The comparison of pre- and post-treatment (99m)Tc HMPAO brain SPECT images in patients with obsessive-compulsive disorder.

The objective of the present study was to compare brain activation in patients with obsessive-compulsive disorder (OCD) who received pharmacotherapy (selective serotonin reuptake inhibitor (SSRI) or a SSRI-risperidone combination) with that in healthy controls using (99m)Tc-hexamethyl propyleneamine oxime (HMPAO) brain single photon emission tomography (SPECT). Twelve OCD patients achieving clinical response (seven SSRI responders, five patients responded to SSRI plus risperidone) underwent post-treatment SPECT scan. The baseline regional cerebral blood flow (rCBF) was significantly reduced in a large part of the cerebral cortex and the left cingulate gyrus in OCD patients compared with controls. After a 50% reduction of the OCD symptoms, bilaterally increased rCBF in the thalamus showed a significant effect of time in both of the patient groups. In the remitted state, although rCBF in the cingulate gyrus did not differ in SSRI responders compared with controls, patients who responded to the combination of SSRI+ risperidone showed significant hypoperfusion in the left anterior cingulate gyrus. SSRI responders had normalized rCBF in the frontal region relative to the control group. Consequently, based on our results, we attribute the observed thalamic rCBF alteration to SSRI treatment. Our results also suggested that brain perfusion changes associated with clinical remission may differ across patient subgroups.

Does hypothyroidism affect gastrointestinal motility?

BACKGROUND: Gastrointestinal motility and serum thyroid hormone levels are closely related. Our aim was to analyze whether there is a disorder in esophagogastric motor functions as a result of hypothyroidism. MATERIALS AND METHODS: The study group included 30 females (mean age +/- SE 45.17 +/- 2.07 years) with primary hypothyroidism and 10 healthy females (mean age +/- SE 39.40 +/- 3.95 years). All cases underwent esophagogastric endoscopy and scintigraphy. For esophageal scintigraphy, dynamic imaging of esophagus motility protocol, and for gastric emptying scintigraphy, anterior static gastric images were acquired. RESULTS: The mean esophageal transit time (52.56 +/- 4.07 sec for patients; 24.30 +/- 5.88 sec for controls; P = .02) and gastric emptying time (49.06 +/- 4.29 min for the hypothyroid group; 30.4 +/- 4.74 min for the control group; P = .01) were markedly increased in cases of hypothyroidism. CONCLUSION: Hypothyroidism prominently reduces esophageal and gastric motor activity and can cause gastrointestinal dysfunction.

[The role of advanced cardiac imaging methods in coronary artery disease]. / Koroner arter hastaliginda ileri kardiyak görüntüleme yöntemlerinin rolü.

Evaluation of the myocardial perfusion and the structures of coronary arteries with the use of various high technologies, such as advanced echocardiography, magnetic resonance tomography, spiral computed tomography as well as large spectrum of techniques of nuclear cardiology, gains more and more important significance in the diagnosis and management of coronary artery disease. Detection of coronary atherosclerosis and evaluation of early signs of myocardial hypoperfusion provide to select effective treatment modality. Nuclear cardiac studies are being frequently used in this field. In asymptomatic and intermediate likelihood patients, assessment of myocardial perfusion by single photon emission computed tomography (SPET) or positron emission tomography (PET) appears to be valuable even when coronary arteries are normal. Different imaging protocols and radiopharmaceuticals allow us to evaluate ventricular functions and myocardial metabolic state besides of myocardial perfusion. In this plane, definite successes are being achieved by PET and combined acquisitions by PET/CT and SPET/CT hybrid systems. Coronary computed tomography angiography (CTA) and myocardial perfusion imaging provide complementary information on vascular structure and myocardial perfusion. However, CTA with fast 16-slice or greater scanners may emerge as the initial test of choice. Myocardial perfusion studies would then be used if the CTA is not available or to assess how a stenosis defined by CTA effects coronary supply. Spiral computed tomography which allows to reveal calcium depositions in blood vessels has an important role in the detection of the severity and extent of atherosclerotic lesions. The use of multislice computed tomography in perspective might partially replace coronary angiography especially for assessing the degree of stenosis and patency of grafts. Magnetic resonance imaging (MRI) also has provided noticeable success in this era. Cardiac MRI clearly has the potential for this application and has already emerged as a highly effective method for assessing ventricular function, myocardial mass and myocardial viability. There is an increasing use of this approach for clinical rest and stress perfusion measurements. While cardiac MRI angiography (CMRA) has great promise as a radiation-free, it currently lags behind CTA for noninvasive coronary angiography. Further perfection of equipment and methodological approaches with the use of novel contrasts is necessary. In patients with coronary artery disease, multimodality applications covering both morphological and functional assessment are helpful for diagnosing and planning of therapeutic strategy. Recent developments in the field of ultrasonography have allowed us objectively quantify global and regional ventricular function, and to get real-time evaluation of coronary walls and lesions. While we achieve more knowledge about atherosclerotic lesions by using intravascular ultrasound technique, tissue Doppler imaging has given us attempt to provide a more objective assessment of myocardial function. Finally, although CTA and CMRA are likely to grow considerably in diagnostic evaluation over the next several years, myocardial perfusion studies with SPET and PET equipment will continue to be very valuable techniques for this purpose.

Elevated homocysteine levels in patients with slow coronary flow: relationship with Helicobacter pylori infection.

BACKGROUND AND OBJECTIVE: Elevation of plasma homocysteine (Hcy) level has been implicated in the pathogenesis of slow coronary flow (SCF) as it can severely disturb vascular endothelial function. Helicobacter pylori chronically infect the human stomach and causes malabsorption of vitamin B(12) and folate in food, leading ultimately to an increase in circulating Hcy levels. METHODS: Forty-three patients with angiographically proven SCF (group I) were enrolled in this study; 43 cases with normal coronary flow pattern (group II) served as controls. Fasting plasma levels of Hcy, vitamin B(12), and folate were measured in all subjects. Presence of H. pylori infection was defined as positive 14 C urea breath test. Coronary flow patterns for each major epicardial coronary artery were determined with the Thrombolysis in Myocardial Infarction (TIMI) frame count method. RESULTS: Mean TIMI frame count was 46.3 +/- 8.7 in group I and 24.3 +/- 2.9 in Group II (p = .0001). Vitamin B(12) levels were similar, whereas folate levels were dramatically reduced in group I compared to group II (13.2 +/- 4.3 vs. 17.1 +/- 5.2, p = .0001). Plasma Hcy levels were significantly higher in group I compared to group II (13.4 +/- 5.6 vs. 7.9 +/- 2.5, p = .0001) as was the prevalence of H. pylori infection (90.7% in group I vs. 58.1% in group II, p = .001). Hcy levels were elevated (11.7 +/- 5.3 vs. 7.5 +/- 2.7, p = .0001) and folate levels were reduced (13.9 +/- 4.7 vs. 18.6 +/- 4.9, p = .0001) in patients with H. pylori infection, while vitamin B(12) levels were similar in patients with and without H. pylori infection. Correlation analysis revealed a significant negative correlation between plasma folate and Hcy levels and also between folate levels and mean TIMI frame counts (r = -.33, p = .002 vs. r = -.33, p = .003). Moreover, there was a significant positive correlation between plasma Hcy levels and mean TIMI frame counts (r = .66, p = .0001). In addition, the folate level was the only significant determinant of the variance of Hcy in multiple regression analysis (r = -.21, p = .03). CONCLUSION: Our data showed that plasma folate levels were decreased and plasma Hcy levels were increased in patients with SCF compared to controls. Also, the prevalence of H. pylori infection was increased in patients with SCF. These findings suggest that elevated levels of plasma Hcy, possibly caused by H. pylori infection, and/or a possible disturbance in its metabolism may play a role in the pathogenesis of SCF.