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Journal Article 2012; 33(3): 340-346 PubMed PMID: 22635095 Citation  Keywords:  Adult, Aged, Bromocriptine:administration & dosage, Dopamine Agonists:administration & dosage, Dose-Response Relationship, Drug, Ergolines:administration & dosage, Female, Heart Valve Diseases:chemically induced, Humans, Male, Middle Aged, Pituitary Neopl.   

OBJECTIVES: Prolactinoma is the most common pituitary adenoma, and dopamine agonists( BRC, and CAB) is the primary therapy. Recently, the increased prevalance of cardiac valvular disease in patients treated with DAs for Parkinson's disease has raised concerns about the safety of this drug in patients with prolactinoma. CAB and pergolide are frequently reported to cause valvulopathy, there are very few studies showing this side effect in BRC administiration which has less potent agonism of 5-HT2B receptors. Male patients who are known to have higher prevalance of macroadenomas compared to women. The dosage of DAs administered were rarely evaluated.

METHODS: We performed a retrospective chart to evaluate the medical management and treatment outcomes of male patients with macro/giant prolactinomas. We evaluated 22 patients with prolactinoma managed with DAs therapy alone for at least 1 year. All patients were followed for a mean of 61 months. Pretreatment echocardiographic examination were not available at that time.

RESULTS: None of them had any resistance or intolerance to DAs. The mean tumor shrinkage was 62%. In three patients the macroprolactinoma disappeared, in two patients the tumor shrinkage was 93% and 70%. The DAs therapy was discontinued in these patient. After a follow up neither MRI showed a recurrence or enlargement of the adenoma, nor prolactin levels showed any elevation. The echocardiography were performed at the last visit of each patient and no valvulopathy in any of the patients on DAs therapy were detected.

CONCLUSIONS: DAs are effective, and safe for valve morphology with mean cumulative doses of 155 mg CAB, and 7 301 mg BRC in patients with macroprolactinoma....

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Journal Article 2012; 33(3): 321-330 PubMed PMID: 22635093 Citation  Keywords:  Adult, Case-Control Studies, Databases, Genetic, Female, Genetic Predisposition to Disease:genetics, Genotype, Humans, Insulin Receptor Substrate Proteins:genetics, Male, Middle Aged, Polymorphism, Single Nucleotide:genetics, Schizophrenia:genetics,.   

OBJECTIVES: Since there are clear indications that schizophrenia is a systemic disorder, we sought for a common molecular basis for schizophrenia abnormalities in brain and body. Our hypothesis was that an impaired insulin and insulin-like growth factor signalling in cells might underlie changes in both brain and body in schizophrenia. In this regard, the insulin receptor substrates 1-4, linking both the insulin and insulin-like growth factor-1 receptors with intracellular pathways, might be of interest to study genetically. In the present study, we chose to study the insulin receptor substrate-3 (IRS-3) gene as a candidate gene in schizophrenia.

METHODS: The IRS-3 gene of 93 patients with the diagnosis of schizophrenia according to DSM-IV criteria and 57 healthy control subjects was screened for DNA sequence variations, followed by case-control analyses of total 10 detected polymorphisms.

RESULTS: The A/G genotype of the single nucleotide polymorphism (SNP) rs117078492 in the IRS-3 gene occurred in 5.3% of the control subjects compared with in 0% of the patients (p=0.05). Similarly, the haplotypes 5 and 3X, constructed from polymorphisms in the IRS-3 gene and including the A allele of this A/G SNP, occurred only in the control subjects and not in the patients (5.3% vs 0%, p=0.05).

CONCLUSION: Our findings suggest that individuals carrying the A allele of this A/G SNP in the IRS-3 gene as well as the estimated haplotypes 5 or 3X including this A allele, have a protection against schizophrenia development....

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Journal Article 2012; 33(3): 294-297 PubMed PMID: 22635087 Citation  Keywords:  Aged, Aged, 80 and over, Brain Ischemia:epidemiology, Coronary Artery Disease:epidemiology, Female, Humans, Logistic Models, Male, Middle Aged, Recurrence, Retrospective Studies, Risk Factors, Stroke:epidemiology,.   

BACKGROUND: Coronary artery disease (CAD) is a leading cause of long-term mortality in Europe and it negatively influences the outcome after stroke. However, its influence on stroke recurrence which endangers stroke patients mostly in the first months following stroke, is unclear. Previous studies have found no association between CAD and ischemic stroke recurrence. However, assessment of the relationship was not the primary endpoint of these investigations. The aim of this study was to assess the possible association between CAD and stroke recurrence.

PATIENTS AND METHODS: In a hospital-based, retrospective study, the set consisted of 190 patients - 105 patients with a first ever stroke (48 males; age 37-88, mean 70.7±12.5 years) and 85 patients with stroke recurrence (36 males; age 46-94, mean 88.0±9.6 years). CAD was correlated with the following other risk factors (age, sex, occurrence of arterial hypertension, atrial fibrillation, diabetes mellitus, plasma levels of total cholesterol, triglycerides, low-density cholesterol, high-density cholesterol, body mass index, presence of carotid plaques). Logistic regression analysis was used for the statistical evaluation.

RESULTS: No significant association was found between CAD and stroke recurrence. Of all of the other observed risk factors, only age showed a significant association with stroke recurrence (OR 1.04, 95% CI: 1.02-1.07).

CONCLUSION: The results of the presented study indicate that CAD does not influence stroke recurrence....

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Case Reports 2012; 33(3): 257-259 PubMed PMID: 22635079 Citation  Keywords:  Androgens:metabolism, Female, Humans, Immunohistochemistry, Middle Aged, Ovarian Neoplasms:complications, Ovary:pathology, Sertoli-Leydig Cell Tumor:complications, Testosterone:metabolism, Virilism:etiology,.   

: Sertoli-Leydig cell tumor is a rare and usually unilateral tumor of the ovary occurring in women's reproductive age. Only about 10% of these patients are over 50 years of age. One third of these patients are suffering from signs of virilisation. This work summarizes the morphological and immunohistochemical characteristics of this tumor in a 56-year old woman with clinical signs of virilisation....

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Journal Article 2012; 33(2): 236-244 PubMed PMID: 22592207 Citation  Keywords:  Adolescent, Adult, Aged, Alleles, Antipsychotic Agents:adverse effects, Cytochrome P-450 CYP2D6:genetics, Female, Genotype, Humans, Male, Middle Aged, Prospective Studies, Psychiatric Status Rating Scales:statistics & numerical data, Psychotic Disorders:d.   

OBJECTIVE: The objective of this prospective, naturalistic study, conducted in first-episode psychosis patients from a Central-European population, was to assess the utility of Cytochrome P-450 2D6 (CYP2D6) genotype testing under normal clinical setting.

METHODS: A total of 35 patients diagnosed for the first time with schizophrenia or acute schizophrenia-like psychotic disorder and treated with risperidone were enrolled in the study. These patients underwent sequentiation of the CYP2D6 gene and evaluations of symptoms and severity of adverse effects using the PANSS and UKU scales, respectively. Doses of antipsychotics and other co-medication were monitored as well. In statistical analysis, Fisher's exact test was used to compare ratios and the Wilcoxon rank-sum test was used in the comparison of continual variables.

RESULTS: PM patients showed a significantly lower reduction in psychotic symptoms and a greater severity of psychotic symptoms following risperidone treatment and higher doses of antipsychotics not metabolized by CYP2D6, which were used as co-medication.

CONCLUSIONS: Based on these results, patients with the PM genotype experiencing first-episode schizophrenia don't appear to be optimal recipients of risperidone treatment. However, as the main limitation of this study was the relatively small sample-size, replication with a larger scale study is needed to confirm these findings....

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Journal Article 2012; 33(2): 217-223 PubMed PMID: 22592205 Citation  Keywords:  Adiponectin:blood, Aged, Aged, 80 and over, Biomarkers:blood, Case-Control Studies, Endometrial Neoplasms:blood, Female, Humans, Leptin:blood, Middle Aged, Postmenopause:blood, Predictive Value of Tests, Sensitivity and Specificity, Uterine Hemorrhage:blo.   

OBJECTIVES: To evaluate the correlation between endometrial cancer and adiponectin plasma concentration, leptin plasma concentration as well as adiponectin to leptin index in the population of postmenopausal women with abnormal vaginal bleeding.

DESIGN: An observational study SETTINg: Department of Gynecology and Obstetrics, Specialist Teaching Hospital in Tychy, Poland. Population. 99 women between 47 and 88 years old, in postmenopausal state.

METHODS: The cases (54 women) were females hospitalized due to postmenopausal vaginal bleeding in whom dilation and curettage (D&C) was performed and endometrial intraepithelial neoplasia (EIN) was diagnosed in anathomopathology. Hysterectomy was then performed in all cases and the endometrial cancer diagnosis was confirmed. The controls (45 women) consists of females with no postmenopausal uterine bleeding in whom endometrial thickness in transvaginal ultrasound was greater than 5 mm. D&C was than performed and no endometrial neoplasia was detected in any of the subjects. Adiponectin and leptin plasma concentration was measured in both groups. Mein outcome measures. The area under the curve, sensitivity, specificity and cutoffs for adiponectin, leptin and adiponectin to leptin index.

RESULTS: Adiponectin, leptin and adiponectin to leptin index were statistically correlated with the risk of endometrial cancer. At the suggested cutoffs, corresponding to the highest accuracy (minimal false-negative and false-positive results), adiponectin to leptin index resulted in the highest sensitivity and specificity compared to adiponectin and leptin alone.

CONCLUSIONS: Adiponectin to leptin index due to the highest sensitivity and specificity may be used as a marker of endometrial cancer in postmenopausal women with abnormal vaginal bleeding....

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Comparative Study 2012; 33(2): 212-216 PubMed PMID: 22592204 Citation  Keywords:  Adult, Endometrium:diagnostic imaging, Endosonography:methods, Female, Humans, Hysteroscopy:methods, Imaging, Three-Dimensional:methods, Middle Aged, Perimenopause, Sensitivity and Specificity, Uterine Hemorrhage:diagnosis, Uterus:diagnostic imaging,.   

OBJECTIVE: In many publications the transvaginal ultrasound is regarded as the first step to diagnose the cause of uterine bleeding in perimenopausal women. In order to improve the sensitivity and specificity of the conventional ultrasound physiological saline solution was administered to the uterine cavity and after expansion of its walls the interior uterine cavity was examined. And this procedure is called 2D sonohysterography (SIS 2D). By the ultrasound scanners which enable to get 3D real time image a spatial evaluation of the uterine cavity is possible. Clinical value of the real time 3D sonohysterography and 2D sonohysterography compared to hysteroscopy with histopathological examination in perimenopausal women.

MATERIAL AND METHODS: The study concerned a group of 97 perimenopausal women with abnormal uterine bleeding. In all of them after a standard transvaginal ultrasonography a catheter was inserted into the uterine cavity. After expansion of the uterine walls by administering about 10 ml of 0,9% saline solution the uterine cavity was examined by conventional sonohysterography. Then a 3D imaging mode was activated and the uterine interior was examined by real time 3D ultrasonography. The ultrasound results were verified by hysteroscopy, the endometrial lesions were removed and underwent a histopathological examination.

RESULTS: In two cases the SIS examination was impossible because of uterine cervix atresion. In the rest of examined group the SIS 2D sensitivity and specificity came up to 72 and 96% respectively. In the group of SIS 3D the sensitivity and specificity reached 83 and 99% respectively.

CONCLUSIONS: Adding SIS 3D, a minimally invasive method, to conventional sonohysterography improves the precision of diagnosis of endometrial pathology, allows to get three-dimensional image of the uterine cavity and enables examination of endometrial lesions. The diagnostic precision of this procedure is similar to the results achieved by hysteroscopy....

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Journal Article 2011; 32(6): 821-830 PubMed PMID: 22286800 Citation  Keywords:  Adult, Aged, Biomarkers, Tumor:metabolism, Breast Neoplasms:enzymology, Diagnosis, Differential, Female, Humans, Matrix Metalloproteinase 11:metabolism, Matrix Metalloproteinase 2:metabolism, Middle Aged, Prognosis, Recurrence, Survival Rate,.   

BACKGROUND: Breast cancer is the most common malignancy in women in the U.S. and Europe. In the early stages of the disease, women are treated surgically, which is supplemented with hormonal therapy, immuno-, chemo- or radiotherapy. Postoperative qualification for further treatment is based on clinical stage, the pathology of the tumor and classic prognostic factors. Despite that, among patients with breast cancer in early stages of clinical advancement, there is a relatively large proportion of observed tumor recurrence. These observations oblige the search for additional prognostic factors that determine the progression of the disease faster, according to which, could emerge a group of women at increased risk of recurrence of the disease.

AIM: The aim of this paper is to determine the meaning of the expression of selected metalloproteinases as prognostic factors in breast cancer.

METHODS: The study group consisted of 108 patients ages 26 to 86 years treated surgically from 1994 to 2000 because of primary breast cancer in the early clinical stage, ie stage I and II according to TNM classification.

RESULTS: Between two of the tested metalloproteinases (MMP-2 and MMP-11) only MMP-2 appears to have prognostic significance in early forms of breast cancer, and its strong expression is associated with shorter survival....

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