Newborn hearing screening in the Czech Republic Abstract The aim of this diploma thesis is to summarize the important and actual information about a newborn hearing screening and its related topics. The theoretical part of this thesis contains the contemporary knowledge of the issue, the definition of terms for a comprehensive setting of issue in the context, illustrates the current state of knowledge of the issue in the Czech Republic in the comparison to some European and world countries and reveals some more directly and inextricably related topics. The practical part is based on the knowledge of the theoretical part. The practical part focuses on identification of the level of awareness of newborn hearing screening among pregnant women, which was investigated by a questionnaire. This part also analyzes, evaluates and discusses the results and suggestions for practice. The task of the practical part was not only to identify the research data, but also to provide information to expectant mothers about the possibilities and significance of the newborn hearing screening by appropriate form, as this topic is very current for the general public. Key words: early care early diagnosis hearing impairment newborn hearing screening otoacoustic emissions rehabilitation of hearing impairment

Over the past decades, Fourier Transform Infrared (FTIR) microspectroscopy has emerged as a potential candidate to complement Histopathology in the study and diagnosis of tissue diseases. Contrary to the histological examination, which relies on the morphological tissue alterations assessed by visual inspection of stained samples, FTIR chemical imaging is a rapid and label-free tool that provide simultaneously information about histological structures as well as the localisation and magnitude of basic molecular units that compose tissue sections (proteins, nucleic acids, lipids, and carbohydrates). Despite the many proof-of-concept studies demonstrating the effectiveness of FTIR spectroscopy in detecting biological disorders with high levels of sensitivity and specificity, translation into clinical practice has been relatively slow due to the substantial cost of infrared transparent substrates required to collect the images. Thus, the main objective of this research is to evaluate the diagnostic potential of infrared chemical images collected from samples placed on conventional histology glass slides as alternative substrates for FTIR spectroscopy. Swiss mice were submitted to a well-established chemical carcinogenesis protocol, in which cancerous and non-cancerous cutaneous lesions were obtained by varying the exposure time of the animals to carcinogenenic factors. FTIR hyperspectral images were acquired in transmission mode over the mid-infrared region from tissue specimens placed on conventional infrared substrates (calcium fluoride - CaF2) and glass slides. In the first phase of our study, spectral datasets were segmented using k-means (KMCA) and Hierarchical Cluster Analysis (HCA) as clustering algorithms to reconstruct the hyperspectral images aiming to evaluate the ability of the false-color maps in reproducing the histological structures of tissue specimens. The images were segmented by each clustering technique using several different combinations varying parameters including the substrate used to place the samples (CaF2 or conventional glass) and the methods employed to preprocess the datasets. Fingerprint (1000-1800 cm-1) and high wavenumber (3100-4000 cm-1) regions from images collected on CaF2 were separately used as input for image reconstruction and only the high wavenumber range was employed in the case of samples placed on glass. All pseudocolor maps were compared to standard histopathology in order to evaluate the quality and consistency of images after segmentation. KMCA presented slightly superior ability in correctly assigning the pixels of morphochemical maps to the histological structures of the specimen, nevertheless, our findings indicate that the choice of the substrate, input data, preprocessing methods, and sample preparation have more influence in the final results than the clustering algorithm used to reconstruct the images. In the second phase of our study, Principal Component Analysis (PCA) was employed to compare datasets from healthy group to animals exposed to chemicals for 8, 16, and 48 weeks in order to evaluate the biochemical changes induced by chemical carcinogenesis. The performance of classification in each pairwise comparison was calculated using a binary classification test based on Linear Discriminant Analysis associated to PCA (PC-LDA). The method achieved satisfactory discrimination (over 80%) comparing healthy tissue to samples that were classified as papilloma (16 weeks) and invasive squamous cell carcinoma (48 weeks) regardless of the substrate used to place the samples. Statistical measurements obtained comparing healthy skin to animals exposed to carcinogenic factors for 8 weeks (free of malignancy based on the morphological and clinical evidence) ranged from 35-78%, indicating that the ability of PC-LDA in correctly classifying spectral data from cancerous and pre-cancerous lesions vary with the stage of the disease during the tumorigenesis process. Thus, as a proof-of-concept, we demonstrate the feasibility of FTIR spectroscopy in evaluating the biological events triggered by cancer using a label-free methodology that do not rely on expensive substrates and do not disrupt the pathologist workflow. This is a major step forward towards clinical application, since the method can be used to complement the diagnostic process of cancer as a non-subjective alternative that do not require laborious and time-consuming procedures nor expensive probes as biomarkers. / Nas últimas décadas, a microespectroscopia de absorção no infravermelho por transformada de Fourier (FTIR) tem surgido como potencial ferramenta para complementar a Histopatologia no estudo e diagnóstico de doenças teciduais. Ao contrário do exame histológico, que se baseia na inspeção visual de amostras coradas visando avaliar as alterações morfológicas que as doenças ocasionam no tecido, o imageamento químico obtido pela técnica de FTIR baseia-se nas características bioquímicas da amostra sem o uso de colorações. Apesar da vasta literatura comprovando a eficácia da espectroscopia FTIR em detectar alterações biológicas causadas por doenças com altos níveis de sensibilidade e especificidade, a implementação do método na prática clínica tem sido relativamente lenta devido ao alto custo dos substratos transparentes no infravermelho que são necessários para aquisição de dados. Diante disso, o objetivo principal do presente trabalho é avaliar a capacidade diagnóstica de imagens hiperespectrais coletadas de amostras em lâminas de vidro como substratos alternativos para a espectroscopia FTIR. Camundongos Swiss foram submetidos a um protocolo de carcinogênese química, no qual lesões cutâneas cancerosas e não-cancerosas foram obtidas variando-se o tempo de exposição dos animais aos fatores carcinogênicos. Imagens hiperespectrais FTIR foram adquiridas no modo de transmissão na região do infravermelho médio a partir de amostras de tecido depositadas em substratos transparentes no infravermelho (fluoreto de cálcio - CaF2) e vidro convencional. Na primeira fase de nosso estudo, os dados espectrais foram segmentados usando as técnicas estatísticas k-means (KMCA) e Análise Hierárquica de Clusters (HCA) como algoritmos de agrupamento para reconstruir as imagens hiperespectrais com o objetivo de avaliar a capacidade dos mapas de cores falsas em reproduzir as estruturas histológicas das amostras de tecido. As imagens foram segmentadas por cada técnica de agrupamento variando-se o substrato usado para colocar as amostras (CaF2 ou vidro convencional) assim como os métodos de tratamento utilizados para pré-processamento dos dados. As regiões de impressão digital (1000-1800 cm-1) e de altos números de onda (3100-4000 cm-1) das imagens coletadas em CaF2 foram usadas separadamente como dados de entrada para a reconstrução das imagens, enquanto apenas a faixa de altos números de onda foi utilizada no caso de amostras colocadas em vidro. Ao fim do processo de segmentação os mapas de cores falsas obtidos foram comparados com a Histopatologia padrão a fim de avaliar a qualidade e consistência das imagens. Os resultados obtidos pela técnica de KMCA foram ligeiramente superiores com relação a HCA na identificação de pixels dos mapas morfo-quimicos correspondentes às estruturas histológicas da amostra. No entanto, nossos achados indicam que a escolha do substrato, dados de entrada, métodos de pré-processamento e preparação de amostras têm mais influência nos resultados finais do que o algoritmo de agrupamento usado para reconstruir as imagens. Na segunda fase do nosso estudo, a Análise de Componentes Principais (PCA) foi empregada para comparar os dados do grupo saudável aos animais expostos aos produtos carcinogênicos por 8, 16 e 48 semanas a fim de avaliar as alterações bioquímicas induzidas pela carcinogênese química. O desempenho da classificação em cada comparação pareada foi calculado usando um teste de classificação binária baseado na Análise de Discriminante Linear associada à técnica de PCA (PC-LDA). O método obteve discriminação satisfatória (acima de 80%) comparando tecido saudável com as amostras que foram classificadas como papiloma (16 semanas) e carcinoma espinocelular invasivo (48 semanas) independentemente do substrato usado para colocar as amostras. A comparação de pele saudável com animais expostos aos fatores carcinogênicos por 8 semanas (livres de malignidade de acordo com as evidências clínicas e morfológicas) apresentou figuras de performance cujos valores variaram entre 35-78%, indicando que a habilidade da técnica de PC-LDA em classificar corretamente dados espectrais de lesões cancerosas e pré-cancerosas variam com o estádio da doença durante o processo de tumorigênese. Diante disso, como uma prova de conceito, demonstramos a viabilidade da espectroscopia FTIR na avaliação dos eventos biológicos desencadeados pelo câncer usando uma metodologia que não requer colorações e substratos caros, assim como não interrompe/altera o fluxo de trabalho atual do patologista. Este é um passo importante na implementação da tecnologia no ambiente clínico, uma vez que o método pode ser usado para complementar o processo de diagnóstico do câncer como uma alternativa não-subjetiva e que não requer procedimentos trabalhosos e demorados, nem sondas caras como biomarcadores.

Este estudo teve como objetivo conhecer as ações que os cirurgiões-dentistas das unidades básicas de saúde do município de São Paulo têm desenvolvido quanto à prevenção e ao diagnóstico precoce do câncer bucal, além de suas percepções para a realização de tais ações, a fim de analisar o comportamento destes profissionais a cerca das questões relativas a esta morbidade. A maioria dos diagnósticos de câncer bucal é feita em estágios avançados em São Paulo, cidade que possui as maiores taxas de incidência nacionais, semelhantes a de outras regiões do mundo. O cirurgião-dentista exerce um papel fundamental e estratégico no combate aos fatores ligados ao aparecimento desse agravo. Foram enviados, em março de 2005, 885 questionários aos cirurgiões-dentistas das 286 unidades básicas de saúde de São Paulo, via Correio. Foi feito um banco de dados utilizando o software de informática Epi Info – versão 6.04b. Participaram da pesquisa 282 profissionais, (taxa de resposta de 32%), em sua maioria do sexo feminino, com mais de 20 anos de graduação, com perfil generalista e que possui outros vínculos empregatícios. Além do baixo grau de conhecimento constatado quanto aos fatores de risco ligados à etiologia e às condições bucais em relação a possível evolução para um câncer bucal, a maioria dos participantes expôs limitações relevantes quanto às práticas relativas ao apoio à cessação do hábito do tabagismo e etilismo e às aptidões para executarem citologia esfoliativa e biópsia. Verifica-se a necessidade de se propor políticas públicas de enfrentamento do câncer bucal em São Paulo, que considere o aprimoramento dos cirurgiões-dentistas das unidades básicas de saúde em relação a esse problema e a melhor estruturação desses locais para a pronta realização dos exames complementares para fins diagnósticos. / The purpose of this study was to know the actions that dentists from basic health units of the city of São Paulo have been developing for the prevention and early diagnosis of oral cancer, besides their perceptions for the accomplishment of such actions, in order to analyze the behavior of these professionals about these subjects in relation to this morbidity. Most of the diagnosis of oral cancer is made in advanced stages in São Paulo that possesses the largest national incidence taxes, similar to other areas of the world. The primary health care dental professional plays a fundamental and strategic role against the linked factors related to the greater appearance of this malignant neoplasm. Eight hundred and eighty-five dentists from 286 basic health units of the city of São Paulo were surveyed in march 2005. It was made a database using the computer software Epi Info, version 6.04b. Two hundred and eighty-two professionals have answered the questionnaires (a response rate of 32% was obtained) and their majority composed by female general dental practitioners, with more than 20 years of graduation and that have other kinds of employment. Besides the low degree of knowledge verified for the risk factors linked to the etiology and the oral conditions in relation to a possible evolution for an oral cancer, most of the participants exposed relevant limitations as for the relative practices to support tobacco and alcohol cessation as for the accomplishment of esfoliative cytology and biopsy. It is verified the need of proposing public policies to face the problem of oral cancer in São Paulo, which considers not only the technical improvement of the primary health care dental practitioners but also the best structuring of those places for the ready accomplishment of the complemental exams to leading final diagnosis.

A síndrome de Prader-Willi é uma desordem complexa neurogenética associada a três mecanismos genéticos distintos: deleção paterna da região 15q11-q13, dissomia uniparental materna do cromossomo 15 e defeitos no centro de imprinting genômico. As principais características da síndrome na primeira fase são a hipotonia de causa desconhecida em neonatos, dismorfismos, dificuldades de alimentação e hipogonadismo. O principal objetivo deste trabalho foi identificar portadores da síndrome de Prader-Willi em neonatos (pacientes com até 28 dias de vida) que apresentaram hipotonia neonatal em maternidades de São Paulo. Neste estudo foram analisados por teste de metilação dois pacientes com suspeita da síndrome de Prader-Willi que apresentavam os requisitos de inclusão do trabalho. Para que o teste fosse feito de maneira menos invasiva possível foi realizada a coleta de saliva dos pacientes por swab de bochecha, para extração de DNA. Em um período de um ano, foi confirmada a síndrome em um paciente do grupo. Mesmo com um número amostral reduzido já esperado pelo curto período de coleta, foi diagnosticado um caso precocemente, o que reforça a importância da inclusão da pesquisa para a síndrome de Prader-Willi no grupo de neonatos hipotônicos de causa desconhecida. / Prader-Willi syndrome is a complex neurogenetic disorder associated with three distinct genetic mechanisms. They are: the 15q11-q13 paternal deletion, maternal uniparental disomy of chromosome 15 and defects in the imprinting center. The main characteristics of the syndrome in the first phase are the hypotonia of unknown cause in neonates, dysmorphisms, feeding difficulties and hypogonadism. The main objective of this study was to identify neonates with Prader-Willi syndrome (patients up to 28 days old) that presented neonatal hypotonia. Two hospitals, Hospital das Clínicas da Faculdade de Medicina da Universidade São Paulo and Hospital Maternidade Amador Aguiar, collaborate with this investigation. In this study, two patients with hypotonia and poor suck satisfied the diagnostic criteria and were analyzed by methylation test. In order to make the test less invasive, saliva was collected from patients by swab. During a period of one year, the syndrome was confirmed in one patient in the group. Even with a reduced sample, already expected due to the short collection period, a case was early diagnosed, which reinforces the importance of including the genetic tests for Prader-Willi syndrome in the group of hypotonic neonates of unknown cause.

Anhand von immunhistochemischen Färbemethoden wurde die Expression von CD 31 (immunhistochemischer Marker für Endothelzellen) und -Aktin (immunhistochemischer Marker für glatte Muskelzellen) auf Zellen der intramyokardialen Blutgefäße herztransplantierter Patienten histomorphometrisch ausgewertet. In die Bewertung der myokardialen Strukturen ging auch die Untersuchung der jeweiligen zugehörigen HE-Färbungen mit ein. Ziel dieser Untersuchungen war die Beurteilung von qualitativen und quantitativen Unterschieden dieser Marker während eines Untersuchungszeitraumes von 14 Monaten nach Herztransplantation (HTx) bei Patienten mit einer angiographisch diagnostizierten Transplantatvaskulopathie (TVP) mit Patienten ohne einer prä- bzw. postmortem diagnostizierten TVP. Der Einsatz dieser Immunomarker richtete sich hierbei auf die selektive Darstellung der terminalen Strombahn mit der Fragestellung, ob ein intramyokardiales morphologisches Korrelat zu der TVP der epikardialen Blutgefäße existiert und ob die histomorphometrische Auswertung der bewerteten Strukturen eine mögliche Frühdiagnose der TVP nach HTx zuläßt. Des weiteren sollte eine mögliche Assoziation der TVP mit den demographischen Charakteristika sowie der Anzahl und dem Schweregrad der Rejektionsepisoden der untersuchten Patienten überprüft werden. Als Basis dienten dabei in Paraffin eingebettete rechtsventrikuläre Rejektionskontrollbiopsien, die im Rahmen der routinemäßig durchgeführten Abstoßungsdiagnostik entnommenen wurden. Nach morphologischer Bewertung dieser Schnitte im Hinblick auf die Existenz und den Schweregrad einer Abstoßungsreaktion wurden diese immunhistochemisch aufbereitet und anschließend quantitativausgewertet. Im Rahmen dieser Arbeit weist die quantitativ- histomorphometrische Erfassung intramyokardialer Blutgefäße in rechtsventrikulären Rejektionskontrollbiopsien auf die mögliche Frühdiagnose einer TVP nach HTx hin. Dieses Verfahren könnte die zur Zeit verwendeten diagnostischen Methoden ergänzen. Jedoch sind noch weitere prospektive klinische Studien für die Validierung dieser Ergebnisse notwendig. / In this study, immunohistochemical and histomorphometric investigations were performed in order to investigate the expression of CD 31 (immunohistochemical marker for endothelial cells) and -Aktin (immunohistochemical marker for smooth muscle cells) on cells of intramyocardial blood vessels in heart transplant (HTx) patients. The evaluation of myocardial structures also implicated the investigation of the corresponding histological H & E stainings. The aim of this study was to ascertain whether HTx patients with angiographic evidence of graft vessel disease (GVD) showed different qualitative and quantitative expression of the above mentioned immunomarkers than HTx patients with no angiopraphic or postmortem signs of this phenomenon. The investigation time included the first 14 months after HTx. The use of these immunomarkers made possible the selective representation of the terminal vascular system to answer the question, as to whether there existed an intramyocardial morphological correlate to GVD of epicardial coronary arteries and whether histomorphometric evaluation of small vessels permits early diagnosis of GVD after HTx. In addition, demographic data, as well the number and grade of rejection episodes of the studied patients, were reviewed in order to ascertain whether there might be an association of these characteristics with GVD. The material studied consisted of paraffin-embedded right ventricular rejection control samples from routine postoperative diagnostic management, which were used to reveal acute rejection episodes. After morphological evaluation of histological slices with regard to the appearence and severity of acute rejection, immunohistochemical staining was performed and finally a quantitative investigation was done. According to the results of this study, quantitative histomorphometric investigations of intramyocardial blood vessels in right ventricular rejection control samples permit the early diagnosis of GVD after HTx and completes the present diagnostic tools. But further prospective clinical studies are necessary to confirm these results.

Submitted by Marlene Santos (marlene.bc.ufg@gmail.com) on 2014-09-23T18:10:18Z No. of bitstreams: 2 Dissertacao final_MESTRADO_ANDRÉA_pdf.pdf: 1572790 bytes, checksum: 50d50dc5744b87dfbdd59a0cd86e00d3 (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) / Approved for entry into archive by Jaqueline Silva (jtas29@gmail.com) on 2014-09-23T18:34:46Z (GMT) No. of bitstreams: 2 Dissertacao final_MESTRADO_ANDRÉA_pdf.pdf: 1572790 bytes, checksum: 50d50dc5744b87dfbdd59a0cd86e00d3 (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) / Made available in DSpace on 2014-09-23T18:34:46Z (GMT). No. of bitstreams: 2 Dissertacao final_MESTRADO_ANDRÉA_pdf.pdf: 1572790 bytes, checksum: 50d50dc5744b87dfbdd59a0cd86e00d3 (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) Previous issue date: 2012-09-19 / Early diagnosis of diabetes mellitus (DM) in dogs or recognition of complications helps to increase the survival rate of animals. In human kidney complications caused by diabetes are well established, unlike canines. This study aimed to determine whether dogs with DM develop changes that lead to renal disease. We studied 31 diabetic dogs, which were divided into three groups, G1 realized that dogs without DR, G2, with urinary tract infection (UTI) and G3, with DR in stage 1. The evaluation consisted of history of animals, clinical examination, measurement of systolic arterial pressure (SAP) and laboratory tests: blood count, urinalysis, blood biochemistry (fibrinogen, glucose, urea, creatinine, total protein, albumin, globulin, phosphorus, calcium, sodium, potassium, fructosamine and cholesterol) and urine biochemistry (protein, creatinine, sodium, potassium and determined the activity of gama glutamiltransferase - GGT). Established the UPC and fractional excretion (EF) of sodium and potassium. The results show relation between DM and DR and the most relevant were found ITU and increase in the UPC, serum phosphorus, urinary GGT, cholesterol, fibrinogen and EF sodium and potassium. About the clinical signs observed polyuria, polydipsia, cataracts, polyphagia, weight loss, dehydration, and neoplasms. Dogs with a mean age of nine years, females, and the Poodle are more predisposed to diabetes. Dogs that have received specific diets, as well as laboratory monitoring, managed glycemic control and improved quality of life. / O diagnóstico precoce do diabetes mellitus (DM) em cães ou o reconhecimento de complicações possibilitam aumentar a taxa de sobrevida dos animais. Em humanos as complicações renais causadas pelo DM estão bem estabelecidas, diferente dos caninos. Este trabalho objetivou verificar se cães com DM desenvolvem alterações que levam à doença renal (DR). Foram estudados 31 cães diabéticos, que foram divididos em três grupos, em que G1 compreendeu os cães sem DR; G2, com infecção do trato urinário (ITU) e o G3, com DR no estádio 1. A avaliação dos animais constou de anamnese; exame clínico; mensuração da pressão arterial sistólica (PAS) e exames laboratoriais: hemograma, exame de urina, bioquímica sanguínea (fibrinogênio, glicose, uréia, creatinina, proteína total, albumina, globulina, fósforo, cálcio, sódio, potássio, frutosamina e colesterol) e bioquímica urinária (proteína, creatinina, sódio e potássio e determinada a atividade da gama glutamiltransferase - GGT). Estabeleceu-se a razão proteína:creatinina urinária (RPC) e a excreção fracional (EF) de sódio e potássio. Os resultados mostram relação entre DM e DR e as alterações mais relevantes encontradas foram ITU e aumento da RPC, do fósforo sérico, da GGT urinária, do colesterol, do fibrinogênio e da EF de sódio e potássio. E quanto aos sinais clínicos, poliúria, polidipsia, catarata, polifagia, emagrecimento, desidratação e neoplasias. Cães com idade média de nove anos, fêmeas e da raça Poodle são mais predispostos ao DM. Cães que passaram a receber dietas específicas, além da monitoração laboratorial, conseguiram o controle glicêmico e melhoria na qualidade de vida.

O câncer bucal é uma doença que afeta principalmente homens acima de 40 anos com hábito de fumar e beber. Em geral, esses pacientes têm o diagnóstico da enfermidade realizado tardiamente, acarretando tratamentos complexos, mutilantes e de alto custo tanto financeiro como social e de prognóstico sombrio a ponto do câncer bucal apresentar uma taxa de sobrevida em 5 anos inferior a 50%. O diagnóstico precoce representa uma alternativa importante para alterar esse panorama. Os recursos de que os profissionais da área da saúde, principalmente os cirurgiões-dentistas, dispõem são o diagnóstico clínico de lesões estabelecidas acompanhado da biópsia com exame histopatológico.Outra alternativa para o diagnóstico precoce dos carcinomas espinocelulares ocorre quando estes são precedidos de lesões cancerizáveis. Nas duas últimas décadas, a utilização da citopatologia como método de diagnóstico de danos celulares prévios ao aparecimento de lesões clínicas possibilitou sua utilização em mucosa bucal. Os estudos apresentados tratam especificamente desta aplicação clínica, abordando: a) os aspectos genéticos do câncer bucal; b) a correlação histocitopatológica de lesões cancerizáveis em câncer bucal e na mucosa normal exposta aos carcinógenos; c) a validação das amostras citopatológicas; d) a padronização da técnica de extração de DNA em células esfoliadas da mucosa bucal. / Oral cancer affects mainly men over 40 years who are exposed to tobacco and alcohol. These patients usually receive a late diagnosis, which results in complex, mutilating treatments with high financial and social costs, poor prognosis, and, therefore, a 5-year survival rate lower than 50%. Early diagnosis is critical to change this situation. The resources currently available to healthcare professionals, particularly dentists, are the clinical diagnosis of lesions and biopsies for histopathologic examination. Another alternative for the early diagnosis of squamous cell carcinomas is the identification of precursor lesions. In the last two decades, cytopathology has been used as a method to diagnose cell damage that precedes the appearance of clinical lesions, and this use can be extended to the oral mucosa. The studies reported here deal specifically with this clinical application, and discuss: A) the genetic factors in oral cancer; B) the cytohistologic correlation of cancer precursor lesions and the normal mucosa exposed to carcinogens; C) the validation of cytopathologic samples; D) the standardization of the technique to extract DNA of cells exfoliated from the oral mucosa.

The aim of this doctoral thesis was to study the influence of memory, pain, age and education on the regional cerebral blood flow (rCBF), i.e. brain function, in early Alzheimer's disease (AD) and in chronic neck pain patients in comparison to healthy controls and in healthy elderly per se. This was done by optimizing single photon emission computed tomography (SPECT) as a method to study rCBF with the tracer Technetium-99m (99mTc) hexamethylpropyleneamine oxime (HMPAO) and by matching all image data to a brain atlas before evaluation. The rCBF-SPECT was evaluated and developed to obtain higher diagnostic accuracy in AD and in chronic neck pain patients it was used to study basic pain related cerebral processes in chronic pain of different origin. A new semimanual registration method, based on fiducial marker, suitable for investigations with low spatial resolution was developed. The method was used to reconstruct images with an improved attenuation and scatter correction by using an attenuation-map calculated from the patients' previously acquired CT images. The influence of age and education on rCBF was evaluated with statistical parametric mapping, SPM in healthy elderly. The main findings were age related changes in rCBF in regions close to interlobar and interhemispheric space but not in regions typically affected in early AD, except for the medial temporal lobe. The theory of a 'cognitive reserve' in individuals with a longer education was supported with findings in the lateral temporal lobe, a region related to semantic memory, and in the frontal lobe. A cross-sectional study of chronic neck pain patients showed extensive rCBF changes in coping related regions in a non-traumatic pain patients compared to both healthy and a pain group with a traumatic origin, i.e. whiplash syndrome. The whiplash group displayed no significant differences in rCBF in comparison with the healthy controls. This suggests different pain mechanisms in these groups. The AD-patients showed a significantly lower rCBF in temporoparietal regions including left hippocampus. These changes were associated to episodic memory performance, and especially to face recognition. The diagnostic sensitivity for AD was high. The face recognition test (episodic memory) was used in AD patients to improve the sensitivity of method, i.e. memory-provoked rCBF-SPECT (MP-SPECT). The results were compared to healthy controls and the reductions of rCBF in temporoparietal regions were more pronounced in mild AD during provocation. Memory provocation increased the sensitivity of AD-related rCBF changes at group level. If a higher sensitivity for AD at the individual level is verified in future studies, a single MP-SPECT study might then be of help to set diagnosis earlier. In conclusion rCBF in temporoparietal regions are associated to an impaired episodic memory in early AD. Changes in these regions do not have a strong connection to chronological age. The diagnostic sensitivity of rCBF-SPECT in AD is high and there is a potentially higher sensitivity if memory provoked investigations are used. The findings in this thesis have given an increased knowledge of underlying cerebral pain processing in non-traumatic and traumatic (whiplash) neck pain. Preliminary results supporting the theory of 'cognitive reserve' by showing a correlation between long education and preserved rCBF was found in healthy elderly.

No description available.

Diss. (sammanfattning) Stockholm : Karol. inst., 2004. / Härtill 5 uppsatser.