Multitask fMRI and machine learning approach improve prediction of differential brain activity pattern in patients with insomnia disorder.

We investigated the differential spatial covariance pattern of blood oxygen level-dependent (BOLD) responses to single-task and multitask functional magnetic resonance imaging (fMRI) between patients with psychophysiological insomnia (PI) and healthy controls (HCs), and evaluated features generated by principal component analysis (PCA) for discrimination of PI from HC, compared to features generated from BOLD responses to single-task fMRI using machine learning methods. In 19 patients with PI and 21 HCs, the mean beta value for each region of interest (ROIbval) was calculated with three contrast images (i.e., sleep-related picture, sleep-related sound, and Stroop stimuli). We performed discrimination analysis and compared with features generated from BOLD responses to single-task fMRI. We applied support vector machine analysis with a least absolute shrinkage and selection operator to evaluate five performance metrics: accuracy, recall, precision, specificity, and F2. Principal component features showed the best classification performance in all aspects of metrics compared to BOLD response to single-task fMRI. Bilateral inferior frontal gyrus (orbital), right calcarine cortex, right lingual gyrus, left inferior occipital gyrus, and left inferior temporal gyrus were identified as the most salient areas by feature selection. Our approach showed better performance in discriminating patients with PI from HCs, compared to single-task fMRI.

Stroke mimics: Clinical characteristics and outcome.

OBJECTIVE: To study the prevalence and nature of stroke mimics (SM) among Saudi patients who came to the emergency department with a sudden neurological deficit and suspected stroke. METHODS: The electronic health records from February 2016 to July 2018 of patients who were admitted to the Stroke Unit at King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia (KAMC-RD) with a suspected stroke were all reviewed. A comparison between SM and stroke was established. Our study identified the predictors of SM by using logistic regression analysis. This study was approved by the local institutional review board. RESULTS: Out of 1,063 patients, 131 (12.3%) had SM. The most common causes were a peripheral vestibular disorder (27.4%) followed by psychogenic causes (24.4%). Stroke mimics were more common among younger individuals and women. Arterial hypertension, diabetes, and smoking were less likely to be found in SMs. At discharge, individuals with SM were more likely to be independent, had milder deficits, and shorter hospital stays. Predictors of SM were young age, female gender, mild deficit at presentation, and good functional status before the stroke. CONCLUSION: The incidence of stroke mimics is common among suspected stroke patients. Practicing physicians should consider potential diagnostic errors, particularly in the hyperacute phase of the stroke.

Structural brain abnormalities in patients with psychogenic nonepileptic seizures.

OBJECTIVES: We assessed the relationship between the clinical features of patients with psychogenic nonepileptic seizures (PNES) and referrals for brain imaging tests. We also hypothesized that some clinical factors might be associated with structural brain imaging abnormalities in these patients. METHODS: In this retrospective study, patients with PNES, who were investigated at Shiraz Comprehensive Epilepsy Center, Iran, from 2008 until 2019, were studied. RESULTS: One hundred thirty-two patients had a brain magnetic resonance imaging (MRI) study available. Forty-seven patients (36%) had abnormal finding(s) in their MRI. Age (odds ratio = 1.040, p = 0.02), and comorbid epilepsy (odds ratio = 3.006, p = 0.005) were significantly associated with having an abnormal brain MRI. In a subanalysis, we excluded the patients with comorbid epilepsy (46 patients). From the remaining 86 patients (with PNES only), 23 patients (26.7%) had abnormal findings on their MRIs. Common epileptogenic structural brain abnormalities (e.g., tumors, mesial temporal sclerosis, encephalomalacia, and developmental anomalies) were common in patients with comorbid PNES and epilepsy (in 19 out of 46 patients; 41%), but not in those with PNES only (in 4 out of 86 patients; 5%) (p = 0.00001). CONCLUSION: While the evidence is convergent on the relatively high prevalence of structural brain abnormalities in patients with PNES, the data so far is suboptimal. In order to investigate the significance of structural brain abnormalities in the development of PNES, future well-designed multicenter studies, which include a large number of patients with a unified methodology of imaging, are desirable.

Reduced left amygdala volume in patients with dissociative seizures (psychogenic nonepileptic seizures).

PURPOSE: This study specifically investigated differences of amygdalar and hippocampal volumes between patients with dissociative seizures (DS), mesial temporal lobe sclerosis (MTS), and normal controls (NC). METHODS: Between 2003 and 2018, 127 patients diagnosed with DS and 278 with MTS were recruited. An additional 52 NC subjects were recruited between 2015 and 2018. We retrospectively selected 29 patients with DS (male:female, 6:23) with absence of structural confounding factors and obtained sex- and age-matched MTS and NC. We used Neuroreader to assess the volume of the amygdala and hippocampus as a percentage of total intracranial volume based on thin-slice (0.9-1.2 mm) T1-weighted images. Statistical analyses controlled for psychiatric comorbidity and logistic regression were used to evaluate efficacy of these values for individual-level diagnosis. RESULTS: The left amygdala and right hippocampus were significantly smaller in DS compared to NC (both p = 0.04), which was not explained by differences in psychiatric comorbidity. When controlling for ipsilateral hippocampal or amygdala volume, which was seen equally in all groups (Spearman, p < 0.02), these differences were no longer significant (amygdala, p = 0.16, hippocampus, p = 0.18), suggesting that amygdalar and hippocampal atrophy may reflect network or regional changes rather than focal abnormalities. The three-way accuracy for differentiating DS, MTS, and NC using these data was 64 % (95 % confidence interval: 54-74 %). CONCLUSION: Volumetric analysis demonstrates smaller left amygdalar and right hippocampal volumes in patients with DS compared to NC, which may mirror abnormalities in functional networks seen in conversion disorders and post-traumatic stress disorder.

Chemical intolerance: involvement of brain function and networks after exposure to extrinsic stimuli perceived as hazardous.

BACKGROUND: Chemical intolerance (CI) is a chronic condition characterized by recurring and severe symptoms triggered by exposure to low levels of odorous or pungent substances. The etiology of CI has been a controversial subject for a long time. The aim of this review is to summarize findings on the neurological processing of sensory information during and after exposure to low levels of odorous or pungent substances in individuals with CI, focusing on the brain function and networks. METHODS: Scientific studies on CI published between 2000 and 2019 in academic peer-reviewed journals were systematically searched using medical and scientific literature databases. Only peer-reviewed articles reporting original research from experimental human studies directly associated with CI, and involving related neurological responses or brain imaging after exposure to odorous or pungent substances (i.e., in chemical provocation tests), were considered. RESULTS: Forty-seven studies were found to be eligible for a full-text review. Twenty-three studies met the selection criteria and were included in this review. Evidence indicated that differences between subjects with CI and healthy controls were observed by brain imaging during and after exposure to odorous or pungent substances. Differences in brain imaging were also observed between initial exposure and after exposure to these substances. Neurological processing of sensory information after exposure to extrinsic stimuli in the limbic system and related cortices were altered in subjects with CI. A previous documentable exposure event was likely to be involved in this alteration. CONCLUSIONS: This review documents consistent evidence for the altered neurological processing of sensory information in individuals with CI. Further neurophysiological research exploring the processing of extrinsic stimuli and cognition of sensation through the limbic system and related cortices in CI, and the appearance of symptoms in individuals with CI, are required.

Memory and motor control in patients with psychogenic nonepileptic seizures.

Psychogenic nonepileptic seizures (PNES) are of the most elusive phenomena in epileptology. Patients with PNES present episodes resembling epileptic seizures in their semiology yet lacking the underlying epileptic brain activity. These episodes are assumed to be related to psychological distress from past trauma, yet the underlying mechanism of this manifestation is still unknown. Using resting-state functional magnetic resonance imaging (fMRI), we investigated functional connectivity changes within and between large-scale brain networks in 9 patients with PNES, compared with a group of 13 age- and gender-matched healthy controls. Functional magnetic resonance imaging analyses identified functional connectivity disturbances between the medial temporal lobe (MTL) and the sensorimotor cortex and between the MTL and ventral attention networks in patients with PNES. Within network connectivity reduction was found within the visual network. Our findings suggest that PNES relate to changes in connectivity in between areas that are involved in memory processing and motor activity and attention control. These results may shed new light on the way by which traumatic memories may relate to PNES.

The application of artificial intelligence to understand the pathophysiological basis of psychogenic nonepileptic seizures.

Psychogenic nonepileptic seizures (PNES) are episodes of paroxysmal impairment associated with a range of motor, sensory, and mental manifestations, which perfectly mimic epileptic seizures. Several patterns of neural abnormalities have been described without identifying a definite neurobiological substrate. In this multicenter cross-sectional study, we applied a multivariate classification algorithm on morphological brain imaging metrics to extract reliable biomarkers useful to distinguish patients from controls at an individual level. Twenty-three patients with PNES and 21 demographically matched healthy controls (HC) underwent an extensive neuropsychiatric/neuropsychological and neuroimaging assessment. One hundred and fifty morphological brain metrics were used for training a random forest (RF) machine-learning (ML) algorithm. A typical complex psychopathological construct was observed in PNES. Similarly, univariate neuroimaging analysis revealed widespread neuroanatomical changes affecting patients with PNES. Machine-learning approach, after feature selection, was able to perform an individual classification of PNES from controls with a mean accuracy of 74.5%, revealing that brain regions influencing classification accuracy were mainly localized within the limbic (posterior cingulate and insula) and motor inhibition systems (the right inferior frontal cortex (IFC)). This study provides Class II evidence that the considerable clinical and neurobiological heterogeneity observed in individuals with PNES might be overcome by ML algorithms trained on surface-based magnetic resonance imaging (MRI) data.

Utilization of brain imaging in evaluating patients with psychogenic nonepileptic spells.

BACKGROUND: Psychogenic nonepileptic spells (PNES) are paroxysmal movements or sensory events that resemble epileptic seizures but lack corresponding ictal electrographic changes. A confirmed diagnosis of PNES is only accomplished via video electroencephalogram (vEEG) monitoring. Prior to diagnosis, patients are often assessed with neurodiagnostic imaging and their conditions treated with anticonvulsant medications, both of which are of limited clinical value and contribute to the higher cost of care. In this study, we assessed the relationship between the semiological features of PNES, medication regimen, or psychiatric comorbidities and the frequency of referrals for brain imaging tests prior to diagnosis of PNES. METHODS: This is a retrospective chart review of 224 adult patients diagnosed as having PNES at a level 4 epilepsy care center from 2012 to 2017. Patients with coexisting epilepsy were excluded. The 882 segments of vEEG records were reviewed for semiology of spells, and patients were categorized into one of seven distinct phenotypic classes according to the accepted clinical classification. The frequency of neurodiagnostic tests completed for each patient prior to vEEG was correlated with PNES phenotype and other clinical characteristics. RESULTS: There were 68 (30%) males and 156 (70%) females diagnosed as having PNES with a median age of 36 years. Seventy-four percent of patients were receiving one or several anticonvulsant medications, and 67% of patients were treated with psychotropic medications other than benzodiazepines. The most prevalent PNES events were characterized by semirhythmic small amplitude movements in the extremities (class 2; 34%) followed by those resembling tonic-clonic seizures (class 4; 28%). Neurodiagnostic imaging tests including computed tomography (CT) and magnetic resonance imaging (MRI) of the brain were performed at least once in 60% of patients and 4 times or more in 11% prior to vEEG. There was a significant association between the frequency of neurodiagnostic tests and the PNES phenotype (p = 0.02). Specifically, patients with sensory changes (class 6) had more imaging tests than those with primitive gesturing and truncal posturing (classes 1 and 5, respectively). Additionally, patients diagnosed with 3 or more psychiatric disorders underwent significantly more neurodiagnostic tests relative to patients diagnosed with two or fewer psychiatric disorders (p = 0.03). Furthermore, patients whose conditions were treated with anticonvulsant medications tended to undergo more imaging scans prior to vEEG as compared with the patients whose conditions were not being treated with anticonvulsants. CONCLUSIONS: These findings suggest that the frequency of brain imaging obtained prior to the definitive diagnosis of PNES is influenced by semiology of spells and the psychiatric health of patients. Patients who demonstrate minimal paroxysmal movements in the settings of multiple psychiatric comorbidities represent a particularly challenging patient phenotype which is linked to more frequent referrals for brain imaging. These patients should be promptly referred for vEEG to improve diagnostic accuracy and prevent treatment with anticonvulsants as well as referrals for serial neurodiagnostic tests.

Cingulo-insular structural alterations associated with psychogenic symptoms, childhood abuse and PTSD in functional neurological disorders.

OBJECTIVE: Adverse early-life events are predisposing factors for functional neurological disorder (FND) and post-traumatic stress disorder (PTSD). Cingulo-insular regions are implicated in the biology of both conditions and are sites of stress-mediated neuroplasticity. We hypothesised that functional neurological symptoms and the magnitude of childhood abuse would be associated with overlapping anterior cingulate cortex (ACC) and insular volumetric reductions, and that FND and PTSD symptoms would map onto distinct cingulo-insular areas. METHODS: This within-group voxel-based morphometry study probes volumetric associations with self-report measures of functional neurological symptoms, adverse life events and PTSD symptoms in 23 mixed-gender FND patients. Separate secondary analyses were also performed in the subset of 18 women with FND to account for gender-specific effects. RESULTS: Across the entire cohort, there were no statistically significant volumetric associations with self-report measures of functional neurological symptom severity or childhood abuse. In women with FND, however, parallel inverse associations were observed between left anterior insular volume and functional neurological symptoms as measured by the Patient Health Questionnaire-15 and the Screening for Somatoform Symptoms Conversion Disorder subscale. Similar inverse relationships were also appreciated between childhood abuse burden and left anterior insular volume. Across all subjects, PTSD symptom severity was inversely associated with dorsal ACC volume, and the magnitude of lifetime adverse events was inversely associated with left hippocampal volume. CONCLUSIONS: This study reveals distinct cingulo-insular alterations for FND and PTSD symptoms and may advance our understanding of FND. Potential biological convergence between stress-related neuroplasticity, functional neurological symptoms and reduced insular volume was identified.

How far to investigate presumed psychosomatic symptoms: Lessons from a particular case .

We describe a 43-year-old patient with subacute appearance of neurological and atypical complaints of anergia, anorexia and weight loss six months earlier. In spite of several admissions in different hospitals, no underlying somatic cause could be found and he was admitted to a psychiatric hospital with a tentative diagnosis of major depressive disorder. Subsequently, he was referred to the unit of medically unexplained physical symptoms within the department of general internal medicine for assessment by the psychiatrist, involved in this programme. Based on clinical suspicion and red flag symptoms such as involuntary weight loss, a broader internal medicine reassessment, including FDG whole-body PET-CT was requested. Neurological clinical exam showed minor deviations, but neither brain imaging nor a lumbar puncture were contributory. However, FDG PET-CT revealed abnormal moderately to intensely FDG positive lymph nodes in the retroperitoneum. Laparoscopic lymph node biopsy indicated germ cell tumour metastasis. Anti-NMDA antibody positivity allowed a diagnosis of paraneoplastic anti-NMDA encephalitis. Treatment of the underlying disease, a pure seminoma stadium II, consisting of orchidectomy and chemotherapy, resulted in a spectacular regression of 'psychosomatic' symptoms with long-term ability to return to work, and documented disappearance of the anti-NMDA antibody response.

Early childhood trauma and hippocampal volumes in patients with epileptic and psychogenic seizures.

OBJECTIVE: Exposure to early life childhood trauma has been implicated as resulting in a vulnerability to epileptic and psychogenic nonepileptic seizures (PNES), hippocampal atrophy, and psychiatric disorders. This study aimed to explore the relationships between childhood trauma, epilepsy, PNES, and hippocampal volume in patients admitted to a video-electroencephalogram monitoring (VEM) unit. METHODS: One hundred thirty-one patients were recruited from the Royal Melbourne Hospital VEM unit. The diagnostic breakdown of this group was: temporal lobe epilepsy (TLE) (32), other epilepsy syndromes (35), PNES (47), other nonepileptic syndromes (5), both epilepsy and PNES (6), and uncertain diagnosis (6). All patients completed a questionnaire assessing exposure to childhood trauma, the Childhood Trauma Questionnaire (CTQ), as well as questionnaires assessing psychiatric symptomatology (SCL-90-R), Anxiety and Depression (HADS), quality of life (QOLIE-98) and cognition (NUCOG). Volumetric coronal T1 MRI scans were available for 84 patients. Hippocampal volumes were manually traced by a blinded operator. RESULTS: The prevalence of childhood trauma in patients with PNES was higher than in patients with other diagnoses (p=0.005), and the group with PNES overall scored significantly higher on the CTQ (p=0.002). No association was found between CTQ scores and hippocampal volumes; however, patients with a history of sexual abuse were found to have smaller left hippocampal volumes than patients who had not (p=0.043). Patients reporting having experienced childhood trauma scored lower on measures of quality of life and higher on measures of psychiatric symptomatology. SIGNIFICANCE: Patients with PNES report having experienced significantly more childhood trauma than those with epileptic seizures, and in both groups there was a relationship between a history of having experienced sexual abuse and reduced left hippocampal volume. Patients with PNES and those with epilepsy who have a history of childhood trauma have overall worse quality of life and more psychiatric symptomatology.

Post-epilepsy surgery psychogenic nonepileptic seizures.

OBJECTIVES: We investigated the prevalence of post-epilepsy surgery psychogenic nonepileptic seizures (PNES) in patients with drug-resistant epilepsy and the possible influence of risk factors on these seizures. METHODS: In this retrospective study, we examined data from all patients with a clinical diagnosis of drug-resistant epilepsy who underwent epilepsy surgery at Graduate Hospital and the Jefferson Comprehensive Epilepsy Center between 1986 and 2016. Postsurgical outcome was identified for up to 15 years after surgery. Diagnosis of PNES was verified in the epilepsy monitoring unit with video-electroencephalography (EEG) ictal recording. Potential associated factors were assessed by comparing patients with or without postoperative PNES. RESULTS: A total of 1,105 patients were studied; 697 patients had postoperative seizures, and, of these, 27 patients (3.9%) had documented PNES after surgery. A full-scale intelligence quotient (IQ) <80 was significantly associated with post-epilepsy surgery PNES (odds ratio [OR] 2.89, p = 0.007, 95% confidence interval [CI] 1.33-6.29). A history of a preoperative psychiatric diagnosis was also significantly associated with post-epilepsy surgery PNES (OR 4.67, p = 0.0001, 95% CI 2.01-10.82). Other factors were not significantly associated with post-epilepsy surgery PNES. SIGNIFICANCE: Post-epilepsy surgery PNES should be considered when patients report recurrent seizures after epilepsy surgery. Although these seizures probably occur relatively infrequently, attention to factors such as appearance of new ictal behaviors, a preoperative history of a psychiatric disorder, and a low full-scale IQ should raise suspicion and lead to appropriate diagnostic measures.

Neuronal substrate and effective connectivity of abnormal movement sequencing in schizophrenia.

Movement sequencing difficulties are part of the neurological soft signs (NSS), they have high clinical value because they are not always present in schizophrenia. We investigated the neuronal correlates of movement sequencing in 24 healthy controls and 24 schizophrenia patients, with (SZP SQ+) or without (SZP SQ-) sequencing difficulties. We characterized simultaneous and lagged functional connectivity between brain regions involved in movement sequencing using psychophysiological interaction (PPI) and the Granger causality modeling (GCM), respectively. Left premotor cortex (PMC) and superior parietal lobule (SPL) were specifically activated during sequential movements in all participants. Right PMC and precuneus, ipsilateral to the hand executing the task, activated during sequential movements only in healthy controls and SZP SQ-. SZP SQ+ showed hyperactivation in contralateral PMC, as compared to the other groups. PPI analysis revealed a deficit in inhibitory connections within this fronto-parietal network in SZP SQ+ during sequential task. GCM showed a significant lagged effective connectivity from right PMC to left SPL during task and rest periods in all groups and from right PMC to right precuneus in SZP SQ+ group only. Both SZP groups had a significant lagged connectivity from right to left PMC, during sequential task. Our results indicate that aberrant fronto-parietal network connectivity with cortical inhibition deficit and abnormal reliance on previous network activity are related to movement sequencing in SZP. The overactivation of motor cortex seems to be a good compensating strategy, the hyperactivation of parietal cortex is linked to motor deficit symptoms.

SPECT perfusion patterns distinguish psychogenic from essential tremor.

BACKGROUND: Psychogenic movement disorders pose formidable challenges to diagnosis and treatment reflecting our limited understanding of the basic brain mechanisms that cause them. Recently, functional brain imaging has been utilized to study psychogenic movement disorders. OBJECTIVES: To identify characteristic patterns of cerebral perfusion distinguishing psychogenic tremor (PT) from essential tremor (ET). METHODS: We studied five patients each with PT, ET and normal controls. SPECT imaging was performed at rest and during a tremor-inducing motor task. RESULTS: In ET, rest imaging revealed increased rCBF (relative cerebral blood flow) in cerebellar hemispheres and left inferior frontal gyrus. During the motor task, ET patients demonstrated increased rCBF in the supplementary motor area (SMA) and contralateral motor cortex and reduced rCBF in the cerebellum and visual cortex. In contrast, PT images at rest revealed increased rCBF in left inferior frontal gyrus and left insula. Motor task imaging revealed increased rCBF in the cerebellum and reduced rCBF in anterior regions of the default mode network. CONCLUSIONS: Our study revealed distinct patterns of cerebral perfusion during rest and motor task that distinguish PT from ET. Deactivation of the default mode network may serve as a marker for psychogenic movement disorders.

Utility of subtraction ictal SPECT when video-EEG fails to distinguish atypical psychogenic and epileptic seizures.

This study was designed to evaluate the utility of subtraction ictal SPECT coregistered to MRI (SISCOM) in atypical psychogenic nonepileptic seizures (PNES). Video-EEG monitoring (vEEG) is the gold standard for PNES diagnosis but, like any modality, has limitations. In difficult cases in which the diagnosis is suspected but remains in question after vEEG, a complementary study that could help differentiate epilepsy from PNES would be desirable. Thirteen SISCOM studies performed in patients with a final diagnosis of PNES were retrospectively reviewed. Common indications for SISCOM were semiology consistent with partial epilepsy (9/13), abnormal head MRI (5/13), and reported abnormal routine EEG (5/13). SISCOM was negative in 85% (11/13) of patients and was helpful in increasing the diagnostic certainty of PNES in these exceptional cases.

DAT imaging in drug-induced and psychogenic parkinsonism.

Parkinson's syndrome (PS) is frequently encountered in disorders associated with prominent degeneration of the nigrostriatal pathway as in Parkinson's disease, multisystem atrophy, and progressive supranuclear palsy (presynaptic PS). Drug-induced parkinsonism, a common, underdiagnosed health problem and psychogenic parkinsonism are causes of Parkinson's syndrome which, evidence suggests, occurs without degeneration of nigrostriatal structures. We review clinical features and results of DAT imaging in drug-induced parkinsonism and psychogenic parkinsonism. These two conditions normally give normal striatal DAT imaging results; an abnormal result in either case could exclude both conditions, corroborating a diagnosis of organic parkinsonism in uncertain cases.

Transient autobiographic amnesia: EEG and single-photon emission CT evidence of an organic etiology.

We describe a 44-year-old patient who had a transient attack of autobiographic amnesia. When assessed during the attack, her learning abilities were normal, with no sign of anterograde amnesia. In the remote memory domain, she showed a striking dissociation between a detailed knowledge of public events and famous people and a complete loss of autobiographic information. During the attack, EEG recorded bilateral frontotemporal slow waves and single-photon emission CT (SPECT) showed hypoperfusion in the right temporal and parietal lobes; no abnormalities were detected when both EEG and SPECT were repeated 1 week later. This case provides evidence for an organic etiology for the episode and supports the hypothesis that autobiographic memory is independent of other forms of retrograde memory.

[Vascular penile study with Doppler ultrasonography in subjects without vascular disease]. / Estudio vascular peneano con eco-Doppler en sujetos sin patología vascular.

The Eco-Doppler technique allows a fast, non-invasive and effective study of pental vascularization. Ninety-three subjects, aged 20-66, with no vascular disease were studied: 20 healthy volunteers and 73 with psychogenic dysfunctions. All subjects underwent a baseline study, and 89 a second study after intracavitary injection (ICI) (10 papaverine and 79 PgE1). No differences were seen between both drugs. Flowmetry parameters were analyzed at rest and post-ICI. At baseline, patients with psychogenic dysfunctions showed less diastolic speed (p < 0.05), acceleration (p < 0.001) and resistance index (p < 0.05) than normal subjects. After administration of the drug, no differences were detected between both groups that formed an homogeneous sample. Subjects with no vascular disease presented arterial dilatation after ICI, the vessels appearing with thin and parallel walls, homogeneous lumen and following a straight course. Flow speed parameters experienced significant changes: systolic speed increase by 153 +/- 97% (p < 0.001) and reached 34.7 +/- 9.3 cm/s; increase of diastolic speed was lower; but flow time and acceleration also increases although not significantly due to their high variability. At 20 minutes after ICI the resistance index is 0.83 +/- 0.1, higher (p < 0.001) than that observed at rest, expressing the high intracavitary pressure that exists when full erection is achieved.

[Psychosomatic correlations in patients with hypertension and renal arterial hypertension]. / Psikhosomaticheskie sootnosheniia u bol'nykh gipertonicheskoi bolezn'iu i pochechnoi arterial'noi gipertoniei.

Psychosomatic status was investigated in 104 patients with essential hypertension (EH) and 111 patients with secondary arterial hypertension (AH) of renal origin in the presence of chronic pyelonephritis. A significant heterogeneity of psychological characteristics was established in patients with these two clinical forms of AH. In EH patients psychological deviations were detected since very early stages of the disease, but they did not become more profound with stabilisation of blood pressure. At the same time the progress of secondary AH was accompanied by obvious deterioration of initially little-changed psychological status, which correlated with the gravity of somatic status, in particular, with the severity of left ventricular hypertrophy.

Evaluation of penile deep arteries in psychogenic impotence by means of duplex ultrasonography.

Echo Doppler flowmetric investigation in patients with erectile insufficiency represents an effective method for hemodynamic evaluation of the penis. The detection of referential standard parameters is helpful to understand the pathogenesis of the disease, since patients with erectile insufficiency due to psychogenic factors cannot be distinguished from normal subjects by means of current diagnostic techniques. Echo Doppler flowmetry applied to rigorously selected subjects with psychogenic impotence allowed for detection of hemodynamic parameters in the penis after corpora cavernosa stimulation with 10 micrograms. prostaglandin E1. Flowmetric investigation was performed only on the deep cavernous artery, since it is well known that the penile dorsal artery does not undergo hemodynamic alterations after stimulation with drugs. A statistically meaningful difference existed between the systolic flow in the psychogenic impotence subjects (group 1) and the controls (group 2, p < 0.0001). In the same manner, the diastolic flows (right and left cavernous arteries, p < 0.0002 and p < 0.0001, respectively) and diameter increase rates of the investigated arteries following stimulation were also different. According to these results, echo Doppler flowmetry could represent the only instrumental method able to detect patients with psychogenic impotence.