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Cilj ove studije preseka je da se kod različitih oblika neurodegenerativnog parkinsonizma: idiopatske Parkinsonove bolesti (IPB), multiple sistemske atrofije (MSA) i progresivne supranuklearne paralize (PSP), pozitronskom emisionom tomografijom (PET) pomoću 18-fluorodeoksiglukoze (FDG) odrede karakteristični, za bolest specifični obrasci regionalnog metabolizma glukoze u mozgu i proceni njihov značaj u diferencijalnoj dijagnozi ovih parkinsonih sindroma u kliničkoj praksi. Metodologija: Studijsku populaciju je činilo 72 bolesnika sa neurodegenerativnim parkinsonizmom (50 muškaraca, 22 žene; starosti 61±10god.) koji su upućeni na FDG-PET pregled od strane neurologa eksperata za bolesti nevoljnih pokreta, Odeljenja za bolesti nevoljnih pokreta i neurodegenerativne bolesti, Neurološke klinike, Kliničkog centra Srbije. Selekcija i grupisanje bolesnika je izvršeno prema kliničkim dijagnozama postavljenim na osnovu važećih kliničkih dijagnostičkih kriterijuma. Dijagnoza IPB postavljena je kod 29 pacijenata (22 muškarca, 7 žena, starosti 60,8±10,4 god.), MSA kod 20 pacijenata (8 muškaraca, 12 žena, starosti 56,3±5,6 god.), PSP kod 21 pacijenta (18 muškaraca, 3 žene, starosti 67,3±5,3 god.). U studiju su uključena i 2 pacijenta (1 žena, 1 muškarac, starosti 59,5±10,6 god.) sa kortikobazalnom degeneracijom (KBD) kao retkim oblikom neurodegenerativnog parkinsonizma. Kod svih pacijenata je urađen detaljan neurološki pregled, procena težine i stadijuma bolesti, i ispitivanje kognitivnog i psihičkog statusa. FDG-PET snimanje je obavljeno prema standardnom protokolu za statičke studije mozga, PET/CT aparatom (Biograph 64 TruePoint, Siemens), 45-60 min nakon injekcije radiofarmaka (doza 121-185 MBq (3-5 mCi) 18F-FDG). 3D akvizicija sprovedena je u trajanju od 15 minuta (CT topogram, niskodozni CT (45 mAs) bez kontrasta, 18F-FDG-PET). Rekonstrukcija tomografskih (FDG-PET) scintigrama (transverzalnih, sagitalnih, frontalnih) je vršena iterativnom metodom (OSEM) uz korekciju na atenuaciju i rasejanje... The aim of this cross-section study is to determine a characteristic, disease-specific brain metabolic patterns using positron emission tomography (PET) with 18-fluorodeoxyglucose (FDG) in different forms of neurodegenerative parkinsonism: idiopathic Parkinson's disease (PD), Multiple System Atrophy (MSA), Progressive Supranuclear Palsy (PSP), and to estimate their importance in differential diagnosis of these Parkinsonian syndromes in clinical practice. Methodology: The study population consisted of 72 patients with neurodegenerative parkinsonism (50 men, 22 women; age 61 ± 10 years) who were referred to FDG-PET imaging of the brain by movement disorder specialists from the Department for Movement Disorders and Neurodegenerative Disorders, Neurology Clinic, Clinical Centre of Serbia. The patients were selected and categorized according to clinical diagnosis, based on valid clinical diagnostic criteria. There were 29 patients with IPD diagnosis (22 males, 7 females, mean age 60.8 ± 10.4 year), 20 patients with MSA (8 males, 12 females, mean age 56.3 ± 5.6 year), and 21 patients were diagnosed with PSP (18 men, 3 women, age 67.3 ± 5.3 years). This study also included 2 patients (1 female, 1 male, age 59.5 ± 10.6 year) with corticobasal degeneration (CBD) as a rare form of a neurodegenerative parkinsonism. Detailed neurological examination was performed in all patients , with assessment of severity and the stage of the disease, testing cognitive and psychological status. The standard 18F-fluorodeoxyglucose-Positron Emission Tomography/Computed Tomography (FDG-PET/CT) static brain study was performed (with Biograph 64, True Point, SIEMENS) 45-60 min after the injection of the radiopharmaceutical (121-185 MBq (3-5mCi) dose of 18F-FDG, 3D mode, 1 bed, 15 minutes). Images were reconstructed using the iterative method (OSEM) and with attenuation and scatter correction. The characteristic pattern of regional glucose metabolism was obtained by qualitative visual assessment and quantitative SPM (Statistic Parametric Mapping) image analysis of the individual scans, but also group analysis based on the final clinical diagnosis (IPD, PSP and MSA). Quantitative voxel-based statistical image analysis was performed using...

Uzroci gubitka svesti su različiti i teško ih je diferencirati. Razlikovanja epileptičkih od neepileptičkih gubitaka svesti je od krucijalnog značaja za ispitivanje, lečenja i prognoze ovih poremećaja. Elektroencefalografija (EEG) je standardna, neinvazivna metoda koja se koristi u ispitivanju nakon gubitka svesti. Inicijalni EEG nalaz nakon prvog gubitka svesti može biti normalan, specifičan ili nespecifičan. Procenat patološkog EEG nalaza je veći kod rano urađenog EEG pregleda. Kod dece rani EEG pregled u roku od 48h ne pokazuje statistički značajne abnormalnosti. Spontanim spavanjem ili EEG pregledom nakon deprivacije spavanja se beleži značajno veća prisutnost epileptiformnih promena kod dece starije od 3 godine, čak i kada je prvi EEG u budnom stanju normalan. Kombinacijama pregleda u budnom stanju i spavanju povećava prisutnost patoloških promena u EEG zapisu. Materijal metode: Istraživanje je obuhvatilo 198 dece uzrasta od 3-12 godine života nakon prvog gubitka svesti. Ispitanici su klasifikovani u dve grupe na osnovu otpusne dijagnoze: na grupu dece kod kojih dijagnoza epilepsije nije postavljena i na grupu dece kod kojih je dijagnoza epilepsije potvrđena. Korelirani su nalazi EEG-a u budnom stanju i spavanju (spontanom ili nakon deprivacije spavanja) sa anamnestičkim i kliničkim podacima o gubitku svesti, podacima o dužini trajanja gubitka svesti i vremena oporavka, vremenom kada je urađen prvi EEG u odnosu na gubitak svesti kao i sa podacima o ličnoj i porodičnoj anamnezi, a koji su navedeni u protokolu istraživanja. Ispitanici su potom podeljeni prema uzrastu u pet grupa u intervalima od 2 godine (3-4; 5-6; 7-8; 9-10; 11-12). Rezultati: Nakon prvog gubitka svesti specifičan (epileptiformni) nalaz EEG u budnom stanju imalo je 41,97% ispitanika, a 58,03% je imalo nespecifičan ili uredan EEG nalaz u budnom stanju, dok je specifičan nalaz EEG u spavanju imalo je 73,57% ispitanika, a 26,43% je imalo nespecifičan ili uredan EEG nalaz u spavanju. Ispitanici koji su imali specifičan EEG nalaz u budnom stanju imali su i specifičan nalaz u spavanju, a 45,07%, nakon deprivacije sna. Ispitanici koji su u budnom stanju imali nespecifičan ili uredan EEG nalaz u budnom stanju su u 35,92% nakon deprvacije spavanja imali specifičan EEG nalaz u spavanju, za razliku od 1,41% dece koji su imali specifičan EEG nalaz u spontanom spavanju. Sumarno gledano bolesnici koji su “aktivirani” odnosno oni kod kojih je deprivacija spavanja uticala na dobijanje specifičnog nalaza (epileptiformnih pormena) u spavanju čine 37.32% od svih ispitanika sa specifičnim (epileptiformnim) promenama u EEG-u u spavanju Zaključak: Kod većine pacijenata nakon prvog gubitka svesti EEG nalaz u budnom stanju je bio nespecifičan ili uredan. Procenat specifičnih EEG nalaza (epileptiformnih promena) se značajno povećao prilikom snimanja EEG u spavanju. Naročito velika korist od deprivacije spavanja kao metode aktivacije potvrđena kod onih pacijenata koji su imali inicijalni EEG u budnom stanju uredan ili nespecifičan. Dobijeni rezultati nesumljivo ukazuju na efikasnost deprivacije spavanja kao provokacione metode i povećanja procenta interiktalnihepileptiformnih EEG promena. Neprovociranih prvi gubitci svesti su se češće javljali u grupi dece kod kojih je dijagnoza epilepsije potvrđena, dok su se provocirani gubitci svesti javljali češće u grupi dece kod kojih dijagnoza epilepsije nije postavljena. Uzrast dece nije uticao na postavljanje dijagnoze epilepsije kao ni na inicijalne nalaze EEGa u budnom stanju i spavanju ali se registrovalo povećanje specifičnih nalaza (epileptiformnih promena) EEG-a, nakon deprivacije spavanja , sa porastom godina života., The reasons for the loss of consciousness are various and difficult to be differentiated. It is of utmost importance to differentiate between epileptic and non-epileptic losses of consciousness for the purpose of testing, treating and giving prognosis related to this disorder. Electroencephalography (EEG) is a standard, non-invasive method used in testing after the loss of consciousness. The initial EEG after the first loss of consciousness can be normal, specific and non-specific. The percentage of pathological EEG findings is higher in EEG exams performed at an earlier stage. In children, an early EEG exam within 48 hours does not reveal any statistically relevant abnormalities. Spontaneous sleeping or an EEG examination after sleep deprivation leads to a significantly higher number of epileptiform changes in children above the age of 3, even in cases when the first EEG in the awake state was normal. Combinations of examinations in the awake state and during sleep lead to an increased presence of pathological changes in the EEG recording. Material and methods: The research included 198 children aged 3-12 who have experienced their first loss of consciousness. The subjects were classified into two groups, based on their discharge diagnosis: children who have not been diagnosed with epilepsy and children who have had epilepsy confirmed. A correlation was established between EEG findings in the awake state and sleep (spontaneous or following sleep deprivation) and medical history and clinical data related to the loss of consciousness, the information about the length of the loss of consciousness and recovery time, the time when the first EEG examination was performed in relation to the loss of consciousness, as well as the data from the personal and family history. The subjects were further divided into five groups, depending on their age, with each group covering a 2-year period (3-4; 5-6; 7-8; 9-10; 11-12). Results: Following the first loss of consciousness, specific (epileptiform) EEG findings were noticed in 41.97% subjects, while 58.03% of them had non-specific, i.e. regular findings in the awake state. When it comes to the findings during sleep, 73,57% were specific, while 26,43% were non-specific, i.e. regular. The subjects who had specific EEG findings in the awake state also had specific findings during sleep, while that percentage was 45,07% after sleep deprivation. The subjects who had non-specific, i.e. regular EEG findings in the awake state had specific EEG findings during sleep in 35.92% of the cases following sleep deprivation, while 1.41% of the children had specific EEG findings during spontaneous sleep. In total, the patients who were “activated”, i.e. those whose sleep deprivation contributed to specific findings (epileptiform changes) during sleep comprise 37.32% of all subjects with specific (epileptiform) changes in the EEG findings during sleep. Conclusion: In most patients suffering from the first loss of consciousness the EEG findings were non-specific, i.e. regular. The percentage of specific EEG findings (epileptiform changes) was significantly increased when the EEG examination was performed during sleep. Sleep deprivation, as an activation method, was particularly useful in patients whose initial EEG findings in the awake state were regular, i.e. non-specific. The results obtained undoubtedly confirm the efficiency of sleep deprivation as a provoking method and the increase of the percentage of interictal epileptiform EEG changes. Unprovoked first losses of consciousness were more common in the group of children who have had the diagnosis of epilepsy confirmed, while provoked losses of consciousness were more common in the group of children who have not been diagnosed with epilepsy. The age of children did not affect the process of establishing a diagnosis of epilepsy, nor did it affect the initial EEG findings in the awake state or during sleep, but it was observed that the number of specific EEG findings (epileptiform changes) following sleep deprivation increased with the increase of the age of the patients.

Introduction: Salivary gland tumors are rather rare neoplasms characterized by a high level of pleomorphism and histological overlapping. Very often, one tumor may contain several cell types, therefore, it is necessary to include additional histochemical and immunohistochemical staining, as well as the morphometric analysis of tumor cells, in terms of an appropriate diagnosis. Materials and methods: The research encompassed 30 benign and 30 malignant tumors, including pleomorphic adenoma (10), Warthin’s tumor (10), basal cell adenoma (6), myoepithelioma (4), adenoid cystic carcinoma (6), mucoepidermoid carcinoma (8), salivary duct carcinoma (6), polymorphous low-grade carcinoma (6), and myoepithelial carcinoma (4). The expression of Ki67, p53, HER-2, p63, CEA, EMA, S-100, CK14, WT-1, GFAP, αSMA and vimentin was analyzed. The morphometric analysis was performed using “ImageJ” software pack. The area, perimeter, Feret diameter, integrated optical density, nucleus circularity and roundness were analyzed. Results: The Ki67 proliferative index was statistically significantly higher in malignant tumors (p