University Hospital of Bratislava

Bratislava, Slovakia

University Hospital of Bratislava

Bratislava, Slovakia
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Schwarz P.,Copenhagen University | Body J.J.,Free University of Colombia | Cap J.,University of Hradec Kralove | Hofbauer L.C.,TU Dresden | And 10 more authors.
European Journal of Endocrinology | Year: 2014

Objective: Medical management of primary hyperparathyroidism (PHPT) is important in patients for whom surgery is inappropriate. We aimed to describe clinical profiles of adults with PHPT receiving cinacalcet. Design: A descriptive, prospective, observational study in hospital and specialist care centres. Methods: For patients with PHPT, aged 23-92 years, starting cinacalcet treatment for the first time, information was collected on dosing pattern, biochemistry and adverse drug reactions (ADRs). Initial cinacalcet dosage and subsequent dose changes were at the investigator's discretion. Results: Of 303 evaluable patients with PHPT, 134 (44%) had symptoms at diagnosis (mostly bone pain (58) or renal stones (50)). Mean albumin-corrected serum calcium (ACSC) at baseline was 11.4 mg/dl (2.9 mmol/l). The reasons for prescribing cinacalcet included: surgery deemed inappropriate (35%), patient declined surgery (28%) and surgery failed or contraindicated (22%). Mean cinacalcet dose was 43.9 mg/day (S.D., 15.8) at treatment start and 51.3 mg/day (31.8) at month 12; 219 (72%) patients completed 12 months treatment. The main reason for cinacalcet discontinuation was parathyroidectomy (40; 13%). At 3, 6 and 12 months from the start of treatment, 63, 69 and 71% of patients, respectively, had an ACSC of ≤10.3 mg/dl vs 9.9% at baseline. Reductions from baseline in ACSC of ≥1 mg/dl were seen in 56, 63 and 60% of patients respectively. ADRs were reported in 81 patients (27%), most commonly nausea. A total of 7.6% of patients discontinued cinacalcet due to ADRs. Conclusions: Reductions in calcium levels of ≥1 mg/dl was observed in 60% of patients 12 months after initiation of cinacalcet, without notable safety concerns. © 2014 European Society of Endocrinology


Balogova S.,LHopital Tenon AP HP | Balogova S.,University Hospital of Bratislava | Huchet V.,LHopital Tenon AP HP | Kerrou K.,LHopital Tenon AP HP | And 10 more authors.
Nuclear Medicine Communications | Year: 2010

Aim: Bronchioloalveolar (BAC) cancer is a source of false-negative F-fluorodeoxyglucose (FDG) PET/computed tomography (CT) results. A few studies reported better diagnostic performances with PET tracers of lipid metabolism, C-choline, or C-acetate, for the detection of well-differentiated adenocarcinoma or BAC. F-fluorocholine (FCH) is a lipid analogue for PET imaging, with advantages in terms of logistics and image resolution. We carried out this prospective pilot study to evaluate whether FCH PET/CT could detect lung cancer with a BAC component and could be more sensitive than FDG in this aim. Methods: Fifteen patients with a lung nodule or lesion suspected for BAC on CT and/or with a history of BAC had PET/CT 60-90min after 5MBq FDG/kg body mass and, on a separate day, 10-20min after 4MBq FCH/kg body mass. The standard of truth was histology and a 6-month follow-up. Results: Nine patients (12 lesions) presented BAC or adenocarcinoma with BAC features, two patients presented adenocarcinoma without BAC features (five lesions) and four patients presented benign lesions (15 non-malignant sites). For both FCH and FDG, patient-based sensitivity was 78% for detecting cancer with a BAC component and 82% for detecting malignancy. Site-based sensitivity for detecting malignancy was 76 and 75% for detecting cancer with BAC features, for both radiopharmaceuticals. Specificity was similar for FCH and FDG (site-based 93 vs. 81%, NS). In these early-stage cancers, only one adrenal metastasis was observed that took up FCH and FDG. Conclusion: In this population of patients with ground-glass opacities selected on CT suggestive of BAC or with a history of BAC and a recent lung anomaly on CT, FCH detected all malignant lesions with at least a 2.0cm short axis. However, FDG had similar performance. © 2010 Lippincott Williams & Wilkins, Inc.


Cavalli R.,Dermatology Unit | Novotna V.,University Hospital of Bratislava | Buffon R.B.,Dermatology Unit | Gelmetti C.,University of Milan
Giornale Italiano di Dermatologia e Venereologia | Year: 2013

Infantile hepatic hemangioma (IHH) is a common liver tumors of infancy with a higher incidence in females. Various treatments for infantile hepatic hemangioma such as systemic corticosteroids, interferon-alpha, vincristine and cyclophosphamide have been suggested, though no consensus exists about the first-choice treatment. Recent evidences suggest that propranolol, a nonselective β-blocker, may be effective and safe as first-line therapy for infantile hepatic hemangioma. We report a case of female bom at term with a weight of 2.450 g started to develop multiple cutaneous IHs at 10 days of age and presenting concomitant multiple cutaneous and hepatic infantile hemangiomas confirmed on magnetic resonance imaging. Propranolol, used as monotherapy, was started at 14 days of age at a dose of 2 mg/kg/day orally and maintained for 6 months. Patient was monitored in the hospital during first days of treatment with propranolol, and discharged after no side-effects were detected. Hepatic and cutaneous lesions had complete resolution in three months, although the fibro-fatty residuum of largest cutaneous nodule was still palpable at month 6. A further control after 6 months showed no recurrences. Our report case suggests that propranolol can be a safe and effective first-line therapy for neonates with concomitant multiple cutaneous and hepatic infantile hemangiomas.


Szarazova A.S.,University Hospital of Bratislava | Bartels E.,Center for Neurological Vascular Diagnostics | Turcani P.,University Hospital of Bratislava
Perspectives in Medicine | Year: 2012

The aim of this preliminary study is to evaluate the hypothesis of a possible causal link between the anatomical findings of vertebral artery hypoplasia (VAH) and the incidence of posterior circulation stroke. We used full ultrasonographic examination to evaluate patients with stroke in the vertebrobasilar circulation territory over a period of 1.5 years. The diameter equal or less than 2.5mm (in V1 and V2 segment of the vertebral artery) was set as a feature of vertebral artery hypoplasia. Magnetic resonance imaging and angiography (MRI and MRA) or computed tomography and angiography (CT and CTA) were performed to confirm the anatomic variation of hypoplasia and the site of the cerebral ischemic territory. In the group of 44 stroke patients, 9 (20%) had a hypoplastic vertebral artery and 35 (80%) were without VAH. Although vertebral artery hypoplasia in previously published literature is seldom shown as a leading risk factor for stroke in vertebrobasilar (posterior) circulation, its occurrence is not negligible and in coexistence with known risk factors of stroke may increase the negative clinical impact. Vertebral artery hypoplasia can be diagnosed non-invasively with duplex ultrasonography. It is therefore a useful method for detection of this anatomic variation and for follow-up examination. © 2012 Published by Elsevier GmbH.


Balogova S.,University Hospital of Bratislava | Cambal M.,Comenius University | Simkova A.,Comenius University | Kekenak L.,Comenius University | And 4 more authors.
Bratislava Medical Journal | Year: 2011

The impact of preoperative scintigraphy on the management of patients with primary hyperparathyroidism has been largely documented for more than two decades. More recently, preoperative scintigraphy has also been used to select patients for intraoperative detection of hyperfunctioning parathyroid glands thanks to a gamma-probe. This procedure is now widely used, with MIBI as the main radiopharmaceutical for both pre-operative scintigraphy and intraoperative detection. However MIBI was not available in Slovakia until very recently and tetrofosmin (TF), the alternative 99mTc labelled radiopharmaceutical for myocardial imaging has some advantages over MIBI and a close biological behaviour. Thus we have been using TF also for parathyroid preoperative scintigraphy and for intraoperative detection, a systematic indication which has never been reported by others. This article aims to demonstrate the feasibility and to present our protocol for TF parathyroid imaging and intraoperative detection, closely associating surgeons, nuclear medicine specialists, pathologists and also biologists as intraoperative assay of intact PTH is necessary.


Szarazova A.S.,University Hospital of Bratislava | Bartels E.,Center for Neurological Vascular Diagnostics | Bartels S.,University Hospital Freiburg | Turcani P.,University Hospital of Bratislava
Journal of Neuroimaging | Year: 2015

BACKGROUND: The clinical significance of vertebral artery hypoplasia (VAH) and the possible pathomechanism of ischemic stroke in patients with VAH are still not completely clear. METHODS: In a group of 80 posterior circulation strokes (PCS) patients, we compared the location of the ischemic areas in VAH (n = 26) and non-VAH (n = 54) group. We assessed the side of VAH (diameter equal to or less than 2.5mm) with the stroke localization. RESULTS: The possible morphological stroke pathomechanisms in the VAH group - "blood flow reorganization" (n = 11) and "pathway liberation for embolization" (n = 10) - were represented equally and may also act together (n = 3). In two cases, the stroke pathomechanism was unknown. The frequency of the presence of conventional risk factors - hypertension (p = 1.0), diabetes mellitus (p = 0.62), hyperlipidemia (p= 1.0) and smoking (p = 1.0) - and the stroke etiology - cardioembolism (p = 0.80), atherosclerotic changes of large (p = 0.76) and small vessels (p = 0.79) - did not differ between the two subgroups. CONCLUSION: In patients with VAH, the combination of several pathomechanisms of ischemic stroke and the contribution of several risk factors can cause the clinical manifestation of PCS. © 2014 by the American Society of Neuroimaging.


PubMed | University Hospital of Bratislava
Type: Journal Article | Journal: Bratislavske lekarske listy | Year: 2012

The impact of preoperative scintigraphy on the management of patients with primary hyperparathyroidism has been largely documented for more than two decades. More recently, preoperative scintigraphy has also been used to select patients for intraoperative detection of hyperfunctioning parathyroid glands thanks to a gamma-probe. This procedure is now widely used, with MIBI as the main radiopharmaceutical for both preoperative scintigraphy and intraoperative detection. However MIBI was not available in Slovakia until very recently and tetrofosmin (TF), the alternative 99mTc labelled radiopharmaceutical for myocardial imaging has some advantages over MIBI and a close biological behaviour. Thus we have been using TF also for parathyroid preoperative scintigraphy and for intraoperative detection, a systematic indication which has never been reported by others. This article aims to demonstrate the feasibility and to present our protocol for TF parathyroid imaging and intraoperative detection, closely associating surgeons, nuclear medicine specialists, pathologists and also biologists as intraoperative assay of intact PTH is necessary. The results of literature are subsequently reported and discussed (Tab. 2, Fig. 4, Ref. 35). Full Text in free PDF www.bmj.sk.

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