OCJENA MNOGOSTRUKIH PODRUČJA NA SREDNJESAGITALNIM SLIKAMA MAGNETSKE REZONANCIJE MOZGA U BOLESNIKA S MULTIPLOM SKLEROZOM

The aim of the study was to compare the first and last magnetic resonance images (MRIs) in patients diagnosed with multiple sclerosis (MS) with MRIs of normal subjects. We wanted to investigate the region initially involved in MS patients. In this retrospective study, midsagittal plane was explored on brain MRIs taken at the time when MS diagnosis was established and the last MRI was obtained following treatment for MS. Comparison was done between healthy subjects and patients diagnosed with MS. The measures included the area of corpus callosum, cerebrum, cerebellum, pons, bulbus, fourth ventricle and pituitary gland. As a result, while there was growth in the fourth ventricle area, there was shrinkage in the other areas in MS patients. In women, the tissues involved at the beginning of the disease were pituitary gland, cerebrum and bulbus, and in men corpus callosum and cerebrum. Atrophy was not time-dependent. Assessment of the correlation between the Expanded Disability Status Scale (EDDS) and atrophy revealed an increase in EDDS (disease progression) to be associated with a decrease in the area of cerebrum and corpus callosum in men, and an increase in the fourth ventricular area in women. In conclusion, we demonstrated that pituitary gland atrophy develops in the early stage of MS, especially in women. Additional studies are needed to investigate the phenomenon of early pituitary and bulbus atrophy in women versus late atrophy of these tissues in men.Cilj rada bio je usporediti prve i posljednje slike magnetske rezonancije (MR) u bolesnika s multiplom sklerozom (MS) sa slikama zdravih osoba. Kod bolesnika s MS htjeli smo ispitati najranije zahvaćeno područje. U ovoj studiji se srednjesagitalno područje kod bolesnika s postavljenom dijagnozom MS pregledalo na slikama MR mozga u vrijeme postavljanja dijagnoze i nakon liječenja. Uspoređivalo se zdrave osobe s bolesnicima kojima je dijagnosticirana MS. Mjerenje je uključilo područje korpusa kalozuma, mozga, malog mozga, ponsa, bulbusa, četvrtog ventrikula i hipofi ze. Kod bolesnika s MS došlo je do porasta na području četvrtog ventrikula, a do smanjenja u drugim područjima. Utvrđeno je da su zahvaćena tkiva u žena na početku bolesti bila hipofi za, mozak i bulbus, a kod muškaraca korpus kalozum i mozak. Otkriveno je da atrofi ja ne ovisi o vremenu. Kada se promatralo korelaciju između zbira na Expanded Disability Status Scale (EDDS) i atrofi je, vidjelo se da s povećanjem EDDS (kada bolest napreduje) dolazi do smanjenja područja malog mozga i korpusa kalozuma u muškaraca, a povećanja područja četvrtog ventrikula u žena. Pokazali smo da se atrofi ja hipofi ze razvija u ranoj fazi MS, osobito u žena. Pozornost privlači rana atrofi ja hipofi ze i bulbusa u žena te kasna atrofi ja ovih tkiva u muškaraca

The perioperative immune response

PURPOSE OF REVIEW A host of immune modulators are now available in clinical practice. The perioperative period is characterized by profound alterations in host immunity, which can result in poor outcomes, which include infection, cancer recurrence and organ failure. Manipulation of the perioperative immune response has the potential to improve outcomes. A complete understanding of the mechanisms and clinical consequences of altered immune function in this setting is therefore imperative. RECENT FINDINGS Recent in-vivo data have emerged which further our understanding of the interaction between tissue damage, immune modulation and clinical outcomes by utilizing novel laboratory techniques capable of monitoring single-cell immune signatures. Traditional gene expression assays have continued to demonstrate their utility and have been instrumental in defining the host response to perioperative allogeneic blood transfusion. These mechanistic studies are complemented by large clinical studies describing associations between anaesthetic modalities and immune-related outcomes. SUMMARY Laboratory techniques are now available that can monitor the perioperative immune response and could be further developed to introduce personalized care pathways. Consideration must also be given to anaesthesia techniques and perioperative treatments that, although not immediately harmful, may be associated with poor outcomes temporally distant from the treatment, secondary to induced immunosuppression