Long-term cerebral outcome after open-heart surgery. A five-year neuropsychological follow-up study.

A prospective 5 years' neuropsychological, neurological, cardiological and electroencephalographical follow-up study was carried out in 44 patients who had undergone open-heart surgery for valve replacement. A distinct interrelationship was found between the clinical outcome immediately after operation and the neuropsychological long-term course despite the rapid recovery of occasional clinical disorders related to operative procedures. In fact, the psychometric performance scores of those who did not develop clinical signs of cerebral dysfunction induced in operation showed a significant difference only years after operation. Similarly, the harmful effects of long perfusion time (extracorporeal circulation) in operation were reflected in the long-term neuropsychological performance. Some evidence seemed to suggest that the correction of the prolonged circulatory disorder might possibly afford real enhancement of higher cerebral functions. The long-term results not only emphasize the importance of a careful clinical evaluation but also emphasize the necessity of considering the subclinical level of events both before and after operation when assessing the overall outcome and cerebral safety of cardiac surgery patients.

Plasma HDL cholesterol and growth hormone in epileptics treated with anticonvulsants.

Plasma high density lipoprotein (HDL) cholesterol and serum growth hormone (GH) levels were determined in 166 epileptic patients undergoing anticonvulsant treatment in 54 healthy controls. HDL cholesterol and GH levels were high in epileptics when compared to the levels in controls. Nineteen out of 31 patients (61%) with elevated GH had elevated plasma HDL cholesterol concentration. This relationship in patients with normal GH was 34/135(25%). In female epileptics with elevated GH plasma HDL cholesterol was in positive relationship to serum GH level (r = 0.47, P less than 0.05). The increase in GH secretion in epileptics might be associated with an increase in hepatic production of HDL.

Plasma HDL cholesterol in epileptics with elevated triglyceride and cholesterol.

Due to the metabolic changes induced, e.g. in the liver by anti-epileptic drugs, the significance of high serum triglyceride and cholesterol in epileptics was studied and the plasma HDL cholesterol level was compared in 190 epileptic patients with elevated or normal triglyceride and cholesterol, with the corresponding values in 43 healthy subjects. One-third of the epileptic patients showed elevated plasma HDL cholesterol levels. Female epileptics had higher plasma HDL cholesterol than the normolipidemic healthy subjects. Epileptics with elevated triglyceride or a combination of elevated triglyceride and cholesterol had a lower plasma HDL cholesterol level than normolipidemic patients with epilepsy. HDL cholesterol level in epileptics with high serum cholesterol did not diverge from the level in epileptics with normal serum triglyceride and cholesterol. The results show significant differences of plasma HDL cholesterol between epileptic patients and normolipidemic healthy controls on one hand, and between epileptics with altered and epileptics with normal serum lipid levels on the other. The findings suggest that the increase of plasma HDL cholesterol level in epileptics undergoing anticonvulsant treatment is influenced by endogenous triglyceride metabolism.