Effects of methylphenidate treatment on the cerebellum in adult attention-deficit hyperactivity disorder: a magnetic resonance spectroscopy study.

OBJECTIVE: This study investigated the relationship between the use of methylphenidate (MPH) and changes in creatine, choline, and N-acetyl-aspartate (NAA) in the dorsolateral prefrontal cortex (DLPFC), striatum, cerebellum, and anterior cingulate cortex (ACC) in adults with attention-deficit hyperactivity disorder (ADHD). PATIENTS AND METHODS: The study enrolled 60 patients 18-60 years of age who met the criteria in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) for ADHD. The amounts of NAA, creatine, and choline in the ACC, cerebellum, striatum, and DLPFC were measured using magnetic resonance spectroscopy. After the first measurement, the patients were given 10 mg oral MPH, and the same metabolite levels were measured 30 minutes later. RESULTS: No significant differences were observed in the NAA and choline levels in the DLPFC, ACC, cerebellum, and striatum after MPH. Although there were no significant differences in the creatine levels in the DLPFC, ACC, and striatum after MPH, the creatine level in the cerebellum increased significantly. CONCLUSIONS: Our results suggest that MPH affects the cerebellum in adult ADHD. Therefore, we suggest that, due to its effects on the cerebellum, MPH can be used in adult ADHD not only for attention deficit symptoms but also for hyperactivity symptoms.

Relationship between the SNAP-25 gene and the effects of methylphenidate on the anterior cingulate cortex of patients with adult attention deficit hyperactivity disorder: a magnetic resonance spectroscopy study.

OBJECTIVE: The effects of certain genetic alterations in the brain function of patients with attention deficit hyperactivity disorder (ADHD) remain unclear and, in fact, there is a limited amount of data in this field. For example, the relationship between the SNAP-25 polymorphism and brain metabolites in response to methylphenidate (MPH) has yet to be investigated. Thus, the present study aimed to determine the relationship between changes in creatine (Cr), choline (Cho), and N-acetyl aspartate (NAA) levels in the prefrontal cortex (PFC) and anterior cingulate cortex (ACC) of adults with ADHD and the SNAP-25 gene polymorphism following the use of MPH. PATIENTS AND METHODS: The present study assessed 60 patients between 18 and 60 years of age who were diagnosed with ADHD according to criteria from the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV). Genetic analyses were carried out using blood samples obtained from the ADHD patients and included a detailed clinical evaluation for the SNAP-25 gene polymorphism. The NAA, Cr, and Cho levels in the ACC and PFC were measured using magnetic resonance spectroscopy (MRS). Following the evaluation, 10 mg of oral MPH was given to the patients, and the same metabolite levels were measured after 30 minutes. RESULTS: The levels of NAA, Cr, and Cho in the PFC and ACC of patients with the SNAP-25 Ddel and Mnll polymorphism genotypes did not significantly differ before and after the administration of MPH. However, in patients with the SNAP-25 Ddel polymorphism T/T genotype and the Mnll polymorphism G/G genotype, there was a significant increase in NAA levels in the ACC after MPH treatment compared with before MPH treatment. CONCLUSION: The present results suggest that the SNAP-25 Ddel and Mnll polymorphisms might be associated with MPH-related changes in NAA levels in the ACC.

Relationship between the DAT1 gene and the effects of methylphenidate administration in adult attention deficit hyperactivity disorder: a magnetic resonance spectroscopy study.

OBJECTIVE: This study investigated the relationship between DAT1 gene polymorphisms and the effects of methylphenidate (MPH) administration on N-acetyl aspartate (NAA), creatine (Cr), and choline (Cho) levels in the anterior cingulate cortex, prefrontal cortex, striatum, and cerebellum in adult patients with attention deficit hyperactivity disorder (ADHD). This was the first study to investigate the relationship between DAT gene variable number tandem repeat (VNTR) polymorphisms and the responses of brain metabolites to MPH. PATIENTS AND METHODS: Samples in this study were collected from 60 patients aged between 18 and 60 years with ADHD according to DSM-IV criteria. Genetic analysis of DAT1 gene polymorphisms was carried out using blood samples obtained after a detailed clinical evaluation. Levels of NAA, Cr, and Cho were measured in the anterior cingulate cortex, prefrontal cortex, striatum, and cerebellum by magnetic resonance spectroscopy. After this evaluation, 10 mg of MPH was given orally to patients, and the levels of the same metabolites were measured 30 min later. RESULTS: No marked difference in NAA, Cr, or Cho levels was detected before and after MPH administration with respect to the DAT1 gene VNTR polymorphisms. A considerable increase in Cr levels in the cerebellum was identified after MPH administration in individuals with the 10/10 repeat genotype as the DAT1 VNTR polymorphism (p=0.008). CONCLUSIONS: An increase in the previously decreased blood flow after MPH therapy may induce an increase in creatine levels in patients with the 10/10 repeat genotype. Our results thus suggest that the 10R allele as the DAT1 gene VNTR polymorphism might be associated with MPH-related changes in brain metabolites in adults with ADHD.

Wallenberg Syndrome following neck cracking: a case report.

Cracking the neck is an age-old practice in contravention of its dangerous affects. One of these affects is Brain stem strokes and in this report we describe a patient with Wallenberg syndrome due to neck cracking who is the one of the rare cases in the literature.

The volume fraction of brain ventricles to total brain volume: a computed tomography stereological study.

This study has been designed to estimate the volume fraction of the brain ventricles volume to total brain volume and to correlate them with gender and age in normal subjects. Cranial computed tomography (CT) images of 80 normally evaluated subjects (five female and five male for each decade) were selected from 1,073 CT examinations. The volumes of total brain, cerebral aqueduct, fourth, third, and lateral ventricles and their ratios were estimated using the Cavalieri method and volume fraction-stereological methods. The ratio of total brain ventricle volume to total brain volume was comparable between the two genders (p > 0.05, independent t test). Mean volume fraction of total ventricle volume to total brain volume was found to be 1.21% in the first and 3.37% in the last decades. Mean volume fraction was found to increase significantly with age (p < 0.01, r = 0.630, Pearson). In conclusion, the mean percentage of total ventricle volume within the total brain volume was found to be 2%. We demonstrated the volume fraction of total ventricle to total brain in normal subjects. Total ventricle volume to total brain volume fractions can be important tools in determining ventricle volumes, which denote variability in some diseases (Alzheimer, schizophrenia, neurodegenerative disorders, etc.) and can be estimated by stereological methods.

Dandy-Walker's variant and tetralogy of Fallot with atrial septal defect and patent ductus arteriosus and primary hypothyroidy--a new association.

An 11-month-old girl who has Dandy-Walker's variant (DWV) associated with tetralogy of Fallot (TOF), atrial septal defect (ASD), patent ductus arteriosus (PDA), and primary hypothyroidy is presented. There has been no report describing a case of DWV associated with TOF, ASD and PDA and primary hypothyroidy. The first case of Dandy-Walker malformation associated with TOF was reported by Kohyama et al in 1988, since then, a few cases were reported in the literature. Our patient is the first reported case.

Association between cholesterols, homocysteine and silent brain infarcts.

BACKGROUND: The aim of this study was to assess the relationship between total plasma homocysteine, cholesterol levels, vitamin B(12), folate, thyroid hormones, urea, ferritin, uric acid, C-reactive protein, cardiovascular risk factors and silent brain infarct (SBI) in patients without any neurological disorder. Whether the factors of interest were associated with SBI is investigated. METHODS: One hundred and forty-two subjects with a mean age of 52.1 +/- 13.1 years (21-87 years) without any history of stroke, transient ischaemic attack and neurological abnormality were enrolled in this cross-sectional study. The subjects underwent brain magnetic resonance imaging and blood chemistry determinations. Student's t-test was used to compare differences in means of laboratory results between the groups with and without SBI. The chi(2)-test was used for categorized variables. Multiple logistic regression analysis was used to determine the independent predictors of SBI. RESULTS: The group comprised 56 men and 86 women. SBI were found in 40 patients (28%). The low-density lipoprotein levels were significantly higher in the infarct group (P = 0.019), homocysteine concentrations were significantly higher in the men-infarct group (P = 0,029) and total cholesterol levels were significantly higher in the women-infarct group than the women non-infarct group (P = 0.006). CONCLUSION: Serum low-density lipoprotein, total cholesterol and homocysteine levels were associated with SBI.

Clinical significance and renal haemodynamics of incidentally detected retroaortic left renal vein: assessment with venous Doppler sonography.

The purpose of this study was to determine whether renal venous pulsations are affected by compression of the left renal vein (LRV) between the aorta and spine, and also to determine the clinical significance of incidentally detected retroaortic LRV. The study population was recruited from 783 consecutive patients undergoing abdominal CT examination for various indications. 22 patients with a retroaortic LRV were prospectively enrolled in this study, and 22 patients without renal disease served as a control group. After measuring the diameters of the central and peripheral portions of the LRV on CT images, the ratio (P/C) and difference (P-C) of the diameters were calculated. Doppler sonography of the interlobar arteries and veins of the left kidney was then performed to obtain impedance indices. Urine analysis of all subjects and scrotal colour Doppler ultrasound of male patients were also performed. The retroaortic LRV diameters were significantly narrower than the pre-aortic LRV diameters (p = 0.002). The left intrarenal venous impedance indices were significantly higher in the patients with retroaortic LRV (p = 0.026) and in the subgroups with P/C>2 (p = 0.020), with P-C>4 mm (p = 0.007) and without nutcracker-like associations (p = 0.006) than in control subjects, but no significant difference was noted between the arterial resistance indices. Haematuria (n = 8), proteinuria (n = 4), varicocele (n = 3) and collaterals (n = 1) were detected in the study group but not in the control group. In conclusion, incidentally detected retroaortic LRV appears to be associated with haematuria, proteinuria, varicocele and altered venous pulsatility. Further investigations are needed to understand the role of venous Doppler ultrasound in the nutcracker phenomenon.

Pneumosinus dilatans and multiplex: report of three rare cases and review of the literature.

Pneumosinus dilatans is a term used to describe a localized abnormal dilatation of one or more paranasal sinuses without radiological evidence of localized bone destruction, hyperostosis or mucous membrane thickening. The involvement of all paranasal sinuses and mastoid air cells has been named pneumosinus dilatans multiplex. Although the involvement of one or more paranasal sinuses has been reported widely, all paranasal sinuses and the concomitant involvement of mastoid air cells has been reported in only one case. Herein, we present three unusual cases of pneumosinus dilatans (one is a second case of pneumosinus dilatans multiplex in English literature, another is the first reported case of a frontal pneumosinus dilatans case associated with frontoethmoidal meningocele, mental retardation and facial asymmetry and the third one is pneumosinus dilatans with a huge arachnoid cyst) along with the review of relevant literature.

Elevated serum CA-125 levels in hemodialysis patients with peritoneal, pleural, or pericardial fluids.

OBJECTIVE: Serum CA-125, an ovarian tumor marker, is used especially in the follow-up of ovarian cancer for monitoring the efficacy of therapy and for early detection of recurrence. A number of benign gynecologic as well as benign and malignant nongynecologic conditions are associated with elevated serum CA-125 levels. Malignant and nonmalignant serosal fluids were also found to be associated with high serum levels of CA-125, suggesting that the presence of fluid in the serosal cavities may stimulate its release. METHODS: We performed a clinical study in 39 patients (21 females, 18 males) on chronic hemodialysis who were divided into two groups based on the presence of fluid in the serosal cavities (peritoneum, pleura, or pericardium) without clinical and radiologic evidence of neoplasia. There were 26 patients (16 females, 10 males) aged 50.11 +/- 13.86 years (range, 20-76 years) in the serosal fluid-negative group (group 1) and 13 patients (8 females, 5 males) aged 45.30 +/- 18.84 years (range, 17-73 years) in the serosal fluid-positive group (group 2). The control group consisted of 52 healthy volunteers (30 females, 22 males) aged 44.19 +/- 12.59 years (range, 19-68 years). RESULTS: Significantly elevated serum CA-125 levels were found in hemodialysis patients with serosal fluid (P < 0.05) when compared with both the hemodialysis patients without serosal fluid and the control group. There was no statistically significant difference between the control group and the patients without serosal fluids (P > 0.05). CONCLUSION: Although CA-125 can be considered a reliable tumor marker in patients undergoing hemodialysis, it should be interpreted with caution in patients with serosal fluids.

Hydatid cyst of the breast diagnosed by fine needle aspiration biopsy. A case report.

A hydatid breast cyst was diagnosed from hooklets obtained by fine needle aspiration biopsy. In rare cases, some palpable lesions suggest a hydatid cyst. This possibility should always be considered during routine cytologic examination.