Differences in onset of disease and severity of psychopathology between toxoplasmosis-related and toxoplasmosis-unrelated schizophrenia.

OBJECTIVE: Toxoplasmosis is a lifelong parasitic disease that appears to be associated to schizophrenia. However, no distinguishing attributes in Toxoplasma-infected schizophrenia patients have been described as yet. METHOD: We searched for differences in symptom profile, cognitive performance and treatment response between 194 Toxoplasma-free and 57 (22.7%) Toxoplasma-infected schizophrenia patients treated in Prague Psychiatric Centre between 2000 and 2010. RESULTS: Infected and non-infected patients differed in severity of symptoms (P = 0.032) measured with the Positive and Negative Symptom Scale (PANSS). Infected patients scored higher in positive subscale of PANSS, but not in the general and negative subscales. Infected men scored higher also in Total PANSS score, and negative, reality distortion, disorganisation and cognitive scores. Higher PANSS scores of positive, negative and disorganised psychopathology were associated with the lower titres of anti-Toxoplasma antibodies suggesting that psychopathology deteriorates with duration of parasitic infection. Infected patients remained about 33 days longer in hospital during their last admission than uninfected ones (P = 0.003). Schizophrenia started approximately 1 year earlier in infected men and about 3 years later in infected women, no such difference was observed in uninfected subjects. CONCLUSION: Latent toxoplasmosis in schizophrenia may lead to more severe positive psychopathology and perhaps less favourable course of schizophrenia.

[The significance of biological intracranial meningioma behaviour for their long-term management]. / Význam biologického chování nitrolebních meningiomu pro jejich dlouhodobý management.

INTRODUCTION: From the histological point of view, most meningiomas are benign tumours. Nevertheless, their recurrence is quite frequent, and identifying the risk factors for recurrent disease is of utmost importance. MATERIAL AND METHODS: Prospective study, patients operated on in the period 2/2008-9/2009. Inclusion criteria for enrolment into the study: age 18-70 years, good health status, and previously untreated solitary intracranial meningioma. Evaluation of clinical, surgical, MRI findings and vascular endothelial growth factor serum levels (prior to procedure, 3 months after, 12 months after, 24 months after procedure and at the time of the last follow-up in 11/2011) was performed. Immunohistochemical analysis of histological samples was carried out. Further treatment (wait and see, redo surgery, treatment with radiation using the Leksell Gamma Knife, external radiotherapy) was recorded in case of a positive follow-up MRI finding (recurrent disease, progression of residual tumour). RESULTS: A total of 50 consecutive patients (34 women and 16 men) were included into the study. Average age at the time of surgery was 59.2 years (range 27-75 years). Radical resection with no residual tumour left was achieved in 35 cases. Histological analysis showed grade I meningioma in 45 cases and grade II (atypical) meningioma in 5 cases. Correlation between E-cadherin expression and recurrent meningioma was proved by immunohistochemical examinations; in the remaining investigations, however, such a correlation was not found. No correlation was detected between the serum vascular endothelial growth factor level and the expression of vascular endothelial growth factor in immunohistochemical investigation. A correlation was found between the expression of vascular endothelial growth factor in immunohistochemical investigation and peritumoural oedema. The tumour recurred in 5 cases. CONCLUSIONS: On the basis of our results as well as literature findings we can conclude that all the patients after meningioma surgery need to be carefully followed for the rest of their life by repeated MRI invetigations.

Aripiprazole as an adjunct to clozapine therapy in adolescents with early-onset schizophrenia: a retrospective chart review.

INTRODUCTION: Combination of antipsychotic substances is a therapeutic option increasingly applied in patients with schizophrenia, who do not respond to antipsychotic monotherapy. Recently, various reports on combination of clozapine with aripiprazole in adults have been published. As there is not yet data on adolescent patients, we aimed to study the above-mentioned augmentation strategy in this population. METHODS: We included 15 patients with schizophrenia from a child and adolescent psychiatric department (8 male; mean age 19.3 [SD+/-1.2, range 17.2-21.2] years). Patients had been under clozapine treatment, followed by aripiprazole augmentation. Retrospectively, patients' medical records were reviewed, using a rating scale in analogy to the Clinical Global Impressions (CGI) scale. RESULTS: Mean observation time was 11.1 [SD+/-9.7] months. Mean CGI-Severity scores improved significantly (p=0.003, d=0.76) from 5.3 (baseline) to 4.5 (endpoint; last observation carried forward (LOCF)). CGI-Improvement scores decreased from 3.7 (after 1 month) to 3.3 (endpoint; LOCF) (p=0.212, d=0.45). CONCLUSIONS: In adolescents with schizophrenia, aripiprazole augmentation of clozapine treatment might be an effective therapeutic strategy. Prospective studies for this age group are required to obtain more specific clinical data on clinical effectiveness.

Variation of a Persistent Primitive Hypoglossal Artery (PPHA) as Incidental Finding in the Diagnostic Clarification of Cerebral Vasculopathy Associated with Intracranial Vasculitis.

We present a very rare variation of a persistent primitive hypoglossal artery (PPHA) arising from the internal carotid artery, detected during a diagnostic angiography. A 50-year-old female patient was admitted with an atypical intracranial hematoma in the left frontal lobe. Catheter angiography revealed intracranial vasculopathy with segmental stenoses, a small aneurysm of the right internal carotid artery bifurcation and a "string of beads" appearance of the left carotid artery, consistent with fibromuscular disease. On the left side, a vertebral artery ending in the posterior inferior cerebellar artery (PICA) was detected, whereas on the right side the vertebral artery was aplastic. During selective angiography of the right common carotid artery, a persistent hypoglossal artery was seen supplying the basilar artery. The literature of persistent embryonal carotid-vertebrobasilar anastomosis and their anatomical variations is discussed with respect to clinical importance for ischemia, interventional procedures, and surgery.

Impact and Effectiveness of Dual Aspiration Technique in Stent-Assisted Mechanical Thrombectomy: Recent Improvements in Acute Stroke Management.

BACKGROUND AND PURPOSE: To evaluate feasibility and impact of dual aspiration technique (DAT) within stent-assisted mechanical thrombectomy on procedural parameters and clinical outcome. MATERIALS AND METHODS: Within 16 months, 76 consecutive patients (mean age 70.7 year; range 33-89) underwent stent-assisted mechanical thrombectomy. Of 52 enrolled patients (68.4 %) with occlusion of the anterior circulation, 22 patients (42.3 %) underwent DAT; 30 patients (57.7 %) were treated in conventional monoaspiration technique (MAT). Epidemiological data, clinical and imaging characteristics (mRS, NIHSS, ASPECTS) as well as procedural details were analyzed (TICI, number of retrieval, procedure time). Clinical outcome was determined with mRS at discharge and after 90 days. RESULTS: In the context of DAT additional carotid artery stenting was required in 45.5 % (10/22) in underlying tandem lesion (vs. 0/30 MAT). No differences were found in NIHSS at admission (MAT: 20.5, range 15-29; DAT: 18.6; range 11-25), mRS at admission (MAT: 4.6 vs. DAT: 4.57) or ASPECT score (MAT: 8.3, ±1.5; DAT: 8.4, ±1.5; P > 0.05). TICI ≥ 2b/3 was conducted in 90 % (MAT) and 100 % (DAT), respectively. The procedure time was longer in the MAT group (65 min, ±25.9, range 18-126) compared to the DAT group (49.7 min, ±15, range 32-101; P = 0.016). The clinical outcome increased from admission to discharge and in follow-up after 90 days (mRS ≥ 2: MAT: 53.3 %, DAT: 54.5 %; P > 0.05). CONCLUSIONS: The dual aspiration technique with an additional intermediate guide catheter placed closed to the stent retriever leads to decreased procedure time in the anterior circulation. Even in cases with higher thrombus load and treated in DAT, clinical outcome improved.

The influence of low-frequency left prefrontal repetitive transcranial magnetic stimulation on memory for words but not for faces.

Brain imaging studies suggest localization of verbal working memory in the left dorsolateral prefrontal cortex (DLPFC) while face processing and memory is localized in the inferior temporal cortex and other brain areas. The goal of this study was to assess the effect of left DLPFC low-frequency repetitive transcranial magnetic stimulation (rTMS) on verbal recall and face recognition. The study revealed a significant decrease of free recall in word encoding under rTMS (110% of motor threshold, 0.9 Hz) in comparison with sham stimulation (p=0.03), while no significant difference was found with facial memory tests. Our findings support the essential role of the left DLPFC in word but not facial memory and confirm the content specific arrangement of cortical areas involved in semantic memory. As a non-invasive tool, rTMS is useful for cognitive brain mapping and the functional localization of the category specific memory system.

Nitric oxide inhibits isoprenaline-induced positive inotropic effects in normal, but not in hypertrophied rat heart.

Evidence has accumulated that, in the rat heart, nitric oxide (NO) inhibits beta-adrenoceptor-mediated positive inotropic effects. The aim of this study was to investigate whether this effect of NO may be altered in cardiac hypertrophy. For this purpose we studied the effects of the NO-donor SNAP (S-nitroso-N-acetyl-D,L-penicillamine) on isoprenaline-induced positive inotropic effects in left ventricular strips from three models of cardiac hypertrophy: a) 12-16 weeks old male spontaneously hypertensive rats (SHR) vs. age-matched normotensive Wistar-Kyoto (WKY) rats, b) six weeks old male Wistar WKY-rats sub-totally nephrectomized (SNX) 7 weeks after SNX vs. sham-operated rats (SOP) and c) four weeks old male Wistar WKY-rats supra-renal aortic-banded (AOB, band diameter 1.0 mm) 8 weeks after AOB vs. SOP. In all three models of cardiac hypertrophy the heart weight/body weight ratio was significantly higher than in their respective controls. On isolated electrically driven ventricular strips isoprenaline (10(-10)-10(-5) M) caused concentration-dependent increases in force of contraction. Maximal increases (Emax) were similar in SHR vs. WKY-rats, but reduced in SNX- (2.9+/-0.29 vs. 5.1+/-0.34 mN, p<0.01) and AOB-rats (2.3+/-0.37 vs. 4.2+/-0.33 mN, p<0.01). In control rats (WKY and the respective SOP) the NO-donor SNAP (10(-5) M) caused a significant rightward-shift of the concentration-response curve for isoprenalinel; this rightward-shift could be inhibited by methylene blue (10(-5) M). In ventricular strips of SHR, SNX- and AOB-rats, however, 10(-5) M SNAP failed to significantly affect isoprenaline-induced positive inotropic effect. We conclude that in cardiac hypertrophy effects of NO are attenuated. Such an impairement of the NO-system could contribute to the development and/or maintenance of cardiac hypertrophy.

Time course of high-intensity transient signals in patients undergoing elective heart valve replacement: a prospective study.

BACKGROUND AND AIMS OF THE STUDY: This study was performed to evaluate the time course of intracranial high-intensity transient signals (HITS) in patients undergoing elective heart valve replacement. METHODS: Thirty-three patients were enrolled in this study. The examination protocol included serial (before and at one, five, 90 and 180 days after surgery) monitoring sessions with transcranial Doppler and detailed neurological examination. Monitoring was performed bilaterally over the middle cerebral arteries for one hour per session using 2 MHz probes. Microembolic signals were recognized according to standard criteria and stored on a computer for later evaluation. RESULTS: HITS prevalence increased from 3% preoperatively to 41% on the first postoperative day and remained unchanged during the postoperative period. No influence of the intensity of anticoagulation or valve type on HITS counts was evident. Unilateral monitoring provided adequate results in 83.9% of cases. CONCLUSIONS: The causative role of the valve implant in the pathogenesis of HITS appears certain, since their prevalence dramatically increases following valve implantation. Valve type, duration of valve implant or intensity of anticoagulation did not influence HITS counts. Bilateral monitoring is warranted for accurate evaluation of HITS counts in this patient group.

Invasive pulmonary aspergillosis: effects of early resection in a neutropenic rat model.

OBJECTIVE: Invasive pulmonary aspergillosis is frequent in neutropenic patients. Usually localized in the beginning, the disease spreads and mortality is high despite antifungal treatment. The role of early adjuvant surgery is not clear. Surgery may help to confirm fungal disease, may control fungal disease locally and may prevent systemic spreading. This study examines effects of early resection on survival and dissemination in a rat model of localized invasive pulmonary aspergillosis. METHODS: Forty persistently neutropenic male albino rats were challenged with standardized conidial aspergillus inoculum injected into peripheral lung tissue of the right upper lobe under direct vision. Animals were divided into four groups. Twenty animals were treated with amphotericin B at 1 mg/kg per day beginning 48 h after inoculation, 20 animals were left untreated. In each group half the animals underwent early resection of localized invasive aspergillosis by lobectomy. Animals were checked daily and mortality was recorded up to 28 days after which surviving animals were sacrificed. RESULTS: Significantly higher survival was observed in resected animals in the non-Am B groups (survival: 10 +/- 19% without early resection and 50 +/- 32% with early resection; P = 0.044). However, early resection did not lead to improved survival in animals treated with amphotericin B (survival 70 +/- 29% without early resection and 50 +/- 32% with early resection; P = 0.316). CONCLUSIONS: In this rat model of localized invasive pulmonary aspergillosis effects of early resection on survival could be demonstrated only in animals not receiving amphotericin B treatment.

[Spasm in a single coronary artery]. / Spasme sur coronaire unique.

A 52 year old man presented with effort and resting angina with positive exercise stress testing and myocardial scintigraphy. The initial coronary angiogram showed a single coronary vessel arising from the right coronary ostium dividing into a right coronary artery with a normal trajectory lined with a few non stenotic atheromatous plaques and a left coronary artery which passed between the aorta and pulmonary artery to reach the left atrioventricular groove. At first, it was suggested that the angina was due to compression of the left coronary vessel by the great arteries during effort, but this mechanism could not explain attacks of resting angina and the failure of betablocker therapy. An ergometrine test performed during repeat coronary angiography induced almost complete occlusion of the right coronary vessel and Prinzmetal diaphragmatic ischaemia. The anginal attacks were completely suppressed by Calcium antagonist drugs. The association of coronary spasm and a single coronary artery is rare; only one case has been previously reported. We do not believe that there was a relationship between the two phenomena in our case: the spasm occurred at a distance from the aberrant course of the vessel. The authors emphasise the diagnostic problems and the potential danger of this association.

[Mitral valve prolapse. Results of electrophysiological studies]. / Prolapsus de la valve mitrale. Résultats des études électrophysiologiques.

Classically, the frequency of latent left-sided Kent bundles and ventricular tachycardia (VT) is increased in mitral valve prolapse (MVP). To verify this hypothesis, 23 patients with clinical and echocardiographic (M mode and 2D) signs of MVP underwent electrophysiological studies for dizziness or syncope (12 cases) or palpitations (11 cases). In addition to the standard electrophysiological studies, analysis of sinoatrial and atrioventricular conduction, they underwent programmed ventricular pacing (St V2): coupled and then paired St V2 in sinus rhythm and during ventricular pacing (100-150/min) under basal conditions (15 patients), after injection of 2 mg Atropine (6 patients), and 10 micrograms of Isoproterenol (4 patients). These manoeuvres showed that symptoms of dizziness were due to increased vagal tone in 6 cases (associated with paroxysmal nodal tachycardia--PNT--in 3 cases), to sinoatrial block in 2 cases (associated with atrial tachycardia in 1 case), to suprahisian conduction defects in 3 cases (associated with atrial tachycardia in 1 case) and to VT in 1 case. Palpitations were due to VT in 1 case, atrial tachycardia in 1 case and PNT in 9 cases. Our analysis showed a high incidence of PNT (10 cases) with normal inter critical ECG. These arrhythmias were due to intranodal reentry in 7 cases (70%), to a latent left-sided Kent bundle in 2 cases and to a paraseptal Kent bundle in 1 case. These PNT were characterised by induction during exercise (6 cases) and by their association with flutter-type reentry (5 cases).(ABSTRACT TRUNCATED AT 250 WORDS)

[Demonstration of the arterial system during phlebography of the leg for blue phlebitis]. / Mise en évidence du système artériel au cours d'une phlébographie du membre inférieur pour phlébite bleue.

Massive filling of thigh and calf arterial network was noted during phlebography in a patient with a typical clinical picture of "blue" phlebitis of lower limb. This paradoxical vascular injection allows support of current physiopathologic concepts of "blue" phlebitis (phlegmasia cerulea dolens).

[Complications of cardiac hydatid cyst. 2 cases]. / Complications du kyste hydatique cardiaque. 2 observations.

BACKGROUND: Cardiac localization of hydatiosis is uncommon, involving 0.5 to 2% of all cases. CASE REPORTS: The first patient was a 15 year old adolescent whose cardiac hydatidosis was revealed by tamponade. The second case was discovered in a 28-year-old woman without cardiac signs who was explored for allergy manifestations with fever, urticaria and joint point. Both patients underwent surgery. Eighteen months after the operation, the second patient developed hemiplegia leading to the discovery of multi-organ localizations (brain, spleen, kidney) which were not evidenced at the initial work-up. The neurological deficit and brain cysts regress with albendazole treatment. DISCUSSION: The risk of rupture of the cardiac hydatic cyst requires rapid surgical cure. Medical treatments are discussed. Anti-hydatic drugs can be used alone in case of a contraindication for surgery. In other patients they are given during the perioperatie period and for a prolonged period after surgery.

[Neuropsychologic rehabilitation of mental functions using computers]. / Neuropsychologická rehabilitace psychických funkcí pomocí pocítacu.

The authors draws attention to the problem of neuropsychological rehabilitation. He emphasizes the problem of exploiting the patient's experience during rehabilitation into practical life. He provides data on rehabilitation in vivo and in vitro. He reflects on the development of computer rehabilitation of cognitive functions from neuropsychological tests and presents some examples based on Scandinavian experience. The author also draws attention to his own experience with the neuropsychological computer programme TRAIN THE BRAIN and gives an account of the work with this programme. He recommends the use of computer programmes in psychological and neuropsychological practice. He emphasizes their possibilities in patients with traumatic brain damage and the possibility to follow up systematically changes during recovery which are difficult to record in written tests. Changes in recovery which were recorded by the computer programme frequently did not correspond with changes of the mental state of the patient. Rehabilitation computer programmes also enable to activate of psychiatric patients with performance disorders. The author emphasizes possibilities of neuropsychological rehabilitation and recommends its further development in the Czech Republic.

[Neuropsychology of traumatic brain damage in children]. / Neuropsychologie traumatického poskození mozku u detí.

The author deals with the neuropsychology of traumatic brain damage in children. He mentions briefly the development of neuropsychology with regard to problems encountered in children. Based on an analysis of the literature he assesses four basic factors when establishing the diagnosis. These factors are: age, type and extent of damage, duration of coma and posttraumatic amnesia and premorbid personality. The author finds discrepancies between assessment of coma in different experimental publications and emphasizes the practical aspect of these basic factors in clinical reflections. He presents results of studies concerning mild, medium and severe cerebral affections in children. He emphasizes the importance of psychotherapy, neuropsychological rehabilitation and crisis intervention.

Assessing neuropsychological impairment using Reitan and Wolfson's screening battery.

The aim was to verify the applicability of Reitan and Wolfson's proposed neuropsychological screening battery for adults (2006, 2008) in the Czech population. The sample consisted of 70 participants aged 19-65 years, all of whom were examined using a screening method as well as the full Halstead-Reitan neuropsychological battery (HRNB). The correlation, logistic regression, ROC curve analysis, sensitivity and specificity, and positive and negative predictive values were all calculated. The Pearson correlation between the screening scale of neuropsychological deficit and the General Neuropsychological Deficit Scale (GNDS) from HRNB was 0.78 (p < .001). When optimal cut-off scores of 8 were utilized (in accordance with Horwitz, Lynch, McCaffrey, & Fisher in Screening for neuropsychological impairment using Reitan and Wolfsons preliminary neuropsychological test battery. Archives of Clinical Neuropsychology, 23, 393-398, 2008, but different from Reitan, & Wolfson in The use of serial testing in evaluating the need for comprehensive neuropsychological testing of adults. Applied Neuropsychology, 15, 21-32, 2008), 78.6% of individuals were correctly classified having neuropsychological impairment or no impairment according to the GNDS. Our results confirm that this neuropsychological screening battery has good psychometric properties in the Czech population.

Treating with an implant: BMS or DES?

As the minimal invasive procedures for the treatment of peripheral arterial disease grow at exponential rates, interventional radiologists and vascular surgeons are more often faced with the difficult decision of which devices are the most appropriate to bring the desired results. Under the light of the newest studies and always having in mind the concept of "leaving no metal behind", when focusing on the lesions within the superficial femoral artery and popliteal arteries, we try to answer the question: treating with an implant, bare metal stents or drug eluting stents?

Solitaire® stent for endovascular coil retrieval.

Coil migration during embolization is an emergency, requiring individual solutions. A 71-year-old female patient was referred to our hospital suffering from subarachnoid hemorrhage due to a ruptured giant aneurysm of the ophthalmic segment of the right internal carotid artery (ICA). During the endovascular procedure, a coil migrated in the ICA. Coil dislocation could be treated by either retrieval or fixation. On intention to treat we retrieved the coil with the self-expanding Solitaire(®) AB stent (Ev3, Irvine, CA, USA). The Solitaire(®) stent is established to perform mechanical thrombectomy for treatment of acute stroke. This report demonstrates the Solitaire(®) stent's potential for safe and effective retrieval of dislocated coils. Other retrieval systems will be discussed.

Attentional networks in euthymic patients with unipolar depression.

BACKGROUND: The capacity to focus and concentrate or to direct attention supports many aspects of cognitive functioning including short-term memory and higher-level cognitive functions. The purpose was to assess attentional networks in euthymic patients with unipolar depression using the Attentional Network Test (ANT). MATERIALS AND METHODS: We investigated performance of attention by virtue of ANT during remission from unipolar depressive disorder and tested a hypothesis that there are no differences between outpatient group (euthymic patients, N=32) and matched controls in attentional variables, the relationship of attentional networks and everyday cognitive failures. RESULTS: No differences between the groups in attentional networks were found and no relationship between attentional networks and cognitive failures was found. LIMITATIONS: One assessment during remission could be insufficient to recognize long-term pattern of cognitive functions. CONCLUSIONS: These data show non-impaired attentional networks possibly explained by sufficient level of remission and ameliorated influence of high education on cognition.