Prognostic factors for impaired plasma sodium homeostasis after transsphenoidal surgery

Abstract Objective. Surgical manipulation of the pituitary stalk, neurohypophysis or the hypothalamus may disturb control of the plasma sodium level. The factors that might predict the risk of postoperative sodium imbalance are not clear, and were investigated in this study. Methods. A retrospective survey of 129 surgical records for the occurrence of plasma sodium levels outside the normal range, following transsphenoidal procedures. Median patient age was 49 (range 20-78) years, 65 female. 73 of the operated lesions were non-functioning pituitary adenomas. Patients were considered to have impaired plasma sodium balance if the range of 135-145 mmol/L was not maintained. Results. Of all 129 surgical cases, 68 (53%) experienced an imbalance in sodium levels. Severe sodium imbalance (≥ 149 or ≤ 131 mmol/L) was observed in 28 patients (22%). 13 showed hypernatraemia (median day 1), and 15 hyponatraemia (median day 6). Tumour size was associated with an increased incidence of sodium imbalance, particularly in patients younger than 49 years; surgery resulted in sodium imbalance in 38% of young patients operated on for tumours < 22 mm and in 76% of young patients, operated on for tumours ≥ 22 mm. Overall, tumour size increased with patients' age, and tumour size was less predictive for sodium disturbances in elderly patients. Median time in hospital was 5 days for patients without sodium imbalance, 6 days for patients with hypernatraemia and 11 days for patients with hyponatraemia. Conclusions. Following pituitary surgery, patients with large tumours, in particular those of young age, are at higher risk for losing control of their plasma sodium level. Increased ADH secretion (hyponatraemia), but not transient diabetes insipidus was associated with a prolonged hospital stay. Postoperative follow-up of patients with sellar tumours should include careful monitoring of plasma sodium levels within the first two postoperative weeks and clear patients' instructions

Stereotactic biopsy for intracranial lesions: clinical-pathological compatibility in 60 patients Biopsia estereotáctica para lesões intracranianas: compatibilidade clínico patológica em 60 casos

OBJECTIVE: Image guided stereotactic biopsy (SB) provides cerebral tissue samples for histological analysis from minimal lesions or those that are located in deep regions, being crucial in the elaboration of therapeutic strategies, as well as the prevention of unnecessary neurosurgical interventions. METHOD: Sixty patients with central nervous lesions underwent SB from November 1999 to March 2008. They were followed up to 65 months. Preoperative diagnosis was based on clinical presentation and neuro-radiological features, pathologic diagnosis, clinical outcome. The compatibility of these findings with the pathologic diagnosis was analyzed. RESULTS: Considering diagnosis confirmation when inflammatory hypothesis were made, our accuracy was of 76%, with 94% of those cases having clinic-pathological correspondence after an average of 65.2 months of follow up. Considering diagnosis confirmation with the preoperative hypothesis of neoplasm, our accuracy was of 69% with 90% of these cases having clinic-pathological correspondence after an average of 47.3 months of follow-up. Morbidity rate was of 5% and mortality was zero. The diagnosis rate was 95%. CONCLUSION: Stereotactic biopsy represents a safe and precise method for diagnosis. Anatomic and histopathological analyses have high compatibility with long-term clinical outcome.<br>OBJETIVO: A biopsia estereotáctica (BE) guiada por imagem propicia amostras de tecido cerebral para análises histológicas, sendo decisiva na estratégia terapêutica e prevenção de intervenções neurocirúrgicas desnecessárias. MÉTODO: 60 pacientes com lesões do sistema nervoso central foram submetidos à biópsia estereotáctica no período de novembro de 1999 a março de 2008. Foram analisados a acurácia do método, a capacidade de confirmar o diagnóstico clínico pré-operatório e o comportamento evolutivo com sua compatibilidade com o diagnóstico patológico. RESULTADOS: As três lesões mais freqüentes foram: neoplasias neuroepiteliais, processos inflamatórios e infecções. Considerando a confirmação diagnóstica quando pensava-se em lesão inflamatória, nossa acurácia foi 76%, com 94% destes casos tendo compatibilidade clínico patológica após média de 65,2 meses de acompanhamento. Considerando a confirmação diagnóstica com a hipótese pré-operatória de lesão neoplásica, nossa acurácia foi 69%, com 90% destes casos tendo compatibilidade clínico-patológica após média de 47,3 meses de acompanhamento. O índice de morbidade foi 5%. A mortalidade foi nula e o índice de diagnóstico foi 95%. CONCLUSÃO: A biopsia estereotáctica é um método seguro e preciso para o diagnóstico. O exame anátomo-patológico possui alta compatibilidade com a evolução clínica dos doentes a longo prazo

Caring for Adolescents and Young Adults With Tuberculosis or at Risk of Tuberculosis: Consensus Statement From an International Expert Panel

BACKGROUND:: Despite being a preventable and treatable disease, tuberculosis (TB) is a leading cause of death among young people globally. Each year, an estimated 1.8 million adolescents and young adults (AYAs; 10–24 years old) develop TB. In 2019, an estimated 161,000 AYAs died of the disease. AYAs have unique developmental, psychosocial, and healthcare needs, but these needs have been neglected in both TB care and research agendas. In order to improve outcomes in this age group, the specific needs of AYAs must be considered and addressed. METHODS:: Through a consensus process, an international panel of 34 clinicians, researchers, TB survivors, and advocates with expertise in child/adolescent TB and/or adolescent health proposed interventions for optimizing AYA engagement in TB care. The process consisted of reviewing the literature on TB in AYAs; identifying and discussing priority areas; and drafting and revising proposed interventions until consensus, defined a priori, was reached. RESULTS:: The panel acknowledged the dearth of evidence on best practices for identifying and managing AYAs with TB. The final consensus statement, based on expert opinion, proposes nine interventions to reform current practices that may harm AYA health and well-being, and nine interventions to establish high-quality AYA-centered TB services. CONCLUSION:: AYA-specific interventions for TB care and research are critical for improving outcomes in this age group. In the absence of evidence on best practices, this consensus statement from an international group of experts can help address the needs of AYA with TB or at risk for TB

Data from: The genetic architecture of ecological adaptation: intraspecific variation in host plant use by the lepidopteran crop pest Chloridea virescens

Intraspecific variation in ecologically important traits is a cornerstone of Darwin’s theory of evolution by natural selection. The evolution and maintenance of this variation depends on genetic architecture, which in turn determines responses to natural selection. Some models suggest that traits with complex architectures are less likely to respond to selection than those with simple architectures, yet rapid divergence has been observed in such traits. The simultaneous evolutionary lability and genetic complexity of host plant use in the Lepidopteran subfamily Heliothinae suggest that architecture may not constrain ecological adaptation in this group. Here we investigate the response of Chloridea virescens, a generalist that feeds on diverse plant species, to selection for performance on a novel host, Physalis angulata (Solanaceae). P. angulata is the preferred host of Chloridea subflexa, a narrow specialist on the genus Physalis. In previous experiments, we found that the performance of C. subflexa on P. angulata depends on many loci of small effect distributed throughout the genome, but whether the same architecture would be involved in the generalist’s adoption of P. angulata was unknown. Here we report a rapid response to selection in C. virescens for performance on P. angulata, and establish that the genetic architecture of intraspecific variation is quite similar to that of the interspecific differences in terms of the number, distribution, and effect sizes of the QTL involved. We discuss the impact of genetic architecture on the ability of Heliothine moths to respond to varying ecological selection pressures