[Usefulness of current and retrospective markers of glycemia for early prognostication of ischemic stroke in diabetics and non-diabetics]

Diabetes mellitus is associated with an increased incidence of ischaemic stroke but it is not established whether it may exacerbate its clinical course and prognosis. In the study we have assessed relations of fasting (1st-2nd day of illness) and pre-stroke glycaemia (measured as HbA1 and FA) with recent clinical manifestation and outcome within one month in 22 diabetics and 37 non-diabetics with ischaemic brain infarction in the internal carotid territory. Merely enhanced HbA1 in the majority of non-diabetic stroke patients confirmed impaired pre-stroke glucose tolerance but did not influence severity of hemiparesis and further prognosis. Abnormally high both HbA1 and dFA in diabetics, reflecting non-sufficient metabolic control of illness did not exacerbate acute manifestation of stroke and outcome. Fasting post-stroke glycaemia that expresses a stress response of brain origin was determinative for clinical state but not for one-month prognosis in diabetics and non-diabetics with brain infarction.

Interleukin-6 concentration in serum and cerebrospinal fluid in multiple sclerosis patients

INTRODUCTION

The aim of the investigation was to determine pleiotropic cytokine IL-6 concentrations in serum and CSF of MS patients, with regard to clinical circumstances.

MATERIAL AND METHODS

The study covered 27 MS patients: 23-51 years old; in the 2-7 clinical stage according to Kurtzke's Scale; mean 3.6 +/- 1.8; disease duration time ranged between 2-22 years. Serum and CSF interleukin-6 were determined by the use of commercial ELISA kits.

RESULTS

Increase of Il-6 in serum of MS patients was found (12.1 +/- 1.8 pg/ml) in comparison to the control group (6.6 +/- 4.5 pg/ml) (p = 0.03). Concentration of IL-6 in CSF of MS patients was 13.4 +/- 1.77 pg/ml and in the majority of patients it was higher than in the serum. The highest mean of IL-6 concentrations in serum and CSF have been found in patients at the longer disease duration time, although there were not statistically significant. We have found some degree of dependence between serum IL-6 concentration and the level of disability in Kurtzke's scale.

CONCLUSIONS

IL-6 participation in the basic MS immune processes is confirmed by its elevated concentration in serum and CSF, its relation to disease severity with the more expressed rise in cerebrospinal fluid.

[Differential diagnosis in multiple sclerosis: description of selected cases]

Multiple sclerosis (MS) should be differentiated with diseases causing disseminated lesions of central nervous system or imitating clinical course of MS. Clinical course and results of laboratory investigations also immunological tests should be taken into account in differential diagnosis of MS. We present four patients whose proper diagnoses were based on the immunological investigations.

[Blood platelet activation markers in patients with acute cerebral infarction during the earliest stage of the disease--evaluation using flow cytometry methods]

Platelet activation seems to play a critical role in a number of vascular diseases, including stroke. The aim of our study was whole-blood flow cytometry evaluation of platelet activation markers: P-selectin (CD62), glycoprotein-53 (CD63) and platelet-derived microparticle in vivo in patients with acute cerebral infarction. We investigated 50 patients (29 men and 21 women, mean age 67.8) with acute cerebral infarction. Parameters of platelet activation were measured on the 1st, 3rd and 7th day after stroke onset. Comparisons were made with 20 control patients matched age. Compared to controls (1.6 +/- 0.7%) the stroke patients showed higher expression of CD62 on the 1st (2.6 +/- 1.4%), 3rd (3.5 +/- 2.3%) and 7th (3.0 +/- 2.0%) day after stroke onset. The differences were statistically significant on all days (p < 0.05). Compared to controls (1.5 +/- 0.6%) the stroke patients had also higher expression of CD63 on the 1st (1.9 +/- 0.6%), 3rd (2.0 +/- 0.6%) day and they showed higher level of platelet-derived microparticles on the 3rd (13.0 +/- 3.0%) day after stroke onset. The differences were statistically significant (p < 0.05). Elevated expression of CD62, CD63 and platelet-derived microparticles level indicate platelet activation during the acute phase of ischaemic stroke. Flow cytometry is a useful tool for in vivo assessment of platelet activation.

[Role thrombocytes in etiopathogenesis of ischemic stroke]

This paper presents the most essential problems concerning the role of platelets in the genesis of ischaemic brain disease and their role in spreading of ischaemic focus. The role of platelets in atherogenesis and development of vascular abnormalities in arterial hypertension and diabetes mellitus was considered, and attention was paid to conditions concerned with the pathogenesis of ischaemic stroke such as presence of antiphospholipid antibodies and presence of large volume platelets, in which platelet activation plays essential role. Then it was shown that platelet hyperactivation occurs in acute phase of ischaemic stroke and mechanisms of destructive action of activated platelets on recent ischaemic focus in brain such as secretion of neurotoxins and blocking of microcirculation by platelet aggregates were discussed.

[Value of glucose, glycosylated hemoglobin and fructosamine in blood of patients with ischemic cerebral infarction without diabetes during the early stage of the disease]

Fasting blood glucose level, glycosylated haemoglobin (HBA1) and fructosamine (FA) were measured in 37 non-diabetic patients with a recent (48 h) brain infarction of the carotid territory. The severity of hemiparesis was assessed on admission, and in the 2nd week and 1st month. The functional outcome and fatality rate was estimated after 1 month. On the basis of elevated the HBA1 concentration the group of 54% patients was diagnosed to have prestroke hyperglycemia. Hyperglycemia predating cerebral infarction did not influence fasting glycemia during the few days after stroke. Fasting blood glucose concentration but not the preceding 2-3 months and 2-3 weeks glycemia correlated strongly with the severity of hemiparesis and predicted stroke outcome. Measurement of HBA1 seems to be useful as a screening test for mild, clinically silent diabetes in patients without other risk factors for cerebral stroke.

[Expression of platelet activation markers--selectin P and glycoprotein CD63 during hemodialysis]

The bleeding tendency is a common feature of chronic uremia. Abnormalities of platelet function play a role in the pathogenesis of this disorder. A direct contact between platelets and an artificial dialysis membrane results in strong activation of thrombolysis. The aim of our study was to investigate platelets activation in vivo during haemodialysis. We used monoclonal antibodies specific against platelet activation markers--selectin P (CD62) and glycoprotein CD63. The expression of those antigens was analyzed by flow cytometry. Blood samples were obtained from 20 long-term haemodialysed patients with end-stage renal disease. After 15 minutes of haemodialysis the expression of CD62 and CD63 was significantly higher (p < 0.001) as compared CD63 glycoprotein. Our results show that haemodialysis has a significant influence on platelet activation and can favour co-existence of the bleeding tendency and the prothrombotic status in long-term hemodialyzed patients.

[Polyradicular neural syndrome in a patient with leukemic variant of malignant histiocytosis]

Malignant histiocytosis is rapidly progressive, fatal disorder characterised by systemic proliferation of abnormal histiocytic cells. We report a case of a 23-year old patient with leukaemia variant of malignant histiocytosis and nervous system involvement as polyradiculoneural syndrome. The leukaemia variant as well as nervous system involvement are extremely rare in malignant histiocytosis.

[The concentration of glucose, glycosylated hemoglobin and fructosamine in blood of patients with cerebral hemorrhage in the acute stage of the disease]

The level of glucose, fructosamine (FA), glucosylated hemoglobin (HbA1) was determined for 21 patients with cerebral haemorrhage at an early stage of their illness. The correct level of FA and HbA1 shows that in the period of 2-3 weeks and 2-3 months before the stroke the average level of glucose in blood was normal. No significant differences of glucose concentration with respect to patients with a good prognosis and patients with a bad prognosis were found.

The comparison of usefulness of computer tomography and angiography in diagnostics of intracranial vascular anomalies

We evaluated 84 patients with SAH to compare the clinical usefulness of CT and cerebral angiography in diagnostics of intracranial vascular anomalies as a source of SAH. Angiography was more effective in detection of aneurysms (in 67.9% cases), also multiple aneurysms. Both methods showed angiomas equally well (in 100%). The agreement in the aneurysms localisation was only 17%. The effectiveness of subtentorial aneurysms detection was poor in both methods (especially in CT). The most common localisation of aneurysms were: the middle cerebral artery, communicating anterior artery, internal carotid artery, anterior artery.