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001-es BibID:	BIBFORM042395
Első szerző:	Fülesdi Béla (aneszteziológus)
Cím:	Impairment of cerebrovascular reactivity in long-term type 1 diabetes / Fulesdi, B., Limburg, M., Bereczki, D., Michels, R. P., Neuwirth, G., Legemate, D., Valikovics, A., Csiba, L.
Dátum:	1997
ISSN:	0012-1797
Megjegyzések:	The early preclinical detection of cerebrovascular complications in individuals with diabetes is one of the goals of care described in the St. Vincent Declaration. In accordance with this goal, the aim of the present work was to investigate whether altered cerebral microvascular function in patients suffering from type 1 diabetes can be detected with a transcranial Doppler probe after the administration of acetazolamide. A total of 72 type 1 diabetic patients and 40 healthy control subjects entered the study. Patients were divided into two groups: those with long-term diabetes (disease duration of >10 years, n = 37) and those with short-term diabetes (disease duration of < or =10 years, n = 35). Mean blood-flow velocity in the middle cerebral artery (MCAV) was measured at rest and at 5, 10, 15, and 20 min after intravenous administration of 1 g acetazolamide with a transcranial Doppler probe and expressed as the percentage change from the pretest measurement. The percentage increase in MCAV (cerebrovascular reactivity) was calculated at each time point and compared between the groups. Cerebrovascular reserve capacity (CRC), expressed as the maximal percentage increase of the MCAV, was compared between the groups. Additionally, a reproducibility study of CRC was performed in 10 patients, using intraclass correlations. Cerebrovascular reactivity in the long-term diabetes group was lower (means +/- SD: 5 min, 23.4 +/- 15.4%; 10 min, 28.8 +/- 17.0%; 15 min, 30.0 +/- 15.6%; 20 min, 24.2 +/- 17.8%) than that of the control subjects (5 min, 43.5 +/- 23.9%; 10 min, 55.3 +/- 24.0%; 15 min, 56.7 +/- 23.8%; 20 min, 54.8 +/- 25.9%) and the short-term diabetic patients (5 min, 43.6 +/- 25.9%; 10 min, 52.2 +/- 27.7%; 15 min, 55.3 +/- 32.2%; 20 min, 45.8 +/- 35.8%). CRC was lower in the long-term diabetes group than in the control group or the short-term diabetes group. Impairment of cerebrovascular reactivity was associated with retino- and nephropathy and increased levels of fibrinogen. In contrast, CRC was independent from actual glucose, insulin, glycosylated hemoglobin, von Willebrand factor antigen, and alpha-2 macroglobulin levels. Transcranial Doppler measurements of the changes in MCAV after stimulation with acetazolamide can detect altered cerebral microvascular function in patients with diabetes. Cerebrovascular reactivity and reserve capacity are reduced in patients with long-term diabetes. Further prospective studies should delineate the clinical significance of our results.
Tárgyszavak:	Orvostudományok Klinikai orvostudományok idegen nyelvű folyóiratközlemény külföldi lapban
Megjelenés:	Diabetes. - 46 : 11 (1997), p. 1840-1845. -
További szerzők:	Limburg, Martien Bereczki Dániel (1960-) (neurológus) Michels, R. P. J. Neuwirth Gyula Legemate, D. Valikovics Attila Csiba László (1952-) (neurológus, pszichiáter)
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001-es BibID:	BIBFORM057003
Első szerző:	Hoksbergen, Arjan W. J.
Cím:	Absent Collateral Function of the Circle of Willis as Risk Factor for Ischemic Stroke / A. W. J. Hoksbergen, D. A. Legemate, L. Csiba, G. Csati, P. Siro, B. Fulesdi
Dátum:	2003
ISSN:	1015-9770
Megjegyzések:	Background: Autopsy studies show a higher prevalence of circle of Willis anomalies in brains with signs of ischemic infarction. Our goal was to examine the collateral function of the circle of Willis in ischemic stroke patients and to assess in a case-control study if a collateral deficient circle of Willis is a risk factor for ischemic stroke in patients with severe internal carotid artery (ICA) occlusive disease. Methods: Our case-control study included 109 patients with an acute ischemic stroke in the anterior circulation and 113 patients with peripheral arterial disease and no known history of cerebral ischemia. The collateral function of the anterior and posterior communicating arteries of the circle of Willis was assessed by means of transcranial color-coded duplex ultrasonography (TCCD) and carotid compression tests. Results: TCCD was successfully performed in 75 case patients (mean age 64 years, range 41-91 years) and in 100 control patients (mean age 61 years, range 35-89 years). In 26 cases and 19 controls, a ? 70% stenosis or occlusion of the ICA was found. A nonfunctional anterior collateral pathway in the circle of Willis was found in 33% of the cases and in 6% of the controls (p < 0.001). The posterior collateral pathway was nonfunctional in 57% of the cases and in 43% of the controls (p = 0.02). In patients with severe ICA occlusive disease, the odds ratios of a nonfunctional anterior and a nonfunctional posterior collateral pathway were 7.33 (95% confidence interval, CI, = 1.19-76.52) and 3.00 (95% CI = 0.77-12.04), respectively. Conclusions: Patients who suffer ischemic stroke in the anterior circulation have a higher incidence of collateral deficient circles of Willis than those with atherosclerotic vascular disease without ischemic cerebrovascular disease. The presence of a nonfunctional anterior collateral pathway in the circle of Willis in patients with severe ICA occlusive disease is strongly associated with ischemic stroke.
Tárgyszavak:	Orvostudományok Klinikai orvostudományok idegen nyelvű folyóiratközlemény külföldi lapban Cerebral ischemia Circle of Willis Collateral circulation Transcranial ultrasound
Megjelenés:	Cerebrovascular Diseases. - 16 : 3 (2003), p. 191-198. -
További szerzők:	Legemate, D. Csiba László (1952-) (neurológus, pszichiáter) Csáti Géza Siró Péter (1973-) (neurológus, aneszteziológus, intenzív terápiás szakorvos) Fülesdi Béla (1961-) (aneszteziológus)
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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)
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001-es BibID:	BIBFORM042398
Első szerző:	Settakis, George
Cím:	Acetazolamide as a vasodilatory stimulus in cerebrovascular diseases and in conditions affecting the cerebral vasculature / Settakis, G., Molnar, C., Kerenyi, L., Kollar, J., Legemate, D., Csiba, L., Fulesdi, B.
Dátum:	2003
ISSN:	1351-5101
Megjegyzések:	Pathologic processes affecting the brain vessels may damage cerebral vasodilatory capacity. Early detection of cerebral dysfunction plays an important role in the prevention of cerebrovascular diseases. In recent decades acetazolamide (AZ) has frequently been used for this purpose. In the present work the mechanism of action and the previous studies are reviewed. The authors conclude that AZ tests are useful in cerebrovascular research. Further investigations are recommended to prove how impaired reserve capacity and reactivity influence the stroke risk in patients and whether these tests may indicate therapeutic interventions.
Tárgyszavak:	Orvostudományok Klinikai orvostudományok idegen nyelvű folyóiratközlemény külföldi lapban
Megjelenés:	European Journal Of Neurology. - 10 : 6 (2003), p. 609-620. -
További szerzők:	Molnár Csilla (1962-) (aneszteziológus) Kerényi Levente Kollár József (1950-) (radiológus) Legemate, D. Csiba László (1952-) (neurológus, pszichiáter) Fülesdi Béla (1961-) (aneszteziológus)
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