Relationship between the hippocampal shape abnormality and serum cortisol levels in first-episode and drug-naïve major depressive disorder patients.

BACKGROUND: We aimed to investigate the relationship between the hippocampal shape deformations and the serum cortisol levels in first-episode and drug-naïve major depression disorder (MDD) patients. METHODS: Thirty first-episode and drug-naïve MDD patients and 40 healthy subjects were recruited. High-resolution T1-weighted imaging and morning blood samples for cortisol measurement were obtained from all MDD patients and healthy subjects. In the hippocampal shape analysis, we compared the hippocampal shape between MDD patients and healthy subjects and evaluated the linear correlation between hippocampal shape deformations and the serum cortisol levels in MDD patients and healthy subjects. RESULTS: MDD patients showed significant inward deformations predominantly in the cornu ammonis (CA) 1 and subiculum in bilateral hippocampi compared to healthy subjects (false discovery rate (FDR) corrected, P < .05). Furthermore, in MDD patients, a significant linear correlation between inward deformations and high cortisol levels were found predominantly in the CA1 and subiculum, extending into the CA2-3 (FDR-corrected, P < .05), whereas no significant linear correlation was observed in healthy subjects. CONCLUSIONS: The serum cortisol levels are therefore considered to be associated with hippocampal shape abnormalities in MDD.

Utility of real-time prospective motion correction (PROMO) on 3D T1-weighted imaging in automated brain structure measurements.

PROspective MOtion correction (PROMO) can prevent motion artefacts. The aim of this study was to determine whether brain structure measurements of motion-corrected images with PROMO were reliable and equivalent to conventional images without motion artefacts. The following T1-weighted images were obtained in healthy subjects: (A) resting scans with and without PROMO and (B) two types of motion scans ("side-to-side" and "nodding" motions) with and without PROMO. The total gray matter volumes and cortical thicknesses were significantly decreased in motion scans without PROMO as compared to the resting scans without PROMO (p < 0.05). Conversely, Bland-Altman analysis indicated no bias between motion scans with PROMO, which have good image quality, and resting scans without PROMO. In addition, there was no bias between resting scans with and without PROMO. The use of PROMO facilitated more reliable brain structure measurements in subjects moving during data acquisition.

Relationship between white matter integrity and serum cortisol levels in drug-naive patients with major depressive disorder: diffusion tensor imaging study using tract-based spatial statistics.

BACKGROUND: Higher daytime cortisol levels because of a hyperactive hypothalamic-pituitary-adrenal axis have been reported in patients with major depressive disorder (MDD). The elevated glucocorticoids inhibit the proliferation of the oligodendrocytes that are responsible for myelinating the axons of white matter fibre tracts. AIMS: To evaluate the relationship between white matter integrity and serum cortisol levels during a first depressive episode in drug-naive patients with MDD (MDD group) using a tract-based spatial statistics (TBSS) method. METHOD: The MDD group (n = 29) and a healthy control group (n = 47) underwent diffusion tensor imaging (DTI) scans and an analysis was conducted using TBSS. Morning blood samples were obtained from both groups for cortisol measurement. RESULTS: Compared with the controls, the MDD group had significantly reduced fractional anisotropy values (P<0.05, family-wise error (FWE)-corrected) in the inferior fronto-occipital fasciculus, uncinate fasciculus and anterior thalamic radiation. The fractional anisotropy values of the inferior fronto-occipital fasciculus, uncinate fasciculus and anterior thalamic radiation had significantly negative correlations with the serum cortisol levels in the MDD group (P<0.05, FWE-corrected). CONCLUSIONS: Our findings indicate that the elevated cortisol levels in the MDD group may injure the white matter integrity in the frontal-subcortical and frontal-limbic circuits.

Genetic Variation in the Catechol-O-Methyl Transferase Val108/158Met Is Linked to the Caudate and Posterior Cingulate Cortex Volume in Healthy Subjects: Voxel-Based Morphometry Analysis of Brain Magnetic Resonance Imaging.

The effect of the catechol-O-methyltransferase (COMT) Val158Met polymorphism on brain morphology has been investigated but remains controversial. We hypothesized that a comparison between Val/Val and Val/Met individuals, which may represent the most different combinations concerning the effects of the COMT genotype, may reveal new findings. We investigated the brain morphology using 3-Tesla magnetic resonance imaging in 27 Val/Val and 22 Val/Met individuals. Voxel-based morphometry revealed that the volumes of the bilateral caudate and posterior cingulate cortex were significantly smaller in Val/Val individuals than in Val/Met individuals [right caudate: false discovery rate (FDR)-corrected p = 0.048; left caudate: FDR-corrected p = 0.048; and bilateral posterior cingulate cortex: FDR-corrected p = 0.048]. This study demonstrates that interacting functional variants of COMT affect gray matter regional volumes in healthy subjects.

RELATIONSHIP BETWEEN THE CORTICAL THICKNESS AND SERUM CORTISOL LEVELS IN DRUG-NAÏVE, FIRST-EPISODE PATIENTS WITH MAJOR DEPRESSIVE DISORDER: A SURFACE-BASED MORPHOMETRIC STUDY.

OBJECTIVE: In major depressive disorder (MDD) patients, higher morning cortisol levels due to a hyperactive hypothalamic-pituitary-adrenal (HPA) axis have been reported. The aim of the present study was to evaluate the relationship between cortical thinning and the serum cortisol levels during the first depressive episode in drug-naïve MDD patients using an automated surface-based morphometry (SBM) method. METHODS: The institutional review board approved this prospective study. MR imaging data were obtained using a 3T scanner by a three-dimensional fast-spoiled gradient recalled acquisition with steady state (3D-FSPGR). Thirty drug-naïve patients with MDD and 41 age- and gender-matched healthy subjects (controls) were enrolled. We then used the SBM method (Freesurfer) to generate cortical thickness maps, and measured the cortical thickness in each subject. Morning blood samples were drawn from all participants for cortisol measurements. RESULTS: We found the serum cortisol levels were significantly higher in the MDD patients than in the controls. The MDD patients manifested significant thinning of the left lateral orbitofrontal cortex compared with the controls. There was a significant negative linear correlation between the thickness of the left lateral orbitofrontal cortex and the serum cortisol levels in the MDD patients. CONCLUSIONS: In the early stage of MDD, the thickness of the lateral orbitofrontal cortex was significantly reduced, and also showed a significant inverse correlation with the serum cortisol levels. Since the lateral orbitofrontal cortex contains a high concentration of glucocorticoid receptor, glucocorticoid receptor-mediated signaling transductions could contribute to neurotoxicity, which might occur when there are high cortisol levels in patients with MDD.

Relationship between the catechol-O-methyl transferase Val108/158Met genotype and brain volume in treatment-naive major depressive disorder: Voxel-based morphometry analysis.

Catechol-O-methyltransferase (COMT) is a methylation enzyme engaged in the degradation of dopamine and noradrenaline by catalyzing the transfer of a methyl group from S-adenosylmethionine. An association was found between the Valine (Val) 108/158Methionine (Met) COMT polymorphism (rs4680) and major depressive disorder (MDD). The authors prospectively investigated the relationship between the Val108/158Met COMT genotype and voxel-based morphometry (VBM) findings for patients with first-episode and treatment-naïve MDD and healthy subjects (HS). Participants comprised 30 MDD patients and 48 age- and sex-matched HS who were divided according to the COMT genotype. Effects of diagnosis, COMT genotype, and the genotype-diagnosis interaction in relation to brain morphology in the Val/Met and Val/Val individuals were evaluated using a VBM analysis of high-resolution magnetic resonance imaging findings. Among the Val/Met individuals, the volume of the bilateral caudate was significantly smaller for MDD patients than for HS. In the Val/Val individuals, the caudate volume was comparable between MDD patients and HS. Significant genotype-diagnosis interaction effects on brain morphology were noted in the right caudate.

Delineation of optic nerves and chiasm in close proximity to large suprasellar tumors with contrast-enhanced FIESTA MR imaging.

PURPOSE: To evaluate whether contrast material-enhanced (CE) fast imaging employing steady-state acquisition (FIESTA) can depict the anterior optic pathways in patients with large suprasellar tumors. MATERIALS AND METHODS: Institutional review board approval was obtained. Twenty-eight patients with large suprasellar tumors undergoing surgical treatment (19 pituitary adenomas, six meningiomas, and three additional miscellaneous tumors) underwent preoperative magnetic resonance (MR) imaging, including CE FIESTA, at 3.0 T. Two radiologists assessed the visibility of five segments of the optic pathways (bilateral optic nerves and optic tracts, optic chiasm) with CE FIESTA and conventional MR imaging, including thin-section coronal T2-weighted imaging and CE T1-weighted imaging, by using a three-point scale. Moreover, the preoperative signal intensity of the optic pathways was correlated with pre- and postoperative visual impairment to determine whether high signal intensity at CE FIESTA is predictive of persistence of visual impairment after surgery. The χ(2) test was used to compare scores assigned to CE FIESTA and conventional MR images. RESULTS: The percentage of anterior optic pathways rated as visible was significantly higher with CE FIESTA than with conventional MR imaging (100% [140 of 140 segments] vs 78% [109 of 140 segments], P < .05). Thirty-one of the 140 segments (22%) were not depicted with conventional MR imaging; all of these 31 segments were visualized with CE FIESTA. For 12 patients who underwent transcranial surgery, the anatomic locations of the optic pathways at CE FIESTA were compatible with the surgical findings. CE FIESTA helped predict persistent visual impairment after surgical treatment with a sensitivity of 75% (three of four patients) and a specificity of 96% (23 of 24 patients). The accuracy of CT FIESTA in the prediction of visual loss was significantly higher than that of T2-weighted imaging (93% [26 of 28 patients] vs 50% [14 of 28 patients], P < .05). CONCLUSION: CE FIESTA is useful for the preoperative localization of the anterior optic pathways in patients with large suprasellar tumors and offers the potential to predict persistent visual impairment after decompression.

Intense accumulation of gallium-67 citrate in pancreatic endocrine tumor.

We report intense accumulation of gallium-67 (Ga-67) citrate in a pancreatic endocrine tumor. A 69-year-old woman was admitted because of cough, fever, and weight loss. An abdominal enhanced computed tomography (CT) scan revealed a large tumor located between the liver and pancreas as well as swollen paraaortic lymph nodes. Whole-body scintigraphy with Ga-67 revealed intense accumulation in the upper abdomen corresponding to the mass, as well as in the midabdomen and the mediastinal lesion. Percutaneous needle biopsy was performed, and the diagnosis was adenocarcinoma of the pancreas. The patient's condition deteriorated, and she died 2 months after admission. The pathological examination at autopsy revealed a pancreatic endocrine tumor. No report has described findings of Ga-67 citrate scintigraphy of pancreatic endocrine tumors. Pancreatic endocrine tumor should be included in a differential diagnosis when such scintigraphic findings are encountered.

Fulminant hepatic failure resulting from small-cell lung cancer and dramatic response of chemotherapy.

Prompt treatment in tumor-associated encephalopathy may prolong survival. We describe a 69-year-old male patient who was presented with fulminant hepatic failure, secondary to small-cell lung carcinoma with rapidly progressing encephalopathy. Both symptoms remitted following chemotherapy, suggesting swift diagnosis and administration of chemotherapy to be effective in treatment of fulminant hepatic failure and encephalopathy.

[Thymic cancer effectively treated by combination chemotherapy of carboplatin and etoposide with concurrent radiotherapy].

A 63-year-old man was admitted to our hospital for acute heart failure. A chest CT scan revealed a large anterior mediastinal mass and pericardial effusion. Percutaneous needle biopsy showed that the mass was an advanced thymic cancer (squamous cell carcinoma). The patient was treated by combination chemotherapy of carboplatin and etoposide with concurrent radiotherapy (44 Gy). There was no severe toxicity except for grade 4 neutropenia. After 3 courses of chemotherapy, the mass showed an approximately 81% reduction in tumor size and disappearance of the pericardial effusion. Finally, the thymic cancer and small pulmonary metastatic lesions were all resected. This concurrent chemoradiotherapy can be effective against inoperable squamous cell carcinoma of the thymus.

Granisetron plus dexamethasone versus granisetron alone in the prevention of vomiting induced by conditioning for stem cell transplantation: a prospective randomized study.

This prospective randomized study compared the efficacy and toxicity of granisetron and dexamethasone to those of granisetron alone for antiemetic control in patients receiving high-dose chemotherapy with or without total body irradiation (TBI) for stem cell transplantation. Patients were divided randomly into 2 groups. Groups received granisetron twice daily at a dose of 40 microg/kg with or without 4 mg dexamethasone (GS group and G group, respectively), starting 30 minutes before each dose of chemotherapeutic agent or TBI, or 12 hours after the first dose if TBI or a drug was given once a day. Fifty patients were evaluated for the analysis. During the first 24 hours of conditioning, 23 of 25 patients (92.0%) in the GS group achieved complete control of emesis (no emetic episodes over the course of a day), compared with 72.0% in the G group (P = .06). For patients receiving TBI on the first day of conditioning, complete emetic control was achieved in all patients (100.0%) in the GS group, compared with 63.2% in the G group (P = .02). The same degree of emetic control was maintained throughout the conditioning period in 38.8% of the GS group and 29.9% of the G group (P = .10). Adverse reactions were observed more frequently in the GS group (68.0% versus 5.0% in the G group). These reactions included insomnia, headache, flushing, and hyperglycemia. None of the events were serious. We conclude that granisetron with dexamethasone seems superior to granisetron alone for the prevention of emesis resulting from the conditioning regimen; however, the more frequent side effects may limit the wide use of this combination.