Since We Parted

Since we parted yestereve,I do love thee,Love, believe,Twelve times dearer, twelve hours longer,One dream deeper, one night stronger,One sun surer:thus much moreThan I lov’d thee, dear, before

Chapter 11a: Pituitary and hypothalamic tumour syndromes in childhood

Central nervous system (CNS) tumours are the second commonest childhood malignancy. and survial has increased as a result of improved multimodality cancer therapies and better supportive care. Measurements of PRL, AFP and β-hCG are essential prior to commencement of any therapy. Craniopharyngiomas and low grade gliomas account for most tumors, while pituitary adenomas are rare. Non-neoplastic masses include pituitary hyperplasia and Rathke’s cleft cysts. Neurological syndromes and endocrine dysfunction must be recognized both before treatment and after. Both the original tumor and its treatment may disturb GH secretion, cause gonadotophin deficiency, or Posterior Pituitary Dysfunction, and less commonly reduce thyroid or adrenal function. The “hypothalamic syndrome” including variable hypothalamic dysfunction and morbid obesity is a common sequelae of surgical treatment, presumably caused by dysregulation of anorexigenic and orexigenic hormone signals

The poetical works of Owen Meredith (Robert, Lord Lytton): Lucile, The apple of life, The wanderer, Clytemnestra, etc, etc.

408 p., [12] h. de lá

Treating gambling addiction : a psychological study in the South African context

The objectives of this study were to provide a detailed biopsychosocial description of the characteristics of a sample of 100 individuals screened and referred by the National Responsible Gaming Programme helpline for their outpatient treatment programme over an eighteen month period, and, importantly, to measure the success of this specific treatment programme at set intervals, up to a one year follow-up period. While 80% of the sample did not relapse during the six-week treatment programme, the number of treatment seekers without any gambling relapses during each follow-up period declined, and those falling back into gambling increased as time went on. After one year 47% of treatment seekers managed not to revert back to gambling – total abstinence. A further 28% reported having relapsed once or twice or that their gambling was controlled. 25% of treatment seekers reported that they reverted back to gambling fulltime which leaves the success rate of the treatment at 75%. Treatment seekers reported an overall reduction in gambling participation, debt and expenditure and an overall improvement in social and vocational functioning. There is evidence in this study to support the perspective that pathological gambling is a multidimensional disorder and that certain sub-groups of gamblers have distinct gambling behaviour.PsychologyM.Soc.Sc

Dione : ultimos días de Pompeya : novela histórica

Donación Rafael Lario PérezFondo antiguo ilustrad

Treatment-resistant pediatric giant prolactinoma and multiple endocrine neoplasia type 1

Background Pediatric pituitary adenomas are rare, accounting for <3 % of all childhood intracranial tumors, the majority of which are prolactinomas. Consequently, they are often misdiagnosed as other suprasellar masses such as craniopharyngiomas in this age group. Whilst guidelines exist for the treatment of adult prolactinomas, the management of childhood presentations of these benign tumors is less clear, particularly when dopamine agonist therapy fails. Given their rarity, childhood-onset pituitary adenomas are more likely to be associated with a variety of genetic syndromes, the commonest being multiple endocrine neoplasia type 1 (MEN-1). Case description We present a case of an early-onset, treatment-resistant giant prolactinoma occurring in an 11-year-old peripubertal boy that was initially sensitive, but subsequently highly resistant to dopamine agonist therapy, ultimately requiring multiple surgical debulking procedures and proton beam irradiation. Our patient is now left with long-term tumor- and treatment-related neuroendocrine morbidities including blindness and panhypopituitarism. Only after multiple consultations and clinical data gained from 20-year-old medical records was a complex, intergenerationally consanguineous family history revealed, compatible with MEN-1, with a splice site mutation (c.784-9G > A) being eventually identified in intron 4 of the MEN1 gene, potentially explaining the difficulties in management of this tumor. Genetic counseling and screening has now been offered to the wider family. Conclusions This case emphasizes the need to consider pituitary adenomas in the differential diagnosis of all pediatric suprasellar tumors by careful endocrine assessment and measurement of at least a serum prolactin concentration. It also highlights the lack of evidence for the optimal management of pediatric drug-resistant prolactinomas. Finally, the case we describe demonstrates the importance of a detailed family history and the role of genetic testing for MEN1 and AIP mutations in all cases of pediatric pituitary adenoma