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Journal Article 2012; 33(2): 217-223 PubMed PMID: 22592205 Citation  Keywords:  Adiponectin:blood, Aged, Aged, 80 and over, Biomarkers:blood, Case-Control Studies, Endometrial Neoplasms:blood, Female, Humans, Leptin:blood, Middle Aged, Postmenopause:blood, Predictive Value of Tests, Sensitivity and Specificity, Uterine Hemorrhage:blo.   

OBJECTIVES: To evaluate the correlation between endometrial cancer and adiponectin plasma concentration, leptin plasma concentration as well as adiponectin to leptin index in the population of postmenopausal women with abnormal vaginal bleeding.

DESIGN: An observational study SETTINg: Department of Gynecology and Obstetrics, Specialist Teaching Hospital in Tychy, Poland. Population. 99 women between 47 and 88 years old, in postmenopausal state.

METHODS: The cases (54 women) were females hospitalized due to postmenopausal vaginal bleeding in whom dilation and curettage (D&C) was performed and endometrial intraepithelial neoplasia (EIN) was diagnosed in anathomopathology. Hysterectomy was then performed in all cases and the endometrial cancer diagnosis was confirmed. The controls (45 women) consists of females with no postmenopausal uterine bleeding in whom endometrial thickness in transvaginal ultrasound was greater than 5 mm. D&C was than performed and no endometrial neoplasia was detected in any of the subjects. Adiponectin and leptin plasma concentration was measured in both groups. Mein outcome measures. The area under the curve, sensitivity, specificity and cutoffs for adiponectin, leptin and adiponectin to leptin index.

RESULTS: Adiponectin, leptin and adiponectin to leptin index were statistically correlated with the risk of endometrial cancer. At the suggested cutoffs, corresponding to the highest accuracy (minimal false-negative and false-positive results), adiponectin to leptin index resulted in the highest sensitivity and specificity compared to adiponectin and leptin alone.

CONCLUSIONS: Adiponectin to leptin index due to the highest sensitivity and specificity may be used as a marker of endometrial cancer in postmenopausal women with abnormal vaginal bleeding....

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Case Reports 2012; 33(2): 107-112 PubMed PMID: 22592189 Citation  Keywords:  Adult, Deamino Arginine Vasopressin:therapeutic use, Diabetes Insipidus:complications, Female, Humans, Pituitary Apoplexy:complications, Pituitary Neoplasms:complications, Postoperative Complications:drug therapy, Pregnancy, Pregnancy Complications, Neopl.   

BACKGROUND: Pituitary apoplexy during pregnancy is so rare that only 15 cases (12 pituitary adenomas, 2 lymphocytic neurohypophysitis, and 1 normal pituitary gland) have been published to date. Here, we report the case of a pregnant woman presenting with pituitary apoplexy from a nonfunctioning pituitary adenoma and provide a possible mechanism and management option for postoperative diabetes insipidus (DI).

CASE PRESENTATION: A 26-year-old woman presented with sudden onset of headache and bitemporal hemianopsia in the 26th week of her first pregnancy. Magnetic resonance imaging clearly revealed an 18 mm pituitary mass with a fluid-fluid level component displacing the optic chiasma upward. Endonasal endoscopic transsphenoidal surgery was successfully carried out 7 days after the onset of symptoms. DI became apparent immediately after the operation and was not controllable by arginine vasopressin (AVP) but by 1-desamino-8-D-arginine vasopressin (DDAVP) instead. This finding suggests an association between DI and vasopressinase secretion from the placenta, because vasopressinase can degrade AVP but not DDAVP. DI had diminished by the time the patient delivered a healthy girl at the 40th week of gestation.

CONCLUSION: Postoperative DI associated with pituitary apoplexy during pregnancy should be treated by DDAVP, which is not affected by placental vasopressinase secretion....

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Journal Article 2012; 33(1): 60-66 PubMed PMID: 22467114 Citation  Keywords:  Epilepsy, Humans, Incidence, Syncope, Syncope, Vasovagal, Tilt-Table Test,.   

OBJECTIVES: Vasovagal syncope (VVS) is the most common type of syncope with the incidence of 21-43%. The aim of this study was to explain difficulties of correct diagnosis of VVS.

DESIGN AND METHODS: Our group comprises 70 patients (24 men, 46 women) at the age of 15-71 years, in whom VVS was verified by the head-up tilt test (HUT-test). We evaluated the type of VVS, admission diagnoses present in the patients, interictal EEG findings and the presence of convulsions during the syncopal states. For statistical processing of the results we used binomial tests for two independent proportions, Fisher-Freeman-Haltons exact test and Cramér's V index.

RESULTS: Out of 70 VVS 35 were vasodepressoric, 19 cardioinhibitive and 16 intermediate. Admission diagnoses present in the patients were: disorders of consciousness of an unknown etiology - 42.9% cases; supposable epilepsy and epilepsy - 30% cases and syncope - 27.1% cases. Interictal EEG was normal in 51.4% cases, nonepileptiform abnormality was present in 48.6% cases. Statistical comparison among particular types of VVS revealed a significant difference in distribution and medial strong association between the type of VVS and the EEG finding (Cramér V=0.35) and also between the type of VVS and the occurrence of convulsions (Cramér V= 0.40).

CONCLUSION: The results of our study evidently suggest that interdisciplinary cooperation in accurate diagnostics in this field of medicine is needed and that HUT-test has to be in standard diagnostic algorithm in patients with failures of consciousness of an unknown cause....

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Journal Article 2012; 33(1): 11-15 PubMed PMID: 22467105 Citation  Keywords:  Adipocytes:metabolism, Adipokines, Adipose Tissue:metabolism, Humans, Metabolic Diseases, Obesity:metabolism,.   

: Adipose tissue is an endocrine and paracrine organ that releases a large number of bioactive mediators. Approximately 100 adipokines have been identified including cytokines, chemokines, growth factors and enzymes. The use of adipoproteomic analyses resulted in new findings and, in consequence, the number of new adipokines is rising rapidly. Novel adipokines such as visfatin, vaspin and omentin were discovered about five years ago. Visfatin and vaspin production and secretion take place in adipocytes, but omentin comes from the stromal cells of adipose tissue. Several differences are noticeable between these adipokines especially in correlation with obesity as visfatin and vaspin serum levels increase in obese subjects while omentin serum levels decrease. It has been suggested that these adipokines act as insulin-sensitizers/insulin-mimetics. Increasing number of publications reporting the role of new adipokines does not allow to assess clearly the influence of those adipokines on the pathogenesis of obesity....

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Journal Article 2011; 32(6): 885-888 PubMed PMID: 22286793 Citation  Keywords:  Adult, Body Weight, Diabetes, Gestational:etiology, Female, Fertilization in Vitro:adverse effects, Glucose Tolerance Test, Humans, Polycystic Ovary Syndrome:complications, Pregnancy, Pregnancy Outcome, Pregnancy Trimesters, Retrospective Studies, Risk Fa.   

OBJECTIVE: Increasing number of pregnancies resulting from In vitro Fertilisation (IVF) combined with increased awareness of Gestational Diabetes Mellitus (GDM) - related morbidity calls for research on possible differences in pregnancy outcomes between IVF and non-IVF GDM complicated pregnancies. The aim of this study was to compare GDM - affected pregnancies, both resulting from IVF and conceived without medical intervention with regards to maternal data, fetal biometry and neoanatal outcomes.

METHODS: We used our Clinic's databases to retrospectively identify 36 women who had successful IVF and developed GDM during the course of their singleton pregnancy (IVF group) and 137 non-IVF women with GDM (non-IVF group). They were matched according to age, pre-pregnancy BMI and none had the history of diabetes mellitus before their pregnancies. We compared the maternal characteristics, course of pregnancy and neonatal outcome.

RESULTS: The weight gain until the diagnosis of GDM in both non-IVF and IVF groups of women was not significantly different (9.81±4.37 vs 10.0±4.8 kg, p=0.8 respectively) with similar time at which they came under the specialist GDM care (29±4.0 vs 28±4.5 wks, p=0.42,). When analyzing first trimester fasting glucose levels we found it to be significantly higher in IVF group (89±16.2 vs 83±11.3 mg/dl, p=0.04). Second trimester oral glucose tolerance test (OGTT) results and glucose levels during GDM treatment did not differ between the groups. No changes were noted in investigated fetal and neonatal variances: 3rd trimester AC, it's percentile and neonatal birth weight (3 460±641 vs 3 200±440 g, p=0.22).

CONCLUSIONS: GDM among women after in vitro fertilisation is characterised by higher first trimester fasting glucose levels. Early diagnostic intervention in IVF pregnancies is specially needed....

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Case Reports 2011; 32(6): 735-740 PubMed PMID: 22286792 Citation  Keywords:  ACTH Syndrome, Ectopic:etiology, Adrenocorticotropic Hormone:secretion, Adult, Carcinoma, Neuroendocrine:complications, Crohn Disease, Fatal Outcome, Female, Gastrointestinal Neoplasms:complications, Humans, Neoplasm Metastasis:pathology,.   

: Gastroenteropancreatic neuroendocrine tumors (GEP-NETs) have been rarely reported in patients with Crohn's disease, being usually small and incidentally detected in areas uninvolved by the inflammatory process. We describe the case of a young female patient with Crohn's disease and a fulminant Cushing's syndrome induced by the ectopic secretion of adrenocorticotropic hormone (ACTH) by an aggressive gastrointestinal neuroendocrine carcinoma (NEC). Despite a multi-therapeutic approach, including the administration of multiple courses of chemotherapy, hypo-cortisolemic agents, somatostatin analogues, as well as the performance of bilateral adrenal vein embolization followed by bilateral adrenalectomy, patient's condition progressively deteriorated and she died nine months after the diagnosis of NEC due to liver failure. The available literature addressing the possible connection between Crohn's disease and NEC is discussed in detail....

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Journal Article 2011; 32(6): 836-840 PubMed PMID: 22286788 Citation  Keywords:  Adolescent, Female, Humans, Impulsive Behavior:metabolism, Loneliness, Neuropsychological Tests, Saliva:chemistry, Testosterone:metabolism,.   

OBJECTIVE: Adolescence is characterized by increases in loneliness, impulsiveness and circulating testosterone levels. We investigated the relationship between these characteristics in adolescent females.

METHODS: For this purpose, we measured impulsivity and loneliness by means of a Go/No-go task and the UCLA loneliness scale, respectively. Testosterone levels in saliva were measured by Enzyme-Linked Immunosorbent Assay (ELISA).

RESULTS: The results showed that testosterone and loneliness have a positive relevance to impulsivity in adolescent females, whereas there was no relationship between loneliness and testosterone levels.

CONCLUSIONS: These results suggest that testosterone and loneliness modulate impulsivity via distinctive pathways....

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Journal Article 2011; 32(6): 879-884 PubMed PMID: 22286785 Citation  Keywords:  Adult, Aged, Diabetes Insipidus, Neurogenic:epidemiology, Female, Glasgow Coma Scale, Humans, Hypernatremia:physiopathology, Intensive Care Units, Male, Middle Aged, Prognosis, Sodium:blood,.   

BACKGROUND: Hypernatremia is a common sodium dysbalance in neurointensive care which is associated with worse outcome. It can be caused by central diabetes insipidus (cDI) or by other mechanisms, more often from osmotherapy and furosemide. The aim of this study was to determine the incidence of cDI and to analyse outcome as compared with other causes of hypernatremias found in neurointesive care.

METHODS: We analysed 75 hypernatremic (serum sodium, SNa+ >150 mmol/l) patients (pts) with brain diseases admitted over a period of five years to Neurologic-Neurosurgical Intensive Care Unit (NNICU). Firstly we diagnosed cDI according to measured serum and urine osmolality, eletrolyte free water clearance (EWC) and response to desmopressin acetate. The remaining hypernatremias were categorised as "non cDI". We observed Glasgow Coma Scale (GCS) on onset of hypernatremia, incidence of cerebral complications, Glasgow Outcome Scale (GOS) upon discharge from NNICU and mortality in NNICU.

RESULTS: We found cDI in 8 pts (mean SNa+ 154.8 ± 5.4 mmol/l). Most pts (67) were classified as "non cDI" hypernatremias (mean SNa+ 154.3 ± 3.6 mmol/l). There were no differences in serum sodium (p=0.682), serum osmolality (p=0.476) between the two groups, however patients with cDI indicated low urine osmolality (p=0.001) and positive EWC (p=0.049). We did not find any differences in GCS score on onset of hypernatremia (p=0.395), incidence of cerebral complications (p=0.705), GOS score upon discharge from NNICU (p=0.61) and mortality in NNICU (p=0.638). More patients in the "non cDI" group received antiedematic therapy (p=0.028) and diuretic furosemide (p=0.026). Multivariate logistic regression analysis showed that independent predictors of NNICU mortality was the highest level of serum sodium (Odds ratio, OR 1.13, per 1 mmol/l increase in maximal hypernatremia during NNICU stay, 95% confidence interval, CI 1.01-1.26, p=0.027), and GCS on admission of less than 9 (OR 2.61, 95% CI 1.41-5.44, p=0.003).

CONCLUSIONS: Central diabetes insipidus is not a frequent type of hypernatremia in neurointensive care. Prognosis is connected with serum sodium level, not with type of hypernatremia....

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