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Journal Article 2009; 30(2): 256-261 PubMed PMID: 19675512 Citation  Keywords:  Adolescent, Adolescent Development:drug effects, Age of Onset, Antipsychotic Agents:adverse effects, Body Weight:drug effects, Female, Humans, Male, Psychotic Disorders:drug therapy, Retrospective Studies, Schizophrenia:drug therapy, Time Factors, Weight .   

OBJECTIVES: The aim of the study was to assess weight changes associated with certain atypical (AAP) and typical (TAP) antipsychotic drugs in patients with early-onset schizophrenia and other related psychotic disorders.

METHODS: Our retrospective study included 109 patients (52 boys, 57 girls) with a mean age of 15.8 +/- 1.6 years. The patients were evaluated based to their medical records prior to starting therapy, and then after 1, 3, and 6 weeks of treatment.

RESULTS: During the first week of treatment, the AAP group (n = 85; risperidone, olanzapine, ziprasidone, and clozapine) gained 1.5% of baseline weight whereas the TAP group (n = 24; haloperidol, perphenazine, and sulpiride) gained only 0.2% (p = 0.049). Differences in relative changes between the two groups were not significant at weeks 3 and 6. Expressed as absolute values, patients in our sample gained an average of 3.4 kg (SD 3.2) on AAP and 2.0 kg (SD 3.9) on TAP during 6 weeks of treatment (p = 0.335). Only the risperidone, olanzapine, and clozapine groups had sufficient numbers of patients to allow a comparison at the endpoint of the study (week 6). The patients gained, on average, 3.6 kg (SD 2.6) on risperidone, 4.4 kg (SD 2.5) on olanzapine, and 2.1 kg (SD 4.0) on clozapine during the six weeks of treatment (p = 0.286).

CONCLUSIONS: In our study, we did not find a difference in weight gain between the AAP and TAP groups, as large as has been described in the literature. It also seems plausible that the unique and variable weight changes associated with individual AAPs in the pediatric population are different from those observed in the adult population....

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Comparative Study 2008; 29(6): 990-994 PubMed PMID: 19112411 Citation  Keywords:  Adult, Antipsychotic Agents:administration & dosage, Chi-Square Distribution, Early Diagnosis, Female, Humans, Longitudinal Studies, Male, Middle Aged, Outcome Assessment (Health Care), Prognosis, Psychotic Disorders:complications, Retrospective Studies, .   

OBJECTIVES: A long duration of untreated psychosis (DUP) is known to be associated with a poorer prognosis and with worse symptomatic and functional outcome. The aim of the study was to test the hypothesis that early detection and treatment with antipsychotics in the prodromal phase of the illness improves the outcome; to compare short and long-term outcome in patients with DUP longer than 1 year (group 1) with patients that were treated already in the prodromal phase of the disease (group 0).

DESIGN AND SETTING: Eighty-seven patients with schizophrenia were included to the retrospective study, 37 patients to group 0 and 50 patients to group 1. The course and outcome of the disease was studied in the two groups. The severity of schizophrenia was evaluated by measuring several outcome parameters. The symptom severity was evaluated using a check list developed from CAARMS inventory; the average daily dose of antipsychotics was calculated as well as the number and duration of hospital admissions. Groups were compared during the acute psychosis of first episode (t1) and at the conclusion of the study (t2).

RESULTS: More symptoms of greater intensity were present during the first and second evaluations in group 1 as compared to group 0 patients. The patients in group 0 needed lower dosages of antipsychotics even several years after treatment had been initiated. This effect persisted until the final evaluation; 11% were without antipsychotics at the conclusion of the study. Patients in group 1 were hospitalized more frequently; they needed more hospitalizations and these were of longer duration. Only 38% of patients in group 0 were treated in the hospital, 27% were hospitalized only once.

CONCLUSIONS: Better outcome can be achieved with early antipsychotic treatment. Patients with long DUP differ from patients who were treated already in the prodromal phase in several outcome measures....

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Journal Article 2008; 29(4): 558-570 PubMed PMID: 18766162 Citation  Keywords:  Adolescent, Autistic Disorder:physiopathology, Child, Child, Preschool, Electroencephalography, Epilepsy:complications, Female, Humans, Intellectual Disability:etiology, Intelligence, Male, Retrospective Studies,.   

: We retrospectively evaluated a set of 205 children with autism and compared it to the partial sub-set of 71 (34.6%) children with a history of regression. From 71 children with regression, signs of epileptic processes were present in 43 (60.6%), 28 (65.12%) suffered clinical epileptic seizures, and 15 (34.9%) just had an epileptiform abnormality on the EEG. In our analysis, autistic regression is substantially more associated with epileptic process symptoms than in children with autism and no history of regression. More than 90% of children with a history of regression also show IQ < 70 and reduced functionality. Functionality and IQ further worsens with the occurrence of epileptic seizures (98% of children with regression and epilepsy have IQ < 70). We proved that low IQ and reduced functionality significantly correlate rather with epileptic seizures than just sub-clinical epileptiform abnormality on EEG. Clinical epileptic seizures associated with regression significantly influence the age of regression and its clinical type. The age of regression is higher compared to children with regression without epileptic seizures (in median: 35 months of age in patients with seizures while only 24 months in other patients). Patients with seizures revealed regression after 24th months of age in 68% of cases, while patients without seizures only in 27%. However, coincidence with epilepsy also increased the occurrence of regression before the 18th month of age (23% of patients), while only 4% of patients without epilepsy revealed regression before the 18th month. Epileptic seizures are significantly associated especially with behaviour regression rather than speech regression or regression in both behaviour and speech. Also epileptic seizures diagnosed before correct diagnosis of autism were significantly associated with delayed regression (both behavioural and speech regression)....

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Journal Article 2008; 29(4): 421-427 PubMed PMID: 18766154 Citation  Keywords:  Anorexia Nervosa:blood, Body Weight, Female, Hormones:blood, Humans, Retrospective Studies, Weight Loss,.   

OBJECTIVES: Body weight loss in patients with anorexia nervosa (AN) is accompanied by a number of hormonal and metabolic disorders. The scope and intensity of these disorders may have a considerable influence on the prognosis in this disease. The goal of the study was an evaluation of selected diagnostic examinations in comparison with clinical data of female patients with AN.

PATIENTS & METHODS: Retrospective studies involved eighty-seven (87) patients with AN. On therapy commencement, routine laboratory tests (full blood cell count, serum concentrations of sodium, potassium, glucose, cholesterol, triglycerides, total calcium, phosphates, total protein and the urea) and hormonal tests (TSH, TSH, FT4, FT3, E2, T, cortisol measured at 8(00), 17(00) and 24(00), LH and FSH in stimulation test with GnRH) were performed in each patient. Correlations were determined between clinical data and the measured hormone concentrations.

RESULTS: In the studied girls, the mean values of routine laboratory tests, performed at the beginning of the therapy, were within the normal ranges (except hypernatremia). The mean concentrations of LH, FSH and FT4 were below reference values; the mean concentration of cortisol considerably exceeded the standard range. Statistically significant relations were demonstrated between BMI values and the concentrations of LH, E2 and cortisol.

CONCLUSIONS: Body weigh loss is not significantly reflected by abnormal results of routinely performed laboratory tests. Hypogonadotropic hypogonadism and hypercortisolemia are the most characteristic hormonal symptoms in girls with AN....

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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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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 2007; 28(4): 524-526 PubMed PMID: 17693989 Citation  Keywords:  Adult, Antidepressive Agents, Tricyclic:therapeutic use, Depression:diagnosis, Fatal Outcome, Female, Humans, Mianserin:analogs & derivatives, Prefrontal Cortex:drug effects, Retrospective Studies, Suicide, Theta Rhythm,.   

: We present a case report of a 37-year old woman diagnosed with depressive disorder, first episode, who was admitted into a psychiatric hospital after a failed suicidal attempt. She responded to antidepressant therapy, as evidenced by a >50% reduction in MADRS total score. She was discharged after 4 weeks of treatment, denying any suicidal ideations. The following day the patient committed suicide; she burned herself to death. It is very likely that the patient dissimulated her symptoms and ideations. Subsequently, her quantitative EEG records were retrospectively analyzed. An increase of prefrontal theta cordance value after the first week of mirtazapine therapy was found. Recently three small studies have revealed that decrease of prefrontal theta cordance after 1 week of antidepressant administration can predict clinical response in patients with unipolar depression. In our previous study the absence of a decreased theta prefrontal cordance was associated with lack of treatment response with NPV 1.0 (Bares et al., 2007). Thus, we hypothesize that prefrontal theta cordance could become an objective marker of change of depressive symptoms, independent of patients' compliance and symptom dissimulation, more precise than objective and self-rated depression rating scales....

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Journal Article 2007; 28(Suppl 2): 30-31 PubMed PMID: 17558374 Citation  Keywords:  Anti-Bacterial Agents:therapeutic use, Cross Infection:drug therapy, Humans, Hydrocephalus:etiology, Infant, Newborn, Language Development Disorders:etiology, Meningitis, Bacterial:drug therapy, Rare Diseases, Retrospective Studies, Streptococcal Infectio.   

: Streptococcus agalactiae is a rare cause of neonatal meningitis in the era of peripartum prophylaxis with prophylaxis with ampicillin in colonized/infected mothers. However 5 cases of meningitis among 171 cases of pediatric nosocomial meningitis database within last 15 years occurred. All 5 children were neonates (one VLBW and early gestation newborn), 2 after neurosurgery. All 5 cases were successfully cured with a combination of cefotaxim (or ceftazidim) plus aminoglycosides, in one case also with addition of vancomycin or ampicillin. However 3 of 5 cured patients had neurologic sequellae, two of them reversible hydrocephalus and in speech retardation....

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