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001-es BibID:	BIBFORM029951
Első szerző:	Bereczki Dániel (neurológus)
Cím:	Mannitol use in acute stroke : case fatality at 30 days and 1 year / Bereczki D., Mihálka L., Szatmári S., Fekete K., Di Cesar D., Fülesdi B., Csiba L., Fekete I.
Dátum:	2003
ISSN:	0039-2499
Megjegyzések:	BACKGROUND AND PURPOSE: Mannitol is used worldwide to treat acute stroke, although its efficacy and safety have not been proven by randomized trials.METHODS:In a tricenter, prospective study, we analyzed the 30-day and 1-year case fatality with respect to mannitol treatment status in 805 patients consecutively admitted within 72 hours of stroke onset. Confounding factors were compared between treated and nontreated patients.RESULTS:Two thirds of the patients received intravenous mannitol as part of their routine treatment (mean dose, 47+/-22 g/d; mean duration, 6+/-3 days). The case fatality was 25% versus 16% (P=0.006) at 30 days and 38% versus 25% (P<0.001) at 1 year in the-mannitol treated and nontreated groups, respectively. Mannitol treatment effect was adjusted for age, stroke severity, fever in the first 3 days, and aspirin treatment (for ischemic strokes) in logistic regression models. Depending on the factors entered into the model, either no effect or harm could be attributed to mannitol. When the analysis was restricted to those admitted within 24 hours (n=568), case fatality differed significantly only at 1 year (35% in treated and 26% in nontreated patients, P=0.044). Although the prognostic scores of the Scandinavian Neurological Stroke Scale were similar in treated and nontreated patients, both in ischemic and hemorrhagic strokes, the patient groups differed in several factors that might also have influenced survival.CONCLUSIONS:Based on the results of this study, no recommendations can be made on the use of mannitol in acute stroke, and properly randomized, controlled trials should be performed to come to a final conclusion.
Tárgyszavak:	Orvostudományok Klinikai orvostudományok idegen nyelvű folyóiratközlemény külföldi lapban
Megjelenés:	Stroke. - 34 : 7 (2003), p. 1730-1735. -
További szerzők:	Mihálka László (1950-) (neurológus) Szatmári Szabolcs (1960-) (neurológus) Fekete Klára (1978-) (neurológus) Di Cesar, D. Fülesdi Béla (1961-) (aneszteziológus) Csiba László (1952-) (neurológus, pszichiáter) Fekete István (1951-) (neurológus, pszichiáter)
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001-es BibID:	BIBFORM010568
Első szerző:	Bereczki Dániel (neurológus)
Cím:	The Debrecen Stroke Database : demographic characteristics, risk factors, stroke severity and outcome in 8088 consecutive hospitalised patients with acute cerebrovascular disease / Bereczki D., Mihalka L., Fekete I., Valikovics A., Csepany T., Fulesdi B., Bajko Z., Szekeres C., Fekete K., Csiba L.
Dátum:	2009
Megjegyzések:	High stroke mortality in central-eastern European countries might be due to higher stroke incidence, more severe strokes or less effective acute care than in countries with lower mortality rate. Hospital databases usually yield more detailed information on risk factors, stroke severity and short-term outcome than population-based registries. Patients and methods The Debrecen Stroke Database, data of 8088 consecutively hospitalised patients with acute cerebrovascular disease in a single stroke centre in East Hungary between October 1994 and December 2006, is analysed. Risk factors were recorded and stroke severity on admission was scored by the Mathew stroke scale. The modified Glasgow outcome scale was used to describe patient condition at discharge. Results Mean age was 68713 years, 11.4% had haemorrhagic stroke. The rate of hypertension on admission was 79% in men, and 84% in women, 40.3%of men and 19.8%of women were smokers, and 34% of all patients had a previous cerebrovascular disease in their history. Case fatality was 14.9%, and 43% had some disability at discharge. Outcome at discharge was worse with higher age, higher glucose, higher blood pressure, higher white cell count and erythrocyte sedimentation rate and more severe clinical signs on admission. In multivariate analysis admission blood pressure lost its significance in predicting outcome. Conclusions In this large Hungarian stroke unit database hypertension on admission, smoking and previous cerebrovascular disease were more frequent than in most western databases. These findings indicate major opportunities for more efficient stroke prevention in this and probably other eastern European countries.
Tárgyszavak:	Orvostudományok Klinikai orvostudományok idegen nyelvű folyóiratközlemény külföldi lapban acute blood pressure cerebral haemorrhage epidemiology ischaemic stroke risk factors
Megjelenés:	International Journal of Stroke. - 4 : 5 (2009), p. 335-339. -
További szerzők:	Mihálka László (1950-) (neurológus) Fekete István (1951-) (neurológus, pszichiáter) Valikovics Attila Csépány Tünde (1956-) (neurológus, pszichiáter) Fülesdi Béla (1961-) (aneszteziológus) Bajkó Z. Szekeres C. Fekete Klára (1978-) (neurológus) Csiba László (1952-) (neurológus, pszichiáter)
Internet cím:	Intézményi repozitóriumban (DEA) tárolt változat DOI
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001-es BibID:	BIBFORM112426
Első szerző:	Galea, Ian
Cím:	Haptoglobin Treatment for Aneurysmal Subarachnoid Hemorrhage : Review and Expert Consensus on Clinical Translation / Galea Ian, Bandyopadhyay Soham, Bulters Diederik, Humar Rok, Hugelshofer Michael, Schaer Dominik J., SAH Delphi Group
Dátum:	2023
ISSN:	0039-2499
Megjegyzések:	Aneurysmal subarachnoid hemorrhage (aSAH) is a devastating form of stroke frequently affecting young to middle-aged adults, with an unmet need to improve outcome. This special report focusses on the development of intrathecal haptoglobin supplementation as a treatment by reviewing current knowledge and progress, arriving at a Delphi-based global consensus regarding the pathophysiological role of extracellular hemoglobin and research priorities for clinical translation of hemoglobin-scavenging therapeutics. After aneurysmal subarachnoid hemorrhage, erythrocyte lysis generates cell-free hemoglobin in the cerebrospinal fluid, which is a strong determinant of secondary brain injury and long-term clinical outcome. Haptoglobin is the body's first-line defense against cell-free hemoglobin by binding it irreversibly, preventing translocation of hemoglobin into the brain parenchyma and nitric oxide-sensitive functional compartments of cerebral arteries. In mouse and sheep models, intraventricular administration of haptoglobin reversed hemoglobin-induced clinical, histological, and biochemical features of human aneurysmal subarachnoid hemorrhage. Clinical translation of this strategy imposes unique challenges set by the novel mode of action and the anticipated need for intrathecal drug administration, necessitating early input from stakeholders. Practising clinicians (n=72) and scientific experts (n=28) from 5 continents participated in the Delphi study. Inflammation, microvascular spasm, initial intracranial pressure increase, and disruption of nitric oxide signaling were deemed the most important pathophysiological pathways determining outcome. Cell-free hemoglobin was thought to play an important role mostly in pathways related to iron toxicity, oxidative stress, nitric oxide, and inflammation. While useful, there was consensus that further preclinical work was not a priority, with most believing the field was ready for an early phase trial. The highest research priorities were related to confirming haptoglobin's anticipated safety, individualized versus standard dosing, timing of treatment, pharmacokinetics, pharmacodynamics, and outcome measure selection. These results highlight the need for early phase trials of intracranial haptoglobin for aneurysmal subarachnoid hemorrhage, and the value of early input from clinical disciplines on a global scale during the early stages of clinical translation.
Tárgyszavak:	Orvostudományok Klinikai orvostudományok idegen nyelvű folyóiratközlemény külföldi lapban folyóiratcikk subarachnoid hemorrhage haptoglobin
Megjelenés:	Stroke. - 54 : 7 (2023), p. 1930-1942. -
További szerzők:	Bandyopadhyay, Soham Bulters, Diederik Humar, Rok Hugelshofer, Michael Schaer, Dominik J. Fülesdi Béla (1961-) (aneszteziológus) Balla József (1959-) (belgyógyász, nephrológus) SAH Delphi Group
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001-es BibID:	BIBFORM038845
Első szerző:	Hoksbergen, Arjan W. J.
Cím:	Collateral configuration of the circle of Willis : transcranial colo r-coded duplex ultrasonography and comparison with postmortem anatomy / Hoksbergen, A. W. J., Fulesdi, B., Legemate, D. A., Csiba, L.
Dátum:	2000
ISSN:	0039-2499
Megjegyzések:	The anterior communicating artery (AcoA) and posterior communicating arteries (PcoA) of the circle of Willis provide the main route for collateral blood flow in cases of carotid artery obstruction. Transcranial color-coded duplex ultrasonography (TCCD) allows real-time measurement of the collateral function of the AcoA and PcoA. The primary objective of this study was to determine the collateral artery threshold diameters for supplying collateral flow. METHODS: In 12 acute stroke patients with a median age of 75 years (51 to 91 years), the collateral integrity of the circle of Willis as assessed by TCCD and carotid compression tests was compared with their postmortem anatomy. The lengths and diameters of the collateral arteries were measured. RESULTS: TCCD demonstrated absent anterior collateral flow in 3 patients. In 1 of these patients, absence of anterior cross-flow was due to an occluded anterior cerebral artery, which was revealed at autopsy. Absent posterior collateral flow was found in 14 hemispheres. In 2 of these hemispheres, autopsy revealed a fetal configuration of the posterior cerebral artery hampering posterior collateral flow. The median (range) diameters as found at autopsy of the functional (n=19) and nonfunctional (n=16) collateral arteries of the circle of Willis were 1.1 (0.4 to 2.0) and 0.5 (0.3 to 0.7) mm, respectively (P=0.003). PcoA diameters were found to correlate negatively (rho=-0. 50, P=0.01) to the diameters of their accessory P1 segments. CONCLUSIONS: The threshold diameter allowing for cross-flow through the primary collateral arteries of the circle of Willis is between 0. 4 and 0.6 mm.
Tárgyszavak:	Orvostudományok Klinikai orvostudományok idegen nyelvű folyóiratközlemény külföldi lapban
Megjelenés:	Stroke. - 31 : 6 (2000), p. 1346-1351. -
További szerzők:	Fülesdi Béla (1961-) (aneszteziológus) Legemate, D. Csiba László (1952-) (neurológus, pszichiáter)
Internet cím:	Intézményi repozitóriumban (DEA) tárolt változat DOI
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