Iron deficiency anaemia influences cognitive functions.

Many diseases, different nutritional, metabolic and hormonal changes, ageing and drugs can alter cognitive functions. Anemia via cerebral hypoxia and other possible mechanisms has been suggested to have a great influence on cognition. Iron deficiency anemia, the most common form of anemia, has been suggested to result in cognitive deterioration and alteration of neurological functions. Previous studies resulted in significant discrepancies considering correlation between anemia and cognitive achievement mainly because different or not sensitive enough tests used to measure cognition. We suggest a significant influence of iron deficiency anemia on dynamic properties and functional features of the central nervous system activity. Cognitive achievement is strongly related to hemoglobin level and could be expected in all patients. Higher hemoglobin level results in better CNS function. As a first step in confirming or refuting our hypotheses we suggest standardization of the method used to measure cognition, such as a very sensitive apparatus like Complex reactiometer Drenovac (CRD).

Lyme borreliosis and multiple sclerosis are associated with primary effusion lymphoma.

Multiple sclerosis (MS) is a chronic disease of the central nervous system characterized by chronic inflammation and demyelination. Studies suggested that the viral, especially Epstein-Barr virus infection, and bacterial infections, especially Borrelia burgdorferi infection, play a role in etiology of MS. MS prevalence parallels the distribution of the Lyme disease pathogen B. burgdorferi. Criteria used for diagnosis of MS can also be fulfilled in other conditions such as Lyme disease, a multisystem disorder resulting from infection by the tick-borne spirochete, B. burgdorferi. In the late period of Lyme disease demyelinating involvement of central nervous system can develop and MS can be erroneously diagnosed. A Lyme borreliosis can mimick central nervous system lymphoma. Also, B. burgdorferi has been implicated not only in etiology of MS, but also in etiology of lymphoma. Studies suggested that there is an increased risk of non-Hodgkin lymphoma in patients, who had a history of autoimmune diseases such as MS and that both non-Hodgkin's lymphomas and Hodgkin's disease were associated with Epstein-Barr virus infection. A small group of lymphomas called primary effusion lymphomas (PEL) is a recently individualized form of non-Hodgkin's lymphoma (WHO classification) that exhibit exclusive or dominant involvement of serous cavities, without a detectable solid tumor mass. These lymphomas have also been linked to Epstein-Barr virus and human herpes virus type 8 infections but virus negative cases have been described. Therefore, we propose that MS and neuroborreliosis are linked to central nervous system primary effusion lymphomas. As a first step in confirming or refuting our hypotheses, we suggest a thorough study of CSF in the patients suspected for the diagnosis of MS and Lyme borreliosis.

[Magnetic resonance cholangiopancreatography]. / Magnetnorezonantna kolangiopankreatografija (MRCP).

Magnetic resonance cholangiopancreatography (MRCP) is a noninvasive imaging test with excellent overall sensitivity and specificity for demonstrating the level and presence of biliary obstruction. Selected MRCP sequences allow relatively stagnant fluids, such as bile and pancreatic juice, to have a high-signal intensity compared with the dark signal of adjacent solid organs and circulating blood, without the use of a contrast agent. Its inability to offer therapeutic interventions is a major weakness of MRCP. MR cholangiopancreatography demonstrates biliopancreatic system at the coronal planes similar to direct cholangiography. Due to very high negative predictive value, MRC has a potential to substitute invasive diagnostics in all patients with suspected choledocholithiasis reserving it for the patients that require therapeutic intervention. MR cholangiography may be useful in establishing the resectability of a malignant neoplasm such as hilar cholangiocarcinoma by helping determine the proximal extent of disease where ERCP may not be successful and in distal obstructions in which percutaneous cholangiography may be of limited value.

Role of magnetic resonance cholangiography in the diagnosis of bile duct lithiasis.

AIM: The aim of our study was to assess diagnostic value of magnetic resonance cholangiography (MRC) in patients with suspected common bile duct (CBD) stones focusing on the capability of this noninvasive method to replace invasive diagnostic procedures in these patients and to limit the use of endoscopic retrograde cholangiography (ERC) to the patients who need simultaneous therapeutic intervention. MATERIALS AND METHODS: Single-shot fast-spin-echo rapid-acquisition thick-section MRC images were obtained in 310 patients recruited into this prospective study. There were 136 male and 174 female patients aged 21-95 years [mean +/- standard deviation (SD) 64.9 +/- 13.6 years]. Patients were subsequently classified into different risk groups (high, moderate, low) according to biochemical abnormalities or morphological features on abdominal ultrasonography and computed tomography. Direct cholangiography was the reference method of CBD evaluation. RESULTS: CBD stones were diagnosed in 115 (37%) patients; 86 of 175 patients in the high-risk group, 24 of 83 patients in the moderate-risk group, and 5 of 50 patients in the low-risk group. In dependent risk groups, the mean CBD caliber was 9.7 +/- 4.5, 7.1 +/- 2.0, and 4.8 +/- 1.2 mm, respectively. The difference was significant between all three groups (P < 0.05). The median size of CBD stones was 7 mm (range 3-21 mm). MRC achieved accuracy and positive and negative predictive values of 97%, 94%, and 98%, respectively. CONCLUSIONS: MRC has a potential to substitute diagnostic ERC in all patients with suspected choledocholithiasis due to its high accuracy, reducing invasive direct cholangiography to patients who require therapeutic intervention.