Assessment of brain and hippocampal volume in patients with Cushing's disease.

INTRODUCTION: The purpose of this study was to assess the volumes of the hippocampus, grey matter, and the whole brain in patients with active Cushing's disease compared to a control group. MATERIAL AND METHODS: We included 36 patients diagnosed with Cushing's disease, with pituitary magnetic resonance imaging (MRI) performed as a standard preoperative assessment. The sample size of the control group was 26 persons. MRI studies were acquired with a 3.0 Tesla MR scanner equipped with a 24-channel head coil. The MRI study protocol included a pre-contrast 3D T1-weighted gradient sequence. Volumetric segmentation of the brain structures was performed using version 6.0 of the FreeSurfer software. RESULTS: We observed statistically significant reduction in the grey matter volume in the study group as compared to the control group (p < 0.001), with no significant differences in the volume of the whole brain (p = 0.104), left hippocampus (p = 0.790), and right hippocampus (p = 0.517). There was a strong positive correlation between grey matter volume and brain volume (r = 0.75, p < 0.001), independent of the study group. CONCLUSIONS: The study showed unevenly distributed brain atrophy in patients suffering from Cushing's disease, with no significant hippocampal atrophy. Significant atrophy was observed within the grey matter, potentially constituting a preliminary stage of whole-brain atrophy.

Endovascular embolization as a treatment for symptomatic adenomyosis - results of preliminary study.

OBJECTIVES: To present preliminary results of minimally invasive endovascular embolization as a treatment of symptomatic adenomyosis or adenomyosis with fibroids and to assess the long-term clinical outcome. MATERIAL AND METHODS: Between 2015 and 2020 twelve patients with symptomatic adenomyosis or adenomyosis with fibroids underwent uterine artery embolization (UAE). All patients were evaluated in terms of patient's overall satisfaction, relief of clinical symptoms, reintervention and hysterectomy as well as menopause rates. RESULTS: Mean age on admission was 48 years. Reported symptoms included: dysmenorrhea with the mean VAS score of 7.8, menorrhagia and problems with urination. Successful embolization was achieved in all patients (100%). A reduction in pelvic pain intensity assessed using VAS was observed in 11/12 (92%) of the patients - pain decreased by 6.2 points on average (from 7.8 to 1.6 pts). In one patient (8%) the recurrence of pain was observed. All patients reported decrease of menstrual bleeding and consequently improvement of everyday life quality. Avoidance of hysterectomy was achieved in 83% of the women. Five patients experience absence of menstrual periods for at least 12 months after the embolization resulting in menopause rate of 42%. Ten patients (83%) reported to be very or fairly satisfied with the results and would recommend this treatment to a friend. CONCLUSIONS: Uterine artery embolization might be safe and effective method of treatment for patients with symptomatic adenomyosis with or without fibroids with very high rate of satisfied patients.

Clinical Application of Autologous Adipose Stem Cells in Patients with Multiple Sclerosis: Preliminary Results.

The clinical outcome of autologous adipose stem cell (ASC) treatment of patients with multiple sclerosis (MS) was investigated following one year of observation. Methods. The clinical and MRI outcomes of 16 ASC-treated patients with RRMS and SPMS are reported after a one-year follow-up period. Results. At 18 months of follow-up, some patients showed "enticing" improvements on some exploratory efficacy measures, although a significant benefit was not observed for any measure across the entire group. Neither the progression of disability nor relapses were observed in any cases. In four patients, we found new gadolinium+ (Gd+) lesions on MRI. Our results indicate that ASC therapy is safe and does not produce any substantial side effects. Disease progression-free survival (PFS) of 18 months was seen in all patients with RRMS and SPMS. In these patients, EDSS scores did not progress above baseline scores. Gd-enhancing lesions were observed in two cases with RRMS, but these patients did not exhibit changes in EDSS score. Conclusion. Intrathecal treatment with ASCs is an attractive form of therapy for patients with MS but should be reserved for cases with aggressive disease progression, for cases that are still in the inflammatory phase, and for the malignant form.

Single hydatid cyst of liver managed with laparoscopy - a case study.

Hydatid disease is not common in human populations of highly developed urban areas. However, increasing immigration, travel and international tourism have led to a recent increase in incidence. Surgery remains the method of choice in the management of hepatic hydatid cysts. Laparoscopic treatment of the disease has been questionable so far, though it is feasible and safe in use. We report a case of an 18-year-old woman, successfully treated with total cystectomy located in a favourable laparoscopic area - the border of the 3(rd) and 4(th) segment of the hepatic left lobe. The operation and hospitalization period were uncomplicated. Controlled follow-up laboratory and radiological tests showed no remaining pathology or recurrence in any form. In conclusion we state that the laparoscopic technique provides a feasible and efficacious option of treatment for some types of hydatid cysts located in the liver. It is a safe miniinvasive surgical approach which enables postoperative discomfort to be reduced and results in a quick recovery.

Idiopathic retroperitoneal fibrosis: case report.

A 45-year-old woman was admitted to the hospital because of abdominal pain, fever, and weight loss. Laboratory tests performed on admission revealed raised inflammatory markers. Ultrasonography of the abdomen showed dilatation of the pyelocalyceal system of the left kidney, while computed tomography showed retroperitoneal concentric periaortic mass extending to common iliac arteries and entrapping the left ureter. We established the diagnosis of idiopathic retroperitoneal fibrosis (RPF). JJ catheter was placed in the left ureter, and treatment with corticosteroids and azathioprine was started. Follow-up examinations showed a gradual improvement, namely a progressive remission of the retroperitoneal mass and normalization of both erythrocyte sedimentation rate and C-reactive protein concentration. Case reports, including our paper, and small case series showed azathioprine to be particularly effective in the treatment of RPF.