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Evaluation Studies 2010; 31(6): 796-800 PubMed PMID: 21206436 Citation  Keywords:  Acromegaly:diagnostic imaging, Adult, Aged, Female, Humans, Magnetic Resonance Imaging, Male, Middle Aged, Paranasal Sinuses:diagnostic imaging, Temporal Bone:diagnostic imaging, Tomography, X-Ray Computed,.   

OBJECTIVE: Acromegaly is a rare disease, which symptoms are caused by excess secretion of a growth hormone (GH) from the anterior pituitary benign tumor - adenoma. Authors present an evaluation of computed tomography (CT) and magnetic resonance (MR) images of temporal bone and paranasal sinuses of patients with acromegaly.

CONCLUSIONS: 1. In all patients with acromegaly, morphological changes in paranasal sinuses were shown. They were mostly pronounced within the maxillary sinuses including the mucosa thickening up to 6 mm and encysted fluid occurrence. 2. CT of temporal bone did not reveal structural changes of internal and median ear. 3. There is a need for further studies on hearing impairment in patients with acromegaly....

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Journal Article 2010; 31(5): 645-656 PubMed PMID: 21200377 Citation  Keywords:  Affect:drug effects, Amitriptyline:pharmacology, Animals, Antidepressive Agents:pharmacology, Antimanic Agents:pharmacology, Benzodiazepines:pharmacology, Cerebral Cortex:cytology, Citalopram:pharmacology, Clorgyline:pharmacology, Cocaine:pharmacology, Cy.   

OBJECTIVE: Monoamine oxidase (MAO), the enzyme responsible for metabolism of monoamine neurotransmitters, has an important role in the brain development and function, and MAO inhibitors have a range of potential therapeutic uses. We investigated systematically in vitro effects of pharmacologically different antidepressants and mood stabilizers on MAO activity.

METHODS: Effects of drugs on the activity of MAO were measured in crude mitochondrial fraction isolated from cortex of pig brain, when radiolabeled serotonin (for MAO-A) or phenylethylamine (for MAO-B) was used as substrate. The several antidepressants and mood stabilizers were compared with effects of well known MAO inhibitors such as moclobemide, iproniazid, pargyline, and clorgyline.

RESULTS: In general, the effect of tested drugs was found to be inhibitory. The half maximal inhibitory concentration, parameters of enzyme kinetic, and mechanism of inhibition were determined. MAO-A was inhibited by the following drugs: pargyline > clorgyline > iproniazid > fluoxetine > desipramine > amitriptyline > imipramine > citalopram > venlafaxine > reboxetine > olanzapine > mirtazapine > tianeptine > moclobemide, cocaine > lithium, valproate. MAO-B was inhibited by the following drugs: pargyline > clorgyline > iproniazid > fluoxetine > venlafaxine > amitriptyline > olanzapine > citalopram > desipramine > reboxetine > imipramine > tianeptine > mirtazapine, cocaine > moclobemide, lithium, valproate. The mechanism of inhibition of MAOs by several antidepressants was found various.

CONCLUSIONS: It was concluded that MAO activity is acutely affected by pharmacologically different antidepressants at relatively high drug concentrations; this effect is inhibitory. There are differences both in inhibitory potency and in mechanism of inhibition between both several drugs and the two MAO isoforms. While MAO inhibition is not primary biochemical effect related to their therapeutic action, it can be supposed that decrease of MAO activity may be concerned in some effects of these drugs on serotonergic, noradrenergic, and dopaminergic neurotransmission....

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Journal Article 2010; 31(6): 829-836 PubMed PMID: 21196931 Citation  Keywords:  Adult, Affect:drug effects, Age Factors, Age of Onset, Antidepressive Agents:therapeutic use, Antipsychotic Agents:therapeutic use, Autonomic Nervous System:physiopathology, Bipolar Disorder:diagnosis, Female, Heart Rate, Humans, Male, Middle Aged, Outpat.   

BACKGROUND: Autonomic nervous system (ANS) dysfunction and reduced heart rate variability (HRV) have been reported in a wide variety of psychiatric disorders, but have not been well characterized in bipolar patients in remission. We recorded cardiac activity and assessed HRV in bipolar outpatients in remission.

AIMS: Ascertain if ANS decrease with the age of the patient; ascertain relation between activity of ANS and level of dissociation, and other components (age of patients, and age of disorder, dosage of psychotropic medication)

METHODS: Autonomic nervous system (ANS) has been evaluated during orthostatic change in three positions (1 - lie down 5 minutes, 2 - stand up 5 minutes, 3 - lie down 5 minutes). The functioning of the ANS has been measured by the diagnostic systems that are using the power spectral analysis which quantifies the heart rate variability (HRV) was assessed using time domain, frequency domain, and nonlinear analyses in 23 bipolar patients in remission.

RESULTS: We found highly statistically significant negative correlations between level of dissociation measured by DES (Dissociative Experience Scale) and most of parameters of ANS. We found negative correlations between the age of the patient and activity of ANS, and negative correlations between activity of ANS and duration and onset of disorder.

CONCLUSIONS: Autonomic dysregulation is associated with bipolar disorder in remission and has relation to level of dissociation and probably to age of patients and age of onset and duration of disorder....

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Journal Article 2010; 31(6): 814-817 PubMed PMID: 21196928 Citation  Keywords:  Adult, Diagnosis, Differential, Electroencephalography, Epilepsy:diagnosis, Female, Humans, Magnetic Resonance Imaging, Male, Middle Aged, Reproducibility of Results, Retrospective Studies, Seizures:diagnosis, Tomography, X-Ray Computed,.   

OBJECTIVE: Authors warn of difficulties in diagnostic of solitary epileptic seizure and epilepsy.

MATERIAL AND METHODS: Our groups have been made up of patients, who have been dismissed from our clinic in the period from January 1997 to January 2007 with diagnosis of solitary unprovoked epileptic seizure (n=84) and epilepsy with sporadic epileptic seizure (n=179). We have evaluated the clinical typology of epileptic seizure, EEG findings and results of imaging methods and we determined the part of patients with complete diagnostic concordance between clinical image of epileptic seizure and results of auxiliary diagnostic methods.

RESULTS: We have denoted the complete diagnostic concordance among the clinical image, EEG findings and results of imaging methods only in 13.1% of patients after solitary unprovoked epileptic seizure and in 24.02% of patients with diagnosis of epilepsy with sporadic epileptic seizures. The receiving diagnosis of unclear seizure status was determined at 49.14% of patients dismissed with diagnosis of solitary epileptic seizure and at 40.78% of patients dismissed with diagnosis of epilepsy with sporadic epileptic seizures in 10 year time period.

CONCLUSION: Our results repeat the confirmation that the diagnostic of seizure disorders, with and without disturbance of consciousness, belong to the difficult part in the clinical praxis....

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Journal Article 2010; 31(6): 823-828 PubMed PMID: 21196926 Citation  Keywords:  Acromegaly:etiology, Adenoma:complications, Adult, Aged, Biomarkers, Tumor:metabolism, Early Diagnosis, Female, Growth Hormone-Secreting Pituitary Adenoma:complications, Humans, Immunohistochemistry, Ki-67 Antigen:metabolism, Male, Middle Aged, Neoplasm I.   

OBJECTIVE: In many pituitary tumor, immunohistochemical studies have been shown to be correlated with different aspects of tumor behavior.There is no study up to date in which markers of Ki-67, p53, VEGF were evaluated concomitantly in GH-secreting adenomas.This study aims to determine which marker has a major role in tumor behavior and whether these markers have a cut-off value to distinguish invasive adenoma from non-invasive pituitary adenoma.

METHODS: Fourty-seven acromegalic patients operated by the same neurosurgeon were included in this study.Twenty-one patients(5micro/16 macro) had non-invasive adenomas and 26 had invasive macroadenomas.Eight patients(6 invasive macroadenomas, 2 microadenomas) were treated with OCT-LAR until one month prior to surgery with treatment duration range of 3-11 months.These patients were excluded from the study group as the noninvasive and invasive adenomas were compared.A separate analysis was performed in invasive adenomas to compare OCT(+) and OCT(-)patients.

RESULTS: Both Ki-67 and p53 expressions showed no correlation with the invasive character of adenomas, but VEGF expression in invasive adenomas was significantly higher with respect to noninvasive group.Our study has taken intermediate staining (>25 %)for VEGF as a cut off value for invasive adenomas.It was also observed that the decrease in VEGF staining in OCT pretreated invasive adenomas was significantly more than those not treated with OCT.

CONCLUSION: VEGF becomes an independent stimulator of angiogenic growth and progression for GH-secreting adenomas with >25% cytoplasmic immunoreactivity.This cut-off value may be useful in determination of prognosis and appropriate treatment strategy.A short term preoperative OCT treatment may be useful as adjunctive therapy especially for locally invasive GH- secreting adenomas....

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Journal Article 2010; 31(6): 818-822 PubMed PMID: 21196921 Citation  Keywords:  Adult, Aged, Aged, 80 and over, Anticonvulsants:therapeutic use, Diagnosis, Differential, Diagnostic Errors:statistics & numerical data, Drug Resistance, Electroencephalography, Epilepsy:classification, Female, Follow-Up Studies, Humans, Male, Middle Aged.   

OBJECTIVE: There is no universally accepted definition of pseudo-intractable epilepsy. Pseudo-intractability means that the resistance to treatment is, in fact, caused by clinical errors. The purpose of our study was to identify the reasons for intractability and subsequent effective therapeutic management approaches in a group of patients with established pseudo-intractable epilepsy.

METHODS: The study was designed as a retrospective audit of 100 adult patients who, in their past medical history, were diagnosed as having intractable epilepsy but, following adjustments to their medical management, were seizure free for at least 2 years. Patients underwent standard clinical evaluation, including EEG and/or video-EEG monitoring. We re-evaluated past medical, family, seizure and pharmacological history and morphological findings. Epilepsy was re-classified according to the ILAE classification.

RESULTS: We identified possible errors including incorrect diagnosis and/or inappropriate previous epilepsy management in all 100 patients. Incorrect diagnosis (seizure type and/or syndrome) was observed in 47 patients (47%). Thirty two patients (32%) with idiopathic generalized epilepsy were treated for complex focal seizures with inappropriate choice of medication. Therapeutic errors were identified in 48 patients (48%). Issues with medication compliance were found in 20 patients (20%). Potential seizure precipitating factors were detected in 23 patients (23%).

CONCLUSIONS: Our study of 100 patients confirmed that the problem of pseudo-intractability still exists. Every case of pharmacoresistance in epilepsy could potentially be caused by one or more clinical errors....

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Journal Article 2010; 31(6): 848-851 PubMed PMID: 21196918 Citation  Keywords:  Age Factors, Animals, Animals, Newborn, Blotting, Western, Cerebral Cortex:metabolism, Disease Models, Animal, Female, Hypothyroidism:metabolism, Male, Mice, Mice, Inbred C57BL, Neurons:metabolism, Nitric Oxide Synthase Type II:genetics, Pregnancy, RNA, M.   

OBJECTIVES: The expression of iNOS mRNA and protein levels was studied in hypothyroid rat cerebral cortex during early days after postnatal life.

METHOD: The homogenate of the cerebral cortex was examined using Real-time reverse transcription polymerase chain reaction (real-time RT PCR) and Western blot analysis.

RESULT: ΔCt in hypothyroid group on day 7, 14, 21 was 18.89±0.92, 18.83±0.99, 16.48±0.29, separately. While in control group, ΔCt was 20.32±0.92, 20.07±0.86, 17.96±0.50, separately. Meanwhile, the protein level was detected only in hypothyroid group of 59 ± 5% on day 14. On day 21, iNOS protein expression showed a decrease (p<0.05) in hypothyroid group (37 ± 3%), compared with control group (58 ± 4%).

CONCLUSION: Our findings show the successive changes of the iNOS mRNA and protein levels in early postnatal days of hypothyroid rat brain, and confirm the cross-talk between the TH and NO signaling pathway in developing cerebral cortex of rats....

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Journal Article 2010; 31(6): 761-765 PubMed PMID: 21196915 Citation  Keywords:  Animals, Circadian Rhythm:physiology, Male, Melatonin:secretion, Microscopy, Electron, Pineal Gland:physiology, Rats, Rats, Sprague-Dawley, Synapses:ultrastructure,.   

OBJECTIVE: The pineal gland is part of the circadian clock system and is under the predominant influence of the endogenous oscillator located in the suprachiasmatic nucleus. A polysynaptic pathway involving hypothalamus, spinal cord and sympathetic system regulates the so far best-studied aspect of its neuroendocrine output, i.e., the synthesis and secretion of melatonin. This parameter increases dramatically at night upon sympathetic activation in rats and many other mammals including man. In addition, parasympathetic, trigeminal, diencephalic and other sites or mechanisms connect the gland, mainly via its stalk, to the nervous system. However, their function for pineal metabolic or morphological features are hardly known. An interesting ultrastructural attribute of the pineal gland are ribbon synapses. These presynaptic structures in pinealocytes are composed of a ribbon and vesicles. They are thought to regulate and facilitate multivesicular release, and display a circadian rhythm with higher levels at night paralleling melatonin synthesis but regulated differently.

METHODS: To gain more insight into the roles of both, the non-sympathetic ("central") innervation and the regulation of pineal ribbon synapses, a surgical transection of the pineal stalk was conducted in rats and the number of synaptic ribbons (SR) were determined by electron microscopy from experimental, sham-operated and control animals.

RESULTS: The transection resulted in normal daytime levels but diminished the nocturnal increase of SR numbers when compared to controls or sham-operated rats.

CONCLUSION: These data provide first evidence that the central innervation of this neuroendocrine organ plays an important role in SR (up)regulation, and that this pathway is antagonistic to the sympathetic innervation....

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