Epidemiological and clinical characteristics of primary headaches in adolescent population: is there a relationship with the way of life?

The headache in the adolescent population is one of the most common conditions that doctors deal with. It is an important source of disability with several health-related considerations. The aim of the study was to investigate the frequency, as well as different epidemiological and clinical characteristics, of primary headaches in adolescents. An epidemiological study was conducted on 1800 adolescents of both sexes based on a questionnaire consisting of 65 questions referring to sociodemographic and clinical characteristics of headaches. Based on the questionnaire information, the examinees were divided into four groups: adolescents with migraine, tension-type and mixed headache and the fourth group were examinees without headaches. The information was statistically processed and the level of significance < 0.05 is considered statistically significant. Out of 1800 respondents, 1160 subjects were those with headache (64.4%) and 640 subjects were without headache (35.6%). The most common primary headache is tension-type headache. The majority of subjects with tension-type headaches attend elementary school and with migraine and mixed headaches high school. There were significantly more headaches among adolescents who had their own computer and who spent more than 2 h using it. More frequent headaches were found in those who travel by public transport and spend more time on Facebook. Primary headaches in adolescent population occur frequently and despite numerous studies, they are still not taken seriously enough. It is necessary to educate parents, teachers and adolescents to avoid risk factors or at least reduce their impact.

Clinical evaluation of psychiatric and behavioral disorders in adolescents with epilepsy: a cross-sectional study.

Background: Epilepsy is a neurological disease that is often associated with psychiatric comorbidities.Subjects and methods: The aim of the study was to examine the frequency of psychic symptoms and their association with different types of epilepsy in the adolescent population. The study involved 100 adolescents with epilepsy and 100 healthy adolescents of both sexes at the age of 13-19. The examinees completed a standardized Symptom Checklist-90-R (SCL-90-R) questionnaire, concerning self-assessment of psychological disorders in the previous week. The value system of ​​nine dimensions and three global indexes of SCL-90-R scales were analyzed.Results: Our results suggest that adolescents with epilepsy have more than one psychic disorder compared to a healthy group of respondents. Somatic symptoms are more common in non-epileptic subjects, while obsessive-compulsive, depressive and phobic symptoms, as well as anxiety, aggressiveness, interpersonal vulnerability and paranoia, are more common in adolescents with epilepsy. Due to the type of epilepsy, obsessive compulsive symptoms are more common in adolescents with focal epilepsy, while the symptoms of phobia are more present in those with generalized epilepsy. The depth and intensity of psychological stress is higher in the group of adolescents with epilepsy compared to the healthy group of respondents.Conclusions: Psychiatric comorbidity is very common in epileptic patients and depending on the type of diagnosed epilepsy, various symptoms are expressed. Furthermore, psychological stress is more observable in adolescents with epilepsy. For patients with epilepsy, mental health care and seizure control is extremely important in the prevention of serious mental disabilities.

HERBALIFE® ASSOCIATED SEVERE HEPATOTOXICITY IN A PREVIOUSLY HEALTHY WOMAN.

Lately there has been an increased consumption of herbal preparations, distributed as nutritional supplements, often claimed to be 'natural' and harmless. However, as their use is not subjected to strict pre-marketing testing and regulations, their ingredients are not clearly defined and there is no quality control or proof of their effectiveness and safety. A growing body of references accentuate their harmful effects, in particular hepatotoxicity, which varies from minimal hepatogram changes to fulminant hepatitis requiring liver transplantation. This case report describes liver damage that was highly suspected to originate from Herbalife® products consumption. We excluded alcohol, viral, metabolic, autoimmune and neoplastic causes of liver lesions, as well as vascular liver disease, but we noticed a connection between the use of Herbalife® products and liver damage. The exact mechanism of liver damage in our patient was not determined. After removing the Herbalife® products, liver damage resolved and there was no need to perform liver biopsy. Taking into consideration the growing consumption of herbal products and their potential harmfulness, we consider that more strict regulations of their production process and sale are necessary, including exact identification of active substances with a list of ingredients, toxicologic testing and obligatory side effect report.

Risk Factors Associated with Black Tooth Stain

The aim of the study was to show whether there is any influence of food, drink or drug intake on the formation of tooth discoloration. A total of 500 patients aged 15-25 years were examined to take part in the study. Of these, 60 patients were selected and divided into two groups of 30 patients each. Group 1 included patients with black pigmentation on vestibular/oral tooth surfaces. Group 2 included patients without discoloration (control). Data were recorded in a questionnaire. Atomic absorption spectrometry was used to determine elements in discoloration samples. The Caries Risk Test (CRT) buffer was used to assess buffer capacity of saliva, while CRT bacteria were used to determine the presence of Streptococcus mutans and Lactobacillus spp. Statistically significant between-group differences were found for the intake of collard greens and beets (p<0.05), but not for other vegetables. As for drink consumption, patients with pigmentation reported less wine intake (p<0.05) than those without pigmentation. There was no difference according to drug intake between patients with and without pigmentation. Patients with pigmentation were older, smoked and had lower saliva pH with lower presence of Streptococcus mutans than those without pigmentation (p<0.05). In tooth discoloration samples, there were traces of calcium, magnesium, iron, copper and zinc. The appearance of tooth discoloration is influenced by many factors, among which diet and saliva seem to be very important. Our study showed that patients with black pigmentation used to take more beets, while patients without pigmentation were taking more collard greens and red wine.

Cardiopulmonary Interactions with Consecutive Pulmonary Abnormalities in Patients with Chronic Heart Failure.

Chronic heart failure places heavy burden on patients, their families and on health care resources, accounting for high numbers of hospital admissions. Despite huge improvements in the treatment of many heart disorders, the clinical syndrome of chronic heart failure as a final pathway of heart pathology is an exception, in that its prevalence is rising, and only small prolongations in survival are occurring. It is associated with high morbidity and poor prognosis, and a survival rate worse than that for some malignant tumors. The reasons for the increasing overall prevalence of chronic heart failure in developed countries lie in prolonged survival owing to modern pharmacological or invasive treatment, better secondary prevention, and aging of the population. Chronic pulmonary disease is common in patients with chronic heart failure. Through sharing some risk factors and overlapping pathophysiological processes, they present diagnostic and therapeutic challenge. The aim of this article is to review various mechanisms responsible for the symptoms of chronic heart failure with consecutive pulmonary interaction and abnormalities in lung function.

Influence of Transiently Increased Nutritional Risk on a Left Ventricle Myocardial Mass Assessed by Echocardiography.

BACKGROUND/AIM: Metabolic derangements due to increased nutritional risk lead to catabolism and loss of proteins, muscle tissue and eventually mass of parenchymatous organs. The aim of our study was to assess whether transitory nutritional risk after heart surgery influences on the left ventricle myocardial mass (LVMM), assessed by echocardiography. METHODS: Consecutive sample of patients scheduled for cardiovascular rehabilitation, in period 0-3 months after surgery. Nutritional risk screening (NRS) was analyzed using the NRS-2002 tool. RESULTS: Study sample included 330 patients after heart surgery for ischemic 186 (56.4%); valvular 91 (27.6%) and valvular plus ischemic 53 (16.1%) heart disease. Age was 65.5 ± 10.6 (range 23-84) and there were more male patients than female - 240 (72.7%) and 90 (27.3%), respectively. The percentage of unintentional loss of weight was 10.8 ± 3.4%, in range 0-23.81%, whereas NRS-2002 was 4.4 ± 1.1. LVMM was 218.7 ± 65.9 g vs. 252.3 ± 51.7 (p = 0.015); for patients with increased nutritional risk and controls, respectively. There was no significant correlation of LVMM with NRS-2002, while the percentage of unintentional loss of weight displayed only weakly inverse correlation (Rho CC = -0.197; p = 0.007). LVMM also correlated significantly with body mass index (Rho CC = 0.247; p < 0.001) and waist-to-hip ratio (Rho CC = 0.291; p < 0.001). In conclusion, LVMM was found to decrease slightly in the period of increased nutritional risk, following heart surgery. Changes in LVMM are partially consequences of systemic catabolic response, as well as anthropometric changes due to unintentional loss of weight.

Pulmonary tumorlets with surrounding fibrous tissue--suspected carcinoma: case report and review of the literature.

Pulmonary tumorlets are small, often multiple nodular proliferations of pulmonary neuroendocrine cells. They are common incidental findings in chronic inflammatory pulmonary diseases. They can also be found in normal lung parenchyma and as one part of the continuum known as diffuse idiopathic pulmonary neuroendocrine cell hyperplasia. In many cases, they are incidental histologic findings of no importance or clinical consequences, or they can be associated with a very slow progression of either obstructive or mixed obstructive/restrictive impairment with good prognosis. Only rarely, they metastasize to an adjacent lymph node or produce ectopic neuroendocrine products. When found during diagnostic examination, they represent a doubt to be a malignant tumor until proven otherwise, which is often impossible without biopsy or surgical removal of the adjacent lung lobe. Hereby, we present a patient with a persistent nodular lung structure after being treated for nonspecific symptoms, cough with non purulent sputum and pain among the scapulae, for a period of one month. He had otherwise normal clinical and laboratory findings, except for a mild mixed obstructive/restrictive pattern of impairment that was shown by lung spirometry. After 8 months, he underwent lobectomy of the medial lobe of the lung with partial lymphadenectomy, since the diagnostic methods applied could not define the nature of lung nodular infiltration. Histologic examination showed a few tumorlets surrounded by the fibrous tissue with a very dense lymphocyte infiltration. We present a review of the literature and emphasize the necessity to include tumorlets with adjacent fibrosis as part of the differential diagnosis of a solitary nodular lung structure.

Role of Ki-67 as a prognostic factor in gastrointestinal stromal tumors.

AIM: To investigate primarily the prognostic value of Ki-67, as well as other parameters, in gastrointestinal stromal tumors (GISTs). METHODS: Ki-67, c-KIT, platelet-derived growth factor receptor-alpha (PDGFRα), smooth muscle actin (SMA), CD34, S100 were stained for immunohistochemistry which was performed on formalin-fixed, paraffin-embeded sections on representative block from each case. Proliferation index counted by Ki-67 antibody was calculated as a number of positive nuclear reaction over 100 cells. Immunoreactivity for c-KIT and PDGFRα was evaluated semiquantitatively (weak, intermediate, strong) and for c-KIT type of reactivity was analyzed (cytoplasmic, membrane and "dot-like" staining). Immunoreactivity for SMA, CD34 and S100 were was evaluated as positive or negative antigen expression. Pathologic parameters investigated in this study included tumor size, cell type (pure spindle, pured epitheloid mixed spindle and epitheloid), mitotic count, hemorrhage, necrosis, mucosal ulceration. Clinical data included age, gender, primary tumor location and spread of disease. χ² test and Student's t-test were used for comparisons of baseline characteristics. The Cox's proportional hazard model was used for univariable and multivariable analyses. Survival rates were calculated by Kaplan-Meier method and statistical significance was determined by the log-rank test. RESULTS: According to the stage of disease, there were 36 patients with localized disease, 29 patients with initially localized disease but with its recurrence in the period of follow up, and finally, 35 patients had metastatic disease from the very beginning of disease. Tumor originated most commonly in the stomach (41%), small intestine was the second most common location (36%). The mean size of primary tumors was 6.5 cm. The mean duration of follow-up was 60 mo. Multiple parameters were analyzed for their effect on overall survival, but no one reached statistical significance (P = 0.06). Analysis of time to progression/relapse in initially localized disease (univariate analysis), tumor size, mitotic count, Ki-67 and type of d-KIT distribution (cytoplasmic vs membrane/"dot-like") showed statistically significant correlation. In multivariate analysis in the group of patients with localized disease, there were only 2 parameters that have impact on relapse, Ki-67 and SMA (P < 0.0001 and P < 0.034, respectively). Furthermore, Ki-67 was analyzed in localized disease vs localized with recurrence and metastatic disease. It was shown that there is a strict difference between these 2 groups of patients (median value was 2.5 for localized disease vs 10.0 for recurrent/metastatic disease, P < 0.0001). It was also shown that the cut-off value which is still statistically significant in terms of relapse on the level of 6%. The curves for survival on that cut-off level are significantly different (P < 0.04, Cox F). CONCLUSION: Ki-67 presents a significant prognostic factor for GIST recurrence which could be of great importance in evaluating malignant potential of disease.

Symptomatic cardiac metastases of breast cancer 27 years after mastectomy: a case report with literature review--pathophysiology of molecular mechanisms and metastatic pathways, clinical aspects, diagnostic procedures and treatment modalities.

Metastases to the heart and pericardium are rare but more common than primary cardiac tumours and are generally associated with a rather poor prognosis. Most cases are clinically silent and are undiagnosed in vivo until the autopsy. We present a female patient with a 27-year-old history of an operated primary breast cancer who was presented with dyspnoea, paroxysmal nocturnal dyspnoea and orthopnoea. The clinical signs and symptoms aroused suspicion of congestive heart failure. However, the cardiac metastases were detected during a routine cardiologic evaluation and confirmed with computed tomography imaging. Additionally, this paper outlines the pathophysiology of molecular and clinical mechanisms involved in the metastatic spreading, clinical presentation, diagnostic procedures and treatment of heart metastases. The present case demonstrates that a complete surgical resection and systemic chemotherapy may result in a favourable outcome for many years. However, a lifelong medical follow-up, with the purpose of a detection of metastases, is highly recommended. We strongly call the attention of clinicians to the fact that during the follow-up of all cancer patients, such heart failure may be a harbinger of the secondary heart involvement.

Cytoprotective effects of ß-melanocortin in the rat gastrointestinal tract.

Recently discovered anti-inflammatory and immunomodulatory properties of melanocortin peptides led to the conclusion that they might serve as new anti-inflammatory therapeutics. The purpose of this work was to examine the effectiveness of ß-melanocortin (ß-MSH) in two experimental models: ethanol-induced gastric lesions and TNBS (2,4,6-trinitrobenzenesulfonic acid)-induced colitis in male Wistar rats. Three progressive doses of ß-MSH were used: 0.125, 0.250 and 0.500 mg/kg. Our results suggest that ß-MSH acts as a protective substance in the gastric lesions model, which can be seen as a statistically significant reduction of hemorrhagic lesions at all three doses, compared to the control group. The most efficient dose was 0.250 mg/kg. Statistically significant reduction in mucosal surface affected by necrosis and the reduction of overall degree of inflammation in the colitis model indicates an anti-inflammatory effect of ß-MSH at a dose of 0.250 mg/kg. The results justify further research on ß-MSH peptide and its derivates in the inflammatory gastrointestinal diseases, and point out the possibility of using ß-MSH in studies of digestive system pharmacology.

HER-2/neu oncogene and estrogen receptor expression in non small cell lung cancer patients.

Non-small cell lung cancers are among the leading causes of cancer morbidity and mortality worldwide. The prognosis is usually based on traditional pathohistological parameters and clinical stage, but additional prognostic survival factors have also been sought. The aim of this retrospective study was to explore the membranous expression of HER-2/neu and estrogen receptors in nonsmall cell lung cancers and their relation to survival of patients with non-small cell lung cancers and to traditional prognostic factors. The sample consisted of 132 consecutive, surgically resected patient tissues of non-small cell lung cancers, and the following parameters were examined: HER-2/neu and estrogen receptor expression, as well as the related clinical and pathological features: tumor, nodes, and metastases stage, level of tumor necrosis, histological and nuclear grade, lymphocytic infiltrate, and number of mitoses. HER-2/neu was positive in 28.8% of tumor samples, and estrogen receptor expression was positive in 29.5% of tumors, but neither was significantly associated with the outcome of non-small cell lung cancers. There was a significant association between HER-2/neu and nuclear grade (P=0.01). In addition, the association between estrogen receptor expression and histological type of tumor (P=0.04) and mitotic rate (P=0.008) was found. Kaplan-Meier analysis showed a significant association of patients' overall survival with the tumor node metastasis stage (P<0.001) and the degree of tumor necrosis (P=0.02). Cox proportional hazard regression analysis showed that male gender (P=0.01), histological type (P=0.03), high degree of necrosis (P=0.006), and higher histological grade (P=0.037) were associated with the patients' survival. Our findings indicate that the expression of HER-2/neu and estrogen receptor is less reliable than traditional histological parameters in predicting the survival of patients with non-small cell lung cancers.

Necrotising sarcoid granulomatosis of the spinal cord: case report.

We report a patient who presented with leg weakness and cervical lymphadenopathy. Thoracical magnetic resonance imaging showed an inhomogenously increased signal in the thickened portion of the cord. Multilevel laminectomy and spinal cord biopsy revealed granulomatous infiltrations with necrosis. Review of the histopathological finding established the diagnosis of necrotising sarcoid granulomatosis (NSG) of the spinal medulla, cytological FNA diagnosis of the neck lymph node was granulomatous inflammation with necrosis, but histopathological analysis of the same neck lymph node disclosed granulomatous inflammation without necrosis. On further radiographic chest evaluation mediastinal lymphadenopathy was found. Immunophenotyping of lymphocytes in bronchoalveolar lavage fluid (BALF) was indicative of sarcoidosis. After the administration of corticosteroid therapy the patient's clinical condition improved, and laryngeal and mediastinal lymph nodes subsided with minor changes remaining in the spinal medulla, which, based upon MR assessment, were considered to be irreversible. To our knowledge, this is the first described case with finding of granulomatous inflammation with and without vasculitis in various organs, consistent with the Churg's study who believes NSG to be a histological variant of sarcoidosis.

Prognostic value of computed tomography morphologic characteristics in stage I non-small-cell lung cancer.

BACKGROUND: In this study, we describe the prognostic value of NSCLC morphologic characteristics obtainable by computed tomography (CT) in the preoperative staging. Starting with the initial hypothesis that CT morphologic characteristics of NSCLC have a prognostic value, we conducted a retrospective study that included 194 patients. PATIENTS AND METHODS: All patients underwent surgery because of stage IA or IB non-small-cell lung carcinoma (NSCLC). Surgical procedures were performed in our clinic over the period of 9 years and 8 months starting in June 1996 and ending in February 2006. Preoperative CT scans and clinical data available for each patient were analyzed retrospectively. RESULTS: Over the study period, 93 patients died. The mean survival time was 78.6 months (95% confidence interval was 72.63-84.57 months). After a 2-year follow-up, 85.57% of patients were alive, but this decreased to 63.9% living patients after 5 years. Morphologic tumor characteristics were obtained by analyzing CT images available for each patient. These CT morphologic characteristics were divided into 5 categories: size, tumor edges, structure, and periphery of the tumor, as well as its relation to visceral pleura. We correlated each of these characteristics to the survival of patients. CONCLUSION: We conclude that, within stage I NSCLC, patient survival and disease prognosis vary significantly depending on such morphologic characteristics. This fact is one of the weakest points of the current tumor-node-metastasis (TNM) classification. Along with already-established tumor prognostic attributes such as size and TNM grade, we identified CT morphologic characteristics as powerful additional prognostic factors for NSCLC.

[Pulmonary Langerhans' cell histiocytosis--case report]. / Plucna histiocitoza Langerhansovih stanica--prikaz bolesnika.

Authors report a case of a 29-year old patient with pulmonary Langerhans' cell histiocytosis who presented with chest pain as a consequence of rib osteolytic process. We carried out a diagnostic work-up which included laboratory and radiographic analysis, lung function tests, bronchoscopy, cytologic and pathologic analysis. After reaching the diagnosis, corticosteroid therapy was introduced with long-term follow-up. In this report, we included a brief review of pulmonary Langerhans' cell histiocytosis.

Nm23 gene product expression in invasive breast cancer--immunohistochemical analysis and clinicopathological correlation.

The nm23 gene/protein is a putative metastatic suppressor identified a decade ago in a melanoma cell line. A number of laboratory, clinical and pathological studies have been carried out to define its real biological and biochemical function as a step in a complex metastatic process. In our study we examined the significance of nm23 expression in 164 breast cancer patients, aged 35 to 74 years, in comparison to other parameters such as age, menopausal status, histological grade, tumor size, lymph node status, and hormone receptor status. Overall survival (OS) and disease-free survival (DFS) were analyzed. The median follow-up was 84 months. Significant changes in OS were found for tumor size, nodal involvement and histological grade but there was no convincing correlation with nm23 expression. When patients were stratified according to nm23 expression, it was shown that overall survival in nm23-positive patients was no longer than that in nm23 negative patients. It was also shown that patients who were lymph node negative and older than 50 years had longer OS than nm23-negative patients. A statistical analysis shows that there is a correlation between axillary node status and nm23 expression (p = 0.018) as well as between patients' ages and nm23 expression (p = 0.043). There was no statistically significant correlation between nm23 expression, lymph node status and their combination on DFS.