Percutaneous treatment options for acute pulmonary embolism: a clinical consensus statement by the ESC Working Group on Pulmonary Circulation and Right Ventricular Function and the European Association of Percutaneous Cardiovascular Interventions

There is a growing clinical and scientific interest in catheter-directed therapy (CDT) of acute pulmonary embolism (PE). Currently, CDT should be considered for patients with high-risk PE, in whom thrombolysis is contraindicated or has failed. Also, CDT is a treatment option for initially stable patients in whom anticoagulant treatment fails, i.e., those who experience haemodynamic deterioration despite adequately dosed anticoagulation. However, the definition of treatment failure (primary reperfusion therapy or anticoagulation alone) remains an important area of uncertainty. Moreover, several techniques for CDT are available without evidence supporting one over the other, and variation in practice with regard to periprocedural anticoagulation is considerable. The aim of this position paper is to describe the currently available CDT approaches in PE patients and to standardise patient selection, the timing and technique of the procedure itself as well as anticoagulation regimens during CDT. We discuss several clinical scenarios of the clinical evaluation of the "efficacy" of thrombolysis and anticoagulation, including treatment failure with haemodynamic deterioration and treatment failure based on a lack of improvement. This clinical consensus statement serves as a practical guide for CDT, complementary to the formal guidelines.

Docking-based analysis and modeling of the activity of bile acids and their synthetic analogues on large conductance Ca2+ activated K channels in smooth muscle cells

OBJECTIVE

The objective of this study was to perform docking-based analysis of bile acid binding on the protein complex of channels and to derive neural network that predicts the influence of bile acids and their synthetic analogues on the activity of BK(Ca) channels in smooth muscle cells based on descriptors for bile acids and their synthetic analogues and on their already published activities using patch-clamp techniques.

MATERIALS AND METHODS

Ligands for molecular docking were optimized using computer routine for minimization of energy by using the force field MMFF94 via Chem3D 15.0 and ligands and protein channel complex were prepared in AutoDockTools 1.5.6. AutoDock Vina 4.0 software was used for blind docking; processing and verification of the obtained results was performed via Discovery Studio 4.0. Neural network was derived using descriptors for bile acids and their synthetic analogues and their already published activities on calcium-activated K+ channels in smooth muscle cells (ChemDraw Professional 15.0, Dragon 6 software).

RESULTS

Molecular docking was performed for: lithocholic acid, deoxycholic acid, 5β-cholanoic acid, 3β-hydroxi-5β-cholanoic acid, henodeoxycholic acid, ursocholic acid and α-muricholic acid. Neural network model Multiple layer perceptron is derived, having 0.9259 training performances and 0.3673 test performances, training error 0.0073 and test error 0,1607. Model was tested for henodeoxycholic, ursocholic and α-muricholic acid, and internal validation of the model is performed.

CONCLUSIONS

Molecular docking suggested that the pharmacophore for maximizing the activity of BK(Ca) channels in the steroid skeleton of bile acids is the C3 quasi-axial α-OH group and the C24 carboxyl function. Derived neural network model successfully predicted activities of tested bile acids on Ca2+ activated K+ channels in smooth muscle cells.

Lipids and Antiplatelet Therapy: Important Considerations and Future Perspectives

Lipids play an essential role in platelet functions. It is known that polyunsaturated fatty acids play a role in increasing platelet reactivity and that the prothrombotic phenotype plays a crucial role in the occurrence of major adverse cardiovascular events. The ongoing increase in cardiovascular diseases’ incidence emphasizes the importance of research linking lipids and platelet function. In particular, the rebound phenomenon that accompanies discontinuation of clopidogrel in patients receiving dual antiplatelet therapy has been associated with changes in the lipid profile. Our many years of research underline the importance of reduced HDL values for the risk of such a rebound effect and the occurrence of thromboembolic events. Lipids are otherwise a heterogeneous group of molecules, and their signaling molecules are not deposited but formed “on-demand” in the cell. On the other hand, exosomes transmit lipid signals between cells, and the profile of such changes can be monitored by lipidomics. Changes in the lipid profile are organ-specific and may indicate new drug action targets.

Authorship: From credit to accountability - Reflections from the Editors' network

The Editors' Network of the European Society of Cardiology (ESC) provides a dynamic forum for editorial discussions and endorses the recommendations of the International Committee of Medical Journal Editors (ICMJE) to improve the scientific quality of biomedical journals. Authorship confers credit and important academic rewards. Recently, however, the ICMJE emphasized that authorship also requires responsibility and accountability. These issues are now covered by the new -(fourth) criterion for authorship. Authors should agree to be accountable and ensure that questions regarding the accuracy and integrity of the entire work will be appropriately addressed. This review discusses the implications of this paradigm shift on authorship requirements with the aim of increasing awareness on good scientific and editorial practices.

Authorship: From credit to accountability - Reflections from the Editors' network

The Editors' Network of the European Society of Cardiology (ESC) provides a dynamic forum for editorial discussions and endorses the recommendations of the International Committee of Medical Journal Editors (ICMJE) to improve the scientific quality of biomedical journals. Authorship confers credit and important academic rewards. Recently, however, the ICMJE emphasized that authorship also requires responsibility and accountability. These issues are now covered by the new -(fourth) criterion for authorship. Authors should agree to be accountable and ensure that questions regarding the accuracy and integrity of the entire work will be appropriately addressed. This review discusses the implications of this paradigm shift on authorship requirements with the aim of increasing awareness on good scientific and editorial practices.

Authorship: from credit to accountability. Reflections from the Editors' Network

The Editors' Network of the European Society of Cardiology provides a dynamic forum for editorial discussions and endorses the recommendations of the International Committee of Medical Journal Editors (ICMJE) to improve the scientific quality of biomedical journals. Authorship confers credit and important academic rewards. Recently, however, the ICMJE emphasized that authorship also requires responsibility and accountability. These issues are now covered by the new (fourth) criterion for authorship. Authors should agree to be accountable and ensure that questions regarding the accuracy and integrity of the entire work will be appropriately addressed. This review discusses the implications of this paradigm shift on authorship requirements with the aim of increasing awareness on good scientific and editorial practices.

Authorship: From Credit to Accountability Reflections From the Editors´ Network

The Editors´ Network of the European Society of Cardiology (ESC) provides a dynamic forum for editorial discussions and endorses the recommendations of the International Committee of Medical Journal Editors (ICMJE) to improve the scientific quality of biomedical journals. Authorship confers credit and important academic rewards. Recently, however, the ICMJE emphasized that authorship also requires responsibility and accountability. These issues are now covered by the new (fourth) criterion for authorship. Authors should agree to be accountable and ensure that questions regarding the accuracy and integrity of the entire work will be appropriately addressed. This review discusses the implications of this paradigm shift on authorship requirements with the aim of increasing awareness on good scientific and editorial practices.

Iatrogenic dissection of the left main coronary artery during elective diagnostic procedures--A report on three cases

INTRODUCTION. Left main coronary artery dissection is a rare and potentially life-threatening complication of coronary angiography and angioplasty which requests urgent revascularization.

CASE REPORT

During the period between 2010 and November 2014 at single healthcare center we did totally 8,884 coronary procedures, out of which 2333 were percutaneous coronary interventions (PCI). In this period we had a total of 3 (0.03%) left main coronary artery dissections, and all of them were successfully treated by PCI. We presented three cases with iatrogenic dissection of the left main coronary artery, occurred during elective diagnostic procedures, successfully treated with PCI with different techniques.

CONCLUSION

PCI could be fast and life-saving approach in iatrogenic dissections of the left main coronary artery.

Clinical experience in treatment of thrombotic thrombocytopenic purpura--hemolytic uremic syndrome with 28 patients

BACKGROUND

Neither optimal treatment nor significance of ADAMTS13 (A Desintegrin And Metalloprotease with ThromboSpondin type 1 repeats) activity for diagnosis and therapy of thrombotic thrombocytopenic purpura (TTP) and hemolytic-uremic syndrome (HUS) have not been defined yet. The aim of the report is to analyze response to different volumes of plasma exchange (PE), and relationship to ADAMTS13.

DESIGN AND METHODS

28 patients clinically diagnosed with idiopathic TTP (n = 18), secondary TTP (n = 4), atypical HUS (n = 3) and typical HUS (n = 3) manifested 31 acute episodes. Patients were treated with PE in 26, and with plasma transfusion in 5 episodes with additional different therapies.

RESULTS

PE volumes were as follows: 1 in 7, 1.5 in 3, 2 in 14, and intensifying schedule (1 to 1.5) in 2 episodes. Procedure number was lower in patients treated with 2 and 1.5 (p = 0.019) than in those treated with 1 volume exchange and PE intensifying, respectively (p = 0.010). PE response rate was 25/26 (96.15%). Exacerbation frequency was higher in idiopathic TTP patients (3/19) treated with 1 compared with patients treated with > 1 volume exchange (p = 0.003). Survival rate was 25/28 (89.29%). ADAMTS13 activity was reduced in 22 with severe deficiency in 14 patients.

CONCLUSION

Patients responded to different treatments regardless of ADAMTS13 activity, requiring less PEs with larger volume exchanges.

Increased inflammatory response in patients with the first myocardial infarction and nonsignificant stenosis of infarct-related artery

INTRODUCTION/AIM

Atherosclerosis presents a serial of highly specific cellular and molecular responses, and could be described as inflammatory diseases. Accordingly, for development of acute myocardial infarction (AMI), structure and vulnerability of atherosclerotic plaque are more important than the extent of stenosis of infarct-related artery. Consequently, inflammation and atherosclerosis and its complications are in good correlation. C-reactive protein (CRP) as nonspecific inflammatory marker, has prognostic significance in coronary artery diseases. The aim of this study was to establish the correlation between inflammatory response expressed as levels of CRP and fibrinogen in serum and extent of coronary artery stenosis.

METHODS

Study included 35 patients with acute myocardial infarction, as the first manifestation of coronary artery disease, which were treated with thrombolytic therapy according to the guidelines. All the patient had a reperfusion. The patients with acute or chronic inflammatory diseases, an increased value of sedimentation, fibrinogen, CK > or = 190 U/L, early and late complications of AMI were excluded. CRP was measured on admission, after 24, 48 and 72 hrs, and 21 days latter, while fibriogen only on admission.

RESULTS

All the patients underwent coronary angiography, and were divided into two groups: the group 1 (23 patients), with significant stenosis of infarct-related artery (stenosis > or = 75%), and the group 2 (13 patients) without significant stenosis (< 75%). Mean value of CRP serum level on admission in the group 1 was 4.4 mg/L, and in the group 2 7.2 mg/L (p < 0.001). The mean value of fibrinogen on admission in the group 1 was 2.7 g/L, and in the group 2 3.0 g/L (p < 0.001). The mean CRP value after 48 hrs in the group 1 was 21.7 mg/L, and in the group 2 42.4 mg/L. (p < 0.001). After three weeks, the mean CRP value was 4 mg/L in the group 1 and 5.5 mg/L in the group 2 (p < 0.001). There was no significant difference between the groups 1 and 2 related to gender, age, localization of AMI, CK, EF value, and risk factors for coronary artery disease.

CONCLUSION

The patients with nonsignificant stenosis of infarct-related artery had increased inflammtory responses according to the CRP value, as a result of inflammatory process in atherosclerotic plaque and/or enhanced individual reactivity.

Histochemical and immunohistochemical analyses of the myocardial scar fallowing acute myocardial infarction

BACKGROUND/AIM

The heart has traditionally been considered as a static organ without capacity of regeneration after trauma. Currently, the more and more often asked question is whether the heart has any intrinsic capacities to regenerate myocytes after myocardial infarction. The aim of this study was to present the existence of the preserved muscle fibers in the myocardial scar following myocardial infarction as well as the presence of numerous cells of various size and form that differently reacted to the used immunohistochemical antibodies.

METHODS

Histological, histochemical and immunohistochemical analyses of myocardial sections taken from 177 patients who had died of acute myocardial infarction and had the myocardial scar following myocardial infarction, were carried out. More sections taken both from the site of acute infarction and scar were examined by the following methods: hematoxylin-eosin (HE), periodic acid schiff (PAS), PAS-diastasis, Masson trichrom, Malory, van Gieson, vimentin, desmin, myosin, myoglobin, alpha actin, smoth muscle actin (SMA), p53, leukocyte common antigen (LCA), proliferating cell nuclear antigen (PCNA), Ki-67, actin HHF35, CD34, CD31, CD45, CD45Ro, CD8, CD20.

RESULTS

In all sections taken from the scar region, larger or smaller islets of the preserved muscle fibers with the signs of hypertrophy were found. In the scar, a large number of cells of various size and form: spindle, oval, elongated with abundant cytoplasm, small with one nucleus and cells with scanty cytoplasm, were found. The present cells differently reacted to histochemical and immunohistochemical methods. Large oval cells showed negative reaction to lymphocytic and leukocytic markers, and positive to alpha actin, actin HHF35, Ki-67, myosin, myoglobin and desmin. Elongated cells were also positive to those markers. Small mononuclear cells showed positive reaction to lymphocytic markers. Endothelial and smooth muscle cells in the blood vessel walls were positive to CD34 and CD31, and smooth muscle cells to SMA. Oval and elongated cells were positive to PCNA and Ki-67. The preserved muscle fibers in the scar were positive to myosin, myoglobin and desmin as well as elongated and oval cells. Other cells were negative to these markers.

CONCLUSION

Our findings speak that myocardial regeneration is maybe possible and develops in human ischemic heart damages and that the myocardium is not a static organ without capacity of cell regeneration.

[Impact of heart myxoma localization upon its clinical course and outcome]

INTRODUCTION

Primary heart tumors are very rare. They can be benign and malignant. Benign ones make about two thirds of all heart tumors. However, they are benign only by their biologic characteristics, but potentially malignant by their localization. About three forths of benign tumors are myxomas. Their growth is usually slow and they can be for a long time silent, particularly if they do not compromise vital functional parts of the heart. Myxomas grow in the atria, mostly in the left one and very rarely in the ventricles.

CASE REPORT

We presented two patients with myxomas in the left, and, in the right atrium which are representative samples of the most common localization of heart myxoma considering previous knowledge of these tumors. Analysis of the clinical course in the two presented patients with characteristic localizations showed general characteristics of the clinical course of heart myxoma. The patients did not have characteristic symptoms for a rather long period of time and the findings obtained by standard examinations did not raise suspicion of heart tumor. Pulmonary symptomatology in one patient and cardial in the other, when tumor had already occupied almost the entire atrium, suggested necessity of cardiologic examination. Indication for operation was in both patients confirmed after performed echocardiography, computed tomography of the thorax and angiography with ventriculography. The size of the removed atrial tumors and their localization explained some of the patients' troubles, but it was also amazing that they had not caused more serious problems. Operation as the only method of treatment was successful in both female patients and its effect was permanent. At annual controls neither recurrence of the tumor nor troubles possibly associated with it were observed.

CONCLUSION

Patients with heart myxoma usually pass through asymptomatic or oligosymptomatic phase, but when troubles become manifested, they do not much differ from those due to other causes. For this reason this tumor can be diagnosed just when complications caused by its localization and growth develop. Modern cardiologic diagnostics, primarily preventive non-invasive echocardiography, enables timely diagnosis and removal of the tumor because only then it may take a name benign tumor.

Neonatal screening of hearing function by otoacustic emissions--a single center experience

BACKGROUND/AIM

Nowadays development of techniques enables detection of hearing impairment in a very short time, immediately after birth by using otoacoustic emissions. They are low-pitched sounds produced in physiologically clear cochlea and can be recorded in cochlear outer meatus. By this method, complete data are found on a whole presynaptic auditory nervous system functioning that has mostly been affected by pathological changes making it a perfect screening test. Reliability and sensibility of this method is up to 98%. The aim of this study was to present the first results of systematic neonatal screening of hearing function by otoacoustic emissions in the Clinical Center Kragujevac (Kragujevac, Serbia).

METHODS

This prospective study of neonatal hearing screening function, initiated systematically by the 2008 at the Clinical Center Kragujevac, included full-term newborns and premature born ones, within the first 24 h after birth, using a DPOAEs interacoustics otoread-screener. Retesting was done after a month.

RESULTS

From January 1st, 2009 to December 1st, 2010, a total number of examined infants by this method was 1,994 out of which 1,778 were full-term and 216 were premature born. The test passing was higher in the group of full-term babies (92.5%) than in the preterm ones (55.1%). No bilateral answers were recorded in premature born children compared to the full-term ones, of whom a larger number was with missing lateral responses. The results of re-examination test in the group of full-term born and premature newborns were 83.7%, and 61%, respectively.

CONCLUSION

Deliberately provoked transient otoacoustic emission is an efficient method in testing hearing function in newborns, since it is non-invasive, rapid and objective. Its correlation with audibly evoked potentials is very high, which confirms its reliability.

Tumor necrosis factor-alfa and interleukin-4 in cerbrospinal fluid and plasma in different clinical forms of multiple sclerosis

BACKGROUND/AIM

Multiple sclerosis (MS) is an immune-mediated central nervous system disease characterized by inflammation, demyelination and axonal degeneration. Cytokines are proven mediators of immunological process in MS. The aim of this study was to investigate whether there is a difference in the production of the tumor necrosis factor alpha (TNF-alpha) and interleukin-4 (IL-4) in cerebrospinal fluid (CSF) and plasma in the MS patients and the controls (other neurological non-inflammatory diseases) and to determine a possible difference in these cytokines in plasma and CSF in different clinical forms of MS.

METHODS

This study involved 60 consecutive MS patients--48 patients with relapsing-remitting MS (RRMS) and 12 patients with secondary progressive MS (SPMS). The control group consisted of 20, age and sex matched, non-immunological, neurological patients. According to the clinical presentation of MS at the time of this investigation, 34 (56.7%) patients had relapse (RRMS), 14 (23.3%) were in remission (RRMS), while the rest of the patients, 12 (20.0%), were SPMS. TNF-alpha and IL-4 concentrations were measured in the same time in CSF and plasma in the MS patients and the controls. Extended disability status score (EDSS), albumin ratio and IgG index were determined in all MS patients.

RESULTS

The MS patients had significantly higher CSF and plasma levels of TNF-alpha than the controls (p < 0.001 for both samples). IL-4 CSF levels were significantly lower in the MS patients than in the controls (p < 0.001), however plasma levels were similar. The patients in relapse (RRMS) and with progressive disease (SPMS) had higher concentrations of CSF TNF-alpha levels than the patients in remission (p < 0.001). IL-4 CSF levels in relapse (RRMS) and SPMS groups were lower than in the patients in remission. The patients in remission had an unmeasurable plasma TNF-alpha level and the patients with SPMS had significantly lower IL-4 levels in plasma than the patients in relapse and remission (p < 0.001). The only significant correlation between cytokine level with either EDSS, or albumin ratio, or IgG index, was found between CSF TNF-alpha levels and albumin ratio in the patients with relapse (R square = 0.431, p < 0.001).

CONCLUSION

According to the obtained data MS relapse was characterized by high concentrations of TNF-alpha in CSF and plasma and low concentrations of IL-4 in CSF. Remission was characterized by high concentrations of IL-4 and low concentrations of TNF-alpha both in CSF and plasma. SPMS was characterized with lower concentrations of TNF-alpha and IL-4 compared to relapse, both in CSF and plasma.

Successful retrieval of an unexpanded coronary stent from the left main coronary artery during primary percutaneous coronary intervention

INTRODUCTION

Dislodgement and embolization of the new generation of coronary stents before their deployment are rare but could constitute a very serious complication.

CASE OUTLINE

We report a case of a stent dislodgement into the left main coronary artery during the primary coronary intervention of infarct related left circumflex artery in a patient with acute myocardial infarction. The dislodged and unexpanded bare-metal stent FlexMaster 3.0x19 mm (Abbot Vascular) was stranded and bended in the left main coronary artery (LMCA), probably by the tip of the guiding catheter, but stayed over the guidewire. It was successfully retrieved using a low-profile Ryujin 1.25x15 balloon catheter (Terumo) that was passed through the stent, inflated and then pulled back into the guiding catheter. After that, the whole system was withdrawn through the 6 F arterial sheath via the transfemoral approach. After repeated cannulation via the 6F arterial sheath, additional BMW and ATW guidewires were introduced into the posterolateral and obtuse marginal branches and a bare-metal stent Driver (Medtronic Cardiovascular Inc) 3.0x18 mm was implanted in the target lesion.

CONCLUSION

Stent dislodgement is a rare but potentially life-threatening complication of the percutaneous coronary intervention. This incident occurring in the LMCA in particular during an acute myocardial infarction requires to be urgently resolved. The avoidance of rough manipulation with the guiding catheter and delivery system may help in preventing this kind of complications.

[Urgent percutaneous coronary intervention leads to a decrease in serum concentrations of soluble CD40 ligand]

BACKGROUND/AIM

Inflammation as a consequence of vascular injury after percutaneous coronary intervention (PCI) is a pathological substrate of restenosis and of its complications. The aim of the study was to examine perprocedural inflammatory response expressed by soluble CD40 ligand (sCD40L) and C-reactive protein (CRP) in patients treated with PCI and dual antiplatelet therapy.

METHODS

The experimental group included 52 patients (80.8% men, age 60 +/- 9 years) with angina pectoris treated by PCI (22 urgent PCI) with stent implantation, and dual antiplatelet therapy (tienopiridins and aspirin), according to the current recommendations for the execution of the intervention. The control group consisted of 8 patients (70.5% men, age 59 +/- 7 years) with angina pectoris, who had undergone coronarography taking aspirin 3 days prior to it. In all the patients 24 hours before and after the PCI concentrations of CRP and sCD40L in the blood were determined.

RESULTS

In the experimental group, the concentration of sCD40L was lower as compared to the control (p < 0.02). In 34 (65%) patients postprocedural decrease in sCD40L was recorded, in 18 (34.6%) of them increase, while in 50 (96%) patients there was a rise in CRP. The patients with postprocedural fall in sCD40L hod greater preprocedural concentration of sCD40L (p < 0.001), and less postprocedural concentration of sCD40L (p < 0.001), compared to the group with an increase in sCD40L after the PCI, while CRP levels between these groups were not statistically different. Patients treated with emergency PCI compared to elective patients had a postprocedural decrease in sCD40L (p = 0.02). Increase in the level of CRP was higher in the group with emergency PCI in relation to elective PCI (p < 0.01).

CONCLUSION

Emergency PCI procedures in the treatment of patients with unstable angina pectoris lead to a postprocedural fall in the serum concentration of sCD40L. Dual antiplate therapy with tienopiridins and aspirin inhibits the release of sCD40L. Regardless a clinical presentation of coronary disease PCI leads to an postprocedural increase in concentrations of CRP in the serum.

[Correlation between neurological finding and gestational maturity of newborns determined by neurosonography]

INTRODUCTION

Maturity is a complex functional condition influenced especially by the development of the vital functions of a fetus, primarily by the degree of the development of its central nervous system. The aim of this investigation was to establish the gestational maturity of the nervous system by neurosonography and neurological status.

MATERIAL AND METHODS

The parameter of the neurological maturity, compared in this research are a neurological status and the degree of girification established by the ultrasound.

RESULTS

All the coefficients of correlation between the gestation age determined by the ultrasound and the establishing of the gestation based on the neurological findings show a statistically significant correlation for p < 0.01. Of particular parametres of the neurological evaluation , the most appropriate ones appeared to be reflexes (the reflex of crossed extension, Moro reflex and the reflex of the main points), then volar flexion of a hand and the poplietal corner as the indicator of the passive tonus, whereas within the area of the evaluation of the active tonus, the motility was the most valid for establishing the maturity of a neonatal. The lowest coefficients of the correlations were in the automatic walk and the active tonus of the neck flexor, which are the ones of the most common neurological indicators of hypoxic ischemic encephalopathy of a neonatal.

CONCLUSIONS

Bearing in mind that the premature babies are a risky group for existence of perinatal brain damages, we believe the neurosonographic establishing of the gestation age to be a precise and comfortable indicator of the maturity of the nervous system.

Diagnostic value of biohumoral markers of necrosis and inflammation in patients with right ventricular myocardial infarction

INTRODUCTION/AIM

Patients with right ventricular myocardial infarction (RVMI) and patients with left ventricular myocardial infarction (LVMI) of the anterior wall with ST-elevation (STEMI), due to the profundity and volume of the necrosis, tend to have a more severe and more complicated clinical outcome as well as a higher mortality level compared to patients with myocardial infarction of inferoposterior localization in the left ventricle (IPILK), without the right ventricle being overtaken. C-Reactive protein (CRP) is a sensitive and reliable indicator of acute inflammation and is in good correlation with creatin kinasis (CK) or the enzymes which indicate necrosis markers in acute myocardial infarction (AIM). Because of this, a common biohumoral answer is of greater importance and more reliable both diagnostically and prognostically; it signifies a more severe and more complicated clinical outcome, especially on the rupture of the myocardium. The main goal of this study was to compare the maximum values of enzymes and CRP in patients with RVMI and LVMI who had first STEMI and who were in the acute phase treated with percutaneous transluminal coronary angioplasty (PTCA).

METHODS

During a six-year period (2000-05), in the Clinic for Urgent Internal Medicine at the Military Medical Academy, a total of 74 patients included in a prospective study were divided into two groups. The first group consisted of patients with RMI 19 (25.67%), and the second group of patients with LMI 55 (74.33%). The patients in both groups received a percutaneous coronary intervention (PCI), if they had been admitted in the first 4 hrs from the beginning of the chest pain, and if there were no contraindications. All the others received thrombolitic therapy, and a "rescue" PCI if needed, in the next 24-48 hours. The risk factors, clinical outcome, necrosis and inflammation biomarkers (enzymes and CRP), coronary status, restenosis of stent, and intra-hospital mortality rate in the first month, as well as a long term prognosis over a period of one year, were analysed.

RESULTS

The average age of the patients in the group with RVMI 19 (7 m + 12 f) was 66.1 +/- 11y, and in the group with LVMI 55 (45 m + 10 f) 59.6 +/-13y, with a statistical trend which indicated that the patients with RVMI were older (66.1 +/- 11y vs. 59.6 +/- 13y, p < 0.061) and that women dominated (63.1% vs. 18.8%, p < 0.001). No statistical differences were found between the two groups of patients concerning the length and the appearance of the chest pain before admission to the hospital and the beginning of the PCI treatment, as well as risk factors such as smoking, cholesterol or diabetes. Of the total of 74 patients with the first STEMI as a primary manifestation of a coronary disease, we performed a primary PCI on 58 (78.37%), and a "rescue" PCI on 16 (21.63%) after the thrombolitic therapy during the 24-48h after admission. We had no cases of death either during the primary or the delayed PCI, or in the next 24h following the intervention. During the hospital phase of treatment, in the group with RMI the causes of death were the rupture of the free wall of the right ventricle (1), acute pancreatitis (1), ARDS and hypostatic pneumonia (1), cerebrovascular insult (1). During the following year, one more patient died due to reinfarction of the anterior localization. In the group with LMI, during the hospital phase of treatment 5 (9.09%) patients died: reinfarction (2), rupture of the left ventricle (1), respiratory insufficiency and severe hypostatic pneumonia (1), cerebrovascular insult (1). During the following year, 4 more patients died, sudden death (2), ischemic dilatative cardiomyopathy (2). The total mortality rate over a one-year period of observation in the group with LMI was 9 (16.3%), and in the group with RMI 5 (26.3%). Radionuclide ventriculography (RNV) was performed in the acute phase of myocardial infarction from 7-14 days after PCI and after 6 months in both groups as an independent indicator of the ejection fraction (EF) of both ventricles. The given results show that a statistically proven significant difference exists in the recovery of the right ventricle in acute phase RMI (49.1 +/- 7.9 vs. 35.4 +/- 10, p< 0.001), as well as after 6 months (49.2 +/- 9.7 vs. 38.3 +/- 11.2, p < 0.010) in patients with RMI.

CONCLUSION

Primary PCI should be done whenever it is possible with all patients who have a great volume and depth of necrosis, especially if that is the first manifestation of a coronary disease and the first acute STEMI, as were all of our patients in both groups. Our results show that older patients with RMI, and dominantly women, have a more severe and more complicated clinical outcome in the acute phase of RMI compared to patients with LMI of the anterior wall. In the longer prognosis of this case, they have a quicker and a more complete recovery of the right ventricle due to which they have a better immediate and long term prognosis, but demand careful overseeing and energetic treatment in the acute phase of the myocardial infarction, especially considering that their treatment is often specific compared to patients with an infarction of the left ventricle.

[Brain abscesses in neonates: neurosonographic diagnosis and long-term follow-up]

Brain abscesses were neurosongraphically diagnosed in 3 out of 44 neonates who had confirmed purulent meningitis. In two cases, the cause was Proteus mirabillis, whereas in one the cause could not be isolated. The ultrasound finding indicated abscess cavities localised in the frontal (in one case bilaterally) and temporal regions of the CNS. Neurosurgical interventions were carried out on all of the neonates who had abscesses (including the evacuation of purulent cavity contents, and later on a ventriculoperitoneal shunt in two cases, because of the development of hydrocephalus). Follow-up on the operated infants revealed that one infant died at the age of 9 months; one, who had a bilateral abscess, demonstrated significant neurodevelopmental retardation in the third month of his life (so far it has not been brought under control); while the third one, whom we monitored until the age of 2, displayed regular psychomotor development (preserved intellect, motor skills, sight, and hearing).

[Rotavirus gastroenteritis]

Rotavirus is the main etiological agent that causes severe diarrheal diseases in newborns and young children up to two years. Every year, about one million children around the globe die of dehydration caused by Rotaviruses. The problem is even bigger in underdeveloped and developing countries. The results of our 18-month research, in the town Kragujevac and its surrounding area from December 1998 to May 2000 indicate that viruses are an important factor in the etiology of the acute diarrheal diseases in our population. In 124 children, aged 0 to 5, with the acute diarrheal diseases treated at the Pediatric clinic HMC "Kragujevac", viruses were the causes in 27% of the time. The Rotavirus belongs to the family Reoviridae. The infections caused by rotaviruses may be detected around the world. The incidence rate is higher in developed countries. The infection is transmitted orally. The entry of the Rotavirus infection is the upper part of the small intestine. The clinical picture is specific. The disease usually lasts four to seven days. The fastest diagnostic method is direct detection of viruses using the electronic microscope. The agglutination tests ELISA and LATEX are used for the examination of numerous samples. Only symptomatic treatment is required. High morbidity and mortality rates in developing countries are the reason to prevent the Rotavirus disease by active immunization.

Monitoring of neurological parameters in newborns with hypoxic-ischemic encephalopathy

Asphyxia i a condition caused by lack of oxygen in tissues and organs. The basic pathogenic mechanisms of asphyxia are: 1)hypoxemia, 2) ischemia. The effects of perinatal asphyxia on the brain of a neonatal baby are critical in development of hypoxic-ischemic encephalopathy. The diagnosis of hypoxic-ischemic encephalopathy is based on clinical data including course of pregnancy and delivery (Apgar score) and especially on the neurological status of the newborn (consciousness, tonus, convulsions, reflexes, vegetative functions, etc.) and it can be confirmed by biochemical analysis and neurological examinations. The aim of this paper is to determine the importance of prenatal and perinatal risk factors for hypoxic-ischemic encephalopathy, as well as their effects on the development of neurological complications and further neurological problems. The research included 148 newborn infants born in the period from January 1, 1996 to January 1, 1999, with gestational age of 27 to 42 weeks, with hypoxic ischemic lesions of the central nervosus system. The control group included 58 children of the same age and the same gestation, with generalized hypotonia ("floppy infant") but without any signs of hypoxic ischemic lesions of the central nervous system. In the group of examined newborn infants with hypoxic ischemic lesions, from 149 children 1 (0.67%) died, 87 (53.89%) had normal findings, whereas the handicap was established in 61 (40.94%). Perinatal asphyxia affects the fetus and newborn infants not by individual factors, but with at least three or four associated factors. The disorders caused by asphyxia are in inverse proportion to the duration and intensity of hypoxic insults and the gestational age of the newborn. .

Molecular epidemiology of rotaviruses in preschool children

Numerous epidemiological studies, conducted in both developed and developing countries, have shown that the rotavirus is an important aetiological agent in severe diarrhoeal diseases among preschool children. In recent years, different biochemical techniques for the genetic and phenotypic analysis of rotaviruses have been developed. The aim of this study was to define the biological and genetic differences among rotaviruses isolated from the faeces of affected children, by using the Polyacrylamide Gel Electrophoresis technique, as well as to type the viruses and establish the number of strains circulating within our population. In total, 124 faeces samples from children up to 5 years of age were analysed. With the use of the ELISA test, rotaviruses were isolated in 10.3% of cases. The extraction of viral RNA was carried out directly from the faeces samples, which was followed by electrophoresis, and finally observation using a UV lamp, and documentation with a photo camera. The analysis of viral RNA, using Polyacrylamide Gel Electrophoresis (PAGE), revealed equal mobility in all segments of the genome. The results of our analysis demonstrated that the same strains of rotaviruses do circulate within our population. Such a result can be explained as a consequence of our years-long isolation as well as of the decreased mobility of our population. However, the results do not signify that the rotavirus genome in this region will not be susceptible to variations and that, consequently, new strains will not be created.

Autologous bone marrow-derived progenitor cell transplantation for myocardial regeneration after acute infarction

Background. Experimental and first clinical studies suggest that the transplantation of bone marrow derived, or circulating blood progenitor cells, may beneficially affect postinfarction remodelling processes after acute myocardial infarction. Aim. This pilot trial reports investigation of safety and feasibility of autologous bone marrow-derived progenitor cell therapy for faster regeneration of the myocardium after infarction. Methods and results. Four male patients (age range 47-68 years) with the first extensive anterior, ST elevation, acute myocardial infarction (AMI), were treated by primary angioplasty. Bone marrow mononuclear cells were administered by intracoronary infusion 3-5 days after the infarction. Bone marrow was harvested by multiple aspirations from posterior cristae iliacae under general anesthesia, and under aseptic conditions. After that, cells were filtered through stainless steel mesh, centrifuged and resuspended in serum-free culture medium, and 3 hours later infused through the catheter into the infarct-related artery in 8 equal boluses of 20 ml. Myocardial viability in the infarcted area was confirmed by dobutamin stress echocardiography testing and single-photon emission computed tomography (SPECT) 10-14 days after infarction. One patient had early stent thrombosis immediately before cell transplantation, and was treated successfully with second angioplasty. Single average ECG revealed one positive finding at discharge, and 24-hour Holter ECG showed only isolated ventricular ectopic beats during the follow-up period. Early findings in two patients showed significant improvement of left ventricular systolic function 3 months after the infarction. There were no major cardiac events after the transplantation during further follow-up period (30-120 days after infarction). Control SPECT for the detection of ischemia showed significant improvement in myocardial perfusion in two patients 4 months after the infarction. Echocardiographic assessment in these two patients also showed significant improvement of systolic function three months after the infarction. Conclusion. Preliminary results of the study showed that the transplantation of bone marrow-derived progenitor cells into the infarcted area was safe, and feasible, and might improve myocardial function. Further follow-up will show if this treatment is effective in preventing negative remodeling of the left ventricle and reveal potential late adverse events (arrhythmogenicity and propensity for restenosis).

[Statins and cerebral ischemia]

<zakljucak> CVB su vodeci uzrok invalidnosti u svetu, drugi uzrok mortaliteta u nerazvijenim zemljama (na trecem mestu u razvijenim zemljama), a jedna trecina bolesnika umire unutar prvih 6 meseci od razbolevanja (95, 96). Ovo su zvanicni podaci Svetske zdravstvene organizacije, a statistika je otisla korak dalje i pokazala da u SAD svake 53. sekunde jedan covek oboli od CVB (97). Mozda bi pricu o statinima i IBM trebalo zavrsiti ovim izrazito nepovoljnim epidemioloskim podacima vezanim za CVB, koji naglasavaju znacaj iznalazenja adekvatne terapije koja bi smanjila rizik obolevanja (98), kao i ogromne troskove vezane za lecenje i posledicnu invalidnost. Aspirin dovodi do redukcije vaskularnog mortaliteta i morbiditeta vezanog za CVB od 13% klopidogrel do 22% (99), a statini nezavisno od upotrebe drugih lekova ukljucujuci i aspirin, do 30%. Imajuci u vidu sve ove izrazito dobre rezultate lecenja statinima, uz dozu rezervisanosti vezanu za eventualne udaljene efekte ove terapije, nema sumnje da se radi o lekovima koji ce uticati na promenu celokupnog pristupa lecenju bolesnika sa rizikom od IBM.

[Fibrinogen as a risk factor in ischemic heart disease]

<zakljucak> Mesto fibrinogena u razvoju ateroskleroze i arterijske tromboze je verovatno znacajno jer on ucestvuje i u procesu nastanka i rasta plaka modulise hemoreoloske osobine krvi, a cini i osnovu koaguluma tokom procesa tromboze. Koncentracija fibrinogena u krvi je dobar nezavisan prognosticki parametar za razvoj akutnog infarkta miokarda, kako kod zdravih odraslih osoba, tako i kod koronarnih bolesnika. Nivo fibrinogena u krvi je delimicno genetski determinisan, ali i brojni faktori spoljasnje sredine uticu na njegov nivo. Vrlo je bitan odnos izmedju fibrinogena i nekih drugih vaznih faktora rizika. Fibrinogen i holesterol imaju izgleda sinergisticki ucinak na razvoj akutnog koronarnog sindroma. Moguce je da je fibrinogen jedna od najznacajnijih spona izmedju pusenja i koronarne bolesti. Veoma je mali broj lekova koji se mogu dugorocno primenjivati i smanjiti nivo fibrinogena u krvi, tako da za sada ne postoje klinicke studije o vrednosti ovakve terapije u lecenju i prevenciji akutnih koronarnih sindroma. Shodno tome sve dok se ne dokaze da se smanjenjem nivoa fibrinogena u krvi smanjuje rizik za ispoljavanje koronarne bolesti, njegova uloga kao faktora rizika ostaje nedovoljno definisana.

[Aortic valve stenosis]

There is a long latent period in the clinical course of aortic valve stenosis in adults. Symptoms usually occur in the case of critical stenosis, when aortic orifice area is under 0.7 cm2 (0.4 cm2/m2). In this study 78 patients with critical aortic valve stenosis were investigated. The first manifestation of the disease was dyspnea (78.2%), angina (52.5%), less often a syncope (34.6%), while 17.9% of patients were asymptomatic. Left ventricular systolic function was preserved in 77% of patients, while left ventricular dyastolic dysfunction occurred in almost all the patients. In 42 patients (53.4%) aortic valve replacement was performed. Left ventricular systolic function improved in 88.1% of patients postoperativelly, as well as in patients with preoperatively preserved or poor systolic function. Recovery was fast particularly during the first 6 postoperative months. After the surgery the improvement of the left ventricular dyastolic function was slower then systolic, particularly in patients with extreme hypertrophy of myocardium in whom the process of recovery might last several years.

Primary percutaneous transluminal coronary angioplasty in the acute infarction of the right ventricle

BACKGROUND

Predilection site for the acute myocardial infarction of the right ventricle, (AMI-RV) is the upper third of the right coronary artery and for this reason such an infarction is followed by numerous complications, primarily by conduction disorders and very often by sudden and rapid cardiogenic shock development.

METHODS

Primary percutaneous transluminal coronary angioplasty (PPTCA) was performed on three patients, in whom the acute infarction of the right ventricular was diagnosed and who had been hospitalized six hours after the beginning of chest pain. In all three patients intracoronary stent was implanted. On the admission patients had been in the threatening cardiogenic shock, with the prominent chest pain and with the elevation of ST-segment in V4R > 2 mV. In the course of intervention patients were administered low-molecular intracoronary heparin, with direct platelet glycoprotein IIb/IIIa inhibitors (abciximab), according to the established procedure applied in such cases.

RESULTS

The complete dilatation of the infarcted artery was established with the signs of reperfusion and the further clinical course was completely normal, there was no heart failure and patients had no subjective difficulties.

CONCLUSION

Invasive approach in the treatment of AMI-RV is justifiable, and possibly the therapy of choice of these patients, providing well trained and equipped team is available.

[Relation between QT dispersion and reperfusion in acute myocardial infarct]

BACKGROUND

QT dispersion (QTd) represents the parameter of the expanded heterogeneity of myocard of ventricles. The aim of this study was to examine the dynamics of changes of QTd during the first 5 days of the acute myocardial infarction (AMI) in dependence to noninvasively estimated success of thrombolytic therapy.

METHODS

Thirty six patients with AMI were included in the study. All patients were treated with alteplaze according to rapid protocol. QTd (QTc max-QTc min) was measured immediately after the reception (0 min), after the thrombolytic therapy (90 min) and since the 2nd to the 5th day of the hospitalization. Reperfusion was estimated on the basis of electrocardiographic and biohumoral parameters.

RESULTS

In the group of 36 patients, 22 male and 11 female, both parameters of the reperfusion were not compatible in 3 patients. The other 23 patients had the reperfusion, while 10 patients did not have it. At the reception there was no significant difference of QTd between the group with reperfusion (79 +/- 34 ms) and the group without reperfusion (65 +/- 19 ms). After receiving alteplase, the average QTd in the group with reperfusion was 67 +/- 31 ms, which was not shorter in relation to the group without reperfusion (70 +/- 23 ms). Since the 2nd day of AMI, significantly smaller QTd in pa-patients with reperfusion was not registered compared with the patients without the reperfusion (54 +/- 17 vs. 73 +/- 20 ms), whereas since the 3rd day the difference became significant (46 +/- 16 vs. 87 +/- 24 ms). On the 4th day it was 43 +/- 12 vs. 78 +/- 21 ms, and on the 5th day it was 38 +/- 11 vs. 62 +/- 23 ms. On the 1st day significant difference of QTd between the groups with and without reperfusion was not registered in the group of patients with anterior AMI (0 min: 97 +/- 47 vs. 72 +/- 16; 90 min: 68 +/- 47 vs. 72 +/- 20) whereas on the 2nd day it became statistically significant (51 +/- 15 vs. 74 +/- 20 on the 2nd day, 51 +/- 20 vs. 88 +/- 24 on the 3rd day, 46 +/- 10 vs. 81 +/- 19 on the 4th day and 40 +/- 8 vs. 69 +/- 22 ms on the 5th day. In the group of patients with inferolateral AMI, only on the 3rd day significant difference of QTd between the group with and the group without reperfusion was registered (43 +/- 14 vs. 69 +/- 29 ms), while in all other measuring it was not registered (0 min: 69 +/- 22 vs. 42 +/- 9; 90 min: 67 +/- 20 vs. 67 +/- 41; 55 +/- 19 vs. 60 +/- 25 on the 2nd day; 41 +/- 14 vs. 51 +/- 6 on the 4th day and 51 +/- 12 vs. 37 +/- 8 ms on the 5th day).

CONCLUSION

Qt dispersion was of significantly shorter duration in patients with the successfully performed reperfusion in relation to the patients without the reperfusion. In patients with the anterior AMI, QTd was significantly different in patients with in relation to the patients without the reperfusion in distinction with the patients with inferolateral AMI.

Autologous pluripotent progenitor cells in the treatment of ischemic heart disease

<zakljucak> Studije na zivotinjama i prva klinicka iskustva na ljudima pokazuju da nakon primene progenitornih celija mioblasta ili poreklom iz kostne srzi dolazi do poboljsanja srcane funkcije. Pomenute metode jos nose sa sobom veoma veliki broj pitanja. Da li je zaista moguce regenerisati miokard ?nekim? novim mioblastima, za koje se ocekuje da se diferenciraju u patoloskim uslovima u plemenito visoko diferentovano, funkcionalno tkivo miokarda? Kada je u pitanju ishemijska bolest srca ne treba zaboraviti osnovni problem - koronarnu insuficijenciju, koja se samom kardiomioplastikom ne resava. Kombinacija revaskularizacionih procedura sa celijskom kardiomioplastikom je sine qua non za prezivljavanje i transplantovanih celija. Da li je veca debljina oziljka na miokardu i njegova elasticnost dovoljna korist da bi se ove celije transplantovale kod bolesnika sa teskim oziljnim promenama na srcu? Koji su bolesnici pravi kandidati za ovaj vid terapije, koji je optimalan broj mioblasta koji treba transplantovati i koji je najbolji nacin za transplantaciju? Ovo su samo neka od ozbiljnih pitanja na koje je sada tesko dati odgovor. Sa druge strane, transplantacija progenitornih celija iz kostne srzi ili njihova mobilizacija faktorima rasta u perifernu krv su metode za pospesivanje arteriogeneze i angiogeneze, koja moze biti veoma brza i efikasna u smislu spasavanja ugrozenog miokarda u akutnim koronarnim sindromima, a dovoljna u sprecavanju ishemije kod teskih hronicnih koronarnih bolesnika. Visednevna primena faktora rasta omogucava dugotrajnu mobilizaciju velikog broja progenitora mezenhimskih celija iz kostne srzi, tj. pospesuje proces koji se i inace dogadja pod uticajem ishemije i nekrozom potaknutane imunske reakcije. Medjutim, koje faktore rasta, kada i u kojoj dozi, treba dati za mobilizaciju endotelnih i mioblastnih progenitora? Da li neki od njih mogu da pospese reperfuziono ostecenje miokarda? Koliko dugo treba primenjivati takvu terapiju? Da li je treba dati samo bolesnicima sa no reflow fenomenom? Dakle, brojna su pitanja koja se namecu i kada je u pitanju ovaj vid celijske terapije. U svakom slucaju dosadasnja istrazivanja otvaraju nove puteve i potrebne su vece, dobro kontrolisane randomizovane studije koje ce lagano da odgovaraju na jedno po jedno od pomenutih pitanja! Kardiologija se spusta na novi nivo, nivo osnovnih bioloskih procesa, diferencijacije, regeneracije, gensku terapiju, terapiju koja je usmerena na razvijanje mikrocirkulacije. Kao i u svemu ranije, bice potrebno puno godina da osetimo korist od istine za kojom tragamo.

[Treatment of acute myocardial infarct with ST segment elevation with a combination of fibrinolytic therapy and abciximab]

BACKGROUND

According to current knowledge, the best way to treat the acute myocardial infarction with ST elevation is primary transluminal coronary angioplasty, which can be performed only in the best equipped tertiary cardiology centers. As it was known that atherothrombosis wais the essence of the acute coronary syndrome we wanted to examine the efficacy and safety of combined therapy of tissue plasminogen activator and glycoprotein IIbIIIa platelet receptor antagonist abciximab.

METHODS

The case is reported of combined abciximab and accelerate schedule of t-PA reperfusion therapy in a young patient with the extensive anterior acute myocardial infarction. Activated partial thromboplastin time and platelet count were regularly measured during therapy.

RESULTS

The combination of these two drugs did not cause any complication in our patient. According to early noninvasive parameters, successful reperfusion was achieved. Postinfarction period was without complications. Coronary angiography was performed 15 days after and was without pathological findings. Eighteen months later the event patient had neither chest pain, nor other complaints with slightly reduced R waves in middle precordial leads and hypokinesis of anterior apical segment of the left ventricle showing the signs of important systolic function impairment.

CONCLUSION

Controlled studies are needed to prove the safety and the benefit of such combined reperfusion therapy and to show which kind of treatment is appropriate in every case considering the patient conditions and the facilities of coronary care unit.

[Predictive value of changes in the hemostasis system in patients with ischemic brain diseases]

The aim of this research was to determine the importance of tracking the dynamics of changes of the hemostatic system factors (aggregation of thrombocytes, D-dimer, PAI-1, antithrombin III, protein C and protein S, factor VII and factor VIII, fibrin degradation products, euglobulin test and th activated partial thromboplastin time--aPTPV) in relation to the level of the severity of ischaemic brain disorders (IBD) and the level of neurological and functional deficiency in the beginning of IBD manifestation from 7 to 10 days, 19 to 21 day, and after 3 to 6 months. The research results confirmed significant predictive value of changes of hemostatic system with the predomination of procoagulant factors, together with the insufficiency of fibrinolisys. Concerning the IBD severity and it's outcome, the significant predictive value was shown in the higher levels of PAI-1 and the lower level of antithrombin III, and borderline significant value was shown in the accelerated aggregation of thrombocytes and the increased concentration of D-dimer. It could be concluded that the tracking of the dynamics of changes in parameters of hemostatic system proved to be an easily accessible method with the significant predictive value regarding the development of more severe. IBD cases and the outcome of the disease itself.

In vivo modulation of the splenocyte yield and composition by female sex steroid hormones

The study was designed to shed more light on the controversial role of the two main ovarian steroid hormones (i.e. estradiol and progesterone) in shaping the size and phenotypic characteristics of the splenic lymphocyte pool. For this purpose ovariectomized adult rats (OVX) were treated for 14 subsequent days with either estradiol or progesterone (to attain physiological concentrations of the hormones). Afterwards, the splenocyte yield, and overall number of splenocytes bearing TCR alpha beta receptor, CD4 and CD8 coreceptor were evaluated. Fourteen-day-long ovarian hormone deprivation produced an increase in the splenic weight and splenocyte yield (on the account of a rise in the number of TCR alpha beta- cells), although the number of TCR alpha beta+ cells was reduced as a result of a decrease in the size of the CD4+ cell subpopulation. Replacement of either estradiol or progesterone prevented the increase in splenic weight and reduced the splenocyte yield to values significantly lower than that in sham-OVX rats. Both the treatments completely abolished the effect of ovariectomy on the size of TCR alpha beta- cell population, but had differential effects on that of TCR alpha beta+ cell population; estradiol did not affect its size, while progesterone caused a reduction on the account of a decrease in the numbers of both CD4+ and CD8+ cells. The results suggest that: a) estradiol and progesterone have similar effects on the size of the splenic B cell population and that replacement of either estradiol or progesterone can prevent the effects of ovariectomy on the size of this population and b) estradiol does not affect while progesterone reduces the size of splenic T cell population. Thus, replacement of none of them is able to compensate the removal of gonads.

In vivo modulation of the distribution of thymocyte subsets by female sex steroid hormones

This study examined the effects of the principal ovarian steroids, 17 beta-estradiol (E) and progesterone (P), on the thymic structure and on the intrathymic development of T-cells. Adult female rats were ovariectomized (OVX) and treated for 14 days with physiological doses of either E or P; controls received an equivalent volume of vehicle. Ovariectomy produced a marked increase (vs. sham-operated controls) in thymus weight, which was associated with an increase in the volume and cellularity of both the medulla and cortex. Treatment of OVX rats with E reduced the thymic weight to value, which was significantly lower than that of sham-operated controls decreasing the volume of cortex below level in sham-OVX rats, and reversing the effect of ovariectomy on the volume of medulla. P only prevented the increases in thymus weight and cortical volume induced by OVX. However, unlike E, it had no discernable effect on the medullary volume. E treatment reduced the cellularity of the cortex and medulla to values, which were lower than those of sham-OVX rats, while P only reversed the effects of OVX on the cellularity of both the compartments. Ovariectomy also had a profound effect on the thymocyte profile, increasing the proportion of CD4+8+TCR alpha beta- cells and producing a corresponding decrease in the relative proportions of all TCR alpha beta high cell subsets. The decrease in the latter was opposed by treatment with E or P. However, the sensitivity of the less mature cells (except CD4-8-TCR alpha beta-, the percentage of which was reduced by both hormones) to the two hormones differed. E reduced the relative proportion of CD4-8+TCR alpha beta-, CD4-8+TCR alpha beta low and CD4+8+TCR alpha beta- cells, while P increased the percentage of CD4-8+TCR alpha beta low cells. The results suggest that E and P affect both the lymphoid and nonlymphoid compartments of the thymus, and that while P increases the volume of the nonlymphoid component of the medulla, E has the opposite effect. The finding that ovariectomy decreased while E and P increased the relative proportion of the most mature thymocytes, which include CD4-8-TCR alpha beta high cells that are believed to harbour potentially autoreactive cell clones, is particularly interesting and may relate to the high propensity of autoimmune diseases in females.

Lipid peroxidation intensity and lipid status parameters in the estimation of the severity of ischemic heart disease

Atherosclerotic changes on the coronary arteries are the basis of the ischemic heart disease. It is assumed that the initial changes in this process occur as a consequence of the lipid peroxidation in the vessel wall. We estimated this process through the level of malondialdehyde (MDA) in the serum of 86 patients in whom selective coronary angiography was done for the suspected ischemic heart disease. According to the number of the stenotic coronary arteries (stenosis greater than 50%), we divided the patients into four groups: the control group with normal coronary angiography finding, simple, double or triple vessel coronary disease. In all the patients we also estimated the other parameters of the lipid status (cholesterol, triglycerides, LDL, HDL, Apo-AI, Apo B) and atherogenic indices Apo-AI/Apo B, LDL/HDL and HDL/total cholesterol. No significant changes were observed in the lipid parameters between the control and experimental group. However, mean MDA level in the whole experimental group was 3.89 mumol/L, 3.93 mumol/L in triple vessel coronary disease, 3.83 mumol/L in double vessel and 3.92 mumol/L in single vessel disease group. The difference between all the experimental and the control group was highly significant (p < 0.001). We concluded that the level of MDA--lipid peroxidation index had the better correlation with the disease status than the other parameters of lipid status and the sensitive atherogenic indices.

Pituitary adenomas secreting large amounts of prolactin may give false low values in immunoradiometric assays. The hook effect

Immunoradiometric assay (IRMA) for serum prolactin (PRL) measurement can give falsely low values, leading to unnecessary surgery in patients with prolactinomas. We studied clinical and biochemical features of patients with pituitary macroprolactinomas in whom plasma PRL levels had been underestimated due to the so-called "high dose PRL hook effect". This phenomenon was observed in four (14.2%) out of 28 patients with pituitary macroadenomas (13 macroadenomas) and 15 non-functioning macroadenomas) reffer during one-year period. Undiluted median (range) PRL levels were 11.3 (3.0-48.7), 983.9 (194.4-1959.4), and 96.9 (66.6-147.7) micrograms/l in patients with non-functioning macroadenomas, macroprolactinomas and the hook effect adenomas, respectively. In all patients assay was performed after serum dilution, and only in patients with the hook effect the median PRL levels increased significantly to 5795.0 (2097.2-12722.2) micrograms/l. The mean age at diagnosis was 38 +/- 6.5, 45 +/- 6, and 53 +/- 3 yr, for the patients with the hook effect, macroprolactinoma and non-functioning adenoma, respectively. Males were predominant (75%) in the hook effect adenoma group. Patients with the hook effect macroprolactinomas were all treated successfully with dopamine agonists, and all patients had significant shrinkage of the tumor mass (more than 50% shrinkage). In conclusion, this study suggests that patients with high dose PRL hook effect are generally younger, more frequently males with very large pituitary adenomas (grade III-IV according to Hardy). It is necessary, whenever performing IRMA for serum prolactin measurement, to dilute samples routinely (1:1 and 1:10 dilutions) in every patient with pituitary tumor.