Prolactin and infertility

Prolactin is a polypetide hormone structurally similar to a growth hormone. It is secreted by lactotrophs in the anterior pituitary gland. The levels rise during pregnancy in response to estrogens formed by the feto-placental unit. Hyperprolactaemia in women causes a characteristic pattern of reproductive disturbance. The most severe form accounts for 15-20% of amennorhoea. Subnormal secretion of estradiol occurs because ovarian follicles do not mature. Symptoms are dyspareunia and dryness during intercourse. Hyperprolactinaemia in men suppresses gonadtropin secretion, and testosterone concentrations may be subnormal. Suppression of prolactin can be achieved by withdrawing drugs which provoke prolactin release, by correcting hypothyroidism and by direct treatment of a prolactin-secreting pituitary tumor. Bromocriptine suppresses prolactin secretion by direct action on the pituitary lactotrophs. It may be possible to avoid procedures such as radiation therapy and surgery in patients with small pituitary tumors who wish to become pregnant, but close cooperation of patients in special units is essential.     

The acute and chronic effects of alcohol on the human immune system.

The immunologic status of 24 male patients admitted for acute alcoholic detoxification was evaluated by in vivo and in vitro parameters. In vivo reactivity, as measured by skin testing with a denovo antigen, dinitrochlorobenzene, as well as a recall antigen, tuberculin, was inact. However, both qualitative and quantitative defects were seen in vitro in the thymus-derived lymphocyte population. These defects were not seen in recovered alcoholics, that is, they appear reversible. The defects seen in the cell-mediated immunity of alcoholics may, in part, be responsible for the high incidence of head and neck cancer observed in this patient population.     

Intestinal perforation during pregnancy

Three cases of bowel perforation were encountered in pregnant women in a community hospital. Two were associated with mechanical obstruction, and one was of unknown etiology. Displacement of abdominal contents by the gravid uterus may predispose pregnant patients to intestinal obstruction in the presence of an underlying bowel abnormality, such as adhesions or malrotation. Prompt diagnosis and appropriate therapy are necessary to avoid a fatal or a severely morbid outcome.     

Combination chemotherapy of ovarian granulosa cell tumor with cis-platinum and doxorubicin

Two patients with metastatic granulosa cell tumors were treated with cis-platinum and doxorubicin, 50 mg/m² of each drug being given by intravenous bolus every 21 days. Both patients attained complete clinical remission. One, who refused second-look surgery, is alive and free of disease 18 months after cessation of treatment. The other patient had minimal gross residual disease at second-look laparotomy. This regimen shows promise in the treatment of disseminated stromal cord tumors.     

The Boston Ocular Surface Prosthesis as a Novel Drug Delivery System for Bevacizumab

Corneal neovascularization causes deterioration of visual acuity and increases surface irregularities. Various techniques have been employed to help control the progression of corneal neovascularization; bevacizumab is a medication that targets the specific pathway of corneal neovascularization. The Boston Ocular Surface Prosthesis (BOSP) is a large diameter contact lens that aids in maintaining corneal surface integrity and may serve as a delivery system for topical bevacizumab. This paper reviews five patients who were treated with topical bevacizumab in their BOSP. All patients demonstrated improvement in their visual acuity and clinical exam. No adverse reactions were noted.     

Risk of complications due to anticoagulation during dermatosurgical procedures: a systematic review and meta‐analysis

Background Management of anticoagulation and anti‐platelet drugs during cutaneous surgery is still a challenge for many dermatologists and standards of care with respect to stopping, continuing or bridging vary widely. Methods We performed a systematic review (Medline, Cochrane Library, until August 27th, 2013) of studies assessing the risk of complications due to anticoagulation during cutaneous surgery. Primary outcomes were mild‐moderate and severe postsurgical bleeding. The secondary outcomes were excessive and uncontrollable intraoperative bleeding and other postsurgical complications as wound dehiscence, erythema, wound infection. Results 1.287 publications were identified and 10 studies were included into the review. The frequencies of bleeding in the control groups in general were low (about 1%). In patients on aspirin, increased risks were seen neither with respect to mild‐moderate postoperative bleeding (RR 1.1, CI 0.5–2.3), nor with respect to severe bleeding (RR 0.9, CI 0.2–4.6). The studies with patients on warfarin showed a risk for mild‐moderate bleeding that was three times as high as in controls (RR 3.2, CI 1.4–7.1) and for severe bleeding that was 15 times higher (RR 14.8, CI 2.7–80.4). In general the study sizes were small and the methodological quality low. Conclusion The risk of bleeding due to a medication with aspirin seems to be negligible. With warfarin, the risk is increased; an exact estimate of the risk increase is difficult to give, because of the lack of sufficient high quality studies. A two‐fold increase appears likely, the 15‐fold increase is most likely due to statistical reasons arising from the rareness of the event in the small number of included patients. Stopping, bridging or continuing a medication should always be an individual decision. In accordance with guidelines from internal medicine for most patients it will be recommendable to continue with the medication.