Band 7, Heft 1

The principle of symmetry-asymmetry is widely presented in the structural and functional organization of the nonliving and living nature. One of the most complex manifestations of this principle is the left-right asymmetry of the human brain. The present review summarizes previous and contemporary literary data regarding the role of brain asymmetry in neuroimmunomodulation. Some handedness-related peculiarities are outlined additionally. Brain asymmetry is considered to be imprinted in the formation and regulation of the individual’s responses and relationships at an immunological level with the external and internal environment. The assumptions that the hemispheres modulate immune response in an asymmetric manner have been confirmed in experiments on animals. Some authors assume that the right hemisphere plays an indirect role in neuroimmunomodulation, controlling and suppressing the left hemispheric inductive signals.

Quality assurance becomes an increasingly important part of clinical medicine and of the field of endoscopy. Endoscopic sphincterotomy is associated with a fairly high complication rate. We aimed to assess our quality of sphincterotomy for benchmarking by using a prospective electronic database registry, and to identify potential risk factors for post-interventional complications. Over 2 years, 471 sphincterotomies were performed in a single tertiary referral centre. Patient- and procedure-related variables were prospectively recorded with the support of a multi-centre international sphincterotomy registry. Multivariate analysis was performed. The overall post-interventional complication rate was 9.3%. Pancreatitis happened in 5.5%, bleeding in 2.1%, perforation in 1.3%, and cholangitis in 0.4%. In the multivariate analysis following variables remained highly significant and predictive for complications: ‘papilla only in lateral view’ (p=0.001), antiplatelet therapy (p=0.024), and opacification with contrast up to the pancreatic tail (p=0.001). The primary success rate of sphincterotomy was 95.1%. The rate of post-interventional pancreatitis did not differ significantly regardless of the presence of prophylactic pancreatic stent (p=0.56). The outcome of sphincterotomy in our centre matches with literature data. The extent of pancreatic duct opacification has an influence on the pancreatitis rate. Prevention of pancreatitis by inserting pancreatic stents is not confirmed.

Only a few studies reveal immunological changes in breast milk after the intake of probiotic and none focus on secretory IgA (sIgA). The aim our report was to investigate the levels of sIgA in human breast milk and stools before and after 4 weeks of probiotic intake in a patient with ulcerative colitis (UC) and a control. The study included 2 lactating women: 1 with UC and 1 control. Both received daily 3.75 billion viable Lactobacillus bulgaricus for 28 days. SIgA was measured in breast milk and stools before and after the probiotic intake. The concentration of sIgA in breast milk before the probiotic intake in UC was 408.5 vs 137.4 µg/ml in contol. Fecal sIgA in UC was 420 vs 274 µg/ml in control. After 28 days of probiotic intake there was a decrease in breast milk sIgA in UC but an increase in control — 266.7 vs 914 µg/ml respectively. There was an increase in fecal sIgA both in UC and control — 674.4 vs 1033 µg/ml. It is tempting to speculate that the different sIgA secretion towards the probiotic may be a result of an altered mucosal immune response in UC.

Intussusception in adults is a very rare entity that occurs in only 5% of all intestinal obstructions. Most often, in 66% of cases, intussusception is localized to the small intestine, while jejunogastric intussusception is very rare and occurs in 0,1%. Since the first case of jejunogastric intussusception after gastrojejunostomy was described by Bozzi in 1914, fewer than 200 isolated cases of postoperative intussusception after gastric surgery have been reported. Here we present a case of anterograde jejunogastric intussusception, 15 years after radical subtotal gastrectomy with Billroth II anastomosis in a 71-year-old man.

Pancreatic pseudocyst is a complication of pancreatic trauma. We describe improved nonoperative treatment of patient with posttraumatic pancreatic pseudocyst with somatostatin analogue. A 9-year-old girl was admitted to our hospital after blunt abdominal trauma with handlebar. Three weeks after abdominal trauma, pancreatic pseudocyst developed. Nonoperative treatment of posttraumatic pancreatic pseudocyst (the largest dimensions 70 × 55 × 65 mm) with somatostatin analogue, octreotide acetate, was applied for the next 52 days. The patient was followed up for 24 months after the discontinuation of octreotide and there were no recurrence of pancreatic pseudocyst. Somatostatin analogue could be usefull in the nonoperative treatment of posttraumatic pancreatic pseudocysts in children.

In this paper a pattern recognition approach to classifying quantitative structure-property relationships (QSPR) of the CYP2C19 isoform is presented. QSPR is a correlative computer modelling of the properties of chemical molecules and is widely used in cheminformatics and the pharmaceutical industry. Predicting whether or not a particular chemical will be metabolized by 2C19 is of primary importance to the pharmaceutical industry. This task poses certain challenges. First of all analyzed data are characterized by a significant biological noise. Additionally the training set is unbalanced, with objects from negative class outnumbering the positives four times. Presented solution deals with those problems, additionally incorporating a throughout feature selection for improving the stability of received results. A strong emphasis is put on the outlier detection and proper model validation to achieve the best predictive power.

The aim of the study was to localize brain parts involved in executive functions in patients with schizophrenia by means of 99mTc-ECD single photon emission computed tomography (SPECT) with 3-dimensional automatic software. We examined 12 men with schizophrenia (mean age 29±3.9 years). Brain perfusion SPECT was performed at rest and during Wisconsin Card Sorting Test (WCST). Two types of quantitative SPECT analysis were applied; voxel-based and volume of interest (VOI)-based. With voxel-based approach, rest and activation SPECT were compared. VOI-based analysis allowed for correlation of regional cerebral blood flow (rCBF) in 20 VOIs with WCST scores. In voxel-based analysis, the patterns of rCBF decrease and increase after activation varied between patients, with combinations of different brain regions involved. In VOI-based approach, the only statistically significant difference between activation and rest was rCBF decrease in the left basal ganglia (p=0.028). The thalami and right temporal cortex correlated with the greatest number of WCST scores, followed by left occipital cortex and left cerebellum. In conclusion, our results suggest that patterns of WCST activation and deactivation vary between patients with schizophrenia. Among the network of involved brain structures, right temporal cortex and thalami appear to play the major role.

Bile duct stones, which obstruct the common bile duct, potentially result in complications, such as acute cholangitis and pancreatitis. We present a case involving a patient with normal liver function tests from whom we removed a giant common bile duct stone measuring 7.5 centimeters × 4.0 centimeters × 4.0 centimeters. Postoperatively recurrent common bile duct stones were observed and removed with an endoscopic maneuver in the three-year follow-up period. Recurrent bile duct stones are frequently reported in the case of large size of stones or multiple stones. Surgical treatment may then be considered as a first-line treatment in cases of recurrent common bile duct stones. When an endoscopic or surgical approach is used for the treatment of giant common bile duct stones, careful observation is of the utmost importance and treatment innovations may be necessary.

A hiccup is a sudden contraction of the inspiratory and diaphragmatic muscles followed by an abrupt closure of the glottis; that produces a characteristic noise resulting from vibrations of the vocal cords. Brief episodes of hiccups are common in humans at all stages of life and are usually benign. Prolonged attacks that last for days or weeks are considered a more serious phenomenon and may indicate an underlying disorder warranting a comprehensive medical evaluation. These attacks have been associated with significant burden and morbidity. The most common triggers for acute hiccups are linked with gastro-intestinal causes, such as the gastric distension that occurs after an abundant meal, or with gastroesophageal disease. Sudden changes in temperature, excessive alcohol consumption, as well as excitement or emotional stress, may also set off acute hiccups. Certain drugs, including benzodiazepines, barbiturates, and many others, have been reported to induce hiccups. Drug-induced hiccups are diagnosed by exclusion of other causes and represent a very unusual side-effect of drugs like corticosteroids. We present a case of hiccups associated with intra-articular Diprospan (Betamethasone Sodium Phosphate) administration.

The study involved 27 lateral cervical schwannomas surgically treated in the last 40 years utilizing either partial or total resection. The study aims to compare the results of total and partial resection of spinal lateral schwannoma and to assess the values of partial resection of large lateral cervical schwannomas. We performed a retrospective analysis of 27 patients operated for lateral cervical schwannomas in the period 1971–2010, out of which 11 had partial resection. The average follow-up of the patients was 136.4 months, comparing pre- and postoperative clinical picture, time to relapse, dynamics of yearly growth of schwannomas, and the need for re-resection. The average period of preoperative complaint in lateral cervical schwannomas was 19.6 months. Unilateral cervicobrachialgia as a manifestation of radiculopathy was observed in 85% of LCSs, and, was, as a rule the first symptom of the disease. Surgical treatment of 27 patients with LCSs resulted in recovery or improvement of complaints in 80% of cases. The treatment effect did not depend on the degree of resection. Reoperation was done, on average, 16.3 years after partial resection. The residues of lateral cervical schwannomas stopped growing 15 years after partial resection and underwent cystic degeneration. Partial resection of lateral cervical schwannomas is an excellent alternative to total resection, not only for the elderly or in cases of increased surgical risk, but also as a method of choice since it is more readily available to a larger number of surgeons and associated with low percentages of surgically relevant relapses and high percentages of improvement.

Primary malignant vascular bone tumors are unusual and include hemangioendothelioma, epitheloid hemangioendothelioma and angiosarcoma. Although few cases of primary bone angiosarcomas have been reported, those of femoral origin are even more infrequent. Such tumors diagnosis may be challenging due to their radiographic and histologic variety. We present a case of a 24-yearold woman with a subperiosteal diaphyseal angiosarcoma originating from the femoral bone and metastatic to the lung at the time of diagnosis. The clinical, histological and radiological features of this extremely rare lesion are presented.

The aim of this study was to determine influence of selected lifestyle factors on kidney cancer. The study brings data from two centres of international multicentric hospital-based analytical observational case-control studies. Data were obtained from a group of 300 patients newly diagnosed with kidney cancer (ICD-O-2 code C64) and 335 controls from two centres in the Czech Republic. Results showed that smoking increased OR to 1.09 (95% CI 0.77–1.55) and 1.06 (95% CI 0.73–1.52), but the results were not statistically significant. Obesity (BMI⩾30) created adjusted OR 1.71 (95% CI 1.11–2.66) and 1.44 (95% CI 0.91–2.28), showing a minor, statistically insignificant, effect of obesity on the development of kidney cancer. For hypertension, adjusted OR was 1.73 (95% CI 1.25–2.40), suggesting a minor to moderate effect of hypertension on kidney cancer. The analysis results showed a positive association between hereditary predisposition and the development of kidney cancer with an OR of 1.97 (95% CI 1.41–2.76) and 1.97 (95% CI 1.40–2.77) depending on the model of adjustment. The reasons for the high incidence of kidney cancer are not fully understood. Genetic polymorphisms, together with other lifestyle and environmental factors, are likely to contribute to various rates of kidney cancer incidence throughout the world.

Multiple arterial and venous thromboses are usually related to thrombophilia or antiphospholipid syndrome. Recurrent pulmonary embolism strongly indicates the presence of genetic or acquired thrombophilic factors. Simultaneous double arterial in situ thromboses are unusual, even in thrombophilic conditions. Simultaneous occurrence of pulmonary embolism and cerebrovascular ischaemic insult are highly indicative of existence of patent foramen ovale. We present herein a patient with the double simultaneous arterial thromboses as the manifestation of thrombophilia (heterozygous for methylenetetrahydrofolate-reductase (MTHFR) C677T gene mutation). There was no patent foramen ovale suspected upon the patient’s admittance to hospital. To the best of our knowledge there have been no similar cases presented to date.

We present three different cases of patients with papilledema: one case with a primary tumour of the optic nerve, and two cases with secondary involvement of the optic nerve (breast carcinoma and non-Hodgkin lymphoma). The visual acuity varies from sudden, painless, decrease of vision, to blurred vision and proptosis on the affected eye. A characteristic ophthalmoscopic examination shows a swollen optic disc and promonence with tortuosity of blood vessels. A fluorescein angiography shows dilated capillaries of the optic disc with leakage in the early phase and diffuse hyperfluorescence during the late phase. A ultrasonography B-scan of the affected eye shows prominent optic nerves with widened optic nerve sheath. An exhaustive history and complete ophthalmological examination are essential for the diagnosis, to which fluorescein angiography, B-scan ultrasonography, ocular coherent tomography, computerized tomography, and magnetic resonance can be used as useful additional tests. Treatment and prognosis depend on the primary process. We emphasize the crucial role of ophthalmologist in the early diagnosis of CNS neoplasia.

The patient presented is a 44-year-old female treated for cavitary changes in the lung apexes. Due to suspected tuberculosis, treatment began with anti-tuberculosis (AT) drugs, despite negative sputum smears for acid-fast bacilli. During hospitalization, the patient was febrile (up to 38°C), hypotensive, extremely cachectic (32 kg), had a dry cough, increased nitrogen products, hypokalemia and anemia. Because of poor response to the applied AT therapy, bronchoscopic tests were repeated and spores of aspergillus fungus were discovered in the pathohistological findings of transbronchial lung biopsy. The appropriate treatment with amphotericin B and voriconazole was initiated. A psychiatric opinion was requested because we suspected that the patient suffered from the anorexic syndrome (anorexia nervosa). This diagnosis was confirmed by a psychiatrist; her psychiatric treatment began simultaneously with the treatment in our facility. Anorexia was the cause of the cachexia, immunodeficiency and invasive pulmonary aspergillosis. The disorder was not recognized before the manifestation of the somatic disorder. There is little data in the available literature on the association between these two diseases.

The prevalence of insomnia is greater in end-stage renal disease. The aim of our study was to determine the frequency of insomnia and subclinical insomnia in patients with various dialysis therapy and kidney transplant recipients, in order to assess the severity of insomnia and examine whether there is a difference in severity among groups. In cross-sectional study, we evaluated 120 patients with terminal renal failure. Based on therapy, patients were divided into four groups: hemodiafiltration, standard bicarbonate dialysis, peritoneal dialysis and kidney transplant recipients. The severity of insomnia was evaluated through the use of the Insomnia Severity Index (ISI). Most patients who reported any kind of insomnia problems with ISI were on conventional dialysis (80%), followed by hemodiafiltration (76.7%) and peritoneal dialysis (63.3%). Transplant recipients had least difficulties with insomnia (46.7%). Insomnia Severity Index showed that insomnia in end-stage renal patients is not very severe. Most of the patients had “no clinically significant insomnia”. Our findings indicate that patients on hemodiafiltration and transplant recipients have a significantly lower score on Insomnia Severity Index. Patients with end-stage renal disease have high frequency insomnia problems. However, our study shows that insomnia in these patients is not severe. Insomnia is the most frequent and severest in patients on standard bicarbonate dialysis.

Temporary henna tattoos have recently become increasingly popular, especially among teenagers. Combining henna with other colouring agents such as para-phenylenediamine (PPD) may increase its potential for contact sensitization, cross-reaction to related compounds, as well as life-long allergy. Several cases of contact dermatitis from temporary tattoos with black henna have been reported in the literature. We present our experiences with 4 pediatric cases of allergic contact dermatitis induced by henna tattooing and give a brief review of the literature. The agent responsible for contact allergy was proven to be PPD in 3 patients, and in one patch testing revealed positive reactions to PPD and benzocaine, as well as to wool alcohols, nickel sulphate and potassium dichromate, to previously used hair dye—all being of clinical relevance.

Patients suffer differential prescribing behavior as a function of their socioeconomic status. The current study was conducted in a qualitative and two observational phases in Lahore metropolitan area to investigate physician’s perspectives of patients’ socioeconomic status and the important indicators influencing prescribing behavior. Semi-structured interviews were conducted with physicians (N=20) from 2 hospitals, 2 diabetes care centers and 2 private clinics and scripts were analyzed for socioeconomic indicators. In the second phase, the opinions of a panel of prescribers (N=43) on the influence socioeconomic indicators on prescribing behavior were elicited. In the third phase a bipolar 5-point Likert rating scale was used to elicit the importance of indicators for physicians (N=100) originated from urban and rural areas. In the interviews physicians gave 15 potential socioeconomic indicators. Following the two Delphi rounds, consensus was reached on 11 (73.3%) of the indicators, the remaining 4 (26.7%) were highly disputable. Bivariate analysis showed that literacy, educational background, compliance, dress and appearance were important indicators at the time of clinical decision making for physicians originating from urban areas than for physicians originating from rural areas. Physicians originating from urban and rural areas perceived the socioeconomic status differently.