Asymptomatic visual field disturbances in multiple sclerosis patients without a history of optic neuritis

BACKGROUND AND PURPOSE: The aim of our study was to evaluate visual field in patients with multiple sclerosis without a history of optic neuritis. We assessed presence and localisation of visual field defects and evaluated correlation between visual field disturbances and patient's neurological status. MATERIAL AND METHODS: A group of 52 patients with multiple sclerosis and 17 healthy persons who served as the control group were enrolled into the study. The patients went through a routine neurological examination, ophthalmologic check-up and perimetric visual field assessment. Visual fields were examined with static perimetry Medmont M700. In all of the patients, results of perimetry were evaluated according to localisation of lesions. A decibel scale was used to quantitatively assess disturbances in patient's visual field. RESULTS: We found that "asymptomatic" visual field disturbances were present in a large number (38, 73.1%) of multiple sclerosis patients. Among these patients, we diagnosed concentric visual field lesions in 46.2%, and we recognized disturbances in the upper part of the visual field in 26.9%. There was a correlation between the presence of those visual field lesions, duration of multiple sclerosis, and the degree of patients' disability. CONCLUSIONS: Asymptomatic visual field disturbances occur frequently in MS patients (despite no history of retrobulbar optic neuritis). Static perimetry may be a valuable, complementary method in addition to examinations used so far in the diagnosis of multiple sclerosis.     

Massive pulmonary embolism mimicking ST-elevation acute coronary syndrome successfully treated with hybrid therapy in a trauma patient receiving nadroparin: diagnostic and therapeutic dilemmas

A case of a 48-year-old woman with a comminuted fracture of the left tibia and receiving prophylactic doses of nadroparin, with massive pulmonary embolism mimicking ST-elevation acute coronary syndrome and complicated by cardiogenic shock and cardiac arrest, is presented. Pulmonary angiography showed total right pulmonary artery occlusion. Intraarterial thrombolysis with reduced dose of alteplase (50 mg), platelet GP IIb/IIIa blockade with eptifibatide, endovascular embolus fragmentation with a pigtail rotation catheter, and rescue pulmonary balloon angioplasty were performed, after which complete recovery was achieved. On day 4 of hospitalisation the patient was transferred to the orthopaedic ward where she underwent uneventful tibial surgery.     

Enhanced oxidative stress in hypertrophic cardiomyopathy

Elevated plasma levels of inflammation and endothelial dysfunction markers have been reported in patients with hypertrophic cardiomyopathy (HCM). The aim of the current study was to determine whether HCM is associated with enhanced oxidative stress. We enrolled 54HCMpatients with sinus rhythm, including 21 subjects with a left ventricular outflow tract (LVOT) obstruction (gradient ≥ 30 mmHg), and 54 age- and sex-matched controls without cardiovascular diseases. Serum levels of 8-isoprostaglandin F_2α (8-iso-PGF_2α), a stable marker of oxidative stress, were determined.Serum 8-iso-PGF_2α levels were elevated in HCM patients compared with controls (35.4 ± 10.2 vs. 29.9 ± 9.9 pg/ml, p < 0.001). Patients with obstructiveHCMdisplayed higher 8-iso-PGF_2α levels compared with the non-obstructiveHCMsubgroup (41.6 ± 12.7 vs. 31.4 ± 5.4 pg/ml, p < 0.0001). Both anatomic (mitral-septal distance) and hemodynamic (subaortic gradient) indexes of LVOT obstruction, but not other echocardiographic variables, correlated with 8-iso-PGF_2α levels (r = –0.43; p < 0.05 and r = 0.39; p < 0.05, respectively).This study is the first to show that HCM is characterized by enhanced oxidative stress as evidenced by higher 8-iso-PGF_2α, which achieves its highest values in the presence of LVOT obstruction in HCM patients.     

Late hyperenhancement in gadolinium-enhanced magnetic resonance imaging: comparison of hypertrophic cardiomyopathy patients with and without nonsustained ventricular tachycardia

Aim To assess the extent of hyperenhancement in hypertrophic cardiomyopathy (HCM) patients with nonsustained ventricular tachycardia (NSVT) in comparison to patients without NSVT. Design In HCM patients, NSVT in Holter monitoring is a risk factor for sudden cardiac death; however, its positive predictive value is low. Varying risk of sudden death related to NSVT may be dependent on the heterogeneous extent of the arrhythmogenic substrate, which seems to be visible as hyperenhancement in gadolinium-enhanced magnetic resonance imaging (MRI). Methods Hyperenhancement was assessed in 47 HCM patients (30 males and 17 females, mean age 42 ± 12 years): 32 patients had NSVT, 15 patients had no NSVT. The extent of hyperenhancement was calculated by software and expressed as a mass. Results In HCM patients with NSVT 97% had some extent of hyperenhancement on MRI, ranging from 1 to 76 g. The mean mass of hyperenhanced myocardium was 19 ± 18 g (8.1 ± 7.6% of total left ventricular mass). In HCM patients without NSVT, a significantly lower percentage of patients (60%) had hyperenhancement (P < 0.05). However, the amount of hyperenhanced myocardium was not significantly different (13 ± 19 g, 6.3 ± 9.1% of total left ventricular mass; P < 0.05). Conclusions Hyperenhancement was visible in almost all HCM patients with NSVT (97%) and in a significantly lower percentage of patients without NSVT (60%). Whether this finding explains the increased risk of sudden death in case of NSVT is not clear, since the extent of hyperenhancement was not significantly different between the two groups.     

Fast disintegrating tablets containing Rhodiola rosea L. extract

Tablets with 250 mg of Rhodiola rosea L. extract disintegrating in less than 10 min were developed. The influence of the extract content and type of fillers and disintegrants on disintegration time and tablet hardness was evaluated. Type of the filler and the extract/filler ratio but not the type of disintegrant determined fast disintegration of the tablets. It was demonstrated that the extract:filler ratio lower than 1:1.5 enables preparation of tablets with the required disintegration time. The tablets containing microcrystalline cellulose as a filler, povidone as a binder and crospovidone as a disintegrant were stable during 6 months storage at 25 degrees C/60% RH, however, due to the decrease of hardness they did not pass the stability test at 40 degrees C/75% RH.