The National High Blood Pressure Education Program presents the complete Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Like its predecessors, the purpose is to provide an evidence-based approach to the prevention and management of hypertension. The key messages of this report are these: in those older than age 50, systolic blood pressure (BP) of greater than 140 mm Hg is a more important cardiovascular disease (CVD) risk factor than diastolic BP; beginning at 115/75 mm Hg, CVD risk doubles for each increment of 20/10 mm Hg; those who are normotensive at 55 years of age will have a 90% lifetime risk of developing hypertension; prehypertensive individuals (systolic BP 120-139 mm Hg or diastolic BP 80-89 mm Hg) require health-promoting lifestyle modifications to prevent the progressive rise in blood pressure and CVD; for uncomplicated hypertension, thiazide diuretic should be used in drug treatment for most, either alone or combined with drugs from other classes; this report delineates specific high-risk conditions that are compelling indications for the use of other antihypertensive drug classes (angiotensin-converting enzyme inhibitors, angiotensin-receptor blockers, beta-blockers, calcium channel blockers); two or more antihypertensive medications will be required to achieve goal BP (<140/90 mm Hg, or <130/80 mm Hg) for patients with diabetes and chronic kidney disease; for patients whose BP is more than 20 mm Hg above the systolic BP goal or more than 10 mm Hg above the diastolic BP goal, initiation of therapy using two agents, one of which usually will be a thiazide diuretic, should be considered; regardless of therapy or care, hypertension will be controlled only if patients are motivated to stay on their treatment plan. Positive experiences, trust in the clinician, and empathy improve patient motivation and satisfaction. This report serves as a guide, and the committee continues to recognize that the responsible physician's judgment remains paramount.

Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure

Co-Planar Stereotaxic Atlas of the Human Brain—3-Dimensional Proportional System: An Approach to Cerebral Imaging, J. Talairach, P. Tournoux. Georg Thieme Verlag, New York (1988), 122 pp., 130 figs. DM 268

New evidence and consensus has led to further revision of the McDonald Criteria for diagnosis of multiple sclerosis. The use of imaging for demonstration of dissemination of central nervous system lesions in space and time has been simplified, and in some circumstances dissemination in space and time can be established by a single scan. These revisions simplify the Criteria, preserve their diagnostic sensitivity and specificity, address their applicability across populations, and may allow earlier diagnosis and more uniform and widespread use.

/pdf/diagnostic-criteria-for-multiple-sclerosis-2010-revisions-to-24iph50480.pdf

Diagnostic criteria for multiple sclerosis: 2010 Revisions to the McDonald criteria

Background and Purpose—The authors present an overview of the current evidence and management recommendations for evaluation and treatment of adults with acute ischemic stroke. The intended audienc...

/pdf/guidelines-for-the-early-management-of-patients-with-acute-19udbft6e7.pdf

Guidelines for the Early Management of Patients With Acute Ischemic Stroke A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association

The International Panel on MS Diagnosis presents revised diagnostic criteria for multiple sclerosis (MS). The focus remains on the objective demonstration of dissemination of lesions in both time and space. Magnetic resonance imaging is integrated with dinical and other paraclinical diagnostic methods. The revised criteria facilitate the diagnosis of MS in patients with a variety of presentations, including "monosymptomatic" disease suggestive of MS, disease with a typical relapsing-remitting course, and disease with insidious progression, without clear attacks and remissions. Previously used terms such as "clinically definite" and "probable MS" are no longer recommended. The outcome of a diagnostic evaluation is either MS, "possible MS" (for those at risk for MS, but for whom diagnostic evaluation is equivocal), or "not MS."

https://www.onlinelibrary.wiley.com/doi/epdf/10.1002/ana.1032

Recommended diagnostic criteria for multiple sclerosis: Guidelines from the International Panel on the Diagnosis of Multiple Sclerosis

What Is the Role of Ancillary Investigations in Establishing the Diagnosis of Multiple Sclerosis

Entzundlich-rheumatische Erkrankungen konnen neben den bekannten muskuloskelettalen Manifestationen auch das zentrale und periphere Nervensystem betreffen. Die moglichen Symptome sind dabei genauso vielfaltig wie die Krankheitsmechanismen, die sie hervorrufen konnen. Eine rasche diagnostische Abklarung, die Einleitung einer adaquaten Therapie und ein regelmasiges Monitoring dieser Patienten sind notwendig, um bleibende Behinderungen abzuwenden. In diesem Artikel werden aktuelle Ansatze der Diagnostik und Therapie neurologischer Manifestationen bei entzundlich-rheumatischen Erkrankungen wie systemischer Lupus erythematodes, M. Behcet, Sjogren-Syndrom, systemische Vaskulitiden und Sarkoidose zusammengefasst.

Diagnose und Therapie neurologischer Manifestationen bei entzündlich-rheumatischen Erkrankungen

Minimizing macro vessel signal in hemodynamic parameter maps using independent component analysis.

Superposition of Morphological MR Information and Functional SPECT Images

EINLEITUNG: Die physiologische Perfusion beschreibt den Transport von Nährstoffen zu Zellen und den Abtransport von Abfallprodukten. Quantitativ wird dieser Vorgang im allgemeinen durch die Menge an Blut, mit der ein Gewebe in einer bestimmten Zeit versorgt wird, erfaßt. Daraus läßt sich klinisch wertvolle Information über vaskuläre und degenerative Erkrankungen, ebenso wie über Tumorentwicklung ableiten. In der MRBildgebung ist man daher bestrebt, neue Pulssequenzen für die Abbildung bzw. für die Quantifizierung der Perfusion zu entwickeln. Waren es bis vor kurzem Indikatorverteilungsmethoden mit paramagnetischem Kontrastmittel (1), so sind es jetzt immer mehr nichtinvasive Methoden, die an Bedeutung gewinnen (2,3). Alle nichtinvasiven Methoden haben gemein, daß sie Kernspins von arteriellen Wasserstoffprotonen (arterielle Spins) als natürliche endogene Indikatoren verwenden. Durch geeignete magnetische Präparation dieser Spins proximal zur untersuchten Schicht läßt sich die Gleichgewichtsmagnetisierung im untersuchten Gewebe modulieren. Dieser Effekt ist allerdings sehr gering, wodurch eine Strategie gefordert ist, die eine Ausnutzung mit möglichst hohem SignalRauschverhältnis und gleichzeitig kurzer Akquisitionszeit erlaubt. Ein wesentlicher Aspekt dieser Arbeit war es , in unserem Perfusionsmodell (4) die TlRelaxationszeit des Blutes zu berücksichtigen und somit eine exaktere Bestimmung der Perfusion zu ermöglichen.

https://www.degruyter.com/view/j/bmte.1996.41.issue-s1/bmte.1996.41.s1.144/bmte.1996.41.s1.144.pdf

Franz Fazekas

Papers

What Is the Role of Ancillary Investigations in Establishing the Diagnosis of Multiple Sclerosis

Diagnose und Therapie neurologischer Manifestationen bei entzündlich-rheumatischen Erkrankungen

Minimizing macro vessel signal in hemodynamic parameter maps using independent component analysis.

Superposition of Morphological MR Information and Functional SPECT Images

Nichtinvasive MR-Perfusionsbildgebung im Hirngewebe mittels Magnetisierungspräparation