Hemoglobin A1c-related histologic characteristics of symptomatic carotid plaques.

BACKGROUND: The aims of our study were to compare the histomorphological characteristics of carotid plaques and glycosylated hemoglobin (HbA1c), which are risk factors for ischemic stroke, in patients who underwent carotid endarterectomy for carotid artery stenosis. Moreover, we aimed to identify the structures that were histologically affected by symptomatic carotid plaques in cases with elevated HbA1c. MATERIALS AND METHODS: A total of 64 patients who presented with ischemic stroke and had not previously been diagnosed with diabetes were retrospectively evaluated. All stroke risk factors were reviewed. Carotid plaques were graded separately by two different pathologists through microscopic assessment of the following parameters: plaque rupture, lipid core, fibrous cup thickness, inflammation, intraplaque hemorrhage, thrombus, calcification, necrotic core, and neovascularization. An HbA1c value <6.3% was accepted as normal or indicative of prediabetes (group 1), whereas patients with values ranging between 6.3-7.4%, 7.5-8.4%, and >8.4% were categorized into the effectively controlled (group 2), less effectively controlled (group 3), and uncontrolled (group 4) groups, respectively. RESULTS: The mean age of the patients was 73.0 ± 4.5 years in group 1, 69.7 ± 2.3 years in group 2, 66.0 ± 8.5 years in group 3, and 62.7 ± 7.1 years in group 4. A negative correlation was present between age and HbA1c. Smoking, hypertension, low-density lipoprotein cholesterol levels, and triglyceride levels were not significantly different among the four groups. According to the HbA1c classifications, the fibrous cup thickness was 2.64 ± 0.3 mm in group 1, 1.85 ± 0.4 mm in group 2, 1.68 ± 0.5 mm in group 3, and 1.45 ± 0.6 mm in group 4. The fibrous cup became thinner as the HbA1c value increased. Other parameters of unstable carotid plaques did not differ among the HbA1c groups. CONCLUSIONS: Increased HbA1c values seem to contribute to plaque instability through the formation of a thin fibrous cup. Thus, of the carotid artery plaque parameters including fibrous cup thickness, plaque rupture, lipid core, inflammation, intraplaque hemorrhage, thrombus, calcification, necrotic core, and neovascularization, fibrous cup thickness is the only histomorphological feature that affected by HbA1c.

Evaluation of aqueductal CSF flow dynamics with phase contrast cine MR imaging in idiopathic intracranial hypertension patients: preliminary results.

OBJECTIVE: We aimed to evaluate dynamic cerebrospinal fluid (CSF) flow in idiopathic intracranial hypertension (IIH) patients with new MRI technology phase contrast cine (PCC) MRI. PATIENTS AND METHODS: Nineteen patients diagnosed with idiopathic intracranial hypertension and 11 healthy volunteers were included in this study. Nine of the IIH cases had been previously diagnosed and had been on drug treatment and 10 cases were diagnosed with IIH recently and had not been put on drug treatment yet. All CSF flow datas were evaluated by phase contrast-MRI using a 1,5 T MRI. The CSF flow was calculated in the equidistant MRI sequence which was taken through a cardiac cycle. RESULTS: Mean aqueduct area in the IIH group was 3.04 ± 1.14 mm², mean peak rate was 3.29 ± 1.77 cm/sec, mean average rate was 0.35 ± 0.33 cm/sec and mean flow was 0.67 ± 0.95 ml/min. In the control group mean aqueduct area was 2.87 ± 1.01 mm², mean peak rate was 4.20 ± 1.40 cm/sec, mean average rate was 0.37 ± 0.18 cm/sec and mean flow was 0.64 ± 0.40 ml/min. A statistically significant difference was found for the PCC MRI parameter of mean rate value (p: 0.007) between the control group and IIH patients. A statistically insignificant (p: 0.058) but marked difference was found for mean flow value. CONCLUSIONS: To our knowledge this study is the first CSF flow study in the idiopathic intracranial hypertension patients. We found a difference between the IIH groups and controls in mean rate and flow parameters. It was interesting that the mean rate and flow values of the untreated group that were higher than the controls. CSF flow analysis may be a marker to follow up IIH patients.

P50 sensory gating in hypoxemic chronic obstructive pulmonary disease patients.

PURPOSE: Chronic obstructive pulmonary disease (COPD) is a condition characterized by progressive airway obstruction and recurrent attacks. Multisystem involvement with extrapulmonary manifestations has been seen in COPD patients. Numerous neurological involvement like cerebrovascular diseases, polyneuropathies, motor neuron diseases and cognitive impairement has been reported in COPD patients. Cognitive dysfunction is usually associated with hypoxia or hypercapnia in COPD patients. To our knowledge there is no study about sensory gating in COPD patients. We performed p50 test to COPD patients and we investigate sensory gating in COPD patients. PATIENTS AND METHODS: 25 male patients with COPD and 17 healthy male subjects for controls included to this study. The patients were diagnosed with COPD according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria. p50 amplitude and latency, percentage of P50 suppression, N100 amplitude and latency and the N100 suppression percentage of the COPD patients and controls presented were measured and compared. RESULTS: We found that the conditioning amplitudes (S1) did not differ between COPD patients and controls (p > 0.05) but (S2) amplitude was significantly increased in COPD patients (p < 0.05). COPD patients showed significantly lower P50 and N100 suppression percentage than controls (p < 0.05). CONCLUSIONS: COPD patients showed a disturbance cognitive function such as attention with p50 suppression rate decrease. P50 sensory gating test can be useful to analyze the pre-attention period of cognitive impairment in the early phase of COPD patients.

Increased mean platelet volume in cervicocephalic artery dissections.

AIM: We aimed to investigate the role of platelets in the pathogenesis of cervicocephalic artery dissections by measuring the mean platelet volume (MPV) and platelet count. METHODS: Thirty-four patients with evidence of cervicocephalic artery dissection were included in the study. Cervicocephalic artery dissection patients were divided into two subgroups as vertebral artery dissections and carotid artery dissections. There were 30 control subjects with similar baseline characteristics. The platelet count and MPV were compared between groups. RESULTS: The analysis showed a significant difference between the MPV values of the cervicocephalic artery dissection group and the control group (p < 0.05). However, when we compared subgroups with controls, we found a significantly higher MPV values only in the vertebral artery dissection group. We did not find any significant difference for total platelet count between the cervicocephalic artery dissection groups and controls. CONCLUSIONS: MPV is a marker of platelet function and activation. Increased MPV may be a result of dissection. In addition, it may be a risk factor for dissection-related stroke. Our study supports the notion that platelet reactivity is important in the pathogenesis of the cervicocephalic artery dissections, especially in vertebral artery dissections.