Disruption of nocturnal melatonin rhythm and immunological involvement in ischaemic stroke patients.

The aim of this study was to evaluate nocturnal and diurnal urinary melatonin excretion in a group of ischaemic stroke patients, and to verify if a possible impairment of this excretion could be linked with some changes of immunological and neuro-psychic status. We assessed 13 ischaemic stroke patients and five healthy controls for nocturnal urinary melatonin excretion, which was found to be impaired in stroke patients (patients, 0.05 +/- 0.01 ng/ml; controls, 30 +/- 3.0 ng/ml; P < 0.001). No differences were found between the groups with regard to diurnal excretion. Patients with impaired nocturnal melatonin excretion presented: a decreased cell-mediated immunity (assessed by a skin-test); a prevalence of anergic status (69% of patients were anergic compared with 0% of controls; P < 0.05); a slight (but not significant) enhancement of plasma cortisol levels; and some changes in lymphocyte subsets (an overall decrease in CD3 lymphocyte number). In almost all the ischaemic stroke patients there was an impairment of cortisol/melatonin ratio (a marker of depression) and an altered sleep rhythm with mood disorders. Our data suggest that ischaemic stroke patients had an impairment of nocturnal urinary melatonin excretion, which was associated with an impaired cell-mediated immunity and some changes of lymphocyte subsets. In addition, reduced melatonin excretion might be associated with neurological and psychical symptoms.

Unreliability of TRH test but not dexamethasone suppression test as a marker of depression in chronic vasculopathic patients.

Thirteen vasculopathic nondepressed men, admitted to the hospital 2 weeks earlier because of stroke, 10 age- and weight-matched patients with major depression, and 10 age- and weight-matched normal controls were tested with TRH and on different occasion with the dexamethasone (DEX) suppression test (DST). Patients with stroke were tested again with TRH and DST after 1 year. All subjects were euthyroid. A blunted TSH response to TRH was observed in 77% of vasculopathic patients, 64% of depressed patients, and 27% of controls. Some depressed patients showed serum GH or cortisol increments in response to TRH. Nonsuppression to DEX was observed in 45% of depressed patients and 15% of vasculopathics but not in normal controls. These data indicate that, in contrast to cortisol nonsuppression to DEX, blunted TSH response to TRH has poor diagnostic value as a marker for depression after stroke and may merely represent the expression of neuroendocrine dysfunction associated with cerebral vasculopathy.

[Parma Stroke Data Bank: embolic stroke]. / Parma Stroke Data Bank: ictus embolico.

Cerebral infarction is one of the three main causes of death in most countries. It is very frequent and, since it is more often disabiliting rather than fatal, it is of high social impact. The correct classification of patients and the accurate diagnostic definition of the various subtypes of stroke is of great prognostic and therapeutic importance since cerebral infarction is not a single entity. In this study we report our findings concerning 244 patients with embolic infarction recorded in the Parma Stroke Data Bank hospital register. Clinical features were studied (risk factors, symptomatology of the onset, degree of severity within 3 days of the onset, post-stroke complications) as were instruments readings (TAC) and evolution (outcome, mortality, personal performance and environmental integration, both 4 weeks after the clinical onset and after one year).

[Parma stroke data bank: atherothrombotic and lacunar stroke]. / Parma stroke data bank: ictus aterotrombotico ed ictus lacunare.

In an epidemiological research about stroke, we studied 235 patients with atherothrombotic brain infarctions and 81 patients with lacunes. It was a longitudinal study concerning patients admitted to our Medical Division during the acute phase and followed up for one year after the onset. We report some anamnestic data, the frequency of positive brain CT scan, main risk factors, symptoms at the onset, severity degree of the stroke within the first 72 hours, complications during, and outcome after, the first four weeks, including personal performances and environmental fitness, mortality rate and frequency of relapses. We also report some of these data after one year from the acute episode.

Prevalence and prognostic value of peripheral arterial disease in stroke patients.

As atherosclerosis is a multi-systemic disease, each patient presenting clinical manifestation of atherosclerosis such as a stroke or RIND should be, from a vascular point of view, globally evaluated. The availability of Doppler ultrasound technique enables us to discover the presence of Peripheral Artery Disease (PAD) which is not always overt in the patient's history. Furthermore the presence of PAD is associated with a poorer prognosis in stroke patients.

Multicentre clinical placebo-controlled study with buflomedil in the treatment of mild dementia of vascular origin.

A study was carried out in 73 male or female patients suffering from mild vascular dementia. The experimental protocol involved an initial run-in period (14 days) and subsequent double-blind, randomized treatment with 300 mg buflomedil or placebo given orally twice daily for 90 days. At the end of this treatment period, all patients received buflomedil for a further 90 days and, thereafter, patients received buflomedil or no further treatment for another 90 days. The efficacy of buflomedil was monitored using rating scales and neuropsychological tests. The findings of the study indicate that buflomedil improved the symptoms of vascular dementia; the most improvement was recorded in patients who had received buflomedil for the longest period. Inadequacy, cooperation, psycho-affective disorders, self-care and somatic complaints were positively influenced by buflomedil. The efficacy of buflomedil may be due to its effects on platelet aggregation and improvement in blood flow distribution to the ischaemic brain and oxygenation of brain tissue.

[Myxedematous coma due to transitory secondary hypothyroidism. Description of a case]. / Coma mixedematoso da ipotiroidismo secondario transitorio. Descrizione di un caso.

Myxedema coma is a rare manifestation of hypothyroidism, and its prognosis is usually poor. We report a case of myxedema coma due to transient pituitary hypothyroidism with complete clinical and endocrinological recovery. The possible vascular origin of the syndrome is discussed.

[Spontaneous changes in blood cholesterol and triglyceride levels in the acute phase of a stroke]. / Variazioni spontanee della colesterolemia e della trigliceridemia nell'ictus cerebrale in fase acuta.

Plasma cholesterol and triglycerides concentration were determined in 32 patients with acute stroke (23 males and 9 females, mean age = 70.5 +/- 10.4 years) within the first 24 hours from the beginning of symptoms, and repeatedly afterwords, until the 22nd day. A progressive decrease of mean cholesterol concentration was observed, which reached lowest values on the 13th day (20% reduction), and stabilized afterwords. A 30% increase of mean triglycerides levels was found on the fourth day, with subsequent return to the basal level on the 13nth day. One year after, mean values of both parameters, determined in 18 patients, did not differ from the ones observed, in the same subjects, immediately after the acute event.

Hematocrit and stroke. A case-control study.

A case-control study was undertaken to evaluate the role of hematocrit (Hct) level in the pathogenesis of stroke. Hct was determined in 110 subjects with acute ischemic stroke and compared with the values obtained in 110 subjects, matched for age and sex, admitted to our Division of General Medicine because of other diseases. Statistical analysis of the results by means of the McNemar test for pairs did not confirm the hypothesis that Hct values in stroke patients differ significantly from the control values.

Correlation between changes induced by venous occlusion on factor VIII-von Willebrand factor components and fibrinolytic activity.

The effects of standardized venous occlusion (VO) on factor VIII-von Willebrand factor (F VIII-VWF) components (F VIII:C, F VIIIR:AG, F VIIIR:RCof) and on fibrinolytic activity were investigated in 45 healthy subjects, in 28 women on oral contraceptives, and in 78 patients with various chronic diseases (28 with peripheral arterial disease, 19 with liver cirrhosis, 13 with rheumatoid arthritis, and 18 with diabetes). All the three F VIII-VWF components showed highly significant increases, although not of the same magnitude, with consequent variations in the ratios between them. A significant activation of fibrinolysis was also demonstrated with both euglobulin lysis time (ELT) and diluted blood clot lysis time (DBCLT). A strong linear correlation between pre- and post-stasis values was recorded for all the F VIII-VWF components and for the two fibrinolysis tests. No significant relationship was, on the contrary, found between F VIII-VWF and fibrinolytic parameters.

[Presentation of forms for the collection of computerized x-ray and angiographic data in cerebrovascular disease]. / Presentazione di schede per la raccolta di dati tomodensitometrici ed angiografici nelle malattie cerebrovascolari.

In the context of a study project on acute cerebrovascular diseases carried out for just a year by both hospital and university units of Parma (Italy), computer-aided charts for coding CT-scan and arteriographic findings were designed. Their models are reported.

Inherited deficiency of antithrombin III in two Italian families. Different response to oral anticoagulant treatment.

A significant decrease of plasma antithrombin III (AT III) levels, measured with four different biological and immunological methods, was found in 8 of 11 members of a Sicilian family (family DM) and in 3 of 14 members of a northern Italian family (family A). Different behaviour after oral anticoagulant treatment with acenocoumarin was seen in 2 long-term treated subjects. The propositus of family DM, who had had a long history of recurrent thrombosis, did not show any increase of AT III levels. A significant increase was, on the contrary, observed in the propositus of family A, who had suffered a recent thrombosis in a branch of the inferior mesenteric vein.

Human platelet aggregation tests in vitro. Effects of dilazep.

The effect of 1,4-bis-[3(3,4,,5-trimethoxybenzoyl-oxy)-propyl]-perhydro-1,4-diazepine (dilazep, Cormelian), a coronaroactive drug, was studied by various tests of hemostasis in vitro on human plasma. The antiplatelet action of the drug was clearly demonstrated: it inhibited, in appropriate concentrations, ADP, adrenaline and collagen induced aggregation platelet factor 3 (PF3) availability and clot retraction induced by ADP-reptilase. Conversely, coagulation tests as well as the lysis time of diluted whole blood were unaffected by the drug.