The Role of Matrix Metalloproteinase 3 and 9 in the Pathogenesis of Acute Neuroinflammation. Implications for Disease Modifying Therapy.

Matrix metalloproteinases (MMPs) are proteolytic enzymes that are involved in a variety of physiological and pathological processes, including those in CNS. In this study, plasma values of MMP-3 and MMP-9 have been compared in clinically isolated syndrome (CIS) and relapsing-remitting multiple sclerosis (RRMS) patients during their acute attacks, in relation to the biological activity of disease. Therefore, we compared the MMPs plasma values regarding Expanded Disability Status Scale (EDSS), progression index of disease (PID), acute brain lesion volume seen on magnetic resonance imaging (MRI) and index of blood-brain barrier (BBB) permeability destruction. The obtained results demonstrated higher plasma values of MMPs in both study groups than control values (p < 0.05). No statistical significances have been detected comparing the obtained values of both enzymes between CIS and RRMS group (p > 0.05). In both CIS and RRMS groups, the patients with higher EDSS showed higher MMPs plasma values (p < 0.05). The MMPs values were also significantly higher in both study patients with higher total number comparing to those with lower number of MRI brain lesion (p < 0.05) (beyond MMP-3 in RRMS). All obtained correlations, between MMPs and EDSS, PID, volume of MRI Gd-enhancement brain lesions, and index of BBB permeability, were positive (p < 0.05.) This study demonstrates alterations of both tested MMPs with closed correlation with the disease biological activity. Although MMPs are being implicated in the pathogenesis of acute neuroinflammation, the MMPs modulation might be useful in the future design of disease modifying therapy with the specific target profile.

New ischemic brain lesions on diffusion-weighted MRI after carotid artery stenting with filter protection: frequency and relationship with plaque morphology.

BACKGROUND AND PURPOSE: CAS carries an inherent risk of distal cerebral embolization, precipitating new brain ischemic lesions and neurologic symptoms. Our purpose was to evaluate the frequency of new ischemic lesions found on DWI after protected CAS placement and to determine its association with plaque morphology. MATERIALS AND METHODS: Fifty patients (mean age 65.13 ± 7.08 years) with moderate and severe internal carotid artery stenosis underwent CAS with distal filter protection. Fibrolipid and fibrocalcified plaque morphology was determined by sonography according to the relative contribution of echogenic and echolucent material, and by multisection CT using plaque attenuation. There were 46.81% of patients with fibrolipid and 53.19% with fibrocalcified plaques. DWI was performed before and 24 hours after CAS. RESULTS: Seven (14.89%) patients showed new lesions. Four (8.51%) had 6 new lesions inside the treated vascular territory. Three had a single lesion and 1 patient had 3 lesions (mean: 1.5 ± 1). Most lesions (66.66%) were subcortical, with a mean diameter of 9 mm (range 5-15 mm). All lesions occurred in the area supplied by the middle cerebral artery and were clinically silent. A significant relationship was found between plaque morphology and the appearance of new lesions. Patients with fibrolipid plaques had a significantly higher number of new lesions compared with patients with fibrocalcified plaques (P = .041). The absolute risk of new lesions in the fibrolipid group was 18.18%. CONCLUSIONS: New ischemic lesions were observed in the treated vascular territory in 8.51% of patients. The appearance of new ischemic lesions was significantly related to the plaque morphology. Fibrolipid plaques were associated with higher numbers of new lesions.

The application of magnetic resonance imaging in preoperative evaluation of patients with endometrial carcinoma.

PURPOSE: The aim of this paper was to assess the usefulness of the preoperative application of magnetic resonance (MRI) imaging in patients with confirmed endometrial carcinoma. METHODS: This prospective study included 50 patients with endometrial cancer. MRI was used for preoperative disease staging and in planning the operative treatment. The parameters monitored by MRI were compared with the findings of curettage pathological examination. Estimated were the depth of myometrial invasion, the involvement of the cervix by the tumor, the presence of adnexal metastases and regional lymph nodes. Sensitivity, specificity, positive (PPV) and negative predictive value (NPV) of the MRI in relation to the aforementioned clinicopathological parameters were assessed. RESULTS: The presence of myometrial invasion was estimated with 100% specificity, 86% sensitivity, 100% PPV and 40% NPV. The estimation of the depth of myometrial invasion (>or<50%) was defined with 89% sensitivity, 54% specificity, 83% PPV and 60% NPV. MRI provided valuable data about cervical invasion (100% PPV for the presence of cervical invasion and 55% PPV for the depth of cervical invasion), thereby helping to decide on the kind of surgical intervention, the choice of approach (open or laparoscopic surgery) and the choice of the surgeon. CONCLUSION: MRI is useful and reliable in preoperative evaluation. The information obtained by MRI provides space and time for planning the treatment modality.

[Results of surgical therapy of advanced stages of retinopathy of prematurity]. / Ergebnisse der operativen Therapie fortgeschrittener Stadien der Retinopathia prämaturorum.

The results of buckling procedures performed in 15 consecutive cases of severe retinopathy of prematurity between 1983 and 1990 are presented and discussed. The preoperative status was stage IV in 6.7% und stage V with an open funnel in 93.3% of these cases. Anatomical success was found in 53.3% in the early postoperative phase, but this had fallen to 33.3% before the long-term follow-up examination. Functional success at least with perception of large forms was recorded in 20%. The surgical technique and postoperative complications are described. The results of closed vitrectomy performed in 104 consecutive cases of severe retinopathy of prematurity between 1983 and 1990 are then dealt with. The preoperative status was stage IV in 13.5%, stage V with an open funnel in 18.3% and stage V with a closed funnel in 68.2%. Anatomical success was achieved in 29.8% in the early postoperative phase, but the proportion fell to 13.5% during a long-term follow-up study. Functional success at least with perception of hand movements was recorded in 10.6%. The surgical technique and postoperative complications are described.

Unilateral renal agenesia in the angiographic material and renovascular hypertension.

Analysis of 1216 abdominal aortographies and selective renovasographies undertaken at the Institute of Radiology, Clinical Hospital Centre Rijeka during the period 1979-1985, was performed 39 (3.2%) unilateral renal agenesias were established, a percentage that is significantly higher than reported by other authors. Analysis of all angiographic parameters of a single kidney was also worked out. A significantly high percentage (66.7%) of hypertension was diagnosed in this group. Congenital renal failures make their appearance in the early embryological development and are discovered, if compatible with life, most frequently at an advanced age. Statistical data on the frequency during a lifetime are less reliable because a great number of anomalies are never discovered during a person's life. The etiology of variations and congenital failure of renal arteries is unknown in 90% of the cases, and most of the malformations are without characteristic symptomatology. Since the anatomic relations in anomalous kidney are disturbed, the sign of the disease can develop atypical forms causing frequent errors in diagnosis. The kidney is supplied by numerous lateral branches of the medial sacral artery, i.e. the aorta, during embryological development. Later, some of them degenerate or mutually connect themselves, and the definitive kidney has been usually penetrated by only one artery and one vein on the same side.(ABSTRACT TRUNCATED AT 250 WORDS)

Vascular complications of the transplanted kidney--angiographic study.

The applied angiographic examination technique of the renal homotransplants performed during a 14-year period has been reported. 101 patients underwent 132 angiographic examinations in the course of 1971-1985. Thirty-two various vascular complications were diagnosed. Arterial stenoses during anastomoses were most frequent. Thromboembolic complications were second (4 arterial, 2 venous). One thrombosis of the iliac artery as a consequence of a wound infection following renal transplantation is described. In addition there were a few other single pseudoaneurysms of the arterial anastomoses and arteriovenous fistulas subsequent to renal biopsies. The importance of this examination technique and the diagnostic use of angiographic investigation of the transplanted kidney is pointed out.

[Recurrent ulcers in the Zollinger-Ellison syndrome]. / Recidivantni ulkusi na bazi Zollinger-Ellisonovog sindroma.

Authors present a case of recurrent duodenal ulcer on the basis of Zollinger-Ellison syndrome. After two operations: vagotomy and gastric resection, it appear a gastrojejunocolic fistula produced by marginal ulceration following gastroenterostomy. Zollinger-Ellison syndrome is proved with echotomography of pancreas, examinations of gastrin, whose levels was high, as well as with examination of gastric secretion and biopsy of gastric mucosa. A total gastrectomy is performed as the safest surgical procedure, because all other operative treatments as vagotomy and resection's methods are of no help. Patient has recovered quickly after the operation with substitutional therapy. There was no more oedema, diarrhea, and he has recovered his working quality.

[Cysts of the choledochus. Report of a case]. / Ciste duktusa choledochusa. Povodom jednog naseg slucaja

Cysts of the common bile duct, (also known as common bile coeles, or as common bile cysts) are quite rare. Those of the ampulla of Vater are a curious phenomena. Cysts of the extrahepatic part of the common bile duct can be quite large, excentrically located, and produce a triad of symptoms: pain, tumor and jaundice. These symptoms are intermittent, however, due to the periodic emptying of the cysts' contents into the duodenum. Cysts of the ampulla of Vater are those which occur in the intraduodenal part of the bile duct, and almost always found projecting into the lumen of the duodenum--imitating a tumor as it was in our case. Preoperative diagnosis of these cysts is extremely difficult, especially if the cyst is situated on the ampullar part of the common bile duct, and they are usually discovered during the operation. Possible compression of the ampulla of Vater, and the pancreatic duct can result in recidivating pancreatitis. The operative approach is dependent on the size of the cyst, and its location. The best is the complete removal of the cyst, and a correction of bile flow.