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Comparative Study 2011; 32(6): 865-873 PubMed PMID: 22286783 Citation  Keywords:  ACTH Syndrome, Ectopic:diagnosis, Adenoma:diagnosis, Adolescent, Adult, Cushing Syndrome:diagnosis, Female, Humans, Male, Middle Aged, Petrosal Sinus Sampling:methods, Retrospective Studies, Treatment Outcome, Young Adult,.   

BACKGROUND: Bilateral inferior petrosal sinus sampling (BIPSS), currently, is the gold standard test for the differential diagnosis of Cushing's syndrome (CS), but few data are available on the efficacy and accuracy of BIPSS in the qualitative diagnosis of ACTH-dependent CS and lateralization of Cushing's disease (CD); especially, the evaluation of BIPSS in all CD patients with transsphenoidal surgery (TSS). As a result, we investigated whether such invasive test compared other noninvasive tests may affect the efficacy and accuracy of diagnosis and TSS treatment in ACTH-dependent CS.

OBJECTIVE: We investigated the efficacy and lateralized accuracy of diagnostic and therapeutic of BIPSS in ACTH-dependent CS.

SETTINGS: A retrospective analysis was conducted at a single care center in Ruijin Hospital, Shanghai City.

PARTICIPANTS: CD was confirmed by histopathology in one hundred and nineteen patients, include sixty-four patients with BIPSS procedure; and ectopic ACTH syndrome (EAS) also was histological confirmed in five patients. MAIN INTERVENTIONS AND OUTCOMES: Sixty-nine patients were all administrated with BIPSS test. Additionally, other noninvasive tests included endocrine examinations, low and high dose dexamethasone suppression test (LDDST and HDDST); imagine examinations include magnetic resonance imaging (MRI) and positron emission tomography and computerized tomography (PET-CT).Gradients of inferior petrosal sinus (IPS) to peripheral (IPS/P) ACTH were calculated before and after BIPSS procedure completed five minutes.

RESULTS: In patients with proven pituitary cases, stringent response criteria in MRI and HDDST testing were fully by 51.6% and 60.3% respectively. While BIPSS, gave direct evidence of CD in 90.6% of these cases. The sensitivity for a basal IPS/P gradient greater than 2 was 89.1%, with 100% specificity and a diagnostic accuracy of 87.5%. A subgroup of 14 patients (all were CD) had contradictory responses to routine test with HDDST; while the sensitivity, specificity and accuracy of BIPSS were 100% respectively. Compared with the MRI and DST, we accepted Receiver Operating Characteristic (ROC) curve analysis showed that BIPSS performance is the best efficacy diagnosis tool in CS. In total, 57 of 64 patients with CD had an IPS/P gradient greater than 2, resulting in the sensitivity, specificity and diagnostic accuracy are 90.5%, 100%, 95.2% respectively. Additionally, the accuracy value of BIPSS in indicating dominant side should also be stressed in adenoma lateralization of CD. Finally, BIPSS test contributed most in the remission efficacy of TSS; then remission rate of underwent BIPSS group is 92.2% compared to the rate of 80% in without BIPSS group (p<0.01), Compared with other noninvasive tests, turn out the highest accuracy rate in remission.

CONCLUSIONS: The application of BIPSS is associated with efficacy and accuracy of ACTH-dependent CS and lateralization of CD, what's more, all above, we can conclude that BIPSS is associated with the surgical therapy in CD patients. Therefore, BIPSS dedicate to the diagnosis, treatment and intraoperation administration of ACTH-dependent CS....

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Case Reports 2011; 32(6): 751-762 PubMed PMID: 22167148 Citation  Keywords:  Antineoplastic Agents:therapeutic use, Breast Neoplasms:pathology, Chemotherapy, Adjuvant:methods, Combined Modality Therapy, Disease-Free Survival, Female, Humans, Neoplasm Metastasis, Remission Induction, Retrospective Studies, Treatment Outcome,.   

OBJECTIVES: To increase the efficacy and reduce the toxicity of cancer therapy.

METHOD: The DBM with MLT (melatonin), Retinoids, vitamins E, D3, and C has a differentiating, cytostatic, antiangiogenic, immunomodulating, factorially synergic effect, at the same time reinforcing those functions that Physiology considers essential for life. With Somatostatin and/or its analogues, the DBM has an antiproliferative effect, negatively regulating the most powerful mitogenic molecule (GH), receptorially co-expressed and interactive with Prolactin, inhibited by Cabergoline and/or Bromocriptin. The negative regulation of GH extends directly to the GH-dependent growth factors. In breast cancer, the DBM entails the use of estrogen inhibitors and minimal apoptotic, non-cytotoxic and non-mutagenic doses of Cyclophosphamide or Oncocarbide, the tolerability of which is enhanced by MLT and the vitamins in the DBM.

RESULTS: Complete and stable cure of 4 cases, and rapid regression of the tumour in another 5 cases with just the DBM (first-line therapy), without surgical intervention. No disease recurrence with the use of the DBM as adjuvant therapy. Five-year survival of 50%, of stage IV cases, considerably higher than the data reported in the literature. A more or less generalised improvement in the quality of life, without any significant and/or prolonged toxicity.

CONCLUSIONS: The acknowledgement of the still underestimated scientific evidence, such as the multiple antitumoral mechanisms of action of MLT, the negative regulation of the interactive mitogens GH-GF (GH-dependent growth factors), Prolactin and estrogens, together with the differentiating and homeostatic action of retinoids and Vitamins E, D3, and C and MLT, made it possible to achieve these results. An essential aspect of the mechanism of action on the clinical response is the factorial synergy of the DBM components....

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Journal Article 2011; 32(2): 121-126 PubMed PMID: 21552191 Citation  Keywords:  Humans, Schizophrenia:therapy, Transcranial Magnetic Stimulation, Treatment Outcome,.   

: One of the fundamental prerequisites of the successful schizophrenia treatment is represented by an adequately significant impact on the negative symptoms of schizophrenia. Since the present pharmacotherapy has probably reached its limit in this area, there is a logical effort to utilize other, non-pharmacological methods. One of the most promising supplements that has been for a long time verified in the clinical practice is rTMS. Most of the studies have arrived at the conclusion that rTMS is an efficient method in the treatment of negative symptoms of schizophrenia. A valuable contribution to the assessment of the rTMS application in the treatment of negative symptoms is represented by meta-analyses. The meta-analyses indicate that the effect is mild to moderate (d=0.43 to 0.68). To sum it up, there will be higher probability of the rTMS effect on negative symptoms if 10 Hz stimulating frequency and a longer stimulation period in the extent at least three, ideally four to six weeks is used....

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Journal Article 2010; 31(4): 425-437 PubMed PMID: 20802450 Citation  Keywords:  Animals, Clinical Trials as Topic, Depressive Disorder:therapy, Electromagnetic Fields, Humans, Magnetic Field Therapy:adverse effects, Treatment Outcome,.   

: Since 1999, attempts have been made in the application of a new technique called magnetic seizure therapy (MST) or magnetic convulsion therapy (MCT) in the treatment of depressive disorder--as an alternative to electroconvulsive treatment. The technique of rapid rate transcranial magnetic stimulation (rTMS) is used to evoke intentional and repeated magnetoconvulsive seizures, though it requires the use of stimulation parameters practically inaccessible in commercially available rTMS magnetic stimulators. Magnetic convulsion therapy has been tested on monkeys as well as humans. A decisive majority of studies carried out both on animals and humans addressed the issue of safety of the MST method and confirmed that the side-effects (mostly of a cognitive nature) which occurred after magnetic seizures were weaker than those observed after electroconvulsive seizures. An analysis of available sources, however, does not confirm any proven antidepressant action of the MST technique. No experimental investigations have been carried out on animal models of depression. Clinical effectiveness had been confirmed in merely a few (perhaps three) patients with depression. The authors submit the results of the hitherto conducted studies on MST to critical analysis, particularly in the aspect of their antidepressant efficacy....

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Case Reports 2010; 31(4): 451-453 PubMed PMID: 20802446 Citation  Keywords:  Adenoma:complications, Adult, Female, Humans, Parathyroid Neoplasms:complications, Quadriplegia:etiology, Treatment Outcome, Vitamin D:therapeutic use, Vitamin D Deficiency:complications,.   

OBJECTIVE: Parathyroid adenomas (PA) are benign tumors. We report an unusual case of delayed diagnosis of a PA and concomitant Vitamin D deficiency presenting as tetraparesia.

METHODS: A 30-year-woman was admitted to our clinic with an inability to walk. Our examination revealed tetraparesia and common, severe muscular atrophy.

RESULTS: Laboratory investigations showed the following: creatinine phosphokinase (CK): 37 IU/L (15-130), calcium (Ca): 11.5 mg/dL (9-11), phosphorus (P): 1.5 mg/dL (2.5-5), parathyroid hormone (PTH): 736.1 pq/mL (15-65), 25-hydroxyvitamin D (25-OHvit D): 4 ng/mL (11-43), and alkaline phosphatase (ALP): 1029.5 lU (64-300). Parathyroid scintigraphy revealed PA. A year after Vitamin D replacement, the patient's neurological status and laboratory findings improved.

CONCLUSION: We suggest that the physicians always keep in mind the primary hyperparathyroidism (HPT) and concomitant Vitamin D deficiency in the differential diagnosis of hypercalcemia when facing atypical neurological symptoms such as tetraparesia....

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Case Reports 2009; 30(1): 22-24 PubMed PMID: 19300386 Citation  Keywords:  Adult, Diabetes Mellitus, Type 2:complications, Exercise Therapy:methods, Humans, Male, Motor Activity:physiology, Obesity:complications, Time Factors, Treatment Outcome,.   

: The case history of a 44-year-old, severely obese Caucasian man with serious decompensation of diabetes and subsequent withdrawal of high-dose insulin is reported. Insulin was withdrawn after 5 years of continuous therapy and the patient was treated for 6 months with diet, individualized physical therapy and oral antidiabetic drugs from the group of insulin sensitizers. Six months later, oral antidiabetics were discontinued for low blood glucose levels, and the treatment was limited to therapeutic life style changes. After insulin withdrawal, the patient's condition markedly improved: he showed better diabetes control, decrease in insulin resistance, weight loss, reduced BMI, reduced waist circumference, sagittal abdominal diameter and body fat, increased fitness level, normalized blood pressure and decreased heart rate at rest....

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Evaluation Studies 2009; 30(1): 17-18 PubMed PMID: 19300379 Citation  Keywords:  Depressive Disorder:drug therapy, Drugs, Chinese Herbal:therapeutic use, Humans, Medicine, Chinese Traditional:methods, Models, Theoretical, Treatment Outcome,.   

: Traditional Chinese Medicine (TCM) has a long history of more than 5,000 years and it has the earliest medicine book in the world: Yellow Emperor's Canon: Internal Medicine (Huang Ti Nei Jing), by the Yellow Emperor of China (2695-2589 BC) (Lin , 1988; Shampo and Kyle, 1989; Wang, 1999). However the combinational and systemic recipes that bring TCM high efficiency also block the promotion of TCM treatment to various diseases, including depression. In this short comment we firstly give some theoretical basis for TCM treatment to depression, then some clinical reports on efficiency; we also present some possible explanations on TCM treatments to depression....

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Journal Article 2009; 30(5): 615-623 PubMed PMID: 20035255 Citation  Keywords:  Adult, Cognitive Therapy:methods, Drug Resistance, Female, Humans, Male, Obsessive-Compulsive Disorder:psychology, Surveys and Questionnaires, Treatment Outcome, Young Adult,.   

OBJECTIVE: The aim of our study was to establish the efficacy of CBT on the sample of non-selected medication-resistant patients with OCD and to search for predictors of therapeutic response in such a group.

METHODS: The treatment was carried out under usual conditions at the department for anxiety disorders. Systematic CBT steps were tailored to the needs of each patient. Pharmacology treatment remained grossly unchanged during the trial period. We used the following outcome measures in the study: Yale-Brown Obsessive Compulsive Scale, subjective version (S-Y-BOCS), the Clinical Global Impression - Severity of Illness scale (CGI-S), Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Somatoform Dissociation Questionnaire (SDQ-20) and Dissociative Experience Scale (DES). The primary outcome measure was a decrease by 35% in Y-BOCS rating. Remission was defined as a 12 point score or lower in Y-BOCS and 1 or 2 points in CGI-S.

RESULTS: 47 patients completed the study (19 male and 28 female). One female patient refused to participate. All patients completed at least 5 weeks of intensive CBT programme and showed significant improvement on Y-BOCS, CGI-S, and BDI scales. At the end of the treatment 40.4% of the patients achieved clinical remission according to the CGI-S scale. The main characteristics present at the beginning of the trial increasing probability of achieving improvement or remission during the treatment were a Y-BOCS score lower than 22, good insight, higher resistance to symptoms, low level of dissociation, and aggressive obsessions.

CONCLUSION: As negative predictors we identified higher scores in Y-BOCS, poorer insight, low resistance to symptoms, high level of dissociation, obsessions focused on control/symmetry and obsessive slowness/ambivalence as associated with poor improvement....

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