[THROMBOPROPHYLAXIS IN PATIENTS WITH NONVALVULAR ATRIAL FIBRILLATION ADMITTED IN UNIVERSITY HOSPITAL SPLIT, CROATIA, DUE TO THE ISCHAEMIC STROKE IN RELATION TO THROMBOEMBOLIC AND BLEEDING RISK].

Aim of the study was to assess the concordance of the thromboprophylactic treatment in patients with nonvalvular atrial fibrillation (nAF) at the time of admission due to ischemic stroke with clinical guidelines of the European Society of Cardiology. METHODS: In the cross-sectional study were included 327 patients [143 (44%) males] treated because of ischemic stroke associated with nAF. The index of the thromboembolic risk (TE) has been established by the CHA2DS2-VASc score, whereas the bleeding risk has been assessed by the HAS-BLED score. RESULTS: Before the ischemic stroke, 98.2% of patients belonged to the group of high TE risk. Among these patients only 179 (55%) were received thromboprophylaxis: 67.5% patients acetylsalicylic acid, 30.5% warfarin, and 4% clopidogrel. Previous ischemic stroke was independently correlated with warfarin administration (OR 2.5; 95% Cl 1.4-4.5; p=0.003), while poorly controlled arterial hypertension was independently correlated with warfarin non-administration (OR 0.47; 95% Cl 0.25-0.88; p=0.019). The 83.7% of 55 patients, who experienced ischemic stroke during anticoagulant treatment, had an INR values lower than therapeutic. CONCLUSION: Thromboprophylaxis among the patients with nAF admitted because of ischemic stroke did not correlate with their TE risk and contemporary guidelines of the European Society of Cardiology.

Comorbidity psychiatric disorders in epilepsy: a review of literature.

While reviewing the available literature, we noticed comorbidity of epilepsy and psychiatric disorders. Psychiatric disorders were observed more frequently in patients with high seizure frequency. There is significant prevalence of epilepsy comorbidity with depression, anxiety disorders, and to a lesser extent with bipolar disorders and other forms of psychosis. Suicidal risk factors, ideation and attempts in these patients as correlates of depression or as psychopathological features were associated to epileptic disease. This is confirmed by additional burden of epilepsy patients with psychic disorders (Ref. 70). 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).

Is C-reactive protein a better predictor of recurrent carotid disease following carotid endarterectomy than established risk factors for atherosclerosis?

BACKGROUND: The study was undertaken to identify possible relations between established and novel risk factors for atherosclerosis (gender, age, diabetes mellitus, hypertension, smoking and C-reactive protein) and the possibility of carotid restenosis following carotid endarterectomy (CEA). PATIENTS AND METHODS: A prospective study of 193 consecutive patients, admitted electively for carotid endarterectomy during 68 months, was conducted. 131 patients had symptomatic and 62 asymptomatic carotid disease. An attempt was made to follow-up on all operated arteries with duplex sonography at 2 months, 6 months, 12 months, and 24 months postoperatively. The correlation of previously mentioned variables (gender, age, diabetes mellitus, hypertension, smoking and average values of C-reactive protein) with progressive or recurrent disease was determined by chi-square analysis and analysis of variance. RESULTS: Of all 193 examined patients 29 demonstrated increasing degree of artery stenosis, while recurrent artery stenosis of > 69% was diagnosed in 11 patients. Age, gender, hypertension, and diabetes did not play a significant role in the presence of progressive (or recurrent) disease, while active smokers and patients with preoperative and average C-reactive protein (CRP) levels over 3.0 mg/L had a greater propensity to develop progression (or recurrence) of carotid disease. CONCLUSIONS: Increased levels of CRP in serum may be a better predictor of carotid restenosis after CEA than other established risk factors for vascular disease--except active smoking.

Effect of simvastatin on micropulmonary red cell mass in patients with hyperlipoproteinemia.

The purpose of this study was to compare the macrocirculatory and microcirculatory effects of simvastatin in hyperlipemic patients. In vitro measurements of lipoprotein levels and macrocirculatory hemorheology were complemented by in vivo measurements of the pulmonary capillary red cell volume (RCVpc) before and after 6 weeks of treatment with 40 mg of simvastatin daily in 30 male patients with hyperlipoproteinemia type IIa. RCVpc was assessed from the vascular component of the lung diffusing capacity for carbon monoxide, using the modification of the Roughton-Forster's method. RCVpc was increased in patients (60.9+/-9 versus 40+/-9 ml in healthy controls) and it decreased to 47+/-6 ml after treatment (P=5x10(-11)). The decreases in RCVpc correlated to concomitant decreases in peripheral hematocrit (R=0.68) and serum total cholesterol (-34% on average; R=0.59). Membrane diffusing capacity was normal in patients and not affected by the therapy; suggesting that increased RCVpc was due to increased micropulmonary hematocrit. Thus, it appears that viscosity in microcirculation is greatly increased in hyperlipemic patients and that simvastatin is able to normalize it. Since microcirculatory conditions can only partly be inferred from in vitro measurements the use of lung diffusional parameters was advocated, which enable in vivo assessment of hemorheology in microcirculation.

Population variation in migraine prevalence--the unsolved problem.

Migraine is one of the most prevalent types of headache, which imposes a substantial burden on society as measured by direct and indirect costs. In the present work we review the obstacles to carrying out migraine epidemiological studies. Knowledge of the epidemiology of migraine has expanded because of the recent proliferation of large scale population-based studies using standardized case definitions. Previous surveys of the prevalence of migraine have given widely differing results. Even in population-based studies, there have been wide variations in estimates of migraine prevalence. The development of International Headache Society (IHS) criteria for migraine has facilitated international comparisons in epidemiologic studies by providing explicit and consistent diagnostic criteria, Recent studies using IHS diagnostic criteria have given relatively consistent estimates of migraine prevalence (about 15-18% of women and 6% of men). Studies of racial diversity in the prevalence of migraine and other headaches are still not conclusive. Further work is needed on epidemiology of migraine and collaboration between epidemiologists and clinicians seems the most likely way to advance understanding in this field.

Liver angiosarcoma and hemangiopericytoma after occupational exposure to vinyl chloride monomer.

Various malignant tumors of the liver, especially liver angiosarcoma, have been described after occupational exposure to vinyl chloride monomer. We present the case records and pathologic findings of two plastic industry workers who had been exposed to high concentrations of vinyl chloride. These workers developed hepatic neoplasms, angiosarcoma, or hemangiopericytoma. We discuss the histogenesis of these tumors; the common vascular origin and the mutual transformation of these two tumors suggest that the hemangiopericytoma may also have developed during occupational exposure to high concentrations of vinyl chloride monomer.

Craniocerebral war missile injuries: clinical and radiological study.

In this study we reviewed the initial clinical and radiological management and early outcomes of 176 consecutive patients from the war in Croatia.

Endoluminal stenting for subclavian artery stenosis in Takayasu's arteritis.

We describe a patient with Takayasu's arteritis (type I): occlusion of all large vessels of the aortic arch except the left subclavian artery which was, however, almost completely occluded, resulting in a characteristic subclavian steal syndrome. Elective left main subclavian artery balloon angioplasty followed by endoluminal stenting was performed with excellent results. After prolonged immunosuppressive treatment, at the 12-month follow-up there was no evidence of restenosis. In selected patients with Takayasu's arteritis and subclavian stenosis, elective endoluminal stenting can be used as a definitive procedure or as a bridge to surgical revascularization.

Subclavian artery stenosis caused by non-specific arteritis (Takayasu disease): treatment with Palmaz stent.

A 32-year old woman was admitted to the hospital with a sudden onset of right-sided hemiplegia and aphasia. Immediate angiographic examination revealed a severe form of type I Takayasu arteritis with occlusion of all supra-aortic vessels, with the exception of the left subclavian artery which was, however, almost completely occluded 1 cm proximal to the origin of the left vertebral artery. Since the latter provided the entire blood supply to the brain tissues, an immediate attempt was undertaken to dilate the left subclavian artery; when this was unrewarding, stenting of the lesion was successfully accomplished with excellent primary and 6-month follow-up results.

[Incidence of stroke in central Dalmatia during the war in the Republic of Croatia (1991-1995)]. / Incidencia de ictus en la región de la Dalmacia media durante la guerra en la República de Croacia (1991-1995).

INTRODUCTION AND METHOD: A retrospective study was made of the incidence of stroke in the Dalmatian region (Split) during the war in the Republic of Croatia (1991-1995), to determine whether the war had affected the incidence of stroke in the population at risk. The data obtained was compared with data regarding the incidence of strokes in the pre-war period (1986-1990). RESULTS AND CONCLUSIONS: There was a small but significant increase in the incidence of strokes during the war period. There was also a considerable increase in patients with primary intracerebral hemorrhage during this period. The possible causes of this increase in patients with primary intracerebral hemorrhage are discussed.

Plasma and cerebrospinal fluid endogenous digoxin-like immunoreactivity in patients with aneurysmal subarachnoid haemorrhage.

Recent evidence indicates the presence of naturally occurring digitalis-like compounds in mammals, collectively known as either digitalis-like (DLF) or ouabain-like (OLF) factors, presumed to be endogenous hormones regulating the biological activity of the NA+/ K(+)-ATPase and its isoforms. This substance has been postulated to enhance renal tubular sodium excretion and to increase peripheral vascular resistance. Digoxin-like immunoreactive substance (DLIS) was observed in plasma of some patients with spontaneous subarachnoid haemorrhage (SSAH). Accumulating evidence suggests the central nervous system as a site of synthesis, but also as a site of hypertensinogenic action of endogenous cardioglycosides. The present study intends to establish the ratio of the DLIS in plasma to that in cerebrospinal fluid (CSF) in patients with SSAH and to investigate possible connection of this substance with development of arterial vasospasm. A prospective analysis of DLIS levels was performed on plasma and CSF samples obtained in 40 patients who had suffered a recent SSAH. DLIS levels were determined by the fluorescence polarisation immuno-assay method immediately after the admission to the Ward, and again seven days later. The comparison of CSF and plasma DLIS levels did not show statistically significant differences between the results--neither for the first (Z = 0.530; P = 0.591) nor for the seventh day after the disease onset (Z = 0.448; P = 0.654). Three possible hypothetical explanations of these results are offered: a) substance determined by digoxin immuno-assay has no essential likeness to digoxin; b) loss of the haemato-encephalic barrier integrity enabling free substance exchange between plasma and central nervous system; c) digoxin-like substance production within the central nervous system. Further, comparison of DLIS plasma levels (7th day from onset of SSAH) with angiography results showed that patients with multiple vasospasm had essentially higher plasma DLIS levels compared to patients with no vasospasms (Z = 2.59; P = 0.0097). The amount of extravasated blood, assessed on the basis of cranial CT scanning, was also connected with higher plasma DLIS levels (X2 = 3.29; P = 0.0305). The enhanced arterial narrowing which occurs in SSAH may be in part mediated by increased digitalis-like factor activity.

Serum prolactin levels after seizure and syncopal attacks.

Loss of consciousness and falling are the key features of syncope. Common accompaniments include tonic and myoclonic muscle activity, eye deviations, automatisms, vocalizations and hallucinations that may render the distinction from epileptic seizures difficult. The frequently increased levels of serum prolactin (SPRL) were observed immediately after generalized and complex partial seizures. Presumably, the hormone release is caused by the propagation of epileptic activity, usually from the temporal lobe to the hypothalamic pituitary axis. Numerous reports have demonstrated that the post-ictal SPRL level may be used to differentiate between epileptic and syncopal, non-epileptic attacks. In order to confirm the hypothesis, the SPRL levels were measured in patients with complex partial seizures (CPS) and patients with vaso-vagal syncopal attacks (VVS). The SPRL levels were prospectively measured for each patient as soon as possible after the event (within 1 hour), then 1 hour after the first determination and finally blood was sampled 24 hours later. During the study period (18 months), 18 patients with CPS and 15 patients with VVS were investigated in total. The mean values of SPRL levels in both groups were increased immediately after the event (CPS group: 1142 +/- 305 mIU/l; VVS group: 874 +/- 208 mIU/l). The elevated SPRL levels were found in 14 (78%) patients immediately after CPS and in 9 (60%) patients immediately after VVS. After examining the results of the present study we conclude that the elevated serum prolactin level after an epileptic attack is of no significant value in differential diagnosis between epileptic and vaso-vagal syncopal attacks.