Surgical outcome of stage III and IV adrenocortical carcinoma

BACKGROUND: Adrenocortical carcinoma (ACC) is a rare tumor usually diagnosed at an advanced stage on invasion of or adherence to adjacent organs. We report surgical outcome of stage III and IV ACCs. METHODS: ACCs from seven patients at clinical stage II (n = 1), III (n = 4), or IV (n = 2) were resected. Combined resection of the liver and inferior vena cava was performed in six patients. Morbidity, mortality, recurrence and survival were analyzed. RESULTS: The pathological stage was stage III in five patients and stage IV in two patients. The mortality was zero and the morbidity was two of seven (29%) patients. The estimated 3-year disease-free and overall survivals for stage III were 20% and 40%, respectively, with a median follow-up of 32 months (range, 11-58). The mean disease-free survival was 21.0 +/- 9.0 months (95% CI: 3.3-38.7). The 3-year disease-free and overall survivals for stage III and IV were 14.3% and 28.6%, respectively. The mean disease-free survival time was 18.6 +/- 6.7 months (95% CI: 5.4-31.8). The most frequent site of metastasis was the lungs, seen in four patients, and liver in three patients. Loco-regional, intra-abdominal lymph node, peritoneum, bone, brain recurrences were also seen in one patient each. The mean survival after recurrence was 19.0 +/- 3.3 months (95% CI: 12.6-25.5), and the 50% survival was 18.4 months with mitotan and cytotoxic drug therapy. CONCLUSIONS: Resection for stage III, IV ACCs affords the possibility of negative margins, acceptable peri-operative morbidity and mortality, and prolongs survival in selected patients.     

Acute stress differentially affects corticotropin-releasing hormone mRNA expression in the central amygdala of the "depressed" flinders sensitive line and the control flinders resistant line rats

Preclinical and clinical evidence suggests that neuropeptides play a role in the pathophysiology of mood disorders. In the present study, we investigated the involvement of the peptides corticotropin-releasing hormone (CRH), neuropeptide Y (NPY) and nociceptin/orphanin FQ (N/OFQ) and of their receptors in the regulation of emotional behaviours. In situ hybridization experiments were performed in order to evaluate the mRNA expression levels of these neuropeptidergic systems in limbic and limbic-related brain regions of the Flinders Sensitive Line (FSL) rats, a putative genetic animal model of depression. The FSL and their controls, the Flinders Resistant Line (FRL) rats, were subjected to one hour acute restraint and the effects of the stress exposure, including possible strain specific changes on these neuropeptidergic systems, were studied. In basal conditions, no significant differences between FSL and FRL rats in the CRH mRNA expression were found, however an upregulation of the CRH mRNA hybridization signal was detected in the central amygdala of the stressed FRL, compared to the non stressed FRL rats, but not in the FSL, suggesting a hypoactive mechanism of response to stressful stimuli in the "depressed" FSL rats. Baseline levels of NPY and N/OFQ mRNA were lower in the FSL rats compared to the FRL in the dentate gyrus of hippocampus and in the medial amygdala, respectively. However, the exposure to stress induced a significant upregulation of the N/OFQ mRNA levels in the paraventricular thalamic nucleus, while in the same nucleus the N/OFQ receptor mRNA expression was higher in the FSL rats. In conclusion, selective alterations of the NPY and N/OFQ mRNA in limbic and limbic-related regions of the FSL rats, a putative animal model of depression, provide further support for the involvement of these neuropeptides in depressive disorders. Moreover, the lack of CRH activation following stress in the "depressed" FSL rats suggests a form of allostatic load, that could alter their interpretation of environmental stimuli and influence their behavioural response to stressful situations.     

Longitudinal neuroendocrine changes assessed by dexamethasone/CRH and growth hormone releasing hormone tests in psychotic depression

Although psychotic depression has been reported to exhibit a greater degree of dysregulation of hypothalamic-pituitary-adrenocortical (HPA) function than non-psychotic depression, little is known concerning hypothalamic-pituitary-somatotropic (HPS) function in psychotic depression and how neuroendocrine function changes after treatment. To investigate the longitudinal changes in HPA and HPS system function in psychotic depression, we performed repeated dexamethasone/corticotropin releasing hormone (DEX/CRH) tests and growth hormone (GH) releasing hormone (GHRH) tests in inpatients with major depressive disorder. The psychotic depression group exhibited greater elevation of ACTH responses to the DEX/CRH test and stronger decreases in GH responses to the GHRH test than the non-psychotic depression group at admission. At discharge, the neuroendocrine responses to the DEX/CRH test of the psychotic depression group were still stronger than those of the non-psychotic depression group, though there were no significant differences in severity of depression between the groups. There were significant longitudinal changes in neuroendocrine responses to the DEX/CRH test between admission and discharge. The psychotic depression group exhibited increased GH responses to GHRH at discharge compared with those at admission, whereas no significant longitudinal change in GH response was found in the non-psychotic depression group. Consequently, there were no significant differences in GH responses to GHRH between the psychotic and non-psychotic depression groups at discharge. The results of GHRH test showed no significant relationships with severity of depression except psychotic features and the results of the DEX/CRH test. Our findings suggest that the HPS axis may be associated with psychotic features rather than general severity of depression. Further longitudinal studies are needed to clarify the role of HPS function in psychotic depression and whether sustained dysregulation of HPA function in psychotic depression is associated with a poor outcome after discharge.     

明胶改性聚β-羟基丁酸酯与鼠肾上腺细胞的生物相容性

目的 :探索明胶改性的聚 β-羟基丁酸酯 (PHB)与鼠肾上腺细胞的生物相容性 ,为以PHB为细胞载体进行肾上腺细胞移植提供实验依据。方法 :以明胶为改性材料对PHB进行改性 ,并将材料与肾上腺细胞共同培养 ,通过观察PHB与明胶对肾上腺细胞的形态学、增殖 (MTT法 )与分泌功能 (放免法 )的影响 ,来评价明胶改性的PHB与鼠肾上腺细胞的生物相容性。结果 :5 %浓度的明胶改性效果较好 ;明胶改性的PHB内可见细胞呈团簇状聚集生长 ,未改性的PHB内无细胞生长 ;PHB及改性材料明胶对体外培养的肾上腺细胞增殖活性 (1.87± 0 .0 3vs1.91± 0 .0 4 ,P >0 .0 5 )以及分泌功能均无影响 [(36 .4 3± 3.6 5 ) pg·ml-1vs (31.72± 2 .4 9) pg·ml-1,P >0 .0 5 ]。结论 :明胶可增加PHB的亲水性能 ;PHB及明胶对肾上腺细胞的生长、增殖、分泌功能无影响 ;以PHB为载体的肾上腺细胞移植治疗肾上腺皮质功能不全具有临床可行性。     

Possible contribution of epiphyseo-adrenocortical relations to antidepressive effect of imipramine

Chronically administered of imipramine decreases, while the depressogen reserpine increases, the level of plasma corticosterone in rats. The only effect of reserpine is antidepressive. Epiphysectomy stimulates the endocrine response to reserpine and attenuates the antireserpine effect of imipramine. This may be caused by antidepressive effect of epiphyseal factors. Translated fromByulleten' Eksperimental'noi Biologii i Meditsiny, Vol. 125, No. 6, pp. 626–627, June, 1998     

Clinical Study of Gushen Tablet(固肾片)in Reducing Children''''s Nephrotic Syndrome Relapse

ObjeCtive:To explore the effect of Gushen tablet(固肾片,GST)In reducing the relapseof chidren’s nephrotic syndrome and the possible mechanism of drugs used.Methods:Fifty Children withprimary nephrotic syndrome who had been induced and alleviated with regular glucocorticoid(GC)wererandomly divided into two groups:the GST group used GST and standard middle-long term course of GC,and the control group adopted standard middle-long term course of GC and immunoinhibitory or immuno-modulatory agents for treatment.The 0.5,1 and 2 years after the treatment the relapse episodes,time forurinary protein negative conversion after relapse,the episodes of patient’s infection and relapse after infec-tion were evaluated.Before and after treatment the plasma cortisol and T lymphocyte subpopulation weredetermined.Results:The relapse rate of GST group:the rates after 0.5,1,2 years were 20.0％,30.0％and 40.9％,and the frequent relapse rate were 0,6.7％ and 9.2％ respectively,which were lower thanthose of control group(60.     

Primary adrenocortical tumors in autopsy records —A survey of “cumulative reports in Japan” from 1973 to 1984—

All cases of primary adrenocortical tumors, including those found incidentally, recorded in the Pathological Autopsy Case Annuals of Japan during a 12 year period from 1973 to 1984 were surveyed. Age- and sex-specific incidences of lesions were estimated from the population, mortality and autopsy statistics for the same period. There were 101 adenomas, 77 of which were presumed to be non-functional, and 222 carcinomas. The age-specific distribution profiles of both the benign and malignant tumors showed single peaks in the sixties and could not be distinguished from one another. The estimated age-specific distribution of morbidity of the non-functional adenomas showed a peak at about 10 years younger than that found in the autopsy records, although it was again similar to that of carcinoma derived from various clinical reports. The morbidity of the non-functional adenomas per 100,000 population was almost equal to that of breast cancer in Japan, being highest in the fifties age group with more than 4,000 people a year being suggested to have adenoma in this age bracket.     

Outcomes of early parent‐child adrenocortical attunement in the high‐risk offspring of depressed parents

This study examined the impact of parent‐child attunement of morning cortisol on parenting and child outcomes in dyads with and without parental depression. Participants included 142 parent‐child dyads (3–5 years‐old) who provided morning cortisol samples at Wave 1, and 98 dyads returned for the 3‐year follow‐up at Wave 2. Results indicated that for parents with a history of depression and for female children, stronger attunement predicted increases in parental hostility from Wave 1 to Wave 2. For females only, stronger attunement was related to children's depressive symptoms at Wave 1 and Wave 2. Stronger attunement was also associated with increases in children's depressive symptoms from Wave 1 to Wave 2, poorer psychosocial functioning at Wave 1, and ADHD symptoms at Wave 2. Findings highlight attunement as an important biological process related to parenting and child outcomes and suggest it may play a role in the intergenerational transmission of depression risk.     

Dance movement therapy and developmental trauma: dissociation and enactment in a clinical case study

This article highlights how body language and non-verbal communication are key elements for the treatment of patients who have suffered from developmental traumas. Contributions from authors from a range of disciplines help the writer to compare the relationship infant-caregiver with the relationship patient-therapist, focusing on common rhythms, attunement, breathing and regulation of affects. The writer investigates how a prolonged lack of attunement from the primary caregiver can have traumatic effects for the child. A clinical case study demonstrates that, through the awarness of his/her own body as 'the instrument', the dance movement therapist can stimulate unconscious implicit body communication and create a sort of vessel where enactments that arise from the therapeutic process can find expression in creative and unexpected ways, as in dreams. This process helps the patient to reintegrate the dissociated aspects of his/herself and can generate significant changes for those involved in the therapeutic process.