The manifestation of systemic vasculitis in the central nervous system--a case report.

We present a case of a patient with systemic vasculitis suffering--besides heart, skin and gastrointestinal lesions--from the rarely reported involvement of the central nervous system. Even though the diagnosis could not be ascertained precisely, immunosuppressive therapy led to prompt regression of symptoms including initially present neurologic manifestations.

[Use of sucrose permeability test (SaLM) for detection of lesions of upper gastrointestinal tract mucosa in upper dyspepsia patients--a pilot study]. / Vyuzití testu propustnosti pro sacharózu (SaLM) v detekci postizení sliznic horní cásti trávicí trubice u pacientu s horním dyspeptickým syndromem--pilotní studie.

INTRODUCTION: Endoscopy, a golden standard with its high diagnostic value, is an invasive and unpleasant method as far as patients are concerned. So far there has been no available non-invasive test in the Czech Republic capable of distinguishing between heavy (i.e. peptic ulcer) and light (i.e. portal gastropathy) lesions of upper gastrointestinal mucosa. AIMS: In this pilot study we decided to test our modification of sucrose permeability test (SaLM test) on upper dyspepsia patients in our conditions. We first needed to compare the results of intestinal permeability obtained from the studied test (containing sucrose, a so called SaLM test) with a formerly established intestinal permeability test (containing glucose, a so called LaMa test) to know, if the new test could replace the old one. Then we wanted to find normal values of sucrose permeability, find a relationship between sucrose permeability and endoscopically verified damage to upper gastrointestinal mucosa and calculate sensitivity and specificity of SaLM test using results of gastroduodenoscopy. After that we tried to suggest possible future benefits of the test for clinical praxis. MATERIALS AND METHODS: A group of 10 young healthy volunteers underwent both SaLM and LaMa tests, which were made methodically indentical to compare the tests as to the results of intestinal permeability. The probands ingested SaLM solution with the following composition: sucrose (25.0 g), lactulose (10.0 g), mannitol (2.0 g), xylose (2.0 g) and water (up to 100 ml). Urine was collected for five hours and the samples were analysed using gas chromatography. From the results normal value of sucrose permeability was calculated, too. After that, 28 patients with upper dyspepsia were included in the study. They were divided into two groups (a group of light lesions with 9 patients and a group of heavy lesions counting 19 patients) according to gastroscopical findings. We compared the results among the three groups. RESULTS: In our volunteers, the intestinal permeability values using LaMa and SaLM tests showed normal distributions. No statistically significant difference (p < 0.05) was found between the tests in regard to the intestinal permeability. The normal value of sucrose permeability was found to be up to 0.10% of the amount taken orally. The permeability for sucrose was significantly higher (p < 0.01) in patients with heavy lesions (0.527 +/- 0.414) versus those with light ones (0.178 +/- 0.090). Moreover, the latter had their sucrose permeability values significantly higher than healthy volunteers (0.088 +/- 0.067), (p < 0.05). Sensitivity and specificity of the test for heavy upper gastrointestinal mucosal damage was 0.95 and 0.33, respectively. CONCLUSION: SaLM test could replace LaMa test without having a significant effect on the intestinal permeability results. It is feasible to study SaLM test on bigger sets of patients and specify it in more detail, since the results of our pilot study (in accordance with many other studies) make it promising for various clinical applications (i.e. in upper dyspepsia patients it might help in deciding about urgency and reasonability of gastroduodenoscopy).

Statins and their influence on brain cholesterol.

BACKGROUND: Growing evidence suggests that different statins are able to lower brain cholesterol synthesis. It is not clear yet whether lipophilic statins influence brain cholesterol in different way than hydrophilic ones. SOURCES OF MATERIAL: The MEDLINE database. FINDINGS: According to the data reported thus far, statins may influence brain cholesterol metabolism directly (because they are able to penetrate BBB no matter whether they are hydrophilic or lipophilic) and also indirectly (by lowering plasma cholesterol). Although the definite mechanism is not known yet, it becomes obvious that statins do not only influence peripheral but also central cholesterol pool. CONCLUSION: Better understanding of the effects of statins on brain metabolism becomes more important because many studies bring evidence of a possible link between cholesterol and neurodegeneration.