[New orally anticoagulants and brain stroke]. / Nowe doustne antykoagulanty a udar mózgu.

Brain stroke is a grave society problem. About 20% ischemic strokes are cardiac related problems. Atrial fibrillation (AF) is the most common cause of ischemic strokes. Decision to deploy anticoagulant treatment with AF patient depends on bleeding and thrombo-embolic risk which summerise scale CHA(2)DS(2)VASc and HAS-BLED. Past recent years in AF treatment anticoagulants from the group of vitamin K antagonist were used. At present in brain stroke prevention and systemic emboilment, new oral anticoagulants (NOA) which weren't worst than vitamin K antagonists, and they are recomendet in most cases of AF unrelated with heart valve defets. Useing NOA causes lower risk of bleeding, including intracranial heamorrhage. It is believed that this is related to the selective inhibition of specific coagulation factors, and respect other hemostatic mechanisms. Results from clinical studies NOA are encouraging, but still lacks clear answers regarding, among other things: long-term safety of treatment and economically viable in everyday clinical practice. In addition, to date there is no specific antidote for this group of drugs.

Platelet Reactivity in Patients With Stroke and Hyperlipidemia, GPIbα Assessment.

The aim of this study was to assess platelet reactivity in patients after ischemic stroke and to investigate the influence of hyperlipidemia (HL) on platelet activity markers. A total of 41 patients after ischemic stroke were divided into the following 2 groups: patients with HL and patients with normolipidemia. Expression of CD42b on resting, thrombin-activated blood platelets, and fibrinogen level was assessed. The CD42b-positive platelets were analyzed using the flow cytometer, anti-CD61, and anti-CD42b monoclonal antibodies. The results confirmed increased platelet reactivity to thrombin in all patients after ischemic stroke manifested by significantly lower CD42b expression and percentage of CD42b(+) platelets after activation by thrombin. The influence of HL on the expression of CD42b on resting and thrombin-activated platelets was not found. However, increased level of fibrinogen but no influence of HL on fibrinogen concentration was observed in patients after ischemic stroke. Increased susceptibility to platelet agonists was found in patients after ischemic stroke in the convalescent phase.

The influence of statin therapy on platelet activity markers in hyperlipidemic patients after ischemic stroke.

INTRODUCTION: Low-density lipoprotein cholesterol (LDL-C) has been reported to increase platelet activation. Reducing the level of LDL-C with statins induces important pleiotropic effects such as platelet inhibition. This association between platelet activity and statin therapy may be clinically important in reducing the risk of ischemic stroke. We investigated the effect of simvastatin therapy on platelet activation markers (platelet CD62P, sP-selectin, and platelet-derived microparticles (PDMPs)) in hyperlipidemic patients after ischemic stroke. MATERIAL AND METHODS: The study group consisted of 21 hyperlipidemic patients after ischemic stroke confirmed by CT, and 20 healthy subjects served as controls. We assessed the CD62P expression on resting and thrombin-activated blood platelets. CD62P and PDMPs were analyzed by the use of monoclonal antibodies anti-CD61 and anti-CD62 on a flow cytometer. The level of sP-selectin in serum was measured by the ELISA (enzyme-linked immunosorbent assay) method. All markers were re-analyzed after 6 months of treatment with simvastatin (20 mg/day). RESULTS: Hyperlipidemic patients presented a significantly higher percentage of CD62+ platelets and higher reactivity to thrombin compared to control subjects. After simvastatin therapy hyperlipidemic patients showed a reduction of the percentage of resting CD62P(+) platelets (p = 0.005) and a reduction of expression and percentage of CD62P(+) platelets after activation by thrombin (median p < 0.05; percentage: p = 0.001). A decrease of sP-selectin levels (p = 0.001) and percentage of PDMPs (p < 0.05) in this group was also observed. CONCLUSIONS: HMG-CoA reductase inhibitor therapy in stroke patients with hyperlipidemia may be useful not only due to the lipid-lowering effect but also because of a significant role in reduction of platelet activation and reactivity.

[The usefulness of P300 potential in hepatic encephalopathy diagnostics of alcoholic etiology]. / Przydatnosc potencjalu P300 w diagnostyce encefalopatii watrobowej o etiologii alkoholowej.

UNLABELLED: The consequence of consuming excessive amount of alcohol is the damage of internal organs, particularly liver. In the liver there comes in turn to its fatty degeneration, hepatitis, fibrosis and finally to its cirrhosis. The aim of the study was the analysis of P300 potential in subjects chronically abusing alcohol with alcohol-related toxic liver damage and the assessment of the usefulness of this potential in the diagnosis of hepatic encephalopathy. MATERIAL AND METHODS: Group I--consisted of 30 men meeting the criteria of alcohol dependency syndrome, with diagnosed alcohol-related toxic liver damage. Comparative group--consisted of 30 physically and mentally healthy men, with no alcohol dependency syndrome. The following were carried out in all the examined: examination of auditory endogenic P300 potential. RESULTS: In subjects chronically abusing alcohol, with diagnosed toxic liver damage statistically significant prolonged latency and also reduced amplitude (p < 0.001) were found in comparison with the control group. CONCLUSIONS: 1. Changes in P300 parameters (latency elongation and amplitude reduction) in alcohol-dependent subjects with alcohol-related liver damage were confirmed. 2. P300 potential may be a complementary method in the diagnosis of hepatic encephalopathy.

[The case of multiple brain abscesses conservatively treated]. / Przypadek mnogich ropni mózgu leczonych zachowawczo.

We report the case of patient with rheumatoid arthritis treated by sulfasalazin. He was hospitalized because of general erythrodermia and diarrhoea with dysproteinemia. The consciousness disturbances and the meningitis syndrome occured in the course of disease. The findings of cerebrospinal fluid suggested viral meningitis and encephalitis. The treatment was started. After short-term improvement, the focal neurological deficits and the consciousness disturbances appeared again. The examinations of the computed tomography and the magnetic resonance image suggested inflammatory or neoplasmatic process. The inflammatory process seemed to be more probable and antibiotic treatment was administered. The following CT and MRI findings confirmed inflammatory changes of brain tissue and abscess formation tendency. After the neurosurgeon consultation the conservatively treatment was continued. The 2 month therapy achieved a successful outcome. We report this case because of the difficulties of diagnostic and treatment choices and the 50% mortality connected with the multiple brain abscesses. It seems that in our case the bacterial infection was secondary to the viral encephalomeningitis. We couldn't find the primary focus of bacterial infection, although the infection cause was undoubtedly hematogenous (abscesses location on the boundaries of cerebral cortex and white matter). There is no evident therapeutic standards and the choice of the best treatment is still under discussion. However, neuroimagining techniques are very useful in the correct diagnosis and optimal treatment.

[Diabetic neuropathy]. / Neuropatia cukrzycowa.

Diabetic neuropathy is most common chronic complication of diabetes mellitus. It is responsible for substantial morbidity, increased mortality and impaired quality of life. Patogenesis of diabetic neuropathy is complex. Chronic hyperglycemia is a major factor induces nerve fibers injury. High level of glucose stimulate the polyol pathway causing osmotic stress and enhance reactive oxygen species generation, as well as it play an important role in diabetic angiopathy development. Distal symmetric polineuropathy is most common type of diabetic neuropathy. Many patient may develop combinations of neuropathies concerning somatic and autonomic system. Early diagnosis and administered suitable treatment are necessary to reduce severe complication of diabetic neuropathy as well as strict glycemic control and risk factor increased.

[Central pontine myelinolysis--case report]. / Centralna mielinoliza mostu--opis przypadku.

Central pontine myelinolysis (CPM) is a neurologic disorder, consists of demyelinisation without inflammation in the base of pons, with a relative sparing of the axons and the nerve cells. Clinical symptoms have various manifestations. They include pseudobalbular paralysis, tetraparesis, locked-in syndrome, coma. Rapid correction of persistence hyponatremia is a well recognized factor predisposing to CPM and nutritional deficiency is a commonly evoked cause of CMP as well. In more than half the cases it appeared in the late stages of chronic alcoholism. Among other medical conditions conjoined with CMP are liver failure and transplantation, electrolyte disturbances, cachexia from various causes, carcinoma, and severe bacterial infections. The autors report the cases of 31 year old patient with 4 year history of alkohol abuse in whom CPM developed with mild tetraparesis.

[Statins and stroke]. / Statyny a udar mózgu.

The occurrence of stroke increases with age, particularly affecting the older elderly, a population also at higher risk for coronary heart disease (CHD). Epidemiological and observational studies have not shown a clear association between cholesterol levels and all causes of stroke. Nevertheless, large, long-term statin trials in patients with established CHD or et high risk for CHD (diabetes, hypertension) have shown that statins decrease stroke incidence in these populations even with a normal baseline cholesterol concentration. In patients with previous stroke statins reduce the incidence of coronary events, but whether they actually reduce the incidence of recurrent strokes in secondary prevention is unproved. In this review we discuss the potential reason for the effects of statins on stroke and the mechanisms of action. Statins probably reduce stroke by a variety of mechanisms. Several studies indicate that statins have multiple effects beyond lowering the cholesterol level. There is evidence that statins have neuroprotective properties for the acute ischaemic brain. Statins interfere with platelet aggregation and have anti-inflammatory and antioxidative properties. Also statins promote stabilisation of atherosclerotic plaques and improve blood flow to the ischaemic brain. The protective effects of statins might be due to their direct effect on endothelial cells leading to improved nitric oxide (NO) bioavailability. However further studies are needed to understand the full role of statins in the prevention of stroke in patients without established cardiovascular disease, representative of the typical stroke population.

[Potential P300 in diagnostics of cognitive functions]. / Potencjal P300 w diagnostyce zaburzen poznawczych.

On the base of accessible literature and own experience general information concerning potential P300, the methodology of its research as well as the influence of different factors on each its components were reviewed. The possibilities of the clinical use of potential P300 in the diagnostics of cognitive disturbances were presented. It emerges that P300 potential can have practical use in the diagnostics of dementias, but because of its physiological and individual changeability it cannot be treated as a fully objective diagnostic method.