Search NEL Online

Journal Article 2012; 33(3): 294-297 PubMed PMID: 22635087 Citation  Keywords:  Aged, Aged, 80 and over, Brain Ischemia:epidemiology, Coronary Artery Disease:epidemiology, Female, Humans, Logistic Models, Male, Middle Aged, Recurrence, Retrospective Studies, Risk Factors, Stroke:epidemiology,.   

BACKGROUND: Coronary artery disease (CAD) is a leading cause of long-term mortality in Europe and it negatively influences the outcome after stroke. However, its influence on stroke recurrence which endangers stroke patients mostly in the first months following stroke, is unclear. Previous studies have found no association between CAD and ischemic stroke recurrence. However, assessment of the relationship was not the primary endpoint of these investigations. The aim of this study was to assess the possible association between CAD and stroke recurrence.r />r /> PATIENTS AND METHODS: In a hospital-based, retrospective study, the set consisted of 190 patients - 105 patients with a first ever stroke (48 males; age 37-88, mean 70.7±12.5 years) and 85 patients with stroke recurrence (36 males; age 46-94, mean 88.0±9.6 years). CAD was correlated with the following other risk factors (age, sex, occurrence of arterial hypertension, atrial fibrillation, diabetes mellitus, plasma levels of total cholesterol, triglycerides, low-density cholesterol, high-density cholesterol, body mass index, presence of carotid plaques). Logistic regression analysis was used for the statistical evaluation.r />r /> RESULTS: No significant association was found between CAD and stroke recurrence. Of all of the other observed risk factors, only age showed a significant association with stroke recurrence (OR 1.04, 95% CI: 1.02-1.07).r />r /> CONCLUSION: The results of the presented study indicate that CAD does not influence stroke recurrence....

Read abstract  Full text PDF

Case Reports 2012; 33(3): 290-293 PubMed PMID: 22635086 Citation  Keywords:  ACTH-Secreting Pituitary Adenoma:diagnosis, Adenoma:diagnosis, Adrenocorticotropic Hormone:metabolism, Aged, Asymptomatic Diseases, Humans, Hydrocortisone:metabolism, Incidental Findings, Male,.   

: Silent corticotroph adenoma (SCA) is a non-functioning macroadenoma that has positive immunoreactivity for ACTH. Few studies have evaluated the biochemical behaviour of these tumours. We present the case of a 65-year-old male incidentally diagnosed with SCA, in which an exhaustive study of the corticotroph axis was conducted....

Read abstract  Full text PDF

Case Reports 2012; 33(3): 285-289 PubMed PMID: 22635085 Citation  Keywords:  Adult, Female, Goiter, Nodular:complications, Humans, Hyperemesis Gravidarum:complications, Pregnancy, Radionuclide Imaging, Thiamine:therapeutic use, Thyrotoxicosis:complications, Vitamin B Complex:therapeutic use, Wernicke Encephalopathy:drug therapy,.   

: Although hyperthyroidism arising from primary thyroid disease is rare in pregnancy, transient gestational hyperthyroidism is not uncommon. This condition can be associated with hyperemesis gravidarum (HG), and Wernicke's encephalopathy. We present the case of a woman with toxic nodular goiter complicating HG-associated Wernicke's encephalopathy. A 38-year-old Caucasian woman, who had received a diagnosis of hyperthyroidism and HG early in her pregnancy, had intrauterine fetal death at Week 16 of gestation. One day after undergoing therapeutic abortion, she was admitted to our clinic with persistent thyrotoxicosis, nausea, and vomiting. A toxic thyroid nodule was detected. She was given antithyroid medication, total parenteral nutrition. On Day 10 of hospitalization, she developed ataxia, aphasia, and somnolence. Cranial magnetic resonance imaging showed increased bilateral thalamic signalization. She was given a diagnosis of Wernicke's metabolic encephalopathy, for which she received thiamine and multivitamin preparations. She responded dramatically on the second day of thiamine therapy. Her consciousness improved rapidly and she began to speak. Her muscle tone was slightly weak and she had paresthesias in both legs. Absorption of thiamine may be particularly impaired in pregnant women with hyperemesis and hyperthyroid disease. Wernicke's encephalopathy should be considered in hyperthyroid women with HG who develop neurological abnormalities....

Read abstract  Full text PDF

Journal Article 2012; 33(3): 279-284 PubMed PMID: 22635084 Citation  Keywords:  Animals, Catalase:metabolism, Cell Line, Tumor, Cell Proliferation:drug effects, Cell Survival:drug effects, Diabetic Neuropathies:metabolism, Glucose:pharmacology, Hyperglycemia:metabolism, Neurilemmoma:metabolism, Oxidative Stress:drug effects, Rats, Re.   

OBJECTIVES: Schwann cells may be involved in the pathogenesis of several neuropathies, such as those linked to an excess of d-glucose. Indeed, hyperglicemic condition can often result in the production of high reactive/nitrosative oxygen species concentration and possible damage of several cell structures. In the present work attention has been focused on the possible nitrosative effect of hyperglycemia on RT4 Schwannoma cell lines.r />r /> METHODS: Cells were cultured for 72hrs in the presence of 180 mM D-glucose. Morphology, growth rate, cell viability, catalase evaluation and Western blot were performed.r />r /> RESULTS: In D-glucose-exposed cells, 3-Nitrotyrosine increase and subsequent modifications in cell morphology, growth rate, viability and catalase activity were found.r />r /> CONCLUSION: Our findings suggested a possible primary role played by Schwann cells in the hyperglicemic neuropathy pathogenesis, through the excessive production of RNS and a decrease in antioxidant defense systems, bearing out the importance of the "nitrosative hypothesis" in the hyperglicemic-induced nervous system complications....

Read abstract  Full text PDF

Case Reports 2012; 33(3): 273-278 PubMed PMID: 22635083 Citation  Keywords:  Adult, Antineoplastic Agents, Hormonal:therapeutic use, Chemoradiotherapy:methods, Female, Humans, Insulinoma:diagnostic imaging, Octreotide:analogs & derivatives, Organometallic Compounds:therapeutic use, Pancreatic Neoplasms:diagnostic imaging, Radionuc.   

BACKGROUND: Insulinomas are the most common functioning neuroendocrine tumours of the pancreas. Hypoglycemia due to excessive production of insulin is a main feature of this disease. Usually these neoplasms are benign and single with surgical excision as a treatment of choice. About 10% are malignant with tendency to form metastases especially to the liver then therapy requires various medical technics.r />r /> CASE REPORT: 43 years old female with reccurent syncopies in course of hypoglycemia was admitted to the hospital to be diagnosed. Having suspected pathology within the pancreas the abdominal MRI was performed. It showed presence of numerous metastatic changes in the liver with no any other deviations in the abdomen including pancreas. Subsequent 18FDG PET-CT revealed metastases to the regional lymph nodes and the liver and suggested the presence of a primary lesion in the tail of the pancreas which was confirmed in EUS. Surgical excision of the tail of the pancreas was done. Pathological result: pancreatic neuroendocrine well differetiated cancer. Due to the recurrence of hypoglycemia patient was admitted to Department of Endocrinology where somatostatin analogue scintigraphy showed the presence of tracer accumulation foci in the liver. Combined long-acting somatostatin analogue (octreotide) and peptide radionuclide receptor ((90)Y-DOTA-TATE) therapy were introduced. Stable blood glucose levels with no tendency to hypoglycemia and partial regression (PR) of liver lesions according to RECIST citeria were observed in course of the treatment....

Read abstract  Full text PDF

Case Reports 2012; 33(3): 268-272 PubMed PMID: 22635082 Citation  Keywords:  Adult, Agranulocytosis:radiotherapy, Antiviral Agents:adverse effects, Female, Hepatitis C, Chronic:drug therapy, Humans, Hyperthyroidism:blood, Hypothyroidism:blood, Interferon-alpha:adverse effects, Iodine Radioisotopes:therapeutic use, Thyrotropin:bloo.   

BACKGROUND: Conventional management of Interferon-α-Induced Hyperthyroidism (IIH) with radioactive iodine (RAI) may be used when treatment with beta blockers or antithyroid drugs (ATD), proves ineffective or is contraindicated.r />r /> CASE PRESENTATION: We present a 38-year-old woman who has been treated with combined pegylated interferon alpha (INF-α) and Ribavirin for chronic hepatitis C. Destructive thyrotoxicosis appeared after four months of continuous IFN-α therapy and a beta blocker was prescribed. Initially, the patient presented normal TSH 2.4 µIU/mL, however during therapy with INF-α, TSH diminished to 0.05 and thyroid hormones were elevated: fT4 23.1 pmol/L, fT3 7.2 pmol/L. Ultrasound examination showed completely irregular and greatly decreased echogenicity of the thyroid gland. The radioiodine uptake (RAIU) was deeply decreased to 2 and 3% at 5 h and 24 h, respectively. The thyroid scintiscan showed lack of isotope accumulation. Hypothyroidism developed and L-thyroxine was prescribed. The following year, hyperthyroidism reoccurred with TSH 0.08 µIU/mL, fT4 26.4 pmol/L, fT3 8.2 pmol/L, positive TSHR-Abs 6.2 (normal <2 IU/L) and mild Graves' Ophthalmopathy (GO). RAIU values were 23% at 5 h and 46% at 24 h. Thyroid scintiscan showed diffuse goiter. At this point beta blocker was introduced and ATD was started. After three months of therapy an increased level of aminotransferases and granulocytopaenia were observed. Hence, the patient received RAI and glucocorticosteroid, while INF-α therapy was continued. After approximately 4 months, hypothyroidism reappeared with insignificantly raised TSH level. One year later the patient was euthyroid and required no further treatment.r />r /> CONCLUSIONS: Our report suggests that: 1. Radioiodine therapy might be an effective and safe method of treatment in cases of IIH with mild GO. 2. IFN-α therapy need not be discontinued in patients with IIH....

Read abstract  Full text PDF

Case Reports 2012; 33(3): 265-267 PubMed PMID: 22635081 Citation  Keywords:  Adrenal Cortex, Adrenal Cortex Hormones:secretion, Adrenal Cortex Neoplasms:pathology, Adrenocortical Adenoma:pathology, Adult, Choristoma:pathology, Humans, Kidney Diseases:pathology, Kidney Neoplasms:pathology, Laparoscopy:methods, Male, Pituitary ACTH .   

: Tumors originating from ectopic adrenal tissue are relatively rare. In this article, we describe a case with Cushing's syndrome caused by an ectopic adrenal adenoma. A 38 year-old male patient presenting with cushingoid appearance for 2 years was diagnosed to have ACTH-independent Cushing's syndrome based on endocrinological evaluation. Mutiple radiological examinations detected bilateral adrenal atrophy. When the images were investigated in a more expanded scope, a 3.0×3.5×5.3 cm mass was detected in the anterior of left renal hilum and left renal vein. The mass was successfully resected with intraoperative endoscopy and pathological evaluation revealed an ectopic adrenal tumor. It is suggested that when the endocrinlogically confirmed adrenal neoplasm could not be well and definitely localized, the possibility of ectopic adrenal should be presumed and further radiography examinations should extend to the field where ectopic adrenal usually presents....

Read abstract  Full text PDF

Case Reports 2012; 33(3): 260-264 PubMed PMID: 22635080 Citation  Keywords:  Adrenal Gland Neoplasms:diagnostic imaging, Adult, Antineoplastic Agents:administration & dosage, Drug Resistance, Neoplasm, Fatal Outcome, Female, Humans, Indoles:administration & dosage, Pheochromocytoma:diagnostic imaging, Pyrroles:administration & dos.   

: We report the clinical response and adverse events of a female patient treated for recurrent malignant pheochromocytoma using the tyrosine kinase inhibitor sunitinib. A 41-year-old woman underwent adrenectomy and nephrectomy forpotentially malignant adrenal pheochromocytoma. Fifty-four months after surgery, abdominal computed tomography (CT) and Iodine-131 metaiodobenzylguanidine((131)I-MIBG) scintigraphy revealed multiple tumors in the liver. Two chemotherapy protocols were administered in succession (first line: cyclophosphamide/vinblastine/dacarbazine; second line: cisplatin/docetaxel/ifomide). Despite these treatments, however, the tumors continued to progress. Treatment with sunitinib was initiated, but the patient quickly developed critical hypertension caused by tumor lysis syndrome. The sunitinib dose was reduced, and a partial response, as defined by the Response Evaluation Criteria in Solid Tumors (RECIST), was observed after 6 treatment cycles. Moreover, no severe adverse events occurred during this lower-dose sunitinib treatment. Unfortunately, sunitinib treatment became unaffordable for the patient, who eventually resorted to palliative care and died 37 months later. This case study is consistent with previous reports indicating that appropriate doses of sunitinib can induce a partial antitumor response in patients with refractory pheochromocytoma....

Read abstract  Full text PDF