[Local immune defects--products of free oxygen radicals]

The discussion about the supporting task of four main active oxygen dependent mechanisms mediating and modulating immune signals was included in the work, along with the discussion on antioxidants influencing these mechanisms. The former include xanthine-oxidase, cyclooxygenase, lipoxygenase, aldehyde oxygenase metabolic chains. Currently, we are just beginning to realize that active oxygen and antioxidants can modulate the induction of physiological signals, and that these effects are not limited to the immune system. The effects of antioxidant treatment could represent neutralization of harmful radicals, albeit they can simply represent modulation of complex biochemical events which are essential parts of normal metabolism. Some natural antioxidants, e.g. alfa-to-copherol, ascorbic acid and beta-carotens are very good means of the primary prevention, but with acute failure of local antioxidants, they do not prevent the excessive production of proliferative inflammatory tissue. Tirilazad-mesylate has threefold beneficial influences: first as an inhibitor of the creation of oxygen radicals, second as a scavenger or quencher of free oxygen radicals, and finally in the arrangement of the defects in the phospholipid bilayer and possible receptors of macrophages, as well as T cells. The drug is suitable for active modulation of locally changed immune reactions and thus it rejects harmful proliferative inflammation in the subdural space. Until recently it has been eliminated by surgical procedure. The authors expel the thick (0.8 cm) subdural collection of the proliferative inflammatory product by tandem treatment which includes methylprednisolon+tirilazad-mesylate for three days, followed by fourteen days of methylprednisolon, which was gradually decreased in daily oral doses. This is a revolutionary change in the treatment of similar intracranial processes. (Fig. 4, Ref. 21.)