Different responses to chronic somatostatin analogues in patients with central hyperthyroidism

OBJECTIVE: Central hyperthyroidism is mainly due to two different causes, TSH-secreting pituitary adenoma (TSH-oma) and resistance to thyroid hormone in its pituitary variant, i.e. patients presenting with signs and symptoms of hyperthyroidism (PRTH). Because therapeutic approach and the clinical follow-up are extremely different in these two disorders, a correct differential diagnosis is mandatory. Unfortunately, no definite pathognomonic tool is presently available and an extensive biochemical and instrumental workup is frequently needed in order to reach the correct diagnosis. Aim of the present study was to investigate the use of somatostatin analogues in the differential diagnosis between TSH-omas and PRTH, as well as the possible treatment of PRTH with these analogues. DESIGN AND PATIENTS: Eight patients with TSH-oma and four with PRTH underwent the acute test with somatostatin analogue Octreotide (0.1 mg subcutaneously), as well as long-acting Octreotide-LAR (30 mg intramuscularly every 28 days) for two months. MEASUREMENTS: Serum TSH, FT3 and FT4 were evaluated in basal condition, at time 0 and every hour for 6 h during acute test, and every 15 days for 2 months during chronic treatment. RESULTS: During acute test, in both patients with PRTH and TSH-oma, a similar reduction in immunoreactive TSH and FT3 levels was observed, while no variations were found in FT4 concentrations. In contrast, during the administration of Octreotide-LAR, no significant variations of all tested parameters were observed in PRTH group, whereas FT3 and FT4 concentrations normalized or presented a significant reduction (> 30% of pretreatment values) in seven of eight patients with TSH-oma, despite minor variation of immunoreactive TSH levels. CONCLUSIONS: Chronic administration of long-acting somatostatin analogues in patients with central hyperthyroidism caused a marked decrease of FT3 and FT4 levels in all patients but one with TSH-oma, while patients with PRTH did not respond at all. Thus, administration of long acting somatostatin analogues for at least 2 months can be useful in the differential diagnosis in problematic cases of central hyperthyroidism. Furthermore, the present findings exclude the possibility of a beneficial effect of chronic administration of somatostatin analogues in controlling thyrotoxic symptoms in PRTH patients.     

Internal carotid artery stent implantation in 25 patients with acute stroke: preliminary results

PURPOSE: To evaluate retrospectively the outcome for patients with acute ischemic stroke in the territory of the middle cerebral artery (MCA) who had undergone stent implantation in the proximal segment of the internal carotid artery (ICA) in addition to intraarterial thrombolysis (IAT). MATERIALS AND METHODS: Stent implantation and retrospective analysis of clinical and radiologic data were approved by the institutional ethical committee. Endovascular treatment was performed after obtaining informed consent from patients or their closest relatives. Informed consent for retrospective review was not required. After pharmacologic and/or mechanical IAT, 25 consecutive patients (seven women, 18 men; mean age, 59 years +/- 14 [standard deviation]) underwent stent implantation in the proximal segment of the ICA (endovascular group). The clinical and radiologic characteristics (ie, interval from symptom onset to arrival at the emergency department, prevalence of vascular risk factors, causes of stroke, stroke severity, early signs of cerebral ischemia, duration of endovascular intervention, type of occlusion, and prevalence of leptomeningeal collateral vessels), recanalization rates, and clinical outcomes for patients in the endovascular group were compared with those for patients in the medical group (10 women, 21 men; mean age, 62 years +/- 12) who experienced ischemic stroke in the territory of the MCA as a result of ICA occlusion and who received antithrombotic treatment only. Differences between groups were assessed by using the chi2 test. A logistic regression analysis was performed to assess the effect of clinical and radiologic factors on recanalization rates and outcome. RESULTS: ICA recanalization was successful in 21 patients. Good recanalization of the MCA was achieved in 11 patients. In nine of these patients, recanalization of the MCA was achieved by using mechanical IAT only. In the remaining 12 patients, administration of intraarterial urokinase was performed in addition to mechanical thrombolysis. Two patients from the endovascular group experienced symptomatic intracerebral hemorrhage. At 3 months, 56% of the endovascular group and 26% of the medical group had a favorable outcome. Mortality was 20% in the endovascular and 16% in the medical group. CONCLUSION: IAT and stent implantation in the proximal segment of the ICA seem to improve the outcome for patients with ischemic stroke caused by occlusion of the cervical portion of the ICA.     

Nuclear medicine imaging of inflammatory/infective disorders of the abdomen

Different nuclear medicine modalities are currently used to study inflammatory and infective disorders of the abdomen. They are usually complementary to radiology and endoscopy, but they play a pivotal role in particular clinical situations. Several radiopharmaceuticals (e.g., 111In or 99mTc labelled white blood cells, monoclonal antibodies, human polyclonal immunoglobulins, 75Ga citrate) are commercially available, but they can not be used indifferently to study abdominal inflammatory disorders. The lack of comparative studies showing the accuracy of each radiopharmaceutical for the study of inflammatory/infective abdominal diseases does not allow the best nuclear medicine technique(s) to be chosen in an evidence-based manner. To this end we performed a meta-analysis of peer reviewed articles published between 1984 and 2004 describing the use of nuclear medicine imaging for the study of inflammatory bowel disorders, appendicitis and vascular graft infections. A guideline for the optimal radiopharmaceutical(s) to be used in each clinical condition and for different aims is provided.     

Spontaneous partial thrombosis of a basilar artery giant aneurysm in a child

We report the complete, spontaneous obliteration of a partially thrombosed dissecting giant aneurysm in the basilar artery by occlusion of both the lumen of the aneurysm and the parent artery in a 15-year-old girl.     

Endovascular treatment of posterior circulation cerebral aneurysms by using Guglielmi detachable coils: a 10-year single-center experience with special regard to technical development

BACKGROUND AND PURPOSE: The purpose of this study was to analyze the immediate and long-term angiographic and clinical results of endovascular treatment of posterior circulation aneurysms with special regard to technical development. MATERIALS: Between 1993 and 2003, 46 patients with 47 aneurysms of the posterior circulation were referred to our institution for endovascular treatment. Mean angiographic follow-up was 1.7 years. Clinical follow-up was determined at hospital discharge and by using a questionnaire for long-term follow-up (mean, 3.3 years). To analyze technical development, patients treated before (group 1) and after (group 2) implementation of 3D Guglielmi detachable coils (3D GDCs) in 1999 were compared. Multivariate analysis was performed to determine factors predictive of clinical and technical outcome. RESULTS: Overall, at initial treatment complete occlusion was achieved in 27 (57.4%) aneurysms, a neck remnant was present in 16 (34.0%) aneurysms, incomplete occlusion was achieved in 3 (6.4%) aneurysms, and in 1 (2.1%) case occlusion was not attempted. Procedure-related permanent morbidity was 4.3%, and the mortality rate was 0%. There was no rebleeding of treated aneurysms. Complete occlusion at initial treatment (P = .003) and recanalization rate (P = .008) correlated with aneurysm sac size. A statistically significant relationship between Hunt and Hess/World Federation of Neurologic Surgeons clinical grading scale score and clinical outcome (Glasgow Outcome Score) was found (P < .05). Subgroup analysis revealed that a higher initial obliteration rate of larger aneurysms was achieved in group 2 (3D GDC, 22 patients, 22 aneurysms) than in group 1 (23 patients, 24 aneurysms; P = .03). At angiographic follow-up, overall recanalization was 47.1% in group 2 and 47.6% in group 1. Aneurysm neck size was not found to be correlated with occlusion and recanalization rate. CONCLUSION: In our series, GDC technology was an effective and safe technique for the treatment of posterior circulation aneurysms. Aneurysm sac size was predictive for occlusion rate and the Hunt and Hess/World Federation of Neurologic Surgeons grade for clinical outcome. The introduction of 3D GDCs into our practice significantly improved the initial occlusion rate but did not affect the incidence of recanalization.     

Screening US and CT for blunt abdominal trauma: a retrospective study

OBJECTIVE: To assess the accuracy of screening US and CT in patients with blunt abdominal trauma admitted to the trauma centre of our General Hospital. MATERIALS AND METHOD: The abdominal US reports of 864 primary trauma patients (139 with major and 725 with minor injuries) and 162 CT reports of a subgroup of the same subjects (64 with major and 98 with minor injuries) were reviewed and compared to the best available reference standard. The accuracy of screening US was assessed by evaluating its overall ability to distinguish negative from positive cases by showing at least one of the lesions documented by the reference standard and its specific ability to depict all lesions; CT reports were evaluated only for the method's performance in depicting all lesions. RESULTS: Screening US exhibited a satisfactory overall ability to distinguish negative from positive patients (91.5% sensitivity and 97.5% specificity in major trauma patients versus 73.3% sensitivity and 98.1% specificity in the minor trauma group) and a satisfactory specific ability to depict all injuries in major trauma patients. In minor trauma cases sensitivity was satisfactory for free fluid but unsatisfactory for organ injuries. Of the 21/864 false negative reports (5 in patients with major and 16 in cases with minor traumas), only one affected patient management, a major trauma case, by delaying an emergency laparotomy. The performance of CT in detecting each single lesion was predictably excellent in both patient groups. CONCLUSION: Its satisfactory accuracy for major trauma suggests that US could be employed not only to screen cases for emergency laparotomy but also as an alternative to CT. However, since major traumatic injuries generally carry an imperative indication for CT, especially as regards neurological, thoracic and skeletal evaluation, US should be employed to perform a prompt preliminary examination using a simplified technique in the emergency room simultaneously with resuscitation.     

Usefulness of rh-G-CSF in early-onset severe neutropenia in neonatal lupus syndrome

Neutropenia is a mild and transient manifestation of neonatal lupus syndrome (NLS) in the second or third month of life. The authors describe a newborn with an early-onset severe neutropenia due to anti-Ro/SSA. In the second day of life, neutropenia has been treated with recombinant human granulocyte colony-stimulating factor (rh-G-CSF). This is the first case in which rh-G-CSF was used in NLS, and the authors studied the pharmacologic action of the drug in relationship to the pathophysiology of NLS.     

Congenital aplasia of the parotid gland with omolateral cheek angioma: case report and review of the literature

Congenital agenesis of the parotid gland is a rare entity whose etiopathogenesis is still unclear. It is usually bilateral and is sometimes associated with other developmental anomalies of the head and neck region. A case is presented in which aplasia of the right parotid gland was associated with an omolateral angioma of the cheek. The radiological diagnostic approach and a review of the literature on agenesis of the salivary glands are presented.     

Over a decade of experience with preimplantation genetic diagnosis

The three respondents provide additional support for preimplantation genetic diagnosis (PGD) having the pivotal place it now has in prenatal genetic diagnosis: chromosomal abnormalities (e.g., unbalanced translocations), Mendelian disorders, and HLA typing for transfer of compatible, genetically normal, embryos. Transferring euploid embryos has decreased the clinical abortion rate and increased the implantation rate in assisted reproductive technologies (ART), but it has not necessarily improved the live-birth rate. Safer embryo biopsy, more extensive diagnostic efforts (i.e., microarray analysis), and more refined patient selection may be required before shifting from preselection of embryos based solely on morphological parameters to transfer of only aneuploidy-free embryos.