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Journal Article 2015; 36(3): 269-281 PubMed PMID: 26313395 Citation  Keywords:  Adult, Amygdala:physiopathology, Cognitive Therapy:methods, Female, Frontal Lobe:physiopathology, Humans, Magnetic Resonance Imaging, Male, Outcome Assessment (Health Care), Panic Disorder:diagnosis, Parietal Lobe:physiopathology, Prognosis,.   

OBJECTIVE: Previous functional brain imaging studies have described various and contradictory activation findings in patients with panic disorder (PD). Our study focused on patients with a chronic PD, who were investigated and treated in a conventional manner, which represents the real PD patients in clinical practice.

METHODS: Continuing their medication, patients were included in a six-week cognitive-behavioral therapy (CBT) program in the psychiatry department. At the onset of the study, participants underwent clinical evaluation using standard scales and were examined using fMRI while listening to verbal threat-related stimuli contrasted to neutral words. According to the therapeutic outcome, they were subsequently divided into two groups, responders, and nonresponders and the two groups were mutually compared.

RESULTS: In non-responders compared to responders, we found increased pre-treatment activation in dorsolateral prefrontal cortex bilaterally, left orbitofrontal cortex, left frontal eye field, right parietal lobule and left amygdala. In addition, both groups showed negative fMRI BOLD correlation with BAI improvement and positive correlation with CGI improvement across the ROIs. We suggest that DLPFC over-activation may reveal a lack of cognitive control over emotional processing, which makes subsequent CBT less effective.

CONCLUSION: Despite several limitations, we found neuroimaging predictors of poor CBT response, under the conditions of standard clinical practice, in real PD patients....

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Journal Article 2015; 36(3): 214-225 PubMed PMID: 26313386 Citation  Keywords:  Functional Neuroimaging:methods, Humans, Magnetic Resonance Imaging:methods, Neurobiology:methods, Panic Disorder:physiopathology, Psychotherapy:methods,.   

: Fifty years ago, when the effect of antidepressants on panic disorder was described, a significant progress in understanding this anxiety disorder has been made. Theoretical mechanisms and models of fear and panic disorder were proposed and tested in animal models and humans. With growing possibilities of non-invasive neuroimaging techniques, there is an increasing amount of information on the panic disorder. Unfortunately, a number of circumstances lead to inconsistent findings and its interpretations. In our review, we focused on functional MRI in panic disorder, limitations of current studies, possible interpretations and proposals for future direction. In our opinion, the current findings support the neuroanatomical model of panic disorder at the level of group data analysis. But at the same time, the results suggest significant inter-individual differences across the patients, which may be related to each patient's individual history, woven into their neural network and affecting the individual symptoms and response to therapy....

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Journal Article 2014; 35(8): 697-702 PubMed PMID: 25702298 Citation  Keywords:  Adult, Depressive Disorder, Major:pathology, Diffusion Tensor Imaging:methods, Female, Humans, Male, Nerve Regeneration:physiology, White Matter:anatomy & histology,.   

OBJECTIVE: While increasing evidence suggests that major depressive disorder (MDD) is coincident with the altered white matter microstructure in many brain regions including the prefrontal cortex, parietal lobe, ventral tegmental area and limbic system, it remains controversial in the nature of white matter structural changes and in its relationship with depression syndrome. We believe that the age of patients and the antidepressant treatment to them would contribute to that controversy. Here in this study we explored the microstructural changes of the entire brain white matter of the adult patients with first-episode, antidepressant drug-naïve MDD.

DESIGN: We performed the diffusion tensor imaging (DTI) among a relatively large sample size of patients and age-matched control individuals (forty-one MDD patients and forty-one control subjects) and used recently developed tract-based spatial statistics to analyze the difference of mean fractional anisotropy (FA) between patients and control individuals.

RESULTS: We surprisingly found that MDD patients exhibited a significantly greater mean FA, which is used to elucidate the structural organization of the neural fibers, than control subjects in the whiter matter of the left superior longitufinal fasciculus. However, this change in the white matter of MDD patient did not correlate with depressive clinical features (HMAD, illness duration and initial age) in the present study.

CONCLUSION: Our data suggest that a potential compensatory regeneration of nerve fibers occurs in the early course of MDD development. Advanced understanding of the potential nerve fiber regeneration in the early course of MDD and its associated mechanisms will possibly shade light on a better strategy for MDD prevention and treatment....

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Case Reports 2014; 35(8): 673-675 PubMed PMID: 25702294 Citation  Keywords:  Adenocarcinoma:diagnostic imaging, Colonic Polyps:diagnostic imaging, Colonoscopy:instrumentation, Female, Humans, Middle Aged, Sigmoid Neoplasms:diagnostic imaging, Ultrasonography:instrumentation, Vagina:diagnostic imaging,.   

: Adenocarcinoma of the colon represents the third most frequent cause of death from cancer, being surpassed only by lung and stomach cancer. Early screening and diagnosis of polyps are important for a good prognosis. Based on a clinical case, a novel approach is presented for screening of sigmoidal polyps and neoplasia using transvaginal 2D, 3D mode in women. This novel and simple technique can be used to visualize the sigmoid diverticula during routine gynecological examination via 3D transvaginal ultrasound probe....

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Journal Article 2014; 35(7): 613-618 PubMed PMID: 25617885 Citation  Keywords:  Adult, Aged, Aged, 80 and over, Biopsy:adverse effects, Brain Neoplasms:mortality, Female, Humans, Lymphoma:mortality, Magnetic Resonance Imaging:methods, Male, Middle Aged, Morbidity, Retrospective Studies, Risk Factors, Stereotaxic Techniques:adverse ef.   

OBJECTIVES: Stereotactic biopsy is a suitable method for sampling intrinsic brain lesions. Although this method is considered to be a safe procedure, some risk of complications still exists. The aim of the study was to retrospectively assess the morbidity and mortality of MRI-guided stereotactic biopsy of lesions which were histologically proven to be brain lymphoma.

METHODS: We retrospectively studied all accessible medical records for patients who had undergone MRI-guided stereotactic biopsy of brain lesions with histologically proven brain lymphoma from January 2007 to December 2012. Our cohort included 45 patients, 27 males and 18 females, aged 23-84 (63±14) years.

RESULTS: Forty-nine biopsies were carried out on 45 patients; the average number of tissue specimens was 3±1. The diagnostic yield of the stereotactic biopsy was 92%. Overall major morbidity directly related to stereotactic biopsy of brain lymphoma was 6.1% (3 cases) including 4.1% mortality (2 cases). Both deaths after the stereotactic procedure were due to intracranial hemorrhage and subsequent complications and both these patients had a history of treatment of systemic lymphomas. In one patient the stereotactic biopsy was complicated by a brain abscess which was successfully treated.

CONCLUSION: Stereotactic biopsy is still a mandatory diagnostic procedure for primary brain lymphomas, with an acceptable risk of complications. However, according to our results, the risk of complications can be higher in patients who have previously been treated for secondary lymphomas....

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Journal Article 2014; 35(7): 608-612 PubMed PMID: 25617884 Citation  Keywords:  Animals, Brain:diagnostic imaging, Brain Edema:diagnostic imaging, Disease Models, Animal, Male, Rats, Wistar, Tomography, X-Ray Computed:methods, Water Intoxication:diagnostic imaging,.   

OBJECTIVES: The aim of this study was to determine whether water intoxication affects the radiodensity of brain tissue in CT scan examination in the rat model of brain oedema.

METHODS: A standard CT scan of the brain was obtained in a group of rats, first at control conditions (controls - CG) and then after hyperhydration (oedema model-EG) in the region of interest (ROI) corresponding to the area of coronary sections with pixel size 0.125 mm in position A (bregma +2.43 mm), position B (bregma -2.92 mm), position C (bregma -12.73 mm). Densitometrically determined mean values (MV), expressed in Hounsfield units (HU) were processed by standard statistical methods.

RESULTS: The average MV density was 120.49±6.79 HU for the control measurement and 88.01±4.72 HU after the hyperhydration, which represents decrease in the density by 32.48 HU (p<0.001). In the control measurement the average value of HU for the position A was 121.98, for position B 112.4 and for position C 127.08. In conditions of hyperhydration, the average MV density in position A was 89.95 HU in position B 84.67 HU and in position C 89.43 HU. The differences between the CG and EG were in all positions A, B, C statistically significant (p<0.001). In the control measurement, the differences between position A×B (p<0.05) and B×C (p<0.001) were statistically significant. After hyperhydration no significant difference between the position A, B, C was found.

CONCLUSION: water intoxication caused by hyperhydration in rats can induce diffuse brain oedema, which is reflected in the CT examination by the decrease of brain tissue density, expressed in HU. The value of the measured density depends on the location and size of the measured brain area....

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Journal Article 2014; 35(7): 602-607 PubMed PMID: 25617883 Citation  Keywords:  Adult, Aged, Breast Neoplasms:metabolism, Carcinoma, Ductal, Breast:metabolism, Carcinoma, Lobular:metabolism, Female, Fibroadenoma:metabolism, Humans, Membrane Lipids:metabolism, Middle Aged, Neoplasm Staging, Oxidative Stress:physiology, Postoperative P.   

OBJECTIVES: To evaluate the level of oxidative damage to membrane lipids due to the breast cancer surgery in the early postoperative period.

PATIENTS AND METHODS: Blood samples were collected on the preoperative day and 24 hours postoperatively in 71 women operated for breast cancer, and preoperatively in 38 female patients with benign breast tumour. Lipid peroxidation (LPO) in the blood samples was estimated by measuring the concentrations of malondialdehyde+4-hydroxyalkenals (MDA+4-HDA) with spectrophotometry.

CLINICAL DATA INCLUDED: tumour site, tumour histological findings, cancer stage, grade, tumour volume, state of lymph nodes, type of surgery for breast, type of surgery for axilla.

RESULTS: Blood LPO level was similar in breast cancer patients and benign tumour patients (2.01±0.46 nmol/ml vs. 1.92±0.39 nmol/ml, respectively; p>0.05). In cancer patients, MDA+4-HDA increased on the first postoperative day, i.e. from 2.01±0.46 nmol/ml to 2.58±0.98 nmol/ml (p=0.0001). In women with benign breast tumour, LPO did not relate to the histological finding (p=0.8915). In the breast cancer group, preoperative LPO did not correlate with age, tumour volume and number of metastatic lymph nodes. Level of MDA+4-HDA was similar in stages I/II (2.03±0.46 nmol/ml) compared to stages III/IV (1.69±0.26 nmol/ml, p=0.1521). Consequently, levels of MDA+4-HDA did not relate to disease stage (p=0.1364).

CONCLUSIONS: Surgery for breast cancer causes peripheral increase in oxidative damage to macromolecules in the early postoperative period. Therefore, perioperative antioxidant supplementation should be considered....

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Journal Article 2014; 35(7): 586-593 PubMed PMID: 25617881 Citation  Keywords:  Aged, Aged, 80 and over, Aging:immunology, Biomarkers:cerebrospinal fluid, Cytokines:cerebrospinal fluid, Dementia:cerebrospinal fluid, Humans, Hydrocephalus, Normal Pressure:cerebrospinal fluid, Postural Balance, Urinary Incontinence:cerebrospinal fluid,.   

OBJECTIVES: Normal pressure hydrocephalus (NPH) is a treatable neurological syndrome developing in the elderly. It is characterized by balance impairment, urinary incontinence and dementia development caused by disorders in the cerebrospinal fluid (CSF) circulation. The diagnosis can be easily mistaken for other neurodegenerative diseases, which are often accompanied by inflammation and the production of cytokines. The aim of our study was to determine and compare selected CSF and plasma cytokines with respect to their informative value for laboratory diagnostics of NPH.

METHODS: The levels of IL-1β, IL-4, IL-6, IL-10, IL-17A, IL-17F, IL-21, IL-22, IL-23, IL-25, IL-31, IL-33, INF-γ, sCD40L and TNF-α were measured in the CSF and plasma in age-matched subjects with NPH (n=20) and controls (n=20) by multiplex assay.

RESULTS: CSF IL-1β, IL-6 and IL-10 were significantly increased on the 1st day of lumbar drainage in NPH (p<0.01). No significant changes were observed in the plasma. The CSF cytokines were one to three orders of magnitude higher compared to the plasma.

CONCLUSION: CSF can better show the neurodegenerative changes in the brain. The cytokines IL-1β, IL-6 and IL-10 may be helpful in NPH diagnostics....

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