Editorial Disease of Adrenal Glands

International audienceThe adrenal gland has been historically an object of interest and scientific curiosity. This is also due to its very heterogeneous structure, number of hormones, complex neural innervation, and multiple and different physiological functions. The adrenal gland also entails an outstanding example of paracrine interactions occurring between histogenetically different tissues as the cortex and the medulla. This special issue is a great opportunity for the reader to learn the latest and emerging findings on the pathophysiol-ogy, diagnosis, and treatment of the adrenal glands disorders. The issue provides a variety of excellent articles covering a broad and contemporary spectrum of aspects of the diseases of the adrenal gland. Of particular interest and novelty is the interplay between hormones of the adrenal glands and other organs, such as the adipose tissue, the endothelium, the bone, and even the brain. In addition to the well-established effects on lipid and glucose metabolism, the hormones of the adrenal glands display a fascinating cross talk with the adipose tissue [1– 3]. The interaction between the adrenals and adipokines is extensively discussed by A. Y. Kargi and G. Iacobellis in a comprehensive and updated review paper. The potential of the fat depot surrounding the adrenal tumors to act like a brown adipose tissue (BAT) is a rapidly emerging topic that will certainly deserve further attention and investigation [4]. Interestingly the authors provided a theoretical basis for potential future pharmacological interventions aimed at adrenal hormone targets in the adipose tissue. Primary aldosteronism is the most common endocrine cause of arterial hypertension. It can cause excess damage to the organs that are target of hypertension and higher cardiometabolic risk [5]. This contention was supported by previous experimental data obtained by Karl Weber's group in rats infused with aldosterone, which exhibited hypercalciuria and raised parathyroid hormone (PTH) levels [6], and, more importantly, by findings in patients with aldosterone-producing adenoma who also showed elevated serum PTH levels that were then normalized by adrenalectomy [7]. The effect of the adrenal hormones on bone metabolism in patients with primary aldosteronism is nicely addressed by L. Petramala et al. The authors sought to test the hypothesis that hyperaldosteronism may influence mineral homeostasis through higher urinary calcium excretion leading eventually to secondary hyperparathyroidism. Of further interest, G. Mazzocchi et al. showed that PTH stimulates aldosterone secretion in a concentration-dependent manner [8], a finding that was complemented by the demonstration of the miner-alocorticoid receptor in the human parathyroid cells [9]. It is well established that a substantial amount of sodium is bound to proteoglycans of bone, connective tissue, and cartilage and that the osmotic force created by the high sodium concentration maintains the high water content in the latter tissue, allowing it to withstand high pressures during exercise [10]. In this special issue P. Alonso et al. further expand on the relationships between the adrenal gland and the skeleton by showing a reduction in the bone mineral densit

Brown Fat Expresses Adiponectin in Humans

The presence of brown adipose tissue (BAT) in humans is unclear. Pheochromocytomas (PHEO) are rare tumors of neuroectodermal origin which occur in 0.1-0.2% of patients with hypertension. We sought to evaluate the presence and activity of BAT surrounding adrenal PHEO in a well-studied sample of 11 patients who were diagnosed with PHEO and then underwent adrenalectomy. Areas of white fat (WAT) and BAT surrounding PHEO were obtained by Laser Capture Microdissection for analysis of uncoupling protein (UCP)-1 and adiponectin mRNA expression. Adiponectin and UCP-1 mRNA levels were significantly higher in BAT than in WAT (0.62 versus 0.15 and 362.4 versus 22.1, resp., for both). Adiponectin mRNA levels significantly correlated with urinary metanephrines (, ), vanilly mandelic acid (VMA) (, ), and serum adiponectin levels (, ). Serum adiponectin levels significantly decreased ( μg/mL versus  μg/mL, ) after adrenalectomy in PHEO subjects. This study provides the following findings: (1) BAT surrounding PHEO expresses adiponectin and UCP-1 mRNA, (2) expression of adiponectin mRNA is significantly higher in BAT than in WAT surrounding PHEO, and (3) catecholamines and serum adiponectin levels significantly correlate with BAT UCP-1 and adiponectin mRNA

Serum Albumin Is Inversely Associated With Portal Vein Thrombosis in Cirrhosis

We analyzed whether serum albumin is independently associated with portal vein thrombosis (PVT) in liver cirrhosis (LC) and if a biologic plausibility exists. This study was divided into three parts. In part 1 (retrospective analysis), 753 consecutive patients with LC with ultrasound-detected PVT were retrospectively analyzed. In part 2, 112 patients with LC and 56 matched controls were entered in the cross-sectional study. In part 3, 5 patients with cirrhosis were entered in the in vivo study and 4 healthy subjects (HSs) were entered in the in vitro study to explore if albumin may affect platelet activation by modulating oxidative stress. In the 753 patients with LC, the prevalence of PVT was 16.7%; logistic analysis showed that only age (odds ratio [OR], 1.024; P = 0.012) and serum albumin (OR, -0.422; P = 0.0001) significantly predicted patients with PVT. Analyzing the 112 patients with LC and controls, soluble clusters of differentiation (CD)40-ligand (P = 0.0238), soluble Nox2-derived peptide (sNox2-dp; P < 0.0001), and urinary excretion of isoprostanes (P = 0.0078) were higher in patients with LC. In LC, albumin was correlated with sCD4OL (Spearman's rank correlation coefficient [r(s)], -0.33; P < 0.001), sNox2-dp (r(s), -0.57; P < 0.0001), and urinary excretion of isoprostanes (r(s), -0.48; P < 0.0001) levels. The in vivo study showed a progressive decrease in platelet aggregation, sNox2-dp, and urinary 8-iso prostaglandin F2 alpha-III formation 2 hours and 3 days after albumin infusion. Finally, platelet aggregation, sNox2-dp, and isoprostane formation significantly decreased in platelets from HSs incubated with scalar concentrations of albumin. Conclusion: Low serum albumin in LC is associated with PVT, suggesting that albumin could be a modulator of the hemostatic system through interference with mechanisms regulating platelet activation

Intramedullary nailing in femoral shaft fractures. Evaluation of a group of 101 cases.

The Authors analyse the results of intramedullary nailing in a group of 101 femoral shaft fractures. Used nails: Universal Synthes (62 cases), Russel-Taylor (14), Gamma long (10), uncannulated femoral nail (9), cannulated femoral nail (4) and proximal femoral nail (2). Stabilisation of the femoral shaft fracture was possible using a reamed technique in 91 cases, unreamed in 10. All nails were locked. Dynamisation was performed in 35 cases and was not in 66. The fracture heal was faster with the reaming and dynamisation technique. Ten fractures were open (5 Gustilo I, 5 Gustilo II) and stabilisation with Universal Synthes nail (8 cases), Russel-Taylor nail (1) and Gamma long nail (1) was performed. No infection was detected. Lung embolism (6) and deep vein thrombosis (3) occurred only in the case of reamed nails. All results confirm the locking nail system as the best treatment in the shaft fractures, especially with new-generation nails

Parafocal osteotomy and Ilizarov method in the treatment of femoral pseudarthrosis. Case report

The case presented is that of a man aged 54 years,with hypertrophic pseudarthrosis shortening by 3 cm and a femoral mechanical axis measuring 13 degrees varus. Parafocal osteotomy according to Paltrinieri was carried out with the aim of correcting the varus femur, the shortening and,secondarily, of obtaining recovery from the pseudarthrosis. Osteosynthesis was achieved by the Ilizarov apparatus. Axial correction and lengthening were obtained after 33 days. The fixator was removed after 5 months and 10 days, during wich the nonunion appeared healed

PLATING IN DIAPHYSEAL FRACTURES OF THE FOREARM

Background and aim of the work: Currently, open reduction and internal plate-screw fixation is generally accepted as the gold standard treatment of diaphyseal forearm fractures. The purpose of this retrospective study was to evaluate the clinical and radiographic outcomes of open reduction and internal fixation by using the Locking Compression Plate (LCP) implant system of radial, ulnar or combined shaft fractures of a skeletally mature patients group treated at our institution. Methods: We examined 47 patients, 44 men and 3 women, mean age 35 years (range 14\u201374) operated for diaphyseal fractures of the forearm. Overall 64 segments were treated: 32 ulnar and 32 radial. All patients received 3.5-mm titanium LCPs (Locking Compression Plates) with \u201ccombi-holes\u201d. Follow-ups included standard X-rays and clinical assessment according to Anderson's criteria and the DASH questionnaire. Results: Mean follow-up was 11 months (range 6-39). The number of the patients who achieved complete consolidation was 43 with a union rate of 91.5%. They showed 37 excellent results and 6 satisfactory results according to Anderson criteria, while non-union occurred in 4 out of 64 segments (2 ulnar and 2 radial) with a non-union rate per patient of 8,5%. The mean score of the DASH scale was 13.5 (range 0-46.7). Conclusions: Our data show that internal plating gives good functional outcomes in the treatment of forearm diaphyseal fractures, as long as the surgical technique is perfect and carried out by expert surgeons. However, further research is desirable to better identify fracture types for which LCPs should be used

La metodica di Ilizarov nel trattamento delle neoplasie maligne di tibia

A total of 3 malignant neoplasms of the tibia are presented: 1 is a mesenchymal chondrosarcoma of the tibial pylon (male aged 14 years), and 2 are cases of squamous skin carcinoma of the leg with tibial infiltration (1 male and 1 female aged 32 and 64 years, respectively). The resections carried out (16.5 cm on the average) were treated by bone transport. Simple transport was used in the first patient, double in the other two. At the end of transport a second surgical stage involving astragalotibial arthrodesis was performed in the first case, and revision of the junction site of bone segments transported with application of autoplastic bone grafts was performed in the other two. The regenerate obtained was slowly corticalized in the first patient, submitted to various cycles of chemotherapy during the course of distraction. In the other two cases, which were not treated by chemotherapy during distraction, corticalization occurred over a shorter amount of time. Follow-up was obtained after 10 years in the first case, and after 2 years in the other 2 patients. There was no long-term recurrence