Paraoxonase 2 gene C311S polymorphism is associated with a risk of large vessel disease stroke in a Polish population.

BACKGROUND: Oxidative stress plays a role in atherosclerosis. Human paraoxonase (PON) gene products exhibit antioxidant properties. We studied the significance of the Q192R and M55L polymorphisms of the PON1 gene and the C311S polymorphism of the PON2 gene in different etiologies of ischemic stroke. METHODS: One hundred and thirty-six patients with large vessel disease (LVD) stroke, 140 with small vessel disease stroke, 272 with cardioembolic stroke, and their age- and sex-matched controls were included. PON genotypes were evaluated by PCR-RFLP analyses. RESULTS: The distribution of PON1 polymorphisms was similar in each stroke group and in the respective controls. Genotypes with the C allele of the PON2 gene C311S polymorphism were overrepresented in LVD stroke patients as compared with their controls, both in univariate and multivariate (dominant model: OR = 1.58, 95% CI: 1.006-2.48) analyses. CONCLUSION: The genotype with the C allele of the PON2 gene is a risk factor for LVD stroke in a Polish population.

[Vascular abnormalities in patients with primary intracerebral hemorrhage]. / Malformacje naczyn mózgowych u chorych z pierwotnym krwotokiem sródmózgowym.

BACKGROUND: To prevent the recurrence of primary intracerebral hemorrhage (PIH) it is important to identify patients with underlying structural vascular abnormalities (VA). According to previous study data-- the site of hemorrhage, the patient's age and pre-existing hypertension affect the likelihood of finding VA. However, the indications for angiography, the gold standard for the diagnosis of VA, still remain controversial. PURPOSE: To assess the frequency of VA and to determine features that might increase the probability of finding VA in patients with PIH. MATERIAL AND METHODS: 100 patients with PIH, without a history of trauma, coagulopathy, or known pre-existing brain abnormality, who were admitted to the Stroke Unit of the Department of Neurology, Jagiellonian University, between January 1999 and November 2000 entered this prospectively designed study. In the group of 96 patients, 53 persons underwent conventional angiography within 14 days of stroke onset (in 4 cases we found bleeding into the tumor and these patients were not included in further analysis). RESULTS: Vascular abnormalities were found in 14 of 53 patients (26.4%); ruptured aneurysms in 9 patients (17.0%), arteriovenous malformations (AVM) in 3 patients (5.7%), venous angioma in 1 patient (1.8%) and cavernous angioma in 1 patient (1.9%). Vascular malformations were found in 12 of 25 patients with lobar hemorrhage, in 1 of 8 patients with hemorrhage originating in the thalamus and in 1 of 2 patients with hemorrhage originating in the pons. Angiographic findings were negative in 8 patients with hemorrhage in the periventricular white matter, in 8 with hemorrhage originating in the basal ganglia and in 2 patients with hemorrhage in the cerebellum. Patients with VA were significantly younger than patients without VA (49.9 +/- 11.7 years and 58.7 +/- 13.3 years respectively, p = 0.03) and they had a history of hypertension significantly less often (50.0% and 89.7%, p = 0.001). Intraventricular hemorrhage and subarachnoid bleeding occurred in a similar percentage of patients with ICH, independent of whether or not they had VA (28.6% and 38.5%; 21.4% and 10.3% respectively, p = n.s.). CONCLUSIONS: (1) A vascular abnormality is the cause of about 26% of ICH, with a higher likelihood in younger patients and with lobar hemorrhage. (2) A history of hypertension does not exclude the presence of VA. (3) Intraventricular hemorrhage or subarachnoid bleeding does not predict the presence of VA.

[Diagnosis and assessment of diabetic nephropathy. Literature review and author's observations]. / Metody rozpoznawania i oceny neuropatii cukrzycowej. Przeglad pismiennictwa oraz doswiadczenia wlasne.

Neuropathy, one of the most common diabetes complications, is characterized by highly variable clinical picture. It is not established what evaluation scheme should be applied in the assessment of patient regarding diabetic neuropathy. The validity of various laboratory tests in the diagnosis of diabetic neuropathy also remains unclear. This paper describes different clinical manifestations of diabetic neuropathy and presents the most important methods of assessment of patients with neuropathy suspected based on literature data and authors' observations. Authors highlighted the implications of different methods in diagnostic process. The most valid methods include physical evaluation, determination of vibration sensation and assessment of nerve conduction velocity. The autonomic functions tests have a special role allowing for the diagnosis of autonomic neuropathy.

A2 alelle of GpIIIa gene is a risk factor for stroke caused by large-vessel disease in males.

BACKGROUND AND PURPOSE: Glycoprotein IIIa (GpIIIa) is a platelet membrane receptor for fibrinogen and von Willebrand factor. It plays a key role in platelet aggregation. Previous studies in stroke patients, without analysis based on specific subtypes of stroke cause, have not shown any link between GpIIIa A1/A2 polymorphism and stroke risk. We studied the significance of the GpIIIa gene A1/A2 polymorphism in stroke patients with different stroke causes. METHODS: We genotyped 92 patients with stroke caused by large-vessel disease (LVD stroke) and 184 matched controls; 103 patients with stroke caused by small-vessel disease (SVD stroke) and 206 controls; and 182 patients with cardioembolic stroke (CE stroke) and 182 controls (TOAST criteria). The GpIIIa A1/A2 polymorphism was analyzed by polymerase chain reaction followed by restriction enzyme digestion and electrophoresis. RESULTS: The genotype distribution of the GpIIIa gene in patients with LVD stroke (A1/A1, 63%; A1/A2, 34.8%; A2/A2, 2.2%) differed significantly from their controls (A1A1, 79.3%; A1/A2, 20.1%; A2/A2, 0.6%). The distribution of the GpIIIa A1/A2 polymorphism in patients with SVD stroke and CE stroke was similar to that of their controls. In contrast to females with LVD stroke, we found that males with LVD stroke presented with an overrepresentation of at least 1 A2 allele of the GpIIIa gene when compared with their controls (39.7% versus 23.0%; P=0.003). Conditional logistic regression analysis showed that possession of at least 1 A2 allele of the GpIIIa gene was an independent risk factor for LVD stroke in males (OR, 2.51; 95% CI, 1.21 to 5.20). CONCLUSIONS: A2 allele of the GpIIIa gene is an independent risk factor for LVD stroke in males.

Hypercortisolemia in acute stroke is related to the inflammatory response.

Hypercortisolemia is thought to be a marker of the stress response following stroke. The aim of this study was to investigate the prevalence and prognostic significance of hypercortisolemia. The circadian variation of cortisol level and the relationship between serum cortisol levels and other stress, inflammatory, and haemostatic markers were also investigated. Seventy consecutive patients with their first ischemic stroke and 24 age- and sex-matched controls were included in the study. Serum cortisol levels (at 6:00 AM, 10:00 AM, 6:00 PM, and 10:00 PM), 24-h urine catecholamine excretion, beta-thromboglobulin levels, and other standard biochemical and haematological parameters were measured on the first day of hospitalisation and in control subjects. Outcome measures used the Barthel Index at Day 30, as well as 30- and 90-day mortality rates. Hypercortisolemia, defined as at least two of the four measurements above the normal range of serum cortisol levels (i.e. >618 nmol/l from the morning samples and >460 nmol/l from the evening samples) was found in 25 (35.7%) of the acute stroke patients and in 3 (12.5%) of the controls (p<0.05). Hypercortisolemia was associated with older age, greater severity of neurological deficit, larger ischemic lesions on CT, and worse prognoses (p<0.05). The study did not find a correlation between serum cortisol levels and other markers of the stress response such as catecholamines excretion and glucose levels. A significant correlation between serum cortisol levels and some markers of the inflammatory response, such as fever, fibrinogen level, white blood cell (WBC) count, and beta-thromboglobulin level, was established in stroke patients. Prognostic significance of hypercortisolemia in acute stroke patients seems to be related to the inflammatory response rather than to the stress response.

[Predictors for diabetic neuropathy according to applied criteria of its diagnosis]. / Czynniki predykcyjne neuropatii cukrzycowej w zaleznosci od przyjetych kryteriów jej rozpoznawania.

It is difficult to establish predictors for diabetic neuropathy because no generally accepted criteria of its diagnosis exist. In previous investigations risk factors profiles for neuropathy differ markedly. The aim of this study was to assess risk predictors for diabetic neuropathy in relation to different criteria of its diagnosis. Ninety-five diabetic patients entered the study. The exclusion criteria included uremia, alcohol abuse and radiculopathy. Control group consisted of 43 healthy volunteers. All patients underwent the clinical assessment, instrumental evaluation of superficial and deep sensation, tests of cardiovascular autonomic function and nerve conduction studies. According to the performed assessment patients were classified into following groups: without neuropathy, suspicion of neuropathy, neuropathy confirmed in clinical examination, neuropathy confirmed in electrophysiological testing, autonomic neuropathy. Analysis showed that the most important predictors in patients with subjective symptoms were type 2 diabetes mellitus, diabetes duration and age of patients. When neuropathy was diagnosed according to the clinical examination, predictors included type 2 diabetesmellitus and duration of the disease. In the cases of neuropathy confirmed by electrophysiological studies and autonomic neuropathy, only diabetes duration appeared to be a significant predictor. Our study demonstrated that predictors for diabetic neuropathy varied in relation to different diagnostic criteria and where the most important predictor for all forms of neuropathy is duration of diabetes. This result indicates the need for frequent screening tests in patients with long duration of the disease, irrespective of its metabolic control, patients' age or type of diabetes.