Montelukast jest skutecznym lekiem w zapobieganiu zespołowi hiperstymulacji jajników: badania eksperymentalne

Objectives: To determine the efficacy of montelukast in comparison with cabergoline in the prevention of ovarian hyperstimulation syndrome (OHSS) in rats. Material and methods: An experimental OHSS model was formed in 35 female Wistar rats. Rats (22 days old) were randomized into 5 groups, each containing 7 animals. The control group received no therapy; the mild OHSS group was administered pregnant mare serum gonadotropin (PMSG) 10 IU for 4 days, hCG 10 IU on the 5th day; the severe OHSS group received PMSG 10 IU for 4 days, hCG 30 IU on the 5th day. The montelukast group: received montelukast 10 mg/kg/day and the cabergoline group was administered cabergoline 100μg/kg/day via oral gavage for 6 days (days 22–27), in addition to those of severe OHSS. All groups were sacrificed on 28th day. Body weight, ovarian diameter and weight, vascular permeability, vascular endothelial growth factor (VEGF), semiquantitative VEGF receptor-1, and VEGF receptor-2 (VEGFR-2) immunohistochemistry were evaluated. Results: Ovarian diameter and VEGF expression were significantly lower in the montelukast and cabergoline groups than in the severe OHSS group. While montelukast was more effective in limiting vascular permeability in the severe OHSS, cabergoline was superior to montelukast with respect to the limiting effect on increased body weight and VEGFR-2 expression. Conclusions: The VEGF/VEGFR-2 interaction plays an important role in OHSS pathogenesis. Montelukast limits VEGF expression, and cabergoline reduces both VEGF and VEGFR-2 expressions; they are both effective therapies for the prevention of severe OHSS.Cel: Ocena skuteczności montelukastu w porównaniu z kabergoliną w zapobieganiu zespołowi hiperstymulacji jajników (OHSS) u szczurów. Materiał i metoda: Model doświadczalny OHSS stanowiło 35szczurów rasy Wistar, płci żeńskiej. Szczury (22 dniowe) podzielono na 5 grup, każda zawierająca 7 zwierząt. Grupa kontrolna nie otrzymała żadnej terapii. Grupa z łagodnym OHSS otrzymała gonadotropinę z surowicy ciężarnych klaczy (PMSG) w ilości 10IU przez 4 dni, hCG 10IU w 5 dniu, grupa z ciężkim OHSS otrzymała PMSG 10IU przez 4 dni, hCG 30IU w 5 dniu. Grupa z montelukastem otrzymała montelukast w dawce 10mg/kg/dzień a grupa z kabergoliną otrzymała kabergolinę 100μg/kg/dzień przez doustny zgłębnik przez 6 dni (dni 22-27). Wszystkie zwierzęta zabito w 28 dniu. Oceniono masę ciała, wymiar i wagę jajników, przepuszczalność naczyń, czynnik wzrostu śródbłonka naczyń (VEGF) oraz w immunohistochemii półilościowo receptor – 1 VEGF i receptor-2 VEGF. Wyniki: Wymiar jajnika oraz ekspresja VEGF były istotnie niższe w grupach z monelukastem i kabergoliną niż w grupie z ciężkim OHSS. Podczas gdy montelukast był bardziej skuteczny w ograniczaniu przepuszczalności śródbłonków w ciężkim OHSS, to kabergolina okazała się lepsza od montelukastu po uwzględnieniu ograniczającego efektu zwiększonej masy ciała i ekspresji VEGFR-2. Wnioski: Wzajemne oddziaływanie VEGF/VEGFR-2 odgrywa istotną role w patogenezie OHSS. Montelukast ogranicza ekspresję VEGF, a kabergolina zmniejsza zarówno ekspresję VEGF jak i VEGFR-2; obie terapie są skuteczne w zapobieganiu ciężkiemu OHSS

Visual and Postural Motion-Evoked Dizziness Symptoms Are Predominant in Vestibular Migraine Patients

Background. Vestibular migraine (VM) is one of the most common underdiagnosed disorders. We aimed to study the clinical characteristics of VM patients who were referred to a neurology-headache unit by otolaryngology after exclusion of peripheral causes of vertigo. Methods. One hundred and one patients diagnosed with VM in the headache unit were included. Description of vestibular symptoms, demographic and clinical features, trigger factors, accompanying diseases, and response to vestibular-suppressant medications and prophylactic migraine treatment were evaluated. Results. Vestibular symptoms were triggered by daily head and body movements and mainly consisted of brief attacks lasting seconds (60.4\% of patients) although the total duration of the vestibular episode lasted hours or days. Other aggravating factors were moving visual stimuli, passive motion, and visually busy environments. Visually induced vestibular symptoms were defined by 71.3\% of the patients, and positional motion-induced vestibular symptoms were described by 82.2\% of the patients. Vestibular symptoms were mainly defined as feeling the ground slipping from under their feet (40.6\%), feeling like there is an earthquake or swaying (27.7\%), sensation of rocking on a boat (26.7\%), and sensation as if stepping on empty space (24.8\%). The majority of the patients (83.2\%) previously used vestibular-suppressant drugs, and these drugs were effective temporarily only in 12.9\%. Conclusions. Chronic recurrent dizziness symptoms, rather than internal or external vertigo, are predominant in our VM patients. Recurrent brief dizziness attacks induced upon routine visual and/or postural motion, longstanding symptoms with limited response to vestibular suppressants, and precipitation by typical migraine triggers are suggestive of VM