Quantitative immunohistochemical assessment of clinically non-functioning pituitary adenomas

Introduction. Immunohistochemical staining is currently the gold standard of diagnostic and classification of pituitary adenomas. However, there are some discrepancies between immunohistochemical staining results and the clinical picture of pituitary adenomas. Pituitary adenomas with positive immunohistochemical reaction might not cause any endocrinological symptoms or changes in serum pituitary hormone levels. Such a discordance may be caused partly by clinically non-functioning pituitary adenomas (CNFPAs). The aim of our study was to establish the frequency of CNFPAs and identify their histological types using quantitative immunohistochemical assessment. Materials and methods. We enrolled in the study 72 patients with pituitary adenoma, and their medical history was evaluated retrospectively. The immunohistochemical panel of anterior pituitary hormones was introduced in all cases. The immunoreactivity index was calculated manually for each specimen. Results. 36.1% patients of the evaluated group presented as CNFPAs. Among the CNFPA patients we found 38.46% cases with positive immunohistochemical reaction for one or more anterior pituitary lobe hormones. In 23.07% of cases the adenomas were monohormonal, and in 15.38% they were plurihormonal. Conclusions. The morphometric method utilising the immunoexpression index introduced in this study provided a very precise recognition of pituitary adenoma pathology. In the case of CNFPAs the immuno-histochemical staining often reveals a positive reaction also for multiple pituitary hormones. Quantitative assessment limits the subjectivity of the examiner and allows objective results comparison, so it should become a standard in histopathological assessment of pituitary adenomas

Early reoperations in chronic subdural hematoma

Background: The recurrence rate of chronic subdural hematoma (cSDH) is high and early reoperation is often required. Aim: The aim of this study was to evaluate prognostic factors for early reoperation of chronic subdural hematomas (cSDH) treated by classical and minimally invasive approach. Materials and Methods: We retrospectively analyzed the medical history of 355 cSDH patients treated with formal craniotomy and minimally invasive burr hole craniostomy. We determined the potential predictors of early reoperations. Results: A total of 33 (9.3%) patients required early reoperation. Those patients more often underwent craniotomies instead of burr hole craniostomies (36.4% vs. 62.7%, p < 0.01) and took steroids before hospitalization (3.0% vs. 0.3%, p = 0.04) than non-reoperated patients. Patients who had surgery on the right side were less likely to be reoperated (51.9% vs. 33.3%, p = 0.04). On multivariate analysis the frontal (OR = 5.284, 95% CI: 1.293–21.76, p = 0.019) and large craniotomy (OR = 2.297, 95% CI: 1.004–5.258, p = 0.048) remained independent risk factors for early reoperation of cSDH. Conclusions: Neurosurgeons should consider the evacuation of a cSDH with help of minimally invasive burr hole craniostomy in most of the cases, as well as avoid large and frontal and craniotomies in order to prevent early reoperation of cSDH

Ethical aspect of quality of life of palliative care patients

In the paper, we attempt a semantic analysis of patient quality of life, which plays an important role in evaluating the patient’s condition and health. The issue seems to be the most important in palliative-hospice care, where doctors work with seriously or terminally ill patients. One of the aims of this branch of medicine is to improve quality of life. This may be achieved, among others, by recognizing the current problems the patient is facing pertaining to family and social relations, beliefs, views or religion. Moreover, by monitoring the behavior of patients and symptoms of their illnesses, the best therapy methods may be selected. Patient quality of life assessment may also enable comparing health care units of the same specialization and be used for the selection of the best standards of care. When discussing the broader meaning of "quality of life", we caution against equating quality of life with the value of life. The main arguments are as follows: subjective character of evaluation of quality of life and, in the future, the possibility of postulates for shortening life of poor quality of life patients when funds for their treatment are insufficient. When accepting quality of life as equal to the value of life, it may result in eliminating unprotected and helpless patients and allowing only the strong to live. Later, this may result in the discrimination of seriously and terminally ill people, even those who do not wish to shorten their lives despite experiencing burdensome symptoms and being aware of the incurable nature of their illness

The reliability of the specimens for neuropathological evaluation in pituitary adenomas treated via transphenoidal route

Introduction: There are some discrepancies between immunohistochemical staining results and clinical picture of pituitary adenomas. Such a discordance may be caused by multiple factors. The problem of securing the histopathological material during the transsphenoidal pituitary surgery and its reliability for neuropathological evaluation deserves a special attention. The surgical biopsy does not always meet the criteria required for a immunohistochemical staining and sometimes not even for the routine histopatho-logical examination. Aims: To determine the frequency of unreliable material for histopathological examination and factors influencing the reliability of histopathological specimens after surgery for pituitary adenomas. Material and methods: The hematoxylin and eosin sections were examined in detail. with a special attention to the presence of incidental findings, i.e. admixture of normal pituitary gland tissue, signs of hemorrhage, necrosis, thermal artifacts, inflammatory changes, respiratory epithelium, vessels or cholesterol granuloma. The impact of incidental findings on further immunohistochemical analysis was investigated. The relationship between the magnetic resonance imaging (MRI)- determined tumor size and the area of histopathological specimen was assessed and considered as a reliability parameter. Results: The unreliable material was estimated at the level of 11.8%. It was assessed that hemorrhages, neurohypophysis, necrosis and quantity of collected histopathological material had the statistically sig-nificant impact on the reliability of the histopathological material. The statistical analysis did not show any relation between the reliability of the histopathological material and the MRI-determined volume of the tumor. Conclusions: The presence of some additional tissue elements and artifacts in the histopathological specimen makes the immunohistochemical evaluation difficult or even impossible. However, this problem is related to a relatively low percentage of cases, mainly small tumors

Mikrostruktura wygrzewanych pokryć cynkowych typu galfan na podłożu stalowym

The commercially available Galfan coating containing 5-7wt.% of Al deposited on the low carbon steel substrate by hot dipping has been examined with respect to the microstructure of the coating/substrate interface area. The application of several experimental techniques (SEM/EDS, XRD, TEM/AEM/EDS/ED) allowed demonstrating the two-phase structure of the alloy coating in non-treated, commercially available Galfan samples: Zn-rich pre-eutectoid phase grains are surrounded by lamellar eutectics of -Al and -Zn. The transition layer between the alloy coating and steel substrate with the considerably higher Al content (SEM/EDS, TEM/EDS) has been found in both non-treated and annealed samples (600oC/5 minutes). Only the monoclinic FeAl3Znx phase however was revealed in the annealed sample (TEM/electron diffraction) remaining uncertain the presence of the orthorhombic Fe2Al5Znx phase, reported by several authors