters were derived from individual measures. Also, a multicomponent index was constructed
via regression analysis and diagnostical values of all US parameters were calculated by using ROC curves
and AUC values.
RESULTS: Among the simple US parameters CSA-I, CIR-I and CSA-O had the best AUCs (0.969, 0.958 i
0.934; p < 0.001), sensitivity (89,8%, 90,9% i 84,1%; p < 0.001) and specificity (96,2%, 91% i 88,5%; p <
0.001). Analysis of two-level parameters resulted in highest AUC for IOM (0.984; p < 0.001) with very
good sensitivity and excellent specificity (100%, p < 0.001). Complex, regression-based ultrasound index
yielded marginaly higher AUC (0.989; p < 0.001) compared to previously mentioned parameters. CONCLUSION: Mean transcarpal CSA (IOM) is a simple and a reliable parameter in confirmation of CTS.
Complex multicomponent regression-based index (UDICTS) provided in our sample even better
diagnostical characteristics compared to IOM. However, it is overly complicated to acquire and timeconsuming,
thus making the IOM an optimal US parameter in routine CTS confirmation
Novel ultrasound diagnostic index in confirmation of carpal tunnel syndrome
No full textUVOD: Kao komplementarna metoda u evaluaciji sindroma karpalnoga kanala (SKK) u kliničkoj
primjeni sve je zastupljenija procjena medijanog živca ultrazvukom (UZV). Unatoč brojnim
dosadašnjim istraživanjima s ciljem pronalaska optimalnog UZV parametra, do sada nije
istraživana mogućnost konstrukcije parametra veće složenosti koji bi imao bolja dijagnostička
svojstva. Cilj ovog istraživanja je utvrditi pruža li kompleksni indeks značajnu dijagnostičku
prednost u usporedbi s jednostavnijim parametrima.
METODE: U studiju je uključeno 88 pacijenata s SKK te 78 kontrolnih ispitanika. Svi pacijenti
podvrgnuti su kliničkom pregledu, neurofiziološkom testiranju te ultrazvučnom pregledu. U
sklopu UZV pregleda, medijani živac je mjeren na četiri anatomske razine. Iz pojedinačnih mjera
izvedeni su dvokomponentni parametri. Regresijskom analizom izračunat je i multikomponentni
indeks te su upotrebom ROC krivulja i vrijednosti AUC za sve parametre procijenjena njihova
dijagnostička svojstva.
REZULTATI: Između jednostavnih ultrazvučnih parametara CSA-I, CIR-I i CSA-O su imali najbolji
AUC (0.969, 0.958 i 0.934; p < 0.001), osjetljivost (89,8%, 90,9% i 84,1%; p < 0.001) i specifičnost
(96,2%, 91% i 88,5%; p < 0.001). Analiza dvokomponentnih parametara rezultirala je najvećim
AUC-om za IOM (0.984; p < 0.001) s dobrom osjetljivošću i odličnom specifičnosti (100%, p <
0.001). Kompleksni indeks utemeljen na regresijskim metodama imao je marginalno veći AUC
(0.989; p < 0.001) u usporedbi s prethodno spomenutim parametrima. ZAKLJUČAK: Prosječna transkarpalna površina presjeka (IOM) jednostavan je i pouzdan
parametar u potvrdi SKK. Složeni multikomponentni indeks utemeljen na regresijskim
metodama (UDICTS) pružio je još bolje dijagnostičke karakteristike u komparaciji s IOM u našem
uzorku. Zbog kompleksnosti izračuna UDICTS je vremenski zahtjevan, čineći time IOM
optimalnim parametrom za potvrdu sindroma karpalnoga kanala. ZAKLJUČAK: Prosječna transkarpalna površina presjeka (IOM) jednostavan je i pouzdan
parametar u potvrdi SKK. Složeni multikomponentni indeks utemeljen na regresijskim
metodama (UDICTS) pružio je još bolje dijagnostičke karakteristike u komparaciji s IOM u našem
uzorku. Zbog kompleksnosti izračuna UDICTS je vremenski zahtjevan, čineći time IOM
optimalnim parametrom za potvrdu sindroma karpalnoga kanala.INTRODUCTION: Ultrasound (US) is becoming an increasingly widespread complementary method in
evaluation of carpal tunnel syndrome (CTS) in a routine clinical practice. Although a large number of
studies have been done in order to find an optimal US parameter, to our knowledge, a possibility of
constructing a complex US parameter with potentially improved diagnostic value has not yet been
adressed. The aim of this research was to construct such a parameter and to compare it to previously
used US parameters to assess its potential diagnostical advantage.
METHODS AND PATIENTS: Eighty eight patients with CTS and 78 asymptomatic participants were
enrolled in the study. All participants went through clinical, neurophysiologic and ultrasound
examination. During US examination, median nerve (MN) was measured on 4 anatomical levels. Twolevel
parameters were derived from individual measures. Also, a multicomponent index was constructed
via regression analysis and diagnostical values of all US parameters were calculated by using ROC curves
and AUC values.
RESULTS: Among the simple US parameters CSA-I, CIR-I and CSA-O had the best AUCs (0.969, 0.958 i
0.934; p < 0.001), sensitivity (89,8%, 90,9% i 84,1%; p < 0.001) and specificity (96,2%, 91% i 88,5%; p <
0.001). Analysis of two-level parameters resulted in highest AUC for IOM (0.984; p < 0.001) with very
good sensitivity and excellent specificity (100%, p < 0.001). Complex, regression-based ultrasound index
yielded marginaly higher AUC (0.989; p < 0.001) compared to previously mentioned parameters. CONCLUSION: Mean transcarpal CSA (IOM) is a simple and a reliable parameter in confirmation of CTS.
Complex multicomponent regression-based index (UDICTS) provided in our sample even better
diagnostical characteristics compared to IOM. However, it is overly complicated to acquire and timeconsuming,
thus making the IOM an optimal US parameter in routine CTS confirmation
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