Parathyroid glands involvement in multiple endocrine neoplasia

Multiple endocrine neoplasias are syndromes characterized by the involvement of at least two endocrine glands. Parathyroid gland involvement is usually noted in Multiple Endocrine Neoplasia (MEN) type I and type II. Parathyroid glands tumor associated with endocrine pancreatic tumor, as well as pituitary tumors is the typical pattern of MEN I. The parathyroid gland is the most frequent abnormality in MEN I. CASES REPORTS: We presented five cases with MEN I and parathyroid glands involvement. In three cases with young ages (28-33 years old) and familial setting, the MEN I syndrome was "complete" (parathyroid adenoma, gastrinoma or insulinoma and pituitary adenoma--prolactinoma or GH-secreting tumors), and, in the other two cases, with 57 and 68 years old respectively, the MEN I syndrome was "incomplete" with parathyroid glands and pituitary gland involvement. The cases with gastrinomas were operated in emergency for complication of peptic ulcer (perforation associated with peritonitis and gastro-intestinal bleeding); then the pancreatic tumors were diagnosed and left pancreatectomy with spleen preservation and respectively, tumor resection have been performed. Hyperparathyrodism was then diagnosed and subtotal parathyroidectomy has been performed in both cases. Unfortunately one patients died due to severe endocrine disorder. During the necropsy, the pituitary adenoma has been diagnosed. The third case with "complete" MEN was a women of 33 years old, admitted for severe hypoglycemia. The imagistic and laboratory test diagnosed a tumor situated into the pancreatic body, and an parathyroid adenoma. The resection of pancreatic tumor associated with resection of the parathyroid adenoma, in the same time, were performed. The other two cases with "incomplete" MEN were older then the first patients, and were diagnosed with hyperparathyrodism and pituitary gland tumor. The resection of parathyroid gland adenoma has been performed in both cases, with uneventful postoperative course. The literature data was also discussed. CONCLUSIONS: The parathyroid glands involvement in MEN is common. There are two kinds of MEN associated with parathyroid gland involvement: the "complete" form, especially in young patients, with diffuse involvement of the parathyroid glands, and the subtotal parathyroidy is the best choice, and the "incomplete" form, especially in elderly, with the involvement of a single parathyroid gland; in this way, the resection of the adenoma associated with biopsy from the other parathyroid gland is the best approach. The presence of gastrinomas, complicate the disease prognosis and the surgical approach. The treatment of these patients is challenging and has to be done in multidisciplinary team.     

Incidental appendicectomy with laparotomy for trauma.

Incidental appendicectomy was performed in 83 of 206 patients undergoing laparotomy for abdominal trauma. No organs were injured in 42 per cent of the appendicectomy patients and in 17 per cent of the non-appendicetomy patients, thus making comparison between the groups unreliable. While the incidence of intestinal perforation was 21 per cent in the appendicectomy patients, the rate of wound infection was only 7 per cent. One complication (pelvic abscess) was possibly attributable to incidental appendicetomy. Since males below the age of 50 face a significant risk of future appendicitis and represent the majority of patients with abdominal trauma, it may be advisable to perform incidental appendicectomy with laparotomy for trauma in such patients. Specific indications for incidental appendicectomy during laparotomy for trauma are suggested.     

Incidental splenectomy associated with Nissen fundoplication.

Despite the relative frequency of iatrogenic splenectomy, its effect on postoperative morbidity and mortality remains controversial. This retrospective study compares the postoperative morbidity and mortality among 72 patients who underwent a Nissen fundoplication for esophageal reflux and 25 patients who had iatrogenic splenectomy and Nissen fundoplication. The age range in both groups was comparable. In the Nissen fundoplication (N.F.) group the average postoperative hospital stay was 9.4 days and in the Nissen fundoplication and splenectomy (N.F. + S.) group postoperative hospital stay was 15 days. In the N.F. group nine patients (12.5%) experienced significant postoperative morbidity in comparison to 36% in the N.F. + S. group (statistically significant p less than 0.1%). In the later group the complications were of a more severe nature. No mortality occurred in the N.F. group and one patient died in the N.F. + S. group. Iatrogenic splenectomy in this patient could well have been a prime factor in precipitating his demise. This retrospective study stongly supports the view that iatrogenic splenectomy in association with Nissen fundoplication adds considerably to postoperative morbidity.     

Cytomegalovirus prostatitis.

Tissue demonstration of cytomegalovirus (CMV) within the male genital tract has rarely been reported. We present a case of extensive CMV prostatitis in a homosexual patient with acquired immune deficiency syndrome (AIDS) dying of disseminated CMV infection.     

Bacterial prostatitis: treatment with trimethoprim-sulfamethoxazole.

Fifteen patients with chronic bacterial prostatitis were treated with trimethoprim-sulfamethoxazole for three months. In 60 per cent of the patients a recurrence of chronic bacterial prostatitis developed during a follow-up period of from one to two and one-half years. It appears that factors other than a diffusion barrier to effective antimicrobial agents into the prostatic gland are responsible for the persistence of chronic bacterial infections of the prostate.     

Diagnostic laparoscopy in nonmalignant disease.

Laparoscopy is useful in the management of a wide range of benign conditions. In the elective situation, it may be chosen to evaluate hepatobiliary disorders, abdominal masses, or chronic pain, and is an ideal way to sample tissue. Under the emergency setting, it is another tool for the assessment of trauma patients and may be of value in those patients with abdominal pain, mesenteric ischemia, fever of unknown origin, or gastrointestinal hemorrhage. It is important for the surgeon to be familiar with the technique, correctly prepare the patient, and be aware of the risks and limitations of this diagnostic modality.     

Ultrasonographic findings in patients with nonbacterial prostatitis.

The potential value of prostatic imaging in the diagnosis of inflammatory disorders of the prostate is largely unexplored. In several studies, specific ultrasonographic characteristics in patients with prostatitis have been described. Also nonspecific echogenic qualities in prostatitis have been pointed out. To evaluate ultrasound of the prostate in patients with nonbacterial prostatitis in this study, ultrasound images of these patients were compared with those of a healthy control group. In contrast with earlier findings, constant dilatation of the periprostatic venous plexus was seen more pronounced in the control group as well as elongation of the seminal vesicles. Finally, prostatic calcifications were frequently encountered in both groups.     

Incidental pituitary macroadenomas.

Five cases of incidentally detected pituitary macroadenomas are described. All five had suprasellar extensions, but none had visual field defects as tested by computed perimetry. One patient had sellar changes seen on an X-ray film taken following a head injury, while the others were detected by computed tomography performed for seizures, stroke and meningitis. Four patients underwent trans-sphenoidal surgery for suprasellar extensions with or without hypopituitarism, while one was managed conservatively as he had normal visual fields and pituitary function and there was a spontaneous decrease in size of the adenoma. The management of such incidental pituitary macroadenomas is discussed.     

Perineural involvement by benign prostatic glands on needle biopsy

Uncommonly, benign prostatic glands can be seen in the perineural space, known as "benign perineural involvement." This phenomenon has not been specifically studied on needle biopsies; 27 needle biopsy cases with perineural involvement were evaluated; 22 (81.4%) were received in consultation, while 5 (18.5%) were in-house cases. In 15 of 22 (68.2%) consult cases, a question was raised by the submitting pathologist regarding the focus. The following patterns of perineural involvement were observed: indentation 14 (51.8%) cases, by up to 3 glands; tracking 8 (29.6%) cases, by up to 6 glands; wrapping 7 (25.9%) from one half to three fourths around the nerve, by up to 3 glands, 1 case showed 95% wrapping; intraneural 4 (14.8%) cases by up to 3 glands; adjacent 2 (7.4%) cases by up to 2 glands. Partial atrophy in the involved glands was seen in 10 (38.4%) cases and complete atrophy in 6 (23%). Of 8 cases with the lesion still present on slides for immunohistochemistry, high molecular weight cytokeratin (HMWCK) and p63 were positive in 6 (75%) and negative in the 2 (25%) cases with partial atrophy. A total of 6 (27%) cases had more than one pattern of perineural involvement. On hematoxylin and eosin sections, basal cells were not identified in 12 (46%) cases, including 2 negative and 1 positive cases stained for HMWCK. Patterns most closely mimicking cancer included intraneural and incomplete perineural encirclement. Perineural invasion by benign atrophic glands cause diagnostic difficulty, especially with negative HMWCK. Careful attention to hematoxylin and eosin morphology and comparison of perineural involvement to adjacent and distant benign glands are necessary.     

Llama oviductal sperm reservoirs: involvement of bulbourethral glands

The aim of this study was to elucidate the role of llama seminal plasma in the formation of oviductal sperm reservoirs. Female llamas with follicles in the mature phase were mated with a bulbourethral glands‐removed male. Females mated with nonbulbourethral glands‐removed males were used as control. Oviducts were obtained by surgery 24 h after mating. The uterotubal junction and isthmus were examined by scanning electron microscopy, and mucopolysaccharides were identified by Alcian blue staining. To know the proteins probably involved in sperm reservoir formation, SDS‐PAGE of seminal plasma (8% and 18% resolving gel) was made. Spermatozoa only adhered to the oviductal mucosa surface of uterotubal junction of females mated with nonbulbourethral glands‐removed males confirming that seminal plasma and, in particular, bulbourethral secretions are related with the oviductal sperm reservoir formation. Histological sections showed sperm in the lumen, immersed in substance, positive for acid mucopolysaccharides. Alcian blue staining of seminal plasma proteins SDS‐PAGE showed a band of high molecular weight containing mucopolysaccharides, only present in nonbulbourethral glands‐removed males. Bulbourethral glands would secrete at least eight different proteins that most likely participate in the process of sperm storage in the oviduct.     

Nonspecific granulomatous prostatitis.

Nonspecific granulomatous prostatitis is a relatively rare disorder of the prostate. We encountered 4 cases of this type of chronic inflammation, including 1 case of xanthogranulomatous prostatitis. In all cases the diagnosis was made by histologic examination of specimens obtained by transurethral resection, retropubic prostatectomy, or transrectal needle biopsy. Echography revealed a hypoechoic lesion in the case of xanthogranulomatous prostatitis, while the other cases showed no specific findings except for the associated adenomas. The major symptoms were frequency and dysuria caused by urinary tract infection or benign prostatic hyperplasia associated with the granulomatous prostatitis.     

Seminal secretory capacity of the male accessory sex glands in chronic pelvic pain syndrome (CPPS)/chronic prostatitis with special focus on the new prostatitis classification

OBJECTIVE: The aim of the study was to evaluate the secretory dysfunction of the male accessory glands in men with inflammatory versus non-inflammatory chronic pelvic pain syndrome (CPPS). METHODS: One hundred and twelve consecutive patients symptomatic for chronic pelvic pain were included into the study. All underwent a combined granulocyte analysis in expressed prostatic secretions (EPS) and a four-glass-test followed by ejaculate analysis. Patients were subgrouped according to elevated granulocyte counts in prostatic secretions, leukocytes in semen, or any of both. The content/total enzyme activity of the secretory seminal plasma parameters gamma-glutamyl-transferase (gamma-GT), fructose, and alpha-glucosidase representing the secretory capacity of the prostate gland, the seminal vesicles, and the epididymes, respectively, were investigated. RESULTS: The only significant findings were a reduced total enzyme activity of gamma-GT in men stratified according to elevated granulocyte counts in prostatic secretions (p=0.022; cutpoint 9.85U per ejaculate; sensitivity 61.1%, specificity 58.8%, AUC 0.6347) and in men with any inflammatory sign (p=0.033; cutpoint 9.9U per ejaculate, sensitivity 63%, specificity 58.33%, AUC 0.6404). CONCLUSIONS: Secretory damage of the prostate gland in men with inflammatory CPPS is demonstrable provided that increased granulocytes in prostatic secretions are part of the diagnostic criteria. However, because of the low sensitivity and specificity of gamma-GT it cannot be recommended as diagnostic tool to detect inflammatory disease on the basis of reduced secretory capacity.     

Selective photothermolysis of the sebaceous glands for acne treatment

BACKGROUND AND OBJECTIVES: The purpose of this study is to evaluate the efficacy of a long pulse diode laser (Cynosure, Inc.) to target and destroy enlarged sebaceous glands that are preloaded with Indocyanine green (ICG) chromophore. STUDY DESIGN/MATERIALS AND METHODS: This study was designed in three phases. First, preliminary studies were performed to determine the ability of ICG to penetrate into enlarged sebaceous glands. Once penetration of the sebaceous gland was confirmed, the second phase was to determine the necessary parameters for the diode laser to effectively target the ICG loaded glands. This was done using laser-tissue interaction analysis. The final phase was done with patients that had active acne on their back to determine if selective destruction of the sebaceous glands could be achieved and also to assess the safety and efficacy of this novel treatment for acne. RESULTS: Fluorescence microscopy of biopsy samples show evidence of ICG penetration into the sebaceous glands. Histological examination of biopsy samples from the treated areas finds selective necrosis of the sebaceous glands. Preliminary clinical results demonstrate a decrease in acne noted in the treatment area at 3, 6, and 10 months follow-up. CONCLUSIONS: ICG and diode laser treatment is a new approach for the treatment of acne based on experimentally observed selective photothermolysis of the sebaceous glands.     

Selective venous sampling for localization of hyperfunctioning parathyroid glands

Selective venous sampling with parathyroid hormone assay was used in 46 patients with primary hyperparathyroidism. All patients had previously been operated on in the neck region. In 80 per cent of the patients the method correctly located the position of the hyperfunctioning gland(s). No complications were observed. The method was found to be of great value when evaluating patients with persistent or recurrent hyperparathyroidism.     

Experimental prostatitis in nonhuman primates: II. Ascending acute prostatitis

Bacterial prostatitis is a common cause of urinary tract infection in males, but little is known of its pathophysiology. To study this, we developed a nonhuman primate model using a wild-type clinical isolate of Escherichia coli. Primates have a prostatic anatomy that is similar to humans, which makes them ideal as an animal model of this disease. The monkeys had a urethral inoculation of this organism and were then followed with urine, blood, and semen cultures, white blood counts, and renal scans. They were sacrificed at from 10 days to 4 weeks, and their genitourinary tracts histologically examined. The prostatitis paralleled that reported in humans, and we conclude that the infection occurs by the ascending route. The organisms causing the infection in man do so in our primate model, and the histologic change is also the same. Thus, the primate model holds promise for studies to help us understand this disease.     

Incidental meningioma. Case report

The authors report the incidental discovery of a meningioma during surgery for an acute infratentorial subdural hematoma. The patient was a 46-year-old female admitted for severe head trauma. A plain skull X-ray showed a sharp linear fracture in the left posterior region, extending from the parietal area to the foramen magnum. An initial computed tomographic scan demonstrated a high-density intracranial mass in the left posterior fossa. Three hours after onset, the patient underwent emergency craniectomy and a subdural hematoma weighing 30 g was aspirated. During this procedure, an infratentorial tumor 30 mm in diameter was found to be attached to the dura and was totally removed. The tumor was a fibroblastic meningioma. The patient's postoperative course was uneventful. Most incidentally discovered meningiomas have been found in patients with ruptured aneurysms or chronic subdural hematomas. This is the first reported case in which the tumor was found in association with an acute infratentorial subdural hematoma.