Hypothalamic damage in multiple sclerosis correlates with disease activity, disability, depression, and fatigue.

OBJECTIVES: Disturbances in the hypothalamo-pituitary axis are supposed to modulate activity of multiple sclerosis (MS). We hypothesised that the extent of HYP damage may determine severity of MS and may be associated with the disease evolution. We suggested fatigue and depression may depend on the degree of damage of the area. METHOD: 33 MS patients with relapsing-remitting and secondary progressive disease, and 24 age and sex-related healthy individuals (CON) underwent 1H-MR spectroscopy (1H-MRS) of the hypothalamus. Concentrations of glutamate + glutamin (Glx), cholin (Cho), myoinositol (mIns), N-acetyl aspartate (NAA) expressed as ratio with creatine (Cr) and NAA were correlated with markers of disease activity (RIO score), Multiple Sclerosis Severity Scale (MSSS), Depressive-Severity Status Scale and Simple Numerical Fatigue Scale. RESULTS: Cho/Cr and NAA/Cr ratios were decreased and Glx/NAA ratio increased in MS patients vs CON. Glx/NAA, Glx/Cr, and mIns/NAA were significantly higher in active (RIO 1-2) vs non-active MS patients (RIO 0). Glx/NAA and Glx/Cr correlated with MSSS and fatigue score, and Glx/Cr with depressive score of MS patients. In CON, relationships between Glx/Cr and age, and Glx/NAA and fatigue score were inverse. CONCLUSION: Our study provides the first evidence about significant hypothalamic alterations correlating with clinical outcomes of MS, using 1H-MRS. The combination of increased Glu or mIns with reduced NAA in HYP reflects whole-brain activity of MS. In addition, excess of Glu is linked to severe disease course, depressive mood and fatigue in MS patients, suggesting superiority of Glu over other metabolites in determining MS burden.

Treatment results of non-varicose bleeding from upper gastrointestinal tract.

UNLABELLED: Treatment results of non-varicose bleeding from upper gastrointestinal tract are changing by improved endoscopic methods and introduction of new drugs in treatment. OBJECTIVE: Objective of this work was to compare the results in treatment of patients with non-varicose bleeding from upper gastrointestinal tract in two different 5-years periods. MATERIAL: We hospitalised 229 patients with non-varicose bleeding from upper gastrointestinal tract at the Department of Surgery in Faculty Hospital of Martin in the period 1992-1996. (161 men and 68 women, average age 56.7, patients up to 60 were 42.4%). 203 patients were hospitalised in the years 2003-2008 (146 men and 57 women, average age 61.5, patients up to 60 were 54%). METHODS: We compared both groups by retrospective analysis and we evaluated differences by using statistical methods (nonparametric test of independence of the qualitative data). RESULTS: There was only minimal difference in primary conservative and endoscopic haemostasis in both groups. Relaps of bleeding was the same in both groups. Definitive conservative and endoscopic haemostasis was higher by 3.2% in the period 2003-2008 and number of urgent operations decreased by 5.1%. Differences in total mortality were minimal between both groups but postoperative mortality was higher by 5.9% in the years 2003-2008. CONCLUSION: Number of urgent operations decreased due to improved results in definitive conservative and endoscopic haemostasis in the treatment of non-varicose bleeding from upper gastroinestinal tract. There was no significant change in the relaps of bleeding. There were only minimal changes in total mortality between both groups, but postoperative mortality increased in the second period (Tab. 8, Ref. 35).

[Neuroendocrine tumours of the upper gastrointestinal tract, characteristics and comparison of localization diagnostics]. / Neuroendokrinné nádory horného tráviaceho traktu, charakteristika a porovnanie efektivity lokalizacnej diagnostiky.

In daily clinical practice it's important to think of neuroendocrine tumors, since their prevalence for the past 5 years exceeded even the common occurrences of stomach, esophageal and pancreatic cancers. Patients diagnosed early and accurately with NET, have a greater chance for complete cure. The diagnostic tools over the past century were significantly inefficient in diagnosing NET i.e. (40% of tumors were not localized after USG, CT, MRI, AG investigations). Until the past 2 decades that major turnover in diagnostic methods has been achieved. In particular, the introduction of the somatostatine receptor scintigrafy (SRS) and endoscopic ultrasonography (EUS) have increased sensitivity of localization diagnostics up to 90%. Our work is to test the success of the localization diagnostics in 22 patients with surgically and histologically confirmed NET ofthe pancreas and duodenum. These patients fulfilled jointly SRS, CT and/or MRI, but also classic USG and EUS. From our comparison, clearly endoscopic USG is the most efficient tool with 90% sensitivity.

[Limitations of liver resections]. / Limitácie resekcií pecene.

Evaluation of the functional reserve before resectional performance and sufficient rest of liver parenchyma function is essential for the surgeon. From these factors, the decision based on operability, the maximum extent of liver parenchyma resection and the severity of post-operative course. In the period from December 2003 to December 2008, at the Dept of Transplant and Vascular surgery, JLF UK Martin, have been performed 161 resections of the liver in 144 patients, of which 91 large resections performances in the liver (hemihepatektomies or greater performance). Six patients have undergone repeated resection (4.1%), in 11 patients was performed Radio Frequency Ablation due to relaps of the disease (6.1%), and 3 patients were performed two steps resection. Of 91 major resection performance in the liver was 62 (68%) performed by anatomical boundaries of individual segments, in remaining 29 (32%) resections was reflected more to the localization of tumor itself as anatomical subdivision called combined anatomical and non-antomical resection. Radical resection R0 has been achieved in 76% of malignant tumors. In the post-operative course in 17% experienced complications, most often to the hematoma and biloma in place of the resection area, pleural effusion and 8 patients had postoperative liver dysfunction. Of this group, 5 patients had made volumetric examinations, and in all was the volume of residual liver parenchyma < 30% of the total volume of functional liver. Mortality within 30 days of the performance was 1.1%. The survival of patients was affected mainly by extent of resection, histological type of tumor, radicality of resection and necessity of the complex surgical procedures. Based on our evaluation of the results of a group of patients was arranged scheme measures for planning resectional procedures of the liver in our department. These include the adjustment of laboratory parameters, management of jaundice, preference of anatomical resections and volumetric examinations in patients with an estimated loss of more than 60-70% functional parenchyma of liver.

Cortical oscillatory changes during warming and heating in humans.

Warmth and heat are registered by different types of cutaneous receptors. To disentangle the cortical activation patterns of warming and heating, we analyzed the temporal evolution of the electroencephalographic 10 and 20 Hz oscillations with the time resolution of hundreds of milliseconds. Sixty heat (from 32 to 50.5 degrees C, rate of change 6 degrees C/s) and warm (from 32 to 42 degrees C, 6 degrees C/s) stimuli were applied on the right thenar using contact thermode. EEG was recorded from 111 scalp electrodes in 12 healthy subjects, and analyzed using event-related desynchronization and low-resolution electromagnetic tomography methods. During warming, the amplitudes of 10 and 20 Hz oscillations over the contralateral primary sensorimotor (SI/MI) and premotor cortices decreased, and the amplitude of 20 Hz oscillations in the anterior cingulate and ipsilateral premotor cortex increased. Heating was associated with additional profound amplitude decreases of 10 and 20 Hz oscillations over SI/MI and premotor cortex, and by amplitude increase of 20 Hz oscillations originating in the posterior cingulate cortex. Results suggest biphasic amplitude changes of the cortical oscillations during ramp increase of temperature attributable to the periods of warming and heating. The amplitude decreases of 10 and 20 Hz oscillations in SI/MI and premotor cortex possibly aid in preparation of motor withdrawal reaction in an event that temperature should reach intolerable pain. Synchronization of the 20 Hz oscillations in the anterior and especially in the posterior cingulate cortex may aid suppression of unwanted movements.

[Potential predictors of therapeutic response in patients with cryptogenic fibrosing alveolitis]. / Potenciálne prediktory liecebnej odpovede u pacientov s kryptogénnou fibrotizujúcou alveolitídou.

The authors present a clinical observation with the objective to test which objective indicators make it possible to predict the effect of treatment in patients with cryptogenic fibrotizing alveolitis. Retrospective analysis of the documentation of a longitudinal follow up of 34 patients with this diagnosis revealed that the presence of fibroproliferative changes on the high resolution CT image predicts significantly the absence of a therapeutic effect and conversely the absence of such changes predisposes for significant improvement of pulmonary functions during treatment. They found also a significant correlation between he ratio of lymphocytes in the bronchoalveolar lavage fluid and the dynamics of the development of pulmonary functions. The age of establishment of the diagnosis correlates also significantly with indicators of the therapeutic response. Based on these results the authors conclude that a favourable therapeutic effect can be expected in patients without fibroproliferative changes, with a significant lymphopcytosis in the bronchoalveolar lavage fluid and a younger age at the time of manifestation. On the other hand, in patients with a marked fibroproliferation and absence of alveolitis there is no point in attempting to influence the disease by pharmacological gents.

[Juvenile hyaline fibromatosis]. / Juvenilná hyalínová fibromatóza.

BACKGROUND: Juvenile hyaline fibromatosis is a sporadic hereditary disease with autosomal recessive mode of inheritance, characterized by the presence of nodules and tumours in the skin and soft tissues and gingival hyperplasia. The majority of patients are growth retarded, suffer from joint disorders, contractures, osteolytic lesions and have a positive family history. The disease most frequently occurs in children, but may be diagnosed also in adults. Since 1873, when the disease was described by Murray, only a few cases were introduced in the literature. THE AIM AND THE BASIS OF THE STUDY: To present the clinical pattern of a patient diagnosed at the age of 28 and describe also the histopathological, immunohistological and electron-microscopic findings of excisions from the lesions. METHODS: The pathologist in cooperation with clinicians from several disciplines established the diagnosis on the basis of typical histopathological picture and additional immunohistological tests not yet introduced in the literature. RESULTS: Tumorous lesions contained hyaline structureless matrix often with chondroid or even osteoid metaplasia, calcium salts. The matrix contained numerous fibroblastoid-like cells with eosinophilic cytoplasm, oval nucleus and often pericytoplasmic halo. ELMI investigation revealed dilated cisternae of rough endoplasmic reticulum and hypertrophic Golgi apparatus. Sporadically were particles with calcium salts density detected. Immunohistochemical tests revealed the expression of vimentin, alfa1-antitrypsin and alfa1-antichymotripsin by the tumorous cells. CONCLUSION: The authors presented an extremely sporadic childhood disease in an adult. The results are in accordance with the data from the literature. Immunohistochemical picture of "cementicles" has not yet been introduced in the available literature. (Fig. 12, Ref. 25.)

Measurement of airway resistance in awake cats.

Airway resistance (Raw) measurement with continuous recording was studied in 10 awake cats. The method used was a transducer enabling to incorporate additive resistances by rotating blind. The signals were processed electronically. Part of the measuring device in a pneumotachographic transducer (measurement V') and VT is obtained by integrating V'. Values for mean Raw were read in both parts of the breathing cycle. The experiments have shown that the method could be used in awake cats. Values for mean Rawinsp. were 1.3 +/- 0.24 kPa.l-1.s, Rawexp. of 1.43 +/- 0.26 kPa.l-1.s, end-inspiratory Raw was 1.44 +/- 0.33 kPa.l-1.s and end-expiratory Raw of 1.49 +/- 0.31 kPa.l-1.s.

Study of cough in anaesthetized cats with experimental pulmonary oedema.

The authors studied parameters of laryngopharyngeal (LPh) and tracheobronchial (TB) cough (the number of efforts--NE, the number of efforts per minute--NE.min-1, the intensity of the maximum effort--IME and the intensity of the attack--IA), respiratory parameters (VT, f, Cdyn), blood gas values (PaO2, PaCO2) and the pH in the arterial blood of anaesthetized cats (Pentobarbital Spofa, 35 mg x kg-1 i.p. with experimental pulmonary oedema. Oedema was induced by the i.v. administration of a fatty acid mixture (capric acid 3.8 g, caprylic acid 3.1 g and olive oil 3.0 g)--in a dose of 0.05 ml x kg-1 in group 1 and of 0.01 ml x kg-1 in group 2. Cough was elicited by stimulating the laryngopharyngeal and tracheobronchial mucosa with a silon fibre. Pulmonary oedema was determined from a macroscopic and microscopic examination of the lungs, from the ratio of lung weight to body weight and from the percentual dry weight of the right lungs. The authors found that the intensity of cough was depressed during pulmonary oedema, particularly in the case of TB cough. VT and Cdyn fell, f rose and the PaO2 and pH values steadily decreased.

Changes induced by severe hypoxia in respiratory defence reflexes in anaesthetized cats.

The authors studied the effects of progressive isobaric hypoxia (FO2 = 0.11, 0.07, 0.06, 0.05, 0.04 and 0.03) on respiratory defence reflexes elicited by mechanical stimulation of the airways in 10 pentobarbital-anaesthetized cats. The intensity of the expiration reflex was already significantly reduced at a hypoxia level of only FO2 = 0.11; the intensity of cough also showed a tendency to decrease. The number of efforts and the intensity of both tracheobronchial (TB) and laryngopharyngeal (LPh) cough fell significantly in hypoxia of FO2 = 0.07. On an average, cough could no longer be elicited at PaO2 = 2.0 +/- 0.06 kPa. The aspiration reflex was found to be the most resistant to hypoxia, and could still be elicited just before hypoxic apnoea developed. During hypoxia with FO2 ranging from 0.21 to 0.06, minute ventilation increased, while the intensity of respiratory defence reflexes diminished. TB cough could not be elicited during hypoxia until the breathing was depressed. It can be seen from the results that the regulatory mechanisms responsible for the intensity of respiratory defence reflexes are less resistant to the consequences of an inadequate systemic oxygen supply than the mechanisms controlling ventilation.

Effects of hypoxia on respiratory defence reflexes. Effects of thirty hours' oxygen deficiency on cough, the expiration reflex and sneezing in awake cats.

The authors studied, in 11 awake adult cats, the parameters of the expiration reflex (ER), tracheobronchial (TB) and laryngopharyngeal (LPh) cough, the respiratory rate (f), tidal volume (VT), the end tidal fractional CO2 concentration (FETCO2), the pH, the blood gases and the heart rate during 30 hours' isobaric hypoxic hypoxia (FO2 = 0.11). During the whole 30 hours the cats developed hypocapnic hypoxemia, f remained unchanged and VT was markedly elevated. In the acute phase (15 min) of hypoxic hypoxia of the same intensity, changes in respiratory parameters were the same and the intensity of respiratory reflexes increased significantly (Tatár et al. 1984). During prolonged hypoxic hypoxia there were no statistically significant changes in the intensity of the ER and of TB and LPh cough. The authors assume that some adaptation of the central mechanisms regulating the defence reflexes of the airways took place; this hypothesis is warranted, because an increase in the susceptibility of the cough centre during constant conditions of the stimulation of cough receptors would not be biologically expedient. The different changes in the intensity of respiratory defense reflexes in the acute and the prolonged phase of hypoxic hypoxia in the presence of identical changes in respiratory parameters are further indirect evidence pointing to the existence of functional differences between the respiratory centre and the cough centre.