Srp Ark Celok Lek
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Clinical Trial
[Evaluation of the long term effect of mitoxantrone on neurological disability in patients with active multiple sclerosis].
Several in vivo and in vitro studies showed that mitoxantrone (MTX), a novel anthracendione antineoplastic agent, had an immunomodulatory effect that suppressed humoral immunity, reduced T-cell numbers, lessened helper activity, enhanced suppressor function and had some positive effect on acute and chronic experimental allergic encephalomyelitis in rats. Up to now, several trials of therapy with MTX have been performed in patients with multiple sclerosis (MS). MTX has been recently shown to reduce disease activity, as expressed by reducing relapse rate and decreasing new, active MRI lesions, in a selected group of patients with active relapsing-remitting (RR) MS. ⋯ Cardiotoxicity was not registered. Our findings further support the notion that mitoxantrone reduces neurological disability in active relapsing and secondary progressive multiple sclerosis patients. However, follow-up suggests that this effect slowly subsides after discontinuation of therapy, implying the need for prolongation of such treatment (up to 120 mg/m2) for a period as long as possible.
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Subarachnoidal hemorrhage (SAH) is the fourth most common intracranial cause of death. Approximately 50 to 85 percent of non-traumatic SAH is caused by rupture of congenital berry aneurysm. Symptoms of rupture are typically sudden and without any heralds. In most SAH cases, the vasospasm following the rupture is the most probable cause of death. In forensic pathology, an isolated SAH episode after minor head trauma should be considered dubious, and as mode of death. ⋯ Sometimes, it is not possible to detect the exact localization of the ruptured berry aneurysm: the rupture may destroy the aneurysm completely. In such case, an autopsy should rule out other possible sources of intracranial bleeding, such as vascular malformations, intraventricular spreading of intracerebral hematomas, neoplasia, hematological disorders, etc.