Adrenal-sparing surgery for a hormonally active tumour — a single-centre experience

Introduction: Surgeries that spare the adrenal cortex during adrenalectomy have profound justification. Indications for this type of surgery are fairly strict, and more than 30 years of observations continuously verify the results of the procedure. Material and methods: Of a total of 650 adrenalectomies, 22 (3.4%) were adrenal cortex-sparing surgeries. There were 16 women and six men in this group. In 10 cases, surgery was performed for pheochromocytoma, eight cases involved Conn’s syndrome, and in four cases — paragangliomas located in the para-adrenal region. Secretory activity was identified in all cases. Results: Laparoscopic partial adrenalectomy was performed in 20 patients. Conversion to open laparotomy was necessary in two cases. In patients after bilateral resection of pheochromocytoma surgery, glucocorticoids were supplemented for six weeks. No significant surgical complications were observed in this group. Conclusions: Partial adrenalectomy for minor lesions should be a much more commonly utilised treatment method (of choice). Where bilateral adrenalectomy is necessary, a sparing procedure on one side protects patients from the need for hormonal substitution. The remaining part of the adrenal gland undertakes satisfactory secretory function after six weeks at the latest.

Surgical treatment of abdominal paragangliomas

Introduction: Extraperitoneal, abdominal paragangliomas most commonly originate from the sympathetic nervous system. Typical features include catecholamine overproduction and the potential for malignancy. Lesions are usually located paravertebrally, but when growing in a more expansive manner they may also appear between the inferior vena cava and aorta. In the authors’ opinion this site excludes laparoscopic tumourectomy. Material and methods: Twenty-eight patients were selected for surgical management of abdominal paragangliomas in the past eight years at our endocrine surgical centre. This group consisted of 21 (75%) women and seven (25%) men, aged 14 to 84 years (mean 47.9). In 13 (46.4%) cases paroxysmal hypertension was observed. Type 2 diabetes was noted in another 10 (35.7%) patients, and Takotsubo acute coronary syndrome in two (7.1%). Patients were preoperatively qualified for either open surgery or laparoscopic tumourectomy based on visualisation and location of the tumours in imaging studies. Results: All patients were successfully operated. Eleven (39.3%) patients qualified for laparoscopy, while the remaining 17 (60.7%) were treated with an open surgical approach due to difficult access to the lesion. The mean operative time was 130 minutes for laparoscopy and 120 minutes for laparotomy (p = 0.2). There were no local or general complications after either type of procedure. Conclusions: The use of laparoscopic access is practically excluded in the treatment of paragangliomas located between the inferior vena cava and aorta, especially at the level of the renal vessels and extending superiorly to the diaphragm.

Putrescine catabolism via DAO contributes to proline and GABA accumulation in roots of lupine seedlings growing under salt stress

The levels of polyamines (PAs), proline (Pro), and γ-aminobutyric acid (GABA) as well as the activity of diamine oxidase (DAO; EC 1.4.3.6) were studied in the roots of 2-day-old lupine (Lupinus luteus L. ‘Juno’) seedlings treated with 200 mM NaCl for 24 h. The effect of adding 1 mM aminoguanidine (AG), an inhibitor of DAO activity, was also analyzed. It was found that in roots of lupine seedlings growing under salt stress, a negative correlation between Pro accumulation and putrescine (Put) content takes place. Pro level increased in roots by about 160% and, at the same time, Put content decreased by about 60%, as a result of ca. twofold increase of DAO activity. The AG added to the seedlings almost totally inhibited the activity of DAO, increased Put accumulation to control level, decreased Pro content by about 25%, and reduced GABA level by about 22%. Addition of 50 mM GABA to the lupine seedlings growing in the presence of AG and NaCl restored Pro content in roots to its level in NaCl-treated plants. In this research, the clear correlation between Put degradation and GABA and Pro accumulation was shown for the first time in the roots of seedlings growing under salt stress. This could be considered as a short-term response of a plant to high salt concentration. Our findings indicate that during intensive Pro accumulation in roots induced by salt stress, the pool of this amino acid is indirectly supported by GABA production as a result of Put degradation

Skuteczność jednostronnej adrenalektomii laparoskopowej w hiperkortyzolemii i subklinicznym zespole Cushinga niezależnych od ACTH — badanie retrospektywne na dużej kohorcie

Introduction: To assess the effectiveness of early unilateral laparoscopic adrenalectomy in ACTH-independent and subclinical hypercor­tisolaemia. Material and methods: We conducted a unicentric, retrospective study. Between 2010 and 2015, 356 laparoscopic adrenalectomies were performed in the Department of General and Endocrine Surgery of the MUW. Hypercortisolaemia was found in 50 (14%) patients, while overt hypercortisolaemia was found in 31 patients. In the hypercortisolaemia group, ACTH-dependent hypercortisolaemia was diagnosed in five (10%) and ACTH-independent hypercortisolaemia in 25 patients (50%). One patient with overt hypercortisolaemia had cancer of the adrenal cortex. The remaining 19 (38%) patients had subclinical Cushing’s syndrome. For our study, we compared patients with ACTH-independent hypercortisolaemia (n = 25) with those with Cushing’s syndrome (n = 19). Patients with ACTH-dependent hyper­cortisolaemia (n = 5) and the patient with cancer of the adrenal cortex (n = 1) were excluded. Results: Patients from both groups (n = 44) underwent a unilateral transperitoneal adrenalectomy. Good early outcomes were observed in 42 patients (93.3%). In one patient, an additional laparoscopic surgery was necessary on postoperative day 0 due to bleeding. In another patient, on day 22 post-surgery, we found an abscess in the site of the excised adrenal gland, which was drained under laparoscopic guid­ance. In three patients (6.8%) with substantial obesity, temporary respiratory insufficiency of varying degrees occurred. We did not observe any thromboembolic complications. All patients with overt hypercortisolaemia and nine patients with subclinical hypercortisolaemia had secondary adrenal insufficiency postoperatively. Conclusions: Transperitoneal unilateral laparoscopic adrenalectomy is an efficient and safe treatment option in patients with ACTH- -independent hypercortisolaemia, both overt and subclinical.Wstęp: Celem pracy była ocena skuteczności wczesnej jednostronnej adrenalektomii laparoskopowej w niezależnej od ACTH i subkli­nicznej hiperkortyzolemii. Materiał i metody: Przeprowadzono jednoośrodkowe, retrospektywne badanie. W latach 2010–2015 wykonano 356 adrenalektomii laparoskopowych w Klinice Chirurgii Ogólnej i Endokrynologicznej Warszawskiego Uniwersytetu Medycznego (WUM). Hiperkortyzo­lemię stwierdzono u 50 pacjentów (14%), natomiast jawną hiperkortyzolemię u 31 pacjentów. W grupie pacjentów z hiperkortyzolemią, hiperkortyzolemię ACTH-zależną zdiagnozowano u pięciu (10%) pacjentów, natomiast ACTH-niezależną u 25 (50%) pacjentów. U jednego z pacjentów z jawną hiperkortyzolemią stwierdzono raka kory nadnerczy. U pozostałych 19 (38%) pacjentów stwierdzono subkliniczny zespół Cushinga. Dla celów niniejszego badania, porównano pacjentów z ACTH-niezależną hiperkortyzolemią (n = 25) z pacjentami z zespołem Cushinga (n = 19). Z badania zostali wykluczeni pacjenci z ACTH-zależną hiperkortyzolemią (n = 5) oraz pacjent z rakiem kory nadnerczy (n = 1). Wyniki: Pacjentów z obu grup (n = 44) poddano jednostronnej adrenalektomii przezotrzewnowej. Dobre wczesne wyniki leczenia zaob­serwowano u 42 pacjentów (93,3%). U jednego z pacjentów konieczna była dodatkowa operacja laparoskopowa z powodu krwawienia w 0. dobie pooperacyjnej. U innego pacjenta, w 22. dobie pooperacyjnej, wykryto ropień w miejscu wyciętego gruczołu nadnerczowego, który został odsączony pod kontrolą laparoskopową. W przypadku trzech pacjentów (6,8%) ze znaczną otyłością, wystąpiła przejściowa niewydolność oddechowa o różnym stopniu nasilenia. Nie zaobserwowano żadnych powikłań zakrzepowo-zatorowych. U wszystkich pacjentów z jawną hiperkortyzolemią oraz u dziewięciu pacjentów z subkliniczną hiperkortyzolemią stwierdzono wtórną niewydolność nadnerczy po operacji. Wnioski: Jednostronna laparoskopowa adrenalektomia przezotrzewnowa jest skuteczną i bezpieczną opcją leczenia pacjentów z ACTH­-niezależną hiperkortyzolemią, zarówno jawną jak i subkliniczną

Man and the hierarchy of the Christian Platonism as presented in selected poems of Edmund Spenser

714915713Studia Anglica Posnaniensi

Polyetherols from melamine cyanurate and ethylene carbobate – synthesis and application

The results of the study on the reactions of melamine cyanurate with ethylene carbonate were presented. As a result of the reactions, polyetherols containing thermostabile 1,3,5-triazine and perhyroxo-1,3,5-triazine rings in their structure were obtained. Basic physical properties such as density, viscosity, hydroxyl number, weight changes were measured. The polyetherols were applied as a polyol component to receiving of thermoresistant polyurethane foams. Some of the properties of the obtained foams were investigated. The value of the apparent density is between 51 and 71 kg/m3, compressive strength 222–356 kPa and the content of the open pores between 14–33%. Thermal resistance was also studied by means of the TGA method. It was found that oxygen index of the selected compositions is between 20–22%

Calcium variously mediates the effect of cytokinin on chlorophyll and LHCPII accumulation during greening in barley leaves and cucumber cotyledons

Abstract During greening, excised etiolated barley leaves and cucumber cotyledons that were depleted of exogenous Ca2+ by a chelating agent (ethylene glycol-bis (beta aminoethyl ether)-N,N,N`N`-tetraacetic acid, EGTA) showed ∼50% reduced chlorophyll (Chl) accumulation and ∼30% accumulation of apoprotein of the light-harvesting chlorophyll a/b-binding protein complex of photosystem II (LHCPII). The Ca2+ channel blocker lanthanum chloride (LaCl3) applied to cucumber cotyledons reduced LHCPII accumulation more than EGTA did. In both plant mate-rials, cytokinins enhanced chlorophyll accumulation by 50-60% and this effect was completely canceled by EGTA application. Hormones significantly increased LHCPII accumulation but EGTA application reduced that effect in barley leaves by ∼30% and in cucumber cotyledons by ∼80%. A similar effect was observed in LaCl3-treated cotyledons. CaCl2 application boosted chlorophyll accumulation in both plant materials. CaCl2 applied together with cytokinin reduced the hormonal effect on chlorophyll accumulation by ∼38% in barley leaves and 23% in cucumber cotyledons, but almost totally inhibited cytokinin-stimulated LHCPII accumulation. Our results indicate that calcium variously mediates the effect of cytokinin on chlorophyll and LHCPII accumulation. Cytokinin-induced enhancement of chlorophyll accumulation seems totally dependent on the exogenous pool of Ca2+, while Ca2+-dependent and Ca2+-independent pathways are involved in the hormonal effect on LHCPII accumulation. The effect of cytokinin on the increase of light-induced LHCPII accumulation appears to be sensitive to exogenously applied Ca2+, which almost totally blocked the hormonal effect. Our results give indirect evidence that the responses to cytokinin and light act on different events leading to Chl and LHCPII accumulation.</jats:p