Biomedical subjects

F Kramár

Publications and source records attributed to F Kramár.

4 recordsLinked to original sources

PubMed2005

[Intracranial meningiomas--criteria for selection of the optimum therapeutic modality].

The authors present their own proposal for a standard diagnostic procedure algorithm in intracranial meningiomas, which they used in their prospective, non-randomized longitudinal study in a group of 30 subjects within a year. The following four criteria were assessed in each patient: age, physical condition according the ASA classification, location of the meningioma on the MRI (superficial, the scull base) and the growth invasivity using selective DSA (ACI+ACE) and MRI (the vascularization type, the oedema index and the change in the oedema signal intensity in 3.5 hours). The criteria helped to establish the optimum therapeutic procedure for each patient: embolisation without a follow-up surgery (2 subjects), observation (2 subjects), pre-operative embolisation (5 subjects) and surgery without preceeding embolisation (21 subjects). This study did not assess the intracranial meningiomas treatment outcome. It highlights significance of the diagnostic procedures standardization in order to establish their optimum therapeutic modality.

Adult↗

PubMed2004

Comparison between degree of carotid stenosis observed at angiography and in histological examination.

BACKGROUND: The generally accepted indications for carotid endarterectomy are the clinical picture and degree of per cent stenosis of the carotid artery. Despite the fact that stenosis measurement is defined, the methods vary considerably. The correlation of particular methods, especially angiography and duplex sonography, has been repeatedly demonstrated. However, the correlation between any technique and true anatomical stenosis, as evaluated on the surgical specimen, has been only anecdotally reported. METHOD: During carotid endarterectomy, the atherosclerotic plaque was removed in one piece and subsequently stored and histologically processed. The histological slides were evaluated under an optical microscope, scanned and the slide with maximum stenosis was determined using a planimetric program. Both the minimal lumen area and the area of the whole plaque were measured. The stenosis was calculated using the planimetric method. On the maximum stenosis slice, the minimal diameter and the diameter of the whole plaque were also measured. Angiographic images were scanned and the per cent stenoses were remeasured, according to the NASCET and ECST criteria. In total, of 147 cases, all above-mentioned parameters were obtained. Student's t tests for paired samples were used to evaluate the results. FINDINGS: The t-tests indicated significant differences between the per cent stenosis as measured on the anatomical specimen and on the angiogram (p<0.05). The results indicate that the angiographic measurement underestimates the degree of in-situ anatomical stenosis. The underestimation was more marked the less the degree of stenosis. CONCLUSIONS: Our study finds that per cent stenosis measurement obtained by angiography with NASCET or ECST methods does not reliably reflect the anatomical degree of per cent stenosis, which makes questionable the rigorous following of percentage stenosis using angiography as the sole indicator for carotid endarterectomy in all cases.

Algorithms↗

PubMed2001

[Doppler scanning in aneurysm surgery].

Subarachnoid hemorrhage still represents important medical problem, from both, ineffective prevention and high morbidity and mortality rate of the condition. On the other hand, majority of patients who survive initial hemorrhage and successful clipping of their aneurysm can live without major medical restrictions. Apart from surviving the initial attack the most important condition is properly clipped aneurysm. Doppler scanning control allows precise placement of the clip on the neck of an aneurysm. Since January 1997 through December 1999 the authors have surgically treated 204 aneurysms in 181 patient. In 40 surgeries the Doppler scanning was employed after the aneurysm complex was dissected free. Using 20 MHz PW Doppler probe the flow within the aneurysm and in the involved arteries was measured (usual depth 1.5 mm, range 1-2.5 mm). After the clipping the flow was evaluated again, to ensure proper exclusion of an aneurysm and good flow in involved arteries. The authors consider the Doppler scanning to be important technical aid in aneurysm surgery, especially in anatomically complex situations.

Cerebrovascular Circulation↗

PubMed2001

[Anterior cervical corpectomy in the treatment of multilevel degenerative stenoses with spondylotic myelopathy. Personal experience with therapy and a literature review].

The authors use as a basis experience with a group of 389 patients operated in 1989-1997 on account of degenerative diseases of the cervical spine with neurological manifestations. The results are compared with experience assembled in 1998-1999. In the new group (188 patients with the same diagnosis) the same indication criteria were used but in case of myelopathy associated with multisegmetal cervical stenosis not only multilevel discectomy was performed (as in the previous group) but in addition also 1-3 segmental corpectomy (somatectomy). The results were evaluated separately for both methods used. The authors emphasize the necessity of a radical approach during decompression of neurological structures incl. removal of uncovertebral osteophytes which must be combined with suitable stabilization of the fusions or possibly be supported by instrumentation. In the discussion the authors illustrate in the form of a review the development of anterior cervical corpectomy as one of the methods of an anterior approach to the cervical spine used at first in traumatic and oncological conditions, later extended to operations on account of degenerative, dysplastic conditions and other diseases. The authors wish to help to define criteria for application of corpectomy when treating stenoses of the spinal canal in the cervical region. The indication will be defined in a perspectively followed up group where a detailed clinical and electrophysiological algorithm for examination was submitted as well as postoperative follow-up and processing of the resulting data.

Bone Transplantation↗