A patient-reported outcome measure for patients with pituitary adenoma undergoing transsphenoidal surgery

Pituitary - Pituitary adenomas affect patients’ quality-of-life (QoL) across several domains, with long-term implications even following gross-total resection or disease remission. While...     

Acute myocardial infarction after simultaneous thrombosis in normal right and left coronary arteries

A 32-year-old male patient with clinical and electrocardiographic evidence of acute myocardial infarction underwent coronary angiographic study. We observed nonocclusive thrombosis simultaneously in right and left anterior descending coronary arteries, without confirmation of spasm or obstructive artery disease in other coronary branches. Documentation of coronary thrombosis in more than one artery is rare, and its pathophysiology is still unknown. With the advent of thrombolytic therapy and immediate coronary angiographic studies in patients with evolving myocardial infarction, it has been possible to confirm the presence of thrombus and the type of coronary disease. In this case, we observed total lysis of both thrombi and the final aspect of "normal" angiographically reperfused coronary arteries.     

Neoadjuvant radiation and chemotherapy in rectal cancer does not increase postoperative complications

Background and aims Neoadjuvant radiation and chemotherapy in rectal cancer reduces local recurrences and increases the rate of conservative sphincter surgery. However, an increase in postoperative morbidity and mortality has also been observed. This study analyzed the operative difficulty and postoperative complications in patients with this treatment.Patients and methods Retrospective review of 103 patients with rectal cancer, divided into two groups: group A, 53 patients undergoing preoperative radiotherapy with 45 Gy combined with chemotherapy, and group B, 50 patients with rectal cancer who received surgery after diagnosis. Both groups were homogeneous. The two groups were compared for both technical difficulty, using intraoperative data and rate of complications.Results There were no statistically significant differences between the two groups with regard to intraoperative or postoperative data. In group A there were 20 complications in 17 patients (32%) and in group B 22 complications in 19 patients (38%). The rates of perineal wound infection were similar. The percentage of anastomotic leaks was higher in group A. A greater number of anterior resections was performed in group A.Conclusion Preoperative radiation and chemotherapy in rectal cancer does not increase postoperative complications and increases the rate of sphincter-preserving surgery.An invited commentary on this paper is available at     

Serum zinc binding capacity in pregnant women

Zinc is an important element during the prenatal period. Since plasma zinc levels are not directly related to the nutritional status of this metal in pregnant women, we designed this study to find out if plasma protein zinc binding capacity is a more reliable parameter than total serum zinc to establish zinc nutritional status during pregnancy. We analyzed total serum zinc and zinc binding capacity in 84 normal pregnant women and in 14 nonpregnant women. Within pregnant women, samples were classified according to the gestational age. Total zinc serum was significantly decreased in pregnant women as compared to control ones. The decrease in zinc occurred slowly during the whole period of pregnancy; a negative correlation was found between serum zinc and gestational time. Protein zinc binding capacity was found to be significantly higher in pregnant women than in the control ones. This parameter was positively correlated to total serum zinc in pregnancy. We conclude that since the protein zinc binding capacity increases with advancing gestation, pregnant women take advantage of this to maintain the levels of serum-free zinc, transferable to the fetus.     

Beneficial effect of AN69 membranes on anemia in hemodialyzed patients

Biocompatible hemodialysis membranes induce a smaller inflammatory response in hemodialysis patients, and remove a larger amount of higher molecular weight retention products, then cellulose membranes. These phenomena could improve uremic anemia in hemodialysis patients. The objective was to evaluate the effects of biocompatible AN69 membranes on anemia in hemodialysis patients. Twenty-five stable patients undergoing hemodialysis with cuprophane membrane for more than 6 months were studied prospectively. These patients were stratified in 2 groups. Group I (GI): 14 patients switched over to a more biocompatible dialyzer (from cuprophan to AN69) and Group II (GII): 11 patients continued treatment with the same cuprophan membrane. The study lasted 5 months. Baseline hematocrit (%), ferritin (ng/mL), transferrin saturation (%), KTV, PCR (g/kg/day) and dose of erythropoietin (EPO) (UI/week) were measured and were revised monthly. Target hematocrit was 33%-35%. A significant increase of hematocrit became obvious after 2 months in GI without changes in dose of EPO and intensity of dialysis, meanwhile GII remains stable. CONCLUSION: Hemodialysis using AN69 membranes increases hematocrit without modifying intensity of dialysis.     

Acute Pancreatitis and Systemic Lupus Erythematosus: Necropsy of a Case and Review of the Pancreatic Vascular Lesions

The role of systemic lupus erythematosus (SLE) in the development of acute pancreatitis is a matter of controversy since, in many cases, this complication has been attributed to the drugs administered. In this study, we present a patient diagnosed as having SLE who developed acute pancreatitis with no apparent cause aside from her basic disease, and in whose necropsy was observed vascular damage consisting of severe intimal proliferation. Pancreatic vascular lesions in previously reported patients with lupus are reviewed.     

Small-intestinal mucosa in pseudoobstruction syndromes

The purpose of this investigation was to determine the frequency and severity of small intestinal mucosal damage in pseudoobstruction syndromes. One hundred eighty-nine interpretable biopsies from 12 patients were blindly reviewed by two investigatiors. The underlying disorders were scleroderma in 7 and idiopathic intestinal pseudoobstruction in 5. All 12 had small-intestinal dilatation on small-bowel series. Eight of the 12 patients had biopsies characterized by moderate, to severe mucosal damage; 3 of these had some biopsies which were flat. The damage did not correlate with: (1) types and numbers of organisms recovered from small intestinal aspirates; (2) duration of illness; (3) degree of dilatation of the proximal small bowel; (4) concentrations of deconjugated bile salts in small intestinal fluid; or (5) amount of fat absorbed in fat-balance studies. We conclude that mucosal damage is common in pseudoobstruction syndromes. The pathogenesis of the damage and its relationship to intraluminal bacteria remain undefined.