Prolactin and growth hormone-producing pituitary adenomas. An immunohistochemical and ultrastructural study

Thirteen prolactin and five growth hormone-producing pituitary adenomas were studied by immunohistochemistry and electron microscopy. The immunohistochemical localization of prolactin and growth hormone correlated well with elevated serum levels of pituitary hormones in all cases. Ultrastructural characterization by granule density and secretory activity was studied in relation to the serum levels of pituitary hormones and the sizes of the tumors. This indicated that markedly elevated serum hormone levels were related to larger tumors with high secretory activity, as indicated by abundant endoplasmic reticulum and well-developed Golgi complexes rather than to the numbers of cytoplasmic granules in the tumors. Two patients with prolactin-producing adenomas had been treated with bromocryptine before surgery. Both tumors showed evidence of degeneration, including cytoplasmic vacuolization. In one case the tumor had an increased number of secretory granules, while in the other case there were few viable cells and an abundance of amyloid deposits. The effects of bromocryptine therapy on pituitary tumor morphology in these two cases include an increased number of pituitary granules, and cellular degenerative changes.     

Reversal of renal allograft rejection with intravenous methylprednisolone "pulse" therapy

Intravenous administration of large doses of methylprednisolone sodium succinate was demonstrated to modify rejection in both canine and human renal allografts. One dose of intravenous methylprednisolone 30 mg./kg. administered during acute rejection in dogs resulted in an increase in urine volume and osmolality, and a decrease in serum and urine LDH. In two dogs treated with a single dose and in one dog treated with four consecutive daily doses histologic evidence of reversal of rejection with reduction of cellular infiltrate was achieved. Ninety-two percent of rejections encountered in 100 consecutive human recipients of renal allografts were halted or reversed with intravenous methylprednisolone 30 mg./ kg. given every 48–72 hours to a maximum of three or four doses. No significant side effects were observed either in dogs or humans with this therapy. The mean circulating half-life of intravenous methylprednisolone was determined to be 3.48 ± 0.7 hours in dogs. Intermittent intravenous administration of methylprednisolone has the potential advantage of being associated with fewer side effects than frequent oral administration and has been shown to be an effective method for modifying rejection.     

Adult renal myoepithelial hamartoma.

A renal myoepithelial hamartoma presented as a lucent filling defect with gross hematuria in an adult female. Preoperative studies caused conflicting impressions. The predominance of smooth muscle and incorporated tubuloepithelial elements characterize the tumor as a hamartoma of myoepithelial type. Pertinent review of the literature confirms the rarity of this lesion in adults.     

The ��reading man flap�� for pressure sore reconstruction

Background:

The treatment of pressure sores represents a significant challenge to health care professionals. Although, pressure wound management demands a multidisciplinary approach, soft tissue defects requiring reconstruction are often considered for surgical management. Myocutaneous and fasciocutaneous flaps can provide stable coverage of pressure sores.

Purpose:

Here, we describe our experience using a recent fasciocutaneous flap, which is named ‘reading man’ flap, in sacral, ischial, and trochanteric pressure sores.

Materials and Methods:

During a period of 1 year the authors operated 16 patients, 11 men, and 5 women, using the reading man flap. The ages of the patients ranged from 24 to 78 years. The location of pressure sores was 8 sacral, 5 ischial, and 3 trochanteric pressure sores. The mean size of pressure sores was 8 cm × 9 cm.

Results:

All pressure sores covered bt the Reading Man flap healed asymptomatically. After follow-up of 2-8 months, no recurrences were encountered and no further surgical intervention was required.

Conclusion:

The reading man flap was found to be a useful technique for the closure of pressure sore in different anatomic locations. The advantage of tension-free closure and the minimal additional healthy skin excision made this flap a useful tool in pressure sore reconstructions.KEY WORDS: Local flap, pressure sore, ‘reading man’ flap     

Endoprosthetic replacement of the distal humerus following resection of bone tumours

Between 1988 and 2006, 18 patients had a custom-made endoprosthetic replacement of the distal humerus for bone tumours at our institution. There were 11 primary malignant neoplasms, six secondary deposits, and one benign aggressive tumour. The mean follow-up was for 4.4 years (1 to 18.2). Complications occurred in nine patients and included aseptic loosening in three (16.6%), local recurrence in two (11%), infection in two (11%), neuropraxia of the radial nerve in one (5.5%) and a peri-prosthetic fracture in one (5.5%). Excision was inadequate in four patients (22%), all of which developed local recurrence and/or metastases. There were seven deaths from the primary disease after a mean of 2.3 years (1 to 5), one of whom had an above-elbow amputation for local recurrence seven months before death. The remaining six had satisfactory elbow function at their last follow-up. The 11 living patients were evaluated using the Musculoskeletal Tumour Society and Toronto Extremity Salvage scoring systems. The mean scores achieved were 76% (67% to 87%) and 73% (59% to 79%), respectively. Overall, 17 of 18 patients had significant improvement in the degree of their pain following operation. Custom-made endoprosthetic reconstruction of the elbow for bone tumours is a viable treatment in carefully selected patients. It maintains satisfactory function and provides good pain relief.     

Seropositivity to Chlamydia pneumoniae or Helicobacter pylori and coronary artery disease

Our aim was to investigate the relationship between the serologic status concerning Chlamydia pneumoniae and Helicobacter pylori with the presence of coronary artery disease (CAD), which remain a controversial issue in literature. We studied 208 patients with CAD and 94 controls with no evidence of obstructive CAD; all of them angiographically confirmed. The seropositivity to C. pneumoniae was 91% in patients with CAD vs 86% in controls (P>0.05). The H. pylori seroprevalence rates were 77% and 68%, respectively (P>0.05). The multivariate analysis, adjusting for age, sex, educational level, diabetes, hypertension, obesity, smoking, family history of CAD and lipids, confirmed the results of univariate analysis. Therefore, this study adds evidence against the association of seropositivity to C. pneumoniae and H. pylori with angiographically documented CAD.     

Surgeons�� and residents�� double-gloving practices at 2 teaching hospitals in Ontario

Background

Surgeons and residents are at increased risk of exposure to blood-borne pathogens owing to percutaneous injury (PI) and contamination. One method known to reduce risk is double-gloving (DG) during surgery.

Methods

All surgeons and residents affiliated with the University of Western Ontario (UWO) and McMaster University in 2005 were asked to participate in a Web-based survey. The survey asked respondents their specialty, the number of operations they participated in per week, their age and sex, the proportion of surgeries in which they double-gloved (DG in ≥ 75% surgeries was considered to be routine), and the average number of PIs they sustained per year and whether or not they reported them to an employee health service.

Results

In total, 155 of 331 (47%) eligible surgeons and residents responded; response rates for UWO and McMaster surgeons were 50% and 39%, respectively, and for UWO and McMaster residents, they were 52% and 47%, respectively. A total of 43% of surgeons and residents reported routine DG; 50% from McMaster and 36% from UWO. Using logistic regression to simultaneously adjust for participant characteristics, we confirmed that DG was more frequent at McMaster than at UWO, with an odds ratio of 3.32 (95% confidence interval 1.35–8.17). Surgeons and residents reported an average of 3.3 surgical PIs per year (2.2 among McMaster participants and 4.5 among UWO participants). Of the 77% who reported at least 1 injury/year, 67% stated that they had not reported it to an employee health service.

Conclusion

Percutaneous injuries occur frequently during surgery, yet routine DG, an effective means of reducing risk, was carried out by less than half of the surgeons and residents participating in this study. This highlights the need for a more concerted and broad-based approach to increase the use of a measure that is effective, inexpensive and easily carried out.     

Pubertal Maturation of Contemporary Greek Boys: No Evidence of a Secular Trend

Purpose

To examine pubertal status of contemporary Greek boys and compare the data with those of a previous study we performed in the year 1996.

Methods

We performed a cross-sectional study of 932 healthy boys, aged from 8.05 to 16.05 years. Development of the genitalia (G) and pubic hair was assessed by the method of Tanner and testicular volume (TV) was determined with a Prader orchidometer. Genitalia stage 2 (G2) was assessed by probit analysis.

Results

Median (95% confidence interval [CI]) age at G2, defined as TV 4 mL, was 11.3 (10.9–11.6) years, almost the same age as in our study performed in 1996, which was 11.4 (10.7–11.7) years (p = .21). When G2 was defined as change in scrotum texture and TV2 mL, median (95% CI) age at onset of puberty was 10.9 (10.5–11.3) years, again similar to the study performed in 1996 which was 11.0 (10.7–11.4) (p = .32). Median (95% CI) age of pubic hair development was 11.2 (10.8–11.6) years versus 11.5 (11.1–12.0) years in 1996, p = .015.

Conclusions

Our data provide no evidence of a secular trend for gonadarche in Greek boys, although such a trend was evident for pubarche.