Primary tumors of the posterior pituitary: A systematic review

In 2017, the World Health Organization established that pituicytoma, granular cell tumor (GCT), spindle cell oncocytoma (SCO) and sellar ependymomas (SE) are posterior pituitary tumors (PPT). They probably arise from the pituicytes and may constitute a unique histopathological entity. We carried out a systematic review using PubMed’s database. A total of 266 patients with pathological diagnosis of PPT (135 pituicytomas, 69 GCT, 47 SCO, 8 SE and 7 mixed histology tumors) were analyzed. Gender distribution was identical and median age at diagnosis was 48?±?21.8 years. Main presentation symptoms were visual disorders (n?=?142; 58.1%), headache (n?=?99; 40.5%), hypopituitarism (n?=?84; 34.4%), hypercortisolism (n?=?10; 4.1%), polyuriapolydipsia (n?=?6; 2.4%) and acromegaly features (n?=?5; 2.0%). On MRI, 122 (47.6%) patients showed sellar with suprasellar extension masses, 67 (23.1%) were suprasellar and 63 (24.6%) exclusively sellar. Median tumor size was 22.0?±?14.2 mm. Two hundred sixty four patients underwent surgery, transphenoidal access was selected in 132 (64.4%) and craniotomy in 58 (28.3%). Complications were hypopituitarism (n?=?70; 42.1%), diabetes insipidus (n?=?55; 33.1%) and hemorrhage (n?=?50; 30.1%). Tumor persisted in 93 patients (45.6%) and recurred in 13 (6.4%). Regarding comparison between main types of PPT, SCO patients were diagnosed later (60.0 vs 47.0 vs 47.0 years, p?=?0.023), the tumor was larger 25.0 mm [10.8] vs 20.0 mm [14.2] vs 2.0 mm [15.0] and they were frequently sellar with suprasellar extension tumors (71.7% vs 46.2% vs 32.8%, p?=?0.003) compared to pituicytoma and GCT. In conclusion, PPT are rare tumors and have been misdiagnosed mainly as non-functioning pituitary adenomas. Different types of PPT share similar epidemiology, clinical manifestations and surgical outcomes. Surgery is the only curative option but complications and subtotal resection are common.

     

Interethnic differences of CYP2C9 alleles in healthy Hungarian and Roma population samples: Relationship to worldwide allelic frequencies

CYP2C9 gene polymorphisms are widely studied in several ethnic groups, however they are less known in the Roma population. The aim of this work was to study the ethnic differences of the CYP2C9 allele distribution in a healthy Roma population in order to compare them with a healthy Hungarian population. A total of 535 Hungarian and 465 Roma volunteers were genotyped for the CYP2C92 (Arg144Cys) and CYP2C93 (Ile359Leu) allelic variants by PCR-RFLP assay. The frequencies of the CYP2C91, 2 and 3 alleles in the Hungarian population were 0.787, 0.125, and 0.088 and in Roma 0.727, 0.118, and 0.155, respectively. We found a significant difference in CYP2C93 prevalence between the Hungarian and Roma populations, which have therapeutic consequences (p < 0.005). The distribution of 1/1, 1/2, 1/3, 2/2, 2/3, and 3/3 genotypes in Hungarians were 0.620, 0.195, 0.139, 0.021, 0.015, and 0.011, while in Roma were 0.533, 0.168, 0.219, 0.011, 0.047, and 0.022, respectively. A significant difference was found between the Hungarian and Roma populations regarding the 1/1, 1/3 and the 2/3 (p < 0.005) genotypes. This is the first study to investigate the polymorphisms of CYP2C9 gene in the two largest populations in Hungary, healthy Hungarians and Roma. The prevalence of variant CYP2C9 alleles in the Hungarian population is similar to that observed in other European populations. In contrast, the Roma population differs from Hungarians, from most of other Caucasian groups, and from Indians in the incidence of CYP2C9 common variants. The difference in allele distribution patterns between the two populations studied has therapeutic implications as it influences the optimization of therapies.     

Dietary behavior and type 2 diabetes care

OBJECTIVE: To explore risk factors modification, as well as barriers and facilitators for behavioral change in Mexican type 2 diabetics and their families. METHODS: Risk assessment and impact evaluation included measurements on anthropometrics, diet, physical activity, nutrition knowledge, and HbA(1c.) The intervention included discussion groups and promoted behavioral change on dietary risk, physical exercise, and basic diabetic knowledge of 48 urban diabetic patients and 38 relatives. The educational method consisted of cognitive reframing and situational problem solving during five meetings over an 8-month period. RESULTS: Diabetics were older and less educated than their participating relatives (55.8+/-11 and 34.7+/-13.7 years old, and 4.5+/-3.4 and 7.8+/-3.7 years of schooling, respectively). Factors such as diet, degree of obesity, physical activity and HbA(1c), reflected that 92% of diabetic patients and 83% of their relatives were at high health risk. After the intervention, nutritional knowledge and diet-health awareness increased (p=.013 and .001 respectively); however, no significant health-risks reduction was observed. DISCUSSION: Focus group analysis suggested that lack of support from family and health services, low income, neighborhood insecurity and misleading "popular knowledge" and advice are key barriers to behavioral change. PRACTICE IMPLICATIONS: The study supports the understanding of constrains to health promotion campaigns and better health provider-patient interactions in Mexican population. Additionally, the study contributes to the general knowledge of ethnic socio-cultural environment influences over health care issues, primarily to diet modifications.     

Relationship between the size of hiatal hernia and esophageal acid exposure time in erosive and non-erosive reflux disease

BACKGROUND: In the last few years studies have demonstrated that hiatal hernias have an important role in the pathogenesis of reflux disease, promoting reflux by many different mechanisms, emphasizing that the larger the hiatal hernia, the higher the reflux intensity and erosive esophagitis prevalence. AIM: To correlate the size of hiatal hernias (small or large) with reflux intensity (measured by pH monitoring parameters) in patients with non-erosive and erosive reflux disease. PATIENTS AND METHODS: We reviewed pH monitoring from patients with typical reflux symptoms (heartburn) previously submitted to upper endoscopy. Reflux intensity was measured by the % of total time of pH < 4 (%TT) and by % of time of pH < 4 in upright (%UT) and supine (%ST) positions. Patients were classified as non-erosive reflux disease if no erosive esophagitis was found in endoscopy and pH monitoring was abnormal and as erosive reflux disease if they had erosive esophagitis. Hiatal hernias were classified as small if their size ranged from 2 to 4 cm and large if > or = 5 cm. RESULTS: A total of 192 patients were included, being 115 in erosive reflux disease group and 77 in non-erosive reflux disease group. In erosive reflux disease patients, there were 94 (81%) with small hiatal hernias and 21 (19%) with large ones and in non-erosive reflux disease patients there were 66 (85%) with small and 11(15%) with large hiatal hernias. In erosive reflux disease group, the %TT, %UT and %ST were of 13.1 +/- 7.1; 13.4 +/- 7.4 and 12.3 +/- 11.5 in small hiatal hernias and 20.2 +/- 12.3; 17.8 +/- 14.1 and 20.7 +/- 14.1 in large hiatal hernias, respectively (P < 0.05 for %TT and %TS). In non-erosive reflux disease patients, %TT, %UT and %ST were 9.6 +/- 4.8; 10.8 +/- 6.8 and 8.6 +/- 7.3 in small hiatal hernias and of 14.6 +/- 13.3; 11.2 +/- 7.5 and 18.1 +/- 21.0 in large hiatal hernias respectively (P < 0.05 for %TT and %TS). CONCLUSION: Large hiatal hernias increase acid exposure time only in supine position in erosive esophagitis patients and in non-erosive patients.     

Teachers' perception of oral health status. Design and validation of an evaluation instrument

The evaluation of health status is a complex process that requires the use of indicators that assess health both in terms of disease and of the impact the health-disease-care process has on the quality of life. The aim of the present study was to design and validate an instrument to evaluate teachers 'perceptions of oral health status. The sample comprised 78 teachers of 4 schools (province of Buenos Aires). DESIGN OF THE INSTRUMENT: (a) identification of the 5 categories that compose the instrument and can measure the object of study based on evidence; (b) creation of a questionnaire that contains 32 items by two researchers; (c) evaluation of the questionnaire by 5 professionals of 4 different professions to standardize criteria (Ventegodt et al, 2003) applying an ordinal scale. Items were reduced to 25 (Index of perception of oral health: IPOH). VALIDATION OF THE INSTRUMENT: the following parameters were evaluated: reliability employing the test-retest method at 30 days; internal consistency employing Cronbach's a coefficient (1951); content validity determined by two experts; construct validity employing the method of extreme groups (Student's t test). The established categories were knowledge on oral health, personal experience with oral health care, expectations regarding their students 'families, expectations regarding dentistry, satisfaction with his/her role as a teacher The instrument proved to be reliable as evidenced by a value of r = 0.80 in the test-retest method; a satisfactory intra-items consistency was evidenced by Cronbach's alpha coefficient value of 0.82. The differences between the results of the groups of teachers in the extreme groups were statistically significant (p = 2.2). The instrument designed to measure the teachers' perception of oral health status would be valid. It would be desirable to enlarge the sample and determine criterion validity by comparison with other instruments.     

A novel antiganglioside specificity against terminal NeuNAc(alfa 2-3)Gal in acute bulbar palsy

We describe a patient with acute oropharyngeal-facial diplegia, tongue palsy and albuminocytological dissociation following upper respiratory tract infection. Electrophysiological abnormalities in blink reflex suggested a brainstem lesion. High titers of anti-GM3, GD1a and GT1b IgG class serum antibodies were initially detected. Absorption studies indicated that antibodies were directed to a common terminal epitope NeuNAc(alfa 2-3)Gal. This novel antiganglioside antibody specificity may play a role in this unusual regional form of acute bulbar palsy of possible central origin. These data are supportive for extending the panel of antiganglioside specificities with anti-GM3.     

Gyneco-psychosomatic counseling in Germany and Switzerland--aims and state of the art

OBJECTIVE: To investigate actual counseling models for gynecological patients in Switzerland and in Germany. METHODS: A questionnaire investigating psychosomatic care was sent to all Swiss (N=183) and German (N=1078) departments of gynecology, obstetrics, and/or endocrinology. RESULTS: One hundred twenty-eight (27%) completed questionnaires from Germany and 57 (31%) from Switzerland were available for statistical evaluation. Eighty-seven percent of the answering clinics from Switzerland and 93% of those from Germany (ns) considered psychosomatic counseling for gynecological and obstetrical patients as very important or important. Seventy-two percent of the Swiss and 70% of the German departments (ns) offered psychosomatic support. Models of counseling varied greatly between types of hospitals and both countries. Less than 15% of the medical doctors had a formation for psychosomatic counseling. CONCLUSION: Actual possibilities seem to be below the need for psychosomatic care. An adequate formation of medical doctors and considering the effects of psychosomatic care in the discussion on cost reduction for medical treatment would help to improve counseling structures.