Acquired prolactin deficiency indicates severe hypopituitarism in patients with disease of the hypothalamic-pituitary axis

OBJECTIVE: Prolactin deficiency has been the subject of many scientific studies, but there is a paucity of information regarding prolactin deficiency in humans. In this report, adults with disease of the hypothalamic-pituitary axis (HPA) were studied to determine the prevalence of severe acquired prolactin deficiency (APD) and the pathophysiological characteristics associated with it. PATIENTS AND METHODS: APD was defined as a serum prolactin level persistently below the detection limit of the assay, i.e. less than 50 mU/l (normal range: male 85-444, female 85-530). Patients with a diagnosis of acromegaly, prolactinoma or with congenital or drug induced prolactin deficiency were excluded. Three hundred and sixty-nine patients (190 women, age range 17-79 years) with disease of the HPA, meeting the specified criteria were identified. RESULTS: Twenty-two (13 women, age range 29-76 years), showed evidence of APD. Thirteen of the 22 patients with APD had been treated for Cushing's disease. In all, 62 patients treated for Cushing's disease were identified, resulting in a prevalence of APD in treated Cushing's disease of 20.97%. Excluding treated Cushing's disease, the prevalence of APD in the remainder of the cohort was 2.93%. Nineteen patients with APD (86.4%) and 183 without APD (52.7%) underwent surgery in the region of the HPA (P = 0.0042). In contrast, nine patients with APD (40.9%) and 283 without APD (80.4%) had received radiotherapy, with fields which included the HPA (P < 0.001). No patient with isolated APD was identified. All patients with APD had evidence of severe GH deficiency (GHD) with a peak GH response to provocative stimuli of < 1.6 mU/l and a median IGF-I standard deviation score (SDS) of -4.85 (quartiles -9.56 to -2.80). Of the 13 patients with APD and Cushing's disease, all were gonadotrophin and TSH-deficient, six were adrenocorticotropic hormone (ACTH)-deficient and six (46.1%) had cranial diabetes insipidus (CDI). Of the remaining nine patients with APD, total anterior pituitary hormone failure was present in all and CDI was present in two (22.2%). CONCLUSIONS: The presence of APD indicates severe hypopituitarism in adults with HPA disease. It is universally associated with severe GHD. It is more common after surgery to the HP region. It has a low overall prevalence except in patients surgically treated for Cushing's disease.     

An electron microscopic study of lymphatics in the dermal lesions of human leprosy

The dermal lymphatic vessels in lepromatous and tuberculoid leprosy lesions were studied by light- and electron-microscopy. In the lepromatous patient, lymphatic vessels were seen in both intra- and peri-granulomatous areas. The lymphatic lining cells contained lipid droplets, lysosomes, and numerous pinocytotic vesicles. Cells bearing bacilli were only occasionally seen. In the tuberculoid cases, lymphatic vessels were seen only along the edges of the granulomas and the lining cells were less prominent. Inflammatory cells, both lymphocytes and histiocytes, were found traversing the walls of lymphatic vessels in both groups of patients. The results of the study confirm the continued and increased functioning of the lymphatic drainage system in dermal leprosy lesions, and indicates that it may be a major route for the clearance of lipids from the lipid-rich bacilliferous lesions in the lepromatous patient. The lymphatic pathway appears to be a minor pathway for the dissemination of Mycobacterium leprae in comparison with the blood vascular system.     

Immunocytochemical detection of p21ras,Raf-1, ERK1/MAP kinase and PKC isoforms in a 20-methylcholanthrene-induced transformed murine embryonal fibroblast cells in culture

An immunocytochemical study using antibodies against p21ras, Raf-1, MAP kinase/ERK1 and PKCalpha, beta, gamma, delta, epsilon, zeta, isoforms were performed on a 20-methylcholanthrene-induced transformed murine embryonal fibroblast cells in both in vitro and in vivo growth conditions. Altered expression of p21ras, Raf-1, MAP kinase in this particular cell line strongly supported the previous findings of the activation of one component of signal transduction under the influence of the other in the MAP kinase cascade of signal transduction during neoplastic transformation and which also seemed to be involved in CNCI-PM-20 cell line. The altered expression of PKCalpha, beta, and delta was thought to be an epigenetic event occurring under the indirect influence of other changes in these cells. Host physiology and metabolism did not have much impact on the expression of these gene products after biological incubation of these cells in syngenic host.     

Percutaneous coronary intervention versus coronary artery bypass grafting in diabetic patients

Revascularization with CABG or angioplasty in diabetic patients is associated with a less favor-able outcome. The value of early intervention will be assessed in the ongoing BARI 2D trial. It remains to be determined whether the widespread use of GP IIb/IIIa drugs and prolonged dual antiplatelet therapy in diabetic patients who receive stents, and possibly drug-eluting stents, will alter results significantly so that outcomes become comparable or even better than CABG (Fig. 3). It seems prudent to consider CABG with LIMA grafting in diabetic patients who have severe multi-vessel disease and to consider angioplasty in selected patients who have more discrete and less severe disease.     

Seasonal changes in plasma steroid levels in Indian major carp Labeo rohita: influence of homologous pituitary extract on steroid production and development of oocyte maturational competence

Circannual variations in plasma levels of testosterone (T), 17beta-estradiol (E(2)), and 17 alpha, 20 beta-dihydroxy-4-pregnen-3-one (DHP) as well as seasonal fluctuations in ovarian steroid synthetic potential were observed in Indian major carp, Labeo rohita. A study was also conducted to examine the mechanism of the development of gonadotropin-induced maturational competence in oocytes of this fish. The present study recorded the lowest values of plasma E(2) and T in L. rohita during the period from October to January. A mild increase in the levels of these steroids observed in February was followed by their rapid rise reaching peak values in April, when the ovary contained mostly the vitellogenic follicles. In the month of May, as the postvitellogenic follicles predominated in the ovary, there was a decline in plasma concentrations of both T and E(2). Low levels of these steroids in plasma remained until January, except a small elevation detectable during June and July (spawning stage). DHP was not detected in the plasma of this fish collected during the period from August to March. Existence of DHP was first recorded in blood in the month of April (vitellogenic stage) and it quickly reached the peak value in May (postvitellogenic stage), followed by a sudden decline in the month of June. Under stimulation of fish pituitary extract (FPE), as a source of gonadotropin, in vitro production of E(2) and T by the vitellogenic follicles was shown to be highest compared to their production rate in other stages, while the postvitellogenic follicles recorded the highest rate of DHP synthesis. Acquisition of oocyte maturational competence (OMC) was shown to develop either by priming the vitellogenic stage fish with a single dose of FPE or by in vitro addition of FPE in culture. In vitro treatment of trilostane, an inhibitor of 3beta-HSD, blocked the FPE-stimulated steroid production but not the development of OMC. Presence of cycloheximide and actinomycin D in the incubation was shown to inhibit FPE-induced development of OMC, indicating the requirement of de novo protein synthesis for this process.     

Ultrastructure of leprous phlebitis

An ultrastructural study on vein biopsies from six lepromatous leprosy patients was carried out. The results showed that a) the lumen-lining bacillated cells were endothelial in origin due to the presence of specific Weibel-Palade endothelial cell granules; b) endothelial cells released Mycobacterium leprae into the lumen by exophagocytosis; c) M. leprae were able to grow and multiply in the endothelial and smooth muscle cells; and d) smooth muscle cells did not show any evidence of reaction due to the presence of M. leprae in their cytoplasm.     

Cardiac catheterization through ipsilateral radial and ulnar artery access during the same procedure

We evaluated the safety and feasibility of ipsilateral radial and ulnar artery cannulation during the same catheterization procedure. Crossover from radial to femoral was done in 122 patients. Both ipsilateral radial and ulnar catheterization were performed in 16 patients without any complications, which was further supported by Doppler ultrasonography.     

Aortic dissection--an update

Acute aortic dissection is a medical emergency with high morbidity and mortality requiring emergent diagnosis and therapy. Rapid advances in noninvasive imaging technology have facilitated the early diagnosis of this condition and should be considered in the differential diagnosis of any patient with chest, back, or abdominal pain. Emergent surgery is the treatment for patients with type A dissection while optimal medical therapy is appropriate in patients with uncomplicated type B dissection. Adequate beta-blockade is the cornerstone of medical therapy. Patients who survive acute aortic dissection need long-term medical therapy with beta-blockers and statins and appropriate serial imaging follow-up. Future advances in this field include biomarkers in the early diagnosis of acute aortic dissection and presymptomatic diagnosis with genetic screening. Overall patients with aortic dissection are at high risk for an adverse outcome and need to be managed aggressively in hospital and long term with frequent follow-up.