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Case Reports 2007; 28(5): 549-553 PubMed PMID: 17984930 Citation  Keywords:  ACTH-Secreting Pituitary Adenoma:blood, Adenoma:blood, Adrenocorticotropic Hormone:blood, Aged, Antineoplastic Agents, Hormonal:therapeutic use, Empty Sella Syndrome:blood, Female, Humans, Octreotide:therapeutic use, Pituitary Neoplasms:blood, Treatment F.   

BACKGROUND: Our patient was a 65-year-old woman previously diagnosed with Addison's disease. She presented an empty sella turcica and, at the age of 47, was discovered to have autonomous hypersecretion of adrenocorticotropic hormone (ACTH), suggesting a corticotropic adenoma secondary to Addison's disease, with a lack of response to high levels of dexamethasone. She maintained high ACTH levels despite corticosteroid treatment.

METHODS: The patient underwent a CRH stimulation test using an intravenous bolus (100 microg) with samples every 30 minutes for 3 hours and, the day after, an octreotide infusion (0.1 mg/200 cc saline) for 2 hours with measurements every 30 minutes for 3 hours. The following month she received subcutaneous octreotide 0.1 mg tid., and samples were taken every week.

RESULTS: Thirty minutes after the corticotropic-releasing-hormone (CRH) stimulation test, baseline ACTH levels (1 063 pg/ml) increased to 1530, the other values lying between 1 020-862. After octreotide infusion, baseline ACTH (1 212 pg/ml) was 946-643-1 630-4 600-1 730 at 30-60-90-120-180 minutes. The following month, with octreotide treatment, serum ACTH levels were 454-768-1233-429 pg/ml each week.

DISCUSSION: Octreotide acts mainly on somatostatin type 2 receptors (SSTR2) and has no effect in Cushing's syndrome, although a suppressor effect in some ACTH ectopic hypersecretions and in Nelson's syndrome has been demonstrated. It has been observed that SSTR5 appear more frequently than SSTR2 in corticotropic adenomas and corticosteroids downregulate octreotide sensitivity.

CONCLUSIONS: Octreotide did not suppress secretion of ACTH in suspected corticotropic adenoma. Newer somatostatin analogues, acting mainly on SSTR5, may be able to control ACTH hypersecretion in cases such as this....

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Journal Article 2007; 28(5): 662-665 PubMed PMID: 17984929 Citation  Keywords:  Adolescent, Adult, Altruism, Amylases:metabolism, Decision Making:physiology, Games, Experimental, Humans, Male, Reference Values, Reward, Saliva:metabolism, Self Concept, Social Perception,.   

OBJECTIVE: Little is known regarding the relationship between social evaluation-induced neuroendocrine responses and generosity in game-theoretic situations. Previous studies demonstrated that reputation formation plays a pivotal role in prosocial behavior. This study aimed to examine the relationships between a social evaluation-induced salivary alpha-amylase (sAA) response and generosity in the dictator game. The relationship is potentially important in neuroeconomics of altruism and game theory.

METHODS: We assessed sAA and allocated money in the dictator game in male students with and without social evaluation. RESULTS Social evaluation-responders allocated significantly more money than controls; while there was no significant correlation between social evaluation-induced sAA elevation and the allocated money.

CONCLUSIONS: Social evaluation significantly increases generosity in the dictator game, and individual differences in trait characteristics such as altruism and reward sensitivity may be important determinants of generosity in the dictator game task....

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Comparative Study 2007; 28(5): 643-646 PubMed PMID: 17984928 Citation  Keywords:  Adult, Age of Onset, Erythrocyte Count, Erythropoietin:blood, Female, Humans, Male, Middle Aged, Pedigree, Restless Legs Syndrome:blood,.   

BACKGROUND: The restless legs syndrome (RLS) is divided into two forms: idiopathic and secondary. About half the cases of the former are found to have a positive family history. The lack of objective and quantitative parameters in familial RLS also represents a drawback for genetic studies. We tried to find a feature distinguishing the sporadic from the familial forms of the RLS.

METHODS: RLS patients were examined for clinical picture and laboratory markers including erythropoietin levels. Patients with a priori known causes of secondary RLS, were excluded. All biochemical and hematological parameters were standardized for sex and age groups relative to the population mean and standard deviation.

RESULTS: In our set of 311 patients (65.3% women, mean age 54.6 years, SD 14.7 years) 96 reported positive family history (64.6% women, mean age 53.1 years, SD 15.8 years). We found a significantly lower age at the onset of RLS symptoms in familial cases (mean 29.3 vs. 44.0, Z 5.9, p<0.0001), and, in sporadic cases, a significantly lower absolute count of red blood cells (Z -2.02, p=0.043 respectively). Erythropoietin levels in the familial cases were significantly lower than in the reference population (median -2.26 SDs from the mean). None of the other parameters were significantly different between the groups.

CONCLUSIONS: Our results confirm previously published lower age at symptom onset in familial RLS and provide the first evidence of lower erythropoietin levels in RLS patients. These observations might help to identify the specific phenotype for genetic association studies....

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Comparative Study 2007; 28(5): 704-707 PubMed PMID: 17984927 Citation  Keywords:  Adult, Female, Genitalia, Female:pathology, Humans, Infertility, Female:diagnosis, Laparoscopy:methods, Microsurgery:instrumentation, Pelvis:pathology,.   

OBJECTIVES: To compare the efficacy of microlaparoscopy and laparoscopy in the assessment of pelvic region in infertile women.

MATERIALS AND METHODS: 47 patients (aged 24-35) had microlaparoscopy and subsequent laparoscopy performed in order to diagnose the cause of infertility. Pelvic region assessment was performed in both procedures and the results were afterwards compared in regard to duration of the operations and findings reported by independent surgeons. The data was statistically analyzed using Statistica for Windows 5.1.

RESULTS: There were no major differences in the assessment of the pelvic region and found abnormalities in the analyzed postoperative protocols. All the diagnosed abnormalities were described similarly by both surgeons; the differences referred only to subjectively evaluated sizes of findings. The assessment of the pelvic region during microlaparoscopy was fully satisfactory in all cases, none required earlier than scheduled conversion to laparoscopy. The duration of endoscopic procedures was calculated from the moment of trocars insertion into the peritoneal cavity. The average duration time of microlaparoscopic evaluation was 6'20"+/-45", while in laparoscopy - 3'40"+/-32" (p<0.0001).

CONCLUSIONS: Microlaparoscopy and laparoscopy are of similar efficacy in the assessment of small pelvis organs and in detecting pathological changes. Both procedures differ significantly only in regard to the duration....

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Clinical Trial 2007; 28(5): 708-712 PubMed PMID: 17984925 Citation  Keywords:  Adolescent, Adult, Analysis of Variance, Dietary Supplements, Exercise:physiology, Humans, Magnesium:administration & dosage, Martial Arts:physiology, Physical Exertion:physiology, Reference Values, Rest:physiology, Statistics, Nonparametric, Thyroid Horm.   

: The effect of magnesium on thyroid hormones of sedentars and sportsperson in Tae-Kwon-Do, has been investigated in a 4-weeks training program. Group 1 consisted of sedentars receiving 10 mg/kg/day Mg for 4 weeks. Group 2 consisted of subjects receiving magnesium (Mg) supplement and practicing Tae-Kwon-Do for 90-120 min/day, for five days a week. Group 3 consisted of subjects practicing Tae-Kwon-Do but receiving Mg supplements. TSH levels increased with training and Mg supplementation (p<0.05). Mg increased FT3 values. (p<0.05). TT3 values of groups reduced in all groups (p<005). After supplementation, group 1 had higher TT4 values than groups 1 and 3 and the group 2 had higher TT4 values than the third group (p<005). Results of this research show that training until exhaustion causes reduction in thyroid hormone activity in sedentars and sportsperson. It has been established that Mg supplementation however, prevents reduction in thyroid hormone activity in sedentars and sportsperson....

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Case Reports 2007; 28(4): 524-526 PubMed PMID: 17693989 Citation  Keywords:  Adult, Antidepressive Agents, Tricyclic:therapeutic use, Depression:diagnosis, Fatal Outcome, Female, Humans, Mianserin:analogs & derivatives, Prefrontal Cortex:drug effects, Retrospective Studies, Suicide, Theta Rhythm,.   

: We present a case report of a 37-year old woman diagnosed with depressive disorder, first episode, who was admitted into a psychiatric hospital after a failed suicidal attempt. She responded to antidepressant therapy, as evidenced by a >50% reduction in MADRS total score. She was discharged after 4 weeks of treatment, denying any suicidal ideations. The following day the patient committed suicide; she burned herself to death. It is very likely that the patient dissimulated her symptoms and ideations. Subsequently, her quantitative EEG records were retrospectively analyzed. An increase of prefrontal theta cordance value after the first week of mirtazapine therapy was found. Recently three small studies have revealed that decrease of prefrontal theta cordance after 1 week of antidepressant administration can predict clinical response in patients with unipolar depression. In our previous study the absence of a decreased theta prefrontal cordance was associated with lack of treatment response with NPV 1.0 (Bares et al., 2007). Thus, we hypothesize that prefrontal theta cordance could become an objective marker of change of depressive symptoms, independent of patients' compliance and symptom dissimulation, more precise than objective and self-rated depression rating scales....

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Journal Article 2007; 28(4): 410-416 PubMed PMID: 17693988 Citation  Keywords:  Adolescent, Adolescent Development:physiology, Anorexia Nervosa:complications, Blood Pressure:physiology, Blood Pressure Monitoring, Ambulatory, Bradycardia:etiology, Case-Control Studies, Child, Circadian Rhythm:physiology, Estradiol:blood, Female, Folli.   

OBJECTIVES: Anorexia nervosa (AN) is characterized by marked neuroendocrine and autonomic dysfunctions. In the recent studies using automatic blood pressure monitoring (ABPM), lower BP values and lack of circardian variation of BP in anorectic patients were demonstrated. Unfortunately effects of hormonal changes, that may explain BP abnormalities were not analysed together.

DESIGN: The aim of our study was the assessment of ABPM and hormonal status in anorectic girls.

SETTINGS: The study was performed on hospitalized 25 female anorectic adolescents aged 12-18 years. Control group was 17 age and height matched girls with normal weight and negative history for hypertension. ABPM was performed between 5 and 7 day of hospitalization, every 30 minutes during active period and every 60 minutes during sleep. Hormones (FSH, LH, estradiol, cortisol and fT4) serum concentrations were also evaluated.

RESULTS: Mean systolic BP values were significantly lower in patients with AN in comparison to controls. Maximal diastolic and mean arterial pressure values for the whole day and active period but not for sleep were lower in AN than in controls. Anorectic girls showed tendency to night-time bradycardia. Moreover, there were no physiological circadian variations of BP in AN.

CONCLUSIONS: We conclude that hormonal regulation of blood pressure and heart rate in anorectic patients is at least partially preserved. Lower blood pressure values, bradycardia and lack of physiological night fall of BP in anorectic patients may result from altered autonomic system function resulting from hormonal disturbances and other centrally mediated mechanisms....

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Clinical Trial 2007; 28(4): 513-517 PubMed PMID: 17693987 Citation  Keywords:  Cervix Uteri:drug effects, Collagenases:metabolism, Dinoprostone:administration & dosage, Female, Humans, Labor, Induced:methods, Muscle Contraction:drug effects, Myometrium:drug effects, Oxytocics:administration & dosage, Pregnancy, Proteoglycans:metabol.   

OBJECTIVES: The aim of the study was to estimate the influence of dinoprostone in two different forms on the ripening of uterine cervix and the course of labor.

MATERIAL AND METHODS: 128 pregnant women with indications for labor induction and uterine cervix Bishop's scores <6, divided into 2 groups: I--62 patients who had dinoprostone in the form of a gel applied for labor preinduction; II--66 women who were administered dinoprostone in the form of vaginal inserts. The effectiveness of both forms of dinoprostone were estimated and compared.

RESULTS: No differences in Bishop's score changes were noticeable between the groups after 6-8 hours from application, however they were significant at the beginning of induction: I - 7.8+/-1.3 vs. II - 6.9+/-1.6 (p=0.0007). Almost half of the patients from group II had spontaneous contractions and required no labor induction at all. The average time from dinoprostone application till delivery was shorter in group II.

CONCLUSIONS: Dinoprostone vaginal inserts seem to influence both uterine cervix and muscle, while gel-prepare uterine cervix for delivery more effectively....

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