Pituitary carcinoma recurrent to the lumbar intradural extramedullary space: case report

Context

Pituitary tumors are rare, and pituitary carcinomas are rarer still. Prognosis is poor, with less than 50% of patients surviving past 1 year after diagnosis. In this case of spinal metastasis from an adrenocorticotropic hormone-secreting pituitary carcinoma, the intradural extramedullary metastases recurred in the same lumbar area 6 years apart.

Findings

Fourteen years prior to presentation in our clinic, a 48-year-old woman was diagnosed with pituitary adenoma which was treated with resection followed by radiation. Eight years later, an intradural extramedullary spinal drop metastasis at L2–L3 was again treated with resection and radiation. Three years later, magnetic resonance imaging (MRI) revealed a mass encasing the right carotid artery, which was treated for 1 year with chemotherapy using temozolomide (Temodar). Three years later, MRI showed intradural extramedullary metastases at the L3–L4 intervertebral disc space and behind the L3 vertebral body; treatment was again resection followed by radiation. Back pain and weakness resolved after surgery and her neurological examination returned to baseline. There was no evidence of recurrence 1 year after surgery.

Conclusion/clinical relevance

In this unusual case, this pituitary carcinoma metastasized twice in 6 years to virtually the same intradural extramedullary lumbar region. Surgical resection of these masses aided in relieving neurological symptoms and prolonging life.     

Therapeutic effects of tender coconut water on oxidative stress in fructose fed insulin resistant hypertensive rats

ObjectiveTo investigate whether tender coconut water (TCW) mitigates oxidative stress in fructose fed hypertensive rats.MethodsMale Sprague Dawley rats were fed with fructose rich diet and treated with TCW (4 mL/100 g of body weight) for 3 subsequent weeks. Systolic blood pressure was measured every three days using the indirect tail cuff method. At the end of the experimental period, plasma glucose and insulin, serum triglycerides and free fatty acids, lipid peroxidation markers (MDA, hydroperoxides and conjugated dienes) and the activities of antioxidant enzymes were analyzed in all the groups.ResultsTreatment with TCW significantly lowered the systolic blood pressure and reduced serum triglycerides and free fatty acids. Plasma glucose and insulin levels and lipid peroxidation markers such as MDA, hydroperoxides and conjugated dienes were significantly reduced in fructose fed rats treated with TCW. Activities of antioxidant enzymes are up regulated significantly in TCW treated rats. Histopathological analysis of liver showed that TCW treatment reduced the lipid accumulation and inflammatory infiltration without any significant hepatocellular damage.ConclusionsThe overall results suggest that, TCW treatment could prevent and reverse high blood pressure induced by high fructose diet probably by inhibition of lipid peroxidation, upregulation of antioxidant status and improved insulin sensitivity.     

Unusual cause of acute mitral regurgitation: idiopathic hypereosinophilic syndrome

Idiopathic hypereosinophilic syndrome (HES) is a rare multisystem condition characterized by dysregulated overproduction of eosinophils. Cardiac involvement in HES is characterized by necrosis from infiltration of eosinophils and thrombus formation and, in the late stage, by fibrosis and chronic valvular regurgitation. We report a very unusual presentation of idiopathic HES with acute mitral regurgitation due to papillary muscle rupture. The transesophageal echocardiogram was suggestive of a flail posterior leaflet and suspicious for endocarditis. Intraoperatively, papillary muscle rupture was seen and the patient underwent mitral valve replacement. The pathologic examination of the valve revealed eosinophilic infiltration of the papillary muscle. The patient was treated with steroids and responded well clinically.     

Isolation and screening for alkaline thermostable xylanases

Screening of xylanase producing microorganisms from soil samples and hemicellulosic materials were carried out in three stages using wheat bran extract agar medium, xylan agar medium and liquid medium with xylan. One of the isolates, identified as Bacillus SSP-34 produced 100 times more xylanase activity than the other isolates. Maximum enzyme production by this isolate was observed after 102 hours of growth. The optimum pH for the crude xylanase preparation range from 6–8 and optimum temperature was at 50 °C. The enzyme was stable up to 20 minutes at 50 °C and at pH range 4.5–9.0 for more than 2 hours.     

Low dose injectable contraceptive norethisterone enanthate 20mg monthly — I. Clinical trials

Clinical trials were undertaken with an injectable low dose progestational contraceptive, norethisterone enanthate 20 mg monthly (Net-en — 20). Data from the study indicate that Net-en — 20 is an effective contraceptivs with lower incidence of menstrual cycle disturbances than the currently used injectable progestogens. There was a prompt return of fertility after the withdrawal of the drug. Net-en — 20 did not have any adverse effect on maternal nutritional status as assessed by anthropometric indices of nutritional scatus, and clinical sign of nutritional deficiencies or on lactational performance as assessed by mothers' impression on milk output and mean duration of lactation.     

Health effects of consanguinity in Pondicherry.

Of 1000 pregnant women studied, consanguinity was observed in 30.8%, with a higher frequency among women from rural areas, and among Hindus. In the consanguineous group, first cousin marriages were present in 47.4%, and uncle niece marriages in 23.4% of women. Coefficient of inbreeding was highest in Harijans (0.0258), followed by non-Brahmins (0.0220) and Brahmins (0.0204). Fertility was not influenced by consanguinity. There was a significantly higher rate of still births and infant mortality in consanguineous matings as compared with non-consanguineous. Total morbidity was higher in the consanguineous group as compared with the non-consanguineous (p less than 0.01), especially that due to neonatal infections and jaundice. There was no significant difference in the prevalence of congenital malformations, chromosomal and genetic disorders between the two groups, although the number of abnormal births in this group was small.     

Enzymes of collagen synthesis in lung tissues of bleomycin-induced pulmonary fibrosis

The activities of prolyl hydroxylase (Pro-OHase), galactosylhydroxylysyl glucosyltransferase (Glu-Gal-Hyl-Tase), and hydroxylysyl galactosyltransferase (Gal-Hyl-Tase) were assayed in lung tissues of hamsters with bleomycin-induced experimental pulmonary fibrosis. Serum Glu-Gal-Hyl-Tase and aspartate transaminase (Asp-NH₂-Tase) were measured in the same animals. Lung fibrosis was induced by intratracheal bleomycin instillation, and the enzyme activities were assayed 2, 3, and 4 weeks after bleomycin administration. The activities of the three lung enzymes increased significantly after bleomycin instillation. However, no difference in the values of serum Glu-Gal-Hyl-Tase or Asp-NH₂-Tase were observed. Histologic examination of lung sections indicated progressive fibrotic foci. These results thus indicate that the activities of collagen processing enzymes are elevated in the fibrotic lung tissues as a reflection of the increased rate of collagen synthesis during the period of active fibrogenesis, but unlike liver fibrosis, the elevation of tissue Glu-Gal-Hyl-Tase is not predicted by a corresponding increase in serum levels of this enzyme.     

Susceptibility of dimethylnitrosamine induced O-methylguanine containing regions in in vivo replicated, hybrid rat liver DNA towards S1 nuclease

Experiments were designed to characterize the carcinogen-modified rat liver DNA following in vivo replication. Replicated hybrid DNA of density 1.718 g/cm³ and greater, containing [¹⁴C]dimethylnitrosamine-induced methylated products and 5-bromo-2-deoxy-uridine was isolated and treated with S₁ nuclease. The extent of destabilized regions in such a hybrid DNA was determined by monitoring the release by S₁ nuclease of O⁶-methylguanine, a lesion known to cause miscoding and N-7-methylguanine, a lesion that apparently does not miscode. The results indicate that when such replicated rat liver hybrid DNA is treated with S₁ nuclease, O⁶-methylguanine containing regions compared to those containing N-7-methylguanine are preferentially digested by the enzyme.