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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): 38-46 PubMed PMID: 23524622 Citation  Keywords:  Adolescent, Adult, Aged, Carica:chemistry, Constipation:drug therapy, Digestive System Diseases:drug therapy, Double-Blind Method, Female, Flatulence:drug therapy, Gastrointestinal Agents:administration & dosage, Heartburn:drug therapy, Humans, Irritable .   

OBJECTIVE: Papaya (Carica papaya L.) is used as a natural remedy in abnormal digestion in tropical and industrialized countries. Besides this wide distribution little evidence has been produced with reference to its physiological effect in humans and the proof of efficacy. Former clinical observations had revealed positive effects for patients with constipation, heartburn, and symptoms of irritable bowel syndrome (IBS) after eating papaya preparations. In line with these former positive clinical observations, we studied the clinical effects of the papaya preparation Caricol® in a double blind placebo controlled study design.

METHODS: In this study the participants were volunteers, with chronic (prevailing) indigestions and dysfunctions in the gastrointestinal tract. During the trial the intake of the substance of intent and placebo was 20 ml daily for 40 days. The endpoints were the frequency of 22 symptoms recorded before and after the documented intake recorded by questionnaire.

RESULTS: The symptoms "Constipation", "Bloating", and "Heartburn" were defined as primary and frequency of "painful (straining) bowel movements" as secondary endpoint. The participation ended after the intake period within two days ("early returnees"). Wash out effects were observed in "late returnees", who returned with a delay of 8.6 (±5.95 days). In the verum group early returnees revealed statistically significant improvements of the symptoms "constipation" and "bloating". The analysis of "heartburn" felt short of significant improvement because of the small number of included cases with this criteria (N=13, p=0.114). None of the significant benefits were observed after the washout phase.

CONCLUSION: We conclude from these results, that the papaya preparation (Caricol®) contributes to the maintenance of digestive tract physiology. It ameliorates various functional disturbances, like symptoms of IBS. The mechanism of this digestive tract physiology support is discussed....

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Journal Article 2013; 34(1): 14-17 PubMed PMID: 23524619 Citation  Keywords:  Adolescent, Adult, Aged, Aged, 80 and over, Blood-Brain Barrier:metabolism, Chemistry, Clinical:methods, Female, Ghrelin:blood, Humans, Male, Middle Aged, Multiple Sclerosis, Chronic Progressive:blood, Multiple Sclerosis, Relapsing-Remitting:blood, Reprod.   

: Ghrelin, an orexigenic peptide, exerts immunomodulatory and other effects in the CNS and has neuroprotective properties. Ghrelin is predominantly produced by X/A-like cells in the gastric mucosa. Hence, ghrelin's main source of production lies outside the CNS while important functions of ghrelin are operated by specific receptors in the CNS. We analyzed 82 samples of our repository (45 samples form patients with multiple sclerosis and 37 control samples) for cerebrospinal fluid (CSF) and corresponding serum concentrations of ghrelin. Desacyl ghrelin concentrations were measured with a commercially available enzyme immunometric assay. We validated the assay for CSF samples. The test-retest reproducibility for ghrelin in CSF samples was excellent. Ghrelin CSF concentrations were higher in patients with multiple sclerosis (p<0.02) compared with controls. CSF concentrations correlated with serum concentrations in patients with multiple sclerosis (p<0.01). No such correlation was found in controls. Our findings endorse existing hypotheses that ghrelin affects the central inflammatory process in MS. The correlation between serum and CSF concentrations in MS, but not in controls, suggests a differential regulation of blood-to-brain transport mechanisms for ghrelin in MS and indicates that central effects of ghrelin in MS might be amenable to pharmacological manipulation of the systemic ghrelin secretion....

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Journal Article 2012; 33(8): 761-764 PubMed PMID: 23391980 Citation  Keywords:  Affect, Aged, Aged, 80 and over, Anxiety Disorders:psychology, Humans, Male, Middle Aged, Orchiectomy:methods, Palliative Care:psychology, Patient Satisfaction, Prostatic Neoplasms:psychology, Psychology, Quality of Life:psychology, Stress, Psychological:.   

OBJECTIVES: The study presented focuses on patients' psychosocial status after a prostate cancer diagnosis that underwent a bilateral orchiectomy.

METHODS: We evaluated the psychosocial implications of 89 patients with prostate cancer after performing castration and a bilateral orchiectomy.

RESULTS: Patients suffered significantly more from sleep disorders during hospitalisation when compared to their time prior to an orchiectomy (p<0.0005). There were some increases in the severity of sleep disorder after discharge (level of evidence p<0.05). However, no additional medications for sleep disorders were required. Additionally, there was a significant reduction in the abuse of medication (p<0.001). Ten per cent of the patients were in the care of a psychologist or a psychiatrist before their diagnosis, and 21% asked for the help of a psychologist or a psychiatrist after having a bilateral orchiectomy. The occurrence of mood disorders is also very different than the occurrence of sleep disorders. Mood disorders occurred much less often after orchiectomy and discharge (p>0.085) compared with the period before surgery. Forty per cent of the patients had mood disorders before their operation, while only 37% still had these after discharge. There was a significant decrease in abuse of medication for anxiety. Twenty-four per cent of the patients took medication during hospitalisation, and only 10% continued after orchiectomy.

CONCLUSIONS: The results of the study show that patients who were notified about their cancer diagnosis, particularly their health status, exhibited moderate stress and psychological impact....

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Journal Article 2012; 33(8): 782-786 PubMed PMID: 23391979 Citation  Keywords:  Animals, Axons:drug effects, Blood-Brain Barrier:drug effects, Brain Edema:drug therapy, Female, Glucocorticoids:pharmacology, Male, Methylprednisolone:pharmacology, Myelin Sheath:drug effects, Nerve Fibers, Myelinated:drug effects, Neuroprotective Agents.   

OBJECTIVES: Our previous experiments proved that methylprednisolone (MP) can significantly reduce axonal impairment accompanying extracellular oedema induced by the osmotic challenge (load) on the blood-brain barrier (BBB). The aim of the present work was to identify whether MP can affect myelin impairment accompanying intracellular oedema induced by water intoxication.

METHODS: For induction of cellular brain oedema, the standard model of water intoxication was chosen. Animals received distilled water in amount corresponding to 15% of the animal's body weight. The volume was divided into three parts and administered intraperitoneally in 8 hours interval. Axonal changes were recognized as signs of myelin disintegration (oedematous distensions, axonal swelling, vesicles, varicosities) at histological sections stained with Black Gold and classified into four grades of myelin degradation. Hippocampal CA1 and CA3 areas and the dentate gyrus were selected for the study. Methylprednisolone was administered either intraperitoneally or intracarotically. Its effect was studied in two different time intervals: in the acute group (30 minutes after hyperhydration and MP application) and in chronic one (1 week after hyperhydration and MP application).

RESULTS: In both the acute and chronic groups, cellular oedema induced by water intoxication brought about apparent damage of myelin (compared to control animals p<0.0001). Intracarotic injection of MP was not able to influence myelin integrity changes either in the acute or in chronic group. However, intraperitoneal administration of MP increased the level of myelin deterioration in the acute group (p 0.05), but improved myelin changes in the chronic group (p<0.005).

CONCLUSION: The effect of MP on axonal impairment during cellular brain oedema induced by water intoxication differs from that during the extracellular osmotic oedema. In the extracellular oedema, cellular metabolism is not significantly affected and myelin changes can be influenced by the neuroprotective effect of MP. The primary cause of cellular oedema is a disorder of cellular metabolism and myelin impairment is one of the structural consequences of such disorder. That is why the myelin changes are not affected by MP administration in a consistent and specific manner....

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