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Journal Article 2007; 28(1): 33-38 PubMed PMID: 17277734 Citation  Keywords:  Adult, Antidepressive Agents:therapeutic use, Anxiety:physiopathology, Combined Modality Therapy, Double-Blind Method, Female, Humans, Male, Middle Aged, Panic Disorder:physiopathology, Prefrontal Cortex:physiopathology, Serotonin Uptake Inhibitors:therap.   

BACKGROUND: Transcranial magnetic stimulation (rTMS) can modulate cortical activity. The goal of our study was to assess whether rTMS would facilitate effect of serotonin reuptake inhibitors in patients with panic disorder.

METHOD: Fifteen patients suffering from panic disorder resistant to serotonin reuptake inhibitor (SRI) therapy were randomly assigned to either active or to sham rTMS. The aim of the study was to compare the 2 and 4 weeks efficacy of the 10 sessions 1 Hz rTMS with sham rTMS add on SRI therapy. We use 1 Hz, 30 minutes rTMS, 110% of motor threshold administered over the right dorso-lateral prefrontal cortex (DLPFC). The same time schedule was used for sham administration. Fifteen patients finished the study,. Psychopathology was assessed using the rating scales CGI, HAMA, PDSS and BAI before the treatment, immediately after the experimental treatment and 2 weeks after the experimental treatment by an independent reviewer.

RESULTS: Both groups improved during the study period but the treatment effect did not differ between groups in any of the instruments.

CONCLUSION: Low frequency rTMS administered over the right dorso-lateral prefrontal cortex after 10 sessions did not differ from sham rTMS add on serotonin reuptake inhibitors in patients with panic disorder....

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Journal Article 2007; 28(1): 21-25 PubMed PMID: 17277730 Citation  Keywords:  Adult, Aged, Appetite Regulation:physiology, Body Weight:physiology, Deep Brain Stimulation:adverse effects, Female, Humans, Male, Middle Aged, Parkinson Disease:physiopathology, Retrospective Studies, Subthalamic Nucleus:physiopathology, Weight Gain,.   

: Deep brain stimulation of the subthalamic nucleus (DBS STN) is an effective treatment method in advanced Parkinson's disease (PD) providing marked improvement of its major motor symptoms. In addition, non-motor effects have been reported including weight gain in PD patients after DBS STN. Using retrospective survey, we aimed to evaluate weight changes in our patients with advanced PD treated with DBS STN. We inquired 25 PD patients (16 men, 9 women), of mean age 55 (42-65) years, mean PD duration 15 (9-21) years, who previously received bilateral DBS STN. We obtained valid data from 23 patients. In the first survey, 1 to 45 months after DBS, weight gain was found in all patients comparing to pre-DBS period. The mean increase was 9.4 kg (from 1 to 25 kg). The patients' mean body mass index (BMI) increased from 23.7 to 27.0 kg/m2, i.e. by 3.3 kg/m2 (+2 to +6.1 kg/m2). In the repeated survey one year later, in 12 of the patients body weight moderately decreased, 3 did not change, and 6 patients further increased their weight. Possible explanations of body weight gain after DBS STN include a reduction of energy output related to elimination of dyskinesias, improved alimentation or direct influence on function of lateral hypothalamus by DBS STN....

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Journal Article 2007; 28(1): 45-51 PubMed PMID: 17277727 Citation  Keywords:  Aged, Dehydroepiandrosterone Sulfate:blood, Disease Progression, Estradiol:blood, Follicle Stimulating Hormone:blood, Hormones:blood, Humans, Hydrocortisone:blood, Luteinizing Hormone:blood, Male, Middle Aged, Prognosis, Prolactin:blood, Prostatectomy, Pr.   

OBJECTIVE: Prostate cancer is now recognized as one of the principal medical problems facing male population and the commonest cancer in males in delevoped countries. The aim of this study was to find out whether serum hormone levels differ significantly in localized (pT2) and locally advanced (pT3-pT4 or N1) prostate cancer.

METHODS: In 250 men (mean age+/-SEM: 63.8+/-0.4) who underwent radical retropubic prostatectomy for histologically confirmed prostate cancer were analyzed serum samples for total testosterone, dehydroepiandrosterone sulfate, estradiol, progesterone, prolactin, cortisol, sex hormone-binding globulin, luteinizing hormone and follicle stimulating hormone. Free testosterone content was calculated from total testosterone and SHBG concentrations.

RESULTS: Significantly lower serum level of FSH, i.e. 5.63+/-0.31 vs. 7.07+/-0.65 U/L was found in patients with localized prostate cancer than in locally advanced (p<0.05). Significant correlation was found between serum levels of DHEAS and cortisol in both groups (p<0.02), estradiol and prolactin in patients with locally advanced prostate cancer, as well between LH and prolactin (p<0.05). No differences were found in other observed hormones.

CONCLUSION: The results point to importance of hormone status as possible additional prognostic marker for patients with prostate cancer. Considerable research is needed to further understand influence of hormones on prostate cancer....

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Clinical Trial 2007; 28(1): 59-64 PubMed PMID: 17277725 Citation  Keywords:  Acute Disease, Adult, Anticonvulsants:administration & dosage, Female, Humans, Injections, Intravenous, Middle Aged, Migraine Disorders:complications, Pain:etiology, Pain Measurement, Prospective Studies, Treatment Outcome, Valproic Acid:administration & .   

: This multicenter study investigated the safety and efficacy of intravenous valproate in acute migraine attacks and the possible impact of prophylactic valproate pre-treatment. Thirty-six patients established on migraine prophylaxis were administered 500 mg sodium valproate intravenously against acute migraine attacks. Pain development was assessed by visual analogue scale up to a 24 hours follow up interview to detect e.g. possible relapse symptoms. A subgroup analysis examined whether prophylactic treatment with valproate affected its acute anti-migraine efficacy. A meaningful headache reduction within two hours was achieved in all 12 patients with and in 20 out of 24 patients without valproate prophylaxis. Headache-associated signs and symptoms were substantially reduced. No serious side-effects were reported. The results confirm the therapeutic value of intravenous valproate in acute migraine attacks described in literature and show a beneficial effect on all investigated efficacy parameters with a trend to even better response in patients receiving valproate prophylaxis....

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Case Reports 2006; 27(Suppl 1): 17-24 PubMed PMID: 17261998 Citation  Keywords:  Adult, Aged, Dental Amalgam:toxicity, Environmental Exposure, Female, Humans, Hypersensitivity:diagnosis, Immunoassay:methods, Lymphocyte Activation, Metals:toxicity, Middle Aged, Occupational Exposure, Reproducibility of Results, Sensitivity and Specific.   

OBJECTIVES: Chronic low-level metal exposure may result in metal sensitization and undesirable side-effects. The main sources of metal exposure are from the environment or from corrosion of dental metal alloys. Affected patients are routinely diagnosed with the epicutaneous (patch) test. However, such testing may induce false-positive (irritative) reactions and may in itself sensitize or exacerbate symptoms. Alternatively, MELISA (Memory Lymphocyte ImmunoStimulation Assay), an optimized lymphocyte transformation test (LTT), can be used. In this study we analyzed the overall frequency and distribution of metal sensitization among symptomatic, metal-exposed patients. In addition, we determined the reproducibility of the assay and assessed its clinical relevance for detecting and monitoring hypersensitivity to metals.

METHODS: To analyze the frequency and distribution of metal sensitization, blood from 700 consecutive patients was tested against a total of 26 metals in the validated LTT-MELISA. For reproducibility testing, 391 single metal tests from 63 patients were performed in parallel. Finally, to assess clinical relevance, 14 patients with known metal exposure showing local (dry mouth, Oral Lichen Planus, Burning Mouth Syndrome, eczema) and/or systemic (chronic infections, fatigue, autoimmune disorders, central nervous system disturbances, depression) effects were tested in LTT-MELISA. In 7 cases testing was repeated following removal of the allergy-causing metals or, in 2 additional cases, without therapeutic intervention.

RESULTS: Of the 700 patients tested, 74.6% responded to >/= 1 metal in LTT-MELISA, with a subgroup of 17.9% responding to >/= 3 metals. Reactivity was most frequent to nickel (68.2%), followed by cadmium (23.7%), gold (17.8%), palladium (12.7%), inorganic mercury (11.4%), molybdenum (10.8%), beryllium (9.7%), titanium dioxide (4.2%), lead (3.7%), and platinum (3.4%). Reproducibility was 94.9%, with most discordant results in a low-positive range. Removal of the alloys or prostheses containing allergenic metals resulted in remarkable clinical improvement correlating with a significant reduction or complete normalization of specific lymphocyte reactivity. In contrast, both LTT-MELISA reactivity and clinical symptoms remained unchanged in follow-up samples from the 2 patients who did not remove the source of metal exposure.

CONCLUSION: The optimized LTT-MELISA test is a clinically useful and reliable tool for identifying and monitoring metal sensitization in symptomatic metal-exposed individuals....

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Journal Article 2006; 27(Suppl 1): 31-35 PubMed PMID: 17261997 Citation  Keywords:  Adolescent, Adult, Aged, Aged, 80 and over, Dental Implants:adverse effects, Humans, Hypersensitivity:diagnosis, Immunoassay, Lymphocyte Activation, Middle Aged, Prostheses and Implants:adverse effects, Titanium:adverse effects,.   

OBJECTIVES: This study was carried out to investigate the potential of titanium to induce hypersensitivity in patients chronically exposed to titanium-based dental or endoprosthetic implants.

METHODS: Fifty-six patients who had developed clinical symptoms after receiving titanium-based implants were tested in the optimized lymphocyte transformation test MELISA against 10 metals including titanium. Out of 56 patients, 54 were patch-tested with titanium as well as with other metals. The implants were removed in 54 patients (2 declined explantation), and 15 patients were retested in MELISA.

RESULTS: Of the 56 patients tested in MELISA, 21 (37.5%) were positive, 16 (28.6%) ambiguous, and 19 (33.9%) negative to titanium. In the latter group, 11 (57.9%) showed lymphocyte reactivity to other metals, including nickel. All 54 patch-tested patients were negative to titanium. Following removal of the implants, all 54 patients showed remarkable clinical improvement. In the 15 retested patients, this clinical improvement correlated with normalization in MELISA reactivity.

CONCLUSION: These data clearly demonstrate that titanium can induce clinically-relevant hypersensitivity in a subgroup of patients chronically exposed via dental or endoprosthetic implants....

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Journal Article 2006; 27(6): 828-832 PubMed PMID: 17187024 Citation  Keywords:  Acromegaly:blood, Adenoma:blood, Adult, Aged, Aged, 80 and over, Bromocriptine:therapeutic use, Female, Follow-Up Studies, Hormone Antagonists:therapeutic use, Human Growth Hormone:blood, Humans, Insulin-Like Growth Factor I:analysis, Male, Middle Aged, P.   

OBJECTIVES: Acromegaly is a rare disease with increased mortality rate. The aim was to present our centre experience in the diagnosis and treatment of a series of patients suffering from acromegaly.

METHODS: 130 patients (55 men, 75 women) aged 19-84 years presenting with clinical and hormonal features of acromegaly, attending Department of Endocrinology and Out-patient Clinic between 1990 and 2004 were studied. They were analyzed their GH and IGF-1 levels, CT and MRI scans, and they were administered medical therapy, neurosurgery and radiotherapy.

RESULTS: We have observed 106 macro-, 16 microadenomas and 1 case of ectopic GHRH. 115 patients were operated, as cured were recognized 74 of them. Pituitary irradiation was applied to 11 patients, in 4 of them it did not cure the disease. Medical therapy was efficacious in 12% patients treated with bromocriptine, 73% with long-acting lanreotide and 58% with long-acting octreotide. In 7 patients other malignant neoplasm were detected. 11 patients died during the follow-up.

CONCLUSIONS: There is possible underdiagnosis of acromegaly in our region, especially in males. We have observed better diagnostic opportunities in recent years when MRI was available. It was accompanied by better outcome of surgical and pharmacological treatment and better control of the complications of the disease....

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Journal Article 2006; 27(6): 769-772 PubMed PMID: 17187022 Citation  Keywords:  Adult, Atrophy, Case-Control Studies, Female, Humans, Hypothalamus:pathology, Intracellular Signaling Peptides and Proteins:metabolism, Magnetic Resonance Imaging:instrumentation, Male, Middle Aged, Narcolepsy:metabolism, Neurons:metabolism, Neuropeptides.   

OBJECTIVES: Narcolepsy with cataplexy is associated with a loss of hypocretin. The question is, if there is an autoimmune or neurodegenerative process selectively killing the hypothalamic hypocretin-containing neurons or if these cells survive but fail to produce hypocretin. To support one of these hypothesis we aimed to detect structural changes in the hypothalamus of narcoletic patients.

MATERIALS AND METHODS: Nineteen narcoleptic patients were compared to 16 healthy controls. We used voxel-based morphometry (VBM), an unbiased MRI morphometric method with a high sensitivity for subtle changes in gray and white matter volumes to investigate hypothalamic region in this condition.

RESULTS: Classical MRI protocol revealed no structural abnormalities, but using VBM we found significant reduction in hypothalamic gray matter volumes between patients and controls.

CONCLUSIONS: VBM showed hypothalamic gray matter loss in narcolepsy with cataplexy. This suggest that functional abnormalities of hypocretin neurons in narcolepsy are associated with structural changes of hypothalamus....

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