Soluble P-selectin glycoprotein ligand - a possible new target in ulcerative colitis.

BACKGROUND: The main characteristic of active inflammatory bowel disease (IBD) is the neutrophil infiltration into the intestinal lamina propria, where neutrophils usually do not reside. Selectins are cell surface glycoproteins responsible for binding the leukocytes to vascular cells and their extravasation into the surrounding tissue. They show high affinity to P-selectin glycoprotein ligand-1 (PSGL-1) receptors. PSGL-1 is expressed on the surface of all leukocytes and they mediate the rolling of neutrophils on P-selectin. Soluble PSGL-1 acts competitively with cellular PSGL in many physiological and pathological processes.The aim of our study was to compare serum sPSGL-1 concentration in the blood of patients with ulcerative colitis (UC) and healthy control subjects. METHODS: Serum concentrations of sPSGL-1 were measured in 20 patients with UC and 20 control subjects. Two-layer immunoenzyme procedure (ELISA) was used. RESULTS: The mean (± standard deviation) serum concentrations of sPSGL-1 in patients with UC and controls were 349.97±75.40 U/mL and 284.39±52.40 U/mL, respectively (p=0.003). CONCLUSION: In the present study, we showed that patients with UC had significantly higher sPSGL-1 blood values in comparison with healthy subjects. A short-term blockade with anti-PSGL-1 antibodies could block the transport of neutrophils and decrease UC activity. Thus it could possibly be employed in a new therapeutic approach to the treatment of UC (Fig. 1, Ref. 25).

Lamotrigine in the treatment of pain syndromes and neuropathic pain.

Anti-epileptic drugs are increasingly used in the treatment of pain syndromes and neuropathic pain. Sodium channel blockers can be effective in the treatment of pain. The object of our interest is the efficiency of lamotrigine in treating the pain. A MEDLINE search was conducted to identify pertinent studies, case reports, letters, and reviews in English published from 1986 to May 2007. The search has indicated efficiency in treating a number of painful syndromes and neuropathic pain; central pain, trigeminal neuralgia and trigeminal neuralgia in multiple sclerosis, pain in multiple sclerosis, SUNCT syndrome, cluster headache, glossopharyngeal neuralgia, neuropathic pain, allodynia, neuralgia after nerve section, postherpetic neuralgia, HIV-associated neuropathy. Further researches are required on the role of lamotrigine in treating the spinal cord injury pain, neuralgia after nerve section, postoperative analgesic requirement, and in migraine (Tab. 1, Ref. 46). Full Text (Free, PDF) www.bmj.sk.

Vertigo associated with Chiari I malformation and syringomyelia.

We report a rare case of a patient with late onset of Chiari I malformation with associated syringomyelia that was successfully treated with foramen magnum decompression. Our patient is presenting initially with vertigo and gradual weakening of the left-hand gross motor ability, gradual hypesthesia. Magnetic resonance imaging demonstrated a Chiari I malformation with syringomyelia. Posterior fossa decompression, C1 laminectomy and duroplasty were performed. After surgery, the vertigo completely resolved (Fig. 2, Ref. 13). Full Text (Free, PDF) www.bmj.sk.

Side effects of ropinirole in patients with idiopathic Parkinson's disease.

OBJECTIVE: Results achieved in treating the Parkinson's disease (PD) by the dopamine receptor agonist, ropinirole, have been hampered by its side effects. According to the MEDLINE, the most common side effects of ropinirole are extreme sleepiness and/or sudden sleep attacks, nausea, dyspepsia, vertigo, orthostatic hypotension and leg oedema. METHODS: The prospective research included PD patients who were administered non-ergoline dopamine agonist, ropinirole, over this period of time. The control group of patients were treated with levodopa. RESULTS: The research included 50 patients: 31 women and 19 men, of the mean age of 61.4 +/- 4.3 years. One patient reported sleepiness and one of them sudden sleep attacks. Nausea was experienced by three patients, and vertigo by two. Depression, orthostatic hypotension, leg oedema, dyspepsia, dry cough and hypersalivation were registered in particular cases. The control group of PD patients, treated with levodopa, comprised 52 patients, 33 women and 19 men of the mean age of 63.2 +/- 4.1 years. In the control group, nausea was registered in two patients. CONCLUSIONS: The non-ergoline dopamine agonist, ropinirole, most commonly causes nausea and sleepiness, less commonly uncontrollable sleep attacks, vertigo, dyspepsia, orthostatic hypotension, leg oedema. Dry cough and hypersalivation are recorded sporadically (Tab. 1, Ref. 22).

Auditory evoked potentials (AEP)--an important help in early diagnosis of Schwannoma originating from vestibular nerve.

Early diagnosis of expansive formations enables efficient therapy and maximal reduction of remaining neurological damage. Schwannoma situated entirely within the inner auditory canal with free pontocerebellar angle is a rather rare event. Of significant diagnostical help are auditory evoked potentials (AEP), computerised tomography (CT) of the temporal bone pyramid with measuring the inner auditory canal diameter, and magnetic resonance (MRI). In this paper we present a case of a 56-year-old woman with gradually advancing noise in the right ear, weakening of hearing and occasional instability while walking. AEP register no evoked response at the right side, whereas at the left side the latencies and amplitudes of evoked acoustic responses are adequate. CT of the temporal bone pyramid shows a difference in the inner auditory canal diameters of 0.04 cm. MRI shows a Schwannoma tumorous formation in the inner auditory canal, situated entirely within the canal with free pontocerebellar angle (Fig. 3, Ref. 16). Full Text (Free, PDF) www.bmj.sk.

Cognitive impairment and epilepsy seizure caused by hypoparathyroidism.

We report a 46-years-old man with idiopathic hypoparathyroidism who presented with gradually cognitive impairment and generalized tonic clonic epilepsy. Computed tomography (CT) and magnetic resonance imaging (MRI) of brain showed calcification in the basal ganglia, thalamus and cerebral white matter. Calcium level was low and phosphor was increased in serum, but parathormon level was low. Following introduction of replacement therapy, cognitive functions improved as well. After treatment with calcium and vitamin D supplementation he showed clinical, cognitive impariment and laboratory improvements (Fig. 2, Ref. 13).

Clinical manifestations of vertebrobasilar dolichoectasia.

Vertebrobasilar dolichoectasia is defined as an increase in the length and diameter of the intracranial arteries. Clinical manifestations of dolichoectasiae result from compression of the cranial nerves and structures of the brain stem, turbulent flow causing tinnitus and vertigo, often with damages of small blood vessels of the brain. Dolichoectasia is an ishemic stroke risk factor. The role of dolichoectasia in occurrence of haemorrhagic stroke, aneurysm and arterial dissection and thrombosis is still not fully understood (Ref. 34).

Clinical importance of somatosensory evoked potentials in early diagnosis of syringomyelia.

We report a rare case of syringomyelia, the development of which was monitored by somatosensory evoked potentials. The evoked potentials recorded over an eight months' period of time were correlated with the incidence of syringomyelia. Changes of the evoked response latency and amplitude were dtected. The evoked potential change and the sensation deficit indicated a pathological process. High-resolution MRI revealed syringomyelia in the cervical and the thoracic segments of the spinal cord. Somatosensory evoked potentials represent a sensitive diagnostic method recording changes in the biopotentials. Potential changes require localisation of a possible process and high-resolution MRI. Evoked potentials enable to monitor both, the disease development, but also the healing process (Fig. 3, Ref 11).

Effects of APACHE II score on mechanical ventilation; prediction and outcome.

AIM: To evaluate the influence of Acute Physiology and Chronic Health Evaluation (APACHE II) score on the choice of mechanical ventilation method and treatment outcome. METHODS: A prospective, randomized trial was carried out at the multidisciplinary Intensive Care Unit over 22 months. Research sample consisted of 129 patients who required mechanical ventilation, divided in two groups: APACHE II < or = 20 and APACHE II > 20. Both groups were than randomized for either noninvasive or invasive mechanical ventilation. Comparison was made based on patient characteristics, objective parameters and influence of APACHE II score on treatment success and failure. RESULTS: APACHE II scoring was shown to have statistical significance on outcome assessment. Statistical significance was in favour of patients with APACHE II score < or = 20 vs > 20 (ventilator associated pneumonia 0 vs. 10, tracheotomy 0 vs. 16, Intensive Care Unit mortality 0 vs 12). Furthermore, in the group with APACHE II score > 20, after randomization, there was a statistical significance in favour of noninvasive mechanical ventilation in need for tracheotomy 2 (4%) vs. 14 (28%) (p < 0.001). CONCLUSION: Using good patient selection and applying strict protocols, in the group of patients with APACHE II < or = 20 all patients had successful mechanical ventilation, while in the group of patients with APACHE II > 20, noninvasive mechanical ventilation can be applied.

Somatosensory-evoked potentials and MRI in tuberculous spondylodiscitis.

Early diagnosis of spondylodiscitis is a condition of efficient conservative treatment. Somatosensory-evoked potentials with clinical examination results are used in assessing the diagnosis, as well as in monitoring the course of disease and healing. MRI clearly shows the inflammatory process, healing and scars. We report a 46-year-old woman suffering from non-specific interscapular pains. The evoked somatosensory potentials of the tibial nerveshow potential conductivity being slowed down through the thoracic spine, which is clearly evident from the prolonged latency and the decreased amplitude of the evoked response. The performed thoracic spine MRI shows spondylodiscitis at the Thl0-11 level. The subject is a nurse administering BCG therapy at a urology clinic, due to the fact of which this was deemed to have been a case of tuberculous spondylodiscitis. Due to the possibility of scattering the causative agent by needle, the biopsy was given up and antituberculous therapy was administered ex juvantibus. The disease was followed up by clinical examinations, somatosensory-evoked potentials and MRI up to fully successful and final recovery from spondylodiscitis. The above examinations are of great help in diagnosing the tuberculous spondylodiscitis and monitoring the recovery (Fig. 6, Ref. 16).

Tinnitus caused by vertebrobasilar dolichoectasia.

A 73-year old man presented with the tinnitus in the left ear for 11 months. Computer tomography (CT) showed an enlarged dolichoectasia of the left vertebral artery. Magnetic resonance imaging (MRI) of the brain shows dolichoectasia of the left vertebral artery and the initial part of the basilar artery. Multi-slices computer tomographic (MSCT) angiography showed an enlarged vertebrobasilar dolichoectasia of the left vertebral artery, which compressed the vestibulocochlear nerve. This study supports a vascular compression of cranial vestibulocochlear nerve and the brainstem as a cause of tinnitus, and demonstrates a MSCT angiography value as an excellent, non-invasive technique to demonstrate the compression (Fig. 1, Ref. 20). Full Text (Free, PDF) www.bmj.sk.

Neurocysticercosis--non-specific clinical and neuroradiological presentation.

Neurocysticercosis (cysticercosis cerebri) is a rare neurological diagnosis in Croatia. It is classically divided into four types: intraparenchymal, basilar cisternal, ventricular and diffuse. Computerized tomography (CT) and magnetic resonance imaging (MRI) established the diagnosis by demonstrating cysticercosis disseminated throughout the cerebral parenchyma. The authors emphasize the potential of the ELISA test to detect anticysticercosis antibodies in blood and cerebrospinal liquor (CSF). Diagnostics of neurocysticercosis is enabled jointly by clinical signs, neuroradiological, serum and liquor tests. We report the case of a 70-year old man with clinical and neuroradiological signs of cysticercosis cerebri. The neurological status is dominated by ataxia, corticospinal pathways damages and cognitive capacity impairments. CT of the brain shows calcificated and cystic lesions of various sizes. MRI of the brain enables the final diagnosis of the cysticercosis cerebri with multiple and multicentric lesions that indicate various stages of the cerebral cysticercosis (Fig. 2, Ref 20). Full Text (Free, PDF) www.bmj.sk.

Stable gastric pentadecapeptide BPC 157 in trials for inflammatory bowel disease (PL-10, PLD-116, PL 14736, Pliva, Croatia). Full and distended stomach, and vascular response.

Gastric pentadecapeptide BPC 157 (GEPPPGKPADDAGLV, M.W. 1419, safe in clinical trials for inflammatory bowel disease (PL 10, PLD 116, PLD 14736, Pliva, Croatia)) has a particular cytoprotective/adaptive cytoprotective activity. The cytoprotective/adaptive cytoprotection researches largely neglect that stomach distension could per se jeopardize the mucosal integrity, with constantly stretched mucosa and blood vessels, and sphincters more prone for reflux induction. After absolute alcohol instillation in fully distended rat stomach, gastric, esophageal and duodenal lesions occur. Throughout next 3 min, left gastric artery blood vessels clearly disappear at the serosal site, indicative for loss of vessels both integrity and function. Contrary, constant vessels presentation could predict the beneficial effect of applied agent. After pentadecapeptide BPC 157 instillation into the stomach the vessels presentation remains constant, and lesions of stomach, esophagus, and duodenum are inhibited. Standards (atropine, ranitidine, omeprazole) could only slightly improve the vessels presentation compared to control values, and they have only a partial effect on the lesions. In this review we emphasize BPC 157 unusual stability, and some of its important effects: effectiveness against various lesions in gastrointestinal tract, on nitric oxide (NO)-system, and NO-agents effects, on somatosensory neurons, salivary glands function, recovery of AMP-ADP-ATP system, endothelium protection, effect on endothelin, and on angiogenesis promotion. It also antagonizes other alcohol effects, including acute and chronic intoxication. Given peripherally, it counteracts the consequence of central dopamine system disturbances (receptor blockade), and induces serotonin release in substantia nigra. Therapeutic potential of BPC 157 as a cytoprotective agent is also seen in its capability to heal various wounds. Given directly into the stomach, BPC 157 instantly recovers disturbed lower esophageal and pyloric sphincter pressure in rats after 12-20 months of untreated esophagitis. All these could be suggestive for its role as a natural protectant in gastric juice with particular function throughout stomach distension.

Diagnostics of incomplete Brown-Sequard syndrome caused by meningococcal myelitis.

We are reviewing a 20-year old girl with the history of acute meningococcal sepsa with meningitis and thoracic myelitis resulting from an early embolia into the spinal cord, which is a very rare complication of meningococcemia. The ipsilateral loss of sensation indicates lesion of the posterior ascendent fiber tracts in the spinal cord, witout contralateral motoricity deficite, this indicating the incomplete Brown-Sequard syndrome. Somatosensory-evoked potentials (SSEP) of the n. tibialis show milder impediments of conductivity by the thoracic segment at left. Magnetic resonance (MRI) of the thoracic spine shows lesion of the posterior ascendent fiber tracts (Fig. 2, Ref. 17).

[A controlled clinical trial of methylprednisolone in patients with the cholestatic form of alcoholic liver cirrhosis]. / Kontrolirano klinicko ispitivanje metilprednisolona u bolesnika sa kolestatskim oblikom alkoholne ciroze jetre.

Fourty patients with alcoholic liver cirrhosis and refractory hyperbilirubinaemia were included in a prospective, double blind, comparative trial. Twenty of them were randomized to methylprednisolone (1 mg/kg/day i.m. over 3 days), and 20 to placebo (saline) of identical shape. In the active group a significant decrease in the bilirubin level (from 248 to 191 mumol/l, a drop by 23%; p < 0.05) was observed, which was not the case in the control group (from 292 to 300 mumol/l, an increase by 2.7%; p > 0.05). A decrease in the alkaline phosphatase activity was observed in both groups (by 11% in the active and by 20% in the control group: p < 0.05) while the encephalopathic indices did not improve in either. It is concluded that a short course of corticosteroid could speed-up the hospital stay and possibly slow down the progression of alcoholic cirrhosis.

Similar concentrations of thyroidal iodothyronines and T3/T4 ratio in normal thyroids from two Yugoslav districts with different iodine intake.

In spite of different daily iodine intake in two yugoslav districts (littoral-Split 297 +/- 76 (Mean +/- SD) and continental-Zagreb 111 +/- 36 micrograms/g creatinine, p less than 0.001), thyroidal iodothyronine concentrations and T4/T3 ratio in normal post mortem thyroids were comparable. T4 was 260.0 +/- 42.6 micrograms/g w.w. (Mean +/- SE) in Split group vrs. 279.9 +/- 59.4 in Zagreb. T3 was 12.8-2.0 vrs. 12.8 +/- 2.2 and T4/T3 ratio 21.6 +/- 1.9 vrs. 21.1 +/- 2.9 in Split and Zagreb, respectively. It has been concluded that relatively small difference in iodine intake has no effect on thyroidal concentrations of iodothyronines and T4/T3 ratio.

Serum thyroid hormones in two Yugoslav districts with different iodine intake.

Serum thyroid hormones were measured in two areas of Yugoslavia, one with relatively low iodine intake, Zagreb (urinary iodide 111 +/- 36 microgram/g creatinine), and the island of Brac with higher iodine intake (247 +/- 76 microgram/g creatinine). The serum concentration of T4 and T3 in two groups were not different. These data confirm previous findings that iodine intake within accepted normal range, is not a factor in determining serum thyroid hormone levels.