Bilateral, incidentally found adrenal tumours - results of observation of 1790 patients registered at a single endocrinological centre

Wstęp: W okresie ostatnich 22 lat 1790 pacjentów z przypadkowo wykrytymi guzami nadnerczy (AI, adrenal incidentalomas) zostało zarejestrowanych w klinice. U 351 spośród nich rozpoznano obustronne guzy nadnerczy. Nasze badania miały na celu analizę charakteru obustronnych guzów i podsumowanie metod postępowania w tych przypadkach. Materiał i metody: W całej grupie 1790 pacjentów było 1311 kobiet i 479 mężczyzn, w wieku 11-87 lat. Grupa pacjentów z obustronnymi guzami nadnerczy obejmowała 258 kobiet i 93 mężczyzn, w wieku 25-83 lat. Przeprowadzono badania hormonalne i obrazowe, w celu poszukiwania podklinicznej nadczynności nadnerczy i określenia potencjału złośliwości guzów. Wyniki: Chirurgicznie leczono 69 pacjentów, ze wskazań onkologicznych albo endokrynologicznych (głównie podkliniczny zespół Cushinga). Wyniki badań histologicznych wykazały istnienie złośliwych zmian nowotworowych: przerzuty - 9, rak nadnercza - 7, chłoniaki - 5 i niezłośliwych zmian: gruczolaki - 24, rozrost guzkowy - 14, myelolipoma - 4, pheochromocytoma - 4 przypadki. Podkliniczny zespół Cushinga występował względnie częściej w rozroście guzkowym (40%) niż w przypadkach gruczolaka (30%). Wnioski: Wskazania do leczenia chirurgicznego ustalono u 20% pacjentów z obustronnymi guzami nadnerczy, najczęściej z powodu gruczolaków, rozrostu guzkowego i złośliwych zmian nowotworowych; rokowanie było dobre w przypadkach nieonkologicznych. (Endokrynol Pol 2010; 61 (1): 69-73)Introduction: During the last 22 years we registered 1790 patients with incidentally found adrenal tumours (AI, adrenal incidentalomas). In 351 of them, bilateral tumours were detected. The aim of our study was to analyze the character of bilateral tumours and summarize the methods of their management. Material and methods: In the whole group of 1790 patients, there were 1311 women and 479 men, aged 11-87 years. The group of patients with bilateral adrenal tumours included 258 women and 93 men, 25-83 years old. Hormonal investigations and imaging examinations were performed to search for subclinical adrenal hyperfunction and to define the malignant potential of the tumours. Results: Sixty-nine patients were treated by surgery for oncological or endocrinological purposes (mainly pre-Cushing’s syndrome). Histological findings included malignant tumours: metastases - 9, adrenal cancer - 7, and lymphomas - 5; and non-malignant tumours: adenomas - 24, nodular hyperplasia - 14, myelolipomas - 4, and pheochromocytomas - 4. Subclinical Cushing’s syndrome was relatively more frequent in nodular hyperplasia (40%) than in adenomas (30%). Conclusions: Indications for surgery were recommended in 20% of patients with bilateral AI, most frequently for adenomas, nodular hyperplasia, and oncological pathologies, with a good prognosis in the non-malignant group. (Pol J Endocrinol 2010; 61 (1): 69-73

Wooden coffins in the Avar-period cemetery in Frohsdorf, Lower Austria

The Avar period cemetery in Frohsdorf is located in eastern Austria in the area of the former western periphery of the Avar Khaganate. In a non-literate culture like that of the Avars, it is only possible to reconstruct everyday culture, including funerary rituals, through archaeological sources. Through archaeological field seasons from 2001 to 2011, we have been able to document numerous coffins and grave fixtures made of wood in inhumation graves. Burials in coffins seemed to be common practice. The coffins are preserved in different states, including wood residues and charred wood residues. In Frohsdorf, in contrast to many other investigated Avar cemeteries, we subjected these coffins and their wooden remains to a detailed analysis. Wood species analyses show a preference for a certain type of wood, namely oak. Based on the preservation status of the wooden remains the authors have developed a hypothesis concerning part of the funeral ritual at this cemetery

An evolutionary perspective on the systems of adaptive immunity

We propose an evolutionary perspective to classify and characterize the diverse systems of adaptive immunity that have been discovered across all major domains of life. We put forward a new function-based classification according to the way information is acquired by the immune systems: Darwinian immunity (currently known from, but not necessarily limited to, vertebrates) relies on the Darwinian process of clonal selection to 'learn' by cumulative trial-and-error feedback; Lamarckian immunity uses templated targeting (guided adaptation) to internalize heritable information on potential threats; finally, shotgun immunity operates through somatic mechanisms of variable targeting without feedback. We argue that the origin of Darwinian (but not Lamarckian or shotgun) immunity represents a radical innovation in the evolution of individuality and complexity, and propose to add it to the list of major evolutionary transitions. While transitions to higher-level units entail the suppression of selection at lower levels, Darwinian immunity re-opens cell-level selection within the multicellular organism, under the control of mechanisms that direct, rather than suppress, cell-level evolution for the benefit of the individual. From a conceptual point of view, the origin of Darwinian immunity can be regarded as the most radical transition in the history of life, in which evolution by natural selection has literally re-invented itself. Furthermore, the combination of clonal selection and somatic receptor diversity enabled a transition from limited to practically unlimited capacity to store information about the antigenic environment. The origin of Darwinian immunity therefore comprises both a transition in individuality and the emergence of a new information system - the two hallmarks of major evolutionary transitions. Finally, we present an evolutionary scenario for the origin of Darwinian immunity in vertebrates. We propose a revival of the concept of the 'Big Bang' of vertebrate immunity, arguing that its origin involved a 'difficult' (i.e. low-probability) evolutionary transition that might have occurred only once, in a common ancestor of all vertebrates. In contrast to the original concept, we argue that the limiting innovation was not the generation of somatic diversity, but the regulatory circuitry needed for the safe operation of amplifiable immune responses with somatically acquired targeting. Regulatory complexity increased abruptly by genomic duplications at the root of the vertebrate lineage, creating a rare opportunity to establish such circuitry. We discuss the selection forces that might have acted at the origin of the transition, and in the subsequent stepwise evolution leading to the modern immune systems of extant vertebrates