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Case Reports 2012; 33(3): 257-259 PubMed PMID: 22635079 Citation  Keywords:  Androgens:metabolism, Female, Humans, Immunohistochemistry, Middle Aged, Ovarian Neoplasms:complications, Ovary:pathology, Sertoli-Leydig Cell Tumor:complications, Testosterone:metabolism, Virilism:etiology,.   

: Sertoli-Leydig cell tumor is a rare and usually unilateral tumor of the ovary occurring in women's reproductive age. Only about 10% of these patients are over 50 years of age. One third of these patients are suffering from signs of virilisation. This work summarizes the morphological and immunohistochemical characteristics of this tumor in a 56-year old woman with clinical signs of virilisation....

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Journal Article 2012; 33(2): 236-244 PubMed PMID: 22592207 Citation  Keywords:  Adolescent, Adult, Aged, Alleles, Antipsychotic Agents:adverse effects, Cytochrome P-450 CYP2D6:genetics, Female, Genotype, Humans, Male, Middle Aged, Prospective Studies, Psychiatric Status Rating Scales:statistics & numerical data, Psychotic Disorders:d.   

OBJECTIVE: The objective of this prospective, naturalistic study, conducted in first-episode psychosis patients from a Central-European population, was to assess the utility of Cytochrome P-450 2D6 (CYP2D6) genotype testing under normal clinical setting.

METHODS: A total of 35 patients diagnosed for the first time with schizophrenia or acute schizophrenia-like psychotic disorder and treated with risperidone were enrolled in the study. These patients underwent sequentiation of the CYP2D6 gene and evaluations of symptoms and severity of adverse effects using the PANSS and UKU scales, respectively. Doses of antipsychotics and other co-medication were monitored as well. In statistical analysis, Fisher's exact test was used to compare ratios and the Wilcoxon rank-sum test was used in the comparison of continual variables.

RESULTS: PM patients showed a significantly lower reduction in psychotic symptoms and a greater severity of psychotic symptoms following risperidone treatment and higher doses of antipsychotics not metabolized by CYP2D6, which were used as co-medication.

CONCLUSIONS: Based on these results, patients with the PM genotype experiencing first-episode schizophrenia don't appear to be optimal recipients of risperidone treatment. However, as the main limitation of this study was the relatively small sample-size, replication with a larger scale study is needed to confirm these findings....

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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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Comparative Study 2012; 33(2): 212-216 PubMed PMID: 22592204 Citation  Keywords:  Adult, Endometrium:diagnostic imaging, Endosonography:methods, Female, Humans, Hysteroscopy:methods, Imaging, Three-Dimensional:methods, Middle Aged, Perimenopause, Sensitivity and Specificity, Uterine Hemorrhage:diagnosis, Uterus:diagnostic imaging,.   

OBJECTIVE: In many publications the transvaginal ultrasound is regarded as the first step to diagnose the cause of uterine bleeding in perimenopausal women. In order to improve the sensitivity and specificity of the conventional ultrasound physiological saline solution was administered to the uterine cavity and after expansion of its walls the interior uterine cavity was examined. And this procedure is called 2D sonohysterography (SIS 2D). By the ultrasound scanners which enable to get 3D real time image a spatial evaluation of the uterine cavity is possible. Clinical value of the real time 3D sonohysterography and 2D sonohysterography compared to hysteroscopy with histopathological examination in perimenopausal women.

MATERIAL AND METHODS: The study concerned a group of 97 perimenopausal women with abnormal uterine bleeding. In all of them after a standard transvaginal ultrasonography a catheter was inserted into the uterine cavity. After expansion of the uterine walls by administering about 10 ml of 0,9% saline solution the uterine cavity was examined by conventional sonohysterography. Then a 3D imaging mode was activated and the uterine interior was examined by real time 3D ultrasonography. The ultrasound results were verified by hysteroscopy, the endometrial lesions were removed and underwent a histopathological examination.

RESULTS: In two cases the SIS examination was impossible because of uterine cervix atresion. In the rest of examined group the SIS 2D sensitivity and specificity came up to 72 and 96% respectively. In the group of SIS 3D the sensitivity and specificity reached 83 and 99% respectively.

CONCLUSIONS: Adding SIS 3D, a minimally invasive method, to conventional sonohysterography improves the precision of diagnosis of endometrial pathology, allows to get three-dimensional image of the uterine cavity and enables examination of endometrial lesions. The diagnostic precision of this procedure is similar to the results achieved by hysteroscopy....

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Case Reports 2012; 33(2): 113-117 PubMed PMID: 22592190 Citation  Keywords:  Adrenal Insufficiency:blood, Adrenocorticotropic Hormone:blood, Aged, Glucocorticoids:pharmacology, Humans, Hydrocortisone:pharmacology, Male, Pituitary Gland, Anterior:drug effects,.   

: A 78-yr-old man was admitted in emergency with fatigue, anorexia, vomiting, hypothermia (35.1 °C on a hot August day), hypotension (89/56 mmHg) and hyponatraemia (126 mEq/l). Plasma corticotropin and cortisol were severely depressed: 0.84 pmol/L and 33.1 nmol/L respectively (reference range, 1.5-13.9 pmol/L and 110-505 nmol/L, respectively). Thyroid stimulating hormone was low-normal and free-triiodothyronine and free-thyroxine were subnormal. Magnetic resonance imaging revealed swelling of the pituitary gland and the stalk. The patient recovered after glucocorticoid replacement (200 mg/day intravenous hydrocortisone on Day 1 followed by tapering). Central diabetes insipidus which had become apparent had been treated with 1-desamino-8-D-arginine vasopressin. A surge of corticotropin and cortisol, 19.4 pmol/L and 712.1 nmol/L respectively, was found on Day 5 when luteinizing hormone, follicle stimulating hormone, and testosterone were subnormal and prolactin was slightly elevated. Subsequently, corticotropin and cortisol levels normalized together with normalization of luteinizing hormone, follicle stimulating hormone, anti-diuretic hormone, thyroid stimulating hormone, prolactin, testosterone and thyroid hormone levels. Shrinkage of the pituitary gland occurred after one month. Serum immunoglobulin G4 was elevated (3.21 and 6.02 g/l at 1- and 3-month follow-ups respectively). In conclusion, a paradoxical surge of corticotropin after glucocorticoid replacement was observed in a patient with central adrenal insufficiency due to immunoglobulin G4-related hypophysitis. Surge of ACTH in central adrenal insufficiency after glucocorticoid replacement has rarely been reported, and this is the second such case report....

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Journal Article 2011; 32(6): 821-830 PubMed PMID: 22286800 Citation  Keywords:  Adult, Aged, Biomarkers, Tumor:metabolism, Breast Neoplasms:enzymology, Diagnosis, Differential, Female, Humans, Matrix Metalloproteinase 11:metabolism, Matrix Metalloproteinase 2:metabolism, Middle Aged, Prognosis, Recurrence, Survival Rate,.   

BACKGROUND: Breast cancer is the most common malignancy in women in the U.S. and Europe. In the early stages of the disease, women are treated surgically, which is supplemented with hormonal therapy, immuno-, chemo- or radiotherapy. Postoperative qualification for further treatment is based on clinical stage, the pathology of the tumor and classic prognostic factors. Despite that, among patients with breast cancer in early stages of clinical advancement, there is a relatively large proportion of observed tumor recurrence. These observations oblige the search for additional prognostic factors that determine the progression of the disease faster, according to which, could emerge a group of women at increased risk of recurrence of the disease.

AIM: The aim of this paper is to determine the meaning of the expression of selected metalloproteinases as prognostic factors in breast cancer.

METHODS: The study group consisted of 108 patients ages 26 to 86 years treated surgically from 1994 to 2000 because of primary breast cancer in the early clinical stage, ie stage I and II according to TNM classification.

RESULTS: Between two of the tested metalloproteinases (MMP-2 and MMP-11) only MMP-2 appears to have prognostic significance in early forms of breast cancer, and its strong expression is associated with shorter survival....

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Case Reports 2011; 32(6): 741-747 PubMed PMID: 22286799 Citation  Keywords:  Base Sequence, DNA Mutational Analysis, Female, Homeodomain Proteins:genetics, Humans, Hypopituitarism:complications, Middle Aged, Molecular Sequence Data, Mutation, Psychotic Disorders:etiology,.   

INTRODUCTION: Untreated congenital hypopituitarism in adult patient is - nowadays - a very rare observation.

CASE: A 52 years old female patient, was referred to the Department of Psychiatry for psychotic symptoms, manifested as auditory pseudohallucinations with delusional interpretation, significant psychomotor agitation, anosognosia, attempts of symptom dissimulation and negativism. At admission, attention was drawn to her short stature and low body weight. Because of general weakness, she was hardly moving, her skin was pale, dry, cold, little elastic and desquamating. Neither axillary nor pubic hair could be traced. Basic studies revealed anaemia, significant hyponatraemia and hypercholesterolaemia. Hormonal tests confirmed diagnosis of hypopituitarism. Genetics studies revealed mutations (150delA and 296_297delAG) in PROP1 gene. Combined somatic and neuroleptic treatment considerably improved the physical and psychic status of the patient, as well as strengthened her social functioning.

CONCLUSIONS: An exogenous, psychotic episode identified in the patient was induced by multihormonal hypopituitarism and disappeared after hormonal replacement therapy....

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Journal Article 2011; 32(6): 874-878 PubMed PMID: 22286795 Citation  Keywords:  Adult, Biomarkers:blood, Cardiovascular Diseases:blood, Cervical Vertebrae:surgery, Female, Humans, Male, Middle Aged, Natriuretic Peptide, Brain:blood, Peptide Fragments:blood, Postoperative Complications:blood, Prospective Studies, Sodium:metabolism,.   

OBJECTIVES: N-terminal pro-B-type natriuretic peptide (NT-proBNP) is increasingly being used as a biomarker of cardiovascular risk. To date neither its cut-off for postoperative period in noncardiac surgery nor whether the cardiovascular risk has any relation to natriuresis has been assessed.

DESIGN: The prospective observational study evaluated postoperative serum levels of NT-proBNP with fractional excretion of sodium (FENa+) and sodium clearance (CNa+) in relation to the occurrence of cardiovascular events in patients after elective cervical spine surgery.

METHODS: In 27 otherwise healthy patients after elective cervical spine surgery we prospectively measured serum NT-proBNP and serum sodium immediately after the operation (day 1) and on day two. We correlated both NT-proBNP with FENa+, CNa+, diuresis and intake of fluids and sodium, which were assessed from the beginning of the operation until day two. We followed the incidence of myocardial infarction, heart failure and cardiac death postoperatively to 1 year.

RESULTS: Immediate postoperative NT-proBNP values were within the reference range (mean 4.53 ± 2.48 pmol/l), but they increased significantly on the second day (mean 23.57 ± 12.27 pmol/l, p<0.001). Significantly elevated CNa+ (0.033 ± 0.014 ml/s, p<0.001), FENa+ (0.018 ± 0.008, p<0.001) and fUNa+ (mean 326.9 ± 125.2 mmol, p<0.01) were found. There was a significant positive correlation between the two values of NT-proBNP (r=0.47, p=0.014), but we did not find any correlation between NT-proBNP and the further measured parameters. None of the patients had any cardiovascular events from operation until 1 year.

CONCLUSIONS: The significant postoperative elevation of NT-proBNP had no relationship with the rise in FENa+, CNa+ or fUNa+ and was not connected with any occurrence of cardiovascular events in patients after elective cervical spine surgery....

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