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Journal Article 2004; 25(3): 207-210 PubMed PMID: 15349087 Citation  Keywords:  Adult, Concanavalin A:pharmacology, Depression:immunology, Depressive Disorder:immunology, Female, Humans, Lymphocyte Activation:drug effects, Male, Middle Aged, Mitogens:pharmacology, Phytohemagglutinins:pharmacology, Reference Values, T-Lymphocytes:drug.   

BACKGROUND: The biological basis of treatment resistance in depression still remains unclear. Some studies suggest that there exists a relationship between a disturbance in the immune system and depression.

AIMS: To investigate the immune status of patients with treatment resistant depression, we compared the in-vitro lymphocytic responses to three different mitogens in 10 drug-free patients with treatment resistant depression and 10 normal controls matched for age and sex.

RESULTS: We observed a marked increase in the lymphocyte mitogenic activity to mitogens of T lymphocytes.

DISCUSSION: This activation of lymphocyte function may be indicative of a pathological stimulation in cell-mediated immunity in patients with treatment resistant depression....

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Journal Article 2004; 25(3): 201-206 PubMed PMID: 15349086 Citation  Keywords:  Adult, Electromagnetic Fields, Estradiol:blood, Follicle Stimulating Hormone:blood, Humans, Low Back Pain:blood, Luteinizing Hormone:blood, Male, Middle Aged, Physical Therapy Modalities, Prolactin:blood, Testosterone:blood, Time Factors,.   

OBJECTIVES: There is widespread public concern that electromagnetic fields might be hazardous. However, studies on the biological effects of magnetic fields (MFs) have not always been consistent. Influence of extremely-low frequency MFs used in physiotherapy on endocrine system was rarely examined. Therefore, the aim of the present study was to investigate the concentrations of some pituitary (FSH, LH, prolactin) and sex (testosterone, estradiol) hormones in men with back pain exposed to magnetic fields applied during magnetotherapy or magnetostimulation over the period of three weeks.

MATERIAL AND METHODS: The study was performed on 20 men aged 28-62 years (mean+/-SEM: 46.4+/-2.0 years) suffering from chronic low back pain who underwent magnetotherapy (10 patients, mean age+/-SEM: 48.4 years, range: 28-62 years) or subjected to magnetostimulation (10 patients, mean age+/-SEM: 44.3 years, range: 34-52 years) for 15 days (daily at 10:00 h, with weekend breaks). Blood samples were collected at 08:00 before magnetic field application, one day and one month following the application. Concentrations of hormones were measured by micromethod of chemiluminescence.

RESULTS: Both magnetotherapy and magnetostimulation lowered levels of prolactin. The levels of LH decreased significantly one month after magnetotherapy in comparison with the baseline whereas following magnetostimulation slight but insignificant increase was observed. Estradiol concentrations were significantly lower one day and one month following magnetosimulation in comparison to the baseline and did not change after magnetotherapy. No statistically significant changes were observed in levels of FSH and testosterone after either magnetotherapy or magnetosimulation at any time examined.

CONCLUSION: Magnetic fields applied in physiotherapy exert no or very subtle effect on concentrations of FSH, LH, prolactin, testosterone, and estradiol in men....

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Clinical Trial 2004; 25(1-2): 109-114 PubMed PMID: 15159693 Citation  Keywords:  Adult, Aged, Body Fluids:metabolism, Choroid Neoplasms:drug therapy, Female, Fovea Centralis:drug effects, Hemangioma:drug therapy, Humans, Male, Middle Aged, Photochemotherapy:adverse effects, Photosensitizing Agents:adverse effects, Porphyrins:adverse e.   

PURPOSE: To determine if optical coherence tomography (OCT) measurements of retinal thickness at the fixation point (RTFP) can be used to confirm the effectiveness of photodynamic therapy (PDT) with verteporfin in the treatment of symptomatic circumscribed choroidal hemangioma (CCH).

METHODS: Nine eyes of nine patients with subretinal fluid under foveal centre were treated by PDT with a dose of 6 mg/m2 of intravenous verteporfin administered 5 minutes before a laser irradiation at 689 nm. Visual outcomes, initial, and final findings were evaluated using biomicroscopy, OCT, ultrasound, fluorescein angiography, and indocyanine green angiography.

RESULTS: After a mean follow-up of 8 months (range, 3-18 months) OCT showed absorption of subretinal fluid in all cases (100%). Maximal decrease of RTFP was seen within first month after treatment. Average RTFP decreased from 378 microm (range, 221 microm-849 microm) preoperatively to 190 microm (range, 118 microm-321 microm) postoperatively (p=0.017, paired t-test). Mean best corrected visual acuity (BCVA) improved from 4/16 (range, 4/5-1/20) preoperatively to 4/8 (range, 4/3-1/15) postoperatively (p=0.0046, paired t-test). An improvement in BCVA was observed in all cases (100%, one to seven lines on Early Treatment Diabetic Retinopathy Study charts). BCVA returned to 4/5 or better in six patients (67%). Mean tumor height decreased from 3.2 mm (range, 1.5 mm-4.0 mm) preoperatively to 0.9 mm (range, 0 mm-2.4 mm) postoperatively (p=0.00003, paired t-test). There was no measurable tumor height in four cases (44%), there were marked reduction in the other five cases (56%) on ultrasound.

CONCLUSIONS: OCT appears to be useful method for evaluation of subretinal fluid absorption after the treatment of CCH by PDT with verteporfin. RTFP value can be used for quantification of subretinal fluid under the foveal centre. Functional results of PDT with verteporfin in CCH are limited in pre-existing retinal alterations. Randomised trial with single versus repeated sessions of PDT with verteporfin is needed....

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Clinical Trial 2004; 25(1-2): 62-69 PubMed PMID: 15159685 Citation  Keywords:  Acute Disease, Adult, Analysis of Variance, Animals, Blood Glucose:analysis, C-Reactive Protein:analysis, Cholesterol, HDL:blood, Cholesterol, LDL:blood, Fractures, Bone:blood, Humans, Lipoproteins:blood, Middle Aged, Pain:blood, Pain Measurement:methods,.   

OBJECTIVES: Our aim was to evaluate whether some biochemical parameters in the blood serum can establish and discriminate pain intensity of different etiology.

METHODS: Three groups of patients hospitalised at the Department of Surgery have been investigated: 1) the patients without pain but with the indicated surgical treatment, 2) the patients with acute pancreatitis, which represents severe pain of the visceral type, and 3) the patients with fractures of upper or lower extremities, which represented acute somatic pain. Whole serum proteins, albumin, C-reactive protein, glucose, total cholesterol, LDL-cholesterol, HDL-cholesterol, triacylglyceroles (triglycerides), apolipoprotein-B and electrophoretic levels of alpha-lipoprotein, beta-lipoprotein and pre-beta-lipoprotein were analysed immediately after the first clinical inspection in the hospital and then 30 days after treatment.

RESULTS: The intensity of pain estimated by the visual analogue scale (VAS) was higher in patients with acute pancreatitis than in patients with fractures. In both diagnoses during persisting pain, the products of lipid metabolism such as triacylglyceroles and HDL-cholesterol were enhanced together with glucose levels. Electrophoretic measurements, revealed higher levels of beta-lipoproteins in fractures, and increased values of pre-beta-lipoproteins and alpha-lipoproteins in both groups of patients suffering from pain. After 30 days of treatment some indicators decreased, but when compared with normal values, they were still higher, especially in patients with pancreatitis (HDL-cholesterol, triacylglyceroles, pre-beta-lipoprotein). In control patients without pain symptoms, an increase of LDL cholesterol, triacylglyceroles and beta-lipoprotein were observed during their stay in hospital, which may be considered to be due to hospitalisation stress per se. Acute stress generally influences glucose levels so that their increase cannot be considered as a specific marker of pain intensity.

CONCLUSIONS: It may be concluded from our investigation, that the biochemical composition of the blood serum is changing during painful states, although the question still remains open to what extent these changes reflect the pain intensity and to what extent they may modulate the perception of pain....

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Case Reports 2004; 25(1-2): 45-48 PubMed PMID: 15159681 Citation  Keywords:  Analgesics, Non-Narcotic:therapeutic use, Blepharospasm:diagnosis, Botulinum Toxins, Type A:therapeutic use, Dronabinol:therapeutic use, Dystonic Disorders:diagnosis, Female, Humans, Middle Aged, Treatment Outcome,.   

: The benign essential blepharospasm is a subliminal form of primary torsion dystonia with still uncertain aetiology. It is characterized by involuntary convulsive muscle contractions of the M. orbicularis occuli, accompanied by unbearable pain of the cornea, eye bulb and the muscle itself. It has been suggested that blepharospasm is neurobiologically based on a dysfunction of the basal ganglia and an impairment of the dopamine neurotransmitter system. Therefore, therapy of blepharospasm contains administration of anticholinergic- and tranquillizing drugs as well as botulinum toxin as neuromuscular blocking agent. However serious side effects can be observed as well as failure of therapy. In the brain a dense co-localisation of cannabinoid (CB1) and dopamine (D2)-receptor was identified which had been associated with the influence of cannabinoids on the dopaminergic reward system. Additionally, it has been demonstrated that cannabinoids may have an impact on the central GABAergic and glutaminergic transmitter system and thus might be involved in the influence of movement control. In the present case we administered the cannabinoid receptor agonist Dronabinol (Delta-9-Tetrahydrocannabinol) to a woman suffering from severe blepharospasm. Multiple treatments with botulinum toxin did not reveal a long-lasting beneficial effect. By contrast, treatment with 25 mg Dronabinol for several weeks improved the patients' social life and attenuated pain perception remarkably. This case study demonstrates that the therapy with a cannabinoid agonist may provide a novel tool in the treatment of blepharospasm and maybe of other multifactorial related movement disorders....

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Clinical Trial 2003; 24(6): 463-467 PubMed PMID: 15073577 Citation  Keywords:  Adult, Continuous Positive Airway Pressure, Humans, Luteinizing Hormone:blood, Male, Middle Aged, Pituitary Gland:physiology, Sleep Apnea, Obstructive:physiopathology, Testis:physiology, Testosterone:blood, Treatment Outcome,.   

OBJECTIVES: Decreased libido and a decline in morning serum testosterone levels were reported in men with obstructive sleep apnea (OSA). Our study aimed to evaluate the pituitary-gonadal axis in middle age men with OSA before and after treatment with nasal continuous positive airway pressure (CPAP).

MATERIAL AND METHODS: Measurement of the nocturnal serum luteinizing hormone (LH) and testosterone levels and sleep recordings before and after nine months of CPAP treatment in five men with OSA aged 49.5+/-5.2 years. Patients were evaluated during nocturnal sleep at base line and during CPAP treatment. Serum LH and testosterone levels were determined at 20 minutes interval between 1900h and 0700h with concomitant determination of sleep quality, respiration and oxygen saturation.

RESULTS: At base line, patients had higher RDI and PaO2<90%, lower mean and integrated (AUC) values of LH and testosterone. During CPAP treatment, RDI and PaO2<90% were normal. Mean and AUC values of testosterone and LH increased.

CONCLUSIONS: OSA in men is associated with dysfunction of the pituitary-gonadal axis. The central suppression of nocturnal testosterone in these patients is partially corrected during chronic CPAP treatment....

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Journal Article 2003; 24(6): 454-458 PubMed PMID: 15073575 Citation  Keywords:  Adult, Aged, Albumins:metabolism, Blood-Aqueous Barrier:drug effects, Emulsions:pharmacology, Female, Humans, Magnetic Resonance Spectroscopy, Male, Middle Aged, Nephelometry and Turbidimetry, Protons, Silicone Oils:pharmacology,.   

PURPOSE: To evaluate the function of the blood aqueous barrier(BAB) in the eyes with silicone oil emulsification (SOE).

METHODS: Protein concentrations, expressed in albumin equivalents,were determined in aqueous humor of the eyes with SOE in 11 consecutive patients by means of proton nuclear magnetic resonance (1H NMR) spectroscopy. Correlations with various clinical factors were studied.

RESULTS: Normal function of the BAB (albumin equivalents 1mg/ml and less was found in 8 eyes (73%) independently on underlying disease, early postoperative reaction after pars plana vitrectomy with SO implantation, degree of SOE and late postoperative complications. Increased permeability of the BAB (albumin equivalents equal 2, 3 and 6.5 mg/ml) was found in 3 eyes (27%) with recent acute complication (retinal detachment after SO removal in 2 eyes, and secondary angle closure glaucoma in 1 eye).

CONCLUSION: SOE in vivo was associated with increased permeability of the BAB in the minority of the eyes. Other factors should be studied to explain the variability of SOE. 1H NMR spectroscopy might be a valuable method for the study of SOE....

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Comparative Study 2003; 24(6): 425-430 PubMed PMID: 15073569 Citation  Keywords:  Adenoma:pathology, Adenoma, Oxyphilic:pathology, Adolescent, Adult, Aged, Female, Follow-Up Studies, Humans, Male, Middle Aged, Neoplasm Recurrence, Local, Pituitary Neoplasms:pathology, Prognosis, Retrospective Studies, Sex Characteristics, Treatment Out.   

OBJECTIVES: Clinically non-functioning pituitary adenomas are common tumors of the pituitary gland. No studies have yet documented gender-related differences in the growth and presentation of these tumors and nothing is known about their effects on their subsequent surgical outcome and prognosis.

SETTING AND DESIGN: Twenty-eight patients with non-functioning pituitary adenoma, that met strict inclusion criteria, and that underwent surgical treatment between January 1990 and June 1997, were retrospectively reviewed.

METHODS: The patient charts, as well as histological (incl. immunohistochemistry) and electron microscopic findings were analyzed. Tumor invasiveness was classified according to the modified Hardy criteria.

MAIN FINDINGS: Eleven patients were women and seventeen were men; the female-to-male-ratio was 1:1.5. Men were significantly older, both at diagnosis and surgery. Visual field defect and visual acuity deficit were the most common presenting symptoms with similar occurrence both in women and men, whereas blindness predominated in women. Microadenomas and invasive adenomas did not differ significantly in MIB-1 index, but patients less than 35 years old had higher MIB-1 indices (n=4, 1.72+/-1.15), than did patients over 45 years (n=11, 0.63+/-0.42) (p: n.s.). MIB-1 labeling indices were higher in adenomas of female compared to male patients (1.5 +/-1.2 vs. 0.8+/-1.8; p < 0.003). The overall outcome was significantly worse in women than in men.

CONCLUSION: The biology and the clinical course of clinically non-functioning pituitary adenoma seem to differ in women and men. In men, tumors are smaller and less invasive at surgery, and the outcome is better than in women. The present findings may justify a more aggressive therapeutic approach to clinically non-functioning pituitary adenomas in women than in men, especially to improve the availability of viable pituitary cells at the time of surgery....

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