Krešimir Dolić | University of Split, Croatia (original) (raw)

Papers by Krešimir Dolić

Biomedicines

Acute ischemic stroke (AIS) is the world’s second leading cause of mortality. An established meth... more Acute ischemic stroke (AIS) is the world’s second leading cause of mortality. An established method for treating stroke patients in acute settings is endovascular therapy (EVT). However, the correlation of the successful endovascular treatment of AIS with the presence of communicating arteries in the circle of Willis needs to be proven. Our study examined clinical and radiological data of 158 consecutive patients treated with mechanical thrombectomy (MT) at our comprehensive stroke center. We analyzed their CT angiograms and digital subtraction angiography (DSA) to assess anatomical variants of Willis’ circle and formed two groups—collateral-negative and collateral-positive group. The first group included patients with aplasia of both anterior (ACoA) and posterior communicating Artery (PCoA). The second group included patients that have at least one communicating artery (either anterior or posterior). We evaluated their reperfusion outcomes and functional recovery three months later...

Biomedicines, Jul 20, 2023

This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY

American Journal of Neuroradiology, Dec 22, 2011

BACKGROUND AND PURPOSE:Chronic cerebrospinal venous insufficiency (CCSVI) is a vascular condition... more BACKGROUND AND PURPOSE:Chronic cerebrospinal venous insufficiency (CCSVI) is a vascular condition characterized by anomalies of the main extracranial cerebrospinal venous routes that interfere with normal venous outflow. Research into CCSVI will determine its sensitivity and specificity for a diagnosis of MS, its prevalence in MS patients, and its clinical, MRI, and genetic correlates. Our aim was to investigate the prevalence and number of intra- and extraluminal structural and functional extracranial venous abnormalities by using DS and MRV, in patients with MS and HCs.MATERIALS AND METHODS:One hundred fifty patients with MS, 104 (69.3%) with RR and 46 (30.7%) with a progressive MS course, and 63 age- and sex-matched HCs were scanned with 3T MR imaging by using TOF and TRICKS sequences (only patients with MS). All subjects underwent DS examination for intra- and extraluminal structural and functional abnormalities of the IJVs. Absent/pinpoint IJV flow morphology on MRV was considered an abnormal finding. Prominence of collateral extracranial veins was assessed with MRV.RESULTS:Patients with MS had a significantly higher number of functional (P < .0001), total (P = .001), and intraluminal (P = .005) structural IJV DS abnormalities than HCs. There was a trend for more patients with MS with extraluminal IJV DS abnormalities (P = .023). No significant differences were found on the MRV IJV flow morphology scale between patients with MS and HCs. Patients with progressive MS showed more extraluminal IJV DS abnormalities (P = .01) and more MRV flow abnormalities on TOF (P = .006) and TRICKS (P = .01) than patients with nonprogressive MS. There was a trend for a higher number of collateral veins in patients with MS than in HCs (P = .016).CONCLUSIONS:DS is more sensitive than MRV in detecting intraluminal structural and functional venous abnormalities in patients with MS compared with HCs, whereas MRV is more sensitive in showing collaterals.

Neurology, Jun 27, 2014

Objective: We report the results of the investigation of safety and efficacy of venous angioplast... more Objective: We report the results of the investigation of safety and efficacy of venous angioplasty in patients with multiple sclerosis (MS) with findings of extracranial venous anomalies, considered hallmarks of chronic cerebrospinal venous insufficiency (CCSVI), in a 2-phase study (ClinicalTrials.gov NCT01450072). Methods: Phase 1 was an open-label safety study (10 patients); phase 2 was sham-controlled, randomized, and double-blind (10 sham procedure, 9 treated). All study patients fulfilled venous hemodynamic screening criteria indicative of CCSVI. Assessment was at 1, 3, and 6 months postprocedure with MRI, clinical, and hemodynamic outcomes. Primary endpoints were safety at 24 hours and 1 month, venous outflow restoration .75% at 1 month, and effect of angioplasty on new lesion activity and relapse rate over 6 months. Secondary endpoints included changes in disability, brain volume, cognitive tests, and quality of life. Results: No perioperative complications were noted; however, one patient with history of syncope was diagnosed with episodic bradycardia requiring placement of a pacemaker before discharge. Doppler evidence-based venous hemodynamic insufficiency severity score (VHISS) was reduced .75% compared to baseline in phase 1 (at 1 month) but not phase 2. In phase 2, higher MRI activity (cumulative number of new contrast-enhancing lesions [19 vs 3, p 5 0.062] and new T2 lesions [17 vs 3, p 5 0.066]) and relapse activity (4 vs 1, p 5 0.389) were identified as nonsignificant trends in the treated vs sham arm over 6 months. Using analysis of covariance, significant cumulative new T2 lesions were related to larger VHISS decrease (p 5 0.028) and angioplasty (p 5 0.01) over the follow-up. No differences in other endpoints were detected. Conclusion: Venous angioplasty is not an effective treatment for MS over the short term and may exacerbate underlying disease activity. Classification of evidence: This is a Class I study demonstrating that clinical and imaging outcomes are no better or worse in patients with MS identified with venous outflow restriction who receive venous angioplasty compared to sham controls who do not receive angioplasty. This study also includes a Class IV phase 1 study of safety in 10 patients receiving the angioplasty procedure.

PLOS ONE, Nov 30, 2011

Background: The role of intra-and extra-cranial venous system impairment in the pathogenesis of v... more Background: The role of intra-and extra-cranial venous system impairment in the pathogenesis of various vascular, inflammatory and neurodegenerative neurological disorders, as well as in aging, has not been studied in detail. Nor have risk factors been determined for increased susceptibility of venous pathology in the intra-cranial and extra-cranial veins. The aim of this study was to investigate the association between presence of a newly proposed vascular condition called chronic cerebrospinal venous insufficiency (CCSVI) and environmental factors in a large volunteer control group without known central nervous system pathology. Methods and Findings: The data were collected in a prospective study from 252 subjects who were screened for medical history as part of the entry criteria and participated in the case-control study of CCSVI prevalence in multiple sclerosis (MS) patients, and then were analyzed post-hoc. All participants underwent physical and Doppler sonography examinations, and were assessed with a structured environmental questionnaire. Fullfilment of $2 positive venous hemodynamic (VH) criteria on Doppler sonography was considered indicative of CCSVI diagnosis. Risk and protective factors associated with CCSVI were analyzed using logistic regression analysis. Seventy (27.8%) subjects presented with CCSVI diagnosis and 153 (60.7%) presented with one or more VH criteria. The presence of heart disease (p = .001), especially heart murmurs (p = .007), a history of infectious mononucleosis (p = .002), and irritable bowel syndrome (p = .005) were associated with more frequent CCSVI diagnosis. Current or previous smoking (p = .029) showed a trend for association with more frequent CCSVI diagnosis, while use of dietary supplements (p = .018) showed a trend for association with less frequent CCSVI diagnosis. Conclusions: Risk factors for CCSVI differ from established risk factors for peripheral venous diseases. Vascular, infectious and inflammatory factors were associated with higher CCSVI frequency.

Expert Review of Neurotherapeutics, Sep 1, 2011

Chronic cerebrospinal venous insufficiency (CCSVI) was recently described in multiple sclerosis p... more Chronic cerebrospinal venous insufficiency (CCSVI) was recently described in multiple sclerosis patients. CCSVI is characterized by impaired brain venous drainage due to outflow obstruction in the extracranial venous system, mostly related to anomalies in the internal jugular and azygos veins. The current CCSVI diagnosis is based on Doppler sonography of extracranial and transcranial venous hemodynamics criteria. To date, prevalence estimates of CCSVI, provided by different groups using various imaging methods of assessment, vary widely from none to 100%. There is an urgent need to define and validate the spectrum of cranial/extracranial venous anomalies and to establish reliable, diagnostic gold-standard test(s). The potential usefulness of endovascular treatment for CCSVI in multiple sclerosis patients is still unknown.

Purpose: The objective of this study was to present our experience with CT perfusion (CTP) compar... more Purpose: The objective of this study was to present our experience with CT perfusion (CTP) compared to noncontrast CT (NCCT) in early diagnosis of acute ischemic stroke at University Hospital Split and to determine the value of these diagnostic procedures in assesment of adequate thrombolytic therapy. Methods and materials: 87 consecutive patients with acute ischaemic stroke within 3 hours of onset of symptoms underwent Stroke protocol that included NCCT, CTP and MSCTA (MSCT Sensation 16 Siemens, Germany). We used 200 ml of nonionic intravenous contrast media iopamidol 370 at an injection rate of 10, 0 ml/s. Patients with confirmed presence of an ischemic penumbra recieved thrombolytic therapy (Alteplase). Results: Ischemic stroke was confirmed in 78, 1% patients who were admitted with stroke symptoms to our emergency department. CTP was significantly superior to NCCT in depicting ischemic stroke (41 patients diagnosed with NCCT, in comparison to 68 with CTP, p= 0, 008). In 27 cases with negative NCCT there were signs of ischemic stroke on CTP, and 16 of patients with significant penumbra received thrombolytic therapy. NCCT sensitivity (taking CTP as the reference method) was 60, 3%. The accuracy of this method was 69%. Negative predictive value of NCCT in comparison to CTP was 41%. Conclusion: CTP is a sensitive tool for identifying early signs of ischemia and it should be done regulary in patients presenting with acute ischemic stroke symptoms. It is crucial in determining whether the thrombolysis is appropriate by estimating ischemic penumbra and infarct core.

Bratislavské lekárske listy, 2008

We report a rare case of a patient with late onset of Chiari I malformation with associated syrin... more We report a rare case of a patient with late onset of Chiari I malformation with associated syringomyelia that was successfully treated with foramen magnum decompression. Our patient is presenting initially with vertigo and gradual weakening of the left-hand gross motor ability, gradual hypesthesia. Magnetic resonance imaging demonstrated a Chiari I malformation with syringomyelia. Posterior fossa decompression, C1 laminectomy and duroplasty were performed. After surgery, the vertigo completely resolved (Fig. 2, Ref. 13). Full Text (Free, PDF) www.bmj.sk.

Sustainability, Jun 14, 2023

This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY

Neuroradiology, Aug 2, 2014

Introduction Conventional magnetic resonance imaging (MRI) techniques are insufficient to determi... more Introduction Conventional magnetic resonance imaging (MRI) techniques are insufficient to determine the causative agent of brain abscesses. We investigated: (1) the value of susceptibility-weighted MR sequences (SWMRS) in the differentiation of fungal and pyogenic brain abscesses; and (2) the effect of different SWMRS (susceptibility-weighted imaging (SWI) versus venous blood oxygen level dependent (VenoBOLD)) for the detection of specific imaging characteristics of pyogenic brain abscesses. Methods We studied six patients with fungal and ten patients with pyogenic brain abscesses. Imaging characteristics on conventional MRI, diffusion-weighted imaging (DWI) and SWMRS were recorded in all abscesses. All lesions were assessed for the presence of a "dual-rim sign" on SWMRS. Results Homogenously hyperintense lesions on DWI were present in 60 % of patients with pyogenic abscesses, whereas none of the patients with fungal abscesses showed such lesions. On SWMRS, 90 % of patients with pyogenic abscesses and 60 % of patients with fungal abscesses had only lesions with a low-signal-intensity rim. On SWI, the dual-rim sign was apparent in all pyogenic abscesses. None of the fungal abscesses on SWI (P=0.005) or any of the pyogenic abscesses on VenoBOLD (P=0.005) were positive for a dual-rim sign. Conclusions In fungal abscesses, the dual-rim sign is not present but a prominent peripheral rim or central susceptibility effects on SWI will be seen. The appearance of pyogenic abscesses on SWMRS depends on the used sequence, with the dual-rim sign a specific feature of pyogenic brain abscesses on SWI.

Biomedicine & Pharmacotherapy

Reviews in Cardiovascular Medicine

Background: The need for computed tomography pulmonary angiography (CTPA) to rule out pulmonary e... more Background: The need for computed tomography pulmonary angiography (CTPA) to rule out pulmonary embolism (PE) is based on clinical scores in association with D-dimer measurements. PE is a recognized complication in patients with SARS-CoV-2 infection due to a pro-thrombotic state which may reduce the usefulness of preexisting pre-test probability scores. Aim: The purpose was to analyze new clinical and laboratory parameters while comparing existing and newly proposed scoring system for PE detection in hospitalized COVID-19 patients (HCP). Methods: We conducted a retrospective study of 270 consecutive HCPs who underwent CTPA due to suspected PE. The Modified Wells, Revised Geneva, Simplified Geneva, YEARS, 4-Level Pulmonary Embolism Clinical Probability Score (4PEPS), and PE rule-out criteria (PERC) scores were calculated and the area under the receiver operating characteristic curve (AuROC) was measured. Results: Overall incidence of PE among our study group of HCPs was 28.1%. The group of patients with PE had a significantly longer COVID-19 duration upon admission, at 10 vs 8 days, p = 0.006; higher D-dimer levels of 10.2 vs 5.3 µg/L, p < 0.001; and a larger proportion of underlying chronic kidney disease, at 16% vs 7%, p = 0.041. From already established scores, only 4PEPS and the modified Wells score reached statistical significance in detecting the difference between the HCP groups with or without PE. We proposed a new chronic kidney disease, D-dimers, 10 days of illness before admission (CDD-10) score consisting of the three aforementioned variables: C as chronic kidney disease (0.5 points if present), D as D-dimers (negative 1.5 points if normal, 2 points if over 10.0 µg/L), and D-10 as day-10 of illness carrying 2 points if lasting more than 10 days before admission or 1 point if longer than 8 days. The CDD-10 score ranged from-1.5 to 4.5 and had an AuROC of 0.672, p < 0.001 at cutoff value at 0.5 while 4PEPS score had an AuROC of 0.638 and Modified Wells score 0.611. The clinical probability of PE was low (0%) when the CDD-10 value was negative, moderate (24%) for CDD-10 ranging 0-2.5 and high (43%) when over 2.5. Conclusions: Better risk stratification is needed for HCPs who require CTPA for suspected PE. Our newly proposed CDD-10 score demonstrates the best accuracy in predicting PE in patients hospitalized for SARS-CoV-2 infection.

Acta Radiologica

Background The potential benefit of neoadjuvant chemotherapy (NAC) in colon cancer is under evalu... more Background The potential benefit of neoadjuvant chemotherapy (NAC) in colon cancer is under evaluation. There is a need to improve preoperative non-invasive diagnostics using techniques that provide more accurate staging information in assessing patient eligibility for NAC. Purpose To investigate the link between the tumor grade (pathohistological confirmed) and the N status (corresponding to lymph node involvement) with apparent diffusion coefficient (ADC) values. Material and Methods A total of 17 patients planned for surgical resection had a biopsy confirming colon carcinoma and participated in the study. Abdominal magnetic resonance imaging with diffusion-weighted imaging/ADC sequence was recorded before surgery. The tumor and all visible lymph nodes were manually delineated directly on a grayscale ADC map for every single slice and detected to access the total tumor and summarized lymph node volume. The mean ADC value was further calculated for the mean tumor and mean lymph nod...

Veleučilište *Lavoslav Ružička* u Vukovaru. Odjel za zdravstvene studije., Nov 11, 2020

Purpose: The objective of this study was to present our experience with CT perfusion (CTP) compar... more Purpose: The objective of this study was to present our experience with CT perfusion (CTP) compared to noncontrast CT (NCCT) in early diagnosis of acute ischemic stroke at University Hospital Split and to determine the value of these diagnostic procedures in assesment of adequate thrombolytic therapy. Methods and materials: 87 consecutive patients with acute ischaemic stroke within 3 hours of onset of symptoms underwent Stroke protocol that included NCCT, CTP and MSCTA (MSCT Sensation 16 Siemens, Germany). We used 200 ml of nonionic intravenous contrast media iopamidol 370 at an injection rate of 10, 0 ml/s. Patients with confirmed presence of an ischemic penumbra recieved thrombolytic therapy (Alteplase). Results: Ischemic stroke was confirmed in 78, 1% patients who were admitted with stroke symptoms to our emergency department. CTP was significantly superior to NCCT in depicting ischemic stroke (41 patients diagnosed with NCCT, in comparison to 68 with CTP, p= 0, 008). In 27 cases...

Journal of Multiple Sclerosis, 2013

The images depicts three cases such as healthy 28y old subject, Relapsing-remitting Multiple scle... more The images depicts three cases such as healthy 28y old subject, Relapsing-remitting Multiple sclerosis patient (27 years old) showing slight cord edema due to intramedullary lesions and Primary Progressive Multiple Sclerosis (29 years old) patient with cord atrophy.

Bratislavské lekárske listy, 2008

Vertebrobasilar dolichoectasia is defined as an increase in the length and diameter of the intrac... more Vertebrobasilar dolichoectasia is defined as an increase in the length and diameter of the intracranial arteries. Clinical manifestations of dolichoectasiae result from compression of the cranial nerves and structures of the brain stem, turbulent flow causing tinnitus and vertigo, often with damages of small blood vessels of the brain. Dolichoectasia is an ishemic stroke risk factor. The role of dolichoectasia in occurrence of haemorrhagic stroke, aneurysm and arterial dissection and thrombosis is still not fully understood (Ref. 34).

Bratislavské lekárske listy, 2008

We report a rare case of a patient with late onset of Chiari I malformation with associated syrin... more We report a rare case of a patient with late onset of Chiari I malformation with associated syringomyelia that was successfully treated with foramen magnum decompression. Our patient is presenting initially with vertigo and gradual weakening of the left-hand gross motor ability, gradual hypesthesia. Magnetic resonance imaging demonstrated a Chiari I malformation with syringomyelia. Posterior fossa decompression, C1 laminectomy and duroplasty were performed. After surgery, the vertigo completely resolved (Fig. 2, Ref. 13). Full Text (Free, PDF) www.bmj.sk.

The Thoracic and Cardiovascular Surgeon, 2015

Bleeding and thrombotic events are among the most common complications detected in patients with ... more Bleeding and thrombotic events are among the most common complications detected in patients with mechanical circulatory support (MCS). Herein, we reviewed the available evidence on the prevalence, etiology, and management of bleeding and thrombotic events in patients following MCS procedures, such as implantation of both intra- and paracorporeal devices that generate either pulsatile or nonpulsatile flow. Extracorporeal life support procedures providing support to the failing heart and lungs were also reviewed. Most bleeding and thromboembolic events occur despite appropriate hemostatic and anticoagulation management based on conventional coagulation laboratory parameters. Prevalence of bleeding events in this population ranges between 5 and 81%. Wide range in prevalence of bleeding reported in literature may be explained by different devices with different anticoagulation protocols being used, as well as different definitions of bleeding outcomes. Although bleeding events are more common than thromboembolic events, the consequences of thrombotic events are often detrimental. Management of bleeding events remains challenging and measures to prevent and treat bleeding events are often followed by thromboembolic events. Therefore, a personalized approach based on point-of-care hemostatic tests and adjusted to device type and patient comorbidities is therefore warranted. To provide advanced understanding of hemostatic disturbances during MCS, prospective trials focused on bleeding and thromboembolic events as primary endpoints should be conducted. Better understanding of the underlying pathophysiology and a shift towards a personalized approach based on functional point-of-care hemostatic properties assessment may provide more favorable clinical outcomes. This should, however, be coupled with further technological improvements providing better device surface hemocompatibility as interaction between blood and device surface affects the hemostatic equilibrium.

Biomedicines

Acute ischemic stroke (AIS) is the world’s second leading cause of mortality. An established meth... more Acute ischemic stroke (AIS) is the world’s second leading cause of mortality. An established method for treating stroke patients in acute settings is endovascular therapy (EVT). However, the correlation of the successful endovascular treatment of AIS with the presence of communicating arteries in the circle of Willis needs to be proven. Our study examined clinical and radiological data of 158 consecutive patients treated with mechanical thrombectomy (MT) at our comprehensive stroke center. We analyzed their CT angiograms and digital subtraction angiography (DSA) to assess anatomical variants of Willis’ circle and formed two groups—collateral-negative and collateral-positive group. The first group included patients with aplasia of both anterior (ACoA) and posterior communicating Artery (PCoA). The second group included patients that have at least one communicating artery (either anterior or posterior). We evaluated their reperfusion outcomes and functional recovery three months later...

Biomedicines, Jul 20, 2023

This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY

American Journal of Neuroradiology, Dec 22, 2011

BACKGROUND AND PURPOSE:Chronic cerebrospinal venous insufficiency (CCSVI) is a vascular condition... more BACKGROUND AND PURPOSE:Chronic cerebrospinal venous insufficiency (CCSVI) is a vascular condition characterized by anomalies of the main extracranial cerebrospinal venous routes that interfere with normal venous outflow. Research into CCSVI will determine its sensitivity and specificity for a diagnosis of MS, its prevalence in MS patients, and its clinical, MRI, and genetic correlates. Our aim was to investigate the prevalence and number of intra- and extraluminal structural and functional extracranial venous abnormalities by using DS and MRV, in patients with MS and HCs.MATERIALS AND METHODS:One hundred fifty patients with MS, 104 (69.3%) with RR and 46 (30.7%) with a progressive MS course, and 63 age- and sex-matched HCs were scanned with 3T MR imaging by using TOF and TRICKS sequences (only patients with MS). All subjects underwent DS examination for intra- and extraluminal structural and functional abnormalities of the IJVs. Absent/pinpoint IJV flow morphology on MRV was considered an abnormal finding. Prominence of collateral extracranial veins was assessed with MRV.RESULTS:Patients with MS had a significantly higher number of functional (P < .0001), total (P = .001), and intraluminal (P = .005) structural IJV DS abnormalities than HCs. There was a trend for more patients with MS with extraluminal IJV DS abnormalities (P = .023). No significant differences were found on the MRV IJV flow morphology scale between patients with MS and HCs. Patients with progressive MS showed more extraluminal IJV DS abnormalities (P = .01) and more MRV flow abnormalities on TOF (P = .006) and TRICKS (P = .01) than patients with nonprogressive MS. There was a trend for a higher number of collateral veins in patients with MS than in HCs (P = .016).CONCLUSIONS:DS is more sensitive than MRV in detecting intraluminal structural and functional venous abnormalities in patients with MS compared with HCs, whereas MRV is more sensitive in showing collaterals.

Neurology, Jun 27, 2014

Objective: We report the results of the investigation of safety and efficacy of venous angioplast... more Objective: We report the results of the investigation of safety and efficacy of venous angioplasty in patients with multiple sclerosis (MS) with findings of extracranial venous anomalies, considered hallmarks of chronic cerebrospinal venous insufficiency (CCSVI), in a 2-phase study (ClinicalTrials.gov NCT01450072). Methods: Phase 1 was an open-label safety study (10 patients); phase 2 was sham-controlled, randomized, and double-blind (10 sham procedure, 9 treated). All study patients fulfilled venous hemodynamic screening criteria indicative of CCSVI. Assessment was at 1, 3, and 6 months postprocedure with MRI, clinical, and hemodynamic outcomes. Primary endpoints were safety at 24 hours and 1 month, venous outflow restoration .75% at 1 month, and effect of angioplasty on new lesion activity and relapse rate over 6 months. Secondary endpoints included changes in disability, brain volume, cognitive tests, and quality of life. Results: No perioperative complications were noted; however, one patient with history of syncope was diagnosed with episodic bradycardia requiring placement of a pacemaker before discharge. Doppler evidence-based venous hemodynamic insufficiency severity score (VHISS) was reduced .75% compared to baseline in phase 1 (at 1 month) but not phase 2. In phase 2, higher MRI activity (cumulative number of new contrast-enhancing lesions [19 vs 3, p 5 0.062] and new T2 lesions [17 vs 3, p 5 0.066]) and relapse activity (4 vs 1, p 5 0.389) were identified as nonsignificant trends in the treated vs sham arm over 6 months. Using analysis of covariance, significant cumulative new T2 lesions were related to larger VHISS decrease (p 5 0.028) and angioplasty (p 5 0.01) over the follow-up. No differences in other endpoints were detected. Conclusion: Venous angioplasty is not an effective treatment for MS over the short term and may exacerbate underlying disease activity. Classification of evidence: This is a Class I study demonstrating that clinical and imaging outcomes are no better or worse in patients with MS identified with venous outflow restriction who receive venous angioplasty compared to sham controls who do not receive angioplasty. This study also includes a Class IV phase 1 study of safety in 10 patients receiving the angioplasty procedure.

PLOS ONE, Nov 30, 2011

Background: The role of intra-and extra-cranial venous system impairment in the pathogenesis of v... more Background: The role of intra-and extra-cranial venous system impairment in the pathogenesis of various vascular, inflammatory and neurodegenerative neurological disorders, as well as in aging, has not been studied in detail. Nor have risk factors been determined for increased susceptibility of venous pathology in the intra-cranial and extra-cranial veins. The aim of this study was to investigate the association between presence of a newly proposed vascular condition called chronic cerebrospinal venous insufficiency (CCSVI) and environmental factors in a large volunteer control group without known central nervous system pathology. Methods and Findings: The data were collected in a prospective study from 252 subjects who were screened for medical history as part of the entry criteria and participated in the case-control study of CCSVI prevalence in multiple sclerosis (MS) patients, and then were analyzed post-hoc. All participants underwent physical and Doppler sonography examinations, and were assessed with a structured environmental questionnaire. Fullfilment of $2 positive venous hemodynamic (VH) criteria on Doppler sonography was considered indicative of CCSVI diagnosis. Risk and protective factors associated with CCSVI were analyzed using logistic regression analysis. Seventy (27.8%) subjects presented with CCSVI diagnosis and 153 (60.7%) presented with one or more VH criteria. The presence of heart disease (p = .001), especially heart murmurs (p = .007), a history of infectious mononucleosis (p = .002), and irritable bowel syndrome (p = .005) were associated with more frequent CCSVI diagnosis. Current or previous smoking (p = .029) showed a trend for association with more frequent CCSVI diagnosis, while use of dietary supplements (p = .018) showed a trend for association with less frequent CCSVI diagnosis. Conclusions: Risk factors for CCSVI differ from established risk factors for peripheral venous diseases. Vascular, infectious and inflammatory factors were associated with higher CCSVI frequency.

Expert Review of Neurotherapeutics, Sep 1, 2011

Chronic cerebrospinal venous insufficiency (CCSVI) was recently described in multiple sclerosis p... more Chronic cerebrospinal venous insufficiency (CCSVI) was recently described in multiple sclerosis patients. CCSVI is characterized by impaired brain venous drainage due to outflow obstruction in the extracranial venous system, mostly related to anomalies in the internal jugular and azygos veins. The current CCSVI diagnosis is based on Doppler sonography of extracranial and transcranial venous hemodynamics criteria. To date, prevalence estimates of CCSVI, provided by different groups using various imaging methods of assessment, vary widely from none to 100%. There is an urgent need to define and validate the spectrum of cranial/extracranial venous anomalies and to establish reliable, diagnostic gold-standard test(s). The potential usefulness of endovascular treatment for CCSVI in multiple sclerosis patients is still unknown.

Purpose: The objective of this study was to present our experience with CT perfusion (CTP) compar... more Purpose: The objective of this study was to present our experience with CT perfusion (CTP) compared to noncontrast CT (NCCT) in early diagnosis of acute ischemic stroke at University Hospital Split and to determine the value of these diagnostic procedures in assesment of adequate thrombolytic therapy. Methods and materials: 87 consecutive patients with acute ischaemic stroke within 3 hours of onset of symptoms underwent Stroke protocol that included NCCT, CTP and MSCTA (MSCT Sensation 16 Siemens, Germany). We used 200 ml of nonionic intravenous contrast media iopamidol 370 at an injection rate of 10, 0 ml/s. Patients with confirmed presence of an ischemic penumbra recieved thrombolytic therapy (Alteplase). Results: Ischemic stroke was confirmed in 78, 1% patients who were admitted with stroke symptoms to our emergency department. CTP was significantly superior to NCCT in depicting ischemic stroke (41 patients diagnosed with NCCT, in comparison to 68 with CTP, p= 0, 008). In 27 cases with negative NCCT there were signs of ischemic stroke on CTP, and 16 of patients with significant penumbra received thrombolytic therapy. NCCT sensitivity (taking CTP as the reference method) was 60, 3%. The accuracy of this method was 69%. Negative predictive value of NCCT in comparison to CTP was 41%. Conclusion: CTP is a sensitive tool for identifying early signs of ischemia and it should be done regulary in patients presenting with acute ischemic stroke symptoms. It is crucial in determining whether the thrombolysis is appropriate by estimating ischemic penumbra and infarct core.

Bratislavské lekárske listy, 2008

We report a rare case of a patient with late onset of Chiari I malformation with associated syrin... more We report a rare case of a patient with late onset of Chiari I malformation with associated syringomyelia that was successfully treated with foramen magnum decompression. Our patient is presenting initially with vertigo and gradual weakening of the left-hand gross motor ability, gradual hypesthesia. Magnetic resonance imaging demonstrated a Chiari I malformation with syringomyelia. Posterior fossa decompression, C1 laminectomy and duroplasty were performed. After surgery, the vertigo completely resolved (Fig. 2, Ref. 13). Full Text (Free, PDF) www.bmj.sk.

Sustainability, Jun 14, 2023

This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY

Neuroradiology, Aug 2, 2014

Introduction Conventional magnetic resonance imaging (MRI) techniques are insufficient to determi... more Introduction Conventional magnetic resonance imaging (MRI) techniques are insufficient to determine the causative agent of brain abscesses. We investigated: (1) the value of susceptibility-weighted MR sequences (SWMRS) in the differentiation of fungal and pyogenic brain abscesses; and (2) the effect of different SWMRS (susceptibility-weighted imaging (SWI) versus venous blood oxygen level dependent (VenoBOLD)) for the detection of specific imaging characteristics of pyogenic brain abscesses. Methods We studied six patients with fungal and ten patients with pyogenic brain abscesses. Imaging characteristics on conventional MRI, diffusion-weighted imaging (DWI) and SWMRS were recorded in all abscesses. All lesions were assessed for the presence of a "dual-rim sign" on SWMRS. Results Homogenously hyperintense lesions on DWI were present in 60 % of patients with pyogenic abscesses, whereas none of the patients with fungal abscesses showed such lesions. On SWMRS, 90 % of patients with pyogenic abscesses and 60 % of patients with fungal abscesses had only lesions with a low-signal-intensity rim. On SWI, the dual-rim sign was apparent in all pyogenic abscesses. None of the fungal abscesses on SWI (P=0.005) or any of the pyogenic abscesses on VenoBOLD (P=0.005) were positive for a dual-rim sign. Conclusions In fungal abscesses, the dual-rim sign is not present but a prominent peripheral rim or central susceptibility effects on SWI will be seen. The appearance of pyogenic abscesses on SWMRS depends on the used sequence, with the dual-rim sign a specific feature of pyogenic brain abscesses on SWI.

Biomedicine & Pharmacotherapy

Reviews in Cardiovascular Medicine

Background: The need for computed tomography pulmonary angiography (CTPA) to rule out pulmonary e... more Background: The need for computed tomography pulmonary angiography (CTPA) to rule out pulmonary embolism (PE) is based on clinical scores in association with D-dimer measurements. PE is a recognized complication in patients with SARS-CoV-2 infection due to a pro-thrombotic state which may reduce the usefulness of preexisting pre-test probability scores. Aim: The purpose was to analyze new clinical and laboratory parameters while comparing existing and newly proposed scoring system for PE detection in hospitalized COVID-19 patients (HCP). Methods: We conducted a retrospective study of 270 consecutive HCPs who underwent CTPA due to suspected PE. The Modified Wells, Revised Geneva, Simplified Geneva, YEARS, 4-Level Pulmonary Embolism Clinical Probability Score (4PEPS), and PE rule-out criteria (PERC) scores were calculated and the area under the receiver operating characteristic curve (AuROC) was measured. Results: Overall incidence of PE among our study group of HCPs was 28.1%. The group of patients with PE had a significantly longer COVID-19 duration upon admission, at 10 vs 8 days, p = 0.006; higher D-dimer levels of 10.2 vs 5.3 µg/L, p < 0.001; and a larger proportion of underlying chronic kidney disease, at 16% vs 7%, p = 0.041. From already established scores, only 4PEPS and the modified Wells score reached statistical significance in detecting the difference between the HCP groups with or without PE. We proposed a new chronic kidney disease, D-dimers, 10 days of illness before admission (CDD-10) score consisting of the three aforementioned variables: C as chronic kidney disease (0.5 points if present), D as D-dimers (negative 1.5 points if normal, 2 points if over 10.0 µg/L), and D-10 as day-10 of illness carrying 2 points if lasting more than 10 days before admission or 1 point if longer than 8 days. The CDD-10 score ranged from-1.5 to 4.5 and had an AuROC of 0.672, p < 0.001 at cutoff value at 0.5 while 4PEPS score had an AuROC of 0.638 and Modified Wells score 0.611. The clinical probability of PE was low (0%) when the CDD-10 value was negative, moderate (24%) for CDD-10 ranging 0-2.5 and high (43%) when over 2.5. Conclusions: Better risk stratification is needed for HCPs who require CTPA for suspected PE. Our newly proposed CDD-10 score demonstrates the best accuracy in predicting PE in patients hospitalized for SARS-CoV-2 infection.

Acta Radiologica

Background The potential benefit of neoadjuvant chemotherapy (NAC) in colon cancer is under evalu... more Background The potential benefit of neoadjuvant chemotherapy (NAC) in colon cancer is under evaluation. There is a need to improve preoperative non-invasive diagnostics using techniques that provide more accurate staging information in assessing patient eligibility for NAC. Purpose To investigate the link between the tumor grade (pathohistological confirmed) and the N status (corresponding to lymph node involvement) with apparent diffusion coefficient (ADC) values. Material and Methods A total of 17 patients planned for surgical resection had a biopsy confirming colon carcinoma and participated in the study. Abdominal magnetic resonance imaging with diffusion-weighted imaging/ADC sequence was recorded before surgery. The tumor and all visible lymph nodes were manually delineated directly on a grayscale ADC map for every single slice and detected to access the total tumor and summarized lymph node volume. The mean ADC value was further calculated for the mean tumor and mean lymph nod...

Veleučilište *Lavoslav Ružička* u Vukovaru. Odjel za zdravstvene studije., Nov 11, 2020

Purpose: The objective of this study was to present our experience with CT perfusion (CTP) compar... more Purpose: The objective of this study was to present our experience with CT perfusion (CTP) compared to noncontrast CT (NCCT) in early diagnosis of acute ischemic stroke at University Hospital Split and to determine the value of these diagnostic procedures in assesment of adequate thrombolytic therapy. Methods and materials: 87 consecutive patients with acute ischaemic stroke within 3 hours of onset of symptoms underwent Stroke protocol that included NCCT, CTP and MSCTA (MSCT Sensation 16 Siemens, Germany). We used 200 ml of nonionic intravenous contrast media iopamidol 370 at an injection rate of 10, 0 ml/s. Patients with confirmed presence of an ischemic penumbra recieved thrombolytic therapy (Alteplase). Results: Ischemic stroke was confirmed in 78, 1% patients who were admitted with stroke symptoms to our emergency department. CTP was significantly superior to NCCT in depicting ischemic stroke (41 patients diagnosed with NCCT, in comparison to 68 with CTP, p= 0, 008). In 27 cases...

Journal of Multiple Sclerosis, 2013

The images depicts three cases such as healthy 28y old subject, Relapsing-remitting Multiple scle... more The images depicts three cases such as healthy 28y old subject, Relapsing-remitting Multiple sclerosis patient (27 years old) showing slight cord edema due to intramedullary lesions and Primary Progressive Multiple Sclerosis (29 years old) patient with cord atrophy.

Bratislavské lekárske listy, 2008

Vertebrobasilar dolichoectasia is defined as an increase in the length and diameter of the intrac... more Vertebrobasilar dolichoectasia is defined as an increase in the length and diameter of the intracranial arteries. Clinical manifestations of dolichoectasiae result from compression of the cranial nerves and structures of the brain stem, turbulent flow causing tinnitus and vertigo, often with damages of small blood vessels of the brain. Dolichoectasia is an ishemic stroke risk factor. The role of dolichoectasia in occurrence of haemorrhagic stroke, aneurysm and arterial dissection and thrombosis is still not fully understood (Ref. 34).

Bratislavské lekárske listy, 2008

We report a rare case of a patient with late onset of Chiari I malformation with associated syrin... more We report a rare case of a patient with late onset of Chiari I malformation with associated syringomyelia that was successfully treated with foramen magnum decompression. Our patient is presenting initially with vertigo and gradual weakening of the left-hand gross motor ability, gradual hypesthesia. Magnetic resonance imaging demonstrated a Chiari I malformation with syringomyelia. Posterior fossa decompression, C1 laminectomy and duroplasty were performed. After surgery, the vertigo completely resolved (Fig. 2, Ref. 13). Full Text (Free, PDF) www.bmj.sk.

The Thoracic and Cardiovascular Surgeon, 2015

Bleeding and thrombotic events are among the most common complications detected in patients with ... more Bleeding and thrombotic events are among the most common complications detected in patients with mechanical circulatory support (MCS). Herein, we reviewed the available evidence on the prevalence, etiology, and management of bleeding and thrombotic events in patients following MCS procedures, such as implantation of both intra- and paracorporeal devices that generate either pulsatile or nonpulsatile flow. Extracorporeal life support procedures providing support to the failing heart and lungs were also reviewed. Most bleeding and thromboembolic events occur despite appropriate hemostatic and anticoagulation management based on conventional coagulation laboratory parameters. Prevalence of bleeding events in this population ranges between 5 and 81%. Wide range in prevalence of bleeding reported in literature may be explained by different devices with different anticoagulation protocols being used, as well as different definitions of bleeding outcomes. Although bleeding events are more common than thromboembolic events, the consequences of thrombotic events are often detrimental. Management of bleeding events remains challenging and measures to prevent and treat bleeding events are often followed by thromboembolic events. Therefore, a personalized approach based on point-of-care hemostatic tests and adjusted to device type and patient comorbidities is therefore warranted. To provide advanced understanding of hemostatic disturbances during MCS, prospective trials focused on bleeding and thromboembolic events as primary endpoints should be conducted. Better understanding of the underlying pathophysiology and a shift towards a personalized approach based on functional point-of-care hemostatic properties assessment may provide more favorable clinical outcomes. This should, however, be coupled with further technological improvements providing better device surface hemocompatibility as interaction between blood and device surface affects the hemostatic equilibrium.