Biomedical subjects
Publications and source records attributed to M Wender.
A case of difficult for classification demyelinating disease of diffuse (transitional) type is presented. The described case seems to testify about the identity of hyperergic (para-infections) encephalomyelitis and acute multiple sclerosis of diffuse type.
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Thyroid hormones serum concentration alters in a variety of nonthyroidal illnesses. Thyroxine and triiodothyronine levels in patients after ischaemic stroke are significantly lower and reverse-triiodothyronine (rT3) and triiodothyronine uptake index (T3I) are considerably higher. At the beginning of insultus rT3 and T3I can be used as the markers of fatal prognosis.
In 136 clinically definite MS cases the comparison was performed of intrathecal IgG production and detection of oligoclonal bands, evaluated by immunological methods with results of colloidal tests. The obtained results show, that the left side precipitation in colloidal tests indicates the presence of intrathecal IgG production, what was a definite value in the diagnosis of MS. However, the value of colloidal tests is very much limited by several times lower sensitivity of colloidal tests in detection of intrathecal IgG production in comparisons with the evaluation of intrathecal production and detection of oligoclonal bands by the immunological methods.
A case of transitional type of multiple sclerosis with large periventricular cuffs of demyelination is presented. The case suggests that in the mechanism of myelin decay a significant role might be played by the diffusion of the demyelinating factors contained in the cerebro-spinal fluid.
The humoral and cell mediated immunity was studied in 75 cases of completed ischaemic stroke. The results demonstrated only in few cases intrathecal IgG production and presence of oligoclonal IgG bands. A significant relative drop of cell count with CD3 reactivity and increase of cells with reactivity Anti-HLADR and CD11 was observed in peripheral blood. The results demonstrate that in the course of ischaemic stroke various immunological reactions may occur in particular cases. However, there exist no evidence that repeated stroke leads to immunization of the patient.
In 34 cases of ischaemic cerebral vascular disease (24 patients with completed stroke and 10 with RIND or TIA) complex studies of serum lipids were performed. The level of total cholesterol, cholesterol HDL, phospholipids, triglycerides and apolipoprotein B was evaluated. The obtained results revealed in RIND and TIA syndrome higher values of phospholipids, apolipoprotein B and cholesterol HDL than in completed ischaemic stroke. However the differences were not great enough, draw conclusions about the dynamics of changes in course of progress of the ischaemic cerebral vascular disease. In allmost all cases of completed stroke and in RIND or TIA syndrome a drop of cholesterol HDL was found. Other deviations of lipid level were noticed only in few cases. Notwithstanding the significance of other than hyperlipidemia risk factors, especially of elevated blood pressure, it seems reasonable to start adequate treatment when in patient with RIND or TIA abnormal values of serum lipids are found.
The aim of the study was to determine IgG subclasses of MBP antibodies in patients with multiple sclerosis. The enzyme-linked immunosorbent assay (ELISA) with monoclonal antibodies against human IgG subclasses was applied. Anti-MBP antibodies were found in the CSF of 16% and in the sera of 20% patients with MS. MBP antibodies belonged to IgG1, IgG2 and IgG3 subclasses (in the CSF) and to IgG1 and IgG3 subclasses (in the sera). The role of MBP antibodies in context of their IgG subclasses distribution is discussed.
65 patients with ischaemic stroke were treated for 6 weeks by intramuscular injections of Sygen--monosialoganglioside 40 mg daily. The results were double-blinded and compared with those in placebo group (Vitamin PP). The results evaluated by Mathew scale did not show any significant differences between both groups. However in the Sygen group we have noticed more patients with very good therapeutic results (almost complete recovery of functions). Immunological studies have not revealed any reaction, which may be considered as a result of allergogenic action of monosialoganglioside.
IgG and its subclasses: IgG1, IgG2, IgG3 and IgG4 were determined in the CSF and sera from 20 patients with multiple sclerosis before and after treatment with azathioprine. The effect of the treatment on IgG and IgG subclasses intrathecal synthesis was studied as well. There was a decrease in IgG level in the CSF of MS patients after the treatment with azathioprine. This was mainly due to the decrease of IgG1 and IgG2 subclasses levels. There was no evidence of the influence of azathioprine treatment on IgG and its subclasses levels in MS sera as well as on IgG and IgG subclasses intrathecal synthesis.
The influence of high-dose prednisone and azathioprine therapy on oligoclonal IgG in the CSF of MS patients was studied. The oligoclonal bands were present in 93% of patients treated with prednisone and in 90% of patients treated with azathioprine. After the treatment with prednisone, the oligoclonal bands density was diminished in 3 patients, and after the treatment with azathioprine in 1 patient. The number of bands and their pattern remained the same.
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IgG subclasses levels in the CSF and sera were measured in 15 patients with neurosyphilis. Intrathecal IgG and IgG subclasses synthesis was studied as well. There was an elevation of IgG1 and IgG3 subclasses in the CSF and IgG1 elevation in the sera of patients with neurosyphilis. General IgG index was elevated in 46% of the patients. This was due mainly to IgG1 and IgG3 intrathecal synthesis. Oligoclonal IgG bands were present in the CSF in seven out of 15 studied patients. These results may be helpful in the first stage of the diagnostic procedure before specific serological tests are performed.
Two cases of posttraumatic apallic syndrome were described in which despite initially severe symptoms full recovery was observed. In complex treatment lasting several months the great role plays the stimulation of various receptors by physiological stimuli. In the discussion to treat or not to treat intensively the severe posttraumatic apallic syndrome our opinion is positively yes.
Gasometric determinations of pCO2, pO2, HCO3 and SO2 were performed in arterial blood in 100 patients with brain stroke. The following conclusions have been drawn. 1. In 2/3 of cases of brain stroke decreased partial oxygen pressure and in 1/3 of cases acid-base equilibrium disturbances are observed. 2. Hypoxia occurs in brain stroke mainly in patients with consciousness disturbances, which suggests that impaired airways patency plays a role in the pathomechanism of this disturbance. 3. Acid-base equilibrium disturbances in cases of brain stroke have in most patients the character of respiratory alkalosis which seems to be due to hyperventilation determined by central nervous mechanisms as well as to hypoxia caused by insufficient patency of airways. 4. Gasometric investigations of arterial blood in brain stroke are important for establishing the degree of homeostasis disturbances and for choice of methods of therapeutic management.
Cases of metachromatic leucodystrophy in brother and sister are presented. The clinical pattern in the female was characterised by the progressing dementia, whereas in the male the first symptom was the manic syndrome. The neurological status was normal. The cases were diagnosed by the demyelination visible in MRI pattern and in the decreased activity of arylsulphatase A in blood leukocytes.
An attempt is presented to use Lamictal (lamotrigine) produced by GlaxoWellcome in 30 patients with primary generalized epilepsy, already taking one of antiepileptic drugs, but refractory to this treatment. The patients were treated with carbamazepine (Amizepin) 600-1200 mg daily or with sodium valproate (Depakine) 1200-1600 mg daily. In the course of add-on therapy patients were receiving in first 4 weeks increasing doses of Lamictal starting from 50 mg or 25 mg (patients treated with sodium valproate). Maintenance dose of lamotrigine was 200 mg daily in two divided doses. The results of first three months of the treatment were generally positive. Half the patients experienced a reduction in seizure count by more than a half, what testify the Lamictal is a valuable medication in the treatment of primary generalized epilepsy. The observed side effects had transitory character.