Headache in lacunar stroke

The presence of headache within a 72-h interval of stroke onset was investigated in a cohort of 145 lacunar infarcts. Fourteen (10%) experienced diffuse or bilateral headache. Hypertension was less frequent (43 vs 76%; 95% CI: 6 to 60%) and of shorter duration (2.4 vs 7.8 years; t = 2.29; p = 0.02) among patients with headache. Leukoaraiosis was less frequent (40% vs 71%; 95% CI: −57 to −7%) and severe (7 vs 24%; 95% CI: −33 to −2%) in patients with headache. Age, sex, stroke risk factors, type of lacunar stroke, mode of onset, stroke severity, ultrasound and other CT findings were similar in patients with and without headache. No differences in the sixth month neurological or functional outcome were detected between lacunar patients with and without headache. Headache in lacunar stroke cannot be predicted by the clinical characteristics of the stroke and is not due to coexisting cardiembolism, intra or extracranial disease. Hypertensive small-vessel disease is less common and severe in lacunar strokes with associated headache.     

The diagnosis and possibilities for the anti-arrhythmia treatment of malignant ventricular disorders of the heart rhythm]

Altogether 130 patients with malignant ventricular disorders of cardiac rhythm were examined to demonstrate a possibility of obtaining the diagnostically significant data with the aid of Holter's monitoring of the ECG in 89.2%, with the aid of bicycle ergometry exercise tests in 72.3%, and by means of an electrophysiological examination of the heart in 82.5% of the above-indicated group of patients. The drug testing with the use of invasive and noninvasive techniques of monitoring the action of antiarrhythmic drugs given per os makes it possible to choose effective therapy on an individual basis. The long-term use of such therapy may prevent ventricular tachycardia relapses and noticeably enhance the patients' survival. Severe organic pathology of the heart associated with a decrease of its pump function seen in the majority of patients with malignant ventricular disorders of cardiac rhythm refractory to pharmacotherapy restricts, in a considerable number of cases, the potentialities of drastic surgical treatment because of the risk of operative death. To improve the disease prognosis of these patients, it is necessary that other methods of nonmedicamentous treatment may be used, requiring a less scope of surgical intervention, such as implantation of a cardioverter-defibrillator.     

Cyclosporin nephrotoxicity in heart and lung transplant patients

Twenty-two patients with heart, lung or heart and lung transplants maintained on cyclosporin for periods ranging from 3 months to 10 years developed renal insufficiency which was investigated by renal biopsy. The histopathological changes were: (i) severe vascular and glomerular damage due to thrombotic microangiopathy (TM); (ii) a form of focal segmental glomerulosclerosis (FSGS); (iii) glomerular ischaemia. Rather than being separate entities, these changes appeared to represent a spectrum of pathology, some biopsies showing all three forms of glomerular injury. In all cases the glomerular changes were accompanied by arteriolar and arterial pathology, and we identified novel ultrastructural changes in the arteriolar endothelial basal lamina. Tubular atrophy was a consistent feature, the severity of which reflected the severity of the glomerular sclerosis, and which appeared to be a consequence of glomerular loss. Our findings are consistent with the nephrotoxic effects of cyclosporin being mediated chiefly via damage to preglomerular vessels and glomerular capillary endothelium. From an analysis of the clinical aspects of these cases, the effects of cyclosporin appear to be to some extent idiosyncratic, and therefore not entirely preventable, but strict monitoring of blood cyclosporin levels is essential to minimize the risk of permanent renal damage. Monitoring urinary protein in addition to plasma creatinine may detect the onset of FSGS, as proteinuria precedes creatinine elevation.      

Cognitive Deficits in Multiple Sclerosis: Recent Advances in Treatment and Neurorehabilitation

Purpose of review

This article highlights recent progress in research on treatment and neurorehabilitation of cognitive impairment in multiple sclerosis (MS) including pharmacological interventions, physical exercise, and neuropsychological rehabilitation, both in conventional and technology-assisted settings.

Recent findings

The most consistent evidence in terms of improvement or preservation of circumscribed cognitive scores in MS patients comes from moderately sampled randomized clinical trials on multimodal approaches that combine conventional or computerized neuropsychological training with psychoeducation or cognitive behavioral therapy. Disease-modifying treatments also appear to have beneficial effects in preventing or attenuating cognitive decline, whereas there is little evidence for agents such as donepezil or stimulants. Finally, physical exercise may yield some cognitive improvement in MS patients.

Summary

Despite substantial and often promising research efforts, there is a lack of validated and widely accepted clinical procedures for cognitive neurorehabilitation in MS. Development of such approaches will require collaborative efforts towards the design of interventions that are fundamentally inspired by cognitive neuroscience, potentially guided by neuroimaging, and composed of conventional neuropsychological training and cognitive behavioral therapy as well as physical exercise and therapeutic video games. Subsequently, large-scale validation will be needed with meaningful outcome measures reflecting transfer to everyday cognitive function and maintenance of training effects.

     

Assessment of the functional status of the left and right ventricles in the intact and damaged heart during volume overload

Changes in hemodynamics, reserve capacities of intact and damaged myocardium have been studied, with the left and right ventricular functions during mounting volume load assessed separately. It has been shown that exclusion of the part of left ventricular myocardium from contraction deteriorated considerably the pump and contractile function not only of the left but also of the right intact heart ventricle. Heart failure in volume overload manifests itself primarily in the right ventricle and depends on the functional heart reverse on the whole: in animals with partial injury of left ventricular myocardium heart failure developed in much lower volume loads than in intact animals. In circulation volume overload, left or right ventricular stroke work index to preload or filling pressure in the corresponding heart chamber ratio was most adequate and prognostically valuable for the detection of latent heart failure.     

The Role of Cytokines in Maintaining the Dynamics of Cell—Cell Interaction between Natural Killer Cells and Trophoblast Cells

Bulletin of Experimental Biology and Medicine - We analyzed the effect of individual cytokines that are secretory products of placenta typical of the uteroplacental bed. The proinflammatory...     

CD4(+)CD25(high)CD127(low) regulatory T cells in patients with stable angina and their dynamics after intracoronary sirolimus-eluting stent implantation

Rapamycin contributes to the expansion of regulatory T cells (Tregs) in vitro. We investigated CD4(+)CD25(high)CD127(low) Treg level dynamics as well as the major parameters of cell immunity and sCD25 and highly sensitive C-reactive protein (hsCRP) concentrations in the blood of patients after coronary stenting (CS) with sirolimus (rapamycin)-eluting stents (SES; n = 43). The relation between initial Treg values and the severity of coronary atherosclerosis was observed. Treg and sCD25 levels were increased 1 month after CS versus baseline values and versus data in the control group (coronary angiography [CA], n = 20). A positive correlation between Treg and sCD25 levels was reported, whereas no relation was observed with the length of SES implanted. HsCRP level was increased during the first 7 days and returned to baseline values 1 month after CS/CA. Treg content is lower in patients with multivessel CAD. Elevated levels of Tregs and sCD25 after SES implantation might occur because of the immunomodulating effect of rapamycin.     

Blood transfusion practices in military medicine

Background: This observational study was conducted in a small, 45 bed border static hospital, located in a field area, where no blood bank facilities were available. The present study was conducted to elucidate the blood transfusion practices of this hospital.