The pharmacological effects of buflomedil in patients with multi-cerebral infarcts dementia: an open, preliminary assessment

The influence of buflomedil on brain circulation was investigated in an open, preliminary trial in 12 patients with dementia caused by multi-cerebral infarcts. Patients were given 150 mg buflomedil 3-times daily for a period of 6 months. Assessments carried out before treatment included regional cerebral blood flow measurements, using a 133Xenon technique, as well as psychometric tests (Weschler and Benton), psychiatric and neurological evaluations, and routine clinical and laboratory (blood and urine) examinations. The tests and investigations were repeated on Days 90 and 180 of treatment. The results showed that mean regional cerebral blood flow increased by 15% to 22% and 16% to 24% in the right and left hemispheres, respectively, by the end of the trial, and marked improvements were noted in psychiatric symptoms and scores in the psychometric tests. A controlled, double-blind study is being planned to validate these preliminary findings.     

Carotid plaque echomorphology and serum vascular endothelial growth factor levels

Neovascularization in atherosclerotic plaques plays an essential role in the progression and rupture of plaques. Vascular endothelial growth factor (VEGF) is an important angiogenic factor. Echomorphologic evaluation of carotid plaques using computer-assisted imaging was found to have a good correlation with the histology of the lesion. The aim of this study was to investigate whether the serum VEGF level could be a determinant of the echomorphology of the carotid plaque. In 28 carotid plaques causing 60-99% stenosis, serum VEGF levels and the mean gray value (MGV) of three-dimensional image of the carotid plaques were measured. A statistically significant inverse correlation was found between serum VEGF concentrations and MGVs (Spearman's correlation coefficient: -0.415, p = 0.028). Our finding indicates that in patients with > or =60% carotid stenosis the serum VEGF levels are associated with the echogenicity of the atherosclerotic plaque.     

Occurrence of new vertebral body fracture after percutaneous vertebroplasty in patients with osteoporosis

PURPOSE: To investigate the prevalence and findings of vertebral body compression fractures adjacent to those previously treated with percutaneous vertebroplasty. MATERIALS AND METHODS: The findings in 177 patients treated with percutaneous vertebroplasty for more than 2 years were reviewed retrospectively. The following parameters were reviewed: primary diagnosis, patient age and sex, date of treatment with vertebroplasty, vertebral level(s) treated, pedicular approach, and amount of polymethylmethacrylate injected per vertebral body. Patients with acute compression fractures secondary to osteoporosis were selected. RESULTS: Of 177 patients treated with percutaneous vertebroplasty, 22 (12.4%) developed a total of 36 new vertebral body fractures following treatment. Of the 36 newly documented fractures, 24 (67%) involved vertebrae adjacent to the previously treated vertebral level(s), whereas 12 (33%) involved the collapse of nonadjacent vertebrae. In addition, 24 (67%) of the 36 new vertebral fractures occurred within 30 days after treatment of the initial fracture(s). CONCLUSION: A substantial number of patients with osteoporosis develop new fractures after undergoing percutaneous vertebroplasty; two-thirds of these new fractures occur in vertebrae adjacent to those previously treated.     

Isolated ocular ischemic syndrome with no cerebral involvement in common carotid artery occlusion

PURPOSE: The ocular ischemic syndrome (OIS) is sometimes a complication of common carotid artery (CCA) occlusion causing complete interruption of blood flow through both the internal and external carotid arteries we investigated a single case of an isolated OIS that remained undiagnosed for two years, because the underlying CCA pathology caused no cerebral involvement. CASE REPORT: A 57-year-old man presented with subacute painful visual loss in the right eye in a setting of hypertension, smoking and coronary artery disease. RESULTS. Neurological examination, a brain CT and MRI scan were all normal. Extensive laboratory work-up excluded small artery disease, inflammatory arteritis or cardiac causes of retinal embolism. Ophthalmologic evaluation and fluorescein angiography gave findings consistent with OIS, while vascular ultrasound evaluation and aortic arch angiography verified right CCA occlusion accompanied by an extensive collateral network. CONCLUSIONS: Had this patient been referred sooner for a simple carotid artery work-up, both the CCA occlusion and the OIS could probably had been prevented.     

Acute laryngotracheobronchitis and associated transient hyperphosphatasemia: a new case of transient hyperphosphatasemia in early childhood

We report the case of a 20-month old boy with markedly elevated serum alkaline phosphatase (ALP) levels, documented during an episode of acute laryngotracheobronchitis. Biochemical investigations and imaging studies revealed no evidence of bone or liver disease. Transient hyperphosphatasemia (TH) was confirmed when serum ALP levels normalized within 2 months. Several theories were suggested for TH pathophysiology, viral infections among them; the exact causes, however, remain unclear. It is important to recognize TH and avoid misdiagnosis and unnecessary investigations.