The correlation between lipid peroxidation in different brain regions and the severity of lindane-induced seizures in rats.

The aim of this study was to investigate the dynamics of lipid peroxidation and the possible correlation between lipid peroxidation in different brain regions and behavioral manifestations in lindane-induced seizures in rats. Male Wistar rats were divided into the following groups: 1. control, saline-treated group; 2. dimethylsulfoxide (DMSO)-treated group; 3. lindane-treated group (8 mg/kg), intraperitoneally. Animals were sacrificed 0.5 or 4 h after treatment and the malondialdehyde level and superoxide dismutase (SOD) activity were determined in various brain regions spectrophotometrically. Behavioral changes were classified according to the descriptive scale (0--no response, 1--head nodding, lower jaw twitching; 2--myoclonic body jerks, bilateral forelimb clonus with full rearing; 3--progression to generalized clonic convulsions followed by tonic extension of fore- and hind limbs and tail; 4--status epilepticus). A significant rise in the malondialdehyde level was detected in the cerebral cortex, hippocampus, and thalamus of lindane-treated animals 0.5 and 4 h after administration (P < 0.05). SOD activity (total and mitochondrial) was significantly decreased in the hippocampus and the cortex of lindane-treated animals at both time points (P < 0.05). An initial fall in SOD activity was detected in the thalamus 4 h after lindane administration (P < 0.05). A positive correlation between seizure severity and the malondialdehyde level was found in the hippocampus at both time points (P < 0.01). These results suggest that lipid peroxidation may contribute to the neurotoxic effects of lindane in early acute lindane intoxication and that behavioral manifestations correlate with lipid peroxidation in the hippocampus of lindane-treated rats.

The long-term risk of stroke in patients with acute myocardial infarction complicated with new-onset atrial fibrillation.

BACKGROUND: The long-term risk of stroke after acute myocardial infarction (AMI) complicated with new-onset atrial fibrillation (AF) remains unclear. The aim of this study was to determine the long-term risk of AF and stroke in patients with AMI complicated with new-onset AF. METHODS: Patients with AMI complicated with new-onset AF (n = 260) and those without new-onset AF (n = 292) were followed for a mean of 7 years. All patients had sinus rhythm at hospital discharge. RESULTS: During the follow-up, AMI patients with new-onset AF had more frequent AF than those without new-onset AF (10.4% vs 2.7%, respectively; P < 0.0001). New-onset AF during AMI was a significant predictor of subsequent AF occurrence (the time elapsing between 2 consecutive R waves [RR] = 3.15, P = 0.004); but AF recurrence in follow-up (RR = 5.08, P = 0.001) and non-anticoagulation at discharge (RR = 0.29, P = 0.008) were independent predictors of stroke (Cox regression analysis). A period of 3.5 hours of AF within the first 48 hours of AMI was the high sensitivity cut-off level for the prediction of low long-term risk of stroke obtained by receiver operating characteristic analysis. Among patients who did not receive anticoagulants at discharge, the patients with short AF did not experience stroke and AF recurrence during follow-up, while those in the other group developed it (10.8%, P = 0.038 and 13.5%, P = 0.019, respectively). CONCLUSION: New-onset AF during AMI identifies the patients at long-term risk for stroke who may potentially benefit from anticoagulant therapy. Atrial fibrillation recurrence in follow-up was independently related to the development of stroke. However, for low-risk patients with AF (those with short AF occurring early in AMI) long-term anticoagulants might not be required.

Byproducts of oxidative protein damage and antioxidant enzyme activities in plasma of patients with different degrees of essential hypertension.

Despite evidence that essential hypertension (EH) is a state of increased oxidative stress, the data on oxidative protein modifications is lacking. Besides, the role of extracellular antioxidant enzymes in EH has not been systematically studied. Study was performed in 45 subjects with EH and 25 normotensive controls. Patients were divided into three groups according to the 2003 ESH/ESC guidelines (grade 1-3). Plasma protein reactive carbonyl derivatives (RCD) and SH-groups (as byproducts of oxidative protein damage) as well as antioxidant enzyme activities superoxide dismutase (SOD), glutathione peroxidase (GPX) and catalase were studied spectrophotometrically and correlated with blood pressure (BP). RCD levels were increased in EH patients compared to controls and correlated significantly with both systolic blood pressure (SBP) (r = 0.495, P<0.01) and diastolic blood pressure (DBP) (r = 0.534, P<0.01). Plasma SH-groups content was significantly lower in all patients with EH, with no correlation with BP. SOD and catalase activity in patients with grade 1 EH were similar to that of controls. Patients with grade 2 and 3 of EH had lower SOD and catalase activity. However, significant correlation with SBP and DBP was observed for catalase only (r = -0.331; P<0.05 and r = -0.365; P<0.05, respectively). EH patients exhibited higher plasma GPX activity compared to those in controls, and it correlated with SBP (r = 0.328; P<0.05). The results presented show that increased oxidative protein damage is present in all grades of EH. In mild hypertension extracellular antioxidant enzyme activities are not decreased, suggesting they are probably not critical in early EH, but could be important in moderate to severe EH.

[Clinical manifestations of familial hypercholesterolemia]. / Klinicke manifestacije porodicne hiperholesterolemije.

Familial hypercholesterolaemia (FH) is an autosomal-dominant inherited disorder clinically characterized by high serum cholesterol (low-density lipoprotein--LDL-fraction) concentrations, xanthomas and premature atherosclerosis. Homozygous individuals suffer from vascular disease in childhood or young adolescence since heterozygous persons are usually at ligh risk of premature cardiovascular death. We present a 42-year old female with coronary heart disease and tuber and tendinous xanthomas, which appeared as a consequence of delayed diagnosis of familial hypercholesterolaemia. She was admitted to the hospital due to unstable angina pectoris. On admission the patient was haemodinamically compensated. Cardiac rhythm was regular and heart sounds were of normal intensity. She also presented two systolic murmurs. The first, the ejection murmur had maximal intensity in the second right intercostal space and radiated to the appex. The second murmur was regurgitant, generated at the appex and propagated to the anterior aixllary line. On inspection, we observed xanthomas in Achillis tendons and palmar extensors as well as tuberous xanthomas in the knees and fingers of both hands and feet. We also observed bilateral xantholasms. Arcus corneae was detected by ophthalmological examination. On admittance, the cholesterol serum level was 13.2 mmol/L, and LDL fraction was 7.6 mmol/L. Echocardiography revealed sclerosis of the aortic valve and mitral annulus. Coronarography documented the three-vessel disease. An aggressive medical treatment, which consisted of bile salts and HMGCoA reductase inhibitors, resulted in significant lowering of serum cholesterol--more than 30%. However, due to refractory angina pectorts, she had to be operated on and aorto-coronary by-pass was performed.

Understanding the role of nationalism in "new democracies".

The transition from communism to democracy has raised numerous discussions regarding the nature of postcommunism in Eastern Europe. According to the author, the two main approaches used to explain the collapse of communism--one that claims that resurrected civil society triumphed over totalitarianism, and, the other that avers Eastern Europe's propensity for irrationalism and a political behaviour based on ethnic exclusion and hatred--overlook the unique nature of postcommunism. In order to properly grasp the nature of this phenomena, the author argues that one must first understand the intrinsic nature of Eastern Europe's transformation. To do this requires an analysis of the social structures that drive political change and identifying the social group that is the main bearer of transformation. The author believes that though her analysis focuses primarily on the case of former Yugoslavia, and Croatia in particular, the conclusions she draws from it are also valid for other East European countries: that the nation is regarded as the principal catalyst for political change and that nationalism is the main legitimizing principle of emerging states. This analysis rejects the common view according to which nationalism is casually discounted as an irrational political movement that is fundamentally hostile to democracy and freedom. Quite the contrary. Throughout Eastern Europe nationalism has had a positive role in bringing down communism and creating a space for democracy to take root. Still, tension exists between nationalism and the democracy it spawned. To understand this paradox requires an extensive sociological and historical study of the particular conditions within which a particular community defines the goals of nationalism and the specific content of its main undergirding concepts like nation and state. Identifying the circumstances within which nationalism begins to act as an obstacle to the establishment of full-fledge democracy is key to understanding the political reality of today's Croatia and of many other East European "new democracies". Nationalism works differently in different socio-political conditions--differently in countries that recently achieved independence from countries with a long tradition of sovereign statehood, differently in countries with an underdeveloped or non-existent civil society from those with a strong civil society, differently in countries that are economically prosperous from those that are experiencing economic hardship. All these factors, not nationalism per se, determine the overall prospects for liberal democracy in Eastern Europe.

[Aortic wall distensibility and the structure and function of the left ventricle in aged persons with isolated systolic hypertension]. / Distenzibilnost zida aorte i gradja i funkcija leve komore srca kod starih osoba s izolovanom sistolnom hipertenzijom.

UNLABELLED: The number of old persons (over 65 years) with arterial hypertension is in a steady increase [1]. Such finding is mainly related to patients with isolated systolic hypertension. They present more than 60% of old persons with arterial hypertension [2]. Isolated systolic hypertension can be defined as increased systolic blood pressure to the value more than 160 mmHg and diastolic pressure to 90-95 mmHg [4, 5]. It has been suggested that the pathologic basis of this entity is in a decreased distensibility of aorta and great arteries. In patients with isolated systolic hypertension we studied the correlation between decreased aortic distensibility and systolic arterial blood pressure value. We also evaluated changes in the left ventricular structure and function during this type of hypertension. PATIENTS AND METHODS: We examined 59 patients older than 65 years. They were divided in two subgroups. First subgroup: 38 patients (74 +/- 11 years) with isolated systolic hypertension (ISH) and the second subgroup: 21 normotensive persons (NT) (73 +/- 6 years). Aortic distensibility was calculated by the formula: Aortic dystensibility = difference between aortic diameters/diameter aortae in diastole x pulse pressure. The ascending aortic diameters were measured 4 cm above the aortic valve by two dimensional echocardiography and pulse pressure was measured simultaneously by sphingomanometry. Using M-mod and two-dimensional echocardiography we measured end-diastolic (EDD) and end-systolic (ESD) left ventricular diameters and thickness of interventricular septum (IVS) and posterior wall (ZZ). We calculated the ejection fraction (EF) using Teichole formula. Changes in left ventricular structure were expressed by sum of interventricular septum and posterior wall thickness and left ventricular mass. We calculated left ventricular mass using the following formula: MLK = /EDD + IVS + ZZ)3 - EDD/ x 1.05. By pulse Doppler echocardiography we measured the peak velocity of the left ventricular filling (VE) and calculated the ratio between early and late peak velocity (VE/VA). RESULTS: Aortic distensibility was significantly lower in patients with isolated systolic hypertension than in normotensive subjects (0.10 +/- 0.02 x 1/100 1/mmHg vs 0.24 +/- 0.04 x 1/100 1/mmHg; p < 0.05). Such findings are presented in Table 1. At the same time, we found a significantly inversed correlation between aortic distensibility and systolic blood pressure value in patients with isolated systolic hypertension (r = 0.67; p < 0.05). From Table 2 it is visible that there were no significant differences between left ventricular diameter and mass in hypertensive patients. The sum of interventricular septum and posterior wall thickness was significantly greater in patients with isolated systolic hypertension than in normotensive patients (2.19 +/- 0.5 cm v.s. 1.93 +/- 0.4 cm; p < 0.05). This finding is also presented in Table 2. We found no statistically significant differences among the ejection fraction values in the studied subgroups (Table 3). The peak velocity of early filling and the ratio of early to late peak velocities were significantly lower in the hypertensive subgroup (0.4 m/s v.s. 0.54 m/s; p < 0.05; 0.69 v.s. 0.76; p < 0.05) (Table 3). DISCUSSION: In old persons with isolated systolic hypertension we found that aortic distensibility was significantly lower in comparison to normotensive subjects of the same age. Such finding supports the hypothesis that the reduced aortic distensibility is the cause of isolated systolic hypertension. At the same time, we found the inversed correlation between aortic distensibility and the mean systolic blood pressure value. Aging has an effect on reduction of aortic and great vessels distensibility. Thus, it causes arterial hypertension which changes the elastic properties of aorta. It is still questionable in which degree the systolic blood pressure value compromises the elastic properties of aorta. (ABSTRACT TRUNCATED)

[Isolated systolic arterial hypertension in the elderly]. / Izolovana sistolna arterijska hipertenzija kod starnih osoba.

Isolated systolic hypertension is a common disorder in the elderly carrying a high risk of stroke and cardiovascular disease. Isolated systolic hypertension is usually defined as a systolic blood pressure greater than or equal to 160 mmHg and diastolic blood pressure less than 95 mmHg. The arterial stiffening is the principal cause of increasing systolic pressure in advanced age. It is due to degeneration of the arterial wall and is associated with progressive arterial dilatation. Hypertension in elderly patients is also characterized by increase of peripheral vascular resistance. Due to the wide variability of blood pressure usually seen in old persons, the isolated systolic hypertension is not easy to recognize and final diagnosis requires a long period of observation. The ambulatory blood pressure monitoring proved to be helpful in distinguishing patients with true isolated systolic hypertension from subjects with exaggerated alarm reaction to the pressure measurement. Although the increased risk of cardiovascular and cerebrovascular mortality is well established for isolated systolic hypertension, there has been much debate whether available antihypertensive treatment can prevent or delay cardiovascular and cerebrovascular complications in this condition. During the last year several large new trials have been published, the so-called STOP-Hypertension, SHEP and MRC trials. All studies have demonstrated that the treatment of isolated systolic hypertension with diuretics or/and beta blockers (frequently used in combination) resulted in a significant reduction in the incidence of stroke and major cardiovascular events. New antihypertensive agents such as calcium channel blockers and angiotensin-converting enzyme inhibitors have also been shown to effectively lower systolic blood pressure in the elderly but the effects on long-term morbidity and mortality are still unknown.

Blood and plasma selenium levels and GSH-Px activities in patients with arterial hypertension and chronic heart disease.

The purpose of this study was to examine the relationship between arterial hypertension (HTN), chronic heart disease (CHD), and selenium (Se) status. Blood and plasma Se concentrations and Se-dependent GSH-Px activities were determined in 40 patients (HTN = 20; CHD = 20) and 17 healthy volunteers aged 41 to 66 years. Whole blood and plasma Se concentrations were significantly lower in the patients with HTN (19.1% and 26.3%, respectively) and CHD (33.1% and 29.4%, respectively) compared with the values obtained in the controls. The hypertensive patients had lower plasma Se-GSH-Px (26.7%), and those with CHD had both lower whole blood (19.5%) and plasma Se-GSH-Px activities (30.2%). A significant positive correlation between plasma Se-GSH-Px activity and ejection fraction (EF) was found in patients with CHD. There were significant correlations between plasma and whole blood Se concentration, plasma Se concentration and Se-GSH-Px activity, and whole blood Se and Se-GSH-Px activity. Our results showed that hypertensive patients and those with CHD had lower Se levels compared with controls. We conclude that low Se content might be a risk factor for development of HTN and CHD.

Recovery of respiratory functional defects after war injuries to the chest.

AIM: Assessment of lung function before, during, and after surgical treatment of war injuries to the chest, and comparison of conservative and operative surgical approach. PATIENTS AND METHODS: A retrospective study of 439 patients with war injuries to the chest inflicted during the wars in Croatia and Bosnia and Herzegovina was performed. Patients were classified by injury mechanism and by physiologic scoring on admission, according to the cardiovascular-respiratory elements of the Injury Severity Score (ISS). "Conservative" surgical treatment with chest tube drainage, appropriate fluid therapy, and antimicrobial and atelectasis prophylaxis was performed in 358 (81.5%) and operations in 81 (18. 5%) patients. Blood gases were analyzed before, during, and after surgical treatments. Pulmonary function was assessed after the stabilization of patients' clinical condition and 3-6 months after the injury. RESULTS: On admission, blood gas profiles showed slight to moderate hypoxemia with consecutive hypercapnia related to the severity of injuries. Surgical treatment left a minimum degree restrictive disorder of ventilation without an obstructive pattern. Definitive repair of lung function presented with normalization of blood gas data, and significantly improved restrictive pattern (p<0.05). There was no difference in definitive lung function between conservatively and operatively treated patients. Mortality was 2%. CONCLUSION: The success of surgical resuscitation was related to ISS scoring. Recovery of respiratory function defects after the injury was not significantly related to the mechanism of injury or the patient's condition at arrival. The recovery of lung function was similar in conservatively and operatively treated patients.

Traumatic arteriovenous fistula. Case report and overview.

The difficulties in detecting vascular injuries associated with penetrating limb trauma are greater than generally appreciated. Any delay in diagnosis will compromise management and potentially may lead amputation. Traumatic arteriovenous fistulas (AV fistula) produce several profound pathophysiological and structural changes in the circulatory dynamic of the vessel associated with fistula. Most of the changes are reversible after surgery. However, in longstanding AV fistulas, irreversible degenerative changes occur in the arterial wall and result in dilation and thrombosis. This can make late closure technically difficult. This report presents a case of a femoral AV fistula persisting for three years durations.

[Blunt heart injuries and diagnostic difficulties]. / Tupe ozljede srca i dijagnosticke teskoce.

The authors present their experiences with blunt heart injuries treated in the University Surgical Hospital in Split, Croatia. The diagnostic approach hospitalization and follow-up of these patients are described. The heart contusion was diagnosed using several repeated electrocardiographic and enzymatic tests combined with two-dimensional echocardiography. We treated 67 patients with heart contusions within two-year period. Out of them, 63 (94%) were dismissed from the hospital as cured, and 4 (6%) of them died. Results of treatment depend on the severity of injury, but also on a timely and adequate management.

[Relation between Doppler echocardiography and the surface area of the mitral valve]. / Zavisnost nalaza Doppler ehokardiografije od povrsine mitralnog usca.

The Doppler signal of mitral flow velocity depends not only on the pressure drop across the mitral orifice, but on the volume flow also. Since the slope of the maximum velocity curve and the rate of decrease of pressure drop during diastole are influenced by the degree of obstruction, we compared the findings of the Doppler examination in our patients with different mitral valve areas determined by 2-D echocardiography.

[Doppler echocardiography in the evaluation of prosthetic valve function]. / Doppler ehokardiografija u proceni funkcije ugradhenih vestackih valvula.

The limitations of invasive and noninvasive procedures, including M-mode and 2-D echocardiography, in the follow-up of patients with prosthetic heart valve replacement, are numerous and well known. Doppler echocardiography helps the functional evaluation of prosthetic valves by reliable detection of valvular regurgitation through a malfunctioning prosthetic valve or due to paravalvular leaks. On the other hand, serial determinations of the values of pressure drops or effective valve orifice areas, calculated from the half-time pressure, enables the diagnosis of prosthetic valve obstruction or dehiscence. The results in the assessment of prosthetic valve function by Doppler echocardiography in a group of operated patients, are reported. Signs of prosthetic valve malfunction were not present in 6 patients with mitral valve prostheses and two patients with two-valve-prostheses (mitral and aortic) in the group ob 13 evaluated patients. In two patients with Björk mitral valves mitral regurgitation was found. It was due to valvular leakage in one patient and to paravalvular leakages in the other. In both patients with aortic prosthetic dysfunction a paravalvular leak was diagnosed. There was an invasive proof of prosthetic regurgitation in the same four patients. The only patient with biologic mitral valve prosthesis presented a significant flow obstruction.