Efficacy and complications of neurosurgical treatment of acromegaly

The aim of the study was to evaluate the frequency of occurrence of pituitary failure following neurosurgery and the efficacy of transsphenoidal tumour resection in acromegalic patients. We retrospectively evaluated 85 patients (60 female and 25 male), of mean age 43.9 ± 13.2 years, treated by transsphenoidal neurosurgery. Macroadenoma and microadenoma of pituitary were found in 66 (77.6%) and 19 (22.4%) of these patients, respectively. Criteria of cure following neurosurgery were: basal GH < 2.5 μg/l, GH at 120 min in OGTT < 1.0 μg/l and serum concentration of IGF-1 within normal ranges for age and sex. After surgery 32 patients (37.6%) were cured and 53 patients (62.4%) required somatostatin analogue treatment. In patients cured by surgery, lower levels of basal GH (P < 0.05), IGF-1 (P < 0.001), GH at 120 min in OGTT and smaller size of pituitary tumour (P < 0.05) were found at diagnosis, as compared to patients in whom surgery was unsuccessful. Significant correlation between basal serum level of GH at diagnosis and size of pituitary tumour was found (P < 0.001). Invasive tumours were found in 45 of 53 (84.9%) patients not cured and in only 8 of 32 (25.0%) patients cured (P < 0.001). Impaired function of pituitary anterior lobe after surgery was observed in 30% and 4% of patients with macro- and microadenoma, respectively (P < 0.05). The efficacy of neurosurgery is affected by concentration of basal serum GH and IGF-1, GH at 120 min in OGTT, tumour size and invasiveness. Hypopituitarism after surgery is more frequent in patients with macroadenoma. Pituitary insufficiency, as a consequence of surgery, was found in 21% of patients with normal pituitary function prior to operation

Adrenocortical oncocytic carcinoma with recurrent metastases: a case report and review of the literature

<p>Abstract</p> <p>Background</p> <p>Adrenal cortex oncocytic carcinoma (AOC) represents an exceptional pathological entity, since only 22 cases have been documented in the literature so far.</p> <p>Case presentation</p> <p>Our case concerns a 54-year-old man with past medical history of right adrenal excision with partial hepatectomy, due to an adrenocortical carcinoma. The patient was admitted in our hospital to undergo surgical resection of a left lung mass newly detected on chest Computed Tomography scan. The histological and immunohistochemical study revealed a metastatic AOC. Although the patient was given mitotane orally in adjuvant basis, he experienced relapse with multiple metastases in the thorax twice in the next year and was treated with consecutive resections. Two and a half years later, a right hip joint metastasis was found and concurrent chemoradiation was given. Finally, approximately five years post disease onset, the patient died due to massive metastatic disease. A thorough review of AOC and particularly all diagnostic difficulties are extensively stated.</p> <p>Conclusion</p> <p>Histological classification of adrenocortical oncocytic tumours has been so far a matter of debate. There is no officially established histological scoring system regarding these rare neoplasms and therefore many diagnostic difficulties occur for pathologists.</p

Enhanced electron density and plasma dynamics on nanosecond time scales in Helium plasma discharges

Enhanced electron density and plasma dynamics are investigated for Helium discharges on nanosecond timescales with Particle-In-Cell simulations. The plasma discharges are driven between planar electrodes with DC, single pulses, and dynamic frequency square waves. It is assumed that the DC and pulse discharges operate in the glow regime. It is shown that as pressure increases with narrowing gap distance, the peak transient electron density rises. This is in contrast to what is observed under a constant pressure-gap (pd) and electric field reduced by neutral density (E/N) values at saturation time. It is shown that although the pd and E/N values and therefore the breakdown voltage are the same across cases, the plasma kinetics are different due to a change in the energy relaxation lengths. The cross-points between the sheath length and energy relaxation length move to higher electron energies at higher pressure. This facilitates high-energy electrons to undergo inelastic collisions and produces different rates of increasing electron density and temperature at nanosecond timescales. Moreover, using a plasma frequency-dependent square wave, the electron density can be increased to 50 times higher over that of the DC case because of a reverse electric field. The electron kinetics on nanosecond time scales can be exploited for high electron density and fast ionization applications