Status of retained deciduous second molars in subjects with agenesis of second premolars in relation to age.

AIM: To evaluate the presence and status of retained DM2 without permanent successors in relation to age. BACKGROUND: Preservation of retained deciduous second molars (DM2) can be applied to treat congenital absence of second premolars (PM2). However, the consequences of caries and progressing root resorption or infraocclusion may affect their survival. METHODS: Panoramic radiographs of individuals >10 years of age with agenesis of at least one PM2 were evaluated and divided into three groups according to age. The presence and location of retained DM2, caries/restorations, infraocclusion and root resorption were investigated. RESULTS: A total of 131 subjects with PM2 agenesis were included (mean age: 13 years 11 months). The majority were missing one or two PM2. In total, 174 retained DM2 were present (33%), and their incidence was higher in the younger age groups. Caries/restorations were found in 88 (50.6%) and infraocclusion in 21 (12%) retained DM2. The roots were resorbed mostly for ½ of the root length (35%). CONCLUSION: Long-term prognosis of retained DM2 without permanent successors seems uncertain, especially within the younger age group. In individuals older than 17 years, the prognosis for a healthy DM2 is favorable, if no distinct infraocclusion or extensive root resorption is present.

Computed tomography with positron emission tomography is more useful in local than systemic infectious process related to cardiac implanted electrotherapy device: a prospective controlled multicenter diagnostic intervention PET-Guidance Trial.

Assess the diagnostic value of 18-F FDG PET/CT in cardiac implantable electronic devices (CIED) infections in facilitating diagnostic process and optimizing decision-making process.Study group (n = 21) patients with initial suspected diagnosis of CIED-related infection or fever of unknown origin and patients referred for device removal due to infection. Control group (n = 13) patients with implanted CIED, who underwent PET/CT due to other non-infectious indications and had no data for infectious process in follow-up.PET/CT scan showed pocket infection in 12 patients (including 1 in whom infection was not finally diagnosed-the examination was performed early after the implantation procedure-1.5 months), increased tracer uptake in intravascular lead part in 3 patients, and increased uptake in intracardiac part in 5 patients.We found that sensitivity, specificity, positive predictive value, and negative predictive value of the diagnosis made by PET/CT in generator pocket infection was 91.7%, 70%, 78.6%, 87.5% and in lead-dependent intracardiac infection 100%, 47.1%, 35.7%, 100% respectively. PET/CT scan enabled reclassification of diagnosis from possible to definite CIED-related infection in 6 out of 9 patients, and to excluded in 3 out of 9.Establishing diagnosis of device related infections may be challenging due to non-specific symptoms. Incorporation of PET/CT scan in the diagnostic schema can improve accuracy and timing of the diagnosis and help to assess the extent of infection. PET/CT is more useful in local than systemic infectious process related to cardiac implanted electrotherapy device.Trial registration Consent of the bioethics committee nr IK-NP.-0021-85/1465/14. Registration in the www.clinicaltrials.gov database: NCT02196753.

Association of the HLA-G gene polymorphism with multiple sclerosis in a Polish population.

Summary In this study, three polymorphic sites in the HLA-G gene: -725C>G>T, -716T>G and 14bp(indel) were genotyped. Significant differences were found between patients and controls in the alleles and genotypes for -725C>G>T and in three-point haplotypes. We observed also a significant difference in the age of disease onset between patients positive and negative for 14bp(ins). The results suggest that single nucleotide polymorphisms in the promoter of the HLA-G gene (mainly -725C>G>T), and 14bp(indel), or some genetic marker in tight linkage disequilibrium with them are associated with multiple sclerosis.

Autonomic dysfunction in primary Raynaud's phenomenon.

AIM: The pathogenesis of Raynaud's phenomenon is still unclear. Neural and intravascular mechanisms are thought to be involved in the pathological process. The role of the autonomic nervous system is continually discussed, with particular attention to over-reactivity of the sympathetic part. The aim of this study was the clinical and electrophysiological analysis of autonomic nervous system function in patients with primary Raynaud's phenomenon. METHODS: Thirty four patients with primary Raynaud's phenomenon and 31 sex and age-matched controls were examined. Neurological examination, modified Low's Questionnaire, orthostatic and sustained handgrip tests, conduction velocity study in three nerves, sympathetic skin response (SSR), and heart rate variability (HRV) during deep breathing and at rest with the fast Fourier transform were performed. RESULTS: In the clinical examinations, 35.3% of the primary Raynaud's patients presented sensory neuropathy, but this was not confirmed in the standard conduction velocity tests. The modified Low's Questionnaire revealed dysautonomy in 82% of the patients. Autonomic regulation during the orthostatic and handgrip tests were within the normal limits. HRV at rest and the E/I ratio were significantly lower in the patient group than in the controls, while HRV spectrum analysis revealed the predominance of the low-frequency band in the patients. CONCLUSIONS: These results indicate the presence of sympathetic dysregulation and impairment of parasympathetic modulation of heart function in primary Raynaud's patients. The different cardiovascular and sudomotor functions are not affected to the same degree. These observations might support the theory of a central impairment of autonomic function in primary Raynaud's phenomenon. Peripheral nerve lesion as a coexisting cause of the observed dysautonomy remains uncertain.

Diffusion tensor imaging findings in the multiple sclerosis patients and their relationships to various aspects of disability.

BACKGROUND: The aim of the study was to assess microstructural changes within strategic brain regions in multiple sclerosis (MS) patients, using diffusion tensor imaging (DTI), with regard to various aspects of disability. MATERIAL AND METHODS: The study comprised 50 patients with relapsing-remitting MS (37 women, 13 men, mean age 36.4 yrs) and 27 age- and sex-matched controls. Using DTI, fractional anisotropy (FA) and apparent diffusion coefficient (ADC) values were obtained within corpus callosum (CC), both thalami (TH) and middle cerebellar peduncles (MCP). Disability was assessed using Expanded Disability Status Scale (EDSS), MS Functional Composite (MSFC), Symbol Digit Modalities Test (SDMT) and Fatigue Severity Scale (FSS). DTI indices were compared between the patients and controls and in the MS group - referred to disability measures. RESULTS: Significant decrease in FA and increase in ADC within CC and both TH were found in MS patients compared to the controls. DTI indices within CC and TH correlated significantly with SDMT score, and within TH and MCP - with MSFC manual dexterity measure. CONCLUSIONS: Changes in DTI measures in normal appearing white and grey matter in the MS patients indicate subtle alterations of the tissue integrity. An occult damage to the strategic brain regions may contribute to various aspects of disability due to MS.

Effect of Selective Antibiotic Pressure on the MLS-B Phenotype in Methicillin-Resistant Staphylococcus aureus Strains Originating From Patients From Transplantation Wards: 24 Years of Observations.

INTRODUCTION: Staphylococcus aureus infection, and health care-associated-methicillin resistant S aureus (HA-MRSA) in particular, is a serious risk for patients treated with organ transplantation. The frequent combined resistance of these bacteria to macrolides, lincosamides, and streptogramin-B (MLS-B) limits the use of these drugs in therapy. AIM: Evaluation of the mechanism of MLS-B resistance among HA-MRSA strains derived from patients treated in surgical-transplantation wards, over a 24-year period, and assessment of correlation of clindamycin use and resistance phenotype. MATERIALS AND METHODS: One hundred and twelve HA-MRSA strains from patients in surgical-transplantation wards (clinical hospital, Warsaw), hospitalized in the period from 1991 to 2014. Methicillin-resistance was determined using phenotypic and genetic methods by detecting the mecA gene. Erythromycin/clindamycin resistance was determined by E-test, the iMLS-B (inductive) and cMLS-B (constitutive) phenotypes by the D-test method. The number of defined daily doses (DDD), statistically per 1000 person-days, was calculated in accordance with the WHO guidelines. RESULTS: Resistance to erythromycin/clindamycin in MRSA strains increased from 1991 to 2004-2007 from 64.7/11.8% to 100/76.9%, respectively. The frequency of the cMLS-B phenotype in the years 1991/2010-2011/2012 was 5.9%/76.9%/69.7%, respectively, and correlated with the increased use of clindamycin in the examined wards. In 2012, the percentage of MLS-B-sensitive isolates increased from 3.9 to 21.7%, while constitutive resistance decreased to 69.7%, which correlated with a decrease in the use of clindamycin. CONCLUSIONS: The proportion of cMLS-B to iMLS-B phenotypes in HA-MRSA is related to the amount of clindamycin used in hospital wards. Limiting the selection pressure of antibiotics can lead to complete loss of resistance or return to the inductive mechanism of its regulation.

Different patterns of activation markers expression and CD4+ T-cell responses to ex vivo stimulation in patients with clinically quiescent multiple sclerosis (MS).

Patients with relapsing-remitting (RR) and secondary progressive (SP) forms of multiple sclerosis (MS), although in long-term clinical remission, showed different patterns of increased expressions of the activation markers: CD69, CD40L, and both membrane/surface and cytoplasmic CTLA-4 (mCTLA-4 and cCTLA-4, respectively) in freshly isolated peripheral blood (PB) CD4+ T cells compared with controls. Also observed were dysregulated responses to ex vivo stimulation in both groups of MS patients accompanied by increased IFN-gamma synthesis. Our findings may suggest that the mechanisms leading to each clinical form of the disease may be heterogeneous.

Characteristics of the expression of KAI1/CD82 and PDGFRß and their impact on glioma progression.

The biological features of glioma cells may define their clinical outcome. Little is known about the interactions between KAI1/CD82 metastatic suppressor protein and PDGFR in gliomas. The aim of the study was to examine KAI1/CD82 and PDGFR expression in gliomas in order to find the impact of these proteins on progression of the tumors. PDGFR, KAI1/CD82 protein expression and mRNA of genes were evaluated on eighty four paraffin-embedded tissue of gliomas using immunohistochemical staining and RT-PCR analysis. The PDGFR expression was higher in IV/III than in I/II glioma grades (p = 0.0004). The level of mRNA PDGFR was associated with the degree of PDGFR immunoreactivity. Downregulation of KAI1/CD82 was associated with tumor malignancy (p = 0.007). The increased level of KAI1/CD82 gene expression (3-4-fold) was found in gliomas with strong KAI1/CD82 immunoreactivity. The parallel KAI1/CD82 and PDGFR expression was more significantly associated with cases in a group graded as III and IV than in a group graded as I/II (p = 0.002). We found that a loss of KAI1/CD82 and an increase in PDGFR expression in gliomas relate to a progressive tumor growth. The correlation between PDGFR and KAI1 expression in high grade gliomas suggests that a direct or indirect interaction between these proteins might have an impact on cell motility and invasive behavior of the tumor.

[General muscular rigidity syndrome (stiff man syndrome) in multiple sclerosis]. / Zespól sztywnosci uogólnionej (stiff man syndrome) w przebiegu stwardnienia rozsianego.

In a 57-year-old woman with a long history of multiple sclerosis a syndrome corresponding to the stiff-man syndrome was observed.

[Autonomic nervous system disturbances in Parkinson's disease]. / Uszkodzenie ukladu autonomicznego w chorobie Parkinsona.

On the basis of neurophysiological tests we conclude that subclinical signs of dysautonomia appear in Parkinsonians. Various autonomic functions are not disturbed in the same degree. Examinations of cardiovascular system showed that functions connected with parasympathetic system were affected, while those connected with sympathetic part were not. Examinations of skin sympathetic reflexes displayed rather patchy, disseminated type of damage: only latencies of responses recorded from hands (but not from feet) were prolonged when compared to the control group.

[Sleep disorders in patients with brain stem lesions]. / Zaburzenia snu u chorych z uszkodzeniami pnia mózgu.

In 10 patients with clinical symptoms of brainstem lesions of various aethiology and different localization within the brainstem polysomnographic records were performed. Patients were divided into two groups (according to age) and the results obtained in each group were compared with the results in control group. In all patients prolongation of I and III+IV phases and reduction of II and the REM phase were noted. In some patients REM was not observed at all. These results may confirm the theory of the localization of the sleep centre in the brainstem, specially the centre of induction of the REM.

[Clinical-electrophysiological characteristics of Alzheimer's dementia and cerebrovascular dementia based on determination of cerebral refraction time]. / Kliniczno-elektrofizjologiczna charakterystyka otepienia alzheimerowskiego i naczyniopochodnego w oparciu o badanie czasu refrakcji mózgowej.

The aim of the study was an electrophysiologic assessment of cerebral refractory period in relation to chosen clinical parameters, EEG and CT in patients with dementia of various origin. The study included 30 patients (11 female, 19 male) aged 50-75: 15 with dementia of Alzheimer type (DAT) and 15 with vascular dementia (VD), and 15 age-matched healthy controls. Cerebral refractory period (CRP) was assessed by means of somatosensory evoked potentials with the use of paired stimulation with varying interstimulus interval, applied to the median nerve. Interstimulus interval, with which one somatosensory response was obtained to paired stimuli, was determined as absolute refractory period. CRP was significantly prolonged in demented patients, when compared to the control group, with no significant difference between groups with DAT and VD. CRP correlated negatively with age and positively with Mini Mental State Examination results, assessing the degree of mental deterioration. Prolonged CRP was noted in patients with vast lesions shown in CT. No relationship between CRP and EEG changes was found. CRP is a sensitive parameter, which may contribute to electrophysiological assessment of cerebral function.

[Clinical course and changes of soluble interleukin-2 receptor and soluble forms of intercellular adhesion molecule-1 (ICAM-1) in serum of multiple sclerosis patients]. / Przebieg kliniczny a stezenie rozpuszczalnego receptora interleukiny-2 i rozpuszczalnej formy miedzykomórkowej czasteczki adhezyjnej (ICAM-1) w surowicy krwi w stwardnieniu rozsianym.

UNLABELLED: Changes were assessed in serum levels of soluble interleukin-2 receptor (sIL-2R alpha) and soluble intercellular adhesion molecule-1 (sICAM-1), indirect indices of activation of immunological system, in the course of multiple sclerosis (ms). 12 patients (av. age 39.2 +/- 9.4 y.) with the first relapse that fulfilled criteria of clinical probable ms acc. to Poser Committee were included into the study. Blood samples were taken at the beginning of the relapse and then every 2-month periods. Simultaneously, neurological impairment (EDSS scale) was assessed. When the next relapse occurred examination was repeated from the beginning. The total time of observation was between 12 and 18 months. The levels of both soluble molecules were examined with ELISA test. In relapse mean serum levels of sIL-2R alpha and sICAM-1 were significantly elevated in comparison to the results obtained in remission (respectively: p < 0.001 and p = 0.03). Changes in serum level of both soluble molecules during the first 2 months after relapse were significantly higher than in subsequent 2-month periods (p < 0.001). Each relapse was accompanied by elevation of serum levels of sIL-2R alpha and sICAM-1. There was no obtainable correlation between improvement in EDSS scale and changes in sIL-2R alpha level during the whole time of observation. Improvement in EDSS scale was correlated with lowering of sICAM-1 but only during the first two months after relapse. CONCLUSIONS: Serum level of sIL-2R alpha and sICAM-1 in ms patients during relapse is significantly higher in comparison to the results obtained during remission. Each relapse is accompanied by elevation of sIL-2R alpha and sICAM-1 in serum, during remission serum levels of both molecules do not changed significantly.

[Changes in blink reflex (OM) after lesions of the nervous system in various locations]. / Zmiany odruchu mrugania (OM) w uszkodzeniu ukladu nerwowego o róznej lokalizacji.

Electrically evoked blink reflex (BR) as a one of the non-invasive methods is used to diagnose function of central nervous system, specially of brainstem. It seems that this method is not fully appreciated in neurological practice. On the basis of literature and own experience the authors present typical pictures of BR on EMG analysis related to the lesions of respective parts of reflex arc and suprasegmental structures involving pyramidal and extrapyramidal tracts.

[Difficulties in diagnosis and therapy in a case of brain inflammatory process in patient with Hodgkin's disease]. / Trudnosci diagnostyczne i terapeutyczne w przypadku zapalenia mózgu w przebiegu ziarnicy zlosliwej.

A rare case of cerebral probable viral inflammatory process in a patient with the Hodgkin's disease has been presented. The diagnosis of the neurological disorder was based on the clinical course of the disease, the dynamics of the process observed in CT and MRI examinations. The pathogen was not identified in bacteriological and viral tests. Hodgkin's disease restricted to the spleen was diagnosed in postmortem examination. The presented case demonstrates variability of the clinical picture and difficulties in diagnosing viral encephalitis.

[Primary and secondary intraventricular hemorrhage--clinical analysis]. / Krwawienia dokomorowe pierwotne i wtórne--analiza kliniczna.

In the recent decades an evident increase in the number of diagnosed intraventricular haemorrhages has been noted. The trial was undertaken of assessing of the incidence of primary and secondary intraventricular haemorrhages, the role of aetiological factors in various types of haemorrhages, the risk factors and the results of imaging procedures, as well as the clinical symptoms and treatment methods. The analysed group comprised 90 patients in hospital with the diagnosis of intraventricular haemorrhage in the years 1989-1996. The diagnosis was based on the results of computerized tomography /CT/ and on autopsy in one case. The clinical course of the cases varied considerably: very serious mainly in secondary intraventricular haemorrhages with high mortality. No signs pathognomic for intraventricular haemorrhage were found. The prognosis in primary intraventricular haemorrhage was better. Hypertension as risk factor was present in 71 cases. Pathological changes of blood vessels were found in 23 cases.

[Measurement of acetylcholine receptor antibodies in serum of patients with myasthenia gravis]. / Badanie poziomu przeciwcial przeciw receptorom acetylocholiny w surowicy chorych z miastenia.

The aim of this study is the evaluation of the level of antiacetylcholine receptor antibodies in patients with different types of myasthenia (according to Osserman's classification) and establishing of correlation between the level of such antibodies and the clinical state of the patients. 63 patients with diagnosed myasthenia and 30 healthy controls without immunological diseases were evaluated. In all of them standard neurological examination was performed and the levels of antiacetylcholine receptor antibodies were measured. In 45 patients electrophysiological investigations were carried out. In 43 cases elevated levels of antiacetylcholine receptor antibodies were noted. In 20 patients the levels were within normal range. The level of antibodies showed correlation with the clinical type of myasthenia according to Osserman (the more severe was myasthenia, the higher was the level of antibodies). But the clinical state of the patient at the moment of examination did not show any clear correlation with the level of antibodies. Acetylcholine receptor antibodies measurement has significant diagnostic value in myasthenia. Nevertheless it should be interpreted with other diagnostic techniques.

[Neural conduction in workers after long-term exposure to mercury vapors]. / Przewodnictwo nerwowe u osób narazonych na przewlekle dzialanie par rteci.

36 workers exposed to mercury vapour intoxication were examined to estimate the abnormalities in peripheral nervous system. 18 workers showed on physical examination features of polyneuropathy and in this group 15 workers had on emg examination sensory polyneuropathy. Statistical analysis was performed to show correlations between polyneuropathy on emg and age, time of exposure to mercury vapour and urinary mercury level. No such correlations were demonstrated.

[Paroxysmal EEG changes in patients with multiple sclerosis]. / Zmiany napadowe w EEG u chorych na stwardnienie rozsiane.

The electroencephalograms (EEG) and visual evoked potentials (VEP) were recorded in 100 multiple sclerosis patients treated from 1981 to 1989. In 35 cases the EEG records were pathological and in 12 of them they showed paroxysmal changes. Pathological EEG were mostly seen in young patients, during the first relapse, with high degree of Kurtzke's disability score. Patients with paroxysmal changes showed on physical examination brain stem lesions that could be responsible for paroxysmal activity in EEG. The latencies of P100 wave and amplitudes of P100/N120 complex were analysed in two groups of patients (with and without paroxysmal activity in EEG). There was no statistically important difference between two groups, although in the group with paroxysmal changes in EEG some prolongation of the latency of P100 wave and a little higher amplitude of P100/N120 complex were recorded.

[Polyneuropathy in non-Hodgkin lymphoma]. / Polineuropatia w przebiegu chloniaka neiziarniczego.

In a group of patients with non-Hodgkin lymphoma axonal sensorimotor polyneuropathy was found in 15%. It appeared in the treated patients, those receiving doses of oncovin. Polyneuropathy was not correlated with the type of malignancy. Treatment seems to be the important factor which can cause polyneuropathy.