Leszek Królicki

Swallowing disorders in Parkinson's disease

The aim of this study was to assess the reflex and oral, pharyngeal, esophageal phase of swallowing in patients with Parkinsons disease (PD). Eighteen patients with PD and 22 healthy control subjects were investigated using electromyography (EMG) and esophageal scintigraphy. This study demonstrated delayed triggering of the swallowing reflex (443+/-84 ms in patients with PD vs. 230+/-96 ms in controls, p<0.05) and prolongation of laryngeal movement (980+/-140 vs. 649+/-145 ms, p<0.05). We found prolongation of the esophageal phase of swallowing (14.46+/-5.30 vs. 7.45+/-1.64 s, p<0.001) in PD patients. The dysphagia limit i.e. the maximum amount of water swallowed at once was smaller in PD patients than in controls (6.23+/-3.67 vs. >20 ml). Dysphagia was observed in all patients studied although only 13 of them complained about it. In the remaining five cases swallowing impairment was subclinical and it consisted of decreased dysphagia limit and prolongation of the esophageal phase. Dysphagia at the subclinical level may be one of the early symptoms of PD.

Assessment of inflow and washout of indocyanine green in the adult human brain by monitoring of diffuse reflectance at large source-detector separation.

Recently, it was shown in measurements carried out on humans that time-resolved near-infrared reflectometry and fluorescence spectroscopy may allow for discrimination of information originating directly from the brain avoiding influence of contaminating signals related to the perfusion of extracerebral tissues. We report on continuation of these studies, showing that the near-infrared light can be detected noninvasively on the surface of the tissue at large interoptode distance. A multichannel time-resolved optical monitoring system was constructed for measurements of diffuse reflectance in optically turbid medium at very large source-detector separation up to 9 cm. The instrument was applied during intravenous injection of indocyanine green and the distributions of times of flight of photons were successfully acquired showing inflow and washout of the dye in the tissue. Time courses of the statistical moments of distributions of times of flight of photons are presented and compared to the results obtained simultaneously at shorter source-detector separations (3, 4, and 5 cm). We show in a series of experiments carried out on physical phantom and healthy volunteers that the time-resolved data acquisition in combination with very large source-detector separation may allow one to improve depth selectivity of perfusion assessment in the brain.

Cardiovascular magnetic resonance findings in a case of Danon disease

Danon disease is a rare X-linked dominant lysosomal glycogen storage disease that can lead to severe ventricular hypertrophy and heart failure. We report a case of Danon disease with cardiac involvement evaluated with cardiovascular magnetic resonance, including late gadolinium enhancement and perfusion studies.

Semiquantitative Analysis and Characterization of Physiological Biodistribution of 68ga-dota-tate Pet/ct

Abstract The aim of this study was to describe the normal physiological distribution of 68Ga-DOTA-TATE using the SUV to reflect the density of somatostatin receptors in various organ systems. Methods A total of 250 patients (90 men and 160 women) were imaged on a Biograph 64 PET/CT TruePoint (Siemens Medical Solutions) 60 to 80 minutes after injection of 120 to 200 MBq (3.2-5.4 mCi) of 68Ga-DOTA-TATE. Visual assessment was performed on all studies on the multimodality workstation, and sites of increased uptake were recorded. The SUVmax was also calculated for each organ demonstrating increased 68Ga-DOTA-TATE uptake. Results Visual assessment of the 68Ga-DOTA-TATE PET/CT studies revealed increased uptake in the pituitary, salivary, thyroid glands, liver, spleen, adrenals, kidneys and bone reflecting normal increased somatostatin receptor expression. These sites were confirmed to be disease free on clinical follow-up and on correlation with other imaging (CT/MRI/ultrasound). Using semiquantitative analysis, SUVmax values were the highest in the pituitary gland [11 (4.5)], spleen [18.9 (6.6)], adrenal [14.0 (5.6)], and kidneys [14.2 (3.6)]. In addition, increasing uptake in the uncinate process of pancreas was noted in 12% of patients with SUVmax of 9.2 (3.3). Moderate 68Ga-DOTA-TATE uptake was also present in salivary gland [3.4 (1.8)], thyroid [2.9 (1.2)], and normal liver [6.5 (2.2)]. The bones generally showed low 68Ga-DOTA-TATE uptake with an SUVmax of 1.0 (0.3). Conclusions Knowledge of the normal 68Ga-DOTA-TATE distribution is highly important for accurate interpretation of this novel imaging modality, which is increasingly being used in the imaging of neuroendocrine tumor.

Emotionally negative stimuli can overcome attentional deficits in patients with visuo-spatial hemineglect

Left unilateral spatial neglect resulting from right brain damage is characterized by loss of awareness for stimuli in the contralesional side of space, despite intact visual pathways. We examined using fMRI whether patients with neglect are more likely to consciously detect in the neglected hemifield, emotionally negative complex scenes rather than visually similar neutral pictures and if so, what neural mechanisms mediate this effect. Photographs of emotional and neutral scenes taken from the IAPS were presented in a divided visual field paradigm. As expected, the detection rate for emotional stimuli presented in the neglected field was higher than for neutral ones. Successful detection of emotional scenes as opposed to neutral stimuli in the left visual field (LVF) produced activations in the parahippocampal and anterior cingulate areas in the right hemisphere. Detection of emotional stimuli presented in the intact right visual field (RVF) activated a distributed network of structures in the left hemisphere, including anterior and posterior cingulate cortex, insula, as well as visual striate and extrastriate areas. LVF-RVF contrasts for emotional stimuli revealed activations in right and left attention related prefrontal areas whereas RVF-LVF comparison showed activations in the posterior cingulate and extrastriate visual cortex in the left hemisphere. An additional analysis contrasting detected vs. undetected emotional LVF stimuli showed involvement of left anterior cingulate, right frontal and extrastriate areas. We hypothesize that beneficial role of emotion in overcoming neglect is achieved by activation of frontal and limbic lobe networks, which provide a privileged access of emotional stimuli to attention by top-down modulation of processing in the higher-order extrastriate visual areas. Our results point to the importance of top-down regulatory role of the frontal attentional systems, which might enhance visual activations and lead to greater salience of emotional stimuli for perceptual awareness.

Time-resolved detection of fluorescent light during inflow of ICG to the brain?a methodological study

It was reported that time-resolved reflectance measurements carried out during inflow and washout of an optical contrast agent may provide information on the blood supply to the brain cortex of human adults. It was also shown that a measurement of fluorescence excited in the dye circulating in the brain is feasible. Unfortunately, patterns of time-resolved fluorescence signals observed during in vivo measurements are difficult to interpret. The aim of this study was to analyze the influence of several factors on the fluorescence signals measured during in vivo experiments. A laboratory instrument for recording the distributions of arrival of fluorescence photons was constructed and optimized for measurements on humans. Monte Carlo simulations and laboratory measurements on liquid phantoms as well as in vivo measurements on healthy volunteers were carried out. An influence of source-detector separation, position of the source-detector pair on the head, as well as a dose of the injected indocyanine green (ICG) on the fluorescence signals were studied in detail. It was shown that even for a small dose of ICG (0.025 mg kg(-1)) the time-resolved signals can be successfully detected on the surface of the head. Strong influence of the studied factors on the fluorescence signals was observed. It was also noted that the changes in moments of distributions of arrival times of fluorescence photons depend on the anatomical structure of the tissues located between the source and the detector.

Polymorphism of the oestrogen receptor beta gene (ESR2) is associated with susceptibility to Graves' disease.

Objective  To investigate whether a polymorphism in the ESR2 gene (rs4986938, previously associated with endometriosis, ovulatory dysfunction and premature onset of coronary heart disease) increases the risk of Graves’ disease (GD).

Repeated cycles of peptide receptor radionuclide therapy (PRRT)--results and side-effects of the radioisotope 90Y-DOTA TATE, 177Lu-DOTA TATE or 90Y/177Lu-DOTA TATE therapy in patients with disseminated NET.

PURPOSE PRRT is a known tool in the management of patients with disseminated and inoperable NETs. The aim of study was to assess the effectiveness of the repeated cycles of PRRT in patients with disseminated and inoperable NETs. MATERIAL AND METHODS Eighty nine patients were included in the PRRT. Among them 16 patients (18%) were qualified for a repeated PRRT cycle due to progression of the disease. In one of the patients qualified for the repeated cycle, PRRT was used as neoadjuvant therapy. The results and side-effects of the repeated cycles of PRRT were analyzed. RESULTS Disease stabilization was observed in 10 patients 6 months after the repeated PRRT cycle and in 5 patients after 12 and 18 months. Ten of the patients who had received repeated PRRT cycles died. In the case of neoadjuvant therapy, further reduction of the tumor size was observed, enabling qualification for surgery. Clinically significant reduction in the mean values of morphological parameters was not observed. Only after 12 and 18 months the mean values of creatinine levels were higher than the normal range (only in 2 patients). CONCLUSIONS The repeated cycles of PRRT did not cause a clinically significant increase of the toxicity of PRRT. The changes in kidney and blood morphology parameters were transient. The repeated cycles of PRRT enabled stabilization of the disease.

Neuroendocrine neoplasms of the small intestine and the appendix — management guidelines (recommended by the Polish Network of Neuroendocrine Tumours)

We present revised Polish guidelines regarding the management of patients harbouring neuroendocrine neoplasms (NENs) of the small intestine and appendix. The small intestine, especially the ileum, is the most common origin of these neoplasms. Most of them are well differentiated with slow growth. Rarely, they are less differentiated, growing fast with a poor prognosis. Since symptoms can be atypical, the diagnosis is often accidental. Typical symptoms of carcinoid syndrome occur in less than 10% of patients. The most useful laboratory marker is chromogranin A; 5-hydroxyindoleacetic acid is helpful in the monitoring of carcinoid syndrome. Ultrasound, computed tomography, magnetic resonance imaging, colonoscopy, video capsule endoscopy, balloon enteroscopy and somatostatin receptors scintigraphy are used in the visualisation. A histological report is crucial for the proper diagnostics and therapy of NENs, and it has been extensively described. The treatment of choice is surgery, either radical or palliative. Somatostatin analogues are crucial in the pharmacological treatment of the hormonally active and non-active small intestine NENs and NENs of the appendix. Radioisotope therapy is possible in patients with a good expression of somatostatin receptors. Chemotherapy is not effective in general. Everolimus therapy can be applied in patients with generalised NENs of the small intestine in progression and where there has been a failure or an inability to use other treatment options. Finally, we make recommendations regarding the monitoring of patients with NENs of the small intestine and appendix.

Inflammatory activity of pericoronary adipose tissue may affect plaque composition in patients with acute coronary syndrome without persistent ST-segment elevation: preliminary results

BACKGROUND The extravascular expression of inflammatory mediators may adversely influence coronary lesion formation and plaque stability through outside-to-inside signalling. It has been shown that the maximal standardised uptake value (SUV) of 18-fluorodeoxyglucose detected by positron emission tomography (PET/CT) is proportional to macrophage density. AIM To investigate whether the inflammatory activity of pericoronary adipose tissue (PVAT) may influence plaque composition in acute coronary syndrome without persistent ST-segment elevation (NSTE-ACS) patients. METHODS In a prospective study, 36 coronary arteries (LM, RCA, LCX, LAD) were investigated in non-diabetic patients with a low or intermediate risk of NSTE-ACS (GRACE ≤ 140). SUV was measured in fat surrounding coronary arteries on the sections corresponding to proximal and medial segments (Siemens biograph 64-PET/CT system). Additionally, SUV was measured in subcutaneous fat (SC), visceral thoracic fat (VS), and epicardial fat over the right ventricle (EPI). Virtual histology intravascular ultrasound (VH-IVUS) was performed to assess plaque composition (Volcano, USA). PET/CT sections were further examined in segments corresponding to coronary plaques. RESULTS PVAT SUV in NSTE-ACS patients was significantly greater than in other fat locations (LM SUV: 1.60; RCA SUV: 1.54; LCX SUV: 1.94; LAD SUV: 2.37 vs. SC SUV 0.57; VS SUV: 0.77; EPI SUV: 0.98; p < 0.001; ANOVA). PVAT SUV positively correlated with plaque burden (r = 0.49, p < 0.05) and necrotic core plaque rate (r = 0.68, p < 0.05), and negatively correlated with fibrous plaque rate (r = -0.52, p < 0.05). CONCLUSIONS The inflammatory activity of PVAT reflected by SUV is greater than in subcutaneous, visceral thoracic, or epicardial tissue in NSTE-ACS patients; PVAT SUV correlates with the plaque burden and necrotic core component of coronary plaque.