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Evaluation Studies 2008; 29(2): 267-271 PubMed PMID: 18404137 Citation  Keywords:  Adolescent, Adult, Early Diagnosis, Female, Hospitalization, Humans, Laparoscopy, Postoperative Period, Pregnancy, Pregnancy, Ectopic:diagnosis, Retrospective Studies, Risk Factors, Salpingostomy:methods,.   

OBJECTIVES: To assess the diagnostic process, laparoscopic treatment and postoperative period in patients hospitalized with a suspicion of ectopic pregnancy.

MATERIALS AND METHODS: 211 women who underwent a typical laparoscopic surgery due to ectopic pregnancy, from 1993 through to 2006, were included in the study. The diagnosis was based on the patient's history, gynecological examination, transvaginal ultrasound findings and beta hCG concentration.

RESULTS: The abnormal uterine bleeding was the most often reported symptom at admission (70.1%). The typical triad for ectopic pregnancy - amenorrhoea, abnormal bleeding and pain were present in only 55 patients (26%). The most frequent ultrasound findings were abnormal echogenic structures on the side of operated ectopic pregnancy (77.3%). 15.7% of women had no abnormalities described. The most frequent site of ectopic pregnancy implantation was the ampulla of the Fallopian tube (59.7%). Salpingectomy was performed in 53.5% of the cases, while salpingotomy in 35%. The postoperative period was generally uneventful in the majority of patients. There were only two cases that required a second surgery because of the worsening general clinical condition of the patient.

CONCLUSIONS: The ectopic pregnancy is currently diagnosed quite early and therefore can be treated with the use of endoscopic tools in a scheduled operation time. Nowadays, only a small percentage of women still require a sudden open surgery intervention....

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Comparative Study 2008; 29(2): 272-280 PubMed PMID: 18404135 Citation  Keywords:  Adolescent, Attention Deficit Disorder with Hyperactivity:blood, Case-Control Studies, Child, Child Development Disorders, Pervasive:blood, Child, Preschool, Developmental Disabilities:blood, Female, Humans, Male, Mothers, Pregnancy, Prenatal Exposure Del.   

BACKGROUND: Many formulations of Thimerosal (49.55% mercury by weight)-containing Rho(D) immune globulins (TCRs) were routinely administered to Rh-negative mothers in the US prior to 2002.

OBJECTIVES: It was hypothesized: (1) if prenatal Rho(D)-immune globulin preparation exposure was a risk factor for neurodevelopmental disorders (NDs) then more children with NDs would have Rh-negative mothers compared to controls; and (2) if Thimerosal in the Rho(D)-immune globulin preparations was the ingredient associated with NDs, following the removal of Thimerosal from all manufactured Rho(D)-immune globulin preparations from 2002 in the US the frequency of maternal Rh-negativity among children with NDs should be similar to control populations.

METHODS: Maternal Rh-negativity was assessed at two sites (Clinic A-Lynchburg, VA; Clinic B-Rockville and Baltimore, MD) among 298 Caucasian children with NDs and known Rh-status. As controls, maternal Rh-negativity frequency was determined from 124 Caucasian children (born 1987-2001) without NDs at Clinic A, and the Rh-negativity frequency was determined from 1,021 Caucasian pregnant mothers that presented for prenatal genetic care at Clinic B (1980-1989). Additionally, 22 Caucasian patients with NDs born from 2002 onwards (Clinics A and B) were assessed for maternal Rh-negativity.

RESULTS: There were significant and comparable increases in maternal Rh-negativity among children with NDs (Clinic: A=24.2%), autism spectrum disorders (Clinic: A=28.3%, B=25.3%), and attention-deficit-disorder/attention-deficit-hyperactivity-disorder (Clinic: A=26.3%) observed at both clinics in comparison to both control groups (Clinic: A=12.1%, B=13.9%) employed. Children with NDs born post-2001 had a maternal Rh-negativity frequency (13.6%) similar to controls.

CONCLUSION: This study associates TCR exposure with some NDs in children....

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Journal Article 2008; 29(2): 246-251 PubMed PMID: 18404133 Citation  Keywords:  Attention Deficit Disorder with Hyperactivity:genetics, Case-Control Studies, Child, DNA Mutational Analysis, Dopamine Plasma Membrane Transport Proteins:genetics, Dopamine beta-Hydroxylase:genetics, Female, Gene Frequency, Genetic Predisposition to Disea.   

BACKGROUND: Pharmacological approach is the most effective way of treatment of ADHD and its early application prevents from the progress of secondary disorders. The study on present neurotransmitter systems in pathology of ADHD can be helpful in selecting appropriate drug, since there are used various substances with different mechanisms of functioning in treatment of the hyperkinetic syndrome.

METHOD: Within our study there were selected the genes of dopaminergic (DRD2, DRD3, DAT1), noradrenergic (DBH) and serotoninergic (5-HTT) systems. With the use of molecular-genetic methods based on association strategy "case-control" there were analysed genes including 11 polymorphisms. The presence of risk alleles was examined in comparison of the sample of 100 ADHD children to a control group of another 100 subjects, who were checked by child psychiatrists and examined with the Conners test in order to exclude eventual cases with ADHD symptoms.

RESULTS: Our research suggests the association of some genes with ADHD. It could be concluded: 1) the risk of ADHD is significantly increased in the presence of one risk allele in genes DRD2 (O.R.=7,5), 5-HTT (O.R.=2,7) and DAT1 (O.R.=1,6). 2) The risk of ADHD is significantly increased at homozygotes for risk alleles in genes DRD2 (O.R.=54,8), 5-HTT (O.R.=6,7) and DAT1 (O.R.=6,6). For polymorphisms G444A and C1603T in DBH, which were detected by univariant analysis, haplotype analysis was performed and resulted in conclusion that: 3) the risk of ADHD is significantly increased in the presence of allele DBH +444A as well as in the presence of allele DBH +1603T (O.R.=15)....

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Journal Article 2008; 29(1): 113-116 PubMed PMID: 18283262 Citation  Keywords:  Adenoma:metabolism, Adult, Aged, Female, Growth Hormone:metabolism, Hemangiopericytoma:metabolism, Humans, Male, Middle Aged, Pituitary Neoplasms:metabolism, Prolactin:metabolism, Receptors, Somatostatin:metabolism, Somatostatin:pharmacology, Tumor Cells,.   

OBJECTIVES: The aim of the study was to examine the effect of somatostatin (SST) on vascular endothelial growth factor (VEGF) secretion from clinically non-functioning pituitary tumors incubated in vitro.

MATERIAL AND METHODS: Eight pituitary tumors surgically removed were investigated. All of the tumors were diagnosed before surgery as non-functioning. Seven of them were diagnosed after surgery as pituitary adenomas and expressed either gonadotropins or their subunits as detected by immunohistochemistry. Two tumors additionally expressed prolactin and growth hormone. One tumor was immunonegative for pituitary hormones and was diagnosed as haemangiopericytoma. All tumors but one were investigated immunohistochemically to detect the somatostatin receptors and expressed at least 3 of 5 subtypes of somatostatin receptors. The cells isolated from the examined tumors were exposed in vitro to native SST-14. The concentration of VEGF in the culture media was performed by means of ELISA method.

RESULTS: It was found that the exposure on SST-14 resulted in the divergent changes (increase in 4 cases and decrease in 3 cases) in VEGF concentrations in the medium. It seems that the inhibition of VEGF secretion is related to the expression of somatostatin receptor subtypes sst1 and sst2.

CONCLUSIONS: The response of VEGF secretion from pituitary tumoral cells to SST seems to depend on the spectrum of expressed somatostatin receptor subtypes. However, this presumption needs further studies on the larger material....

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Controlled Clinical Trial 2008; 29(1): 146-150 PubMed PMID: 18283261 Citation  Keywords:  Aged, Biomarkers:blood, Cardiovascular Diseases:blood, Cholesterol, LDL:blood, Diabetes Mellitus, Type 2:blood, Female, Fenofibrate:adverse effects, Humans, Lipoproteins:blood, Male, Middle Aged, Peroxisome Proliferator-Activated Receptors:agonists, Phosp.   

BACKGROUND: Particle size distribution in both HDL and LDL is reflected in the fractional esterification rate of cholesterol by lecithin cholesterol acyltransferase (LCAT) in plasma depleted of apoB containing lipoproteins (FER(HDL)). We studied FER(HDL) in a group of patients with type 2 diabetes and determined the impact of two different PPAR agonists (fenofibrate and rosiglitazone) on this marker of lipoprotein particle quality.

PATIENTS AND METHODS: 66 patients with type 2 diabetes (26 women) and 32 control subjects (19 women) were included in the study. 33 patients received fenofibrate and 33 rosiglitazone as add on therapy. Average duration of treatment was 4 months. Plasma lipoprotein glucose levels were determined using an automated analyzer (COBAS Mira, Roche). LDL cholesterol concentrations were calculated by Friedewald formula. FER(HDL) was determined by a radioassay after precipitating apo-B containing particles of plasma. The assays were performed at baseline and at the end of each treatment. SPSS base program was used for statistical evaluation.

RESULTS: Both fenofibrate and rosiglitazone resulted in a significant decrease of FER(HDL) (24.62 +/- 11.27%/h vs. 19.93 +/- 10.34%/h; 20.0 +/- 6.1%/h vs. 15.8 +/- 5.8%/h, p < 0.001). Rosiglitazone was significantly more effective in FER(HDL) lowering than fenofibrate (p < 0,02)

CONCLUSIONS: Both fenofibrate and rosiglitazone improve FER(HDL) in patients with type 2 diabetes. The effect is more pronounced for rosiglitazone. Qualitative change of plasma lipoproteins reflected by FER(HDL) can contribute to antiatherogenic action of PPAR agonists. On contrary, changes of lipoprotein composition induced by PPAR agonists cannot explain adverse cardiovascular effects observed in some large clinical trials with PPAR agonists....

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Clinical Trial 2008; 29(1): 107-112 PubMed PMID: 18283256 Citation  Keywords:  Acromegaly:complications, Adenoma:etiology, Adult, Aged, Blood Glucose:metabolism, Colonic Polyps:etiology, Colorectal Neoplasms:etiology, Female, Growth Hormone:blood, Homeostasis:physiology, Humans, Hyperinsulinism:complications, Insulin:blood, Insulin .   

INTRODUCTION: Pathogenesis of colonic lesions in patients with acromegaly remains still unclear. There are suggestions that apart from somatotropin axis hormones (GH and IGF-1), other agents also take part in this process. Molecular and animal studies indicate a vital role of hyperinsulinemia in development of colorectal neoplasms.

AIM OF THE STUDY: To evaluate a relation between insulin level, insulin resistance and its anthropometric markers and colorectal lesions in patients with acromegaly.

MATERIAL AND METHODS: The study consisted of 40 patients with active, newly diagnosed acromegaly; 24 women and 16 men aged from 24 to 77 years (mean age 50.1, SD+/-12.1). The analysis included the results of somatotropin axis function (GH and IGF-1 level), carbohydrate metabolism assessment (fasting serum glucose and insulin levels, oral glucose tolerance test, HOMA-IR for insulin resistance), the results of anthropometric measurement (BMI, WHR) and colonoscopy.

RESULTS: Colon pathologies (60 polyps and 2 flat lesions) were discovered in 19 (47.5%) patients with acromegaly, 8 of them had multiple polyps. Hyperplastic polyps were revealed in 11 (27.5%), while adenomas in 8 (20%) acromegalics. Patients with colorectal lesions were found to have higher WHR then subjects with normal colon (p=0.033). Positive correlation between the number of hyperplastic polyps in the patients with multiple changes in the colon and IGF-1 (p=0.025), insulin level (p=0.005) and HOMA-IR (p=0.001) was found. Multiple adenomas correlated positively with insulin level (p=0.007), HOMA-IR (p=0.006) and BMI (p=0.015).

CONCLUSIONS: The study results show a relation between hyperinsulinemia, insulin resistance and colon pathologies in acromegaly. Fasting insulin level and HOMA-IR correlate positively with the number of hyperplastic polyps and adenomas in acromegalic patients with multiply colorectal lesions....

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Case Reports 2008; 29(1): 41-43 PubMed PMID: 18283254 Citation  Keywords:  Adult, Anticoagulants:therapeutic use, Female, Heparin:therapeutic use, Humans, Hypothyroidism:complications, Intracranial Hypertension:diagnosis, Sinus Thrombosis, Intracranial:diagnosis, Thyroxine:therapeutic use,.   

: Several cases of hypothyroidism have been reported to develop idiopathic intracranial hypertension not directly precisely linked with cerebral venous sinus thrombosis (CVT). A 31-year-old Chinese woman presented with bilateral blurred vision and paroxysmal amaurosis for about 6 months without headache. Neurological examination revealed normal expect for the sixth cranial nerve palsy and bilateral papilledema. Laboratory tests showed pronounced hypothyroidism and greatly increased serum triglyceride. Cerebral spinal fluid showed the increased opening and closing pressure. Digital subtraction angiography (DSA) disclosed a filling defect in the adjunction of bilateral transverse sinuses and sigmoid sinuses. Her symptoms gradually improved with levothyroxine, mannitol and anticoagulants treatment. In presenting the rare case of lateral sinus thrombosis associated with primary hypothyroidism, we wish to alert physicians that patients presenting with papilledema and hypothyroidism may require investigations of DSA for CVT, even in the absence of headache....

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Controlled Clinical Trial 2008; 29(1): 168-172 PubMed PMID: 18283250 Citation  Keywords:  Adult, Affect:physiology, Anorexia Nervosa:physiopathology, Appetite:physiology, Body Temperature:physiology, Bulimia Nervosa:physiopathology, Circadian Rhythm:physiology, Eating:physiology, Female, Humans, Hunger:physiology, Phototherapy:methods,.   

OBJECTIVES: Light and food are important synchronizers of circadian rhythmicity. In eating disorders, the circadian rhythms of food intake and temperature are abnormal.

METHODS: We analyzed the effect of the morning light application on the circadian rhythm of tympanic temperature and its association with hunger and mood changes in the sample of 25 female patients hospitalized with DSM-IV diagnosis of eating disorders (14 bulimia nervosa and 11 anorexia nervosa) and in 6 healthy women.

RESULTS: Light therapy reduced interindividual variability of the temperature acrophase, synchronized the temperature and hunger rhythms and showed an antidepressant effect on patients with eating disorders. Bright light therapy normalized the circadian rhythm of body temperature in both anorexic and bulimic patients: phase advanced rhythm was delayed and phase delayed rhythm was advanced. In contrast with anorexic patients, the majority of bulimic patients had normal temperature rhythm before the therapy and this rhythm was not changed by the therapy.

CONCLUSION: The light therapy normalized temperature circadian rhythm in patient with eating disorders. We hypothesize that the light therapy can also contribute to improvement of pathological eating pattern because of the functional connections between light and food entrained oscillators. The light may help to restore the irregular circadian rhythmicity induced by chaotic food intake....

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