Procjena cerebrovaskularne bolesti magnetskom rezonancijom mozga i magnetskom angiografijom

Magnetic resonance imaging (MRI) is an important imaging technique for evaluation of cerebral ischemic changes. Using magnetic resonance angiography (MRA), both large and medium sized intracranial arteries and veins can be visualized by selecting appropriate imaging parameters. The aim of this retrospective study was to evaluate our own results in the diagnosis of cerebrovascular diseases with MRI and MRA, and to compare them with literature data. Data on 278 patients with cerebrovascular symptomatology (158 female and 120 male, mean age 45-54 years), examined between April 2001 and November 2002, were analyzed. MRA was performed in all 278 and both MRA and MRI in 231 patients. On MRA, 90 pathologic alterations of intracranial arteries (69 aneurysms and 21 vascular malformations), 13Rintracranial arterial occlusions, 19 intracranial arterial stenoses, and 14 cases of intracranial arteriosclerotic changes were identified. On MRI, 114 strokes (73 brain infarctions, 22 cerebral hemorrhages and 19 sub-arachnoid hemorrhages), 14 vascular malformations and 14 cases of small vessel disease were detected. MRI was found to be a powerful tool to detect ischemic lesions immediately upon stroke onset. MRA is highly sensitive for the detection of occlusive disease in large intracranial arteries. For cerebral venous and sinus thrombosis, MRI and MRA are first line studies. MRA of extracranial and intracranial vessels alone or in combination with transcranial color-coded duplex sonography (TCCD) as well as computed tomography angiography (CTA) may eliminate the need of intra-arterial digital subtraction angiography (DSA) in most patients studied for occlusive cerebrovascular disease. DSA may be reserved for those patients in whom there is a disagreement among the results obtained by use of noninvasive techniques, and for the diagnosis of arteriovenous malformations, whereas MRA can prove useful on follow-up examinations.Magnetska rezonancija (MR) mozga je važna tehnika prikazivanja u procjeni ishemijskih promjena moždanoga parenhima. Magnetskom angiografijom (MRA) se birajući odgovarajuće parametre prikaza mogu pokazati i velike i male intrakranijske arterije i vene. Cilj ove retrospektivne studije bila je procjena vlastitih rezultata u dijagnostici cerebrovaskularnih bolesti pomoću MR mozga i MRA, te njihova usporedba s literaturnim podacima. Analizirani su podaci 278 bolesnika (158 žena i 120 muškaraca srednje životne dobi od 45,54 godine), koji su bili pregledani u razdoblju od travnja 2001. do studenoga 2002. Učinjeno je 278 postupaka MRA, a u 231 bolesnika učinjena je i MR mozga. MRA je otkrila 88 patološki promijenjenih intrakranijskih krvnih žila (69 aneurizma i 21 vaskularnu malformaciju), 13 okluzija intrakranijskih arterija, 19 stenoza intrakranijskih arterija, te 14 slučajeva arteriosklerotskih promjena intrakranijskih arterija. MR mozga otkrila je 114 cerebrovaskularnih inzulta (73 cerebralne ishemije, 22 intracerebralne hemoragije i 19 subarahnoidnih hemoragija), 14 vaskularnih malformacija, te 14 slučajeva "patologije malih krvnih žila". MR mozga je moćno sredstvo u otkrivanju ishemijskih promjena neposredno nakon nastupa moždanog inzulta. RMRA ima visoku osjetljivost za otkrivanje okluzivne bolesti velikih intrakranijskih arterija. MR mozga i MRA su osnovne pretrage za dijagnozu tromboze moždanih vena i sinusa. Samo se pomoću MRA ekstrakranijskih i intrakranijskih krvnih žila ili u kombinaciji s obojenom dupleks sonografijom krvnih žila glave i vrata (TCCD) te kompjutoriziranom tomografijskom angiografijom (CTA) može isključiti potreba za intraarterijskom digitalnom subtrakcijskom angiografijom (DSA) u većine bolesnika pregledanih zbog okluzivne cerebrovaskularne bolesti. DSA može biti rezervirana za one bolesnike kod kojih postoji neslaganje između nalaza neinvazivnih metoda pregleda, te za dijagnozu arteriovenskih malformacija, dok se MRA može rabiti za daljnje praćenje

Singular limit for the compressible Navier--Stokes equations with the hard sphere pressure law on expanding domains

The article is devoted to the asymptotic limit of the compressible Navier-Stokes system with a pressure obeying a hard--sphere equation of state on a domain expanding to the whole physical space $R^3$. Under the assumptions that acoustic waves generated in the case of ill-prepared data do not reach the boundary of the expanding domain in the given time interval and a certain relation between the Reynolds and Mach numbers and the radius of the expanding domain, we prove that the target system is the incompressible Euler system on $R^3$. We also provide an estimate of the rate of convergence expressed in terms of characteristic numbers and the radius of domains

Panhipopituitarizam u 45-godišnje bolesnice: prikaz slučaja

A case of a 45-year-old woman with untreated panhypopituitarism is presented. Hypopituitarism is a rare disorder consisting of multiple deficiencies of hormones originating from the adenohypophysis. It is divided into primary and secondary. Primary disorders manifest at the pituitary level, whereas secondary hypopituitarism implies hypothalamic affection. Partial or total loss of all pituitary hormones is called panhypopituitarism. Hypopituitarism can be slow and insidious or severe and life-threatening. The expression of symptoms largely depends on the patient\u27s age and the hormones involved. The leading symptom is growth retardation when the disorder develops in childhood or puberty. Sometimes years may elapse without accurate diagnosis, as in the case described. To date, only a few cases of untreated hypopituitarism have been published. In our patient, clinical examination revealed short stature and weak osteomuscular constitution, primary amenorrhea and lack of development of secondary sex characteristics. The patient\u27s clinical history revealed signs of hypopituitarism from childhood, which had been untreated until she presented to our clinic. The results of complete testing showed the lack of all pituitary hormones and antidiuretic hormone, which was consistent with panhypopituitarism, including central diabetes insipidus.Prikazuje se slučaj 45-godišnje bolesnice s neliječenim panhipopituitarizmom. Hipopituitarizam je rijedak poremećaj koji obilježava manjak više hormona prednjega režnja hipofize. Može biti primaran ili sekundaran. Primarni poremećaji nastaju na razini hipofize, dok su sekundarni na razini hipotalamusa. Djelomičan ili potpun manjak svih hormona hipofize naziva se panhipopituitarizam. Tijek hipopituitarizma može biti spor i podmukao ili nagao i životno ugrožavajući. Izražajnost simptoma ovisi prvenstveno o dobi bolesnika te zahvaćenim hormonima. Vodeći simptom je zaostajanje u rastu, kada bolest zahvati bolesnika u djetinjstvu ili pubertetu. Ponekad može proći niz godina bez potpune dijagnoze, kao što je opisano i u naše bolesnice. Do danas je objavljeno svega nekoliko slučajeva neliječenog hipopituitarizma. Kliničkim pregledom naše bolesnice nađen je nizak rast i slaba osteomuskularna građa, primarna amenoreja i nerazvijene sekundarne spolne značajke. Anamnestički podaci otkrivaju sliku hipopituitarizma od dječje dobi, ali bolesnica nije liječena do dolaska u našu kliniku. Rezultati sveobuhvatne obrade pokazali su manjak svih hormona hipofize i antidiuretičnog hormona, što govori u prilog panhipopituitarizma, uključujući i centralni dijabetes insipidus