Release of corticosteroids from human adrenals in vitro

From morphological criteria, it is often difficult to evaluate whether adrenocortical tumors secrete hormones or not. An increasing number of nonfunctioning tumors are detected using modern imaging techniques. In a consecutive series of 13 patients with adrenocortical disease, a functional characterization was done by determining the ability of the resected tissue to release cortisol and aldosterone in vitro. Significant secretion of aldosterone was only found in tumors from 4 patients with hyperaldosteronism, 1 of whom turned out to have a cortisol-secreting tumor as well. All other tumors, both from patients with Cushing's syndrome and patients judged to have nonfunctioning adenoma, released cortisol in vitro. The method provides valuable pathophysiological information on adrenal tumors.

---

Resumen Con base en criterios morfológicos, frecuentemente es difícil determinar si los tumores adrenocorticales secretan hormonas o no. Con el uso de las modernas técnicas de imagenología, se détecta un numéro creciente de tumores no funcionantes. En una serie consecutiva de 13 pacientes con patología adrenocortical, se realizó una caracterización funcional determinando la capacidad del tejido resecado para liberar cortisol y aldosterona in vitro. Se encontró secreción significativa de aldosterona sólo en tumores provenientes de 4 de nuestros pacientes con hiperaldosteronismo, 1 de los cuales también presentó un tumor secretor de cortisol. Todos los otros tumores, tanto de pacientes con síndrome de Cushing como de pacientes que se considéró tenían adenoma no funcionante, liberaron cortisol in vitro. El método provee valiosa información patofisiologica sobre los tumores suprarrenales.

---

Résumé Il est souvent difficile, à partir des critères morphologiques, d'évaluer si les tumeurs corticosurrénaliennes sont des tumeurs sécrétantes ou non. Un nombre croissant de tumeurs dites nonfonctionnantes sont détectées par l'utilisation des techniques modernes d'imagerie. Une caractérisation fonctionnelle est réalisée par les auteurs à partir d'une série consécutive de 13 patients présentant une pathologie corticosurrénalienne en determinant les capacités de sécrétion in vitro de cortisol et d'aldostérone du tissu réséqué. Une sécrétion significative d'aldostérone est présente seulement dans les tumeurs de 4 patients avec hyperaldostéronisme, l'un d'entre eux révéla posseder de même une tumeur sécrétant du cortisol. Dans tous les autres cas, aussi bien chez les patients avec un syndrome de Cushing que chez les patients considérés comme ayant un adénome nonfonctionnant, les auteurs observent une sécrétion de cortisol in vitro. Cette méthode donne une information physiopathologique précieuse sur les tumeurs surrénaliennes.

---

---

Presented at the International Association of Endocrine Surgeons in Paris, September 1985.

---

Supported by grants from the Swedish Medical Research Council (2330) and Karolinska Institute.     

Giving a voice to patient experiences through the insights of pragmatism

As a philosophical position, pragmatism can be critiqued to distinguish truth only with methods that bring about desired results, predominantly with scientific enquiry. The article hopes to dismiss this oversimplification and propose that within mental health nursing, enquiry enlightened by pragmatism can be anchored to methods helping to tackle genuine human problems. Whilst pragmatists suggest one reality exists, fluctuating experiences and shifting beliefs about the world can inhabit within; hence, pragmatists propose reality has the potential to change. Moreover, pragmatism includes being cognisant of what works to whom reality concerns, making reality context-driven, with a view to understand how actions shape experiences so what is generated has usefulness. Hence, it somewhat follows pragmatism can inform mental health nursing, after all, nursing is a discipline of action, and awareness is needed in how actions produce experiences that patients find helpful. Given the principles of recovery are preferably adopted in mental health care, the paper will explore how pragmatism can help nurses move towards that goal; specifically, with patients voicing their experiences. This is because like pragmatism, recovery subscribes to hope that reality can progress, and through meaningful experiences and beliefs, patients have expertise about personal difficulties alongside how life may flourish, despite mental illness.     

Sexual Contact as Risk Factor for Campylobacter Infection,Denmark

Campylobacteriosis is a disease of worldwide importance, but aspects of its transmission dynamics, particularly risk factors, are still poorly understood. We used data from a matched case-control study of 4,269 men who have sex with men (MSM) and 26,215 controls, combined with national surveillance data on Campylobacter spp., Salmonella spp., and Shigella spp., to calculate matched odds ratios (mORs) for infection among MSM and controls. MSM had higher odds of Campylobacter (mOR 14, 95% CI 10–21) and Shigella (mOR 74, 95% CI 27–203) infections, but not Salmonella (mOR 0.2, 95% CI 0–13), and were less likely than controls to have acquired Campylobacter infection abroad (χ² = 21; p<0.001). Our results confirm that sexual contact is a risk factor for campylobacteriosis and also suggest explanations for unique features of Campylobacter epidemiology. These findings provide a baseline for updating infection risk guidelines to the general population.     

Randomized controlled trial comparing magnetic marker localization (MaMaLoc) with wire-guided localization in the treatment of early-stage breast cancer

Wire-guided localization (WGL) is the standard of care in the surgical treatment of nonpalpable breast tumors. In this study, we compare the use of a new magnetic marker localization (MaMaLoc) technique to WGL in the treatment of early-stage breast cancer patients. Open-label, single-center, randomized controlled trial comparing MaMaLoc (intervention) to WGL (control) in women with early-stage breast cancer. Primary outcome was surgical usability measured using the System Usability Scale (SUS, 0–100 score). Secondary outcomes were patient reported, clinical, and pathological outcomes such as retrieval rate, operative time, resected specimen weight, margin status, and reoperation rate. Thirty-two patients were analyzed in the MaMaLoc group and 35 in the WGL group. Patient and tumor characteristics were comparable between groups. No in situ complications occurred. Retrieval rate was 100% in both groups. Surgical usability was higher for MaMaLoc: 70.2 ± 8.9 vs. 58.1 ± 9.1, p < 0.001. Patients reported higher overall satisfaction with MaMaLoc (median score 5/5) versus WGL (score 4/5), p < 0.001. The use of magnetic marker localization (MaMaLoc) for early-stage breast cancer is effective and has higher surgical usability than standard WGL.