Publications by authors named "Zunker P"

Background And Purpose: Lp(a) lipoprotein plays an important part in atherothrombogenesis and is considered an independent risk factor for coronary heart disease. However, its role in cerebrovascular disease remains unclear, in particular because of the heterogeneous nature of strokes. We investigated whether elevated Lp(a) is more frequent in ischemic stroke related to atherothrombosis than in other etiologies of stroke.

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Objective: Acute coronary syndromes and ischemic cerebral stroke share similarities regarding elevated platelet activation. In coronary syndromes, the importance of inflammation with platelet-leukocyte interaction has been demonstrated. Recent infection is an established risk factor for ischemic stroke; the role of platelet-leukocyte interaction in these patients had not been investigated.

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Objective: The aim of the present study was to evaluate the periapical and periodontal healing of apicomarginal defects 12 months after periradicular surgery and guided tissue regeneration in a series of consecutively treated patients.

Study Design: Patients with apicomarginal defects who were referred for periradicular surgery were included. Apicomarginal defects were grafted with Bio-Oss bone mineral and covered with a Bio-Gide membrane.

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The pathophysiology of the reversible neurological manifestation in eclamptic women remains unclear. We report on 2 women with eclampsia who were repetitively examined by (1) transcranial Doppler (TCD), (2) magnetic resonance imaging (MRI) including T1- and T2-weighted images, fluid attenuated inversion recovery sequence, dynamic susceptibility-weighted perfusion imaging and magnetic resonance angiography (MRA), and (3) (18)fluoro-2-deoxy-D-glucose positron emission tomography (FDG-PET). In both cases repetitive TCD revealed no signs of vasospasm; the same was true for MRA.

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Background And Purpose: The present study was undertaken to determine the frequency of use of the ultrasound contrast agent (UCA) Levovist in routine transcranial ultrasound (TU). Additionally, we evaluated the diagnostic validity of contrast-enhanced TU using 3-dimensional time of flight MR angiography.

Methods: Indication for the UCA was an insufficient evaluation of the intracranial arteries after a combined approach with transcranial color-coded Duplex and transcranial Doppler examination.

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This paper describes a previously unreported clinical onset of carcinomatous meningitis with bilateral deafness. Typical changes in the cerebrospinal fluid aside from positive cytology findings are reviewed. In cases of suspected carcinomatous meningitis the clustering of increased CSF protein, lactate, decreased glucose, and a high opening pressure is suggestive of the diagnosis.

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We report of a woman with post-partum cerebral angiopathy (PCA), in whom we repetitively performed transcranial Doppler sonography (TCD), MR imaging (MRI), and MR angiography (MRA) to evaluate the underlying pathophysiology. A 31-year-old woman, Gemini pregnant, complained of severe throbbing frontal headache four days after an uneventful delivery by Cesarean section. Blurred vision occurred eight days after delivery, followed by three generalized tonic-clonic seizures.

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The prognosis of periradicular surgery is affected by the amount and location of bone loss. Apicomarginal defects are localized bony defects encompassing the total root length, and periradicular surgery on these teeth is associated with a lower success rate. This paper reviews the etiology, pathogenesis, and morphology of apicomarginal defects as encountered in periradicular surgery on the basis of a series of 24 consecutively treated patients.

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Noonan syndrome is an autosomal-dominant inherited syndrome with variable expression of multiple malformations including cardiovascular and craniofacial anomalies. While cerebrovascular insults due to cardiogenic emboli, coagulation abnormalities or cerebrovascular malformations have been documented before, intracerebral occlusive artery disease is not well recognized as a cause of stroke in this syndrome. A 6-year-old girl with Noonan syndrome presented with repetitive transient ischemic attacks consisting of dysphasia and right-sided central facial and arm weakness.

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Objectives: Resistance to activated protein C (APC) is the most frequent cause of thrombophilia and a well known risk factor for deep and cerebral vein thrombosis. Its causative role in ischaemic stroke is still a matter of debate. We undertook this study to determine the prevalence of APC-resistance in a cohort of consecutive patients with acute ischaemic stroke, especially with respect to patients' age and the underlying stroke causation.

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Aim: To compare maternal cerebral hemodynamics, as assessed by transcranial Doppler studies, with the clinical and radiological findings in different types of pregnancy-related hypertension and to determine their pathophysiology.

Methods: A prospective study of 66 consecutive pregnant women with hypertensive disorders (eclampsia, n = 3; pre-eclampsia, n = 41; isolated hemolysis, elevated liver enzymes, and low platelet count (HELLP)-syndrome, n = 12; pre-eclampsia superimposed on chronic hypertension, n = 5; chronic hypertension, n = 5) and 21 women with uncomplicated pregnancies. Mean blood flow velocities (Vmean) were assessed serially by means of transcranial Doppler in all basal arteries and correlated with changes in mean arterial blood pressure (MABP) and the clinical course.

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Recent studies suggest that high plasma levels of tissue-type plasminogen activator (tPA) and its inhibitor (plasminogen activator inhibitor-1, PAI-1) are markers of an increased risk of atherothrombotic ischemic events such as stroke and myocardial infarction. In this prospective study, we measured tPA antigen, PAI-1 antigen and activity, as well as tPA/PAI-1 complex in patients with acute stroke. Stroke subtypes were classified according to the TOAST criteria.

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Slow and rhythmic spontaneous oscillations of cerebral and peripheral blood flow occur within frequencies of 0.5-3 min-1 (0.008-0.

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Objective: To investigate the temporal peripartal course of plasma endothelin 1 (ET-1), angiotensin II (ANG II), and atrial natriuretic peptide (ANP) in patients with pre-eclampsia as compared to women with normotensive pregnancy.

Methods: Levels of ET-1, ANG II, and ANP were measured by means of radio-immunoassay twice a week in 17 patients with pre-eclampsia and in 17 women with normotensive uncomplicated pregnancy during four different periods: (a) from admission to 1 week before delivery, (b) 1st week before delivery, (c) 1st week after delivery, and (d) 2nd week after delivery.

Results: ET-1 levels were not statistically different between the two groups.

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We compared the value of 3D time-of-flight (TOF) and phase-contrast (PC) MR angiography (MRA) for detection and grading of intracranial vascular steno-occlusive disease. Unenhanced 3D-TOF MRA and 3D-PC MRA (30-60 cm/s velocity encoding) were performed at the level of the circle of Willis in 18 patients, mean age 56 +/- 10 years. Postprocessed images using a maximum-intensity projection reconstruction with multiple targetted projections were analysed.

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Supraventricular and ventricular tachyarrhythmia are established causes of syncope. We investigated the mean blood flow velocities (Vmean) of the middle cerebral arteries (MCA) during routine cardiac electrophysiologic studies in patients with supraventricular and ventricular tachyarrhythmias in order to evaluate the changes in cerebral hemodynamics associated with pre-syncopal and syncopal states. Thirty-two patients with a history of supraventricular (n = 14) or ventricular (n = 18) tachyarrhythmias were investigated in the nonsedated, post-absorptive state in supine position.

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Background And Purpose: We undertook this study to evaluate the prevalence and clinical correlations of Doppler microembolic signals (MES) in stroke-prone patients.

Methods: Patients with potential cardiac (n = 300) or carotid (n = 100) embolic source and control subjects (n = 100) were monitored with transcranial Doppler sonography for MES. Transthoracic (n = 192) and/or transesophageal (n = 134) echocardiography and carotid studies (continuous-wave Doppler, n = 181; color-coded duplex, n = 47) were performed in all patients with potential native cardioembolic source.

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Background And Purpose: Middle cerebral artery (MCA) stenosis is a relatively rare occlusive disease with an annual stroke risk of approximately 7% to 8%. However, the frequent coincidence of cardiac or ipsilateral carotid artery disease may lead to difficulties in identifying the relevant embolizing source in symptomatic patients. We undertook this study to evaluate the prevalence of microembolic signals (MES) as well as the potential and limitations of bigate monitoring in patients with MCA stenosis.

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Background And Purpose: The applicability of a novel differentiation technique in embolus detection based on the coincidence principle and using a multigate probe was evaluated in this study.

Methods: According to the coincidence method, high-intensity transients should only be classified as microembolic signals if they appear sequentially in the two sample volumes monitored and within a defined time window calculated from the blood velocity and the spatial distance between the insonation depths. Part A: microbubbles were introduced in a continuous flow bench model of the middle cerebral artery to evaluate the accuracy of the multigate probe in embolus detection.

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Background And Purpose: High insulin levels are a recognized risk factor for atherosclerosis. Microvascular endothelium is more susceptible to metabolic and mitogenic effects of insulin than large-vessel endothelium. Besides their atherogenic effect, high insulin levels impair fibrinolysis by enhancing plasminogen activator inhibitor-1.

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Pre-eclampsia and eclampsia represent a syndrome with progressive pregnancy-induced hypertension. They are associated with considerable morbidity and mortality. The pre-eclampsia/eclampsia syndrome has been hypothesized to reflect a subtype of hypertensive encephalopathy.

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