Effects of atorvastatin on blood-brain barrier permeability during L-NAME hypertension followed by angiotensin-II in rats

Recent studies suggest that 3-hydroxy-3 methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors, statins, can have direct effects on blood vessels beyond their cholesterol-lowering effects. We investigated the effects of atorvastatin on the functional and structural properties of blood-brain barrier (BBB) and the activity of astrocytes during the N(omega)-nitro-L-arginine methyl ester (L-NAME) hypertension followed by angiotensin (ANG) II. We found that decreases in concentration of serum catalase and plasma nitric oxide (NO) induced by L-NAME were significantly ameliorated by atorvastatin, whereas L-NAME-induced serum malondialdehyde and cholesterol concentration increases were significantly reduced by atorvastatin. The content of Evans blue (EB) dye significantly increased in cerebellum, left cerebral cortex and diencephalon regions but atorvastatin markedly reduced the increased BBB permeability to EB in the brain regions of animals treated with L-NAME and L-NAME plus ANG II. Brain vessels of L-NAME-treated animals showed a considerable loss of immunoreactivity of tight junction proteins, zonula occludens (ZO)-1 and occludin. Immunoreactivity for ZO-1 and occludin increased in animals treated with atorvastatin and L-NAME plus atorvastatin. Glial fibrillary acidic protein (GFAP) immunoreactivity was seen in few astrocytes in the brain sections of L-NAME, but immunoreactivity for GFAP increased in L-NAME plus atorvastatin-treated animals. We suggest that long-term L-NAME treatment may affect BBB permeability through disruption of tight junction proteins, at least partly, via decreased NO concentration and increased oxidant capacity; the improvement of BBB integrity and astrocytic activity would be more closely associated with the action of atorvastatin favoring the increase in anti-oxidant capacity and expression of tight junction proteins and GFAP.     

Intrahepatic arterioportal fistula and its treatment with detachable balloon and transcatheter embolization with coils and microspheres

BACKGROUND: Although intrahepatic arterioportal fistula (APF) due to acquired or congenital causes are infrequent, they are listed among the causes of portal hypertension. PURPOSE: The aim of this study was to present the results of intrahepatic APF treatment with embolotherapy in six cases. MATERIAL AND METHODS: Transarterial detachable balloon and coil embolization was used on six consecutive cases with traumatic intrahepatic APF from 1989 to 2003. Six-month follow-up angiography was obtained in every case. RESULTS: Successful disconnection of hepatic arterial and portal system was achieved in five cases. At least symptomatic improvement was achieved in one. CONCLUSION: Transcatheter embolization may be the first line of treatment for intrahepatic APF.     

T102C polymorphism of the 5-HT2A receptor gene may be associated with temporomandibular dysfunction

OBJECTIVE: To assess whether a relationship existed between the T102C polymorphism of 5-HT2A receptor gene and temporomandibular dysfunction. METHODS: Sixty-three patients with temporomandibular dysfunction, and 54 healthy volunteer controls were included in the study. Molecular analysis of the T102C polymorphism of the 5-HT2A receptor gene was performed using PCR technique. RESULTS: The C/C genotype was over represented in the patients whereas T/T genotype was over represented in the controls (P < 0.05). The genotype distribution of the patients who had temporomandibular dysfunction was not different than those who did not have temporomandibular dysfunction (P > 0.05). CONCLUSION: The T102C polymorphism may be involved in the etiology of temporomandibular dysfunction. The overrepresentation of the C/C variant of 5-HT2A receptor gene in temporomandibular dysfunction suggests a possible role of the serotonergic system in this disease, particularly at the receptor level.     

Observer variability based on the strength of MR scanners in the assessment of lumbar degenerative disc disease

OBJECT: aim of this study was to analyse the observer variability in the diagnosis and definition of disc pathologies with low and high-field strength MR scanners. MATERIAL AND METHODS: 95 patients with low back pain or radicular pain who were referred from two different centers were included in the study. Fifty-seven patients were scanned with 0.3 T MR (group 1) and 38 patients with 1.5 T (group 2). The intraobserver and interobserver reliability were assessed with the cappa coefficient which was characterised as follows: values less than 0.0 = 'poor' agreement, values 0.01-0.2 = 'slight' agreement beyond chance, 0.21-0.4 = 'fair' agreement, 0.41-0.60 = 'moderate' agreement, 0.61-0.80 = 'substantial' agreement and 0.81-1.00 = 'almost perfect' agreement. RESULTS: intraobserver agreement in group 1 and group 2 for both readers was 'almost perfect' in differentiating normal and pathological discs; 'substantial-almost perfect' in defining the disc pathologies, 'moderate-substantial' in root compression, and 'moderate-substantial' in spinal stenosis. Interobserver agreement was 'almost perfect' in differentiating normal and pathological discs, 'substantial' in defining disc pathologies, 'moderate' in root compression and 'moderate' in spinal stenosis in the group 1, whereas in group 2, it was 'almost perfect' in differentiating normal and pathological discs, 'almost perfect' in defining disc pathologies, 'slight-substantial' in root compression and 'moderate' in spinal stenosis. CONCLUSION: in the diagnosis of root compression and spinal stenosis, the intra and interobserver agreements were relatively poor with both high and low-strength field MRIs, indicating a need for more objective criteria. In differentiating normal and pathologic appearance of disc, the interobserver agreement was considerably better with high-field compared to low-field strength MRI. In cases where this definition is important, high-field strength scanners should be preferred.     

Seroprevalence of antibodies to legionella pneumophila in hemodialysis patients

Patients with chronic renal failure are at increased risk for infections because of impaired cellular immunity. This study was designed to determine the prevalence of antibodies to Legionella pneumophila serogroups 1 to 6 and to evaluate the possible risk factors for Legionnaires' disease in hemodialysis patients. Serum samples to be screened for antibodies against L pneumophila and risk factor data were collected from 252 hemodialysis patients. The overall prevalence of L pneumophila antibodies in hemodialysis patients was found to be 5.16% There was no statistically significant difference between L pneumophila seropositivity and potential risk factors. Further studies are needed to determine possible risk factors for Legionnaires' disease in hemodialysis patients.     

Comparison of clinical outcomes of different erythropoietin usage strategies

AIM: There is no comprehensive study that compares the different usage strategies of recombinant human erythropoietin (rHuEPO) in platinum-induced anemia. In order to clarify this issue, we conducted a prospective clinical study. MATERIAL AND METHODS: Seventy-seven patients were studied in three main groups. Group 1 (n = 17) consisted of cancer patients without anemia. These patients received rHuEPO starting from the first chemotherapy cycle. Group 2 (n = 26) consisted of patients whose hemoglobin (Hb) values decreased by at least 1 g/dL after the first cycle of chemotherapy. Group 3 (n = 34) consisted of patients whose Hb values dropped below 10.5 g/dL after the second chemotherapy cycle. Groups 2 and 3 were each divided into two subgroups. In groups 1, 2A and 3A rHuEPO (5000 U/day subcutaneously three times a week) treatment was continued until three weeks after the completion of chemotherapy. In groups 2B and 3B, rHuEPO was given for 12 weeks only. RESULTS: There were no prominent differences between the Hb values of these groups throughout the chemotherapy cycles. Transfusion rates and the number of patients who became anemic were also not different between groups. CONCLUSION: No rHuEPO usage strategies are superior to others in terms of Hb levels and transfusion requirements. The decision as to when rHuEPO is to be added to platinum-containing therapy should be tailored to the health conditions of individual patients.     

Utility of dobutamine stress echocardiography in Kawasaki disease: a case report and review of the literature

Dobutamine stress echocardiography (DSE) has become widely accepted in the evaluation of adult patients with coronary heart disease. There are new challenges about the use of DSE in the pediatric age group to document ischemia. DSE can demonstrate ischemia noninvasively in Kawasaki disease (KD) patients who are candidates for coronary angiography. We wanted to assess the feasibility and the physiologic responses of DSE in a KD patient with coronary aneurysm. The patient had no ischemia in DSE, which was confirmed by coronary angiography showing no stenosis. The literature about DSE use in KD is reviewed.     

Giant aneurysm of the azygos pericallosal artery: case report and review of the literature

BACKGROUND: Pericallosal aneurysms are encountered less than 6.7%, and giant aneurysms among them even less. Giant azygos pericallosal artery aneurysm at the callosomarginal bifurcation is extremely rare, and our case presented herein is the second one. The case is discussed with thorough review of the literature. METHODS: A 65-year-old woman presented with an extremely rare giant aneurysm on the azygos pericallosal artery manifesting as subarachnoid hemorrhage in World Federation of Neurosurgical Societies Grade 3. Computed tomography (CT), magnetic resonance angiography (MRA), and four vessel angiography revealed a giant azygos pericallosal artery aneurysm associated with a second aneurysm at the left M1. RESULTS: After recovery to Grade 2, she underwent surgery via the right frontal interhemispheric approach for the azygos artery aneurysm on the 17th day after bleeding. The true dimensions of the aneurysm were greater than indicated by angiography because of partial thrombosis. Trilobulate aneurysm was carefully dissected from the surrounding structures. Postoperative cerebral angiography showed no filling of the clipped aneurysm and preservation of circulation. CONCLUSIONS: The treatment of distal anterior cerebral artery aneurysms is often difficult, because of their broad-based irregular configurations and adherence to surrounding tissue, tendency to bleed irrespective of size and the coexistence of other cerebral aneurysms. However, excellent outcomes can be obtained based on thorough preoperative radiologic evaluation, including magnetic resonance imaging (MRI), and correct selection of surgical approach.