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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(2): 83-96 PubMed PMID: 23645303 Citation  Keywords:  Bipolar Disorder:prevention & control, Cognitive Therapy:methods, Family Therapy:methods, Humans, Psychotherapy:methods, Secondary Prevention,.   

OBJECTIVE: Bipolar affective disorder runs a natural course of frequent relapses and recurrences. Despite significant strides in the pharmacological treatment of bipolar disorder, most bipolar patients cannot be treated only by drugs. The limitations of using medication alone in symptomatic, relapse prevention, and satisfaction/quality of life terms have long prompted interest in wider forms of management. One of the promising way how to enhance remission seems to be combination of pharmacotherapy and psychoeducation.

METHODS: Studies were identified through PUBMED, Web of Science and Scopus databases as well as existing reviews. The search terms included "bipolar disorder", "psychoeducation", "psychotherapy", "psychosocial treatment", "family therapy", "individual therapy", "group therapy", and "psychoeducation". The search was performed by repeated use of the words in different combinations with no language or time limitations. This article is a review with conclusions concerned with psychoeducation in bipolar disorder.

CONCLUSIONS: Randomized controlled trials of cognitive behavioral therapy, interpersonal and social rhythm therapy, individual, group and family psychoeducation show that these approaches augment stabilizing effect of pharmacotherapy. Patients and their families should be educated about bipolar disorder, triggers, warning signs, mood relapse, suicidal ideation, and the effectiveness of early intervention to reduce complications. Psychosocial approaches are important therapeutic strategies for reducing relapse and rehospitalization in bipolar disorder....

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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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Journal Article 2013; 34(1): 71-74 PubMed PMID: 23524627 Citation  Keywords:  Acromegaly:epidemiology, Adult, Colonoscopy, Female, Humans, Incidence, Irritable Bowel Syndrome:diagnostic imaging, Male, Middle Aged, Pilot Projects, Quality of Life, Ultrasonography,.   

BACKGROUND: In acromegaly, the gastrointestinal system is under the influence of excessive growth hormone (GH) and insulin like growth factor-1 (IGF-I). Increased bowel length and delayed transit time may cause functional disturbance of the bowel. The objective of the current study is to evaluate the frequency of irritable bowel syndrome (IBS) in cases with acromegaly.

PATIENTS AND METHODS: Twenty-three active cases with acromegaly newly diagnosed between 2010-2011 were included in the study. The control group consisted of ninety gender and age-matched healthy controls (HC). All cases were questioned for presence of IBS using Rome III criteria. Abdominal ultrasonography and colonoscopy results of acromegalic patients were obtained. In addition, cases with acromegaly were evaluated for their quality of life and status of depression by using the Acromegaly Quality of Life Questionnaire (AcroQoL) and Beck Depression Inventory (BDI), respectively.

RESULTS: The median GH and IGF-1 levels of cases with acromegaly were 5.72 [IQR: 2.2-34] ng/ml and 753 [IQR: 503-1050] ng/ml, respectively. The median AcroQoL score of patients with acromegaly was 56 [IQR: 43-71.5] and the median BDI score was 16 [IQR: 11-21]. Rome III diagnostic criteria were positive in 2 of 23 acromegaly patients and in 3 of 90 HC (p=0.26). IBS was present in 1 of 23 of the acromegaly patients compared to 3 of 90 HC (p=0.81).

CONCLUSION: Although acromegaly and IBS may cause similar gastrointestinal symptoms, acromegaly is not associated with a greater incidence of true IBS....

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Journal Article 2013; 34(1): 52-57 PubMed PMID: 23524624 Citation  Keywords:  Acute Disease, Aged, Aged, 80 and over, Brain Ischemia:immunology, Female, Glutathione:blood, Humans, Inflammation:immunology, Insulin Resistance:immunology, Interleukin-10:blood, Interleukin-6:blood, Male, Malondialdehyde:blood, Middle Aged, Nitric Oxide.   

OBJECTIVE: Insulin resistance (IR) has effects on inflammation and oxidative stress which have importance in acute stroke. Our aim was to investigate the relationships between IR, inflammation, oxidative stress and stroke severity in acute ischemic stroke patients.

METHODS: We examined the relationships between inflammation, oxidative stress and stroke severity in 75 acute stroke patients with and without IR. Serum levels of oxidative stress markers (nitric oxide (NO), malondialdehyde (MDA), glutathione (GSH)) were measured as well as the cytokines interleukin-6 (IL-6) and interleukin-10 (IL-10).

RESULTS: The levels of IL-10 (13.7±19.11 vs 51.20±89.32 pg/ml, p<0.00) in IR group were significantly reduced. Patients with IR had higher levels of NO (30.26±17.63 vs 22.57±14.5 µmol/L, p=0.04) and IL6 (27.44±57.13 vs 8.68±11.8 pg/ml, p<0.00) and higher NIHSS scores (11.40±5.35 vs 8.81±5.76, p=0.04) when compared with noninsulin resistant group. IL-10 was found negatively correlated with HOMA. Additionally, the parameters with positive correlations with HOMA were NIHSS, IL-6 and NO.

CONCLUSIONS: Inflammation and oxidative stress are more evident in acute stoke patients with insulin resistance which may cause worse stroke severity. Our data also suggest that IL-10 as an antiinflammatory cytokine can be much lower in insulin resistance in acute phase of ischemic stroke. However it can be elevated as an adaptive mechanism in metabolic syndrome as a chronic condition....

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