Does metoprolol inhibit the cortical spreading depression? Acute effects of systematic metropol on CSD in rats.

Cortical spreading depression (CSD) is supposed to be the underlying biological basis of the migraine aura. Metoprolol was proven to be effective in migraine prophylaxis in clinical trials, but its mechanism of action has not been clarified yet. We studied direct effects of metoprolol on a continuous CSD induction model in rats. Six adult Wistar rats were anaesthetized with intraperitoneal thiopental (50 mg/kg). CSD was induced with application of 1 m KCL through a burr hole into the left frontal dura-mater, and recorded by an Ag/AgCl DC electrode on the left parietal dura-mater. After a basal recording of CSD induction during the first 40-min period, metoprolol (5 mg/kg) was infused within 4 min. Then DC recordings were maintained for a further 120 min. Any significant differences in total number and duration of CSDs before and after metoprolol administration were not detected. This study suggests that the mode of action of metoprolol in prophylaxis is not via direct CSD inhibition.

Jervell and Lange-Nielsen syndrome: neurologic and cardiologic evaluation.

Recurrent syncope, malignant ventricular arrhythmias, and sudden death are complications of the long QT syndrome (LQTS). Two well-known syndromes with long QT intervals are known. The Jervell and Lange-Nielsen syndrome (JLNS) is characterized by prolongation of the QT interval, deafness, and autosomal-recessive inheritance, and the Romano-Ward syndrome is characterized by a prolonged QT interval, autosomal-dominant inheritance, and no deafness. In the present study assessment was performed of the diagnostic importance of the ventricular derepolarization parameters, clinical features, and prevalence of JLNS among 132 children with congenital hearing loss (CHL). In the CHL group the mean QT, QTc, JT, and JTc intervals and the dispersion values (QT-d, JT-d, QTc-d, and JTc-d) were significantly longer than those of control subjects (n = 96) (P < 0.05). Patients with CHL and JLNS (n = 5) had significantly longer mean values of QT, QTc, JT, and JTc intervals and dispersion values than those of CHL without JLNS (n = 127) and control subjects (P < 0.05). The results suggest that assessment of ventricular derepolarization parameters in children with CHL will be helpful in the early detection of JLNS because infants with CHL cannot accurately describe the symptoms of syncope.

Echocardiographic features and QT dispersion in borderline isolated systolic hypertension in the elderly.

The aim of our study was to examine the structure of left ventricle, diastolic filling indexes and QT dispersion in elderly patients (aged 60 years and over) with borderline isolated systolic hypertension in a population screening program and to compare them with age matched controls. One hundred and four subjects (66 female, 38 male, mean age 66+/-5) and 110 normotensive age and sex matched controls (64 female, 46 male, mean age 66+/-5) were included in the study. Echocardiographic features of left ventricle, left atrium and cardiac valves, diastolic filling indexes and QT dispersion in 12 lead electrocardiographic examination were studied. In borderline hypertensive elderly, left ventricular hypertrophy was a more frequent finding compared with the controls (33% versus 15% respectively). Diastolic filling indexes were impaired, presence of left atrial enlargement and cardiac valve calcification were also more frequent in the patients group. In the electrocardiographic examination, the duration of QT and corrected QT interval and dispersion of QT and QTc were significantly prolonged compared with the controls. It is concluded that patients with borderline isolated systolic hypertension have more unfavourable echocardiographic and electrocardiographic findings compared with the normotensive elderly and especially those with end organ damage should be treated as defined for isolated systolic hypertension.

Significance of QTc prolongation on ventricular arrhythmias in patients with left ventricular hypertrophy secondary to essential hypertension.

The present study was designed to detect the arrhythmogenic effect of left ventricular hypertrophy, QTc prolongation and the relationship between the QTc duration and ventricular arrhythmias in patients with left ventricular hypertrophy secondary to essential hypertension. Sixty-eight hypertensive patients (51 male and 17 female, mean age 52+/-6 years) and 30 healthy normotensive subjects (22 male and eight female, mean age 49+/-6 years) were enrolled in the study. The frequency of ventricular arrhythmias was investigated with 24-h ambulatory electrocardiographic monitoring and grade 3 and 4 ventricular arrhythmias according to a modified Lown and Wolf classification were accepted as complex arrhythmias. The echocardiographic features of the patients were divided into five groups as follows: (1) normal left ventricular diameter and wall thickness, (2) concentric left ventricular hypertrophy, (3) asymmetric septal hypertrophy, (4) dilated left ventricle, (5) dilated and hypertrophic left ventricle. The frequency of complex ventricular ectopia and the QTc duration were estimated for each group and compared with Student's t-test. Left ventricular hypertrophy was detected in 38 of 68 patients (56%) with essential hypertension. In patients with left ventricular hypertrophy, the incidence of complex ventricular arrhythmias was two- and fivefold higher compared with patients without left ventricular hypertrophy and with controls, respectively. All of the patients with echocardiographic left ventricular dilatation had experienced complex ventricular arrhythmias. QTc duration correlated positively with left ventricular mass index and left ventricular internal diastolic dimension. The highest QTc intervals were detected in patients with left ventricular hypertrophy and complex arrhythmias. In patients with left ventricular hypertrophy, a QTc duration longer than 380 ms had a sensitivity of 74% and a specificity of 89% for detecting complex ventricular arrhythmias. It is concluded that patients with left ventricular hypertrophy have a higher incidence of complex ventricular arrhythmias and QTc prolongation in those patients can be a good marker for the increased risk of arrhythmias.

EEG investigation of temporal lobe epilepsy.

We report the results of the study assessing the role of electroencephalogram (EEG) in the evaluation of patients with temporal lobe epilepsy (TLE). A prospective interictal EEG study was performed in 80 patients with TLE, and the results were compared with those of neuroimaging magnetic resonance imaging (MRI) and computed tomography (CT). All patients had interictal scalp-recorded electroencephalographic monitoring with a full array of electrodes placed according to the International 10-20 Placement System, CT and MRI. Scalp EEG had a success rate of 70% in TLE patients, this rate was 50% for MRI and 15% for CT. Epileptiform EEG abnormalities were unilateral in 25 (31%) and bilateral in 31 (39%) patients. In 56% of patients with unilateral interictal activity and 97% of patients with bilateral interictal activity, epileptiform activity was localized at the temporal electrodes. The wave morphology which we most frequently saw in our study was the sharp, sharp-slow wave or spike, or spike-wave. A correlation was observed between the focal MRI-CT abnormalities and the EEG findings. We found abnormal imaging incidence in patients with unilateral EEG findings to be significantly greater than in patients with bilateral EEG findings (chi 2 = 4.62, p = .032). EEG showed abnormality in 28 (70%) of 40 patients whose neuroimaging (NI) tests were found abnormal and also did in 70% of 40 patients whose NI tests were normal. In our study EEG has remained as the most efficient test in the localization of an epileptogenic focus.

The diagnostic and prognostic value of adenosine deaminase in tuberculous pericarditis.

Because of the difficulty in isolating the causative organism, pericardial tuberculosis is rarely diagnosed. Adenosine deaminase activity measured in the pericardial fluid of 108 patients was initially of undetermined origin. Subsequently, we classified five sources: (1) tuberculosis (20 cases); (2) idiopathy (82 cases); (3) neoplasia (three cases); (4) purulent bacterial infection (two cases); and (5) radiotherapy (one case). The highest mean adenosine deaminase value (126 +/- 16.68 U.l(-1) was found in group 1; other values were 29.4 +/- 8.9, 27 +/- 7.21, 29.5 +/- 13.4, 26 U.l(-1) in the idiopathy, neoplasia, purulent bacterial infection and radiotherapy groups, respectively. there was a statistically significant difference between group 1 and the other groups (P less than 0.001), indicating that the adenosine deaminase value has 100% sensitivity and 91% specificity. In addition, there was a positive correlation between high adenosine deaminase values and the development of constrictive pericarditis. In this study, two patients required pericardectomy. Therefore, the adenosine deaminase value is a significant prognostic indicator for the development of constrictive pericarditis in tuberculous pericarditis.

Doppler evaluation of left ventricular diastolic filling in Behçet's disease.

Although cardiac involvement such as pericarditis, myocarditis, coronary arteritis and valvular disease in Behçet's disease occurs, few studies have assessed left ventricular diastolic function. This study assesses the prevalence of both systolic and diastolic left ventricular dysfunction in patients with Behçet's disease who have no clinical cardiac manifestations. Twenty-two patients (12 women and 10 men, mean age 34 +/- 2.4 years) underwent full clinical examination, electrocardiography, M-mode, two-dimensional, and Doppler echocardiography. The mean disease duration was 5 +/- 4.7 years (range, 1 month-16 years). As age and sex-matched control group of 20 healthy subjects was also studied. Prolonged isovolumic relaxation time, prolonged deceleration time, reversal of the early and late peak transmitral diastolic flow velocities, late peak transmitral diastolic flow velocities (E/A ratio) and increased atrial filling fraction were noted in five patients. It is concluded that left ventricular dysfunction occurs frequently in patients with Behçet's disease and Doppler echocardiography may be valuable in detecting diastolic filling abnormalities as an early sign of cardiac involvement.

The Jervell and Lange-Nielsen syndrome.

The association of prolongation of the QT interval with recurrent attacks of syncope, sudden death, and malignant ventricular arrhythmias is known as the long QT syndrome. The syndrome may be familial with or without congenital deafness, or idiopatic. The syndrome with deafness (Jervell and Lange-Nielsen syndrome) is inherited through an autosomal recessive mechanism. In this study, we attempted to identify patients with the Jervell Lange-Nielsen syndrome amongst 154 deaf mute school children. Two patients had a corrected QT interval of 0.52 and congenital sensorineural hearing loss with the other electrocardiographic changes characteristic of the syndrome, such as inverted or bifid T wave. There was no evidence of electrocardiographic (ECG) abnormality in family members, except only one case of parental deafness. This is the first and preliminary report that analyzed the incidence of the Jervell and Lange-Nielsen syndrome amongst 154 deaf mute school children in Turkey. Our study was conducted to identify patients with this syndrome amongst children of another deaf mute school in Turkey.

Prevalence and risk factors of varicose veins in an elderly population.

The prevalence of and risk factors for varicose veins (VV) were studied in elderly persons over 60 years of age who had visited the Tonya and Farabi Hospitals in Trabzon, a city in northeastern Turkey. VV were defined as dilated, tortuous and elongated veins of the lower extremities and were classified into four types. The total prevalence of VV was 36.7% (14.6% in males and 22.1% in females). Segment type varices were observed in 16.5%, saphenous type in 5.6%, reticular type in 4.7%, web type in 2.3%, and combined types in 7.5%. The prevalence of VV increased with age and was greater among those with a family history of the condition in 154 of 312 patients with VV (49.4%). Other factors, such as congestive heart failure, angina pectoris, hypertension, cigarette smoking, diabetes mellitus, height, weight, obesity, or hyperlipidemia, were not found to be associated with the prevalence of VV. However, the factors of age, work posture and childbirth did show an association with prevalence, as reported by others.

Locked-in syndrome: a case report.

A 46-year-old man developed a "locked-in" syndrome due to ventral pontine infarction. MRI showed abnormal signal intensity regions in the ventral pons. The EEG, BAEPs and SEPs were all within normal limits.

Prevalence of ventricular premature complexes in healthy and untreated hypertensive elderly people.

Twenty-four-hour ambulatory electrocardiographic examination was performed in 130 elderly patients (49 healthy, active subjects; 40 hypertensive without left ventricular hypertrophy; and 41 hypertensive with left ventricular hypertrophy). In the study group, mean age was 72.4 +/- 7.1 (sixty-five to eighty-eight) years. A significantly high prevalence of ventricular ectopic complexes was found both in hypertensive and in normotensive groups. According to the Lown grades, in grade 1, VPCs had very high prevalence in healthy subjects, in grade 2, VPCs had a high prevalence in hypertensives with left ventricular hypertrophy (73.5% and 48.8%, respectively). The results of this study demonstrate that ventricular premature complexes were common in hypertensive patients and healthy elderly but did not cause high complexity in either group. Ventricular premature complexes detected by ambulatory ECG monitoring in healthy, active subjects and in untreated hypertensive patients are not an independent risk factor in elderly patients.

Oral nifedipine in the treatment of hypertensive crises in patients with hypertensive encephalopathy.

Hypertensive emergencies, including hypertensive encephalopathy represents an acute threat to vital organ functions and call for urgent treatment. The intravenous medications currently available for the management of hypertensive emergencies, have significant potential for serious side effects and acute lowering of blood pressure has often been the cause of considerable morbidity and mortality. Nifedipine is known to be effective as an antihypertensive agent and it is widely used in hypertensive emergencies. We studied the efficacy and effective dose of nifedipine in 22 patients (9 females and 13 males; mean age 51) with hypertensive encephalopathy. Nifedipine (20 mg by oral drop) caused a significant fall in diastolic an systolic blood pressure in all patients from 236/121 to 172/96 mmHg after 30 minutes (P less than 0.005, P less than 0.001). Continuous therapy with nifedipine (2-5 mg every 2-3 hours, mean total dose 52 mg/24 h) gave successful control of blood pressure. These data prove that nifedipine can be used as the first-line drug for the treatment of hypertensive crises in patients with hypertensive encephalopathy.

Treatment of acute spinal cord injuries: comparison of thyrotropin-releasing hormone and nimodipine.

The effects of nimodipine and thyrotropin-releasing hormone (TRH) were compared in a clip-compression model of experimental spinal cord injuries (SCI) in rats. Thirty rats received a 50-g clip-compression injury on the cord at T9. Ten rats were given 0.02 mg/kg nimodipine and dextran 40 (3 ml) i.v. 1 h after injury. Ten rats were given 2 mg/kg TRH and dextran 40 (3 ml) i.v. 1 h after injury followed by 1 mg/kg per hour for 4 h. The remaining ten rats were given only saline. TRH treatment significantly improved somatosensory-evoked potentials (SEPs) and mean arterial blood pressures (MABPs), whereas nimodipine treatment had no effect on these variables (Fisher's exact test (P less than 0.01).

Treatment of hypertensive urgencies with oral nifedipine, nicardipine, and captopril.

Sixty-five patients with uncomplicated hypertensive urgencies were treated in the emergency and cardiology departments with 20 mg nifedipine, 20 mg nicardipine, or 25 mg captopril in a randomized study. The study population consisted of 65 patients ranging in age from forty-one to seventy-one. Blood pressure and heart rate were assessed for six hours after intake of the antihypertensive agents. Within sixty minutes nifedipine reduced blood pressure by an average of 74.7 mmHg for the systolic and 35.4 mmHg for the diastolic. Average heart rate increased significantly by 11.6 beats/min at within thirty minutes. Nicardipine and captopril produced equivalent falls in systolic (-81.6 and -79.4 mmHg) and diastolic (-37.3 and -33 mmHg) blood pressure respectively, but did not increase heart rate significantly. The antihypertensive effect of each drug was maintained until six hours after medication. In conclusion, nifedipine, nicardipine, and captopril show similar efficacy in the treatment of hypertensive urgencies. The authors believe that these drugs can be used as first-line therapy in the treatment of hypertensive urgencies safely and effectively.

A case of neurenteric cyst.

An eight-month-old female infant with a neurenteric cyst situated in the lumbar region is presented because of its rarity and because it can mimic other neurological malformations which occur on the same site. Microscopic examination of the surgically excised cyst revealed Water-Paccini corpuscles, lymphoid follicles, intestinal mucosa and meningeal tissue which originated from two ectoderm and endoderm-germ layers.

Left ventricular mass index and prevalence of heart disease in the population aged 80 years and over.

Clinical, electrocardiographic and echocardiographic findings of 69 subjects aged 80 years or over were analyzed in order to assess the prevalence of left ventricular mass, hyperlipidemia, hypertension and cigarette smoking. Of the 69 subjects studied, 41 had no symptoms or sign of cardiovascular disease, 28 had one or more cardiac symptoms (NYHA stage 2-4). 25 had electrocardiographic evidence of left ventricular hypertrophy and there were no differences between the asymptomatic and symptomatic groups. Echocardiographically, the left ventricular mass index ranged between 103 to 247 g/m2 in men and 170 to 251 g/m2 in women. In 36 subjects with high left ventricular mass index, the ventricular septal thicknesses ranged from 12 mm to 15 mm in 19 subjects, and posterior wall thicknesses ranged from 12 mm to 16 mm in 17 subjects. Of the 58 patients with an adequate echocardiogram, 47 had clinically diagnosed hypertension (81%). In our study population, a prevalence of left ventricular hypertrophy (62%), isolated systolic hypertension (26%), definite hypertension (33.3%), high LDL-cholesterol (63%), low HDL-cholesterol (26%), abnormal Q wave (16%), cigarette smoking (47.8%) and diabetes mellitus (1.4%) were found.

Intracerebral myiasis from Hypoderma bovis larva in a child. Case report.

Cerebral myiasis with a 10-day history of convulsions due to an intracerebral hematoma caused by a Hypoderma bovis larva is reported in an 8-year-old child. Computerized tomography (CT) showed the hematoma in a right parieto-occipital location. The H. bovis larva and the extensive intracerebral hematoma were discovered during surgery. Among human parasitoses, cerebral myiasis is rare: a review of the literature revealed only two reports, one published in 1969 and one in 1980. This is the first case that has been diagnosed as cerebral myiasis with exact identification of the Hypoderma bovis larva both from the CT scans and at surgery in a patient during life.

The effect of chronic antihypertensive therapy on the index of left ventricular mass in patients with essential hypertension.

M-mode echocardiography was used in 80 patients with essential hypertension to study changes in the index of left ventricular mass during treatment over 3 years with reserpine, prazosin, indapamide and atenolol, separately or in combination. Forty patients completed a follow-up period of 36 months, while 5 patients died during this period. In all 5 groups, the index of left ventricular mass decreased significantly from the baseline after 1 and 3 years of treatment, except in those patients receiving prazosin in which there was no significant difference in the index of left ventricular mass between 1 and 3 years of treatment. Our results confirm that effective treatment of blood pressure results in a significant reduction in the index of left ventricular mass. Furthermore, this reduction was seen with all modes of treatment and suggests that it was reduction of blood pressure rather than any specific pharmacological property of the drugs that was of major importance.

Complex partial status epilepticus.

Clinical features, ictal manifestations, EEG and CT findings of two patients with CPS are presented. Status consisted of confusion associated with continuous focal EEG findings in both cases.