Pituitary macroadenomas (>3cm) in young adulthood: Pathologic and proliferative characteristics

Background There are scarce data regarding the significance of the tumor size, hormonal activity and size of the pituitary tumor of the young; therefore, the study was designed to define the relation of the hormonal status of the large pituitary adenomas. Objective We compared those features with tumors of the elderly (>40) with the young patients, and analyzed the clinicopathologic and proliferative features of pituitary macroadenomas in young adulthood (≤40). Methods 20-year archives of pituitary tumors in our clinics were reviewed and macroadenomas with diameter ≥3cm were included in the study. We identified 46 pituitary adenomas and immunohistochemically stained them with pituitary hormones, p53 and Ki-67. Twenty-four cases were ≤40-year with an age range of 11–40 years (mean 28.0). Twenty-two cases were >40 with an age range of 44–78 years (mean 58.8). Results In the young patient group, 15 (62.5%) were functional adenomas (6 prolactinomas, six growth hormone [GH], one adrenocorticotrophic hormone [ACTH] adenoma, two multihormonal [GH+ACTH]) and nine (37.5%) were either gonadotrophic or null cell adenomas. In the elderly group, five (22.7%) were functional adenomas (two adrenocorticotrophic hormone [ACTH] adenoma, one prolactinoma, one growth hormone [GH], one multihormonal [GH+ACTH]) and 17 (77.3%) were either gonadotrophic or null cell adenomas. Ki-67 proliferation index in adenomas of the young was approximately two-folds higher than the elderly (2.7% vs. 1.2%). Conclusion In both groups, rare p53 positivity was identified. In conclusion, pituitary macroadenomas of the young show hormonal expression frequently with relatively high Ki-67 proliferation indices

Analysis of lymphocyte subgroups in Crimean-Congo hemorrhagic fever

SummaryObjectivesThis study examined the association between lymphocyte subgroups and mortality in patients with Crimean-Congo hemorrhagic fever (CCHF) in Turkey.MethodsDuring the spring and summer of 2007, peripheral blood was collected from hospitalized patients with suspected CCHF. Lymphocyte subgroups were characterized by fluorescence-activated cell sorting. CCHF cases were confirmed by detecting viral RNA by PCR and/or IgM antibodies by ELISA. Lymphocyte subgroups were compared between fatal and non-fatal cases. The correlation between lymphocyte subgroups and viral loads was also investigated.ResultsSeventy-seven confirmed cases of CCHF were included in this study (five cases were fatal (6.5 %)). No differences in lymphocyte subgroups were found between fatal and non-fatal cases, except for significantly higher CD3+CD8+ T cells in the fatal cases (p=0.017). A positive correlation between viral load and CD3+CD8+ T cells was also detected (p=0.044). There was no correlation between other lymphocyte subgroups and viral load.ConclusionsHigher levels of CD3+CD8+ T lymphocytes were detected in fatal compared to non-fatal CCHF cases. Despite this cytotoxic immune activation, a fatal outcome could not be prevented. We hypothesize that high viral load and other factors may influence this outcome, although more studies are required to explain the pathogenesis of CCHF

Kuduz Hastalığına Bağlı Bir Adli Otopsi

Kuduz hastalığı, Rhabdoviridea ailesinden Lyssavirus’un neden olduğu, akut seyreden ve profilaksi yapılmadığında ölümle sonuçlanan viral bir enfeksiyondur. Sağlık Bakanlığı verilerine göre Türkiye’de 1973-2001 yılları arasında 529 kuduz hastalığına bağlı ölüm olgusu bildirilmiştir. Dünyadaki insan kuduz vakalarının yıllık insidansının 25.000’in üzerinde olduğu belirtilmektedir. Olgumuz, 21 yaşında erkek olup bir köpek tarafından frontal bölgesinden ısırıldığı, temas sonrası profilaksinin yapıldığı, 25 gün sonra öldüğü bildirilmiştir. Kuduz hastalığına bağlı ölüm olgularında, kesin ölüm nedeninin saptanabilmesi için genel otopsi uygulamaları yanında laboratuvar araştırmaların da yapılması gerekmektedir. Otopsi ekibinin, etkenin bulaşma riskine karşı önlem alması, otopsi salonunun ve otopsi aletlerinin dezenfeksiyonu ile postmortem inceleme için uygun dokular alınmasında, ayrıca uygun koşullarda muhafaza edilerek laboratuvara gönderilmesinde standart protokollerin uygulanması önem taşımaktadır. Olgumuz, profilaksiye rağmen ölüme neden olabilecek faktörlerin tartışılması ve kuduz hastalığı şüpheli olguların otopsilerinde dikkat edilmesi gereken önlemlerin vurgulanması amacıyla sunulmaktadır. Anahtar Kelimeler: Kuduz, otopsi, biyolojik korunma

Crimean-Congo Hemorrhagic Fever Seroprevalence in Healthcare Workers

In our country, cases with Crimean-Congo hemorrhagic fever (CCHF) have increased since 2002. Our clinic is one of the major centers that follows the CCHF cases. Healthcare workers are at risk for transmission of CCHF virus. This study was conducted after a nurse had developed symptomatic CCHF 3 days after resuscitating a CCHF patient. The aim of this study is to investigate CCHF specific IgG by ELISA in remaining 27 staff taking care of CCHF patients in our clinic. Test result was found positive in one doctor who had developed an asymptomatic infection. The nurse with symptoms had taken standard contact isolation precautions during the resuscitation however blood of the patient had splashed to his gown. It was considered that during that time unnoticed mucosal contact had occurred. This study suggested that transmission of CCHF virus might occur during emergent interventions and optimal contact isolation precautions should be taken very carefully