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Case Reports 2008; 29(6): 871-873 PubMed PMID: 19112397 Citation  Keywords:  Abscess:complications, Anti-Bacterial Agents:therapeutic use, Cesarean Section, Female, Humans, Pregnancy, Pregnancy Complications, Infectious:drug therapy, Pregnancy Outcome, Treatment Outcome, Uterine Diseases:complications, Uterus:abnormalities, Young .   

: A 20 year old primigravida with a double uterus was admitted with a viable fetus in the right uterus and pus oozing from the left one. Management consisted of a regimen of intravenous antibiotics and intravaginal antibiotic tablets. Tocolysis was used to arrest imminent preterm labor. In the course of pregnancy IUGR was diagnosed. At 38 weeks of pregnancy a SGA baby boy of 2,440 g was delivered by cesarean section. The mother and the baby were discharged from the hospital in good general condition....

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Journal Article 2008; 29(6): 1038-144 PubMed PMID: 19112390 Citation  Keywords:  Acromegaly:blood, Adenoma:complications, Adult, Aged, Follow-Up Studies, Humans, Insulin-Like Growth Factor I:analysis, Male, Middle Aged, Pituitary Neoplasms:complications, Somatostatin:analogs & derivatives, Treatment Outcome,.   

OBJECTIVE: The aim of our study was to investigate the characteristics of acromegalic patients diagnosed at a tertiary University Hospital and to evaluate the results of the recommended treatment protocols.

PATIENTS AND METHODS: All our acromegalic patients were included (n=48; 27 women). Demographic, hormonal, visual and imaging data at diagnosis and during follow-up were recorded, as well as the treatments applied.

RESULTS: In 73.0% of the patients, acromegaly was due to a pituitary macroadenoma. From those under periodic surveillance, 68.2% underwent surgery and 36.4% had radiotherapy. At the time of the study 88.6% of the patients were receiving medical therapy, 28.2% of them as first-line treatment. Applying current criteria, only one patient was cured by surgery. Considering normal age and sex-matched concentrations of IGF-I as a control criteria, surgery resulted in disease control in 10% of the patients who had surgery, while medical treatment controlled the disease in 76.9% (P <0.05). Of those who receive medical therapy as first-line treatment, tumour size decreased in 45.5%, while in the rest no significant changes were observed during follow-up.

CONCLUSIONS: Not all centres obtain the results reported in the literature in terms of disease control and morbidity after surgical treatment of growth hormone-secreting tumours. It is possible that in some hospitals first-line medical treatment should be chosen, unless the patient has visual disturbances, as long as it is not clear that partial surgical removal of the tumour significantly improves response to medical therapy or reduces its costs....

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Journal Article 2008; 29(Suppl 1): 123-132 PubMed PMID: 19029877 Citation  Keywords:  Deep Brain Stimulation:adverse effects, Humans, Mental Disorders:therapy, Psychiatry, Treatment Outcome,.   

: Deep brain stimulation (DBS) is a reversible surgical procedure that involves stereotactic implantation of electrodes into the targeted brain regions, with a subcutaneously placed pulse generator powering the electrodes via one or two leads. The mechanism of action can be explained by the stimulation-induced modulation of impaired network activity. So far, the main use of DBS has been for neurological conditions, such as essential tremor, motor symptoms in Parkinson's disease, dystonia, epilepsy, and chronic pain. In psychiatry, case series and open studies indicate treatment efficacy of DBS in Gilles de la Tourette syndrome, treatment-resistant obsessive-compulsive disorder, and refractory major depression. Neuroimaging studies have confirmed the effects of DBS on the brain regions implicated in specific neuropsychiatric disorders. It is a well-tolerated method with relatively few serious side effects. Additional well-designed and appropriately powered controlled clinical trials are needed to conclusively establish the efficacy and safety of DBS and to identify the patient population(s) who may benefit most. Ongoing research with stimulation techniques may also significantly contribute to our understanding of major neuropsychiatric disorders....

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Historical Article 2008; 29(Suppl 1): 11-32 PubMed PMID: 19029876 Citation  Keywords:  Clinical Trials as Topic, Electroconvulsive Therapy:adverse effects, Ethics, Medical, History, 20th Century, Humans, Mental Disorders:therapy, Practice Patterns, Physicians', Psychiatry:methods, Treatment Outcome,.   

: Electroconvulsive therapy (ECT) is largely historical but is still in use. Modern psychiatry requires careful selection of patients in whom ECT will be performed. The indications for ECT treatment are limited, and the selection criteria should be strictly followed. The advantages and the disadvantages of the methods are discussed here. Despite the limitations, ECT seems to have real value in selected mental conditions in which it can even be considered a life-saving procedure....

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Journal Article 2008; 29(1): 163-167 PubMed PMID: 18283255 Citation  Keywords:  Female, Gynecologic Surgical Procedures:adverse effects, Humans, Laparoscopy:adverse effects, Leiomyoma:surgery, Retrospective Studies, Treatment Outcome, Uterine Neoplasms:surgery,.   

OBJECTIVES: To analyze the indications, safety and feasibility of laparoscopic myomectomies performed during the last 10 years.

MATERIAL AND METHODS: The studied material consisted of 187 typically performed laparoscopies, mostly due to uterine myomas. All the patients underwent an ultrasound examination at the time of admission and those with the maximum of 3 tumors, where the largest tumors were less than 10cm in diameter, were qualified for endoscopic surgery.

RESULTS: Out of 187 women, 39 patients had laparoscopy performed twice, with a 3-4 months interval for GnRH analogues treatment. Among 164 operative laparoscopies myomas were enucleated in 132 of the women (80.5%). In the case of 18 patients (9.6%) there was a need for laparoconversion resulting from the difficulties with enucleation, adhesions, and the size or localization of the tumor. There were also 62 cases of diagnostic laparoscopy, where myomas were either too large or too small to be enucleated. On analyzing the number and size of the tumors it occurred that a single myoma was the most frequent finding, while more than half of all the enucleated uterine tumors found during diagnostic and operative endoscopies were up to 2cm in diameter.

CONCLUSIONS: Laparoscopic myomectomy is a safe and reliable surgical alternative for women suffering from symptomatic myomas and is a method of choice in young patients of reproductive age. Beside skillful surgical techniques, a proper qualification for the operation is essential for the desired outcome....

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Case Reports 2008; 29(1): 69-70 PubMed PMID: 18283246 Citation  Keywords:  Adult, Depression:therapy, Female, Humans, Pregnancy, Pregnancy Complications:psychology, Transcranial Magnetic Stimulation:adverse effects, Treatment Outcome,.   

: Sir: For women diagnosed with Recurrent depressive disorder, pregnancy poses a major treatment challenge. Apart from antidepressants, the most commonly used biological therapeutical method is ECT (electroconvulsive therapy). We believe that similar efficacy can be achieved using rTMS as a safer option with substantially less side effects. So far, only a few case-reports reporting the use of rTMS for treatment of pregnant patients with depression were published....

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Case Reports 2008; 29(1): 47-50 PubMed PMID: 18283244 Citation  Keywords:  Adolescent, Antipsychotic Agents:therapeutic use, Benzodiazepines:therapeutic use, Electroconvulsive Therapy, Humans, Male, Schizophrenia, Catatonic:drug therapy, Treatment Outcome, Twins, Monozygotic:psychology,.   

: We describe a case of monozygotic (MZ) male twins (14.6 years old) who suffered from a severe form of catatonic schizophrenia. On admission, the principal symptoms of the brothers were stupor, mutism, catatonic posturing, rigidity, negativism, and refusal of food and liquids. They were treated with electroconvulsive therapy (ECT) with no effect (twin A) and almost no effect (twin B). Both twins improved with initiation of olanzapine therapy. Twin B showed a marked improvement by week 2 on a dose of 10 mg daily (qd). Improvement in twin A was seen by week 4 on a dose of 15 mg qd. Twin B was discharged after 8 weeks and twin A after 11 weeks of olanzapine treatment. This appears to be the first report on concordant positive responses to olanzapine in MZ twins with catatonic schizophrenia, as well as, the first report on concordant resistance to ECT....

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Journal Article 2007; 28(Suppl 3): 33-34 PubMed PMID: 18030276 Citation  Keywords:  Anti-Bacterial Agents:therapeutic use, Community-Acquired Infections:drug therapy, Diabetes Complications:drug therapy, Diabetes Mellitus, Humans, Meningitis, Bacterial:drug therapy, Outcome Assessment (Health Care), Oxacillin:therapeutic use, Staphylococ.   

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