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Journal Article 2010; 31(2): 270-274 PubMed PMID: 20424586 Citation  Keywords:  Adult, Blood Glucose:metabolism, Diabetes Complications:blood, Fasting:blood, Female, Hemoglobin A, Glycosylated:metabolism, Humans, Hyperprolactinemia:blood, Magnetic Resonance Imaging, Male, Middle Aged, Pituitary Gland:pathology, Prevalence, Prolactin:.   

OBJECTIVE: Prolactin levels have been shown to be reduced in poorly controlled diabetes mellitus; however, diabetic patients with high prolactin levels may be seen in clinical practice. The aim of this study was to evaluate diabetic patients with hyperprolactinemia, and to determine the role of macroprolactinaemia in these patients.

MATERIALS AND METHODS: The study included 174 patients (153 women and 21 men) with hyperprolactinemia, retrospectively reviewed over a 2 years period. Data on presenting symptoms, the presence of diabetes mellitus, prolactin levels, macroprolactin levels, pituitary magnetic resonance imaging were collected in all patients. In addition; HbA1c, fasting blood glucose levels and postprandial glucose levels were collected in diabetic patients.

RESULTS: Of the 174 patients, 27 were diagnosed with diabetes mellitus (15.5%). Eighteen of the diabetic patients with hyperprolactinaemia had macroprolactinaemia (66.6%). The prevalence of macroprolactinaemia in diabetic patients is higher than the non-diabetic population (66.6% vs. 39.5%, p=0.009). In diabetic patients with macroprolactinaemia, HbA1c levels were higher than the diabetic patients without macroprolactinaemia.

CONCLUSION: The prevalence of macroprolactinaemia in diabetic patients was higher than the non-diabetic population. It seems necessary to determine macroprolactin levels in diabetic patients with hyperprolactinaemia; and in this case, further diagnostic evaluation is not warranted....

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Case Reports 2010; 31(2): 174-177 PubMed PMID: 20424585 Citation  Keywords:  Adult, Brain:pathology, Brain Neoplasms:diagnostic imaging, Female, Fetal Diseases:diagnostic imaging, Gestational Age, Humans, Hydrocephalus:diagnostic imaging, Magnetic Resonance Imaging, Pregnancy, Prognosis, Teratoma:diagnostic imaging, Ultrasonograph.   

: Fetal intracranial teratomas are rare neoplasms that can be readily detected via USG and MRI. While early discovery of such a condition may be helpful, the prognosis remains poor. We present a case of a massive intracranial teratoma and hydrocephalus initially detected via USG at 33 weeks of gestation....

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Journal Article 2010; 31(1): 73-86 PubMed PMID: 20150883 Citation  Keywords:  Adult, Brain Mapping, Cerebral Cortex:physiopathology, Dystonic Disorders:therapy, Female, Handwriting, Humans, Magnetic Resonance Imaging, Male, Middle Aged, Models, Biological, Pilot Projects, Placebos, Radiation, Somatosensory Cortex:physiopathology, T.   

: Since the somatosensory system is believed to be affected in focal dystonia, we focused on the modulation of the primary somatosensory cortex (SI) induced by repetitive transcranial magnetic stimulation (rTMS) in order to improve symptoms of writer's cramp. Patients with writer's cramp (N=9 in the pilot study and N=11 in the advanced study) were treated with 30-minute 1 Hz real- or sham-rTMS of the SI cortex every day for 5 days. Before and after rTMS, 1.5 T fMRI was examined during simple hand movements. While in the pilot study the rTMS coil was navigated over the SI cortex with a maximum of blood oxygenation-level dependent (BOLD) signal induced by passive movement, patients in the advanced study had the coil above the postcentral sulcus. After real-rTMS, 4 pilot study patients and 10 advanced study patients experienced subjective and objective improvement in writing, while only minimal changes were observed after sham-rTMS. Patients involved in the active movement task exhibited a rTMS-induced BOLD signal increase bilaterally in the SI cortex, posterior parietal cortex and in the supplementary motor area (P<0.001 corrected). After sham-rTMS, no BOLD signal changes were observed. In conclusion, 1 Hz rTMS of the SI cortex can improve writer's cramp while increasing the cortical activity in both hemispheres. Handwriting improved in most patients, as well as the subjective benefit, and lasted for 2-3 weeks. The beneficial effects of rTMS paralleled the functional reorganization in the SI cortex and connected areas, reflecting the impact of somatosensory system on active motion control....

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Case Reports 2009; 30(6): 700-704 PubMed PMID: 20038929 Citation  Keywords:  Dacryocystitis:drug therapy, Glucocorticoids:administration & dosage, Humans, Hypopituitarism:drug therapy, Lymphocytes:pathology, Magnetic Resonance Imaging, Male, Methylprednisolone:administration & dosage, Middle Aged, Pulse Therapy, Drug, Treatment Ou.   

OBJECTIVE: Lymphocytic hypophysitis (LH) is a rare autoimmune disorder associated with lymphocytic cell infiltration of the pituitary. It is often detected in patients with other autoimmune systemic diseases such as Hashimoto's thyroiditis, epinephritis, megaloblastic anemia, and Langerhans cell histiocytosis. Pituitary biopsy and invasive histopathological examination provide the most reliable evidence for LH diagnosis. However, because glucocorticoids are extensively used for the treatment of disease, pathological diagnosis is not always necessary. Here, we report a rare case of a male patient (50 y) with LH associated with dacryoadenitis that was successfully treated with high-dose of methylprednisolone.

RESULTS: The patient had a history of swollen lacrimal glands for two years. In addition, magnetic resonance imaging (MRI) showed a markedly thickened infundibular stem and an indiscernible signal in the posterior lobe of the pituitary. Biopsy of the lacrimal glands revealed reactive hyperplasia of the lymphoid tissue. After a high-dose of methylprednisolone pulse treatment (HDMPT), lacrimal gland swelling and infundibular stem thickness were reduced, and adenopituitary function improved within a short time period.

CONCLUSIONS: Although association of LH with dacryoadenitis is a rare, it can be effectively managed with HDMPT. In addition, response to HDMPT can avoid the more invasive diagnostic procedures, including surgical intervention and pituitary biopsies....

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Case Reports 2009; 30(4): 437-449 PubMed PMID: 20010503 Citation  Keywords:  Antioxidants:therapeutic use, Drug Therapy, Combination, Humans, Infant, Magnetic Resonance Imaging, Male, Melatonin:therapeutic use, Neuroblastoma:diagnostic imaging, Positron-Emission Tomography, Remission Induction, Retinoids:therapeutic use, Retroperi.   

OBJECTIVES: The combined use (MDB) of Somatostatin, Melatonin, Retinoids, Vitamins E, C, and D3, with Calcium, Chondroitin sulfate, and microdoses of Cyclophosphamide in a seven-month old baby affected by a voluminous retroperitoneal neuroblastoma measuring 4 x 8 cm produced a 50% objective response in six months, an almost total response in one year and a complete response at 14 months, with cure and absence of disease for over ten years.

RESULTS: This paper discusses the rationale and the molecular mechanisms of action of the treatment which has a differentiating, apoptotic and antiproliferative effect, preserving and enhancing both the trophism and functionality of organs and tissues, and the neuroimmunoendocrine and antiblastic homeostasis. This result is in agreement with the positive results already published on the use of the MDB in lymphoproliferative diseases, in stage III and IV lung cancer, in breast cancer and in cancers of the upper aerodigestive epithelia. Without the need for hospitalisation and with no toxicity, the MDB rapidly reduced and then eliminated the voluminous tumoral mass, allowing a normal quality of life and a perfectly normal psychophysical development.

CONCLUSIONS: We believe it is of use to report this case in order to invite greater interest in the oncological possibilities offered by the immunoneuroendocrine and biological-receptorial properties of the MDB treatment....

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Journal Article 2009; 30(4): 496-500 PubMed PMID: 20010492 Citation  Keywords:  Cerebral Cortex:physiology, Decision Making:physiology, Emotions:physiology, Female, Game Theory, Games, Experimental, Gyrus Cinguli:physiology, Humans, Magnetic Resonance Imaging, Male, Social Behavior, Young Adult,.   

OBJECTIVES: This study examined the roles of the insula and the anterior cingulate activations in the rejection of unfair offers in the impunity game.

METHODS: Fifteen participants played the impunity game in ten trials as responders during neuroimaging.

RESULTS: About 45% of the unfair offers were rejected by the responders even when responders could not restore a fair outcome, which cannot be accounted for by social preference of inequity aversion. Imaging data showed that the right anterior insula was activated when participants faced and rejected unfair offers.

CONCLUSIONS: The insula activation during a rejection of the unfair offers is the reflection of an emotional response, rather than social preference of inequity aversion. The role of emotion in the neuroeconomics of fairness was demonstrated....

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Case Reports 2008; 29(6): 867-870 PubMed PMID: 19112415 Citation  Keywords:  Adult, Brain Neoplasms:complications, Central Nervous System Neoplasms:complications, Humans, Lymphoma, B-Cell:complications, Magnetic Resonance Imaging, Male, Multiple Sclerosis, Relapsing-Remitting:complications,.   

: We present the patient with the diagnosis of multiple sclerosis (MS), relapsing-remitting form with long lasting remission. Unexpectedly, this patient presented dramatical clinical deterioration and revealed clinical symptoms such as bradypsychia, cognitive symptoms, central vestibulare syndrome, spastic quadruparesis. Clinical findings suggested secondary progressive MS, but MRI called in question this diagnosis. The MRI appearance suggested, that MS had been complicated by a different brain pathological lesion, and the brain biopsy was indicated. A histological examination confirmed primary CNS lymphoma (PCNSL). This case exemplifies important aspects of clinical neurology. A re-evaluation of the diagnosis of MS should always be performed in a patient when new symptoms are presented that are unusual or could be due to other pathological processes. MRI offers the highly sensitive way to detect the coexistence of MS and other brain disease. Primary goal of imaging modalities is differential diagnosis between demyelinating diseases, such as MS and other brain lesions. Advanced focus demand contrast- enhancing and mass- effect lesions. It is important to realize, that contrast-enhancement and brain edema may be mitigated by treatment with corticosteroids. In some cases a brain biopsy is needed....

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Journal Article 2008; 29(6): 879-883 PubMed PMID: 19112395 Citation  Keywords:  Adolescent, Analysis of Variance, Anorexia Nervosa:classification, Atrophy:pathology, Brain:pathology, Cushing Syndrome:complications, Female, Humans, Hypogonadism:complications, Hypovolemia:complications, Magnetic Resonance Imaging, Nutritional Status:ph.   

OBJECTIVES: In patients with anorexia nervosa (AN), computer tomography (CT) scanning and/or magnetic resonance imaging (MR) are usually applied to visualise trophic changes of the brain, resulting from considerable malnutrition or general cachexia of the organism. The goal of the study was an evaluation attempt of the degree of trophic changes in the central nervous system (CNS) of girls with AN, following CT scanning of the brain, together with an analysis of selected clinical and diagnostic parameters, related to the trophic changes in question.

PATIENTS & METHODS: The study involved fifty-five (55) female patients with AN. Following CT of the brain - scanning of the cortical sulci - four (4) groups of the patients were identified. The following classification of lesions was applied: Group I - width of cortical sulci < 1.5 mm - standard; Group II - the presence of cortical sulci of width < 1.5 mm and 1.5-3 mm; Group III - width of cortical sulci 1.5-3 mm; Group IV - the presence of cortical sulci of width at 1.5-3 mm and > 3 mm. We did not observe any patient with AN in whom the width of all the cortical sulci was bigger than 3 mm (Group V). In all the groups, clinical parameters, as well as routine laboratory tests and selected hormonal tests, were analysed.

RESULTS: In the performed CT scanning of the head in patients with AN, trophic changes in the CNS (as evaluated by the width of cortical sulci) were revealed in 67.3% of the patients. Among the studied groups, statistically significant differences were found for: body weight loss (BWL), the percent of BWL (BWL%), the BWL to disease duration ratio (BWL/time) and BWL%/time, serum concentrations of potassium, calcium, glucose, total protein and urea, as well as serum concentrations of LH, E2, cortisol, FT3 and FT4. The most pronounced disturbances were observed in Group IV, while the least ones - in Group I.

CONCLUSIONS: In CT scanning of the head, trophic changes in the CNS were observed in girls with AN, measured by the width of cortical sulci. The higher severity of trophic changes in the CNS was associated with higher BWL/time ratio, higher hypercortisolemia, more enhanced hypogonadotrophic hypogonadism, disorders in the peripheral metabolism of the thyroid hormones and with the obtained values of routine laboratory tests, indicating some tendency towards hypovolemia....

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