Severe dilated cardiomyopathy as a complication of well controlled Churg-Strauss syndrome

We present a case of a 42 year-old male with Churg-Strauss syndrome (CSS), who despite clinical remission developed severe dilated cardiomyopathy. Intensified immunosuppression helped to improve heart function. As heart involvement in CSS is very common, and may occur without prior symptoms, magnetic resonance imaging is advisable to identify patients with heart damage and introduce proper treatment.     

The use of extracorporeal membrane oxygenation (ECMO) in the treatment of acute respiratory distress syndrome due to pandemic influenza

Pandemic influenza particularly often is associated with symptoms of acute respiratory failure, and in case of refractory hypoxemia patients may have indications for the extracorporeal membrane oxygenation (ECMO). The paper presents a case of a pandemic influenza virus infection, where classical indications for veno-venous ECMO occured. Practical aspects of this kind of treatment in the intensive care unit are discussed.     

Spinal cord stimulation for the treatment of refractory angina pectoris

Spinal cord stimulation (SCS) is a well known method of treatment used worldwide since the 80's of the last century. High efficiency of SCS was observed in the treatment of various types of pain. Promising clinical results were observed in the treatment of patients with refractory angina (RA). Reduction of angina attacks reduces doses of medications and improves quality of life. SCS efficacy in RA is comparable to that observed among patients treated with cardiac surgery (CABG) and percutaneous coronary intervention (PCI), with lower risk of complications and rehospitalisation. SCS is more cost effective compared to CABG and PCI. SCS might be considered for patients who did not respond to reperfusion therapy. The mechanism of action in RA is not well understood. It is known that SCS reduces the activity of the sympathetic nervous system, by which improves the coronary perfusion and oxygenation of the heart muscle. It is important that SCS does not mask the pain related to the infarct.     

Relevance of erythrocyte deformability to the concentration of soluble cell adhesion molecules and glomerular filtration rate in patients with untreated essential hypertension

Relationship between erythrocyte deformability and: a) soluble cell adhesion molecules concentration, b) glomerular filtration rate (eGFR) has been investigated in three study groups: a group of 20 patients with diagnosed arterial hypertension, a group of 20 individuals with exclusively hypercholesterolemia and a group of 22 healthy persons. The individuals with hypertension or hypercholesterolemia were free of any other cardiovascular disease risk factor and were not on any therapy prior to entering the study. Clinical and laboratory data included systolic and diastolic blood pressure (obtained by ABPM), lipids profile, eGFR, red blood cell (RBC) deformability (assessed by shear stress laser diffractometry) and levels of circulating soluble vascular adhesion molecules-1 (sVCAM-1) as well as soluble intracellular adhesion molecules-1 (sICAM-1). In the group of hypertensives, RBC deformability and concentration of circulating soluble adhesion molecules showed statistically significant negative correlations: RBC deformability decreases with increasing level of: a) sVCAM-1, R = -0.61, p < 0.002, b) sIVCAM-1, R = -0.53, p < 0.009. In parallel, statistically significant increase of eGFR was observed with rising erythrocyte deformability, R = 0.60, p < 0.005. In the groups of healthy individuals and patients with hypercholesterolemia there was no sign of any correlations between the considered parameters. The observed correlations suggest that in patients diagnosed exclusively with hypertension, firstly, erythrocyte deformability may serve as a marker of endothelial dysfunction and, secondly, red blood cells may be mediators of adverse changes in kidneys.     

Reduced prefrontal oxygenation during object and spatial visual working memory in unpolar and bipolar depression

Altered prefrontal brain activity (e.g. hypofrontality) during cognitive tasks such as working memory is a core neuroimaging marker in unipolar (UNI) and bipolar (BI) depression. The present study investigated for the first time UNI (n = 16) and BI patients (n = 14) in a working memory task including different processes (storage and matching) and components (object and spatial visual) with functional near-infrared spectroscopy (fNIRS) over the prefrontal cortex. In healthy controls (n = 15) comparable to both patient groups, changes of oxygenated and deoxygenated haemoglobin indicated increased ventro-lateral, dorso-lateral prefrontal and superior frontal cortex activity for object and spatial visual working memory storage as compared to the control condition. In contrast, both patient groups showed diminished brain activity in all working memory conditions. Results revealed unspecific deficits that did not allow the differentiation between unipolar and bipolar depression in dependence of working memory processes or components. However, fNIRS can be considered as a valid, easy manageable, low cost and rapid tool for measuring (diminished) prefrontal cortex functions.     

Protective effects of haloperidol and clozapine on energy-deprived OLN-93 oligodendrocytes

Magnetic resonance imaging and postmortem studies on schizophrenia provided evidence for compromised myelin integrity and reduced numbers of oligodendrocytes, which may worsen during the disease course. However, it is not clear whether these findings result from disease-inherent oligodendrocyte degeneration or side effects of antipsychotic treatment. Therefore, effects of haloperidol and clozapine on the viability and apoptosis of immature oligodendrocytes (OLN-93 cells, immunopositive for NG2, Olig1, Olig2) have been evaluated in the present study by labeling with propidium iodide and a caspase 3 assay. Given the indications for impaired cerebral energy supply in schizophrenia, a serum and glucose deprivation (SGD) model was chosen in comparison with the basal condition (BC). SGD led to increased necrotic and apoptotic cell death. Haloperidol and clozapine were partially protective in this model and reduced the percentage of propidium iodide–positive cells, while caspase 3 activity was not altered. No significant drug effects were observed under BC. The observed protective effects of haloperidol and clozapine on energy-deprived OLN-93 oligodendrocytes suggest that previously reported reductions in oligodendrocyte density in schizophrenia are rather disease related than a side effect of medication. A new mechanism of antipsychotic action is suggested, which may help to establish new oligodendrocyte-directed therapies of schizophrenia.