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Journal Article 2010; 31(6): 823-828 PubMed PMID: 21196926 Citation  Keywords:  Acromegaly:etiology, Adenoma:complications, Adult, Aged, Biomarkers, Tumor:metabolism, Early Diagnosis, Female, Growth Hormone-Secreting Pituitary Adenoma:complications, Humans, Immunohistochemistry, Ki-67 Antigen:metabolism, Male, Middle Aged, Neoplasm I.   

OBJECTIVE: In many pituitary tumor, immunohistochemical studies have been shown to be correlated with different aspects of tumor behavior.There is no study up to date in which markers of Ki-67, p53, VEGF were evaluated concomitantly in GH-secreting adenomas.This study aims to determine which marker has a major role in tumor behavior and whether these markers have a cut-off value to distinguish invasive adenoma from non-invasive pituitary adenoma.

METHODS: Fourty-seven acromegalic patients operated by the same neurosurgeon were included in this study.Twenty-one patients(5micro/16 macro) had non-invasive adenomas and 26 had invasive macroadenomas.Eight patients(6 invasive macroadenomas, 2 microadenomas) were treated with OCT-LAR until one month prior to surgery with treatment duration range of 3-11 months.These patients were excluded from the study group as the noninvasive and invasive adenomas were compared.A separate analysis was performed in invasive adenomas to compare OCT(+) and OCT(-)patients.

RESULTS: Both Ki-67 and p53 expressions showed no correlation with the invasive character of adenomas, but VEGF expression in invasive adenomas was significantly higher with respect to noninvasive group.Our study has taken intermediate staining (>25 %)for VEGF as a cut off value for invasive adenomas.It was also observed that the decrease in VEGF staining in OCT pretreated invasive adenomas was significantly more than those not treated with OCT.

CONCLUSION: VEGF becomes an independent stimulator of angiogenic growth and progression for GH-secreting adenomas with >25% cytoplasmic immunoreactivity.This cut-off value may be useful in determination of prognosis and appropriate treatment strategy.A short term preoperative OCT treatment may be useful as adjunctive therapy especially for locally invasive GH- secreting adenomas....

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Journal Article 2010; 31(6): 747-753 PubMed PMID: 21196923 Citation  Keywords:  Anisotropy, Attention Deficit Disorder with Hyperactivity:diagnosis, Case-Control Studies, Child, Cognition, Diffusion Tensor Imaging, Executive Function, Female, Frontal Lobe:pathology, Functional Laterality, Humans, Male, Neuropsychological Tests,.   

UNLABELLED: Abnormalities of frontal white matter (WM) have been found in some children with ADHD. The purpose of this study was to explore the changes in WM in child patients with ADHD by DTI, which detects changes in WM microstructure based on properties of diffusion. We also expect to investigate the relationship between the changes in WM and executive function in child patients with ADHD. DTI was performed on 24 patients with ADHD and 20 healthy controls. A series of neuropsychological tests and a structural interview were conducted to assess the cognitive functions and clinical data of the ADHD patients and controls. Firstly, child patients with ADHD have higher fractional anisotropy (FA) values in WM in the right frontal region. Secondly, FA in right frontal WM is positively correlated with scores in the Stroop test.

CONCLUSIONS: Increased FA of right frontal WM implies a higher degree of myelination and lower degree of neural branching in WM, contributing to the neurological deficits of ADHD....

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Journal Article 2010; 31(6): 754-760 PubMed PMID: 21196922 Citation  Keywords:  Adolescent, Adult, Analysis of Variance, Antidepressive Agents:therapeutic use, Body Mass Index, Body Weight:drug effects, Combined Modality Therapy, Feeding and Eating Disorders:diagnosis, Female, Humans, Inpatients, Male, Personality Inventory, Precisio.   

OBJECTIVE: The goal of this study is to determine how a comprehensive approach comprising a combination of a particular psychotherapeutic programme and antidepressant treatment influences the signs and symptoms of eating disorders.

METHODS: Inpatients entering a particular 6-week programme were assessed using body mass index (BMI), Eating Disorder Inventory (EDI), Eating Attitudes Test (EAT-26) and psychological symptoms using Symptom Checklist (SCL-90).

RESULTS: In the whole group (n=84) the mean BMI remained stable (17.9, 17.8). There was a significant effect of TIME in the repeated measures ANOVA with most of dependent variables. The "TREATMENT" had no effect (antidepressants, no antidepressants) and there was no significant interaction between "TREATMENT" and "TIME". Post-hoc analysis revealed significant differences between baseline and end-point values of all but two EDI, all EAT items and some SCL dimensions in the antidepressant-treated group.

CONCLUSIONS: The comprehensive and individualized approach is able to achieve weight stabilization, and improvement in attitudes, pathological eating behaviour and psychopathology....

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Journal Article 2010; 31(6): 818-822 PubMed PMID: 21196921 Citation  Keywords:  Adult, Aged, Aged, 80 and over, Anticonvulsants:therapeutic use, Diagnosis, Differential, Diagnostic Errors:statistics & numerical data, Drug Resistance, Electroencephalography, Epilepsy:classification, Female, Follow-Up Studies, Humans, Male, Middle Aged.   

OBJECTIVE: There is no universally accepted definition of pseudo-intractable epilepsy. Pseudo-intractability means that the resistance to treatment is, in fact, caused by clinical errors. The purpose of our study was to identify the reasons for intractability and subsequent effective therapeutic management approaches in a group of patients with established pseudo-intractable epilepsy.

METHODS: The study was designed as a retrospective audit of 100 adult patients who, in their past medical history, were diagnosed as having intractable epilepsy but, following adjustments to their medical management, were seizure free for at least 2 years. Patients underwent standard clinical evaluation, including EEG and/or video-EEG monitoring. We re-evaluated past medical, family, seizure and pharmacological history and morphological findings. Epilepsy was re-classified according to the ILAE classification.

RESULTS: We identified possible errors including incorrect diagnosis and/or inappropriate previous epilepsy management in all 100 patients. Incorrect diagnosis (seizure type and/or syndrome) was observed in 47 patients (47%). Thirty two patients (32%) with idiopathic generalized epilepsy were treated for complex focal seizures with inappropriate choice of medication. Therapeutic errors were identified in 48 patients (48%). Issues with medication compliance were found in 20 patients (20%). Potential seizure precipitating factors were detected in 23 patients (23%).

CONCLUSIONS: Our study of 100 patients confirmed that the problem of pseudo-intractability still exists. Every case of pharmacoresistance in epilepsy could potentially be caused by one or more clinical errors....

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Comment 2010; 31(6): 728; author reply 729-730 PubMed PMID: 21196919 Citation  Keywords:  Brain:pathology, Child, Diagnosis, Differential, Diffusion Magnetic Resonance Imaging, Edema:diagnosis, Humans, Magnetic Resonance Imaging, Male, Nephrotic Syndrome:complications, Posterior Leukoencephalopathy Syndrome:diagnosis,.   

: Kabicek and colleagues described a case of nephritic-syndrome-associated posterior reversible encephalopathy syndrome (PRES) (Kabicek, et al. 2010). This adds to the accumulating evidence that PRES can be associated with disorders other than hypertension. However, we wonder how the authors would explain the neuroimaging findings unsuggestive of vasogenic oedema. PRES (also named reversible posterior leukoencephalopathy syndrome, RPLS) represents a clinicoradiological syndrome characterized by vasogenic oedema as revealed by apparent diffusion coefficient (ADC) map of diffusion-weighted imaging (DWI) (Bartynski, 2008). The pathogenesis of PRES has been suggested to be autoregulation failure and endothelial dysfunction (Sharma, et al.). ......

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Journal Article 2010; 31(6): 837-841 PubMed PMID: 21196912 Citation  Keywords:  Adult, Attention, Autistic Disorder:diagnosis, Female, Humans, Japan, Male, Salivary Glands:metabolism, Sex Factors, Testosterone:metabolism,.   

OBJECTIVES: The purpose of this study is to examine the relationship between salivary testosterone levels and autistic traits in adults.

METHODS: A total of 92 male and female adults participated in the present study. Their salivary testosterone level (T) and score of Japanese version of Autism-spectrum Quotient (AQ) were assessed to examine the relationship between salivary testosterone level and autistic traits in adults.

RESULTS: We observed a positive correlation between T and AQ in a group of both sexes. The correlation disappeared when we conducted correlation analysis by sex. However, although there was no sex difference in the score of the subscale of attention switching, attention switching was related to T.

CONCLUSIONS: Although the relationship between T and AQ may mainly result from sex differences, the subscale of attention switching may be modulated by testosterone....

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Journal Article 2010; 31(6): 842-847 PubMed PMID: 21196907 Citation  Keywords:  Adult, Comorbidity, Diagnosis, Differential, Female, Fetal Development, Fetal Growth Retardation:diagnostic imaging, Fetus, Humans, Hypertension, Pregnancy-Induced:diagnostic imaging, Pregnancy, Smoking:adverse effects, Ultrasonography, Prenatal, Umbilica.   

OBJECTIVE: The aim of this study was to determine the characteristic features of the umbilical cord morphology in selected cases of intrauterine growth restriction (IUGR): tobacco smoking, pregnancy-induced hypertension and idiopathic IUGR.

MATERIALS AND METHODS: 136 pregnant women were included in the study - 86 patients with IUGR (IUGR group) and 50 women with uncomplicated course of pregnancy (control group). In the IUGR group 31 women were smokers, 27 suffered from pregnancy-induced hypertension, and 28 had an unknown reason for IUGR. Each of them underwent ultrasound examination to measure fetal growth and to assess morphological parameters of the umbilical cord.

RESULTS: Significant differences between the control group and the whole IUGR group in terms of the diameter of the umbilical cord and diameter of the umbilical vein - smaller diameters in the IUGR group than in the control group. Significant differences among IUGR subgroups in terms of area of Wharton's jelly and diameters of the umbilical cord, vein and artery. Significant difference in the length of the uncoiled section among the IUGR subgroups.

CONCLUSIONS: 1. The umbilical cord in IUGR and concomitant tobacco smoking is hyper-coiled with coiling index independent of fetal weight and high content of Wharton's jelly. 2. The umbilical cord in IUGR and concomitant pregnancy-induced hypertension is thinnest with thinnest vessels and the smallest content of Wharton's jelly. 3. The assessment of umbilical cord morphology should become an integral part of ultrasound exam in pregnancies complicated by IUGR....

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Case Reports 2010; 31(Suppl 2): 5-7 PubMed PMID: 21187823 Citation  Keywords:  Disease Progression, Fatal Outcome, Humans, Incidence, Infant, Newborn, Male, Metal Metabolism, Inborn Errors:complications, Molybdoferredoxin, Neurodegenerative Diseases:diagnosis, Slovakia:epidemiology,.   

OBJECTIVE: To present the case of a term newborn with rapid progression of signs of neurodegenerative disease.

RESULTS: In a case of a term newborn with numerous dysmorphic features, with seizure activity from the 3rd day of life, hypertonia and serious changes on brain parenchyma were presented. Diagnosis of molybdenum cofactor deficiency was confirmed by the decreased level of uric acid, 31 μmol/l, in serum, increased excretion of thiosulfate and S-sulfocysteine in urine, taurine (1729.3 μmol/mmol crea; normal range 30-300 μmol/mmol crea) and xanthine (276.9 μmol/mmol crea; normal range < 25 μmol/mmol crea) in urine. Sulfite oxidase activity on skin fibroblasts in culture was not detectable. The patient died at the age of 28 days of life.

CONCLUSION: Deficiency of molybdenum cofactor leads to accumulation of toxic metabolites (levels of sulfite), which causes disturbances of neurotransmitters even before delivery. Therapy is symptomatic, no effective therapy is available. Seizures are difficult to suppress. This case report is about the first patient in Slovakia....

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