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Case Reports 2017; 37(8): 535-539 PubMed PMID: 28326748 Citation  Keywords:  Adult, Appendiceal Neoplasms:diagnosis, Carcinoid Tumor:diagnosis, Female, Follow-Up Studies, Humans, Parturition:physiology, Pregnancy, Pregnancy Complications, Neoplastic:diagnosis, Prognosis, Receptors, Somatostatin:metabolism, Treatment Outcome,.   

: Neuroendocrine neoplasms are detected very rarely in pregnant women. The following is a case report of carcinoid tumor of the appendix diagnosed in 28 year-old woman at 25th week of gestation. The woman delivered spontaneously a healthy baby at the 38th week of gestation. She did not require adjuvant therapy with somatostatin analogues. The patient remained in remission. There are not established standards of care due to the very rare incidence of carcinoid tumors in pregnancy. A review of the literature related to management and prognosis in such cases was done....

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Case Reports 2016; 37(7): 473-477 PubMed PMID: 28326740 Citation  Keywords:  Abortion, Habitual:therapy, Adult, Enoxaparin:administration & dosage, Female, Humans, Pregnancy, Pregnancy Outcome, Sildenafil Citrate:administration & dosage, Treatment Outcome,.   

OBJECTIVES: Does addition of Intralipid to sildenafil and enoxaparin immunotherapy improve pregnancy outcome?

MATERIALS AND METHOD: Report of a striking case of a patient with history of 4 recurrent pregnancy losses (RPL) and IVF failures.

RESULTS: Adding of Intralipid resulted in giving birth to a healthy male baby in the 3th IVF cycle.

CONCLUSION: Combination therapy that includes Intralipid may generate successful IVF outcome, although this problem merits further study, especially regarding safety issues....

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Case Reports 2016; 37(7): 469-472 PubMed PMID: 28326739 Citation  Keywords:  Adolescent, Adrenal Insufficiency:diagnosis, Female, Hormone Replacement Therapy, Humans, Hyponatremia:diagnosis, Hypopituitarism:blood, Pituitary Diseases:complications, Pituitary Gland:metabolism, Seizures:complications, Sodium:blood, Treatment Outcome,.   

: Pituitary stalk interruption syndrome (PSIS) is a congenital disease with isolated growth hormone deficiency (GHD) or multiple anterior pituitary hormone deficiencies (MPHD). The typical clinical manifestations of PSIS are growth retardation, hypoglycemia or delayed pubertal development. However, few reports showed cases of PSIS were diagnosed with acute epileptic seizures accompanied by hyponatremia. Here, we report an 18-year-old female presenting with episodes of intermittent seizures for 13 years. The electrolyte examination on many occasions has shown hyponatremia, even as low as 99.9 mmol/L. However, the cause of hyponatremia has not been further discussed. The patient had short stature and no pubertal development. The laboratory tests revealed growth hormone deficiency, secondary adrenal insufficiency, hypothyroidism and hypogonadotropic hypogonadism. MRI showed an ectopic hyperintense signal of the posterior pituitary and no visible anterior pituitary gland or stalk. The hormone replacement therapy helped to raise the sodium concentration to a normal level and in the termination of seizures....

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Case Reports 2016; 37(3): 174-178 PubMed PMID: 27618599 Citation  Keywords:  Adult, Biopsy, Fine-Needle, Female, Goiter:diagnostic imaging, Histiocytosis, Langerhans-Cell:complications, Hormones:blood, Humans, Hypopituitarism:diagnostic imaging, Magnetic Resonance Imaging, Treatment Outcome, Ultrasonography,.   

: Langerhans cell histiocytosis (LCH) in adults is a rare disorder of unknown etiology characterized by monoclonal proliferation of Langerhans cells. It belongs to dendritic cell disorders and occurs in 1-2 adults per million. The most common endocrine manifestation of classical LCH is associated with the posterior pituitary, with clinical symptoms of diabetes insipidus. Less than 80 reported cases of LCH involving the thyroid gland have been published so far. We present the case of a 39 years old woman with 10 years history of diabetes insipidus and secondary amenorrhoea, which appeared after second delivery. She was suspected for lymphocytic inflammation of pituitary and she was administered steroid treatment. She was also treated symptomatically with desmopressin, L-thyroxine, estrogen and progestagen replacement therapy due to diabetes insipidus, secondary hypothyroidism and hypogonadotropic hypogonadism. In September 2014, she noticed a painless, firm tumour of the neck. Ultrasound (US) examination demonstrated bilateral, solid, hypoechogenic thyroid nodules. The result of fine-needle aspiration biopsy (FNAB) was not diagnostic. Due to rapid progression and US image of the tumour, she was referred for surgery. In postoperative histopathology tumour cells were positive for CD1a and S-100 protein, therefore diagnosis of LCH was established. Postoperatively, the results of thoracic computed tomography scan, abdominal US and bone scintigraphy revealed no evidence of multifocal disease. We have not observed any disease recurrence in the patient after a year of follow-up in postoperative course. This case illustrates diagnostic and therapeutic difficulties in patient with LCH....

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Journal Article 2015; 36(8): 771-778 PubMed PMID: 26921578 Citation  Keywords:  Adult, Cohort Studies, Epilepsy, Temporal Lobe:psychology, Female, Humans, Intelligence, Intelligence Tests, Male, Memory, Middle Aged, Neuropsychological Tests, Radiosurgery, Retrospective Studies, Treatment Outcome,.   

OBJECTIVES: The aim of this study is to summarize our experience with neuropsychological changes after radiosurgical treatment for mesial temporal lobe epilepsy and subsequent surgery due to insufficient seizure control.

METHODS: Between November 1995 and May 1999, 14 patients underwent radiosurgical entorhinoamygdalohippocampectomy with a marginal dose of 18, 20 or 25 Gy to the 50% isodose. 9 of these patients subsequently underwent surgery. We compared Memory Quotients and Intelligence Quotients before and after the interventions.

RESULTS: We found a slight, but nonsignificant decline in intelligence and memory quotients one year after GKRS. Two years after radiosurgery there were no significant changes in any of the quotients. After surgery, we found significant increase in Global and Visual MQ, (p<0.05). There were no statistically significant changes in verbal memory and intelligence performance after surgery.

CONCLUSION: Epilepsy surgery after unsuccessful radiosurgery could lead to improvements in cognitive functions in patients with mesial temporal lobe epilepsy....

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Journal Article 2015; 36(4): 387-393 PubMed PMID: 26454496 Citation  Keywords:  Adult, Age Factors, Female, Gravidity:physiology, Humans, Hypertension, Pregnancy-Induced:epidemiology, Obstetric Labor Complications:epidemiology, Oligohydramnios:epidemiology, Parity:physiology, Poland:epidemiology, Pregnancy, Pregnancy Outcome:epidemio.   

OBJECTIVE: The aim of the study was to compare the pregnancy course and neonatal outcome in women at least 40 years old during conception.

DESIGN: Data were collected on the basis of medical records of patients who gave birth between 2009-2014 at the 1st Department of Obstetrics and Gynecology, Medical University of Warsaw. Women enrolled were at least 40 years old at the moment of conception and delivered after 22 completed weeks of gestation - they were also assigned into 2 groups: primiparas and multiparas. Demographic features, pregnancy and delivery complications, mode of delivery and neonatal outcome were analyzed and compared.

RESULTS: 9760 women delivered at the Department during the study period, among them 193 met the inclusion criteria for the study: 40 primiparas (average age 40.9 ± 1.14) and 153 multiparas (average age 41.3 ± 1.35). No relation between parity and preterm delivery was observed (5% primiparas vs 11.1% multiparas; p>0.05). However, gestational age at delivery was associated with the number of pregnancies - the higher the pregnancy number, the lower the gestational age (p=0.009; R=-0.188). Primiparity was associated with an increased rate of oligohydramnios (RR=4.78; 95% CI 1.15-20.63) and pregnancy induced hypertension (RR=2.34; 95% CI 0.93-5.58). Primiparas had a significantly greater risk of operative delivery (RR=1.83; 95% CI 1.42-2.12) and unsuccessful labor inductions (RR=3.60; 95% CI 1.04-5.29). They were more often diagnosed with fibroids (RR=3.04; 95%CI 1.15-7.81). No relations between parity and birth weight, fetal abnormalities or Apgar score were observed.

CONCLUSIONS: Delayed childbearing of a first child seems to increase the risk of perinatal complications, which is important for counseling purposes....

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Comparative Study 2015; 36(4): 368-373 PubMed PMID: 26454493 Citation  Keywords:  Adult, Case-Control Studies, Cognitive Therapy:methods, Cohort Studies, Diet Therapy:methods, Female, Humans, Middle Aged, Obesity:diet therapy, Patient Compliance, Treatment Outcome, Weight Loss,.   

OBJECTIVE: The aim of this nested case-control study was to compare the effectiveness of cognitive-behavioral treatment (CBT) for treatment-resistant obese (body mass index [BMI] ≥ 30 kg/m²) women compared with standard dietary treatment. The main outcome measures were attrition and weight loss success.

METHODS: We designed a 6-month case-control study, nested within a cohort of adult (age ≥ 18 years) treatment-resistant (history of at least two previous diet attempts) obese women. Cases were 20 women who were offered CBT sessions. Controls (n=39) were randomly selected from the source population and matched to cases in terms of baseline age, BMI, and number of previous diet attempts.

RESULTS: Compared with controls, cases were significantly more likely to complete the 6-month program in both age-adjusted (odds ratio [OR]=2.94, 95% confidence interval [CI]=1.05-8.97) and multivariate-adjusted (OR=2.77, 95% CI=1.02-8.34) analyses. In contrast, cases were not more likely to achieve weight loss success in age-adjusted (OR=1.32, 95% CI=0.86-1.67) and multivariate-adjusted (OR=1.21, 95% CI=0.91-1.44) analyses.

CONCLUSIONS: Compared with a standard dietary treatment, CBT was significantly more effective in reducing attrition in treatment-resistant obese women, without differences in terms of weight loss success....

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Journal Article 2015; 36(4): 348-353 PubMed PMID: 26454490 Citation  Keywords:  Adolescent, Body Height:drug effects, Child, Dwarfism:drug therapy, Female, Growth Hormone:administration & dosage, Human Growth Hormone:deficiency, Humans, Male, Neural Networks (Computer), Outcome Assessment (Health Care):methods, Recombinant Proteins,.   

INTRODUCTION: The leading method for prediction of growth hormone (GH) therapy effectiveness are multiple linear regression (MLR) models. Best of our knowledge, we are the first to apply artificial neural networks (ANN) to solve this problem. For ANN there is no necessity to assume the functions linking independent and dependent variables. The aim of study is to compare ANN and MLR models of GH therapy effectiveness.

MATERIAL AND METHODS: Analysis comprised the data of 245 GH-deficient children (170 boys) treated with GH up to final height (FH). Independent variables included: patients' height, pre-treatment height velocity, chronological age, bone age, gender, pubertal status, parental heights, GH peak in 2 stimulation tests, IGF-I concentration. The output variable was FH.

RESULTS: For testing dataset, MLR model predicted FH SDS with average error (RMSE) 0.64 SD, explaining 34.3% of its variability; ANN model derived on the same pre-processed data predicted FH SDS with RMSE 0.60 SD, explaining 42.0% of its variability; ANN model derived on raw data predicted FH with RMSE 3.9 cm (0.63 SD), explaining 78.7% of its variability.

CONCLUSION: ANN seem to be valuable tool in prediction of GH treatment effectiveness, especially since they can be applied to raw clinical data....

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