Transient pituitary dysfunction, empty sella, pseudotumor cerebri in a morbidly obese adolescent

We report a 16-year-old morbidly obese African-American female who developed pseudotumor cerebri, partially empty sella syndrome and transient central hypothyroidism. After reduction of the increased intracranial pressure by lumbar puncture, normalization of the thyroid function occurred. The mechanism of the transient pituitary dysfunction in relation to the pseudotumor cerebri and empty sella is discussed.     

Polymer-Derived Biosilicate®-like Glass-Ceramics: Engineering of Formulations and Additive Manufacturing of Three-Dimensional Scaffolds

Silicone resins, filled with phosphates and other oxide fillers, yield upon firing in air at 1100 °C, a product resembling Biosilicate^® glass-ceramics, one of the most promising systems for tissue engineering applications. The process requires no preliminary synthesis of parent glass, and the polymer route enables the application of direct ink writing (DIW) of silicone-based mixtures, for the manufacturing of reticulated scaffolds at room temperature. The thermal treatment is later applied for the conversion into ceramic scaffolds. The present paper further elucidates the flexibility of the approach. Changes in the reference silicone and firing atmosphere (from air to nitrogen) were studied to obtain functional composite biomaterials featuring a carbon phase embedded in a Biosilicate^®-like matrix. The microstructure was further modified either through a controlled gas release at a low temperature, or by the revision of the adopted additive manufacturing technology (from DIW to digital light processing).     

Weight gain in childhood and blood lipids in adolescence

Aim: To assess the effect of weight gain in childhood on blood lipid levels in adolescence.
Methods: A population-based birth cohort carried out in Pelotas, Southern Brazil. All newborns in the city's hospitals were enrolled in 1982. The subjects have been followed up for several times in childhood. At age 18, 79% of all males were followed, and 2083 blood samples were available. Adjusted analyses controlled for household assets index, family income, parental schooling at birth, maternal smoking during pregnancy and breastfeeding duration.
Results: Birth weight for gestational age and weight gain in the first 20 months was not associated with blood lipid levels in adolescence. On the other hand, those subjects whose weight gain from 20 to 42 months of age was faster than that predicted from birth weight and weight-for-age z-score at the mean age of 20 months had lower high-density lipoprotein cholesterol (HDL) cholesterol [−0.78 (95% confidence interval: −1.28; −0.29)] and higher very low-density lipoprotein cholesterol (VLDL) and low-density lipoprotein cholesterol (LDL)/HDL ratio in adolescence. After controlling for current body mass index (BMI), the regression coefficient for HDL cholesterol decreased from −0.78 mg/dL to −0.29 mg/dL (95% confidence interval: −1.00 to 0.05).
Conclusion: Weight gain from 2 to 4 years is related to an atherogenic lipid profile in adolescence and this association is mediated by current BMI.     

Psychological well-being in adults transplanted in childhood

Few studies have explored the long-term psychological effects on young adults of childhood transplants. The aim of the present work was to examine psychological adaptation related to self-concept, self-esteem and subjective well-being in young adults who had undergone solid organ transplantation in childhood. Twenty-four adults transplanted in childhood participated in the study (13 of them received kidney transplants, five heart transplants and six liver transplants). Participants were of both sexes, aged 18-22, and were selected from three public hospitals in Madrid. The results reveal no differences in psychological adaptation according to the transplant type (kidney, heart, or liver), and a significant difference in negative affect between women and men (women present more negative affect than men). Hierarchical regression analysis, after controlling for possible confounding effects of demographic and clinical variables, showed the predictive power of self-esteem to explain positive affect (60% of the total variance). Furthermore, physical self-concept, health status and time on waiting list explain 71% of the negative affect variance. Our data suggest the importance of self-esteem for the positive affect, and the power of clinical variables for the negative affect in young adults transplanted in childhood.     

A phase II study of sequential 5-fluorouracil, epirubicin and cyclophosphamide (FEC) and paclitaxel in advanced breast cancer (Protocol PV BC 97/01).

Sequential administration of the association of 5-fluorouracil, epirubicin and cyclophosphamide (FEC) and paclitaxel could be better tolerated than the association of an anthracycline and paclitaxel while having a similar antitumour effect. 69 patients with advanced breast cancer previously untreated with anthracyclines or paclitaxel entered a phase II multicentre study in which FEC was followed by paclitaxel. Both regimens were administered 4 times every 21 days. The median follow-up is 20 months and 38/69 patients have died. Grade III-IV toxicity was acceptable. Leukopenia occurred in 26% of patients, thrombocytopenia in 2% and anaemia in 4%. One patient had reversible heart failure during FEC therapy. Peripheral neuropathy and arthralgia-myalgia occurred in 9% and 4% of patients, respectively and one patient had respiratory hypersensitivity during paclitaxel treatment. 9 patients did not complete therapy because of: treatment refusal (n = 1), cardiac toxicity (n = 1), early death during FEC chemotherapy (n = 1), major protocol violations (n = 4), hypersensitivity reaction (n = 1) and early death during paclitaxel chemotherapy (n = 1). The overall response rate was 65% (95% CI = 53-76), and 7% of patients had stable disease. Therapy was defined as having failed in 28% of patients because they were not evaluable (13%) or had progressive disease (15%). The median time to progression and survival are 13.2 and 23.5 months, respectively. Sequential FEC-paclitaxel is a suitable strategy for patients with metastatic breast cancer who have not been previously treated with anthracyclines and/or taxanes. In fact, it avoids major haematologic toxicity and has a good antitumour effect.     

LYMPHOCYTIC HYPOPHYSITIS: SPONTANEOUS RESOLUTION ON MRI WITH PROGRESSION OF ENDOCRINE DEFECT

Lymphocytic hypophysitis is an uncommon condition that typically occurs during the last trimester of pregnancy or in the postpartum period. Presentation is of an anterior pituitary mass with varying degrees of pituitary dysfunction. We present a case in which there was dramatic resolution of the pituitary lesion on sequential MRI scanning. Despite this apparent resolution, however, the patient continues to have significant pituitary dysfunction.     

Functional analysis of gene expression in risperidone treated cells provide new insights in molecular mechanism and new candidate genes for pharmacogenetic studies

Risperidone is a potent antagonist of both dopamine and serotonin receptors. However, little is known about the underlying molecular mechanism by which risperidone acts. Although a number of genetic variants have been observed to correlate with treatment response there are no definitive predictors of response. We performed a genome-wide gene expression analysis (Human Genome U219 Array Plate) of a human neuroblastoma cell line (SK-N-SH) exposed to risperidone to identify molecular mechanisms involved in the cellular response to risperidone and thus identify candidate genes for pharmacogenetic studies. Our results revealed that cellular risperidone treatment is associated with a range of gene expression changes, which are time (6–48 h) and dose related (0.1–10 μM). We found that functional clusters of these changes correspond to Gene Ontology categories related to neural cell development functions, and synaptic structure and functions. We also identified Canonical Pathways related to these functional categories: neurogenesis and axon guidance; synaptic vesicle; and neurotransmitter signaling (dopamine, serotonin and glutamate). Finally, we identified candidate genes for pharmacogenetic studies related to the main risperidone secondary effects: motor disorders, cardiovascular disorders and metabolic disorders. Our results suggest that risperidone treatment affects the neurogenesis and neurotransmission of neuroblastoma cells, which is in agreement with the “initiation and adaptation” model to explain the mechanism of action of psychotropic drugs.