Epidemiology of pituitary tumors

Prema brojnim istraživanjima adenomi hipofize vrlo su česte neoplazme, a među njima su najčešći prolaktinomi. Suvremene epidemiološke studije pokazuju da su adenomi hipofize 3 do 5 puta učestaliji nego što se mislilo. Razvojem i dostupnošću modernih neuroradioloških metoda, kao i pouzdanim mjerenjem koncentracije hormona u plazmi bolesnika, dijagnoza adenoma hipofize postala je jednostavnija i pouzdanija. Sve češće susrećemo tzv. incidentalome, tzv. slučajno nađene tumore hipofize, kod potpuno asimptomatskih bolesnika, bez biokemijskih ili neuroloških promjena. Adenomi hipofize najčešće se dijagnosticiraju u mladih žena u reproduktivnoj dobi. Kod muškaraca i starijih osoba su rjeđi, a obično se dijagnosticiraju u uznapredovanoj fazi kao nefunkcionalni adenomi ili makroprolaktinomi s dominacijom neuroloških ispada u kliničkoj slici. U djetinjstvu su rijetki, a mogu se javiti i u obliku nasljednih adenoma hipofize. Atipični invazivni adenomi javljaju se u 15 % makroadenoma hipofize, a maligna alteracija izuzetno je rijetka. Cijena njihovog liječenja je visoka. Poznavanje epidemioloških podataka omogućuje kvalitetnije planiranje kliničke obrade u zdravstvenom sustavu uz smanjenje nepotrebnog morbiditeta, kao i troškova liječenja.According to numerous studies pituitary adenomas are very common neoplasms with prolactinomas as the most frequent. Contemporary epidemiological studies show that pituitary adenomas are 3 to 5 times more common than previously thought. The diagnosis of pituitary adenomas has become more simple and accurate with development and availability of modern neuroradiological methods as well as reliable measurement of hormone concentration in patient plasma. Today we frequently encounter pituitary adenomas which were found by coincidence in completely asymptomatic patients who have no laboratory or neurological abnormalities. These tumors are called incidentalomas. Pituitary adenomas are most frequently diagnosed among young women in their reproductive age. In men and older people they are less sommon and are usually recognized in advanced stages as nonfunctional adenomas or macroprolactinomas with neurological abnormalities as major clinical features. Childhood pituitary adenomas are also rare and can occur as inherited pituitary adenomas. Atypical invasive adenomas occur in 15 % of pituitary macroadenomas and malignant alteration is extremely rare. Although the price of treatment is very high, knowing epidemiological data enables better planning of resources in the health system and decreases the unnecessary morbidity and costs of treatment

Does mobile phone use cause brain tumors?

U današnje doba živimo u gustom moru polja elektromagnetskog zraèenja, za koje se procjenjuje da je 100 do 200 puta jaèe nego što je bilo prije sto godina. Dalekovodi, radari odašiljaèi, elektrièni vodovi, mobilni telefoni, televizori, digitalni satovi, CD/radioplejeri, raèunala i bežièni internet stvaraju elektromagnetska polja, a problem elektromagnetskog “zagaðenja” pogoršava upravo eksplozija bežiènih tehnologija. Tijekom rada, spomenuti ureðaji emitiraju elektromagnetsko zraèenje koje utjeèe na žive sustave. S obzirom na to da mobilne telefone za vrijeme razgovora prislanjamo na uho, dio njihovog zraèenja apsorbiraju tkiva glave, te postoji opravdana zabrinutost da njihovo korištenje utjeèe na razvoj tumora mozga i drugih fizioloških poremeæaja. U svijetu se progresivno poveæava broj korisnika i uèestalost korištenja mobilnih telefona, stoga je ovo pitanje od velikog javnozdravstvenog znaèaja. Mnogobrojne studije pokušale su ustanoviti utjeèe li korištenje mobilnih telefona na nastanak tumora mozga. Ovaj èlanak prikazuje problematiku vezanu uz štetne zdravstvene utjecaje uzrokovane korištenjem mobilnih telefona te komentira rezultate znaèajnijih studija iz tog podruèja.aWe live in a dense field of electromagnetic radiation today. It is estimated that this field is up to 200 times stronger than it was a 100 years ago. Power lines, radars, transmiters, electrical appliances, mobile phones, televisions, digital watches, CD/radio players, computers and wireless internet all produce electromagnetic fields, and the problem of electromagnetic “pollution” grows further with explosion of wireless technologies. These devices emit electromagnetic radiation that influences live organisms. When a mobile phone is used, it is held in a close proximity of head and a fraction of emited electromagnetic energy is absorbed by the user’s head. There is a concern that this electromagnetic radiation may cause brain tumors and other physiological disturbances. There is a growing number of new mobile phone users in the world making this concern a big publichealth issue. Many studies have tried to answer weather cell phone use causes brain tumors. This article examines the different aspects of mobile phone influence on genesis of brain tumors and comments the results of some of the important studies.elefo

Does mobile phone use cause brain tumors?

U današnje doba živimo u gustom moru polja elektromagnetskog zraèenja, za koje se procjenjuje da je 100 do 200 puta jaèe nego što je bilo prije sto godina. Dalekovodi, radari odašiljaèi, elektrièni vodovi, mobilni telefoni, televizori, digitalni satovi, CD/radioplejeri, raèunala i bežièni internet stvaraju elektromagnetska polja, a problem elektromagnetskog “zagaðenja” pogoršava upravo eksplozija bežiènih tehnologija. Tijekom rada, spomenuti ureðaji emitiraju elektromagnetsko zraèenje koje utjeèe na žive sustave. S obzirom na to da mobilne telefone za vrijeme razgovora prislanjamo na uho, dio njihovog zraèenja apsorbiraju tkiva glave, te postoji opravdana zabrinutost da njihovo korištenje utjeèe na razvoj tumora mozga i drugih fizioloških poremeæaja. U svijetu se progresivno poveæava broj korisnika i uèestalost korištenja mobilnih telefona, stoga je ovo pitanje od velikog javnozdravstvenog znaèaja. Mnogobrojne studije pokušale su ustanoviti utjeèe li korištenje mobilnih telefona na nastanak tumora mozga. Ovaj èlanak prikazuje problematiku vezanu uz štetne zdravstvene utjecaje uzrokovane korištenjem mobilnih telefona te komentira rezultate znaèajnijih studija iz tog podruèja.aWe live in a dense field of electromagnetic radiation today. It is estimated that this field is up to 200 times stronger than it was a 100 years ago. Power lines, radars, transmiters, electrical appliances, mobile phones, televisions, digital watches, CD/radio players, computers and wireless internet all produce electromagnetic fields, and the problem of electromagnetic “pollution” grows further with explosion of wireless technologies. These devices emit electromagnetic radiation that influences live organisms. When a mobile phone is used, it is held in a close proximity of head and a fraction of emited electromagnetic energy is absorbed by the user’s head. There is a concern that this electromagnetic radiation may cause brain tumors and other physiological disturbances. There is a growing number of new mobile phone users in the world making this concern a big publichealth issue. Many studies have tried to answer weather cell phone use causes brain tumors. This article examines the different aspects of mobile phone influence on genesis of brain tumors and comments the results of some of the important studies.elefo

The Effect of Analgesics and Physical Therapy on Respiratory Function after Open and Laparoscopic Cholecystectomy

In this study we present prospective clinical trial included 100 patients. One half of the patients underwent open cholecystectomy, whereas laparoscopic cholecystectomy was performed in the other half. Spirometric parameters, arterial blood gases, acid-base balance, were determined preoperatively, and then at 6 h, 24 h, 72 h and 144 h postoperatively. The impact of physical therapy on the respiratory parameter patterns, VAS-pain score and use of tramadol were studied after cholecystectomy. Significantly lower VAS-pain score and less tramadol use, higher values and faster recovery of ventilation parameters and PaO2 were recorded after laparoscopic cholecystectomy than after open cholecystectomy (p=0.001 for both). Physical therapy resulted in a significant improvement in the values of respiratory parameters in the open cholecystectomy group within a short time (30 min) after therapy was performed. Physical therapy failed to produce any improvement of respiratory parameters in laparoscopic cholecystectomy, whereas in open cholecystectomy group who had a favorable although transient effect, strictly limited to the short time from its application. (p=0.005). The patients operated on by open cholecystectomy had statistically significantly more pronounced disturbances including hypoxia, hypocapnia and hyperventilation when compared to the group submitted to laparoscopic cholecystectomy. It is recommended that physical therapy be more frequently performed during the postoperative period in patients submitted to open cholecystectom

Clostridial gas gangrene after laparoscopic cholecystectomy: the role of SARS-CoV-2 virus – a case report and review of literature

Klostridijska plinska gangrena je brzo šireća nekrotična infekcija mekog tkiva s visokim smrtnim ishodom. Rijetka je komplikacija laparoskopske kolecistektomije. Predstavljamo 68-godišnju bolesnicu koja je razvila klostridijsku plinsku gangrenu nakon laparoskopske kolecistektomije. Bolesnica je prethodno bila bez komorbiditeta osim što je 14 dana ranije imala SARS CoV-2 infekciju s blagim respiratornim simptomima. Klostridijska infekcija je nastala neposredno nakon operacije uzrokujući gangrenu trbušne stijenke, septički šok i multiorgansko zatajenje. Unatoč pravovaljanoj i pravodobnoj antibiotskoj terapiji, kirurškom debridementu i ostalim mjerama intenzivnog liječenja, ishod bolesti bio je letalan. Postavljamo si dva pitanja: je li virus SARS CoV-2 mogao biti inicijator letalne kaskade u ove bolesnice i bismo li promijenili ishod da smo odgodili operaciju?Clostridium gas gangrene is fast-spreading necrotic infection of soft tissue relevant to high mortality rates. It is a rare complication after laparoscopic cholecystectomy. We present a case of a 68-year old woman who developed clostridial gas gangrene after laparoscopic cholecystectomy. The patient didn’t have have any comorbidity except SARS CoV-2 infection with mild respiratory symptoms 14 days ago. The infection developed immediately after the operation causing gangrene of the abdominal wall, septic shock and multi-organ failure. Although the patient was treated with appropriate and prompt antibiotic therapy and thorough surgical debridement and with other supportive measures, outcome was lethal. Based on this case we ask ourselves: Could the SARS CoV-2 virus initiate lethal cascade and should we change the outcome if we postponed the operation

Ishemijska apopleksija hipofize, hipopituitarizam i dijabetes insipidus: trijada specifična za nekrotizirajući hipofizitis

A rare case of necrotizing hypophysitis (NH) in a 52-year-old man presenting with pituitary apoplexy and sterile meningitis is described. This case indicates that the diagnosis of NH could be made without biopsy, based on concomitant presence of diabetes insipidus, hypopituitarism and radiologic features of ischemic pituitary apoplexy. Conservative management of pituitary apoplexy should be advised in NH. Additionally, this is the first report of a case of sterile meningitis caused by ischemic pituitary apoplexy.Autori prikazuju rijedak slučaj nekrotizirajućeg hipofizitisa u 52-godišnjeg muškarca koji se inicijalno prezentirao apopleksijom hipofize i sterilnim meningitisom. Ovaj slučaj ukazuje na mogućnost da je dijagnozu nekrotizirajućeg hipofizitisa moguće postaviti i bez biopsije ako postoji patognomonična trijada ovoga sindroma: dijabetes insipidus, hipopituitarizam i radiološki znakovi ishemijske apopleksije hipofize. Dodatno, ovo je prvi opisani slučaj sterilnog meningitisa uzrokovanog ishemijskom apopleksijom hipofize

Isolated intracranial sinus histiocytosis: Report of two cases with Rosai-Dorfman disease

Cilj: Rosai-Dorfman bolest (RDD) je idiopatska histiocitna proliferacijska bolest koja zahvaæa limfne èvorove. RDD se rijetko pojavljuje kao izolirana intrakranijska bolest, bez zahvaæenosti ostalih regija. U ovom èlanku prikazat æemo dva sluèaja RDD koja su se manifestirala kao izolirani intrakranijski procesi. Prikaz sluèaja: Prvi bolesnik je tridesetdevetogodišnji muškarac s dobro ogranièenom lezijom desnog temporalnog režnja, za koju se preoperativno smatralo da je meningeom. Histološkom i imunohistokemijskom analizom ustanovljeno je da se radi o RDD. Intracerebralna pojava ove bolesti ima benigan tijek. Drugi bolesnik je èetrdesetjednogodišnji muškarac koji se klinièki prezentirao vertiginoznim sindromom i blagom cerebelarnom ataksijom. Raèunalna tomografija prikazala je solitarnu leziju lokaliziranu desno cerebelarno. Imunohistopatološke karakteristike takoðer su ukazale na to da se radi o RDD. Rasprava i zakljuèak: U èlanku æemo prikazati znaèajke, diferencijalnu dijagnozu i terapiju intrakranijske lokalizacije RDD. Detaljna preoperativna priprema bolesnika je obavezna, a kad god je moguæe treba uèiniti i biopsiju. Neurokirurško lijeèenje ovog tumora nije uvijek nužno, no bitno je za postavljanje prave dijagnoze. Ishod bolesti i rizik od recidiva manji je kod kompletnog odstranjenja tumora. Recidiv tumora nije opažen prilikom kompletnog odstranjenja tumora, te u tim sluèajevima ne postoji potreba za daljnjom terapijom. S klinièkog stajališta, RDD se može smatrati važnim intracerebralnim tumorskim entitetom zato što može oponašati druge tumorske procese.Aim: Rosai-Dorfman Disease (RDD) is an idiopathic histiocytic proliferation affecting lymph nodes. Rosai-Dorfman disease rarely affects intracranial structures without involvement of other sites. In this paper we are presenting two cases of RDD with isolated intracranial involvement. Case report: The first patient is a 39-year-old male presenting with an isolated well-circumscribed brain mass in the right temporal lobe, preoperatively thought to be a meningioma. Histological and immunohistochemical analysis confirmed that the lesion was RDD. The intraparenchymal brain location of RDD appears to have a benign course. We also describe the case of 41-year-old man presenting with vertiginous symptoms and mild cerebellar ataxia who was diagnosed with a solitary lesion localised deep in the right cerebellar hemisphere. Immunohistological findings also revealed Rosai-Dorfman disease. Discussion and conclusion: In this paper we are presenting the clinical features, tumor characteristics, differential diagnosis and treatment options. Thorough preoperative evaluation is mandatory and biopsy should be done whenever possible. Surgical treatment of this type of tumour is not always necessary, however, it is essential for postulating the right diagnosis. When total tumor removal is achieved, the outcome is generally better. Recurrence was not observed in our cases where total surgical excision was performed and there was no need for additional therapy. From the clinical point of view RDD might be an important intracerebral entity because it might mimic other lesions, particularly other histiocytic disorders.,îÿ