Piotr Luchowski

Monocyte chemoattractant protein (MCP-1) A-2518G gene polymorphism in stroke patients with different comorbidities

OBJECTIVES The aim of our study was to assess the effect of A-2518G polymorphism in the monocyte chemoattractant protein-1 gene on development of stroke. DESIGN AND METHODS A total of 194 patients with stroke and 320 healthy controls were genotyped for the MCP-1 gene -2518 polymorphism. RESULTS There was a significant difference in genotype frequencies between ischemic stroke patients and controls (p=0.01). Stroke patients were subdivided according to gender, presence of renal disease, small-vessel disease, diabetes, atherosclerosis and hyperlipidemia. There were differences in genotype frequencies between stroke patients with atherosclerosis and controls (p=0.03), and in allele frequencies between diabetic patients and controls (p=0.04). In hyperlipidemia, the OR 2.33 for the GG genotype may be due to stroke, because it was found only vs. controls and not vs. group without hyperlipidemia. CONCLUSIONS Our results demonstrate an association between the polymorphism in the regulatory region of MCP-1 gene and susceptibility to ischemic stroke.

B-type natriuretic peptide as a marker of subclinical heart injury during mitoxantrone therapy in MS patients—Preliminary study

The aim of this study was to evaluate the plasma level changes of B-type natriuretic peptide (BNP), biochemical marker of heart failure, and echocardiographic parameters during mitoxantrone treatment in 22 multiple sclerosis (MS) patients (8 males, 14 females, mean age 37.1+/-6.6). Mitoxantrone (after mean cumulative dose of 58.0+/-7.0 mg/m(2)) did not alter left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVEDD), posterior wall thickness (PWT) and left ventricular end-diastolic volume (LVEDV). However, mean plasma level of BNP raised from 14.53+/-3.29 pg/ml at the baseline to 16.79+/-3.05 pg/ml and 18.83+/-4.90 pg/ml (P<0.01) after mean mitoxantrone dose of 30.7+/-5.9 mg/m(2) and 58.0+/-7.0 mg/m(2), respectively. These results strongly suggest subclinical myocardial dysfunction in mitoxantrone-treated group. We assume, that low-cost, repeated BNP measurements may be a good alternative for detection of early subtle myocardial injury in MS patients during routine mitoxantrone therapy.

Unilateral progressive brain lesions confirmed as multiple sclerosis.

Multiple sclerosis (MS) often demonstrates highly variable clinical course and some heterogeneity in histopathology [1]. The diagnosis of MS is based on a classic history and symptoms and/or typical findings on magnetic resonance imaging (MRI). Newer MRI techniques, such as MR spectroscopy (MRS) promise to yield important information regarding MS recognition, prognosis, and treatment effects [2]. We report a case of MS confirmed by brain biopsy, that did not fulfill McDonald’s criteria [3]. Our patient at the age of 19 had her first episode of seizures (initially adverse, later on grand-mal epilepsy). Physical examination was normal, whilst neurologic examination demonstrated four-limb hyperreflexia, bilaterally presented Babinski’s sign and clonus. MRI revealed the presence of few T2 hyperintensities in the periventricular region, two lesions within the corpus callosum, as well as few cortical–subcortical lesions limited to the right hemisphere (Fig. 1a). Vasogenic brain lesion and symptomatic epilepsy was diagnosed. MRI scans, performed 6 months and 3 years later, revealed minimal or even no changes when compared with the previous one. At the age of 24, emotional disturbances were present (panic disorder, generalized anxiety disorder) and the patient was hospitalized in Psychiatric Department. One year later, the occurrence of seizures had increased and she started complaining of left limb weakness. At this time she was admitted to our Department. Neurologically, a slight upper left limb paresis with pyram-

Evaluation of seasonal changes of triterpenic acid contents in Viscum album from different host trees.

Abstract Context: Viscum album L. (Loranthaceae) is a semi-parasitic plant used in pharmacy and medicine mostly for its hypotensive and anticancer activity. The effects may be related to the presence of triterpenic acids, such as betulinic (BA) and oleanolic (OA) acids. Objectives: In our investigations the content of triterpenic acids in V. album from different host trees depending on the season of harvest was determined. Material and methods: V. album herb was dried and extracted with ethyl acetate using ultrasound energy. The reversed phase HPLC-PDA method was used for the analysis of triterpenic acids. The structure of the target components was confirmed by mass spectrometry with an electrospray ionization source. Results: Diversity in the content of both compounds was noted; however, OA was the dominant triterpenic acid and the amount thereof was ∼10 times higher than that of BA. The analysis of changes in the amount of triterpenic acids during the spring-winter period revealed the highest content of OA in summer (from 6.84 to 13.65 mg/g). In turn, in the other seasons of harvest, the content was in the range of 4.41–9.83, 6.41–9.56 and 5.59–12.16 mg/g for spring, autumn and winter, respectively. In most cases, a similar tendency was observed for BA. Discussion and conclusion: In most cases, the highest amount of the investigated compounds was found in summer; thus, this period seems to be optimal for acquisition of plant material rich in triterpenic acids.

Standards in neurosonology. Part III.

The paper presents standards related to ultrasound imaging of the cerebral vasculature and structures. The aim of this paper is to standardize both the performance and description of ultrasound imaging of the extracranial and intracranial cerebral arteries as well as a study of a specific brain structure, i.e. substantia nigra hyperechogenicity. The following aspects are included in the description of standards for each ultrasonographic method: equipment requirements, patient preparation, study technique and documentation as well as the required elements of ultrasound description. Practical criteria for the diagnosis of certain pathologies in accordance with the latest literature were also presented. Furthermore, additional comments were included in some of the sections. Part I discusses standards for the performance, documentation and description of different ultrasound methods (Duplex, Doppler). Part II and III are devoted to standards for specific clinical situations (vasospasm, monitoring after the acute stage of stroke, detection of a right-toleft shunts, confirmation of the arrest of the cerebral circulation, an assessment of the functional efficiency of circle of Willis, an assessment of the cerebrovascular vasomotor reserve as well as the measurement of substantia nigra hyperechogenicity).

Standardy badań ultrasonograficznych. Neurosonologia. Część III

The paper presents standards related to ultrasound imaging of the cerebral vasculature and structures. The aim of this paper is to standardize both the performance and description of ultrasound imaging of the extracranial and intracranial cerebral arteries as well as a study of a specific brain structure, i.e. substantia nigra hyperechogenicity. The following aspects are included in the description of standards for each ultrasonographic method: equipment requirements, patient preparation, study technique and documentation as well as the required elements of ultrasound description. Practical criteria for the diagnosis of certain pathologies in accordance with the latest literature were also presented. Furthermore, additional comments were included in some of the sections. Part I discusses standards for the performance, documentation and description of different ultrasound methods (Duplex, Doppler). Part II and III are devoted to standards for specific clinical situations (vasospasm, monitoring after the acute stage of stroke, detection of a right-to-left shunts, confirmation of the arrest of the cerebral circulation, an assessment of the functional efficiency of circle of Willis, an assessment of the cerebrovascular vasomotor reserve as well as the measurement of substantia nigra hyperechogenicity).

Predictors of intracranial cerebral artery stenosis in patients before cardiac surgery and its impact on perioperative and long-term stroke risk

BACKGROUND The aim of this prospective study was to determine the prevalence of stenosis within intracranial and extracranial arteries in patients before coronary artery bypass surgery (CABG), to evaluate the influence of intracranial artery stenosis on neurological outcome and to identify preoperative risk factors for these patients. METHODS One hundred and seventy-five patients (71% males, mean age=66.1) scheduled for CABG were enrolled for extracranial Doppler duplex sonography, transcranial color-coded duplex sonography (TCCS) and transcranial Doppler (TCD) examination. RESULTS Twenty-six patients (14.7%) had extracranial stenosis or occlusion and 13 patients (7.3%) intracranial vascular disease. Six patients (3.5%) had both extra- and intracranial artery disease. The presence of peripheral artery disease and diabetes mellitus was a strong risk factor for extracranial artery stenosis but not for intracranial artery stenosis, which occurred independently also of typical atherosclerotic risk factors like age >70, male sex, hypertension, hyperlipidemia, hyperhomocysteinemia, smoking habit, obesity (BMI>30) and waist to hip ratio >1. Functional neurological outcome of the patients with intracranial arterial disease evaluated 7 days after CABG was the same as the patients without extra- and intracranial stenosis. However, 12-months neurological follow-up revealed significantly more ischemic strokes in patients with intracranial artery stenosis compared to patients without intracranial stenosis (p=0.015). CONCLUSION The occurrence of intracranial artery stenosis in CABG patients cannot be predicted by well-known atherosclerotic risk factors and seems not to be associated with perioperative stroke.