Neutrophil-to-Lymphocyte, Monocyte-to-Lymphocyte and Platelet-to-Lymphocyte Ratios in Relation to Clinical Parameters and Smoking Status in Patients with Graves' Orbitopathy-Novel Insight into Old Tests.

Graves' orbitopathy (GO) is an autoimmune disease with a chronic inflammatory background. Smoking behavior is the main environmental factor responsible for the transition of this major extra thyroidal manifestation of Graves' disease (GD) from the subclinical to the overt form. Complete blood count-derived parameters are suggested to be novel inflammatory indices. The aim of this retrospective study was to investigate the association between neutrophil-to-lymphocyte (NLR), monocyte-to-lymphocyte (MLR), and platelet-to-lymphocyte ratios (PLR) with selected clinical parameters and smoking status in 406 GD patients with (n = 168) and without GO (n = 238). The control group consisted of 100 healthy individuals. The activity of GO was graded according to Clinical Activity Score. Significantly higher white blood cells (WBC), neutrophil, and NLR (p < 0.05) values were observed in GD patients with GO compared with those without GO. PLR values were significantly higher in GO patients than in the controls. WBC (6.81 ± 1.56 vs. 5.70 ± 1.23) and neutrophils (3.89 ± 1.06 vs. 3.15 ± 0.95) count was higher in active GO patients than in those with inactive GO. Positive correlation (p < 0.05) between CAS score and WBC, neutrophil and monocyte count, and NLR was found. Smoking was associated with higher WBC (p = 0.040), neutrophil (p = 0.049), PLR (p = 0.032) values. Multivariate analysis revealed that WBC, NLR may be risk factors for GO development. WBC, neutrophil, NLR and PLR values seem to be useful tools in the assessment of inflammation in GD.

Results of rehabilitation in patients after subarachnoid haemorrhage from ruptured intracranial aneurysm and after surgical treatment.

BACKGROUND AND PURPOSE: Non-traumatic, or spontaneous subarachnoid haemorrhage (SAH) is responsible for 5-7% of strokes. In Podkarpackie voivodeship, 217 patients were hospitalized in 2003 with spontaneous SAH. The aim of this study was to assess the relationship between the results of rehabilitation carried out in patients after surgical treatment of SAH estimated on the Brunnström, Barthel, and Rankin scales and patients' initial condition measured by means of the Hunt-Hess Scale. MATERIAL AND METHODS: The examined group consisted of 55 patients after surgically treated SAH (clipping). Severity of bleeding was graded with the Hunt-Hess Scale on admission to the neurosurgery ward. Patients' clinical status was assessed with the Barthel Index and Rankin and Brunnström scales on admission to a rehabilitation ward, and rehabilitation effects were assessed after 4 weeks of the rehabilitation period and after at least 6 months from the end of rehabilitation on the ward. RESULTS: The study did not reveal any significant correlation between severity of bleeding and the results of rehabilitation. No explicit advantage was observed in the process of treatment of patients with grade I or II grade according to the Hunt-Hess Scale in the later period. In each group of patients (grades I to IV) there were patients whose final condition improved evidently. CONCLUSIONS: No significant correlation was observed between the clinical status at the onset of the disease and clinical or functional status in early and late periods of rehabilitation.

[Stroke in young woman in the first day after delivery]. / Udar mózgu u mlodej kobiety w pierwszej dobie po porodzie.

Strokes among young people are not only the most threatening complications of the cerebrovascular diseases, but they also lead to considerable disability and society' dependency. Among patients under 40 years old heart diseases constitute about 18% causes of ischaemic strokes. Other causes of strokes are: artery wall dissection, blood clotting disturbances, birth control pills, stimulants (alcohol abuse, cigarettes, narcotics), vascular immunological diseases. Among these causes there are modifiable factors, which can be eliminated through patients' education, change of the lifestyle and proper treatment of diseases. In paper there is presented the case of 22-year-old woman, who had in the first hours after delivery the paresis of left limbs with paresis of left facial nerve, proceded by loss of consciousness and convulsions. In computer tomography (CT) and magnetic resonance imaging (MRI) there was extensive angiogenic lesion in the area of right internal cervical artery revealed in duplex ultrasonography. In transesophageal echocardiography (TEE) there was revealed haemodynamically significant patent foramen ovale (PFO). In the patient in ten months after stroke there was performed diagnostic cathetarization and then transvascular occlusion of PFO using Starflex 28 mm implant. The patient was rehabilitated from the early time after stroke. Based on carried out examination results that the most likely hypothesis seems to be embolic-thrombotic stroke in the course of hemodynamically significant heart defect (paradoxical embolism in patent foramen ovale) revealed in drastic way during delivery. The earlier lasted process of dissection of cervical internal right artery cannot be also excluded as a cause of stroke.