Neuropsychiatric complications after stroke

Stroke represents a major public health problem in Hungary, but relatively little attention is directed toward poststroke neuropsychiatric disturbances. Stroke patients frequently represent mood disturbances, cognitive decline, anxiety disorders, and sometimes serious schizophorm or paranoid states. Poststroke depression is the most common and possibly amenable form to therapeutic intervention. Depressive symptoms have negative effect on the rehabilitation process, quality of life and even on long-term survival. Considering drug therapy, in the past decade tricyclic drugs have been replaced by newly developed antidepressants with milder side-effects profile. Our knowledge on the relationship among vascular and other types of dementia has been extended in the recent years. This development also has some therapeutic implications. It seems likely that other psychiatric disorders, psychoses, pathological affect and personality disorders also inhibit recovery and limit long-term quality of life, but available data on this topic is limited.     

In vivo labeling of rabbit cholinergic basal forebrain neurons with fluorochromated antibodies

Cholinergic basal forebrain neurons (CBFN) expressing the low-affinity neurotrophin receptor p75 (p75(NTR)) were previously selectively labeled in vivo with carbocyanine 3 (Cy3)-tagged anti-p75(NTR), but the applied 192IgG-conjugates recognized p75(NTR) only in rat. The antibody ME 20.4 raised against human p75(NTR) had been shown to cross-react with the receptor in monkey, raccoon, sheep, cat, dog, pig and rabbit. Hence, for in vivo labeling of rabbit CBFN in the present study, ME 20.4 was fluorochromated with Cy3-N-hydroxysuccinimide ester and purified Cy3-ME 20.4 was injected intracerebroventricularly. Two days post-injection, clusters of Cy3-ME 20.4 were found in CBFN displaying choline acetyltrans-ferase-immunoreactivity. Following photoconversion, electron microscopy revealed fluorochromated antibodies in secondary lysosomes. In conclusion, Cy3-ME 20.4 might become an appropriate marker for CBFN in live and fixed tissues of various mammalian species.     

Incidence and clinical characteristics of the metabolic syndrome in patients with coronary artery disease

BACKGROUND AND OBJECTIVES: Several studies suggested that the insulin resistance-associated metabolic syndrome (MS) is a major risk factor for coronary artery disease (CAD), but the criteria to identify MS were only recently standardized by the National Cholesterol Education Program (NCEP) Adult Treatment Panel (ATP) III. METHODS: We evaluated the incidence of the newly defined MS in patients with documented CAD and compared the characteristics of patients with and without this syndrome. RESULTS: In a Canadian population with CAD (793 men and 315 women, age 58.1+/-9.8 years) 51% had MS. As compared to patients without the MS syndrome, these patients had significantly higher waist circumference, blood pressure levels and fasting glucose and triglyceride, but lower high-density lipoprotein (HDL)-cholesterol levels. Their homeostatic model assessment (HOMA) insulin resistance index was significantly higher, with indicators of highly atherogenic, small low-density lipoprotein (LDL) and HDL particles. Family history of diabetes and the use of hypoglycemic agents, beta-blockers and thiazides were more frequent, but physical exercise and alcohol consumption were less frequent in MS positive patients. Cumulative coronary stenosis score and the frequency of patients with >50% coronary artery narrowing were higher and there was a strong tendency for higher rates of previous myocardial infarction in MS positive patients. CONCLUSIONS: In a CAD population documented in 1991-1992, 51% of participants had MS and in several respects a more advanced coronary disease than those without the syndrome. These results support the view of NCEP ATP III, that in CAD prevention, beyond lowering LDL-cholesterol levels, interventions concerning the constituents of MS should be important.     

Information on diagnosis and management of systemic lupus erythematosus derived from the routine measurement of 8 nuclear autoantibodies

OBJECTIVE: To determine the value of routine measurement of a panel of 8 nuclear autoantibodies (ANA/8) for the diagnosis and management of patients with systemic lupus erythematosus (SLE). METHODS: To estimate disease sensitivity of ANA/8, we studied 25 patients with new SLE and 114 with new and established SLE. To estimate disease specificity, 100 patients with other autoimmune rheumatic diseases were included. We used computerized statistical analysis of the level of 8 ANA in relation to clinical activity determined as Systemic Lupus Activity Measure disease activity scores (DAS). Data were collected retrospectively from the charts of 114 patients with 698 visits and evaluated by multiple and piece-wise linear regression analysis (PWLRA) and correlation and cluster analyses. RESULTS: The disease sensitivity of the 3 types of SLE profiles identified was 100% for new SLE patients (n = 25) and 87% for mixed SLE patients; the disease specificity was 98%. Autoantibody levels of anti-ssDNA, dsDNA, and Scl-70 were the best individual correlates of general and organ-specific DAS. Twenty-four percent (R2) of the variability in the general DAS was explained by the multiple regression (R = 0.49), with significant contribution made by anti-Scl-70 (beta = 0.39), dsDNA (beta = 0.17), Sm (beta = 0.10), and SSA (beta = 0.08). PWLRA indicated that for 68% of the 698 clinical presentations (average 6/patient), the observed DAS and the predicted DAS from autoantibody levels were both low and clustered; they were partially discrepant for the remaining 32%, which was explained by the relatively high correlation of DAS with prior changes in autoantibody levels (R = 0.6). The changes in DAS and in anti-dsDNA levels were significantly predicted by the multiple regression at one prior visit, with anti-ssDNA as the main contributor. CONCLUSION: The ANA/8 profile showed ~ 100% sensitivity and ~ 98% specificity for SLE and correlated with contemporary and subsequent changes in DAS and autoantibody levels. Among autoantibodies of this profile, anti-ssDNA (ssDNA) was the most sensitive indicator of SLE and the main contributor to prediction of subsequent changes in DAS.     

Diversity of polyketide synthase gene sequences in Aspergillus species

Fungal polyketide synthases are responsible for the biosynthesis of several mycotoxins and other secondary metabolites. The aim of our work was to investigate the diversity of polyketide synthases in Aspergillus species using two approaches: PCR amplification using oligonucleotide primers, and bioinformatics. Ketosynthase domain probes amplified DNA fragments of about 700 bp in each examined isolate. Sequences of these domains were aligned and analyzed by phylogenetic methods. The ketosynthase domain sequences were highly diverse indicating that they most probably represent polyketide synthases responsible for different functions. A. albertensis and A. niger ketosynthase domain sequences clustered together with sequences of genes required for pigment biosynthesis (wA) in A. nidulans and P. patulum, while the ketosynthase domain sequence of A. muricatus was most closely related to an A. parasiticus wA type domain sequence, and those of the A. ochraceus isolates formed a distinct clade on the tree. These sequences were highly homologous to an A. terreus naphthopyrone synthase gene. An Aspergillus fumigatus genomic database was also searched for ketosynthase domain sequences, which have been included in the phylogenetic analysis. Altogether 14 putative ketosynthase domain sequences were identified. Clustering of the ketosynthase domain sequences correlated well with the type of metabolites produced by the corresponding polyketide synthases. At least 8 clusters with putative ketosynthase domain sequences of unknown function have been identified. Further studies are in progress to clarify the role of some of the identified polyketide synthase genes.     

Quantitative assessment of blood flow reserve using <Superscript>99m</Superscript>Tc-HMPAO in carotid stenosis

Dynamic imaging of the inflow of technetium-99m hexamethylpropylene amine oxime (HMPAO) to the brain has been proved to allow estimation of the hemispherical cerebral blood flow (CBF) using the Patlak plot. In this study, we compared the hemispherical CBF (in ml/min/100 g) of different patient groups. A total of 25 patients (comprising 13 with migraine and 12 scheduled for endarterectomy owing to angiographically confirmed severe stenosis of the internal carotid artery on at least one side) underwent baseline and acetazolamide 99mTc-HMPAO brain perfusion studies. In addition, acetazolamide 99mTc-HMPAO studies were performed in 12 healthy subjects (no baseline study was performed for ethical reasons.) Dynamic studies were acquired by means of a dual-detector gamma camera with a large field of view (HELIX, Elscint). Special difference images were created to make definition of the aortic arch and hemispherical brain regions easier and more reproducible. A semi-automatic method was developed to determine the transit time from the aorta to the brain, making the generation of the Patlak plot even more robust. The baseline CBF values did not significantly depend on the disease (P>0.1), whereas the CBF values obtained after acetazolamide provocation did do so (ANOVA, P<0.001). Patients suffering from migraine showed a significant increase in global CBF values after acetazolamide provocation (paired t test, P<0.05), but we could not find any effect of the provocation in patients awaiting carotid endarterectomy, indicating a lack of cerebrovascular reserve capacity. Comparison of the results of the acetazolamide study in patients and the control group revealed the CBF values to be significantly lower in patients with carotid stenosis (two-sample t-test, P<0.001), but not in those with migraine (P>0.1). In summary, using quantitative analysis of 99mTc-HMPAO brain studies we could objectively compare the CBF of patients suffering from different diseases. Especially the CBF values obtained after acetazolamide provocation permitted effective differentiation of disease states. The quantitative results may be of assistance in therapy planning, e.g. in selection of the correct operative technique.     

Video-assisted thoracoscopy (VATS) during the last ten years (1992-2001)

We summarize and analyse the video-assisted thoracoscopies (VATS) performed in our department during the last ten years. In this period 296 patients underwent VATS for diagnosis or therapy. We describe indications, advantages and disadvantages, we also analyse the complications. Video-assisted thoracoscopy is less demanding to the patients than thoracotomy, it reduces the length and cost of inpatient treatment. We recommend extensive use of VATS in suitable patients.     

Successful treatment of a T1 cancer of the pancreatic head with high dose rate brachytherapy and external radiotherapy

In this report, a unique case of a localized (T1N0M0) adenocarcinoma of the head of the pancreas is presented, which was successfully treated with interstitial high dose rate brachytherapy combined with percutan irradiation after biopsy. A total dose of 18 Gy was delivered with brachytherapy (6 Gy per fraction on three consecutive days) to the tumor via after-loading catheter. Brachytherapy was followed by external radiotherapy, delivering an additional dose of 46 Gy (18 MV-x) with four-field technique using conventional fractionation (2 Gy/day). Thirty-six months after completion of the treatment the patient is alive with no evidence of disease. The combination of interstitial high dose rate brachytherapy and external beam radiation therapy may be an effective tool to deliver curative dose without any significant sequelae in the treatment of operable pancreatic carcinoma, when the patient's condition contraindicates surgery.     

Frequency of hyperhomocysteinemia in hemodialysis patients with folic acid supplementation

BACKGROUND: It is known that hyperhomocystinemia is an independent risk factor for development of atherosclerosis. In end stage renal disease the frequency of hyperhomocystinemia is much greater than in normal populations. AIM: In this study homocystein (Hcy), folic acid and vitamin B12 concentrations were determined in 125 chronic renal failure patients being on folic acid supplementation (3 mg/day). In 107 patients the frequency of C667T polymorphism of methylene tetrahyrofolate reductase (MTHFR) was also determined. The relationships between these parameters were also studied. RESULTS: It was found that in these patients who are under continuous folic acid supplementation the mean level of homocysteine was 16.8 +/- 7.2 mumol/L, a value considerably lower than the homocysteine concentration reported for non-supplemented patients. The elevation of homocysteine concentrations was independent of gender, time spent in renal replacement therapy, and the type of renal replacement therapy (hemodialysis: 17.6 +/- 12.6; hemodiafiltration: 16.6 +/- 12.9 mumol/L). Data showed an inverse relation between plasma homocysteine concentrations and the concentrations of folic acid and vitamin B12. Moderately severe hyperhomocystinemia (Hcy > 20 mumol/L) was found in about 30% of patients. In those the frequency of patients for homozygous T677 allele of MTHFR was about 25-30%. However, in all ESRD patients the frequency of the homozygotes was the same then in the normal population. Homocysteine plasma levels correlated with MTHFR polymorphism: in the wild type group Hcy was 14 +/- 7 mumol/L, in the heterozygous group was 17.2 +/- 6.2 mumol/L, and in the homozygous group was 21 +/- 19 mumol/L. CONCLUSIONS: Long-term folic acid supplementation decreased the homocysteine level in end stage renal disease patients. However, in folic acid resistant group, who were in 30% homozygotes for C667T of MTHFR (suggesting that homocysteine-methionine remethylation cycle is disturbed), instead of the administration of folic acid, methylene tetrahydrofolate supplementation might be considered.     

Pregnancy termination among South African adolescents

Although African adolescents' risk of undergoing abortion and of related health complications is well-documented, little is known about the procedure's prominence in their lives and the pathways that lead to their reliance upon it. This study investigates abortion dynamics among male and female Zulu adolescents in KwaZulu/Natal, South Africa. It explores the role of abortion in young people's sexual and reproductive experience, its acceptability, the reasons and likelihood of young people's choosing abortion, and the commonly used methods of pregnancy termination. The study, a rural-urban comparison using focus-group discussions, narrative workshops, and role playing, involved surveys and in-depth interviews. Factors contributing to the commonplace nature of backstreet procedures among adolescents include: social stigma, inadequate knowledge of the legal status of abortion, and a complex group decisionmaking process. Young people invoke "relative moralities" concerning adolescent abortion, recognizing and condoning it on a context-specific basis. Age, gender, and geographic differences are examined. The methodological triangulation used offers the opportunity for alternative theoretical and methodological approaches to research on abortion-related issues.