Serum prolactin levels in psoriasis and correlation with cutaneous disease activity

Background. Prolactin (PRL), a neuropeptide secreted by the anterior pituitary gland, possesses a variety of physiological actions. It has been implicated as an important immunomodulator and exerts a proliferative effect in cultured human keratinocytes via specific receptors. Some studies have indicated an increase in serum PRL levels in psoriasis and exacerbation of psoriasis when a prolactinoma is present. Aim. To evaluate the correlation between serum PRL levels and Psoriasis Area and Severity Index (PASI). Methods. Serum PRL levels were measured in 20 patients (10 mean, 10 women, age range 18–88 years) with plaque‐type psoriasis before and after a 6‐week period of topical treatment with tacalcitol ointment. Results were compared with a group of 20 healthy volunteers. Results. Serum PRL levels were significantly increased in the psoriatic group compared with the control group (P < 0.001) and were significantly reduced after treatment (P = 0.001). There was a correlation between pretreatment serum PRL levels and PASI (r = 0.33; P = 0.02). Conclusions. These results indicate that serum PRL levels may serve as a biological marker of psoriatic disease activity.     

Stent expansion of stretch Gore‐Tex grafts in children with congenital heart lesions

Objective : To evaluate the efficacy and safety of expanding vascular shunt grafts beyond original nominal diameter using stents. Methods : Bench testing confirmed the expandability of 3.5 mm and 4.0 mm vascular Gore‐Tex® stretch grafts. A retrospective analysis included eleven systemic to pulmonary artery shunts with diminished flow which were stented with the aim of increasing the original nominal diameter of the shunts. Results : During bench testing, the grafts could be expanded to 4.5 mm and 5.8 mm, respectively. Fourteen stents were implanted in 11 stretch grafts a median of 18.9 months (3.2; 21.6 months) after shunt surgery. There was a median increase in diameter of 1.4 mm (0.9; 1.7 mm) [P = 0.001, 95% CI: 0.47; 1.7) from original nominal to final stented diameter of the shunts with a median gain of 28%. A simultaneous improvement in saturations from a median of 73% (66; 77%) to 87% (84; 89%) [P = 0.015; 95% CI: 3; 22] was observed. No complications were experienced during the procedures. Conclusion : In our limited experience, stretch Gore‐Tex vascular grafts can be safely expanded beyond nominal diameters using high pressure vascular stents. This leads to improvement in saturation and pulmonary blood flow. It allows the clinician to tailor pulmonary flow in relation to pulmonary artery size and growth, ensuring best possible timing for the next surgical procedure. © 2009 Wiley‐Liss, Inc.     

Reduction mammaplasty: An advantageous option for breast conserving surgery in large-breasted patients

Oncoplastic breast conserving surgery is a good approach for large-breasted women with breast cancer, as it increases the rate of breast conserving surgery, improves cosmetic results and prevents both cosmetic sequelae and the symptoms associated with macromastia. We reviewed ten publications in which 276 patients had been treated with bilateral reduction mammaplasty. All showed the same conclusion: women with breast cancer and macromastia candidates for breast conserving surgery could obtain clear oncological and cosmetic advantages and an improvement in quality of life if they were treated using bilateral reduction onco-therapeutic mammaplasty.     

Laparoscopic versus open distal pancreatectomy in pancreatic tumours: a case–control study

Laparoscopic distal pancreatectomy has become an increasingly used procedure in the surgical treatment of benign or borderline cystic and endocrine tumours. The feasibility and safety of this technique is well known but its results when compared with open distal pancreatectomy were rarely reported in literature. Data from 22 consecutive patients who underwent laparoscopic distal pancreatectomy were recorded in a prospective database from January 2006 to January 2010. These patients were matched with 22 patients who underwent open distal pancreatectomy from January 2000 to December 2005, regarding age, gender, American Society of Anesthesiologists score, pancreatic pathology. Intraoperative parameters and postoperative outcome were compared between the two groups. Blood loss, amount of analgesic drugs administered, postoperative mortality and morbidity and pancreatic fistula rate were similar in laparoscopic and open groups. Tumour size was significantly smaller in laparoscopic group (2.0 ± 3.3 vs. 5.0 ± 4.2 cm; P = 0.038). Operative time was significantly shorter in open group (145 ± 49 vs. 225 ± 83 min, P = 0.045). Time to adequate oral intake and length of postoperative hospital stay were significantly better in laparoscopic group than in open group (3.0 ± 0.8 vs. 4.0 ± 0.7 days; P = 0.030 and 8.0 ± 1.3 vs. 11.0 ± 3.0 days; P = 0.011, respectively). Laparoscopic distal pancreatectomy is a feasible and safe surgical approach as well as open distal pancreatectomy.     

Acute gastrointestinal bleeding following aortic valve replacement in a patient with Heyde's sindrome. Case report

A 58-year old man was admitted to the hospital because of melena. He had a 1-year history of mechanical aortic valve replacement and coronary stent placement because of myocardial infarction and he was taking warfarin and clopidogrel. Esophagogastroduodenoscopy and colonoscopy were negative for bleeding. Capsule endoscopy showed bleeding diffuse angiodysplasia of the small bowel. The patient was treated with octreotide 20 mg, at monthly interval. After 25 months there had been no recurrence of gastrointestinal bleeding. The case suggests that mechanical valve replacement may not prevent gastrointestinal bleeding in Heyde syndrome and that octreotide treatment should be considered in these cases.