Polyneuropathy and myopathy in beta-thalassemia major patients.

The thalassemias are the most common single gene disorder in the world. Nowadays, the average life expectancy of patients in developed countries has increased significantly, while, there was an increase of complications. We aimed to investigate peripheral neuropathy and myopathy in this patient group using a neurophysiological study. We performed nerve conduction studies and electromyography of upper and lower extremities on 36 beta-thalassemia major (ß-thal) patients. The electrophysiological findings were correlated with demographic data and laboratory parameters of the disease. Patients with ß-thal present polyneuropathy or myopathy at (50%). Polyneuropathy was detected in (38.9%) and myopathy in (27.8%), while polyneuropathy and myopathy were present at (16.7%) with an overlap of the diseases in 1/3 of the patients. There was not a statistically significant correlation of polyneuropathy and myopathy with age, sex, splenectomy, nor with respect to laboratory parameters, hemoglobin, and ferritin. However, there was a statistically significant correlation of polyneuropathy and myopathy with iron overload, as recorded by the magnetic resonance imaging (MRI) of the heart and the liver. Our findings suggest that iron overload plays a key role in the pathogenesis of polyneuropathy and myopathy in ß-thal patients, and performing heart and liver MRI for the prediction of such lesions in an annual basis is warranted.

[Artistic expression and Psychiatry in Greece: Prominence highlights (1950-2011)].

The art of the confined began to be studied by psychiatrists in the late 19th century for diagnostic purposes, while the first studies of aesthetic interest were found in the first decades of the 20th century, when psychiatrists as the Swiss W. Morgenthaler and the Austrian H. Prinzhorn published studies on mentally ill artworks, having mainly aesthetic approach. The artworks of the mentally ill belong to the field of Art found in the international literature by the term of Art Brut. The term "Brut" was introduced in 1945 by J. Dubuffet to describe the production of art by authors who were not taught academic art, did not belong to any artistic movement and were indifferent to a potential identification with the viewer or the collector. This French painter and sculptor named Art Brut the founded movement, whose main field was the works of mental patients. Dubuffet was particularly affected, in terms of artistic expression, like so many other creators of expressionism and surrealism, by the art of the mentally ill. Regarding the Greek scene, the relationship between our country and this category of Art began in 1950, at the Psychiatric Hospital of Attica "Dromokaitio", when Professor G. Pampoukis and Dr N. Drakoulidis sent patients' works to the Exposition Internationale d' Art Psychopathologique ( International Exhibition of Psychopathological Art) held in Paris that year. By the late 1980's, only occupational therapy projects existed. The first major artist appearance with a mental disorder is that of O.K. with his participation in the 2nd Biennale of Young Artists of the Mediterranean, in 1987. The year 1994 was a very important one in terms of art production of the mentally ill, as the Cultural Communication Unit (CCU) of the Psychiatric Hospital of Thessaloniki (P.H.T.) was founded, which aim was to produce original works that recorded the psychic reality of the patients and did not recreate other artists' projects. Regarding the promotion of this art, of great significance are the three Panhellenic Exhibitions held in 1996, 1997 and 2001, the last under the auspices of the Greek Psychiatric Association, which brought together the patient-artists' projects of various institutions of our country with the general public, receiving very positive feedback from both the press and the critics. Worth mentioning is also the honorary discrimination of two patient-artists who cooperated with the CCU, D.Z. and A.V., in EUWARD 2004 and 2007 of the German Foundation Augustinum, and also of G.M., who was awarded the first prize at the competition of "Very Special Art" in USA. Two other important moments of the effort of projecting the relationship between Art and Psychiatry were first in 2004 with the exhibition On The Other Bank, as part of the Cultural Olympiad, and the other in 2005 at the Christian and Byzantine Museum of Athens, where the exhibition Art against Stigma, organized by the World Psychiatric Association, the Greek Psychiatric Association and a privately held pharmaceutical company took place. Finally in 2011, again under the auspices of the Greek Psychiatric Association, works of the famous Prinzhorn Collection were exhibited both in Athens and Thessaloniki. In this way the public, once again, came into contact with works in which fears, insecurities and demons within the soul of every patientartist were imprinted, these projects serving not only as clinical evidence but also as creations of unquestionable artistic value.

Neurological complications of beta-thalassemia.

The thalassemias are the most common single gene disorder in the world. Over the last years, several reports have demonstrated neurological complications in beta-thalassemia patients. In most cases, these complications remained subclinical and were detected only during neuropsychological, neurophysiological, or neuroimaging evaluation. Cognitive impairment, abnormal findings on evoked potentials, complications due to extramedullary hematopoiesis, cerebrovascular disease, and peripheral neuropathy comprise the broad spectrum of neurological involvement. Chronic hypoxia, iron overload, desferrioxamine neurotoxicity, and bone marrow expansion are implicated, but sufficient explanatory evidence is lacking and development of biomarkers is needed. This review summarizes current knowledge of the neurological complications. As life expectancy for beta-thalassemia patients increases, we support the use of neurophysiological, neuropsychological, or neuroimaging monitoring, enabling the evaluation of neural pathway impairment, to achieve appropriate management and as a result a better quality of life for this patient group.

A case of peduncular hallucinosis due to a pontine infarction: a rare complication of coronary angiography.

BACKGROUND: Cerebral thromboembolism is a rare, but well-recognized complication of angiographic procedures. Peduncular hallucinosis (PH) is a form of complex visual hallucinations usually associated with lesions in the midbrain and thalamus. CASE PRESENTATION: We report the case of a 79-years-old male patient with internuclear ophthalmoplegia and vivid lilliputian visual hallucinations (peduncular hallucinations), caused by a pontine infarction following coronary artery catheterization. The patient was started on quetiapine treatment with good results and tolerance. In the next three months, the medication has been discontinued, and the patient is without symptomatology thereafter. CONCLUSION: An understanding of how different pathologies may produce complex visual hallucinations can lead to an appropriate treatment, depending on the site and the nature of the lesion. Furthermore, cerebral embolism due to any angiographic procedure, although rare, should always be taken into consideration, upon any neurological manifestation, visual hallucinations included. Hippokratia 2015; 19 (3): 268-269.

A pilot, open label, clinical trial using hydroxyzine in multiple sclerosis.

Multiple sclerosis (MS) is an autoimmune disorder of myelin destruction. Blood-brain-barrier (BBB) disruption precedes pathological or clinical findings and could involve mediators from perivascular brain mast cells, such as histamine and vascular endothelial growth factor (VEGF). Mast cells could be activated by many triggers, including acute stress that has been correlated with MS exacerbations. We considered that the histamine-1 (H1) receptor antagonist hydroxyzine, which also partially inhibits brain mast cells and has anxiolytic properties, may reduce MS symptoms. This open label, pilot, clinical trial investigated the effect on MS of an oral solution of hydroxyzine (100 mg per day), together with caffeine (200 mg per day) to reduce sedation. Twenty patients (8 males; 12 females) with relapsing-remitting or relapsing-progressive MS completed the study (12 +/- 1 months) and were evaluated using disability scales. Most patients on hydroxyzine (75%) remained stable or improved neurologically and all but one showed improved mood. Hydroxyzine could be used as an adjuvant in MS, but the small number of patients enrolled and the short duration of the study precludes any definitive conclusions. A double-blind, placebo-controlled study is warranted.

A comparison of platelet monoamine oxidase activity and phosphatidylserine content between chronic paranoid schizophrenics and normal controls.

Mitochondrial monoamine oxidase (MAO), type B, has been implicated in the etiology of schizophrenia. We have found the phospholipid, phosphatidylserine (PS) to be a highly specific inhibitor of MAO-B, which has led us to postulate that the PS-MAO interaction might offer a basis for the lower MAO levels observed in platelets from certain schizophrenic populations. In this study we compared platelet MAO activity with phospholipid composition in a group of normals and chronic paranoid schizophrenics. The phospholipids in platelets and erythrocytes were extracted and separated by high-performance liquid chromatography into major classes phosphatidylcholine (PC), phosphatidylethanolamine, lysophosphatidylethanolamine, phosphatidylinositol and PS. The paranoid subjects showed statistically significantly lower MAO activity as well as higher mean levels of PS and lower levels of PC in both platelets and erythrocytes, consistent with our hypothesis. The Ca2+-stimulated synthesis of serine-lipid in platelets was also monitored by incorporation of radioisotope into lipid extracts from 14C-labelled serine substrate, and no significant differences were found between subjects groups with respect to this parameter.