Expression of Ki-67 and p53 in meningiomas.

UNLABELLED: Meningiomas account for about 30% of all primary brain tumors. It is difficult to predict the behaviour of meningiomas, and identification of protein markers responsible for the regulation of cell proliferation can be very helpful. The aim of this study was to evaluate immunohistochemical expression of Ki-67 and p53 in 170 meningiomas.A total number of 170 meningioma samples were classified according to WHO, immunohistochemically stained for Ki-67 and p53 and analysed using light microscope. Of 170 meningiomas analysed, 142 were grade I, 17 grade II and 11 grade III. Female to male ratio was 1.42:1. Statistically significant correlation was found between tumor grade and Ki-67 (p<0.001). There was significant correlation between Ki-67 levels and tumor subtypes (p=0.009). The optimal cut-off value for Ki-67 was 3.195. Tumors with Ki-67 ≤3.195 were 2 cm smaller than tumors with Ki-67 >3.195. Statistically significant correlation was found regarding p53 expression and tumor size (p=0.034). No correlation was established between Ki-67 or p53 and location of the tumor.According to positive correlation between tumor grade and subtype with Ki-67 levels, as well as positive correlation between Ki-67 and p53 with tumor size, indicate that Ki-67 and p53 might have influence on meningioma development and progression. KEYWORDS: meningioma, Ki-67, p53, immunohistochemistry.

Nano-HPLC-MS analysis of phospholipids in cerebrospinal fluid of Alzheimer's disease patients--a pilot study.

There is emerging evidence that lipids play an important role in many neurodegenerative processes, for example in Alzheimer's disease (AD). Although different lipid alterations in the AD brain have been reported, there have only been very few investigations of lipid changes in the cerebrospinal fluid (CSF). Recent developments in mass spectrometry (MS) have enabled fast and sensitive detection of lipid species in different biological matrixes. In this study we developed an on-line HPLC-MS method for phospholipid profiling in the CSF based on nano-HPLC separation using an Amide column and detection with electrospray (ESI) quadrupole-time of flight (QTOF) MS. We achieved good separation, reproducibility, and sensitivity in monitoring of the major phospholipid classes, phosphatidylethanolamine (PE), phosphatidylcholine (PC), phosphatidylinositol (PI), and sphingomyelin (SM) in CSF. To emphasize the applicability of the method, a pilot study was performed on a group of CSF samples (N = 16) from individuals with probable AD and non-demented controls. We observed a statistically significant increase of SM levels (24.3 ± 2.4%) in CSF from probable AD individuals vs. controls. Our findings indicate that SM levels in the CSF could potentially provide a new lead in AD biomarker research, and show the potential of the method for disease-associated CSF phospholipid screening.

Role of haematological testing: ratio values of circulating platelet aggregates in visual field loss associated with pseudoexfoliation glaucoma.

The aim of the work is to examine the role of circulating platelet aggregates (CPAs) in association with pseudoexfoliation glaucoma (PXG) and searching for visual field (VF) progression. The impact of CPAs in association with PXG and ischaemic events related to optic nerve damage and VF progression has not been so far sufficiently explained. The examination included 80 patients, of whom 35 (44 %) were men with average age of 68.3 +/- 7.0 and 45 (56 %) were women with average age of 65.7 +/- 7.0 (t = 1.66; p = 0.101). Forty of them suffered from primary open-angle glaucoma (POAG) and were included into a control (healthy) group, and 40 patients suffered from pseudoexfoliative glaucoma (PXG) and were included into the experimental group. All the examinees underwent complete ophthalmologic examination of visual acuity, ocular fundus, intraocular pressure and anterior eye segment by biomicroscopy and gonioscopy. In addition, VF examination was performed three times in six-month intervals. Laboratory testing of CPA proportion values was performed by means of Wu an Hoak method. The obtained decreased values of CPA proportion were caused by hypercoagulability of blood in PXG group resulting finally in ischaemia and hypoxia helping the progression of visual field. In conclusion, our study shows that CPA examination improves the assessment of the vascular role and PXG prognosis (Tab. 3, Ref. 30).

Gait apraxia.

Gait apraxia is most commonly a part of the Hakimov triad (gait apraxia, urinary incontinence, dementia) in normotensive hydrocephalus (NPH), although it may be a symptom of some other conditions. In our case the patient was a long term Parkinson's disease sufferer who developed normotensive hydrocephalus and consequently gait apraxia. Only after a third successive evacuation of the CSF his gait apraxia improved (Fig. 1, Ref. 15). Full Text (Free, PDF) www.bmj.sk.

Clinical manifestations of neurosarcoidosis.

Sarcoidosis is a chronic disease of unknown aetiology. Neurosarcoidosis is registered in 5% of patients with sarcoidosis. Clinical manifestations of sarcoidosis are numerous and diverse. Manifestation of Neurosarcoidosis includes partial- and grand-mal seizures, low-grade fever, headache, increased intracranial pressure, visual disturbances, diabetes insipidus, amenorrhea- galacterorrhea syndrome and pituitary failure, hypogonadotropic hypogonadism, hyperprolactinemia, unilateral and bilateral facial palsy, infiltration of meninges (aseptic meningitis) and nerve roots, leptominingitis, pachymeningitis with cranial neuropathies, pseudotumor, mild cognitive disorder, psychosis, delirium, dementia, disorientation, amnesia, progressive visual deterioration and proptosis, axonal polyneuropathies, mononeuropathies, chronic polyradiculoneuritis, peripheral neuropathy, cranial nerve abnormalities, radiculopathies, peripheral neuropathy, mononeuritis multiplex, progressive numbness and deep sensation disturbance in bilateral lower extremities, hemiplegia, hyperreflexia with pathological reflexes and hypesthesia, upward gaze palsy, spinal cord compression, dysarthria, dysphagia, weakness, episodes of blurred vision, diplopia, intracerebral hemorrhage, neuro-ophthalmic manifestations, intranuclear ophthalmoplegia, dysorientation, vasculitis presenting with strokes, intracranial hypothalamic lesion, paresthesis, hemiparesis, myelopathy in the cervico-thoracic region, lumbar pain, sensory level and inability of lateral gaze (Tab. 2, Ref. 60).

Why Croatian patients increasingly opt for treatment in private medical clinics?

The professional conduct of medical professionals should be a guarantee to the citizens of Croatia that, if they become patients, their medical institutions, regardless of whether they are private or state-owned, will provide them with a good-quality and timely medical care. Efficient organization of medical care depends on the entire medical community, and patient's satisfaction is a result of its members' interaction. Unacceptably long waiting lists, preoccupied primary care doctors, insufficient quantities of drugs and financial resources make the functioning of public medical institutions difficult. The objective of this article is to assess the reasons why patients opt for treatments in privately owned medical centers. The survey has been conducted in February 2008 on 200 patients of one privately owned health institution in Zagreb. The questionnaire consisting of 13 questions, compared different aspects of treatment in private and public health care institutions. Answers pointed out that three most frequent difficulties the patients meet while being treated in public institutions are long waiting lists for examination or surgery, too long waiting times in outpatient clinics, and indifference of the medical staff. The average grade of satisfaction with treatment is 4.57 in public institutions and 8.89 in private institutions (Tab. 8, Ref. 14).

Anterior ischemic optic neuropathy comorbid with Factor V Leiden and PAI-1 4G/5G mutation.

Acute anterior ischemic optic neuropathy (AION) is a disabling disease which impairs visual functions. AION is characterized by ischemic injury of the optic nerve caused by hypoperfusion in the short posterior ciliary arteries supplying the optic nerve head. AION is a complex multi-factorial disease and is difficult to diagnose based on clinical symptoms and signs alone. We describe the case of a 54-year-old patient affected by AION, with only known risk factors were PAI-1 4G/5G and Factor V Leiden mutation with hyperlipidaemia (Ref. 36). Full Text (Free, PDF) www.bmj.sk.

Amaurosis fugax caused by hereditary thrombophilia due to mutation of gene.

We are presenting a 59-year-old woman and 37-year-old man with amaurosis fugax. They underwent a comprehensive ophthalmological and neurological examination. Standard diagnostic examination revealed no possible cause of this temporary condition, therefore additional genetic analysis for possible hereditary thrombophilia was performed. Examination established hereditary thrombophilia: the heterozygotic type gene for MTHFR (C677), deletion/insertion polymorphism for PAI-1 (4G/5G) in women and deletion/insertion polymorphism 4G/5G for PAI-1 and heterozygotic genotype DD (190 bp) for angiotensin converting enzyme (ACE) in man. In our patients, amaurosis fugax is probably caused by hereditary thrombophilia (Ref. 16). Full Text (Free, PDF) www.bmj.sk.

Predictive value of assessment of disc-radicular conflict of the cervical segment by somatosensory evoked potentials.

Somatosensory evoked potentials (SSEP) of the n. medianus, with clinically significant neurological findings helps in diagnosing a number of different cervical spine lesions. SSEP of the n. medianus and neurological observations also aid in diagnosticis of the disc-radicular conflict. A final diagnosis is set by the computerised tomography (CT). The tested positive predictive value of assessment of disc-radicular conflict of the cervical spine by means of SSEP is 87%. The 95% confidence interval (CI) is 0.87 (0.81-0.93) (Tab. 3, Fig. 4, Ref. 23). Full Text (Free, PDF) www.bmj.sk.

Comorbidity psychiatric disorders in epilepsy: a review of literature.

While reviewing the available literature, we noticed comorbidity of epilepsy and psychiatric disorders. Psychiatric disorders were observed more frequently in patients with high seizure frequency. There is significant prevalence of epilepsy comorbidity with depression, anxiety disorders, and to a lesser extent with bipolar disorders and other forms of psychosis. Suicidal risk factors, ideation and attempts in these patients as correlates of depression or as psychopathological features were associated to epileptic disease. This is confirmed by additional burden of epilepsy patients with psychic disorders (Ref. 70). Full Text (Free, PDF) www.bmj.sk.

Lamotrigine in the treatment of pain syndromes and neuropathic pain.

Anti-epileptic drugs are increasingly used in the treatment of pain syndromes and neuropathic pain. Sodium channel blockers can be effective in the treatment of pain. The object of our interest is the efficiency of lamotrigine in treating the pain. A MEDLINE search was conducted to identify pertinent studies, case reports, letters, and reviews in English published from 1986 to May 2007. The search has indicated efficiency in treating a number of painful syndromes and neuropathic pain; central pain, trigeminal neuralgia and trigeminal neuralgia in multiple sclerosis, pain in multiple sclerosis, SUNCT syndrome, cluster headache, glossopharyngeal neuralgia, neuropathic pain, allodynia, neuralgia after nerve section, postherpetic neuralgia, HIV-associated neuropathy. Further researches are required on the role of lamotrigine in treating the spinal cord injury pain, neuralgia after nerve section, postoperative analgesic requirement, and in migraine (Tab. 1, Ref. 46). Full Text (Free, PDF) www.bmj.sk.

Spondylodiscitis.

Spondylodiscitis is the most common complication of sepsis or local infection, usually of an abscess. Very often it develops in patients immunocompromised by a malignant disease, infection, or during immunosupression for organ transplantations etc. Presently, the basic diagnostic examinations to establish spondylodiscitis are the magnetic resonance (MRI) and biopsy, with microbiological tests. Lately, infection causes are increasingly proven by PCR method. In this paper we describe the causes of spondylodiscitis by reviewing the existing literature. The main causative organisms are staphylococci and Mycobacterium tuberculosis. The causes of spondylodiscitis are assigned to a large number of bacteria, fungi, zoonoses, which is to be taken into consideration in diagnostic treatment of patients (Ref. 51). Full Text (Free, PDF) www.bmj.sk.

Vertigo associated with Chiari I malformation and syringomyelia.

We report a rare case of a patient with late onset of Chiari I malformation with associated syringomyelia that was successfully treated with foramen magnum decompression. Our patient is presenting initially with vertigo and gradual weakening of the left-hand gross motor ability, gradual hypesthesia. Magnetic resonance imaging demonstrated a Chiari I malformation with syringomyelia. Posterior fossa decompression, C1 laminectomy and duroplasty were performed. After surgery, the vertigo completely resolved (Fig. 2, Ref. 13). Full Text (Free, PDF) www.bmj.sk.

Side effects of ropinirole in patients with idiopathic Parkinson's disease.

OBJECTIVE: Results achieved in treating the Parkinson's disease (PD) by the dopamine receptor agonist, ropinirole, have been hampered by its side effects. According to the MEDLINE, the most common side effects of ropinirole are extreme sleepiness and/or sudden sleep attacks, nausea, dyspepsia, vertigo, orthostatic hypotension and leg oedema. METHODS: The prospective research included PD patients who were administered non-ergoline dopamine agonist, ropinirole, over this period of time. The control group of patients were treated with levodopa. RESULTS: The research included 50 patients: 31 women and 19 men, of the mean age of 61.4 +/- 4.3 years. One patient reported sleepiness and one of them sudden sleep attacks. Nausea was experienced by three patients, and vertigo by two. Depression, orthostatic hypotension, leg oedema, dyspepsia, dry cough and hypersalivation were registered in particular cases. The control group of PD patients, treated with levodopa, comprised 52 patients, 33 women and 19 men of the mean age of 63.2 +/- 4.1 years. In the control group, nausea was registered in two patients. CONCLUSIONS: The non-ergoline dopamine agonist, ropinirole, most commonly causes nausea and sleepiness, less commonly uncontrollable sleep attacks, vertigo, dyspepsia, orthostatic hypotension, leg oedema. Dry cough and hypersalivation are recorded sporadically (Tab. 1, Ref. 22).

Auditory evoked potentials (AEP)--an important help in early diagnosis of Schwannoma originating from vestibular nerve.

Early diagnosis of expansive formations enables efficient therapy and maximal reduction of remaining neurological damage. Schwannoma situated entirely within the inner auditory canal with free pontocerebellar angle is a rather rare event. Of significant diagnostical help are auditory evoked potentials (AEP), computerised tomography (CT) of the temporal bone pyramid with measuring the inner auditory canal diameter, and magnetic resonance (MRI). In this paper we present a case of a 56-year-old woman with gradually advancing noise in the right ear, weakening of hearing and occasional instability while walking. AEP register no evoked response at the right side, whereas at the left side the latencies and amplitudes of evoked acoustic responses are adequate. CT of the temporal bone pyramid shows a difference in the inner auditory canal diameters of 0.04 cm. MRI shows a Schwannoma tumorous formation in the inner auditory canal, situated entirely within the canal with free pontocerebellar angle (Fig. 3, Ref. 16). Full Text (Free, PDF) www.bmj.sk.

Cognitive impairment and epilepsy seizure caused by hypoparathyroidism.

We report a 46-years-old man with idiopathic hypoparathyroidism who presented with gradually cognitive impairment and generalized tonic clonic epilepsy. Computed tomography (CT) and magnetic resonance imaging (MRI) of brain showed calcification in the basal ganglia, thalamus and cerebral white matter. Calcium level was low and phosphor was increased in serum, but parathormon level was low. Following introduction of replacement therapy, cognitive functions improved as well. After treatment with calcium and vitamin D supplementation he showed clinical, cognitive impariment and laboratory improvements (Fig. 2, Ref. 13).

Pediatric polytrauma at intensive care unit.

BACKGROUND: Polytrauma and its consequences present a rising diagnostic and therapeutic problem we face at ICU every day. The goal of this research was to analyze and improve the diagnostic and treatment procedures. PATIENTS AND METHODS: A prospective research carried out at the multidisciplinary Intensive Care Unit during a period of over 2 years included 126 patients aged less than 15 years. Immediately on admission, all patients received the necessary care strictly complying with polytrauma treatment algorithms. We recorded the patients basic data (age, sex), cause of injury (fall, traffic accidents etc.) and injury type (blunt or penetrating) as well as the immediately performed procedures. The analysis of patients and calculation of mortality rates was based on time that had elapsed from injury to arrival at ICU, and severity of their injuries assessed as ISS score. Injury severity was assessed on admission also by using GCS, PTS, NISS and TRISS. Performed surgical interventions, mechanical ventilation duration, and total ICU time were recorded, as well as the need for transfer to a pediatric trauma centre. RESULTS: 96 patients arrived within 2 hrs from injury, with ISS>15, and/or PTS<8. 52 patients arrived within "golden hour"; 37 of them had ISS 16-26 and 15 had ISS>26 with mortality rate 3 (8%) vs 3 (20%) (p<0.001). Of the remaining 44 patients, 30 had ISS 16-26 and 14 had ISS>26, with mortality rate 7 (23.3%) vs. 5 (35.7%) (p<0.001). CONCLUSION: The arrival at ICU during "golden hour", precise algorithms, high quality of diagnosis, monitoring and therapeutic procedures had an essential influence on the positive end-outcome and improved the survival and recovery rates in polytraumatized children (Tab. 4, Fig. 1, Ref. 18). Full Text (Free, PDF) www.bmj.sk.

An acute headache and hydrocephalus caused by the dermoid cyst.

We present a case report of a 41-year-old man with an acute headache and hydrocephalus caused by the dermoid cyst. The dermoid cyst of the third brain ventricle caused an acute hydrocephalus and an increased intracranial pressure (with neurological signs such as nausea, vomiting, oedema papilae n. optici) and, consequently, an acute intensive headache. Computed tomography scans demonstrated a mass in the third ventricle extending into the prepontine cistern, whereas any initially established cerebrospinal fluid ventriculoperitoneal shunt required further revision (Fig. 2, Ref. 12). Full Text (Free, PDF) www.bmj.sk.

Clinical manifestations of vertebrobasilar dolichoectasia.

Vertebrobasilar dolichoectasia is defined as an increase in the length and diameter of the intracranial arteries. Clinical manifestations of dolichoectasiae result from compression of the cranial nerves and structures of the brain stem, turbulent flow causing tinnitus and vertigo, often with damages of small blood vessels of the brain. Dolichoectasia is an ishemic stroke risk factor. The role of dolichoectasia in occurrence of haemorrhagic stroke, aneurysm and arterial dissection and thrombosis is still not fully understood (Ref. 34).

Recombinant activated factor VII in refractory gastrointestinal haemorrhage of unknown aetiology.

We report a 27-year-old patient who suffered severe gastrointestinal (GI) bleeding of unknown aetiology after undergoing elective abdominal surgery to remove a colonic tumour. Although the immediate postoperative recovery period was uneventful, rectal bleeding and signs of haemorrhagic shock developed within 10 hours of surgery. Nasogastric aspiration and laparotomy failed to reveal the cause of the GI haemorrhage, and the patient remained unresponsive to conventional haemostatic therapy. Treatment with a single dose of recombinant activated factor VII (rFVIIa) 45 microg/kg led to reduced bleeding, improvements in haemodynamic status, and reduced transfusion requirements. Although further investigation is warranted, our findings suggest that rFVIla may be useful in the rescue treatment of severe GI haemorrhage of unknown origin (Tab. 1, Ref. 17).