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Clinical Trial 2007; 28(1): 53-59 PubMed PMID: 17277726 Citation  Keywords:  Adult, Brain Mapping, Case-Control Studies, Cognition:physiology, Female, Fluorodeoxyglucose F18, Hallucinations:diagnostic imaging, Humans, Male, Positron-Emission Tomography, Prefrontal Cortex:diagnostic imaging, Psychotic Disorders:diagnostic imaging, .   

OBJECTIVE: The aim of the study was to detect whether the abnormal regional brain activity correlates with auditory verbal hallucination-proneness (AVH) in a group of patients with schizophrenia and schizophrenia-related psychoses.

METHODS: 15 patients with prominent AVH (score for hallucination intensity--item 3 in the PANSS > or =4) and 15 control patients without AVH (item 3 PANSS score < or =2) underwent 18FDG positron emission tomography at rest.

RESULTS: SPM group analysis revealed an increased uptake of 18FDG in the right middle frontal gyrus (BA46) in subjects with high verbal hallucination score compared to non-hallucinating patients (p<0.001, uncorrected). Activation in BA46 positively correlated with the intensity of hallucinations (Spearman r=0.57; p<0.001).

CONCLUSIONS: The observed functional recruitment of the right prefrontal cortex in subjects with high hallucination score may reflect impairment in the integration of intended actions and sensory feedback resulting in misattribution of internal events to an external source. This mechanism may form the cognitive basis for AVH....

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Journal Article 2006; 27(6): 769-772 PubMed PMID: 17187022 Citation  Keywords:  Adult, Atrophy, Case-Control Studies, Female, Humans, Hypothalamus:pathology, Intracellular Signaling Peptides and Proteins:metabolism, Magnetic Resonance Imaging:instrumentation, Male, Middle Aged, Narcolepsy:metabolism, Neurons:metabolism, Neuropeptides.   

OBJECTIVES: Narcolepsy with cataplexy is associated with a loss of hypocretin. The question is, if there is an autoimmune or neurodegenerative process selectively killing the hypothalamic hypocretin-containing neurons or if these cells survive but fail to produce hypocretin. To support one of these hypothesis we aimed to detect structural changes in the hypothalamus of narcoletic patients.

MATERIALS AND METHODS: Nineteen narcoleptic patients were compared to 16 healthy controls. We used voxel-based morphometry (VBM), an unbiased MRI morphometric method with a high sensitivity for subtle changes in gray and white matter volumes to investigate hypothalamic region in this condition.

RESULTS: Classical MRI protocol revealed no structural abnormalities, but using VBM we found significant reduction in hypothalamic gray matter volumes between patients and controls.

CONCLUSIONS: VBM showed hypothalamic gray matter loss in narcolepsy with cataplexy. This suggest that functional abnormalities of hypocretin neurons in narcolepsy are associated with structural changes of hypothalamus....

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Clinical Trial 2006; 27(6): 813-817 PubMed PMID: 17187014 Citation  Keywords:  Adult, Female, Genital Diseases, Female:complications, Humans, Hysteroscopy, Infertility, Female:diagnosis, Laparoscopy, Pelvis:diagnostic imaging, Ultrasonography, Uterus:diagnostic imaging,.   

OBJECTIVES: The aim of the study was to analyze the use of endoscopic procedures in the group of infertile patients.

MATERIAL AND METHODS: The study material consisted of 636 patients, aged 20-41. They all had endoscopic procedures performed (laparoscopy and/or hysteroscopy) due to infertility, and were qualified for the procedure after a gynecological examination and ultrasound scan. The study group was divided into subgroups of primary and secondary sterility and endoscopic procedures were then analyzed.

RESULTS: A total of 724 endoscopic procedures were performed on 636 patients. Eighty eight women had both hysteroscopy and laparoscopy performed, 476 had only laparoscopy, while 72--only hysteroscopy. Women diagnosed due to primary sterility more often had no visible abnormalities in the pelvic region (30%) and patent oviducts than those with secondary sterility. The remaining 70% more often had ovaries typical for polycystic ovarian syndrome and endometriosis. However, periadnexal adhesions and tubal impotency were more common in the group of secondary sterility. As to hysteroscopy, women with primary sterility more often had congenital uterine malformations, while submucosal myomas and intrauterine adhesions were less common in that group. All the surgical procedures performed during laparoscopies were analyzed. Tubal patency assessment and ovarian drilling were significantly more often performed in the subgroup of primary sterility. All intrauterine pathologies were treated during hysteroscopy.

CONCLUSIONS: Laparoscopy and hysteroscopy play an important role as both diagnostic and therapeutic tools in the infertility treatment centers....

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Case Reports 2006; 27(6): 733-736 PubMed PMID: 17187002 Citation  Keywords:  Adrenocorticotropic Hormone:blood, Female, Follicle Stimulating Hormone:secretion, Gonadotrophs:pathology, Humans, Hydrocortisone:blood, Magnetic Resonance Imaging, Middle Aged, Neoplasms, Multiple Primary:pathology, Pituitary ACTH Hypersecretion:blood, P.   

OBJECTIVE AND IMPORTANCE: We encountered a Cushing's disease patient whose surgically removed pituitary macroadenoma was not an ACTH-producing, but rather a gonadotroph adenoma. Cure was obtained only after a tiny microadenoma, overlooked on preoperative studies, was removed by a 2nd operation from a compressed thin normal anterior pituitary gland.

CLINICAL PRESENTATION: This 45-year-old woman with Cushing syndrome presented with diabetes mellitus and steroid psychosis. Endocrinological examinations suggested Cushing's disease and MRI disclosed an invasive macroadenoma (22 mm in diameter) with suprasellar extension.

INTERVENTION: Despite total removal of the invasive macroadenoma by transsphenoidal surgery, her elevated serum cortisol- and ACTH levels failed to decrease. Histologic study of the surgical specimen disclosed that the tumor was a silent FSH-producing, rather than an ACTH-producing adenoma. Detailed re-evaluation of pre- and postoperative MRI suggested the presence of a 3-mm microadenoma on the left side of a thin compressed normal gland. Venous sampling of the cavernous sinus confirmed this suspicion. In a 2nd operation an ACTH-producing microadenoma was removed from inside the thin remaining compressed normal pituitary gland and endocrinological cure of Cushing's disease was achieved.

CONCLUSION: Although double adenomas, being a non-ACTH producing macroadenoma associated with an ACTH producing tiny microadenoma, are extremely rare in patients with Cushing's disease, detailed preoperative MRI evaluation is necessary to avoid missing tiny adenomas hidden in a compressed normal pituitary gland which is the cause of Cushing's disease, especially when a macroadenoma is found in patient with Cushing's disease....

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Case Reports 2006; 27(6): 737-739 PubMed PMID: 17187000 Citation  Keywords:  Acute Disease, Akathisia, Drug-Induced:diagnostic imaging, Antipsychotic Agents:adverse effects, Benzodiazepines:adverse effects, Cerebellum:diagnostic imaging, Fluorodeoxyglucose F18, Humans, Male, Middle Aged, Positron-Emission Tomography:methods, Radio.   

OBJECTIVES: Akathisia is a clinical important symptom, frequently induced by neuroleptic treatment. Despite its clinical importance, less is known about its pathophysiology.

METHODS: Using [18]-FDG-PET, imaging patterns of cortical metabolic activity were obtained in a patient during olanzapine-induced akathisia and after recovery.

RESULTS: Akathisia was characterized by a reduced metabolic activity in thalamus and cerebellum. After discontinuing medication akathisia disappeared, reflected by a recovery of metabolic activity in these brain areas.

CONCLUSION: [18]-FDG-PET may be useful to identify cortical regions mediating clinical aspects of drug-induced akathisia, thereby offering a deeper insight into the pathophysiology of this serious side effect....

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Journal Article 2006; 27(Suppl 2): 116-120 PubMed PMID: 17159794 Citation  Keywords:  Brain Injuries:blood, Gene Expression Profiling, Humans, Magnetic Resonance Imaging, Metallothionein:blood, Nerve Growth Factors:blood, Phosphopyruvate Hydratase:blood, Radiography, S100 Calcium Binding Protein beta Subunit, S100 Proteins:blood,.   

OBJECTIVES: The aim of this study was to evaluate the correlation of neuron specific enolase (NSE), protein S100B and time-profile of Glasgow Coma Score (GCS) development with metallothionein (MT) blood levels in patients with traumatic brain injury (TBI) during 10 days of hospitalization. Patients were divided into 2 groups with respect to NSE and S100B levels - with (group I) and without (group II) GCS improvement.

METHODS: Serum NSE and S100B concentrations were measured by immunochemical methods; serum metallothionein concentration by electrochemical technique. Cortical biopsies were investigated immunohistochemically and by electron microscope. A cDNA microarray containing 700 gene probes was used to study the changes in gene expression in the ipsilateral cortex.

RESULTS: Values of MT in the blood of group I showed a non-significant decrease compared to group II during 1-3 days after admission. There was an increase of MT during 4-8 days in comparison with values of 1-3 days. The highest value of MT during hospitalization was found in a patient with diffuse axonal injury (group II). The data of cDNA microarray suggested an increase in expression of gene transcripts for oxygen free radical scavenger proteins corresponding with the increase of MT during 4-8 days in both groups.

CONCLUSIONS: The experimental data indicate that monitoring the content of MT in patients with trauma brain injury would be a suitable approach to evaluate the degree of injury or duration of prolonging unconsciousness, particularly in diagnosis of diffuse axonal injury....

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Clinical Trial 2006; 27(4): 523-528 PubMed PMID: 16891990 Citation  Keywords:  Adult, Female, Humans, Hysteroscopy:methods, Infertility, Female:diagnostic imaging, Leiomyoma:diagnostic imaging, Polyps:diagnostic imaging, Predictive Value of Tests, Sensitivity and Specificity, Sodium Chloride, Ultrasonography:methods, Uterine Neoplas.   

OBJECTIVES: The preliminary study was performed to evaluate the diagnostic accuracy of saline infusion sonohysterography (SIS) in the detection of intrauterine pathologies in infertile women The SIS findings were compared to the results of two widely used procedures: transvaginal sonography (TVS) and hysteroscopy (HS).

MATERIAL AND METHODS: 68 infertile women, aged 27-42 were enrolled in the study. TVS, SIS and diagnostic HS were consecutively performed in every patient. The results of each method were compared. Sensitivity, specificity, positive predictive value and negative predictive values for TVS and SIS were obtained.

RESULTS: Intrauterine pathologies were diagnosed in 25% of patients. TVS detected 6 (37.5%) and SIS revealed 11 (87.5%) of 13 intrauterine pathologies finally visualized at diagnostic hysteroscopy. TVS failed to visualize three submucous myomas, one endometrial polyp and two cases of septate uteri. All three cases of intrauterine synechiae were not detected with this method One submucous myoma and one endometrial polyp were not identified with SIS. The study group was, however, too limited to show statistically significant differences in diagnostic accuracy among TVS, SIS and HS.

CONCLUSIONS: Saline infusion sonohysterography is simple, sensitive and inexpensive diagnostic method. The procedure is not time-consuming, causes minimal discomfort to the patient and may be performed without anesthesia in office settings. The method may be recommended for the diagnosis of intrauterine pathologies in infertile women....

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Case Reports 2006; 27(1-2): 288-289 PubMed PMID: 17159812 Citation  Keywords:  Adnexa Uteri:surgery, Anesthesia, General, Cystadenoma:complications, Female, Humans, Laparoscopy, Ovarian Neoplasms:complications, Pregnancy, Pregnancy Complications, Neoplastic:surgery, Ultrasonography, Uterus:diagnostic imaging,.   

: Interstitial pregnancy is a rare condition of tubal pregnancy with a mortality rate of 2-2.5% [4] that can easily be misdiagnosed. The prevalence of interstitial pregnancy is 0.8% in normal population and it increased during the past few decades due to reproduction techniques development even up to 11% in groups of women after in vitro fertilization. A comprehensive MEDLINE and OLDMEDLINE search covering years 1950-2005 using query terms "interstitial", "pregnancy" and "adnexectomy" identified only 10 cases reported in worldwide literature. The first treatment of interstitial pregnancy used to be a resection of the uterus body via laparotomy. Along with the evolution of sensitive biochemical assays, imaging technologies and the development of operative techniques, the management of interstitial pregnancy became less invasive. We report a case of spontaneous left interstitial pregnancy after left adnexectomy due to left ovarian tumor of borderline malignancy....

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