Cerebral Effects of a Single Dose of Intravenous Vinpocetine in Chronic Stroke Patients: A PET Study

The effects of vinpocetine (Cavinton) on the cerebral glucose metabolism of chronic stroke patients are studied with positron emission tomography. The regional and global cerebral metabolic rates of glucose (C MR91 u) and the kinetic constants related to them are quantified before and after single-dose intravenous vinpocetine treatment. These measurements are completed with transcranial Doppler sonography and single photon emission computed tomography to explore the possible mechanisms underlying the resulting changes in glucose uptake and metabolism in the brain. The authors' findings indicate that a singledose vinpocetine treatment, although it does not affect significantly the regional or global metabolic rates of glucose, improves significantly the transport of glucose (both uptake and release) through the blood-brain barrier in the whole brain, the entire contralateral hemisphere, and in the brain tissue around the infarct area of the symptomatic hemisphere. These changes are in accord with increased blood flow in the entire contralateral hemisphere as well as decreased blood flow velocity and increased peripheral vessel resistance in the entire symptomatic hemisphere.     

Electrical cataract and optic neuropathy

We report on a 20 year old male, who developed mature cataract (Electrical Cataract) on both eyes after a severe electric shock from high voltage. Both of his hands and the left foot had to be amputated, because of the severe injury. Although electrical cataract due to high voltage or lightning is rare, they may still occur after industrial or home electric accidents. Even if extracapsular cataract extraction with intraocular lens implantation is successfully performed, the final visual acuity will depend on other ocular damage due to the electric current.     

History and development of pediatric otorhinolaryngology in Hungary

The first pediatric otorhinolaryngological department was set up in Hungary at the Heim Pál Children's Hospital, Budapest in 1948. The first head of the department and the founder of Hungarian pediatric otorhinolaryngology was Ferenc Kallay. He was followed in leadership by Jenő Hirschberg, and at present Gábor Katona. In Budapest 10 pediatric otolaryngological departments and in other parts of the country seven departments have been working until recently with overall 344 beds. The Pediatric Otorhinolaryngological Section was developed in 1977. The discipline is independent specialty since 1978. Conferences with various special topics have been organized every year since then. Two international congresses were held in Hungary: the first one in Eger, 1986 presided by Jenő Hirschberg and Zoltán Lábas; and the second in Budapest in 2008, organized by Gábor Katona. The Hungarian pediatric otorhinolaryngologists assumed initiative role in the development of this special discipline six decades ago, early joined in the international life and have had important positions in several international associations (IFOS, ESPO, UEP, IALP, IAP) as president, board member or chairman of committees. Besides the organizational work, they have taken part in the scientific and research work as well: in the present paper the authors detail the results achieved by them in several topics of pediatric otorhinolaryngology.     

Three-dimensional (3D) contrast-enhanced power Doppler imaging in Legg-Calvé-Perthes disease

Background. The revascularization process of the femoral head in Legg-Calvé-Perthes disease has not been well studied on Doppler images. We incorporated two relatively new developments in ultrasound: 3D power Doppler imaging combined with the use of contrast agents.¶Patients and methods. We studied two children with unilateral Legg-Calvé-Perthes disease through anterior-sagittal approaches with pre- and post-contrast power Doppler images, acquired in 2D and 3D planes.¶Results. In one patient, intraosseous vessels were detected only in the pathological femoral head both pre- and post-contrast administration. In the other, no flow was identifiable without the use of contrasts.¶Conclusion. The use of ultrasound contrast agents combined with 3D imaging modalities offers new alternative methods for visualization of intraosseous vascularity.     

Lung biopsy using harmonic scalpel: a randomised single institute study.

OBJECTIVE: Applicability of harmonic scalpel in lung biopsy was investigated in a randomised single institute study. METHODS: Safety of the method, morbidity, drainage duration and in-hospital stays were compared in two randomised groups of patients in which either ultrasonic harmonic scalpel (n:20) or endostapler (n:20) were used for pulmonary biopsies during VATS. RESULTS: An advantage of 16min in average operation time was found in favour of the harmonic scalpel (30.75 vs 46.9min) which was significant. There were no differences in average drainage duration (40.2 vs 30.6h) and pleural fluid volume (258 vs 232ml). Minor complication rates (3 vs 3) were identical and in-hospital stays (7.6 vs 7.2 days) were also similar. CONCLUSIONS: Overall, the vibration transmission method was shown not to be inferior to the standard endostapling technique. A safe new method offers an alternative technique for peripherial lung biopsy.     

The effect of an amino acid-lowering diet on the rate of melphalan entry into brain and xenotransplanted glioma.

Melphalan (L-phenylalanine mustard, L-PAM, alkeran; molecular weight, 305,000) is transported across tumor cell membranes and the blood-brain barrier by the large neutral amino acid (LNAA) transport system. Normally, plasma LNAA levels are high enough and the affinity low enough that this system does not transport much melphalan into the brain. However, plasma amino acids can be reduced by fasting and protein-free diet. We used this method to reduce competition and to increase melphalan transport into brain tumors. In nude mice fasted for 12 h and then fed a protein-free diet for 2 and 6 h, mean plasma LNAA levels were 46% and 42% of control values. Nude mice with xenotransplanted D-54MG human gliomas were used to study tissue distribution and uptake kinetics of [3H]melphalan in a control group and a diet group (after a 12-h fast and 2 h of a 0% protein diet). The K1 (blood-to-tissue transfer constant) of melphalan, determined by graphical analysis and by nonlinear fitting to a 2-compartment model, was higher in the diet group in all tumor regions except the necrotic center of subcutaneous tumors; the increase was significant in the tumor periphery of brain and s.c. tumors. The ratio of K1s (diet to control) varied from 1.2 to 1.3 in brain tumors, 1.9 to 2.1 in subcutaneous tumors, and 1.8 to 3.1 in tumor-free brain. The apparent [3H]melphalan distribution space was significantly higher in the tumor periphery of both brain and subcutaneous tumors of the 15- and 30-min diet group. We also measured blood-brain barrier transport of [alpha-14C]aminoisobutyric acid and blood flow (with [131I]iodoantipyrine): the K1 of [alpha-14C]aminoisobutyric acid was 28.1 +/- 6.6 (SE) in brain tumors and 24.3 +/- 8.9 microliters/g/min in subcutaneous tumors. Blood flow was 58.2 --> 3.9 in brain tumors and 5.2 +/- 0.4 ml/100 g/min in subcutaneous tumors. Fasting, when combined with a protein-free diet, reduces plasma amino acid levels and thereby reduces competition between melphalan and LNAAs. This may increase the amount of melphalan that can enter a brain tumor without increasing the administered drug dose and suggests a therapeutic manipulation that can be used to increase the delivery of melphalan.     

Effect of childhood obesity and obesity-related cardiovascular risk factors on glomerular and tubular protein excretion

There is increasing evidence that obesity may damage the kidney in otherwise healthy individuals. Our study investigated the effect of childhood obesity on urinary albumin and beta-2-microglobulin excretion, and the association of these with obesity-related cardiovascular risk factors. Random morning spot urine samples were collected from clinically healthy obese ( n =86; median age 12.9 years, range 8.9–17.2 years; median weight 80.6 kg, range 46.1–136.8 kg; median body mass index 30.4 kg/m², range 24.5–43.2 kg/m²) and normal weight children ( n =79; median age 13.5 years, range 10.7–14.9 years; median weight 51.0 kg, range 27.3–72.5 kg; median body mass index 18.2 kg/m², range 13.2–23.9 kg/m²). The obese children were examined for the presence of common obesity-related cardiovascular risk factors including hyperinsulinaemia, impaired glucose tolerance (IGT), dyslipidaemia, hypercholesterolaemia, and hypertension. Obese children had a significantly higher urinary albumin/creatinine ratio (U-ACR) (median 11.7 mg/g, interquartile range 12.9 mg/g versus median 9.0 mg/g, interquartile range 5.1 mg/g; P =0.003) and urinary beta-2-microglobulin/creatinine ratio (U-BMCR) (median 63.9 µg/g, interquartile range 34.7 µg/g versus median 34.6 µg/g, interquartile range 44.1 µg/g; P <0.001) than normal weight children. Among the obese children, the U-ACR was associated with fasting hyperinsulinaemia, IGT, and hypercholesterolaemia (all P <0.05), and significantly correlated with the fasting ( r =0.23, P <0.05) and 2-h ( r =0.37, P <0.001) plasma glucose levels measured during an oral glucose tolerance test. Obese children with no more than one of the features of the metabolic syndrome had significantly lower U-ACRs than obese children with two or more features (median 10.4 mg/g, interquartile range 5.8 mg/g versus median 15.3 mg/g, interquartile range 14.9 mg/g; P <0.05). Conclusion:According to our results, clinically healthy obese children have a higher degree of albuminuria and beta-2-microglobulinuria than normal weight children, indicating early renal glomerular and tubular dysfunction as a consequence of childhood obesity. The urinary albumin/creatinine ratio in the obese children was associated with certain metabolic derangements linked to obesity, and also with the clustering of features of the metabolic syndrome.     

TIM-4 is the ligand for TIM-1, and the TIM-1-TIM-4 interaction regulates T cell proliferation

The newly identified TIM family of proteins is associated with regulation of T helper type 1 (T(H)1) and T(H)2 immune responses. TIM-1 is genetically linked to asthma and is a receptor for hepatitis A virus, but the endogenous ligand of TIM-1 is not known. Here we show that TIM-4, which is expressed by antigen-presenting cells, is the ligand for TIM-1. In vivo administration of either soluble TIM-1-immunoglobulin (TIM-1-Ig) fusion protein or TIM-4-Ig fusion protein resulted in hyperproliferation of T cells, and TIM-4-Ig costimulated T cell proliferation mediated by CD3 and CD28 in vitro. These data suggest that the TIM-1-TIM-4 interaction is involved in regulating T cell proliferation.