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Acta Neurochir (Wien). 2000;142(9):1047-54.
The effect of tizanidine on chronic vasospasm in rats.
Berkman MZ, Iplikcioglu AC, Berkman MK, Erbengi T, San T, Sav A.
Department of Neurosurgery, Okmeydani Social Security Hospital, Istanbul, Turkey.
BACKGROUND: Cerebral vasospasm after subarachnoid hemorrhage (SAH) has remained a major cause of morbidity and mortality in patients with SAH. Excitatory neurotransmitters are gathered in the extracellular space during ischemia due to cerebral vasospasm and initiate or stimulate a series of pathophysiological biochemical processes which consequently lead to neuronal death. Tizanidine (Sandoz compound DS 103-282, 5-chloro-4,2 (2-imidazolin-2-yl-amino)-2,1,3-benzothiazol hydrochloride) is a centrally-acting muscle relaxant and a selective alpha 2 adrenoreceptor agonist which shows its effect by stimulating presynaptic alpha 2 adrenoreceptors in central ASPergic and GLUergic system by inhibiting aspartic acid and glutamic acid release. In this study, the effect of Tizanidine on vasospasm was evaluated. METHODS: We used a femoral artery vasospasm model in rats which has been described by Okada et al. 60 rats were examined in three groups. The first group was used as control group (Control) (n = 20), in the second group subarachnoid hemorrhage was performed (SAH) (n = 20), in the third group Tizanidine was administered in addition to SAH (SAH + Tizanidine administration) (n = 20). Animals in SAH + Tizanidine administration group received 0.3 mg/kg/day intraperitoneally for 7 days. Seven days after the experiment, after perfusion-fixation, 10 mm segments of both femoral arteries were removed and the femoral artery was prepared for light microscope examination, scanning and transmission electron microscopy and for morphometric analysis. RESULTS: There was a statistically significant difference between the electron, scanning and light microscopic observations and morphometric analysis of SAH + Tizanidine administration group and SAH group, and no statistically significant difference between SAH + Tizanidine administration group and control group. CONCLUSION: This study has disclosed that Tizanidine administration before the vasospasm reduces ultrastructural and morphometric vasospastic insult significantly. However, the clinical application of Tizanidine as a protective and therapeutic agent in cerebral vasospasm needs further studies including the employment of clinically more relevant SAH models.
Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11086815&dopt=Abstract hemorrhage
Neurology. 2000 Nov 14;55(9):1315-20.
Onset seizures independently predict poor outcome after subarachnoid hemorrhage.
Butzkueven H, Evans AH, Pitman A, Leopold C, Jolley DJ, Kaye AH, Kilpatrick CJ, Davis SM.
Department of Neurology, Royal Melbourne Hospital, Parkville VIC, Australia.
OBJECTIVE: To determine whether onset seizures after subarachnoid hemorrhage (SAH) carry independent prognostic information and to investigate the risk factors for late seizures after SAH. BACKGROUND: Modern management of SAH, including early operation, has substantially reduced mortality. No study has adequately assessed the importance of onset seizures in a contemporary SAH cohort. METHODS: The authors analyzed the records and initial CT scans of 412 consecutive patients with aneurysmal or nonaneurysmal SAH admitted to the Royal Melbourne Hospital from 1990 to 1996. Each patient with an onset seizure (n = 32, 7.8% of cohort) was age and sex matched to two nonseizure patients of the same cohort. Each patient with a late seizure (n = 17, 5.1% of cohort) was matched to five control subjects of the same cohort. RESULTS: With use of logistic regression analysis, onset seizures correlated with the sum score of blood on initial CT scan (OR = 1.1, p = 0.05), but there was no significant correlation with duration of loss of consciousness at onset, Glasgow Coma Score (GCS), presence of aneurysm, or past history of hypertension or epilepsy. Disability 6 weeks after SAH according to the Glasgow Outcome Scale was independently predicted by initial GCS of <6 (OR = 13.7, p < 0.01) and onset seizure (OR = 7.8, p = 0.04). Late seizures within the first 6 weeks were independently related to rebleeding (OR = 94, p < 0.01) and onset seizures (OR = 27, p < 0.01) but not to other onset variables, development of hydrocephalus, or vasospasm. CONCLUSION: In this single-institution cohort of patients with SAH, onset seizures were an independent risk factor for late seizures and a predictor of poor outcome.
Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11087774&dopt=Abstract hemorrhage
Srp Arh Celok Lek. 2000 May-Jun;128(5-6):165-71.
[Non-traumatic subarachnoid hemorrhage of unknown origin]
[Article in Serbo-Croatian (Cyrillic)]
Milenkovic Z, Igic A, Mitic R, Stamenic J.
Department of Neurosurgery, Clinical Centre, Nish.
In a series of 441 patients with signs and symptoms of spontaneous subarachnoid haemorrhage (SAH) in 62 subjects haemorrhagic aetiology could not be established. All patients were admitted during the first week of haemorrhage (most of them within 72 hours). The majority belonged to Hunt's and Hess' 1 and 2 degrees of bleeding (80.64%). Blood in subarachnoid region could not be verified by CT in 30.03% of patients. Among patients with manifested haemorrhages in 59% haemorrhage was localized in perimencephalic cisternae, and in the others a kind of SAH with characteristics of aneurysmal rupture was observed. Digital substratum angiography (DSA) of four cerebral blood vessels was performed in all patients; in 17 patients the procedure had to be repeated, but without a new pathologic substrate. The recovery of the majority of patients (91.93%) was good, and only one patient died one year after the insult. The patients with aneurysmal SAH were separately treated. In these patients the recovery was noted in 73.33% of subjects, and the rest manifested a mild invalidity. In general, patients with SAH of unknown aetiology have a better prognosis than those with aneurysmal SAH.
Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11089416&dopt=Abstract hemorrhage
Ann Thorac Surg. 2002 Nov;74(5):1450-7; discussion 1457-8.
Use of stentless xenografts in the aortic position: determinants of early and late outcome.
Akar AR, Szafranek A, Alexiou C, Janas R, Jasinski MJ, Swanevelder J, Sosnowski AW.
Department of Cardiothoracic Surgery, University Hospitals of Leicester, Glenfield Hospital, United Kingdom.
BACKGROUND: Whether to perform a stentless aortic valve replacement (AVR) is not well established. Our aim was to determine the outcome after AVR with stentless xenograft valves. METHODS: Between 1996 and 2001, a total of 404 patients (mean age 70.4 years) underwent a stentless AVR by one surgeon in our unit. Concomitant procedures were performed in 132 patients (33%). Twenty patients (6.4%) had undergone previous AVR. Eleven types of stentless xenograft valves were implanted: Medtronic Freestyle in 221 patients (55%), Shelhigh in 55 (14%), Shelhigh composite conduit in 33 (8%), Sorin in 26 (6%), Cryolife O'Brien in 25 (6%), Aortech-Elan in 17 (4%), Edwards Prima in 14 (4%), Toronto SPV in 7 (2%), and other valves in 6 (1%). A subcoronary implantation technique was used in 302 cases (76%), complete root replacement in 62 (15%), and a modified Bentall-De Bono procedure in 33 (8%). Mean follow-up was 19.4 months (range, 1.2 to 60.6 months). RESULTS: Overall hospital mortality was 4.2%. This was 2.4% for isolated AVR, 3.6% for AVR and coronary artery bypass grafting, 5.5% for replacement of two or more valves, and 12% for the modified Bentall procedure. On multiple logistic regression redo cardiac operation (p = 0.0006), cardiogenic shock (p = 0.001), left ventricular ejection fraction less than 0.30 (p = 0.01), modified Bentall procedure (p = 0.03), and endocarditis (p = 0.04) were predictors of in-hospital death. Five-year freedom from thromboembolism, hemorrhage, prosthetic endocarditis, structural valve deterioration, and reoperation was 97%, 99%, 99%, 98%, and 96%, respectively. Kaplan-Meier survival at 5 years was 88%. On Cox regression, cardiogenic shock (p = 0.001) and older age (p = 0.03) were adverse predictors of survival. At echocardiographic examination within 6 months from the operation, mean aortic valve gradients were 15 +/- 6 mm Hg, 12.8 +/- 3 mm Hg, 10.8 +/- 4 mm Hg, 9.3 +/- 3 mm Hg, 9.1 +/- 4 mm Hg, and 8.2 +/- 3 mm Hg for valve sizes of 19, 21, 23, 25, 27, and 29 mm, respectively. CONCLUSIONS: The availability of several stentless valve designs facilitates the surgical treatment of diverse aortic valve or root diseases with encouraging early and mid-term results. Patients requiring concomitant procedures may also benefit from the excellent hemodynamic characteristics of a stentless valve. We consider stentless AVR the treatment of choice for patients older than 60 years and those having small aortic roots.
Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12440592&dopt=Abstract hemorrhage
Bull Soc Belge Ophtalmol. 2002;(285):37-40.
[Cause of unusual unilateral vitreous hemorrhage: neuroretinitis of Cat-Scratch disease. Presentation of a case]
[Article in French]
Degueldre F, Bonnet S.
Centre Hospitalier Universitaire de Liege.
A 49 years old woman presents an unilateral decrease of vision. An important vitreous hemorrhage obscures the fundus. After partial resorption a typical aspect of neuroretinitis is seen: macular and disc edema with macular star formation. Cat-Scratch disease is suspected after general examination of the patient. This diagnosis will be confirmed by the laboratory investigation. This disease is not so rare and represents one of the principal causes of neuroretinitis. The vitreous hemorrhage can be due to vascular insult by the bacterium responsible for Cat-Scratch disease which one has an important tropism for endothelial cells and can be responsible for vascular occlusive phenomena. Clinical signs, treatment and evolution of this disease are going to be discussed in this article.
Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12442341&dopt=Abstract hemorrhage
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