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.     

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.      

EAACI Position paper on the standardization of nasal allergen challenges

Nasal allergen challenge (NAC) is an important tool to diagnose allergic rhinitis. In daily clinical routine, experimentally, or when measuring therapeutic success clinically, nasal allergen challenge is fundamental. It is further one of the key diagnostic tools when initiating specific allergen immunotherapy. So far, national recommendations offered guidance on its execution; however, international divergence left many questions unanswered. These differences in the literature caused EAACI to initiate a task force to answer unmet needs and find a consensus in executing nasal allergen challenge. On the basis of a systematic review containing nasal allergen challenges of the past years, task force members reviewed evidence, discussed open issues, and studied variations of several subjective and objective assessment parameters to propose a standardized way of a nasal allergen challenge procedure in clinical practice. Besides an update on indications, contraindications, and preparations for the test procedure, main recommendations are a bilaterally challenge with standardized allergens, with a spray device offering 0.1 mL per nostril. A systematic catalogue for positivity criteria is given for the variety of established subjective and objective assessment methods as well as a schedule for the challenge procedure. The task force recommends a unified protocol for NAC for daily clinical practice, aiming at eliminating the previous difficulty of comparing NAC results due to unmet needs.     

Management of patients with raised and non-raised ST acute coronary syndrome

Unstable angina pectoris has been regarded for many years as an intermediate state between chronic stable angina and acute myocardial infarction. Recently it has been found that unstable angina pectoris and myocardial infarction are consequences of the same pathophysiological process--rupture or erosion of atherosclerotic plaque and joining thrombosis and embolism of distal vessels. It would be valid to use the term "acute coronary syndrome" (ACS) as a provisional diagnosis. Among AC8 patients there are patients with and without ST segment elevation. This dictates therapeutic policy and predicts the patients' survival. Two clinical cases illustrate the validity of the above division and effectiveness of adequate policy of the above patients therapy.     

Changes of autologous coronary vessels and aortocoronary grafts in patients with ischemic heart disease after coronary artery bypass grafting

AIM: 1) to assess effect of coronary lesion morphology on changes of grafts during first year after surgery; 2) to study the state of native coronary vascular bed during first year after surgery; 3) to elucidate special features of atherosclerosis in grafts and coronary arteries in remote period after surgery. MATERIAL AND METHODS: One hundred eighty seven patients with 3-vessel coronary artery disease subjected to aorto-coronary or mammary-coronary grafting. RESULTS AND CONCLUSION: Proportions of closed venous grafts were 24,2% among grafts to arteries with 50-75% stenoses, 13.1% among grafts to occluded arteries (p=0.023), and 20.1% among grafts to arteries with 75-99% stenoses. Among venous grafts to arteries with lumen diameter <1.5 mm 30.4% were occluded what was significantly more than among grafts to vessels with 1.5-2.5 mm (15.5%, p=0.003) and >2.5 mm (14.5%, p=0.004) diameter. Morphological risk factors of venous graft closure in immediate postoperative period were 50-75% stenosis and lumen diameter <1.5 mm. All mammary-coronary anastomoses were patent in 1 year, 99% of them remained patent 5 years after surgery. No relationship was found between patency of venous grafts after 5 years of follow-up and morphological characteristics (lumen diameter and percent stenosis) of bypassed arteries. During first year there was no significant differences between patients with patent and occluded grafts both in incidences of novel atherosclerotic lesions (10.4 and 10.3%, respectively, p=0.943) and proportion of closures of initially stenotic arteries (9.6 and 10.3%, respectively, p=0.085). After 5 years novel atherosclerotic lesions were found in 31.9 and 33.6% of patients with patent and occluded grafts, respectively (p=0.910). Complete occlusions of stenosed vessels proximal to anastomosis occurred more often among patients with patent than with occluded grafts (28.6 and 15.9%, respectively, p=0.047). Thus in remote postoperative period development of atherosclerosis in proximal segments of arteries with patent grafts was more 'aggressive' than in arteries with occluded grafts.     

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.     

Comparative studies of local antibody and cellular immune responses to influenza infection and vaccination with live attenuated reassortant influenza vaccine (LAIV) utilizing a mouse nasal-associated lymphoid tissue (NALT) separation method

The first and most significant barrier against influenza infection is the mucosal-associated lymphoid tissue of the upper airways and rodent nasopharyngeal-associated lymphoid tissue (NALT) is considered equivalent to the lymphoid tissue of human Valdryer's ring. This study is the first attempt to analyze and compare local and systemic cellular and antibody immune responses in NALT and spleen in a mouse model of experimental influenza infection and intranasal vaccination with LAIV (live attenuated reassortant influenza vaccine). It was shown that the vaccine strain completely inherited the ability to induce high-grade local antibody responses (secretory IgA + IgG + IgM), local cellular lymphoproliferative activity, CD4⁺, CD8⁺ and CD19⁺ lymphocyte and cytokine production responses from the virulent parental strain but it had less capacity to stimulate production of serum IgG, accumulation of CD8⁺ cells and IFN-γ production in the spleen. Primary non-complicated influenza infection and primary vaccination were accompanied by a short-term (24 h) increase in the levels of lymphocyte apoptosis in both NALT and spleen. However, experimental data indicated that vaccination with LAIV and uncomplicated forms of influenza infection did not influence immune system apoptosis following a secondary immune response.