[Intravenous treatment of intracranial hypertension and cerebral edema with stabilized solutions of glycerol-sodium ascorbate].
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Biomedical subjects
Publications and source records attributed to N Battistini.
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Impairment of nervous functions has been investigated by clinical and neurophysiological methods in 55 workers exposed to inorganic mercury intoxication and 27 controls living in the same area. A polyneuropathy, mainly of sensory type, has been found in 6 exposed workers (10,9%) and 2 control (7,4%); a mono or multineuropathy of sensory or motor type was present in 15 exposed (27%) and 10 control (29,6%) subjects. Central N.S. involvement has been found in 7 out of 12 exposed workers examined and in 1 out of 7 controls by electronystagmography. Neurological examination demonstrated minor signs of cerebellar type in 3 instances.
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The present study investigated the effect of serum lipoproteins on sterol synthesis by isolated rat hepatocytes. These cells were maintained in culture medium for 24 hr and incubated for the same period of time with increasing concentrations of serum lipoproteins (5-150 microgram of lipoprotein-protein per ml) isolated from different animal species. The viability of the cells was ascertained by their ability to synthesize cholesterol and protein and to secrete serum proteins into the medium. Rat VLDL and LDL did not alter sterol synthesis, which was stimulated instead by HDL. Rat serum chylomicrons were also ineffective. Human LDL significantly reduced the synthesis of sterols from both acetate and tritiated water; this effect was also induced by human VLDL to a reduced extent. VLDL isolated from hypercholesterolemic rabbit (VLDLC) strongly inhibited sterol synthesis from acetate but not from mevalonate. Cholesteryl-ester-rich VLDL isolated from a patient with type III hyperlipidemia (type III VLDL) were more effective than normal VLDL in suppressing sterol synthesis from acetate. The implications of these findings are discussed with regard to the possible role of cholesteryl-ester-rich lipoproteins on the in vivo regulation of sterol synthesis in the liver.
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In normal conditions, there is a precise link between regional metabolism and blood flow in the brain. In pathological states there may be an uncoupling between CBF and metabolism, due to many mechanisms. In particular, anaerobic glycolisis, membrane depolarization, and altered neurotransmitter release are relevant for the final damage of the tissue. Postischemic recovery was analyzed in experiments with 14C-deoxyglucose. In men, the noninvasive approach with 15O by inhalation allowed the determination of regional oxygen utilization. In TIAs, there is a chronic ischemic condition, while in strokes there is often a relative luxury perfusion.
With corticosteroids and diuretics, glycerol treatment may be an effective therapy of early edema accompanying focal brain ischemia. The suggested regimen for intravenous infusion is 500 ml of 10% glycerol solution during at least 2 h, twice a day, starting as soon as possible after stroke onset and continuing thereafter for 5--7 days.
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Regional cerebral blood flow and its autoregulation after intravenous glycerol infusion have been studied in eight patients in the acute phase of cerebral infarction. Glycerol seems to improve the cerebral blood flow in the damaged region but does not seem to restore autoregulation.
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Twelve patients who were comatose after head injuries were studied with serial determinations of regional cerebral blood flow, jugular PO(2) tension, and intraventricular pressure. These determinations began a few hours after the injury, and were followed throughout the clinical course. Diffuse derangement of cerebral vasomotor regulation is confirmed after severe head trauma, which may contribute to deterioration and poor prognosis, and which indicates a need for therapeutic maintenance of rich oxygenation, hyperventilation with moderate hypocapnia, and steady blood pressure. Continuous recording of IVP (eventually sensitized by fluid infusion or CO(2) inhalation tests) may give an early indication of the subsequent clinical state and may suggest the need to submit the patients to further investigative and therapeutic procedures.
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