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Journal Article 2001; 22(1): 53-73 PubMed PMID: 11393163 Citation  Keywords:  Adrenal Glands:physiology, Animals, Biological Clocks, Blood Pressure:physiology, Chronobiology Disorders:physiopathology, Chronobiology Phenomena, Chronotherapy, Circadian Rhythm:physiology, Drug Administration Schedule, Genomics, Homeostasis, Humans, Pi.   

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Case Reports 2012; 33(8): 769-772 PubMed PMID: 23391981 Citation  Keywords:  Adult, Astrocytoma:complications, Biopsy, Diagnosis, Differential, Encephalomyelitis:complications, Fatal Outcome, Humans, Magnetic Resonance Imaging, Male, Spinal Neoplasms:complications,.   

: The aim of this paper is to demonstrate that differential diagnostics of intra-medullary spinal lesions can sometimes be very difficult, even when the latest complement examinations are used, including magnetic resonance imaging. The particular case dealt with here was complicated by the presence of two different pathological processes. We present the case report, where the case history, clinical course and results of the paraclinical examinations, including the magnetic resonance imaging, suggested an intra-medullary inflammatory/demyelinating process. The post-mortem histological finding was a surprise, because besides signs of non-specific encephalomyelitis, it also displayed signs of a spinal tumor (histological character of diffuse astrocytoma grade II-III). We would like to emphasize some important facts in our discussion, especially from the perspective of the magnetic resonance imaging. Finally, we would like to ask if the presence of both pathologies (astrocytoma and nonspecific myelitis) was coincidental, or if the myelitis had an iatrogenic etiology (by therapy, by infection during the lumbar punctions)....

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Journal Article 2012; 33(8): 761-764 PubMed PMID: 23391980 Citation  Keywords:  Affect, Aged, Aged, 80 and over, Anxiety Disorders:psychology, Humans, Male, Middle Aged, Orchiectomy:methods, Palliative Care:psychology, Patient Satisfaction, Prostatic Neoplasms:psychology, Psychology, Quality of Life:psychology, Stress, Psychological:.   

OBJECTIVES: The study presented focuses on patients' psychosocial status after a prostate cancer diagnosis that underwent a bilateral orchiectomy.

METHODS: We evaluated the psychosocial implications of 89 patients with prostate cancer after performing castration and a bilateral orchiectomy.

RESULTS: Patients suffered significantly more from sleep disorders during hospitalisation when compared to their time prior to an orchiectomy (p<0.0005). There were some increases in the severity of sleep disorder after discharge (level of evidence p<0.05). However, no additional medications for sleep disorders were required. Additionally, there was a significant reduction in the abuse of medication (p<0.001). Ten per cent of the patients were in the care of a psychologist or a psychiatrist before their diagnosis, and 21% asked for the help of a psychologist or a psychiatrist after having a bilateral orchiectomy. The occurrence of mood disorders is also very different than the occurrence of sleep disorders. Mood disorders occurred much less often after orchiectomy and discharge (p>0.085) compared with the period before surgery. Forty per cent of the patients had mood disorders before their operation, while only 37% still had these after discharge. There was a significant decrease in abuse of medication for anxiety. Twenty-four per cent of the patients took medication during hospitalisation, and only 10% continued after orchiectomy.

CONCLUSIONS: The results of the study show that patients who were notified about their cancer diagnosis, particularly their health status, exhibited moderate stress and psychological impact....

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Case Reports 2012; 33(8): 757-760 PubMed PMID: 23391976 Citation  Keywords:  Adult, Anorexia Nervosa:complications, Avitaminosis:complications, Chronic Disease, Female, Humans, Hyperthyroidism:complications, Microscopy, Electron, Motor Neurons:physiology, Polyneuropathies:etiology, Sensory Receptor Cells:physiology, Severity of Il.   

OBJECTIVES: Hyperthyroidism is often associated with various neuromuscular disorders, most commonly proximal myopathy. Peripheral nerve involvement in hyperthyroidism is very uncommon and has rarely been reported. We describe a 29-year-old woman with untreated hyperthyroidism who presented with chronic severe axonal sensory-motor polyneuropathy. Peripheral nerve involvement developed together with other symptoms of hyperthyroidism 2 years before presentation. She also had anorexia nervosa for the past 6 months, resulting in multivitamin deficiency.

RESULTS: Electrophysiological and pathological findings as well as clinical manifestations confirmed the diagnosis of severe axonal polyneuropathy. Anorexia nervosa has been considered a manifestation of untreated hyperthyroidism. We considered hyperthyroidism to be an important causal factor in the polyneuropathy in our patient, although peripheral nerve involvement in hyperthyroidism is rare. To our knowledge, this is the first documented case of chronic severe axonal polyneuropathy ascribed to both hyperthyroidism and multivitamin deficiency.

CONCLUSION: Our findings strongly suggest that not only multivitamin deficiency, but also hyperthyroidism can cause axonal polyneuropathy, thus expanding the clinical spectrum of hyperthyroidism....

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Case Reports 2012; 33(8): 765-768 PubMed PMID: 23391974 Citation  Keywords:  Adenoma:surgery, Adult, Angiography, Digital Subtraction, Female, Humans, Male, Middle Aged, Neuronavigation:methods, Neurosurgical Procedures:methods, Oculomotor Nerve Diseases:surgery, Pituitary Neoplasms:surgery, Sella Turcica:diagnostic imaging, Sphen.   

: A concha non-pneumatized sphenoid is considered to be a contraindication for the transsphenoidal resection of a pituitary adenoma. Specifically, this anatomical variation makes it difficult to approach the sella turcica. However, in this report, an intra-operative navigational system was used as a guide to access the sella through the sphenoid sinus. This procedure was found to be both reasonable and safe....

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Journal Article 2012; 33(8): 792-795 PubMed PMID: 23391971 Citation  Keywords:  Acidosis, Lactic:mortality, Acute Kidney Injury:mortality, Aged, Critical Care:statistics & numerical data, Diabetes Mellitus, Type 2:drug therapy, Female, Hospital Mortality, Humans, Hypoglycemic Agents:therapeutic use, Incidence, Male, Metformin:therape.   

OBJECTIVES: To evaluate the significance of diabetes mellitus and metformin in patients admitted to medical ICU with lactic acidosis.

METHODS: All the patients admitted to medical ICU with serum lactic acid exceeding 5 mmol/L and pH<7.35 were enrolled into analysis. The impact of diabetes mellitus and metformin treatment on ICU presence of lactic acidosis and its mortality was evaluated. The metabolic parameters were compared with respect to the presence of diabetes mellitus and metformin application.

RESULTS: Lactic acidosis was detected in 69 (4%) out of 1,755 admitted patients, 44 were nondiabetic and 25 had diabetes mellitus, 11 of them treated with metformin. No significant impact of diabetes mellitus or metformin application on presence of lactic acidosis and its mortality was detected. In nondiabetic subjects mortality was associated with eGFR and the presence of acute renal failure while in diabetic patients with sepsis. Acute renal failure was detected in 9 out of 11 patients on metformin. Three patients died due to sepsis, however only 1 out of 6 due to another cause if renal replacement therapy was started soon after admission. The acidosis was more expressed in diabetic subjects mainly in patients taking metformin. It might be attributed to the more pronounced acute renal failure in diabetic patients.

CONCLUSION: The presence of diabetes mellitus and metformin application is not associated with the presence of lactic acidosis in medical ICU and its mortality. The prognosis of acute renal failure of patients on metformin is good if the subjects with sepsis are excluded....

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Clinical Trial 2012; 33(7): 722-726 PubMed PMID: 23391885 Citation  Keywords:  Abdomen:surgery, Adult, Analgesics, Opioid:administration & dosage, Biomarkers:blood, Drug Monitoring:methods, Elective Surgical Procedures, Female, Humans, Hysterectomy:methods, Infusions, Subcutaneous:methods, Middle Aged, Morphine:administration & dosa.   

OBJECTIVES: Systemic β-endorphin, an endogenous opioid and stress hormone, has been demonstrated to correlate with the postoperative pain intensity, however its putative role as a postoperative pain biomarker has not been cleared.

METHODS: Thirty patients scheduled for elective hysterectomy were included into the study. Postoperative pain was assessed by a numeric rating scale from 0 to 10. Plasma morphine concentrations were determined using high performance liquid chromatography with UV detection. Plasma β-endorphin concentrations were measured by a radioimmunoassay.

RESULTS: Administration of morphine in intravenous infusion turned out to be a markedly better method of morphine administration up to 4th hour postoperatively regarding both drug concentration and pain rating. A significant correlation between systemic β-endorphin concentration and pain rating at the 4th postoperative hour was found. No association between morphine and β-endorphin concentrations was detected.

CONCLUSION: Systemic β-endorphin is not an appropriate pain marker in postoperative gynaecologic patients....

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Journal Article 2012; 33(7): 713-721 PubMed PMID: 23391884 Citation  Keywords:  Acute-Phase Reaction:chemically induced, Animals, Anti-Inflammatory Agents, Non-Steroidal:pharmacology, Body Temperature:drug effects, Brain:drug effects, Dopamine:biosynthesis, Fever:chemically induced, Indomethacin:pharmacology, Lipopolysaccharides:toxi.   

OBJECTIVES: The antipyretic and neuroprotective potential of the nonsteroidal anti-inflammatory drug "indomethacin" was tested against lipopolysaccharide-produced hyperthermia and biosynthesis of norepinephrine and dopamine, in six brain regions of male rat.

METHODS: Observations were based on a single intraperitoneal injection of each of lipopolysaccharide (250 µg Kg-1 body wt) and indomethacin (20 mg Kg-1 body wt) followed by sampling and assaying of brain specimens after 2, 8, 12 and 24 hrs. lipopolysaccharide induced a general hyperthermia (8-24 hr) that was completely abolished by pretreatment with indomethacin.

RESULTS: In virtually all brain regions tested, lipopolysaccharide stimulated the biosynthesis of norepinephrine and dopamine. Yet, pretreatment with indomethacin provoked substantial mitigation predominantly after 24 hrs. A time-based manner attended by a regionally nonselective manner characterized lipopolysaccharide-induced monoamine biosynthesis; whereas, indomethacin alleviation seems to proceed in a time-dependent and regionally-selective pathway since the pons proved the fastest and/or most responsive brain region to indomethacin action. A role of prostaglandin synthesis in the development of lipopolysaccharide-induced fever and catecholamine biosynthesis was suggested, given that both responses were abolished by the cyclooxygenase-inhibitor indomethacin.

CONCLUSION: Accordingly, our data verified the potent therapy potential of indomethacin in protecting cerebral noradrenergic and dopaminergic systems against lipopolysaccharide-induced acute phase reactions....

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