Total Antioxidant Status in Stable Chronic Obstructive Pulmonary Disease.

Objective: This study evaluates the total antioxidant status (TAS) in plasma of stable chronic obstructive pulmonary disease (COPD) patients. Earlier studies of their relationship showed inconsistent findings. Patients and Methods: We compared TAS between 90 COPD patients and 30 age- and sex-matched controls (mean age 67 ± 7.9, 87 males and 33 females) according to airway obstruction severity, gender, smoking status (current/ former/ non-smoker), smoking-dose, the number of exacerbations in the previous year, nutritional status and hypercapnia. Results: There were no differences in pack-years between COPD and controls, neither in COPD groups. The median time from the last exacerbation was 5 months (interquartile range 3-8.3). TAS was significant higher in COPD than controls (1.68 [1.55-1.80] versus 1.59 [1.54-1.68], respectively; P = 0.03). TAS was significantly higher in COPD men than women (1.7 [1.6-1.8] versus 1.57 [1.5-1.7], respectively; P = 0.001). In COPD groups, there were no significant differences between the severity of airway obstruction and TAS. We found significant positive correlation between pack-years and TAS in all participants (Rho = 0.429, P = 0.004) and COPD patients (Rho = 0.359, P = 0.02), but not in controls. TAS was a significant predictor of COPD (ß = 3.26; P = 0.04; OR = 26.01; 95% CI: 1.20 to 570.8). We failed to find significant differences between TAS and smoking status, frequency of exacerbations in the previous year, nutritional status and hypercapnia. Conclusion: TAS was a significant predictor of COPD. TAS was a significantly higher in stable COPD than controls, higher in COPD men than women, but there was no significant correlation between TAS and the airway obstruction severity. Our results suggest that it could be appropriate to include the time from the last exacerbation in the oxidant-antioxidant balance analysis of COPD patients.

Impaired cerebrovascular reactivity in chronic obstructive pulmonary disease.

Impaired cerebrovascular reactivity (CVR) is associated with stroke. Cerebrovascular diseases are common comorbidity in chronic obstructive pulmonary disease (COPD) patients. The aim of our study was to quantify CVR in the anterior and posterior cerebral circulation during voluntary breath-holding in COPD patients according to airflow limitation severity. In this cross-sectional study, we compared 90 COPD patients without previous cerebrovascular disease and 30 age- and sex-matched healthy volunteers (mean age 67 ± 7.9, 87 males). Using transcranial Doppler ultrasound and breath-holding index (BHI), we analysed baseline mean flow velocities (MFV) and CVR of middle cerebral artery (MCA) and basilar artery (BA). Our results demonstrated that COPD patients had lower baseline MFV of both MCA and BA than controls. COPD patients had significantly lower BHImMCA and BHImBA than controls (0.8 and 0.7 versus 1.24 and 1.07, respectively; p < 0.001). With the severity of airflow obstruction, there were significant declines of BHImMCA and BHImBA in mild (0.94 and 0.83), moderate (0.8 and 0.7) and severe to very severe COPD (0.7 and 0.6), respectively (p < 0.001). For all participants, we found a significant and positive correlation between forced expiratory volume in one second (FEV1) and BHImMCA (Rho = 0.761, p < 0.001) and between FEV1 and BHImBA (Rho = 0.409, p < 0.001). COPD patients have impaired CVR in anterior and posterior cerebral circulation. Impairment of CVR increase with the airflow limitation severity. CVR is an appropriate marker to identify vulnerable COPD subjects at high risk to develop cerebrovascular disease. Prospective studies are needed for further evaluation.

Bilateral Abducens Nerve Palsy Due to Extensive Cerebral Venous Sinus Thrombosis.

Cerebral venous sinus thrombosis (CVST) is a relatively rare condition. We present a case of an acute aseptic thrombosis of the sagittal, transverse and sigmoid sinus in a puerperium patient with protein S deficiency. The specifics of the case include high intracranial pressure (ICP) caused by sinus thrombosis with typical symptomatology and bilateral papilloedema, which also manifested in transient bilateral abducens nerve palsy and, consequently, bilateral horizontal diplopia. The recovery of the cranial nerve function occurred 3 to 4 weeks after it was initially reported. Prompt and adequate anticoagulant therapy contributed to the almost complete recanalization of the dural venous sinus thrombosis and a positive outcome of the disease.

Cerebrovascular reactivity in acute hyperoxia in patients with acute ischaemic stroke.

AIM: This study aimed to assess the effect of acute hyperoxia on cerebral and systemic heamodynamics and the plasma concentration of prostacyclin and thromboxane in patients with stroke. METHODS: Mean blood flow velocity (MBFV), pulsatility and resistance indices of the middle cerebral artery using transcranial Doppler ultrasound before and during acute hyperoxia (4 L of 100%O2/15' over facial mask) in 92 participants - 25 patients with acute ischaemic stroke (AIS) that occurred within 72 hours and diabetes mellitus (SPDM), 26 AIS patients without DM (SP) and in 41 healthy controls (HS), were measured. Partial pressure of O2 (pO2), blood pressure and heart rate were measured using pulse oxymeter and pressure gauge, respectively. All the above measurements, as well as cerebral vasoreactivity assessments were performed, before, at the end of the 15 minute period of hyperoxia, and 15 minutes after hyperoxia. The plasma concentration of thromboxane and prostacyclin were determined by ELISA assays. RESULTS: MBFV increased in both SP and SPDM, while MBFV decreased in HS in response to hyperoxia. Thromboxane correlated negatively and prostacyclin positively with MBVF in the SPDM, although their concentrations did not differ significantly after hyperoxia among groups. CONCLUSION: Results suggest impaired vascular reactivity to acute hyperoxia in patients with stroke and the possible role of thromboxane A2/prostacycline in mediating cerebrovascular reactivity in SPDM. ABBREVIATIONS: ANG, II angiotensin II; ASA, acetylsalicylic acid; ATP, Adenosine triphosphate; BP, blood pressure; CBF, cerebral blood flow; CDI, colour Doppler imaging; COX, cyclooxigenase; COVR, cerebrovascular oxygen vasoreactivity; CVR, cerebrovascular reactivity; HR, heart rate; HS, healthy subjects; MBFV, mean blood flow velocity; MCA, middle cerebral artery; PG, 6-keto-PGF1alfa; PGI2, prostacycline; PI, pulsatility index; pO2 partial pressure of O2; RI, resistance index; ROS, reactive oxygen species; SP, stroke patients; TCD, transcranial doppler; TXA2, thromboxane A2; TXB, thromboxane B2; VSMC, vascular smooth muscle cell; 20-HETE, 20-hydroxieicosatetraenoic acid.

Health-related quality of life and ways of coping with stress in patients with migraine.

The aim of our study was to examine the relationship between the mode of coping and health-related quality of life (HRQoL) in patients with migraine. We have also tried to examine the relationship of disease duration and the frequency of attacks with HRQoL and the ways of coping with stress. The research was done on a sample consisting of 106 participants (95 women and 11 men); mean age of 40 years (IQR 28-48) with the migraine lasting for 10 years (IRQ 5-20 years). The average number of attacks, over the last month, was two attacks (IRQ 1-3 attacks). Ways of coping questionnaire were used to estimate the mode of coping with stress and SF-36 questionnaire for HRQoL. The result showed the self-control as the most common way of coping with stress in patients with migraine. They also confirmed the existence of a significant connection of ways of coping with stress and HRQoL in people with migraine. There is a larger number of significant correlations of ways of coping connected with the domains of mental health than with the physical health. Escape/avoidance is significantly negatively correlated with the largest number of HRQoL domains, especially with existence of significant mental health (ρ = -0.447) and role limitation due to the emotional problems (ρ = -0.361). The number of migraine attacks has greater influence on HRQoL in patients with migraine than the disease duration. Our study showed the existence of significant correlations between the ways of coping with stress and HRQoL, especially with mental domains. In some domains, the correlation was even stronger than the one showing the disease duration and the number of attacks. The above-mentioned results suggest the directions in further formulation of psychological interventions that would be helpful for the additional treatment of migraine.

Type I persistent proatlantal artery associated with fusiform subclavian artery aneurysm: Report of one case.

We report a 61 years old male presenting with a right cerebral infarction, along with a type I persistent left proatlantal artery (PA), which is a form of primitive carotid-basilar anastomosis. The patient had an absence of the ipsilateral vertebral artery (VA) and hypoplasia of the contralateral VA, while the basilar artery was supplied by the PA. Other vascular anomalies present were a fusiform aneurysm of the right subclavian artery, and an A1 segment aplasia of the hypoplastic anterior right cerebral artery, which originated from the anterior communicating artery. To our knowledge these anomalies were not described previously.

Type I persistent proatlantal artery associated with fusiform subclavian artery aneurysm: Report of one case / Arteria proatlántica persistente tipo I asociada a un aneurisma fusiforme de la arteria subclavia: Presentación de un caso

We report a 61 years old male presenting with a right cerebral infarction, along with a type I persistent left proatlantal artery (PA), which is a form of primitive carotid-basilar anastomosis. The patient had an absence of the ipsilateral vertebral artery (VA) and hypoplasia of the contralateral VA, while the basilar artery was supplied by the PA. Other vascular anomalies present were a fusiform aneurysm of the right subclavian artery, and an A1 segment aplasia of the hypoplastic anterior right cerebral artery, which originated from the anterior communicating artery. To our knowledge these anomalies were not described previously.

Relationship between Age and Thickness of Carotid Arteries in a Population without Risk Factors for Atherosclerosis.

The intima-media thickness (IMT) of carotid arteries is a marker of subclinical atherosclerosis associated with risk factors for atherosclerosis and a predictor of vascular disease. The aim of the research was to determine the correlation of IMT and age, and above normal IMT values in healthy adults in Slavonia (eastern Croatia). The study included 275 subjects of both sexes, aged between 20 and 79, who had no clinical manifestations of vascular disease or presence of major risk factors for atherosclerosis (hypertension, hypercholesterolemia, diabetes mellitus, cigarette smoking). Ultrasonic measurement of IMT in the B-mode was performed on far walls of the carotid arteries on both sides at three locations (common and internal carotid artery, carotid bifurcation). At all three sites of measurement a high correlation between the IMT values and age was found in both sexes, including the maximum for IMT of carotid bifurcation (men r=0.92, women 0.91). Upper normal values (75th percentile) IMT of common carotid arteries were determined for the ten year age groups. It is the same for both men and women in age groups both 20-29 and 30-39 (0.41, 0.46 mm). On the other hand, in age groups 40-49, 50-59, 60-69 and 70-79 upper normal values for men are 0.57, 0.62, 0.77 and 0.96 mm, and for women 0.50, 0.57, 0.71 and 0.81 mm. Our study in healthy adults in Slavonia (eastern Croatia) established a clear con- nection between carotid IMT and age, which implies a need for taking the age as an essential factor into account when conducting researches that involve the IMT.

Subclavian fusiform aneurysm causing partial subclavian steal syndrome. Case report.

We present a 55-year-old man with repeated transient symptoms of vertebrobasilar arterial pathology. Physical examination detected no signs that would indicate the stenosis of the proximal subclavian artery segment. Ultrasound detected hemodynamic disorder of right vertebral artery, which correspond to a partial subclavian steal syndrome. Angiography shows fusiform aneurysm of ipsilateral subclavian artery in which central part is the base of hypoplastic vertebral artery. In the literature are rare reports of cases of partial subclavian steal syndrome caused by aneurysmal expansion of subclavian artery.

Basilar artery occlusion treated conventionally with good outcome.

It presents a case of a 39-year old woman with acute symptomatic occlusion of basilar artery proximal segment, which was manifested by severe neurological symptomatology and deficits. The patient was treated conventionally (anticoagulant, then antiplatelet agent therapy) with excellent short-term and long-term outcome. In spite of serious acute neurological symptomatology of basilar artery occlusion, proximal localization of the occlusion, fluctuating symptomatology flow, younger age and development of collateral circulation can suggest a good outcome in conventionally treated patients.