Effect of the 5-HTTLPR polymorphism on affective temperament, depression and body mass index in obesity.

BACKGROUND AND AIM: Many studies show high prevalence of affective disorders in obese patients. Affective temperament is a subclinical manifestation of such conditions. The 5-HTT gene encoding the serotonin transporter may be involved in both mood and eating dysregulation. The aim of this study was to investigate the influence of a polymorphism in the 5-HTT gene on affective temperament types, depressive symptoms and Body Mass Index (BMI) in obese patients. METHODS: This study involved 390 patients (237 females, and 153 males) with obesity. The TEMPS-A questionnaire, Beck Depression Inventory (BDI) and Hamilton Depression Rating Scale (HDRS) were used to evaluate affective temperaments and prevalence of depression. DNA was obtained for serotonin transporter gene-linked polymorphism (5-HTTLPR) genotyping. RESULTS: In obese patients S/S genotype was associated with depressive and L/L with cyclothymic temperament. Subjects with L/L genotype presented significantly higher BMI and greater intensity of depressive symptoms in BDI and HDRS. Females scored higher in anxious and depressive, while males in hyperthymic, cyclothymic and irritable temperaments. Females scored higher in BDI (subjective depression) while males in HDRS (objective depression). LIMITATIONS: TEMPS-A, BDI and HDRS are frequently used in studies on affective disorders. However, these methods do not examine all dimensions of mood and personality. CONCLUSIONS: In obese patients S allele of 5-HTTLPR was associated with development of depressive temperament while L allele corresponded with greater obesity and prevalence of depression. Different mechanisms may be involved in manifestation of depression in males and females with obesity.

Stress hyperglycaemia in patients with first myocardial infarction.

OBJECTIVE: To investigate the incidence of stress hyperglycaemia at first acute myocardial infarction (MI) with ST-segment elevation, occurrence of stress hyperglycaemia as a manifestation of previously undiagnosed abnormal glucose tolerance (AGT), and its relation to stress hormone levels. MATERIALS AND METHODS: The population of this prospective cohort study consisted of 243 patients. On admission glucose, adrenaline, noradrenaline and cortisol levels were measured. Patients without previously diagnosed diabetes (n = 204) underwent an oral glucose tolerance test on day 3 of hospitalisation and 3 months after discharge. RESULTS: Abnormal glucose tolerance at day 3 was observed in 92 (45.1%) patients without a previous diagnosis of diabetes mellitus and resolved after 3 months in 46 (50.0%) patients (p < 0.0001). Stress hyperglycaemia, defined as admission glycaemia ≥ 11.1 mmol/l, affected 34 (14.0%) study participants: 28 (54.9%) patients with diabetes vs. 3 (8.8%) subjects with newly detected impaired glucose intolerance (p < 0.00001) and 1 (2.2%) person with AGT at day 3 (p < 0.000001). Multivariable analysis identified elevated glycated haemoglobin (HbA(1c) ; p < 0.0000001), anterior MI (p < 0.05) and high admission cortisol concentration (p < 0.001), but not catecholamines, as independent predictors of stress hyperglycaemia. The receiver operating characteristic curve analysis revealed the optimal cut-off values of 8.2% for HbA(1c) and 47.7 µg/dl for admission cortisol with very good and sufficient diagnostic accuracies respectively. CONCLUSIONS: Newly detected AGT in patients with a first MI is transient in 50% of cases. Stress hyperglycaemia is a common finding in patients with a first MI with ST-segment elevation and diabetes mellitus, but is rarely observed in individuals with impaired glucose tolerance or transient AGT diagnosed during the acute phase of MI. The risk factors of stress hyperglycaemia occurrence include elevated HbA(1c) , anterior MI and high admission cortisol concentration.

Thyroid ultrasound in diabetic patients without overt thyroid disease.

PURPOSE: To assess thyroid volume and to evaluate possible lesions in the gland structure using thyroid ultrasound in patients with diabetes mellitus type 1 (DM1) and 2 (DM2) without overt thyroid disease. MATERIAL AND METHODS: Consecutive adult patients with DM2 (n = 98) and DM1 (n = 30) without overt thyroid disease referred to our department because of poorly controlled disease and/or diabetic complications were prospectively analyzed. Thyroid volumes, gland echogenicity, thyroid nodules incidence, and TSH levels were compared with control groups (n = 50 and 38) and matched according to sex and age. RESULTS: Significant increases in median thyroid volume were observed in both subjects with DM1 (17.3 cm3, interquartile range (IR) 13.9-21.6 cm3 versus 14.4 cm3, IR 11.3-18.3 cm3; P < 0.05) and DM2 (20.5 cm3, IR 14.9-27.1 cm3 versus 14.1 cm3, IR 11.3-18.3 cm3; P < 0.001) in comparison to their control groups. Moreover, in the population of type 2 diabetics, thyroid nodules (OR 2.37, 95% CI 1.14-4.93), parenchymatous goiter (OR 5.40, 95% CI 1.20-24.30), and all kinds of thyroid goiter according to the WHO definition (OR 4.18, 95% CI 2.02-8.66) were remarkably more frequent. In our patients, reduced (but within normal range) TSH level occurred in DM1 (median 0.97 mIU/l, IR 0.61-1.58 mIU/l versus median 1.66 mIU/l, IR 0.76-2.09 mIU/l; P < 0.05). The presence of a negative linear correlation between thyroid volume and TSH concentration was noticed in patients with DM2 (RS = -0.38, P < 0.01). CONCLUSION: In individuals with DM1 and DM2 treated for poorly controlled disease and/or diabetic complications, thyroid volumes were significantly higher than in the normal population. Moreover, nodular thyroid structure and parenchymatous goiter occurred more frequently in these type 2 diabetic patients.

The role of positron emission tomography (PET) in diagnostics of gastroenteropancreatic neuroendocrine tumours (GEP NET).

PET is a successful modality to detect cancer and in recent years has demonstrated a great diagnostic value in large series of tumour types. PET combines high sensitivity and reasonable resolution, and offers the ability to perform whole body scans. 18F-deoxyglucose (FDG)-PET has also been used to diagnose tumours of neuroendocrine origin. Even if 18F-FDG has been successfully and widely employed in oncology, it has not demonstrated a significant uptake in well differentiated neuroendocrine tissues. Thus 18F-FDG is not a good tracer for neuroendocrine tumours, as FDG-PET imaging of number of GEP tumours revealed increased glucose metabolism only in less differentiated GEP tumours with high proliferative activity and in metastatising MTC associated with rapidly increasing CEA levels. In such a situation, additional 18F-FDG PET should be performed only if somatostatin receptor scintigraphy (alone or with 99mTc-DMSA) is negative. On the contrary, other positron emitter tracers seem to be more promising. 68Ga-DOTA-NOC (tetraazycyclododecanetetraacetic acid-[1-Nal3]-octreotide) has been used as a positron emitter tracer for the detection of NETs in preliminary studies. A serotonin precursor 5-hydroxytryptophan (5-HTP) labelled with 11C has shown an increased uptake in carcinoids. This uptake seems to be selective and some clinical evidence has demonstrated that it allows the detection of more lesions with PET than with CT or octreotide scintigraphy. Another radiopharmaceutical in the development for PET is 11C-L-DOPA, which seems to be useful in imaging endocrine pancreatic tumours.

Iodine prophylaxis intensification. Influence on radioiodine uptake and activity of 131I used in the treatment of hyperthyroid patients with Graves' disease.

UNLABELLED: Poland, a country with mild/moderate iodine deficiency introduced an obligatory iodination salt system in 1996. AIM: To compare the results of radioiodine (131I) uptake after 5 h and 24 h with the activity of radioiodine used in the treatment of hyperthyroid patients with Graves' disease in the years 1995 and 2003. PATIENTS, METHODS: The marker of iodine content in the diet was urinary iodine excretion. 1000 randomly chosen patients (average age: 46 +/- 12 years) were included in the study. Every patient had routinely estimated radioiodine uptake after 5 h and 24 h and the activity of 131I was calculated using scintigraphy and ultrasonography of the thyroid gland. Urinary iodine excretion in samples from year 1995 and 2003 was also determined in some patients and healthy volunteers. RESULTS: The iodine load in the diet increased from 66 microg (average) in the year 1995 to 115 microg in the year 2003. Thyroid radioiodine uptake was 40% lower in comparison with the results from 1995. The average activity of 131I given in the year 2003 (10 mCi) was about 40% higher than in the year 1995 (7 mCi). CONCLUSION: There was significant negative correlation between higher iodine content in the diet and lower values of radioiodine uptake, which led to the application of the higher activity of 131I during treatment.

Function, structure, and volume of thyroid gland following allogenic kidney transplantation.

The aim of the study was to assess the structure, volume, and function of the thyroid gland following kidney transplantation compared with those features of long-term transplant recipients as well as patients with normal native kidney function. Study group A consisted of 30 patients undergoing allogenic kidney transplantation, study group B included 30 long-term kidney transplant recipients who displayed stable renal function at 4 to 11 years following transplantation; control group C comprised 38 patients who were diagnosed or treated for reasons other than thyroid or renal insufficiency. Mean FT-3 concentrations in group A decreased from 2.19 pg/mL preoperatively to 1.52 pg/mL on the first posttransplantation day, returning to the preoperative values (2.06 pg/mL) at 30 days postoperatively. After 6 months the concentrations of thyroid hormones were similar to those among the long-term posttransplantation group (group B), although still lower than those in the control group. Mean thyroid volume in dialyzed patients was 17.10 mL; in the long-term group, 17.60 mL; and in the control group, 15.82 mL between groups that were not statistically significant. Abnormal structure of the thyroid gland was observed in 63% of group A (n = 19), 70% of group B (n = 21), and 29% of the control group. Significantly more abnormal thyroid gland structures were observed among dialyzed or transplanted patients. The thyroid volume was similar in all groups. Significant transient decrease in thyroid stimulating hormone (TSH) and free triidothyronine (FT-3) was not free thyroxine (FT-4) concentrations following kidney transplantation. Occasionally, increase accompanied by a change in FT-4 and TSH concentrations were observed, and antithyroid antibodies were detected only sporadically.

[Effect of lanreotide on prolactin level in patients with pituitary mixed tumors]. / Influence du lanréotide sur la concentration sérique de prolactine chez les patients atteints de tumeurs somato-lactotropes.

Acromegaly is a disease caused by a pituitary tumor (somatotropinoma) or by ectopic secretion of GH or IGF-1. About 15% of tumors secrete not only GH but PRL as well. Last time a lanreotide and an octreotide (the somatostatine analogues) are useful in the therapy of acromegaly. We observed the influence of the lanreotide on GH and prolactin. We noticed that the lanreotide caused not only serum level reduction of a growth hormone but also prolactine in patients with mixed pituitary tumors.

[Changes of regional cerebral blood flow in stroke patients assessed by SPECT]. / Zmiany regionalnego przeplywu krwi u chorych z udarem mózgu badane przy pomocy tomografii emisyjnej pojedynczego fotonu.

UNLABELLED: The aim of our work was to evaluate changes in regional cerebral blood flow (rCBF) in patients with TIA and/or completed stroke and localisation of fotopenic foci in basal conditions and, in some cases, after stimulation pharmacological trial with acetazolamide. One hundred and fifty three patients participated in the study--105 with completed stroke and 48 with TIA. Regional CBF (rCBF) was evaluated using a single-headed rotating gamma camera (Diacam, Siemens) with high resolution collimator, after injection of 740 MBq 99mTc-HMPAO (Ceretec, Amersham). Sixteen patients with TIA underwent SPECT at baseline and after injection of acetazolamide (ACZ). Relative regional perfusion was expressed as the ratio of cerebral/cerebellar activity. In the completed stroke population, the perfusion ratios were significantly lower than those of controls and TIA at baseline (p < 0.001) and TIA after ACZ (p < 0.01). CONCLUSIONS: This study shows a significant difference in rCBF in patients with completed stroke and/or TIA and controls. In patients with TIA and rCBF similar to that observed in controls, perfusion deficits may be visible after ACZ injection.

[The effect of antidepressants on regional cerebral blood flow measured with 99m Tc HMPAO SPECT in depressive patients]. / Wplyw leczenia przeciwdepresyjnego na miejscowy przeplyw mózgowy oceniany za pomoca 99mTc HMPAO SPECT u chorych na depresje.

The results of investigations of regional cerebral blood flow using 99mTc HMPAO SPECT in 19 depressed patients before treatment and after 6 weeks of pharmacotherapy are presented.

Semiquantitative analysis of SPECT images using 99Tc(m) -HMPAO in the treatment of brain perfusion after the attenuation correction by the Chang method and the application of the Butterworth filter.

The aim of this work was to optimize the parameters for semiquantitative analysis with regard to the average number of counts per pixel in tomographic projections. The analysed studies were divided into three groups, proportionally, to average the counts per pixel. The analysis of results proved the dependence (P<0.05) between the average geometric contrast of images with the maximum counts per pixel higher than 500, reconstructed with the cut-off frequency fc=0.50fn, and the standard image. Also, the same dependence was found between the group with an average of 200 counts per pixel and the standard image at the cut-off frequency fc=0.40fn. The analysis of the attenuation coefficient, c, showed significant differences. The attenuation coefficient c=0.12 cm-1 as accepted for further studies. Optimization of the matrix order of interpolation filter proved increasing of contrast with decreasing size of the matrix. In conclusion, according to the average number of counts per pixel in a projection the parameters of image reconstruction, particularly the cut-off frequency fc of the Butterworth filter, should be changed. Additionally, an attenuation correction with coefficient c=0.12 cm-1 and interpolation with matrix size equal 7x7 should be applied.

[The effect of chemotherapy on bone metabolism in patients with non-small cell lung cancer]. / Wplyw chemioterapii na metabolizm kostny u chorych na niedrobnokomórkowego raka pluca.

UNLABELLED: In this study the influence of chemotherapy on bone metabolism in patients with III stage of non-small cell lung cancer has been evaluated. 30 patients (men) in average age 57.1 years were enrolled to this trial. The trial carried out on 2 groups of patients: group A consisted of 30 patients with NSCLC, group B of 15 patients without neoplastic process. In all participants bone scintigraphy was done and the following biochemical markers were measured: osteocalcin concentration, alkaline phosphatase's bone fraction, twenty-four-hour calcium and hydroxyproline urine excretion. In patients after two courses of chemotherapy (mitomycin, cisplatin, vinblastine) statistically significant reduction of serum concentration of osteocalcin, alkaline phosphatase, also reduction of calcium and hydroxyproline urine excretion have been observed. Scintigraphic examination of bones showed statistically significant decrease in resorption of isotope (MDP 99mTc) in patients after chemotherapy (p < 0.05). CONCLUSIONS: The study shows positive influence of chemotherapy on bone metabolism in patients with NSCLC. Patients treated with chemotherapy have bone metastases less frequently.

[Diagnostic value of regional cerebral blood flow in SPECT pattern in Alzheimer's disease]. / Wartosc diagnostyczna badania regionalnego przeplywu krwi w mózgu metoda tomografii emisyjnej w chorobie Alzheimera.

Regional cerebral blood flow in SPECT pattern was estimated in 20 cases of Alzheimer disease. In all patients diffuse hypoperfusion was found evidencing a great diagnostic value of SPECT. A special significance has the study of regional cerebral blood flow in the differential diagnosis of Alzheimer disease, frontal lobe dementia and pseudodementia in major depression.

[The efficiency of goiter prevention due to iodine deficiency in pregnant women]. / Skutecznosc profilaktyki wola z niedoboru jodu u kobiet ciezarnych.

The iodine is indispensable element for life that is also fundamental substract for thyroid hormone synthesis which make very important influence on protein's lipid's, carbohydrate's and highly caloric substances metabolism and are a requisite of proper man development. The pregnant women are one of population group which is the most sensitive on iodine's deficiency. The results of researches indicate on insufficient iodine intake in pregnant women diet, whose take food even according to diet's recommendation given by physician. The wide iodine's prophylaxis which was provided as yet is insufficient in case of pregnant and nursing women. It is confirmed the necessity of additional iodine supplementation. A set of control tests should be done in requires cases that inform physician about changes in function and size of thyroid gland and make possible the individualization of treatment. The supplementation doses of iodine about 150 micrograms are safe and there was not observed any side effects during their taking.

Thyroid volume and function in patients with acromegaly living in iodine deficient areas.

The aim of our study was to evaluate the size and function of the thyroid in patients with acromegaly. In 39 patients concentrations of HGH, PRL, TSH, T3 and T4 were measured and the thyroid volume was calculated with the using of ultrasound examination. The control group comprised 5 patients with acromegaly in a stage of remission and 98 controls. We concluded that the size of the goiter in patients with acromegaly depends on serum concentration of HGH, but it does not depend on the concentration of TSH, T3, T4 and PRL. Goiter is present in 87% of patients with acromegaly, 46% of them are nodular goiters. The thyroid function in acromegaly is normal.

[Modern diagnostic methods for thyroid gland diseases]. / Nowoczesne metody diagnostyczne w chorobach tarczycy.

The paper overviews the role of diagnostic procedures in evaluating patient with thyroid gland disease. It focuses on the diagnostics of functional disturbances and on the modern approach to the nodular goitre. The role of supersensitive, immunoenzymatic assay of TSH (sTSH) in the diagnostics of functional disturbances in underlined, particularly in subclinical course of thyroid gland diseases, or in diagnostically difficult cases. The complimentary role of tests' triangle-ultrasound, scintigraphy and fine needle biopsy in the evaluation of focal changes of the thyroid (nodular goitre) is discussed and the diagnostic algorithm of patient's qualification to surgery is proposed.

[Radioimmunologic methods for determining cortisol binding globulin-CBG in human serum]. / Radioimmunologiczna metoda oznaczania transkortyny (Cortisol Binding Globulin-CBG) w surowicy ludzkiej.

The authors described double antibodies radioimmunoassay of human cortisol binding globulin serum level in support of previous isolated and purified trancortin and anti-transcortin antibodies produced by rabbit immunization. Antigen was iodinated by chloraminet method and purification on Ultragel AcA 54 column. Standard curve had specific Bx/Box100%. Using described method investigation of transcortin globulin serum level is precise and repetitive.

[The assessment of regional cerebral blood flow using HMPAO-SPECT during depressive episode and in remission]. / Ocena przeplywu mózgowego krwi za pomoca HMPAO-SPECT u chorych w czasie fazy depresyjnej oraz po jej ustapieniu.

Twenty patients who met the DSM-IV criteria for major depressive disorder were investigated at rest using Single Photon Emission Computed Tomography (SPECT). Participation in the study required a minimum score of 18 points on the 17-item Hamilton Rating Scale. All patients were drug free for at least one week before the SPECT scan. Assessments were made twice during depression and after recovery. Regional tracer uptake was measured by a semiquantitative method. The reference region was delineated on the cerebellum. In remission a significant increase of 99m Tc-uptake in almost all regions of interest was observed what may point on the improvement of regional blood flow after recovery from depression. For most regions except right frontal and left parietooccipital there were no significant differences of tracer uptake between patients with bipolar and unipolar depression. The negative correlation between regional cerebral blood flow and Hamilton score was found in temporal areas and left temporo-parietal region. We did not find the influence of age on regional cerebral blood flow. In conclusion, during depression global reduction of brain metabolism was observed, which may point on the role of subcortical nuclei with diffuse cortical projection in pathogenesis of depression.

[The Landau-Kleffner syndrome. SPECT and EEG investigations]. / Zespól Landaua i Kleffnera. badania SPECT i EEG.

Four children (three boys and one girl) with acquired epileptic aphasia (the Landau-Kleffner syndrome) have been observed in the Department of Developmental Neurology University of Medical Sciences in Poznan. We present the dynamic of clinical symptoms and fluctuations in EEG studies. The changes in the brain in single photon emission computed tomography (SPECT) during remission of clinical symptoms are discussed.

[Primary hyperparathyroidism--diagnostic problems]. / Pierwotna nadczynnosc przytarczyc--problemy diagnostyczne.

Parathyroid imaging with 99m Tc-MIBI, introduced at the beginning of the 90's seems to be a promising method for parathyroid adenomas localization. The aim of the study was to assess the efficacy of parathyroid imaging with 99m Tc-MIBI for preoperative localization of parathyroid adenomas and to compare that method with the high-resolution ultrasonography. Thirteen patients with primary hyperparathyroidism of duration from 2 to 25 years were included in the study. The presence of parathyroid adenomas was confirmed by histopathology in all patients. The sensitivity for scintigraphy and ultrasonography was 92.8% and 78.5%, the number of false positive results was 0 and 2 and false negative-0 and 1, respectively. Parathyroid imaging with 99m Tc-MIBI is a useful method for parathyroid adenomas localization, and in contrast to ultrasonography its sensitivity does not decrease if a parathyroid adenoma is located ectopically. Nevertheless, because of the greater accessibility, lower costs and its simplicity ultrasonography should be used as a screening modality for parathyroid adenoma localization.