Calcaneal ultrasound parameters in men and women from central Croatia.

BACKGROUND: The aim of this study was to compare quantitative ultrasound parameters between women and men of various ages in a population from central Croatia and also to estimate the prevalence of osteoporosis in women. MATERIAL/METHODS: A total of 1006 participants were recruited for this study (550 men, 456 women), aged 20 to 89 years. Calcaneal quantitative ultrasound measurements were performed using a Sahara device (Hologic). Data were analyzed using the t-test and analysis of variance (ANOVA) with Tukey's post hoc test. RESULTS: Comparison of the ultrasound measures of the men exhibited significant differences across the age groups with the exception of broadband ultrasound attenuation (BUA). In the women, significant differences were found for BUA, speed of sound (SOS), and the quantitative ultrasound index (QUI). Gender comparison revealed significant differences between ultrasound parameters in the last three decade groups. Using a T-score threshold of -1.8, the prevalence of osteoporosis in women aged over 50 was 30.7% based on the quantitative ultrasound index. CONCLUSIONS: This study is the first report of quantitative ultrasound parameters in Croatian women. The results revealed lower QUI, BUA, and SOS in postmenopausal women than in men of the same age. The prevalence of osteoporosis in women over 50 years of age based on the quantitative ultrasound index was considerably higher than the previously reported prevalence of osteoporosis in men.     

Endoluminal stenting for subclavian artery stenosis in Takayasu's arteritis

We describe a patient with Takayasu's arteritis (type I): occlusion of all large vessels of the aortic arch except the left subclavian artery which was, however, almost completely occluded, resulting in a characteristic subclavian steal syndrome. Elective left main subclavian artery balloon angioplasty followed by endoluminal stenting was performed with excellent results. After prolonged immunosuppressive treatment, at the 12-month follow-up there was no evidence of restenosis. In selected patients with Takayasu's arteritis and subclavian stenosis, elective endoluminal stenting can be used as a definitive procedure or as a bridge to surgical revascularization.     

Neuropsychological outcome after unilateral pallidotomy for the treatment of Parkinson's disease

OBJECTIVE: To assess the long term cognitive outcome of unilateral posteroventral pallidotomy (PVP) and the overall efficacy of the surgery. METHODS: Forty two (29 left and 13 right PVP) patients with Parkinson's disease underwent neurological and neuropsychological testing before PVP and at 3 and 12 months after PVP. The neuropsychological testing battery emphasised measures of verbal learning and memory, visuospatial abilities, speed of information processing, executive functioning, and affective functioning. RESULTS: All patients demonstrated motor improvements after surgery during their off state, and 86% of patients also showed improvements in motor functioning in their on state. Repeated measures ANOVA showed significant improvements in confrontational naming, visuospatial organisation, and affective functioning 3 months and 12 months after surgery, with inconsistent improvements in executive functioning 12 months post-PVP. Patients demonstrated a transient impairment in verbal memory, with verbal learning performance returning to baseline 12 months post-PVP after a significant decline 3 months after PVP. When three patients with lesions extending outside of the PVP were excluded from the analysis, a decline in verbal fluency performance after PVP was not found to be significant. Differences due to side of lesion placement were not found on any of the cognitive measures. CONCLUSIONS: In the largest long term follow up study reported to date, the cognitive changes found up to a year after PVP are minimal compared with the robust improvements in motor function. The findings highlight the need to investigate the relation between the specific fibre tracts affected by the lesions and cognitive outcome.     

An extended 5'-tau susceptibility haplotype in progressive supranuclear palsy

OBJECTIVE: To confirm the association of an extended 5'-tau haplotype on chromosome 17q with the disease phenotype in clinically ascertained individuals with sporadic progressive supranuclear palsy (PSP). BACKGROUND: PSP is a neurodegenerative disease with parkinsonian signs accompanied by vertical supranuclear palsy and tau pathologic features. Previously, we documented the complete segregation of an extended 5'-tau haplotype consisting of four single nucleotide polymorphisms (SNP) with the disease phenotype in sporadic PSP. This study was conducted in an independent cohort to confirm these results and to improve the statistical power of the data. DESIGN AND METHODS: Direct sequencing and restriction enzyme digests were used to analyze four SNP in tau Exons 1, 4A, and 8. These contiguous SNP were used to reconstruct an extended 5'-tau haplotype in 52 affected and 54 age-matched control individuals. RESULTS: The four SNP formed two homozygous 5'-tau haplotypes (HapA and HapC) or a heterozygous genotype. Fifty-one (98%) patients with PSP had HapA; one (2%) with a later onset was heterozygous; and none had HapC. These PSP haplotype frequencies were different (p < 0.00001) from those of the age-matched control group, in which 18 (33%) people had HapA; 26 (48%) were heterozygous; and 10 (19%) had HapC. The extended 5'-tau haplotype, HapA, had a high sensitivity (98%) and a moderate specificity (67%) as a marker for PSP. CONCLUSIONS: A 5'-tau susceptibility haplotype may be a sensitive marker for sporadic PSP and a genetic defect in, or closely linked to, tau may contribute to the cause of PSP.     

Hereditary myoclonus and progressive distal muscular atrophy

Myoclonus occurs in a variety of pathological conditions, some inherited. We recently evaluated 3 members of a Louisiana-Texas family with an autosomal dominant disorder manifested by adult-onset, generalized, stimulus-sensitive myoclonus and slowly progressive distal muscle weakness and wasting. The analyses of cerebrospinal fluid homovanillic acid and 5-hydroxyindoleacetic acid before and after probenecid provided some evidence of impaired turnover of central dopamine and serotonin. Treatment with clonazepam resulted in complete and lasting improvement of the myoclonus. A postmortem examination in 1 member of the family revealed chiefly neuronal degeneration of the anterior horn cells, Clark's nucleus, and the lower cranial nerve nuclei. A similar syndrome has not previously been reported.     

Haemorrhagic complications of multiple sclerosis.

Neurological exacerbations in multiple sclerosis patients are usually attributed to relapses of the disease. This report emphasises that other conditions, such as spontaneous CNS haemorrhage, may be responsible for the clinical deterioration. We describe two patients appropriately diagnosed as having multiple sclerosis who developed spontaneous CNS haemorrhage.     

Teaching research methodology in medical schools: students' attitudes towards and knowledge about science

OBJECTIVE: To explore the relationship between teaching scientific methodology in Year 2 of the medical curriculum and student attitudes towards and knowledge about science and scientific methodology. DESIGN: Anonymous questionnaire survey developed for this purpose. SETTING: Zagreb University School of Medicine, Croatia. PARTICIPANTS: A total of 932 students (response rate 58%) from all 6 years were invited to participate. MAIN OUTCOME MEASURES: Score on attitude scale with 45 Likert-type statements and score on knowledge test consisting of 8 multiple choice questions. RESULTS: The average attitude score for all students was 166 +/- 22 out of a maximum of 225, indicating a positive attitude towards science and scientific research. The students' average score on the knowledge test was 3.2 +/- 1.7 on 8 questions. Students who had finished Year 2 had the highest mean attitude (173 +/- 24) and knowledge (4.7 +/- 1.7) scores compared with other year groups (P < 0.001, anova and Tukey posthoc test). For students who had attended a mandatory Year 2 course on the principles of scientific research in medicine (Years 3 to 6), multiple linear regression analysis showed that knowledge test score (B = 3.4; SE = 0.4; 95% confidence interval 2.5-4.2; P < 0.001) and average grades (B = 7.6; SE = 1.5; 95% CI 4.6-10.6; P < 0.001) were significant predictors of attitude towards science, but not sex or failure to pass a year (B = - 0.6; SE = 1.7; 95% CI - 3.9-2.6; P = 0.707; and B = - 3.1; SE = 1.9; 95% CI - 6.8-5.7; P = 0.097, respectively). CONCLUSION: Medical students have generally positive attitudes towards science and scientific research in medicine. Attendance of a course on research methodology is related to a positive attitude towards science.     

Preliminary assessment of magnetic resonance spectroscopic imaging in predicting treatment outcome in patients with prostate cancer at high risk for relapse

The purpose of the study was to determine whether 3D proton magnetic resonance spectroscopic imaging (MRSI) can predict treatment outcome in high risk patients with prostate cancer. Endorectal magnetic resonance imaging (MRI) and 1H-MRSI were performed in 16 patients with prostate cancer who were considered high risk because of clinical stage T3-4, Gleason score>/=8, and/or prostate-specific antigen (PSA) level>20 ng/mL. Patients were treated with chemotherapy/hormone therapy, underwent radical prostatectomy (RP) or radiation therapy, and were followed for PSA relapse (follow-up, 19-43 months). The ratio of choline plus creatine to citrate was used to localize peripheral zone cancer. An MRSI risk score on a scale of 0-3 was derived from the volume and degree of metabolic abnormality. Magnetic resonance spectroscopic imaging risk score, MRI tumor/node (TN) stage, clinical stage, Gleason score, and PSA were used as predictors of pathologic stage in patients treated with RP (n=10) and PSA relapse in all patients. Magnetic resonance imaging TN stage (P<0.01) and MRSI risk score (P<0.05) correlated with pathologic stage, but clinical stage did not (P=0.35). Magnetic resonance imaging TN stage was the only significant predictor of PSA relapse in the univariate analysis (P<0.05). Although the MRSI risk score did not reach significance (P=0.13), 6 patients with a score<0.9 were relapse-free, whereas 7 of 10 patients with a score>0.9 relapsed. Magnetic resonance imaging and MRSI risk assessments agreed in 15 of 16 patients. These preliminary results suggest that tumor metabolic assessment may indicate treatment outcome in high-risk patients with prostate cancer. Although MRSI did not provide added prognostic value to MRI in this small number of patients, MRSI might increase the confidence of the clinician in assessing risk on MRI by contributing supporting metabolic data.     

Mozart's movements and behaviour: a case of Tourette's syndrome?

In this review, we intend to explore the often asked question: "Did Mozart have Tourette's syndrome?" Although there are numerous reports attributing Mozart's peculiar personality and behaviour to a spectrum of neurobehavioural disorders such as Tourette's syndrome, autistic disorder, Asperger's syndrome, attention deficit hyperactivity disorder, obsessive-compulsive disorder and paediatric autoimmune neuropsychiatric disorders associated with streptococcal infection, the evidence for any of these disorders is lacking. Whether Mozart's behaviour was nothing more than a reflection of his unique personality or a more complex neurological disorder, aggravated later in life by enormous demands by his father and society, his behaviour has been the subject of many biographies. It will also remain unknown to what extent his accomplishments and failures were shaped by his childhood experiences, pressured lifestyle, and his innate genius and extraordinary talent. Lessons from his life may have important implications for other gifted individuals and savants whose special attributes may lead them to succeed or, on the other hand, suppress their emotional growth and make them more vulnerable to stress and failure.