Pheochromocytoma diagnosed during pregnancy: lessons learned from a series of ten patients

BACKGROUND: Pheochromocytoma (PHEO) in pregnancy is a life-threatening condition. Its management is challenging with regards to the timing and type of surgery. METHODS: A retrospective review of the management of ten patients diagnosed with pheochromocytoma during pregnancy was performed. Data were collected on the initial diagnostic workup, symptoms, treatment, and follow-up. RESULTS: PHEO was diagnosed in ten patients who were between the 10th and the 29th weeks of pregnancy. Six patients had none to mild symptoms, while four had complications of paroxysmal hypertension. Imaging investigations consisted of MRI, CT scan and ultrasounds. All had urinary metanephrines, measured as part of their workup. Three patients had MEN 2A, one VHL syndrome, one suspected SDH mutation. All patients were treated either with α/β blockers or calcium channel blockers to stabilize their clinical conditions. Seven patients underwent a laparoscopic adrenalectomy before delivery. Three out of these seven patients had a bilateral PHEO and underwent a unilateral adrenalectomy of the larger tumor during pregnancy, followed by a planned cesarean section and a subsequent contralateral adrenalectomy within a few months after delivery. Three patients had emergency surgery for maternal or fetal complications, with C-section followed by concomitant or delayed adrenalectomy. All newborns from the group of planned surgery were healthy, while two out three newborns within the emergency surgery group died shortly after delivery secondary to cardiac and pulmonary complications. CONCLUSIONS: PHEO in pregnancy is a rare condition. Maternal and fetal prognosis improved over the last decades, but still lethal consequences may be present if misdiagnosed or mistreated. A thorough multidisciplinary team approach should be tailored on an individual basis to better manage the pathology. Unilateral adrenalectomy in a pregnant patient with bilateral PHEO may be an option to avoid the risk of adrenal insufficiency after bilateral adrenalectomy

Genetic aspects of potato resistance to phytophthorosis

Phytophthora infestans Mont. de Bary is the main oomycete pathogen of cultivated crops in the family Solanaceae, especially potato (Solanum tuberosum). Because potato is the fourth most cultivated crop worldwide, its annual losses from late blight are tremendous. Studies of the basic mechanisms of interaction between potato and the late blight pathogen not only expand the fundamental knowledge in this area, but also open up new possibilities for regulating these interactions in order to increase resistance to the pathogen. The interaction of potato and the late blight pathogen can be considered from a genetic point of view, and it is interesting to consider both the response of the potato to the colonization process by P. infestans and the change in gene activity in late blight during plant infection. We can also investigate this process by changing the profile of secondary metabolites of the host and the pathogen. In addition to fundamental work in this area, applied work in the form of the development of new preparations for protecting potatoes is of no less importance. This review briefly describes the main stages of studies of potato resistance to late blight, starting almost from the first works. Much attention is paid to key works on changing the profile of secondary metabolites phytoalexins. A separate section is devoted to the description of both qualitative and quantitative characteristics of potato resistance to the late blight pathogen: their contribution to overall resistance, gene mapping, and regulation capabilities. Both types of traits are important for potato breeding: quantitative resistance due to R-genes is quickly overcome by the pathogen, while quantitative trait loci make it possible to create varieties with almost absolute resistance due to the pyramid of effective genes. The latest approaches in molecular biology make it possible to study translatomic profiles, which makes it possible to look at the interaction of potatoes and the late blight pathogen at a different angle. It has been shown that the process of potato colonization affects not only the activity of various genes and the profile of secondary metabolites: proteins­markers of the response to infection from potatoes have also been identified: they are pathogen-bound proteins and plastid carbonic anhydrase. On the part of P. infestans, fungal cellulose synthase proteins and haustorium-specific membrane protein were markers of infection. Thus, the review contains information on the most relevant complex studies of the genetic mechanisms of potato resistance to late blight

Ultrasound Features of Liver Damage in Patients with Co-infection of Tuberculosis/ HIV Combined with Viral Hepatitis B and / or C

The objective of the research was to investigate the state of the liver parenchyma and its blood flow based on echogenic characteristics during ultrasound examination in patients with co-infection of tuberculosis / HIV in combination with viral hepatitis B and C.Materials and methods. Ultrasonic features of liver injury were studied in 58 patients with co-infection of with tuberculosis (TB)/HIV (FDTB) in combination with viral hepatitis B and/or C (VH). Patients were examined before the start of TB chemotherapy. The ultrasonography results were compared with the indications of 58 co-infected TB/HIV patients without viral hepatitis at the beginning and during of anti-TB treatment (after 2 months of intensive phase (IP)).Results. Ultrasound signs of liver damage manifested in hepatomegaly, decreased or increased parenchymal echogenicity and portal blood flow parameters were observed in more than 50% of patients with concomitant viral hepatitis. In 68.6% of cases these violations were asymptomatic and without an increase in ALT, AST. At the beginning of TB treatment ultrasound signs of liver damage were rare in patients without viral hepatitis. After the intensive phase of chemotherapy ultrasound signs of liver disease were observed in 18.9 % of patients with increased echogenicity of the liver parenchyma and blood flow. Significantly increased rates of ALT, AST were observed in 10 out of 15 (66.7 %) patients with increased hepatic blood flow parameters. Severe hepatotoxic reactions were noticed in 13.3% of cases.Conclusions. Ultrasonography is addition to laboratory methods which diagnose changes in the state of the liver and allocate the risk group of the increased adverse reactions to anti-tuberculosis drugs.

Вірусна персистенція в атеросклеротичних бляшках пацієнтів з ішемічним інсультом і транзиторною ішемічною атакою після каротидної ендартеректомії

Objective — to assess the frequency of detection of embologic and nonembologenous atherosclerotic plaques, moderate stenosis (50 — 69 %) and severe degree (79 — 99 %) in patients with ischemic stroke and transient ischemic attack with progression of atherosclerosis and the presence of herpetic infection of the carotid endothelium.Methods and subjects.103 patients with IS/TIA after carotid endothelium were examined: 67 males of 66.1 ± 1.4 (42 — 82 y/o), 36 females  63.0 ± 1.3 (44 — 81 y/o). Mean age was 65.1 ± 0.9. We examined the width of IMC,  presence of the atherosclerotic plaques, their constitution (hypoechoic, echoic), structure, localization, spread, shape. Using the methods of transfection and polymerase chain reaction in the atherosclerotic plaque and blood of patients, the presence of HSV1, 2, EBV, CMV, HHV6 viruses was established.Results. In 32 patients in atherosclerotic plaque and blood, prevalence of CMV and its viral atherosclerosis associations (CMV/HSV1, CMV/HSV2) was revealed, in 23 — HHV6 isolated and in atherosclerosis associations (HSV1/HHV6, HHV6/HSV1/HSV2).Conclusions. In the case of persistence of CMV and atherosclerosis, CMV/HSV1 and CMV/HSV2 significantly increase the risk of developing hypoechoic embolic atherosclerotic plaques in the internal carotid artery. In the case of persistence of HHV6, the association of HSV1/HHV6 and HSV1/2/HHV6 in atherosclerotic plaques in the internal carotid arteries, the relative risk of developing severe stenosis in patients with symptomatic stenosis is significantly increased, which is an indication for carotid endothelium. The results obtained testify to the need for periodic ultrasound scan to exclude stenosis of the internal carotid artery in patients with cerebrovascular disease.Цель — оценить частоту выявления эмбологенных и неэмбологенных атеросклеротических бляшек, стенозов среднего (50 — 69 %) и тяжелой степени (79 — 99 %) у пациентов с ишемическим инсультом и транзиторной ишемической атакой с прогрессированием атеросклероза и наличием герпетической инфекции в анамнезе после каротидной эндартерэктомии.Материалы и методы. Обследованы 103 пациента после каротидной эндартерэктомии, среди них были 67 мужчин (средний возраст — (66,1 ± 1,4) года (42 — 82 года)) и 36 женщин (средний возраст — (63,0 ± 1,3) года (44 — 81 год). Определяли толщину комплекса интима — медиа, наличие атеросклеротической бляшки, ее консистенцию (гипоэхогенная, эхогенная), структуру, форму, локализацию, распространение. С помощью методов трансфекции и полимеразной цепной реакции в атеросклеротической бляшке и крови пациентов устанавливали наличие вирусов HSV1, 2, ЕВV, CMV, HHV6.Результаты. У 32 больных в атеросклеротической бляшке и крови выявлено преобладание CMV и его вирусных ассоциаций (CMV/HSV1, CMV/HSV2), у 23 — HHV6 изолированно и в ассоциации (HSV1/HHV6, HHV6/HSV1/HSV2).Выводы. В случае персистенции CMV и ассоциации CMV/HSV1 и CMV/HSV2 статистически значимо повышается риск развития гипоэхогенных эмбологенных атеросклеротических бляшек во внутренней сонной артерии. В случае персистенции HHV6, ассоциации HSV1/HHV6 и HSV1/2/HHV6 в атеросклеротических бляшках во внутренней сонной артерии статистически значимо повышается относительный риск развития выраженного стеноза у больных с симптоматическими стенозами, что является показанием к проведению каротидной эндартерэктомии. Полученные результаты свидетельствуют о необходимости периодического проведения ультразвуковой допплерографии для исключения стенозирования внутренней сонной артерии у больных цереброваскулярными заболеваниями.Мета — оцінити частоту виявлення ембологенних та неембологенних атеросклеротичних бляшок, стенозів середнього (50 — 69 %) і тяжкого ступеня (79 — 99 %) у пацієнтів з ішемічним інсультом і транзиторною ішемічною атакою з прогресуванням атеросклерозу та наявністю герпетичної інфекції в анамнезі після каротидної ендартеректомії.Матеріали і методи. Обстежено 103 пацієнта після каротидної ендартеректомії, серед них було 67 чоловіків (середній вік — (66,1 ± 1,4) року (42 — 82 роки)) і 36 жінок (середній вік — (63,0 ± 1,3) року (44 — 81 рік). Визначали товщину комплексу інтима — медіа, наявність атеросклеротичної бляшки, її консистенцію (гіпоехогенна, ехогенна), структуру, форму, локалізацію, поширення. За допомогою трансфекції та полімеразної ланцюгової реакції в атеросклеротичній бляшці та крові пацієнтів установлювали наявність вірусів HSV1, 2, ЕВV, CMV, HHV6.Результати. У 32 хворих в атеросклеротичній бляшці та крові виявлено переважання CMV та його вірусних асоціацій (CMV/HSV1, CMV/HSV2), у 23 — HHV6 ізольовано та в асоціації (HSV1/HHV6, HHV6/HSV1/HSV2).Висновки. У разі персистенції CMV та асоціації CMV/HSV1 і CMV/HSV2 статистично значущо підвищується ризик розвитку гіпоехогенних ембологенних атеросклеротичних бляшок у внутрішній сонній артерії. У разі персистенції HHV6, асоціації HSV1/HHV6 та HSV1/ 2/HHV6 в атеросклеротичних бляшках у внутрішній сонній артерії статистично значущо підвищується відносний ризик розвитку вираженого стенозу в хворих із симптоматичними стенозами, що є показанням до проведення каротидної ендартеректомії. Отримані результати свідчать про необхідність періодичного проведення ультразвукової допплерографії для заперечення стенозування внутрішньої сонної артерії у хворих на цереброваскулярні захворювання

BROWN TUMOR OF BONE AS INITIAL MANIFESTATION OF PRIMARY HYPERPARATHYROIDISM

Primary hyperparathyroidism (PHPT) is characterized with primary hyperproduction of parathyroid hormone (PTH) by affected parathyroid glands and with a corresponding increase in concentration of extracellular calcium. Long-term development of PHPT through decades leads to calcium-related symptoms and distinct changes in the skeleton, kidneys, digestive tract and other organs. In the clinical picture of PHPT, granulomatous pseudo-tumors in bones are observed as a rare manifestation of the disease – these lesions, which could imitate Malignancy, are called «brown tumors». The present publication that goes into details about a clinical diagnosis, in which a brown tumor became the primary manifestation of PHPT, may be useful for physicians across various fields