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Journal Article 2013; 34(3): 185-199 PubMed PMID: 23685416 Citation  Keywords:  Consensus, Evidence-Based Medicine, Fatigue Syndrome, Chronic:diagnosis, Humans, Neuroendocrinology, Oxidative Stress:physiology,.   

: The symptom spectrum of Myalgic Encephalomyelitis (ME) was first detailed in 1959 and later operationalised into a diagnostic protocol (Melvin Ramsey). In 1988 the Holmes case definition coined the term chronic fatigue syndrome (CFS). Fukuda's Centers for Disease Control and Prevention criteria are very heterogeneous and comprise patients with milder symptoms than the Holmes case definition. The CDC Empirical Criteria for CFS lack sensitivity and/or specificity. Other CFS definitions, e.g. the Oxford criteria, delineate people with idiopathic fatigue. Some authors make the clinical CFS diagnosis when slightly increased self-rated fatigue scores are present. In 2011, Carruthers' International Consensus Criteria attempted to restore the focus on selecting people who suffer from ME. Cognitive bias in criteria construction, patient selection, data collection and interpretation has led to the current state of epistemological chaos with ME, CFS, CFS/ME and ME/CFS, and CF being used interchangeably. Moreover, none of the above mentioned classifications meet statistically based criteria for validation. Diagnostic criteria should be based on statistical methods rather than consensus declarations. Ongoing discussions about which case definition to employ miss the point that the criteria did not pass appropriate external validation. In 2012, Maes et al. performed pattern recognition methods and concluded that CFS patients (according to Fukuda's criteria) should be divided into those with CFS or ME, on the basis that people with ME display a worsening of their illness following increases in physical or cognitive activity. Both ME and CFS are complex disorders that share neuro-immune disturbances, which are more severe in ME than in CFS. This paper expands on that strategy and details a range of objective tests, which confirm that a person with ME or CFS has a neuro-immune disease. By means of pattern recognition methods future research should refine the Maes' case definitions for ME and CFS by including well-scaled symptoms, staging characteristics and neuro-immune biomarkers, including immune-inflammatory assays, bioenergetic markers and brain imaging....

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Journal Article 2013; 34(2): 162-171 PubMed PMID: 23645314 Citation  Keywords:  Adult, Analysis of Variance, Brain:pathology, Brain Mapping:methods, Cognitive Therapy:methods, Electroencephalography, Female, Humans, Imaging, Three-Dimensional:methods, Male, Middle Aged, Panic Disorder:diagnosis, Psychiatric Status Rating Scales, Trea.   

BACKGROUND: Standardized low-resolution electromagnetic tomography (sLORETA) is a new quantitative EEG method for determining distribution of neuronal electrical activity in the form of three-dimensional images of current density of the cerebral cortex. Unlike standard quantitative EEG, it allows noninvasive and detailed localization of neuronal generators responsible for surface EEG with zero localization error. The study aimed at finding electrotomographic differences between patients with panic disorder who respond well to cognitive behavioral therapy (CBT) and those with an inadequate response and to determine factors predicting a response to treatment.

METHODS: The study comprised 24 patients diagnosed with panic disorder with or without agoraphobia (ICD-10 F41.0). The severity of symptoms was measured with the Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI), Sheehan Anxiety Scale, subjective and objective Clinical Global Impression (CGI) and Dissociative Experiences Scale (DES). Additionally, quality of life was evaluated using the Q-LES-Q questionnaire. Based on final BAI score decreases by 25%, the patients were classified into two groups - responders and non-responders. 21-channel EEGs were recorded at baseline and after completion of therapy. Power spectra and intracortical tomography were computed by sLORETA in seven frequency bands and compared between (responders vs. non-responders) and within (pre- vs. post-treatment) groups.

RESULTS: There were no differences between responders and non-responders with respect to age, gender and baseline disorder symptomatology. Statistical analysis of sLORETA values demonstrated no significant inter-group differences in the pretreatment current density distribution. After treatment, only responders showed a significant decrease of alpha-2 sources (p<0.05) in the occipital lobes and cuneus and a statistical trend for increased beta-3 sources (p<0.10) in the posterior cingulate. In non-responders, there were no statistically significant changes in sLORETA findings following therapy.

CONCLUSIONS: The study failed to use pretreatment sLORETA in the prediction of therapeutic response in patients with panic disorder. However, we clearly demonstrated that only treatment response was associated with significant changes of electric neuronal activity. An analysis of demographic data suggested that duration of the disease, age, level of dissociation and employment may be considered as factors influencing the response....

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Case Reports 2013; 34(2): 111-117 PubMed PMID: 23645307 Citation  Keywords:  Brain Edema:diagnosis, Female, Humans, Magnetic Resonance Imaging:methods, Meningeal Neoplasms:diagnosis, Meningioma:diagnosis, Middle Aged, Neurosurgical Procedures:methods, Skull Base Neoplasms:complications, Treatment Outcome,.   

: Meningiomas are very common neurosurgical problem. Their histological appearance, different size and localization, adherence to vital neural and vascular structures or extensive peritumoral brain edema (PTBE), especially in deep seated tumors, may lead to severe, life-threatening complications. We report a case of tuberculum sellae meningioma (TSM). A 48-year old female presented with 7-month history of blurred vision and progressive visual impairment. Intracranial tumor was confirmed by magnetic resonance imaging (MRI). After ophtalmological and endocrinological evaluation, the patient underwent surgical removal of the tumor. She immediately recovered from her visual disturbances and no tumor recurrences were seen during follow-up. Pathological diagnosis showed a meningioma of the secretory subtype (MS). We discuss the role of immunohistochemical staining in the diagnosis and the role of different factors in the PTBE formation. Selection of surgical route to the TSM is discussed, as well. Review of the literature is presented....

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Case Reports 2013; 34(2): 107-110 PubMed PMID: 23645306 Citation  Keywords:  Adult, Aged, Biopsy:methods, Female, Giant Cell Tumors:diagnosis, Humans, Hyperparathyroidism, Primary:diagnosis, Jaw Neoplasms:pathology, Male, Maxillary Neoplasms:diagnosis, Middle Aged, Parathyroid Neoplasms:diagnosis, Treatment Outcome,.   

OBJECTIVE: Giant cell tumors of the maxillofacial skeleton are uncommon, they are usually late manifestation of primary hyperparathyroidism. A series of five clinical cases in four women and one man presenting as the giant cell lesions in the maxilla and/or mandible are discussed.

METHODS: Biopsy of the lesions, biochemical and hormonal analyses, densitometry and parathyroid scintigraphy were carried out.

RESULTS: Biopsy of the lesions showed giant cell tumor of bone. The medical history and laboratory analyses showed primary hyperparathyroidism. Bone density loss was documented and scintigraphy revealed the presence of parathyroid adenomas in four cases. Surgical treatment of hyperparathyroidism, and in the second step - after 6-12 months - the subsequent excision of residual brown tumors in all cases was performed.

CONCLUSIONS: One should have in mind that osteolytic bone lesions may be due to metabolic disease of the bone. Accurate diagnosis enabling the proper treatment should be carried out, avoiding unnecessary harm to the patients....

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Case Reports 2013; 34(2): 102-106 PubMed PMID: 23645305 Citation  Keywords:  Autoimmune Diseases:diagnosis, Empty Sella Syndrome:diagnosis, Female, Glucocorticoids:therapeutic use, Humans, Hypopituitarism:diagnosis, Inflammation:pathology, Magnetic Resonance Imaging:methods, Middle Aged, Pituitary Gland:pathology, Treatment Outcom.   

: Autoimmune hypophysitis (AH) is commonly believed to be a rare chronic inflammatory condition of the pituitary gland. In clinical practice, however, the disease is often seen indeed. It typically presents with hypopituitarism and pituitary mass found by MRI. We report here unusual presentations of two females with AH followed by empty sella syndrome. The two females, aged at 64 and 57-years-old, presented with anterior pituitary dysfunction, diplopia and diabetes insipidus. By MRI the two patients shared the common characteristics with diffuse homogenous contrast enhancement of the gland and increased stalk thickness. After a long period treatment with glucocorticoids, empty sella was eventually detected by MRI....

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Case Reports 2013; 34(2): 97-101 PubMed PMID: 23645304 Citation  Keywords:  Adult, Female, Humans, Iodine Radioisotopes:therapeutic use, Ovarian Neoplasms:surgery, Ovariectomy:methods, Struma Ovarii:diagnosis, Thyroid Neoplasms:pathology, Thyroidectomy:methods, Young Adult,.   

INTRODUCTION: Malignant struma ovarii is a rare ovarian neoplasm composed predominantly of mature thyroid tissue.

CASE REPORT: A right ovarian tumor was discovered at ultrasound examination in a 20-year-old woman. Complete right ovariectomy was done - histopathological examination revealed papillary thyroid carcinoma arising in struma ovarii (malignant struma ovarii). Patient underwent subsequent total thyroidectomy - the thyroid was found to be without any pathological lesions. After operations the patient received ablative radioiodine treatment (200 mCi 131I). An 131I posttherapeutic whole-body radioiodine scintigraphy was performed and showed uptake in bone metastases. L-thyroxine TSH suppresive doses followed radioiodine ablation and thyroglobulin level is monitored. Next doses of radioiodine has been scheduled.

DISCUSSION: Authors suggest that the management of malignant struma ovarii should be the same as differentiated thyroid cancer, so after surgical excision of ovarian neoplasm, we recommend thyroidectomy, radiotherapy with 131I and levothyroxine suppressive therapy. Long-term follow-up for the detection of metastases or tumor recurrence by serial serum thyroglobulin measurements and 131I scan may be required in patients with this rare tumor....

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Journal Article 2013; 34(1): 75-80 PubMed PMID: 23524628 Citation  Keywords:  Adolescent, Adult, Cardiotocography, Female, Fetal Distress:diagnosis, Heart Rate, Fetal:physiology, Humans, Hypoxia:diagnosis, Middle Aged, Oxygen:blood, Predictive Value of Tests, Pregnancy, Pregnancy Complications:diagnosis, Sensitivity and Specificity.   

OBJECTIVES: The evaluation of hypoxia index (HI) in the prediction of abnormal fetal heart rate at delivery in uncomplicated pregnancies.

MATERIAL AND METHODS: The study group included 148 pregnant patients at term (69 patients with and 79 without brain sparing effect). The value of C/U ratio and HI was determined. Next, its value in predicting abnormal fetal heart rate during labor was evaluated. Then the predictive value of the HI index, C/U and last abnormal values of PI and RI in the MCA and the UA were compared in relation to the analyzed parameters. Evaluation included signs of fetal distress in CTG and abnormal fetal outcome. Then selected parameters, characterizing pregnancy course and fetal outcome with abnormal Doppler indices, were compared.

RESULTS: The designated value of hypoxia index characterized by abnormal neonatal outcome was >10 for sHI and >14 for HI. Low prognostic value of MCA PI and RI, and UA PI and RI has been shown. The highest predictive value was marked by C/U and HI. There were no statistically significant differences in prediction of abnormal fetal heart rate during labor between C/U ratio, HI and sHI.

CONCLUSIONS: The C/U ratio showed the highest sensitivity in the prediction of fetal abnormal heart rate. The C/U ratio, as a easier test, should be recommended as a first-line test in the prediction of abnormal CTG recordings in uncomplicated pregnancies....

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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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