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Journal Article 2008; 29(4): 461-466 PubMed PMID: 18766142 Citation  Keywords:  Adult, Atrophy:pathology, Brain:pathology, Disability Evaluation, Disease Progression, Female, Humans, Magnetic Resonance Imaging, Male, Middle Aged, Multiple Sclerosis, Chronic Progressive:pathology, Multiple Sclerosis, Relapsing-Remitting:pathology, Sta.   

OBJECTIVES: To monitor the interaction between the clinical manifestation of the secondary progressive form of multiple sclerosis (SPMS) expressed in the Expanded Disability Status Scale (EDSS) and abnormal findings in magnetic resonance imaging (MRI) of the brain. To compare a time line of brain atrophy in patients with SPMS, patients with relapsing-remitting multiple sclerosis (RRMS) and the healthy population.

METHODS: Brain atrophy, volume of increased signal lesions on Fluid Attenuated Inversion Recovery Sequence (FLAIR) sequence (s.c.lesion load) and decreased signal lesions on T1 weighted sequence (s.c. black holes) were measured semi-automatically and correlated with EDSS in 12 patients. Further, we compared a time line of brain parenchyma fraction (BPF) loss in patients with SPMS, patients with RRMS and the healthy population.

RESULTS: In patients with SPMS, no statistical correlation was found between lesion load in FLAIR and EDSS and there was also no significant statistical correlation (p=0.1134) between the volume of "black holes" and EDSS. However, we did confirm a significant correlation between increase in brain atrophy and clinical status (p=0.0093). Comparison of patients with SPMS or RRMS and the healthy population revealed that brain atrophy progressed most rapidly in patients with SPMS.

CONCLUSIONS: The presence of a statistically significant difference in BPF loss between patients with SPMS or RRMS and the healthy population merits further study despite the small size of our sample. We postulate that the measurement of brain atrophy could be helpful in determining the transition of RRMS to SPMS and thereby predict the progression of the disease in the future....

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Journal Article 2008; 29(3): 292-294 PubMed PMID: 18580844 Citation  Keywords:  Abnormalities, Multiple:surgery, Adult, Amoxicillin:therapeutic use, Anti-Bacterial Agents:therapeutic use, Cesarean Section, Female, Humans, Infant, Newborn, Infant, Premature, Ischium:abnormalities, Kidney Function Tests, Laparotomy, Male, Pelvis:abnorm.   

: We present a case of a pregnancy in a 24 year old woman who was born with ectopia vesicae, split pelvis and hypoplasia of ischial bones. From childhood to adulthood she had undergone reconstructive surgeries of the abdomen and perineum, as well as urine diversion surgery. During pregnancy she experienced recurrent urinary tract infections which were treated with antibiotics. In spite of tocolysis, she delivered by cesarean section a premature baby boy at 35th week of gestation due to premature uterine contractions. The postoperative period was uneventful and they were discharged from the hospital in a good general condition....

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Journal Article 2008; 29(2): 256-260 PubMed PMID: 18404143 Citation  Keywords:  Adolescent, Adult, Complement System Proteins:analysis, Female, Humans, Male, Middle Aged, Multiple Sclerosis:blood, Neuromyelitis Optica:blood, Thyroxine:blood, Triiodothyronine:blood,.   

OBJECTIVE: The aim of this study is to assess serum levels of thyroid hormones (TH) and complement C3, C4, CH50 in patients with multiple sclerosis (MS) and neuromyelitis optica (NMO), and investigate whether there is a correlation between serum TH and complement factors in these patients.

METHODS: One hundred and eighty-eight MS patients and sixty-five NMO patients were included in this study. The levels of serum TH were measured by magnetic antibody enzyme linking immunoassay and complement C3, C4 and CH50 were determined by immunoturbidimetry.

RESULTS: The levels of TT4, complement C4 and CH50 in the serum were significantly higher in NMO patients than that in the MS. There were no significant differences in serum TT3, FT3, FT4 concentrations between NMO and MS patient. In MS patients, significant correlations between mean EDSS levels and serum C3 (r=0.223, p=0.014), and serum C4 (r=0.216, p=0.017) were found, and serum TT3 was positively correlated with serum CH50 (r=0.342, p=0.01). In NMO patients, the positive association between serum FT4 and C4 (r=0.533, p=0.006) were also found.

CONCLUSIONS: These results indicate that NMO patients has different serum TH and complement C3, C4 and CH50 levels from MS patients, and that serum TH levels is correlated with CH50 and C4 in these patients, suggesting TH may play a different role in modulating the complement activation in MS and NMO....

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Case Reports 2006; 27(6): 733-736 PubMed PMID: 17187002 Citation  Keywords:  Adrenocorticotropic Hormone:blood, Female, Follicle Stimulating Hormone:secretion, Gonadotrophs:pathology, Humans, Hydrocortisone:blood, Magnetic Resonance Imaging, Middle Aged, Neoplasms, Multiple Primary:pathology, Pituitary ACTH Hypersecretion:blood, P.   

OBJECTIVE AND IMPORTANCE: We encountered a Cushing's disease patient whose surgically removed pituitary macroadenoma was not an ACTH-producing, but rather a gonadotroph adenoma. Cure was obtained only after a tiny microadenoma, overlooked on preoperative studies, was removed by a 2nd operation from a compressed thin normal anterior pituitary gland.

CLINICAL PRESENTATION: This 45-year-old woman with Cushing syndrome presented with diabetes mellitus and steroid psychosis. Endocrinological examinations suggested Cushing's disease and MRI disclosed an invasive macroadenoma (22 mm in diameter) with suprasellar extension.

INTERVENTION: Despite total removal of the invasive macroadenoma by transsphenoidal surgery, her elevated serum cortisol- and ACTH levels failed to decrease. Histologic study of the surgical specimen disclosed that the tumor was a silent FSH-producing, rather than an ACTH-producing adenoma. Detailed re-evaluation of pre- and postoperative MRI suggested the presence of a 3-mm microadenoma on the left side of a thin compressed normal gland. Venous sampling of the cavernous sinus confirmed this suspicion. In a 2nd operation an ACTH-producing microadenoma was removed from inside the thin remaining compressed normal pituitary gland and endocrinological cure of Cushing's disease was achieved.

CONCLUSION: Although double adenomas, being a non-ACTH producing macroadenoma associated with an ACTH producing tiny microadenoma, are extremely rare in patients with Cushing's disease, detailed preoperative MRI evaluation is necessary to avoid missing tiny adenomas hidden in a compressed normal pituitary gland which is the cause of Cushing's disease, especially when a macroadenoma is found in patient with Cushing's disease....

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Case Reports 2006; 27(5): 569-572 PubMed PMID: 17159826 Citation  Keywords:  Adenoma:complications, Aged, Gonadotropin-Releasing Hormone:analogs & derivatives, Goserelin:therapeutic use, Humans, Male, Neoplasms, Multiple Primary:diagnosis, Pituitary Apoplexy:etiology, Pituitary Neoplasms:complications, Prostatic Neoplasms:complica.   

: LHRH analogs have become a promising modality in prostate cancer therapy as an alternative to surgical castration, and the use of these agents is generally considered to be safe. Since now, only few cases of an apoplexy of previously undiagnosed pituitary adenoma (usually gonadotropinoma) at the beginning of therapy have been described in the medical literature. We present a case of a 74 year old patient who was diagnosed of prostate cancer at the age of 68. There was no evidence of metastatic disease. Radical prostatectomy was performed and LHRH analog gosereline (Zoladex 3.6 mg s.c.) was administered. During the first day after gosereline injection the patient developed headaches that became more severe over the next 3 days. Then the patient experienced nausea and vomiting, double vision and eyelid ptosis. On the 5th day the patient temporarily lost consciousness and was admitted to hospital. Imaging (computerized tomography, magnetic resonance imaging) revealed the presence of a pituitary tumor and hemorrhage within the gland. There was no evidence of pituitary dysfunction in hormonal studies. Neurosurgical intervention was postponed for 5 days after admission. Pathological mass with signs of recent hemorrhage was removed via transsphenoidal route. The tumor had negative immunohistochemical GH, ACTH and PRL staining. Neurological impairment resolved within 9 months after the operation. As a result the patient required adrenal and thyroid replacement. During 6 years of follow-up there was no evidence of prostate cancer recurrence....

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Comparative Study 2005; 26(6): 819-822 PubMed PMID: 16380704 Citation  Keywords:  Adult, Analysis of Variance, Female, Ghrelin, Humans, Male, Matched-Pair Analysis, Middle Aged, Multiple Sclerosis, Chronic Progressive:blood, Multiple Sclerosis, Relapsing-Remitting:blood, Peptide Hormones:blood, Reference Values, Severity of Illness Ind.   

: In addition to metabolic and neuroendocrine actions, the recently discovered hormone ghrelin has been found to have inhibitory effects on inflammatory processes. This novel finding suggests possible involvement of the peptide in the pathogenesis of inflammatory disorders including the inflammatory demyelinating disease of the central nervous system, multiple sclerosis (MS). The aim of the present study was to evaluate serum ghrelin levels in patients with MS. Serum ghrelin levels were measured in 40 MS patients and 20 controls. Control subjects were selected from healthy individuals, matched for age, sex and BMI. Fasting plasma levels of ghrelin were determined by radioimmunoassay. Serum ghrelin level was significantly higher in MS group (226.16 +/- 35.84 pg/ml, n=40) than that in the control group (113.04 +/- 11.28 pg/ml, n=20, P<0.001). Both, relapsing remitting and secondary progressive MS patients had ghrelin levels significantly higher than controls, while there was no significant difference between the ghrelin levels of patients with these two categories of MS. This study for the first time shows that patients with MS have higher levels of ghrelin and this increase in circulating ghrelin level may function against the proinflammatory process in these patients....

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Case Reports 2005; 26(1): 67-68 PubMed PMID: 15726023 Citation  Keywords:  Adult, Anti-Inflammatory Agents:therapeutic use, Brain:pathology, Female, Humans, Magnetic Resonance Imaging, Methylprednisolone:therapeutic use, Multiple Sclerosis:complications, Thyroiditis, Autoimmune:complications,.   

: Our patient developed Riedel's thyroiditis soon after having an exacerbation of multiple sclerosis (MS). MS has been associated with other autoimmune diseases, including thyroiditis, and both Hashimoto's thyroiditis and subacute thyroiditis have been described in connection with MS. Yet, we are not aware of any other patient reported to have concomitant MS and Riedel's thyroiditis. The association between MS and Riedel's thyroiditis remains obscure but may reflect an autoimmune disorder common to both diseases....

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Journal Article 2001; 22(4): 248-250 PubMed PMID: 11524631 Citation  Keywords:  Adult, Contraceptives, Oral:pharmacology, Female, Humans, Hyperandrogenism:complications, Incidence, Italy, Menstruation Disturbances:complications, Multiple Sclerosis:complications, Reference Values,.   

: A mild prevalence of multiple sclerosis (MS) is present in females (2:1). To elucidate the pathogenetic role of sex steroids on the disease, we studied 76 women affected by MS, compared to 50 healthy women (mean age +/- SD, 34.9 +/- 0.9 vs. 33.4 +/- 1.7 years). The menarche was at mean age of 12.3 +/- 0.2 vs. 12.4 +/- 0.2. Interval between menses was 28.0 +/- 0.3 vs 27.8 +/- 0.3 days, with duration of menstrual flow of 5.0 +/- 0.2 vs. 5.0 +/- 0.2 days. Oligo- or amenorrhea was present in 20% of patients and in 16% of controls. Oral contraceptives were assumed by 21% of patients and 34% of controls (n.s.). Premenstrual symptoms were found in 43% of patients and in 46% of controls (n.s.). The incidence of hyperandrogenism (greasy skin, acne and hirsutism), evaluated by a specific questionnaire, was higher and statistically significant in MS patients than in controls (28% vs. 10%, p<0.05). Further studies, including a complete clinical and laboratory evaluation of gonadal function, are necessary in order to clarify whether hyperandrogenism may influence MS disease activity....

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