Morpholocial and Functional Recovery of Brain Associated with Sobriety from Alcoholism

Amaç: Alkolizm beyinde serebral hacim kaybının ve nöropsikolojik bozulmaların eşlik ettiği beyaz ve gri madde hasarına yol açar. Ancak alkol kesilmesi ve ayıklık (sobriety) döneminin ilk günlerinden itibaren serebral hacim kaybı, metabolik ve nöropsikolojik bozukluklar kısmen de olsa geri dönüşümlüdür. Yöntem: Bu gözden geçirme yazısında alkol bağımlılığında ayıklık döneminde beyinde izlenen yapısal ve fonksiyonel düzelmeler ele alınmış ve konuyla ilgili çalışmalar özetlenmiştir. Bulgular: Nörogenezde artış, kolin düzeyinde yükselme, gri ve beyaz cevherde büyüme, beyin devrelerinde reorganizasyon, yeni nöronların oluşumu ve ventriküllerde küçülmenin yanı sıra nörogenezin artmasına paralel olarak yürütücü işlevlerde, bellek ve dikkatte düzelme, davranışsal kontrol ve duygudurumda iyileşme de izlenir. Araştırmalar ayıklık döneminde düzenli fiziksel egzersiz programı uygulanması ile nörogenezin hızlanabileceğini düşündürmektedir. Sosyal içicilik ya da yasal sınırlar içindeki düşük miktarlarda alkol kullanımının da nörogenez üzerine olumsuz etkiler gösterdiğini bildiren çalışmalar, alkol bağımlılığı sonrasında beyin işlevleri zarar görmüş kişilerin ayıklık döneminde alkolden tamamen uzak durmalarının önemini göstermektedir. Sonuç: Ayıklık döneminde izlenen nöronal düzelmenin mekanizmalarının anlaşılması ile beyin rejenerasyonuna ait bir model geliştirilebilecek ve gelecekte diğer nörodejeneratif hastalıkların tedavisinde yol gösterici olabilecektir

Differences in Executive Functions and Problem Solving Styles of Protracted Sober and Relapsed Alcohol-dependent Patients.

In this study, it is aimed to compare the executive functioning and problem solving styles of relapsed alcoholdependent and protracted sober patients and to evaluate the potential clinical factors that act on the duration of sobriety. Fifty-six male patients meeting the DSM-IV alcohol dependence criteria included in the study. All patients were in sobriety period, classified as 32 of them in acute sobriety (relapsed after a maximum period of 6 months sobriety and just completed 3 weeks of detoxification) and 24 of them as protracted sobriety group (sober for a minimum period of 12 months). To evaluate the executive functions and problem solving styles Stroop test, Hanoi Tower Test and Problem Solving Inventory were applied. No significant differences found between two groups regarding executive functions. The protracted sobers were found to use “reflective” and “planfulness” styles more than the relapsed group. There was not any correlation between executive function and cumulative drinking, length of sobriety, educational status, age, alcohol dependency in the family, duration of illness, the amount of daily drinking, and amount of hospitalization. It is concluded that problem solving styles may play a role in staying sober as the “reflective” and “planfulness” styles were being used significantly more in the protracted sober group. Executive functioning which had been shown to be distorted in alcohol-dependent patients did not differ in relapsed and protracted sobriety. Further studies are needed to receive these results to be a determinant in the duration of sobriety

Salivary gland hybrid tumour revisited: could they represent high-grade transformation in a low-grade neoplasm?

Salivary gland hybrid tumour, first described in 1996, is a very rare neoplasm for which exact morphological criteria have not been universally agreed upon. In contrast, the concept of high-grade transformation (HGT) in salivary neoplasms has been widely accepted during the last decade, and the number of reported cases is rapidly increasing. A review of the literature revealed 38 cases of hybrid tumour reported in 22 publications. During approximately the same time period, well over 100 cases of HGT in salivary neoplasms have been reported. There are important histological similarities between hybrid tumours and salivary tumours with HGT. In the latter, containing one tumour component of low-grade malignancy and the other of high grade, the two tumour components are not entirely separated and appear to originate in the same area. Virtually, all cases reported as hybrid tumour had no clear lines of demarcation between the two tumour types. We are inclined to suggest that most of the 38 cases of hybrid tumours described in the literature would today better be called tumour with HGT rather than hybrid tumour. The relative proportion of the two components may vary, and the high-grade component is sometimes very small, which emphasises the importance of very generous sampling of the surgical specimen. The molecular genetic mechanisms responsible for HGT, including what used to be called hybrid tumour, remain largely unknown. Abnormalities of a few genes (including p53, C-MYC, cyclin D1, HER-2/neu) have been documented. As insufficient data exist on gene abnormalities in these lesions, conclusions as to whether or not they have a common origin and which mechanisms are involved in transformation cannot be drawn. Due to the small number of cases reported, many of which lack follow-up details; indicators of prognosis of hybrid tumours are not available, but their behaviour seems to be similar to that of tumours with HGT, i.e. an accelerated aggressive course. HGT of salivary gland neoplasms greatly influences macroscopic and microscopic evaluation of the specimen but also, given the high incidence of metastases and morbidity, carries significant treatment implications