Cerebral activations related to ballistic, stepwise interrupted and gradually modulated movements in parkinson patients

Patients with Parkinson's disease (PD) experience impaired initiation and inhibition of movements such as difficulty to start/stop walking. At single-joint level this is accompanied by reduced inhibition of antagonist muscle activity. While normal basal ganglia (BG) contributions to motor control include selecting appropriate muscles by inhibiting others, it is unclear how PD-related changes in BG function cause impaired movement initiation and inhibition at single-joint level. To further elucidate these changes we studied 4 right-hand movement tasks with fMRI, by dissociating activations related to abrupt movement initiation, inhibition and gradual movement modulation. Initiation and inhibition were inferred from ballistic and stepwise interrupted movement, respectively, while smooth wrist circumduction enabled the assessment of gradually modulated movement. Task-related activations were compared between PD patients (N = 12) and healthy subjects (N = 18). In healthy subjects, movement initiation was characterized by antero-ventral striatum, substantia nigra (SN) and premotor activations while inhibition was dominated by subthalamic nucleus (STN) and pallidal activations, in line with the known role of these areas in simple movement. Gradual movement mainly involved antero-dorsal putamen and pallidum. Compared to healthy subjects, patients showed reduced striatal/SN and increased pallidal activation for initiation, whereas for inhibition STN activation was reduced and striatal-thalamo-cortical activation increased. For gradual movement patients showed reduced pallidal and increased thalamo-cortical activation. We conclude that PD-related changes during movement initiation fit the (rather static) model of alterations in direct and indirect BG pathways. Reduced STN activation and regional cortical increased activation in PD during inhibition and gradual movement modulation are better explained by a dynamic model that also takes into account enhanced responsiveness to external stimuli in this disease and the effects of hyper-fluctuating cortical inputs to the striatum and STN in particular

Нейроэндокринная опухоль — параганглиома, симулирующая зоб

This paper presents two rare case reports with one common feature. Patients with thyroid nodules, who had undergone a comprehensive clinical evaluation based on standard algorithms according to their preoperative diagnosis of “Multinodular goiter, grade II”, were scheduled for surgical treatment (thyroidectomy). Postoperative morphological examination revealed, however, the extremely rare neuroendocrine tumor paraganglioma that simulated multinodular goiter with tracheal compression. Our analysis of these clinical cases showed common systematic mistakes that were committed during conventional, standardized preoperative examination, resulting in certain difficulties in the treatment of these patients.В данной статье представлены два редких клинических наблюдения, имеющих один объединяющий их признак. Пациентам с узловыми образованиями в щитовидной железе, обследованным в полном объеме согласно стандартным алгоритмам, с установленным до операции диагнозом «многоузловой зоб II степени», планировалось хирургическое лечение в объеме тиреоидэктомии. Однако после выполненных операций было установлено, что за многоузловой зоб с компрессией трахеи была ошибочно принята крайне редко встречающаяся нейроэндокринная опухоль — параганглиома, имитировавшая зоб с признаками компрессии органов шеи. При анализе клинических случаев нами были выявлены общие систематические ошибки, допущенные при обследовании с соблюдением общепринятых стандартизированных подходов, что привело к определенным сложностям в лечении этих пациентов

PATIENTS’ PSYCHOSOMATIC STATUS BEFORE AND AFTER ORTHOPEDIC CORRECTION OF MAXILLOFACIAL DEFECTS

A medicopsychological study of the time course of psychic changes was conducted in 88 cancer patients with defects of facial soft tissues (n = 38) and maxilla (n = 50). Since the patients’ visit to an oncologist, the diagnostic-stage depth of mental disorders was rather various: from mild asthenia to depression. Thus, 88 (100 %) patients were found to have an anxious feeling, 16 (18.2 %) had affective-shock reactions; 7 (7.9 %) had reactive depression. In the postoperative period, anxiety-depressive syndrome gave way to astheno-depressive one. After hospital discharge, the reactive state became less tense during psychosocial readaptation, the characteriological personality changes were increasingly more pronounced in the forefront in the patients. They became anxious, suspicious, unconfident about themselves, sensitive, tried to avoid difficult situations in life. The circle of interests was limited to thoughts on their own health. Combination therapy with psychotropic drugs was used to correct the mental status of patients with acquired maxillary defects in the study group. The dosage of the drugs was individually adjusted according to the degree of psychopathological manifestations

Medullary Thyroid Cancer: Management Guidelines

Представленные клинические рекомен дации объединяют мнения членов рабочей группы по ключевым и наиболее спорным проблемам диагностики и лечения МРЩЖ, которые сложились в отечественной клини ческой практике. В рабочую группу вошли специалисты, работающие в различных ле чебных и научноисследовательских учреж дениях. Этот документ не является официально утвержденным различными структурами Ми нистерства здравоохранения РФ. Представ ленные в нем положения носят рекоменда тельный характер