Biomedical subjects

Zoltán Nagy

Publications and source records attributed to Zoltán Nagy.

At least 19 recordsLinked to original sources

PubMed2006

[New methods in the investigation of brain hypoxia].

The main challenge is the investigation of mechanism for apoptosis research and the drug development. Mitochondria have a key position in the production of reactive oxygen species and in the evolution of apoptosis. More possible pathway will be known with the apoptosis investigation. For development of neuroprotective molecules could give strategies the investigation of apoptosis. Exact knowledge of apoptosis provides the possibility to screen new neuroprotective molecules. We developed a research assay, that could provide quantitative and qualitative data about the free radical production and the mitochondrial transmembrane potential using confocal microscopy. Thus, we could screen drug candidate, neuroprotective molecules.

Animals↗

PubMed2006

[Epidemiology of stroke in the elderly].

BACKGROUND: In the industrialized countries the very old stroke patient is more frequent than before. For the time being Japanese people have the highest expected lifespan, so the epidemiological features of stroke in the very old can be examined here quite easily. From a few publications with low case number it is known that in this group of patients the statistical characteristics of stroke is remarkably different from the younger ones. SUBJECTS AND METHODS: The subjects aged 85 or more years were selected from the Akita Stroke Registry with first-ever acute stroke from 1996 to 1998. RESULTS: 8046 cases were recorded. There were 7362 patients aged <85 years, and 684 patients aged > or =85 years (8.5%). Sex ratio (women/men) was 1.89 in the two age groups. In the population of Akita the crude incidence of first-ever stroke was 222/100,000/year, and 1085/100,000/year in the very old, who were characterized with relatively lower prevalence of stroke risk factors, except that of atrial fibrillation (26.9%) and cardiac diseases (34.2%). The stroke subtype distribution (cerebral infarction 73.2%, intracerebral haemorrhage 20.6%, subarachnoidal haemorrhage 6.1%) was significantly different from the one known in Japan. Mortality rates were considerably high, especially in the SAH group. The most powerful prognostic factor of death was the level of consciousness at the onset. The next in the order of predicting value was the SAH subtype. CONCLUSION: While people aged 85 years or more had relatively lower prevalence of cardiovascular risk factors, they suffered stroke with very high frequency, the evolved cerebrovascular event caused very severe symptoms and led to death with high rate. Implicitly this is illuminating the complexity of aging as a process, furthermore it increases the importance of prevention, and even more of the care and rehabilitation of acute stroke in this old age group.

Adolescent↗

PubMed2006

Factor V Leiden and apolipoprotein E genotypes in severe femoropopliteal atherosclerosis with restenosis.

BACKGROUND: The role of factor V (Leiden) mutation, thrombophilia, and apolipoprotein E (apoE) alleles in the pathogenesis of accelerated atherosclerosis and restenosis was studied in patients requiring reoperation within five years after femoropopliteal angioplasty with artificial grafts. METHODS: One hundred ninety-eight consecutive patients with femoropopliteal atherosclerotic disease, reoperated for restenosis were contacted by phone and 100 of them returned for laboratory and clinical work-up. In addition to clinical evaluation and routine laboratory investigations, parameters of lipoprotein metabolism, factor V (Leiden) mutation and apolipoprotein E (apoE) allele were studied by PCR amplification of DNA and endonuclease digestion techniques. RESULTS: A significantly higher incidence of factor V (Leiden) mutation was found in patients with atherosclerosis and restenosis, compared to 445 healthy blood donors (13/200, 6.5% vs. 34/890, 3.8%, p=0.0379). Distribution of the alleles of the apolipoprotein E (apoE) gene was different, when the patients were compared to 372 controls; however, the difference only approached the level of statistical significance (25/200, 12.5% vs. 56/744, 7.5%, p=0.0515). Comparing the two groups, the number of epsilon4 allele carriers was significantly higher among patients with restenosis (25/100, 25% vs. 53/272, 14%, p=0.0147). CONCLUSION: Factor V (Leiden) mutation may influence the progression of atherosclerosis and the development of restenosis after revascularization in patients with accelerated femoropopliteal atherosclerosis. Further investigation is needed whether long-term anticoagulation has an impact or not on the course of disease in such cases. ApoE epsilon4 allele should be screened in patients with femoropopliteal atherosclerosis, because it indicates a faster progression of atherosclerosis and may predict restenosis after revascularization procedure.

Adult↗

PubMed2006

[Vascular risk factors in healthy population in the repeated screening examinations].

UNLABELLED: An epidemiological study on vascular risk factors have been repeated two times in a two years interval in a cohort of 4511 healthy subjects. The participants in this study were volunteer members of Dimenzio Health Insurance. METHODS: Data on life style, family history of vascular diseases have been documented. Detailed physical examination including neurological examination and structured questionnaire on stress and related problems, blood glucose, and cholesterol level, carotid Doppler ultrasound and ECG examinations made complete this screening program. RESULTS: Blood pressure, total cholesterol, glucose level increased steadily and significantly by age. Significant differences between male and female groups have been noted in favor of females in all age groups. In subjects having positive family history of vascular diseases, all the blood pressure, cholesterol and glucose level were significantly higher as in the sex and age matched subjects with negative family history. Comparing the dataset of two consecutive screening periods, the average value of blood pressure of different age groups did not increase, even decreased in the older age groups. Smoking habit is also decreased. Interestingly enough the cholesterol level increased significantly in all age groups by the time of second examination. CONCLUSION: Stressful life has been reported mostly by females. The frequency of stress increased significantly by the two years lapsed between the two data collections. Parallel with the stress frequency consumption of antidepressants and anxiolytics increased significantly. The average blood pressure of subjects with stressful life was significantly higher compared to subjects without stress. This cohort study is the first in this country in which we used repeatedly a screening program for identifying high risk subjects, or high risk age groups in a healthy population. Data subtracted from this study could support a prevention strategy.

Adolescent↗

PubMed2006

[Changes in EEG-complexity after subcortical ischemic brain damage].

INTRODUCTION: Complexity analysis of the EEG is a relatively new field in theoretical and clinical electrophysiology. The authors present results of EEG-analysis in a patient with stroke, utilizing the sensitivity of the new procedures with respect to linear and nonlinear synchronization. PARTICIPANTS AND METHODS: The EEG (19 channels) was recorded in a patient with subcortical unilateral ischaemic completed stroke involving the frontoparietal white matter while leaving the cortex intact and in 12 healthy controls in eyes open and in eyes closed conditions. RESULTS: In the patient, increased Omega-complexity was found in slow (delta, theta) and lower alpha frequencies in the side of the stroke and in high frequencies (beta2 in eyes closed, alpha2, beta1 and beta2 in eyes open conditions) in the intact side. Synchronization likelihood was higher in the ischaemic side in the beta2 (eyes closed) and both in the beta1 and beta2 (eyes open) frequencies. Increasing Omega-complexity caused by eyes opening was markedly reduced in the patient in the beta frequencies compared to that seen in the controls. The difference was more conspicuous in the side of the infarct and involved not only the beta but also the alpha frequencies as well. Opening the eyes decreased synchronization likelihood in all frequency bands in the controls and also in the patient except the alpha2, beta1 and beta2 bands in the side of the lesion. CONCLUSIONS: The increased Omega-complexity and decreased synchronization likelihood in the slow frequencies in the infarcted side is probably the result of lesioned interneuronal connections lowering the level of cooperation of neuronal systems involved in this type of activity. The increased Omega-complexity and decreased synchronization likelihood caused by eyes opening could not be observed in the beta and alpha frequencies in the side of the lesion, possibly caused by damaged thalamocortical connections.

Alpha Rhythm↗

PubMed2006

Transition metal complexes of terminally protected peptides containing histidyl residues.

Histidine-containing peptide fragments of prion protein are efficient ligands to bind various transition metal ions and they have high selectivity in metal binding. The metal ion affinity follows the order: Pd(II)>>Cu(II)>>Ni(II)Zn(II)>Cd(II) approximately Co(II)>Mn(II). The high selectivity of metal binding is connected to the involvement of both imidazole and amide nitrogen atoms in metal binding for Pd(II), Cu(II) and Ni(II), while only the monodentate N(im)-coordination is possible with the other metal ions. The stoichiometry and binding mode of palladium(II) complexes show great variety depending on the metal ion to ligand ratio, pH and especially the presence of coordinating donor atoms in the side chains of peptide fragments. It is also clear from our data that the peptide fragments containing histidine outside the octarepeat (His96, His111 and His187) are more efficient ligands than the monomer peptide fragments of the octarepeat domain.

Animals↗

PubMed2006

Cytoprotective effect of two synthetic enhancer substances, (-)-BPAP and (-)-deprenyl, on human brain capillary endothelial cells and rat PC12 cells.

Enhancer regulation is a new control mechanism in the brain [Knoll, J., 2003. Enhancer regulation/endogenous and synthetic enhancer compounds: a neurochemical concept of the innate and acquired drives. Neurochemical Research 28(8), 1275-1297]. Enhancer substances exert their effect in bi-modal form with a highly characteristic dose-dependency. Two bell-shaped concentration curves have been published. The one in ultra low concentration range (fM) specific form of enhancer regulation and the other at high concentration (100 microM) non-specific form of enhancer regulation. Catecholaminergic neurons proved to be enhancer-sensitive cells. Since rat PC12 cells and human brain endothelial cells (HBEC) work under catecholaminergic influence, it was reasonable to expect that both the specific and non-specific form of the enhancer regulation might be detectable in these cells. We tested this possibility on these cultured cells under normoxia and hypoxia-reoxygenation. After 1 h hypoxia produced by Argon gas and 0, 2, 4, and 20 h reoxygenation the cell loss was calculated by propidiumiodide assay and the cell activity was investigated by Alamar Blue assay colorimetric measurement. The percentages of living and necrotic cells were expressed after propidiumiodide staining. Broad scale concentrations of the two compounds (1 fM-100 microM) were added to the culture strait after the oxygen deprivation. (-)-BPAP and (-)-deprenyl, due to their enhancer effect, exerted a significant cytoprotective effect on both HBECs and PC12 cells. In harmony with Knoll's publications we were able to demonstrate by the aid of (-)-BPAP and (-)-deprenyl that both HBEC and PC12 are enhancer-sensitive cells. We detected the specific form of the enhancer regulation in the ultra low concentration range (fM-pM) and also the non-specific form of the enhancer regulation was visible (mM-microM).

Animals↗

PubMed2006

[Spectral EEG-characteristics of subcortical ischemic brain lesion--a case study].

INTRODUCTION: Although the EEG-changes caused by ischemic stroke are well known, data of the literature are rather ambiguous. The EEG-findings recorded in a patient with a unilateral subcortical ischemic lesion are evaluated with special emphasis related to the effect of the dynamics caused by eye opening. PARTICIPANTS AND METHODS: Data recorded from a patient (54 years old male with a completed stroke involving the frontal and parietal subcortical region in the left side) were compared to those of a control group (12 healthy age matched subjects). Absolute and relative frequency spectra, theta/beta quotients, the interaction index characterizing the effect of eyes opening and the symmetry index were calculated from the EEG recorded in eyes closed and eyes open conditions. Data of the patient were compared to those recorded in the control group on the basis of 95% confidence intervals. RESULTS: Irrespective of the recording conditions the predominance of slow activity and the increase of theta/beta quotients were found in the absolute frequency spectra. The increase of beta and beta2 frequency bands following eye opening on the side of the lesion were found to be less obvious than that seen on the intact side and that observed in the control group. With respect to the interaction index related to the side differences caused by eye opening the change of the beta2 frequency band was found to be the most conspicuouS. The symmetry index underscored the predominance of slow (delta, theta, alpha1) frequencies on the lesion side, and that of the fast (beta1, beta2) frequencies on the intact side in both recording conditions. CONCLUSIONS: Localized lesion of the white matter without cortical damage can cause the predominance of slow activity and decrease of the fast frequency bands on the side of the lesion which can be shown by the absolute frequency spectra and is revealed by the symmetry index. The lack of functional reactivity of the fast frequencies in the side of the lesion can clearly be seen in the change of relative spectra following eye opening and on the basis of the calculation of the interaction index reflecting the dynamics of side differences.

Alpha Rhythm↗

PubMed2006

Visualization of mitochondrial membrane potential and reactive oxygen species via double staining.

Quantitative and qualitative analysis of both generated reactive oxygen species (ROS) and mitochondrial membrane potential cannot be detected simultaneously. We here introduce a simple, new double staining method. We have successfully used this for several years utilizing cerium for ROS detection and JC-1 staining to assess the mitochondrial membrane potential. The resultant signals on laser confocal images can be localized in the same cells and can easily quantify them. We used a confocal microscope along with our new, combined staining method to both visualize mitochondrial membrane potential (DeltaPsim) and imaged ROS. These were quantified by JC-1 staining and by cerium ions with reflectance in a method modified in our laboratory. To test this double labeling technique we used PC 12 cells subjected to 1 h hypoxia and 24h re-oxygenization. We are able to produce a quantitative analysis of red/green signals of JC-1 that reflected the energy state of the cells. Cerium reflectance correlates with the amount of ROS release in the same cells. Significant differences have been calculated after hypoxia and re-oxygenation in both modality of the cell staining. The red/green ratio was 18.2+/-9.3 (n=30) in normoxic cells versus 1.65+/-0.9 (n=30) in the hypoxia/re-oxygenation group (p<0.05). In the same randomly selected cells the average cerium reflectance signal intensity was 2.5+/-1.2 (n=30) in the control group while 5.8+/-3.1 (n=30) in the hypoxia/re-oxygenation group (p<0.05). This assay, by characterizing hypoxic injury and re-oxygenization induced ROS production, offers a qualitative and quantitative method to detect the consequences of oxidative stress in experimental conditions and to detect different cell protective strategies.

Analysis of Variance↗

PubMed2006

Spectral and complexity features of the EEG changed by visual input in a case of subcortical stroke compared to healthy controls.

OBJECTIVE: To compare spectral and complexity characteristics of the EEG in a unique case of subcortical infarct to those seen in healthy controls. METHODS: Absolute and relative frequency spectra, theta/beta ratio, the brain symmetry index (BSI), Omega-complexity and synchronization likelihood were calculated of the EEG recorded in eyes closed and eyes open conditions. RESULTS: Increased absolute delta, theta, and Omega-complexity in these frequency bands, higher theta/beta ratios, and decreased relative beta activity were found in the side of the infarct. The BSI localized the excess of slow, and decrease of fast frequency activity to the area of ischemia. Following eyes opening the increase of fast and decrease of slow frequencies, the increase of Omega-complexity in the alpha and beta bands, and the decrease of synchronization likelihood for the fast frequency bands were reduced in the side of the infarct. CONCLUSIONS: The subcortical infarct caused ipsilaterally increased slow, and decreased fast frequency activity accompanied by decreased synchronization of slow, increased synchronization of fast frequencies. Reduced reactivity in the ischemic side was particularly apparent for complexity measures. SIGNIFICANCE: Complexity indices of the EEG are sensitive complementary measures of electrophysiological changes caused by local lesions such as subcortical stroke.

Brain Ischemia↗

PubMed2006

Contribution of the -455G/A polymorphism at beta-fibrinogen gene and of the Leiden mutation to hemorheological parameters in ischemic stroke patients.

UNLABELLED: The concentration of plasma fibrinogen (FIB) is an important factor in the coagulation cascade and also in the determination of blood and plasma viscosity depending on both genetic and acquired factors. The -455G/A polymorphism of the beta-FIB gene is connected to the plasma concentration of FIB but the effect of Leiden mutation on hemorheological parameters is unclear. The two genetic polymorphisms were studied by polymerase chain reaction in healthy subjects and ischemic stroke cohort and the effects on the concentration of plasma FIB, whole blood and plasma viscosity of patients as well. A total of 278 ischemic stroke patients and 173 control subjects were enrolled. Marcro-rheological parameters as plasma FIB concentration, whole blood viscosity (90 sec(-1) shear rate) and plasma viscosity have been measured also in the subgroup of young (age < 50 years) and in a subgroup of non-smoker patients. RESULTS: No significant difference was found in the prevalency of H1/H2 genotype between controls and cases in pooled stroke group OR 0.95 (95% CI: 0.47-1.27), however H2/H2 genotype frequency was increased in young subgroup of patients (OR: 1.66 95% CI: 0.52-5.25). Plasma FIB concentration was increased both in the total cohort (p < 0.05) and in the non-smoker subgroup (p < 0.03) of patients carried H2/H2 as compared to H1/H1 genotype and the prevalence was increased in the group of patients having plasma FIB concentration > 4 g/l (p < 0.05). The whole blood viscosity was elevated in the H2/H2 group as compared to the group carrying wild type (p < 0.03). A tendency of increased plasma viscosity in the group of patients with H2/H2 genotype as compared to wild type was found (p = 0.07). Leiden mutation prevalence showed an increased risk OR: 1.67 (95% CI: 0.75-3.70) in the young patients group as compared to controls. In patients who have had the highest plasma viscosity, higher frequency of Leiden mutation was detected as compared to wild type, in total group (p = 0.01), in young patients (p = 0.03) and in subgroup of non-smoker patients (p = 0.05). CONCLUSIONS: Our findings support the notion that the homozigous variant of beta-FIB gene can raise both plasma FIB concentration and whole blood viscosity. Leiden mutation connected to the elevation of plasma viscosity could demonstrate a new pathway of increased thrombophylic potential in ischemic stroke patients.

Aged↗

PubMed2005

Copper(II) interaction with unstructured prion domain outside the octarepeat region: speciation, stability, and binding details of copper(II) complexes with PrP106-126 peptides.

Copper(II) complexes of the neurotoxic peptide fragments of human and chicken prion proteins were studied by potentiometric, UV-vis, CD, and EPR spectroscopic and ESI-MS methods. The peptides included the terminally blocked native and scrambled sequences of HuPrP106-126 (HuPrPAc106-126NH2 and ScrHuPrPAc106-126NH2) and also the nona- and tetrapeptide fragments of both the human and chicken prion proteins (HuPrPAc106-114NH2, ChPrPAc119-127NH2, HuPrPAc109-112NH2, and ChPrPAc122-125NH2). The histidyl imidazole-N donor atoms were found to be the major copper(II) binding sites of all peptides; 3N and 4N complexes containing additional 2 and 3 deprotonated amide-N donors, respectively, are the major species in the physiological pH range. The complex formation processes for nona- and tetrapeptides are very similar, supporting the fact that successive deprotonation and metal ion coordination of amide functions go toward the N-termini in the form of joined six- and five-membered chelates. As a consequence, the peptide sequences investigated here, related to the neurotoxic region of the human PrP106-126 sequence, show a higher metal-binding affinity than the octarepeat fragments. In the case of the HuPrP peptide sequences, a weak pH-dependent binding of the Met109 residue was also detected in the 3N-coordinated complexes.

Amino Acid Sequence↗

PubMed2005

Extensive piano practicing has regionally specific effects on white matter development.

Using diffusion tensor imaging, we investigated effects of piano practicing in childhood, adolescence and adulthood on white matter, and found positive correlations between practicing and fiber tract organization in different regions for each age period. For childhood, practicing correlations were extensive and included the pyramidal tract, which was more structured in pianists than in non-musicians. Long-term training within critical developmental periods may thus induce regionally specific plasticity in myelinating tracts.

Adolescent↗

PubMed2005

Effects of vinpocetine on the redistribution of cerebral blood flow and glucose metabolism in chronic ischemic stroke patients: a PET study.

The pharmacological effects of the neuroprotective drug vinpocetine, administered intravenously in a 14-day long treatment regime, on the cerebral blood flow and cerebral glucose metabolism in chronic ischemic stroke patients (n=13) were studied with positron emission tomography in a double-blind design. The regional and global cerebral metabolic rates of glucose (CMRglc) and cerebral blood flow (CBF) as well as vital physiological parameters, clinical performance scales, and transcranial Doppler parameters were measured before and after the treatment period in patient groups treated with daily intravenous infusion with or without vinpocetine. While the global CMRglc values did not change markedly as a result of the infusion treatment with (n=6) or without (n=7) vinpocetine, the global CBF increased and regional CMRglc and CBF values showed marked changes in several brain structures in both cases, with more accentuated changes when the infusion contained vinpocetine. In the latter case the highest rCBF changes were observed in those structures in which the highest regional uptake of labelled vinpocetine was measured in other PET studies (thalamus and caudate nucleus: increases amounting to 36% and 37%, respectively). The findings indicate that a 2-week long intravenous vinpocetine treatment can contribute effectively to the redistribution of rCBF in chronic ischemic stroke patients. The effects are most pronounced in those brain regions with the highest uptake of the drug.

Brain Chemistry↗

PubMed2005

Human cerebral microvessel endothelial cell culture as a model system to study the blood-brain interface in ischemic/hypoxic conditions.

(1) Cerebral ischemia and reperfusion induce several changes on the endothelial cells at the microcirculatory level. (2) Vasogenic brain edema due to compromised blood-brain barrier, transformation of the endothelial cell surface from an anticoagulant to a procoagulant surface are important factors in the pathogenesis of ischemic stroke. (3) Release of prostaglandins, endothelin-1, complement proteins, and matrix metalloproteinase-9 by microvascular endothelial cells are other components in the complex mechanism of brain ischemia/hypoxia. (4) Ultrastructural studies documented the opened paracellular avenues in the course of vasogenic edema in different experimental models (5) Tight junctions of endothelial cells have been characterized with freeze fracture electron microscopy, and the process of transvesiculation was analyzed using rapid freeze and freeze substitution procedure before electron microscopy studies (6) In endothelial cell-culture experiments, we used rodent and later human brains. (7) Endothelial cells co-cultured with astroglia resulted in an elaborate tight junctional complex. (8) This co-culture technique becomes the basis of in vitro blood-brain barrier studies On endothelial cells of human brain origin, different regulatory factors found to be responsible for the complex mechanism of ischemic stroke.

Blood-Brain Barrier↗

PubMed2005

Impaired inactivation by antithrombin and hirudin and preserved fibrinogen-clotting activity of thrombin in complex with anti-thrombin antibody from a patient with antiphospholipid syndrome.

Immunoglobulin G (IgG) isolated from the blood plasma of a patient with secondary antiphospholipid syndrome (APS) expresses fibrinogen-clotting and amidolytic activity (the thrombin activity in 20 micromole IgG is equivalent to approximately 5 nmole pure thrombin), and activates factor XIII. Hirudin (1 microM) decreases the intrinsic thrombin activity of the APS IgG by only 25%, whereas it inhibits completely pure thrombin with equivalent activity. Under conditions, when antithrombin inactivates 60% of the thrombin activity in the presence of normal IgG, the APS IgG protects almost completely the added thrombin against inactivation by antithrombin. Heparin, however, partially relieves this protective effect and at the same time it facilitates the inhibition of the intrinsic thrombin activity by antithrombin. The APS IgG reduces the thrombin activity in protein C activation assay by 50% compared to the activity in the presence of normal IgG. All described properties are related to the Fab fragment of the antibody. The IgG preserving the fibrin-generating activity of thrombin with concomitant protection against inhibitors unravels a new aspect of the thrombotic mechanism in APS. This condition is probably rare: only one out of 23 examined patients with primary or secondary APS expresses IgG with the described properties.

Adult↗

PubMed2005

Prevalence of rheumatoid arthritis in the South-Transdanubian region of Hungary based on a representative survey of 10,000 inhabitants.

OBJECTIVE: To assess the prevalence of rheumatoid arthritis (RA) in a representative study of the South Transdanubian region of Hungary. METHODS: Ten thousand individuals aged between 14-65 years were interviewed. The stratified sample was representative for age, sex and urban/rural residence structure of the regional population of the South-West Hungarian region. As a second step, all individuals with possible RA were asked to undergo a clinical investigation to confirm the diagnosis of RA according to the American Rheumatism Association (ARA) 1987 criteria. Of 10,000 interviewed individuals, 632 reported having RA or symptoms including digital pain, stiffness, and/or swelling. Two hundred and twenty-four individuals were investigated clinically. Individuals fulfilling the 1987 ARA criteria were considered as having definite RA, and their clinical data were evaluated. RESULTS: RA was confirmed in 13 cases. The male/female ratio was 3/10. The prevalence of RA among individuals aged 14-65 years was 0.37% (95% confidence interval, CI: 0.26-0.51), 0.23% (95% CI: 0.15-0.35) in men and 0.48% (95% CI: 0.35-0.64) in women. CONCLUSION: The prevalence of RA in the South Transdanubian region of Hungary is similar to those of other recent studies from other regions around the world.

Adolescent↗

PubMed2004

[Effectiveness and safety of intraventricular fibrinolysis in secondary intraventricular hemorrhages (a prospective, randomized study)].

BACKGROUND AND PURPOSE: Intraventricular clot secondary to brain hemorrhage has still one of the worst prognosis among all stroke subtypes, regardless of conservative therapy or surgical interventions. The rapid clot resolution with thrombolytic agents could improve the outcome by restoring the impaired cerebrospinal fluid circulation, for this reason, the authors examined the safety and efficacy of Urokinase therapy in a randomized, controlled study. METHODS: They enrolled 27 patients with severe intraventricular hemorrhage between 1998 and 2002. All patients had supratentorial intracerebral hemorrhage caused by hypertension, with IVH, moreover clinically worsening course due to the obstructive hydrocephalus confirmed by CT. Eleven persons were treated with ventriculostomy alone and 16 received adjunctive intraventricular urokinase. The authors examined the early, 30-day and 1-year mortality, furthermore the neurological (Scandinavian Stroke Scale) and functional outcome (Barthel Scale). The mean age was 60 +/- 9.5. The initial Scandinavian Stroke Scale was 7.51 +/- 8.64, Glasgow Coma Scale was 6.85 +/- 2.52, intracerebral hemorrhage volume was 22.44 +/- 18.14 ml. RESULTS: The 1 year survival rate was significant higher in the urokinase treated group (p = 0.014), This tendency in the mortality (31.3% vs. 54.5%) and in the neurological/functional condition (SSS, p = 0.078/Barthel, p = 0.119) at 30th day have been also documented. No hemorrhagic complications due to urokinase were observed. Two meningitis (7.4%) and two intraparenchymal hemorrhages (7.4%) related to drain insertion were detected (p = 0.009). The probability of pulmonary infection was roughly two times higher in the group without clot lysis (RR = 1.870; 95% CI: 1.004-3.482). CONCLUSIONS: In the authors experience, urokinase treatment reveals to be safe in the intraventricular clot lysis. This therapy allows earlier mobilization and rehabilitation, and decreases the number of infections, which are favorable to the long-term survival rate.

Adult↗