Poloxamer-188 and citicoline provide neuronal membrane integrity and protect membrane stability in cortical spreading depression

Under pathological conditions such as brain trauma, subarachnoid hemorrhage and stroke, cortical spreading depression (CSD) or peri-infarct depolarizations contribute to brain damage in animal models of neurological disorders as well as in human neurological diseases. CSD causes transient megachannel opening on the neuronal membrane, which may compromise neuronal survival under pathological conditions. Poloxamer-188 (P-188) and citicoline are neuroprotectants with membrane sealing properties. The aim of this study is to investigate the effect of P-188 and citicoline on the neuronal megachannel opening induced by CSD in the mouse brain. We have monitored megachannel opening with propidium iodide, a membrane impermeable fluorescent dye and, demonstrate that P-188 and citicoline strikingly decreased CSD-induced neuronal PI influx in cortex and hippocampal dentate gyrus. Therefore, these agents may be providing neuroprotection by blocking megachannel opening, which may be related to their membrane sealing action and warrant further investigation for treatment of traumatic brain injury and ischemic stroke.

Apical hypertrophic cardiomyopathy--case report and review of the literature

Hypertrophic cardiomyopathy is a well-known clinical entity. Hypertrophy engraving the left ventricular apex, so called, apical hypertrophic cardiomyopathy (characterized by the giant negative T waves at ECG and a "spade-like" view of left ventricle) is very rare variant of the pathology. In this report, we present a 51-year-old patient with apical hypertrophic cardiomyopathy together with a brief review of the literature. It was concluded that in patients presenting to the clinic with typical or atypical chest pain or dyspnea, in whom ECG indicating negative giant T waves, before an early invasive strategy, the diagnosis of ApHCM should be kept in mind and an echocardiography should be performed to confirm the diagnosis. Additionally; not only the ApHCM can easily mimic the life threatening condition of acute coronary syndrome but also these two may be seen simultaneously but independently in the same patient. For this reason before making the final diagnosis the physicians always exclude the conditions, which may lead to acute coronary syndromes.

Central neurogenic hyperventilation in anti-NMDA receptor encephalitis

Central neurogenic hyperventilation (CNH) is a rare condition that is generally associated with infiltrative tumors of the brainstem. Respiratory dysfunction, particularly central hypoventilation, is common in anti-N-methyl D-aspartate (NMDA) receptor encephalitis. CNH, to the best of our knowledge, has not been described previously in this disease. A 24-year-old woman was diagnosed with anti-NMDA receptor encephalitis secondary to ovarian teratoma. In addition to the typical symptoms of the disease, recurrent CNH episodes were observed during the course of the illness, which subsided with midazolam and propofol infusion. Supportive and disease-specific treatments, including oopherectomy, plasmapheresis and intravenous immunoglobulin, provided excellent recovery. These observations suggest that NMDA receptors may play a role in the pathophysiology of CNH.

Huge meningiomas: a review of 93 cases

Between 1972 and 1996, 450 consecutive patients with intracranial meningiomas were operated on at Cukurova University School of Medicine. By size, intracranial meningiomas were classified as huge (>6 cm minimum diameter when extrapolated to anatomic size) or not huge (<6 cm). The present study involves 93 patients who underwent 109 craniotomies for the removal of huge meningiomas. All patients are adult, with 31 men and 62 women or a 1:2 male to female ratio, with a mean age of 48.7 +/- 2.3 years at the time of diagnosis. The average duration of observed survival in 85 patients followed in the computed tomography (CT) era was 4.8 years and that of 8 patients in the pre-CT era was 8.8 years. Eleven patients died by the last follow-up assessment. Seventy-nine patients were still alive at the last follow-up assessment. The overall postoperative mortality rate was 3.2%. The overall recurrence rate was 19%. In descending order of frequency, the first five anatomic locations of the huge meningiomas were the parasagittal region in 18 patients (19.3%), the cerebral convexity in 15 (16.1%), the olfactory groove in 15 (16.1%), the falx in 12 (12.9%), and the tuberculum sellae in 11 (11.8%). The overall results of surgical treatment in 93 patients were total removal in 59 (63.4%), radical subtotal in 18 (18.3%), and subtotal in 16 (17.2%), with good outcome in 69 (74.1%), fair in 16 (17.2%), and poor in 5 (5.3%). In conclusion, the huge size of meningiomas affects the extent of removal, recurrence rate, postoperative outcome, operative morbidity and mortality rates, and survival time negatively.

[Safety and efficacy of the use of glycoprotein IIb/IIIa inhibitors in the invasive treatment of patients with ST-elevation acute coronary syndrome]

The purpose of the study was to estimate the safety and the efficacy of the use of tirofiban, its influence on the function of the left ventricle of the heart and the clinical outcome of the patients with ST elevation acute coronary syndrome (ACS) during the rescue coronary angioplasty after the unsuccessful thrombolysis. The study included 112 patients who were randomized into two groups: in group I rescue percutaneous coronary intervention (PCI) with stenting was carried out, the patients in group 2 were administered tirofiban and rescue PCI was conducted. Analysis of the immediate events (0-30 days) showed that in the frequency (group I - 13.7%, group II - 19.2%) and intensity of bleeding there were no distinct differences between groups (p>0.05). In the tirofiban group the distinct growth in the ejection fraction LV (6+/-3% versus 3+/-5% in group I, p=0.005) was recorded. Late events (31-180 days) occurred significantly more rarely in group II (5.8% versus 21.6% in group I, p<0.05). Multivariate analysis showed that the development of cardiogenic shock (OR=6.8, 95%CI: 1.8-26, p=0.005) was an independent risk factor of prominent cardiovascular complications and events during 6 months after PCI. Thus only the use of tirofiban during PCI had a significant effect of the decrease of significant cardiovascular complications and events during 6 months after PCI (OR=0.15, 95%CI: 0.04-0.53, p=0.003).

CONCLUSION

the performance of rescue PCI in combination with glycoprotein IIb/IIIa inhibitors allows to reach optimal results of the treatment of patients with ST elevation ACS after failed thrombolysis. The remote prognosis of patients after rescue PCI improves if during the intervention a patient receives IIb/IIIa inhibitors of glycoprotein receptors but at the same time considerably worsens in case of cardiogenic shock development.

[Thienopyridines in the treatment and prevention of cardiovascular diseases. Part II. Clinical pharmacology of clopidogrel]

In a series of articles the authors consider clinical pharmacology and experience of clinical application of blockers of platelet P2Y12 receptors, most well known representatives of which ticlopidine and clopidogrel according to chemical structure belong to thienopyridine derivatives. In the second communication we describe in detail clinical pharmacokinetics and pharmacodynamics of the most often used thienopyridine derivative - clopidogrel. We discuss results of randomized studies and clinical observations which have shown that pharmacokinetics of clopidogrel might vary substantially in dependence of polymorphisms of genes responsible for synthesis of P2Y12 receptors of platelets or cytochromic isoenzymes P-450 CYP of liver with participation of which formation of active metabolite of clopidogrel occurs. Contrary to practically healthy people in patients with various forms of ischemic heart disease (IHD) concomitant therapy, for instance some statins and calcium antagonists, can affect clopidogrel pharmacokinetics. Pharmacodynamics of clopidogrel in patients with IHD with acute coronary syndrome or diabetes mellitus or before percutaneous coronary interventions (PCI) also differs from that in healthy people, because in these patients hyperaggregation of platelets takes place initially and antiaggregatory action of clopidogrel is less expressed. In 10-30% of patients with IHD partial or complete resistance to antiaggregation action of clopidogrel is detected, which according to some observations is combined with elevated risk of thrombotic cardiac complications after PCI. Possible causes of resistance to clopidogrel and ways of its overcoming are discussed.

[The use of tirofiban in invasive treatment of patients with non-ST-elevation acute coronary syndrome]

The study assessed 123 patients with non-ST-elevation acute coronary syndrome who were randomized into two groups: percutaneous coronary intervention (PCI) (62 patients) and PCI against background of tirofiban injection (61 patients). The results of the study were estimated during the early (up to 30 days) and the late (up to 180 days) follow-up. It was stated that the use of tirofiban has led to the increase of minor bleedings (11% versus 4.8%, p<0.05), but the total amount of bleedings between the groups did not differ: 19.7% in the tirofiban group versus 14.5% in group I. The use of tirofiban has led to the significant growth of the LV ejection fraction (5+/-4% versus 2+/-3%, p<0.05) and increment of the LV wall motion index (0.28+/-0.18 versus 0.12+/-0.21, p<0.001). There was no difference in the frequency of the early events: 9.6% versus 8.2% in the groups without and with the use of tirofiban accordingly (p<0.05). The use of tirofiban was associated with the decrease in the frequency of all events during the first 180 days after PCI: 30.7% in group I and 13.1% in the tirofiban group (p<0.005). Absence the main cardiovascular complications according to Kaplan-Meier method for all patients amounted to 77+/-6%, in the group of the patients who received tirofiban 88+/-6%, and 64+/-8% in the group of the patients who did not receive tirofiban (p=0.009). Thereby, the use of tirofiban in the treatment of the patients with non-ST-elevation acute coronary syndrome does not lead to the increase in the frequency and severity of bleedings. At the same time, the use of tirofiban in the treatment of the patients with acute coronary syndrome has a significant influence on the growth of the LV wall motion index and the LV ejection fraction by increasing them. Under these conditions when using tirofiban in the late period the frequency of all events during PCI is 2.3 times lower compared to the patients who did not receive tirofiban.