Clinical and Surgical Outcomes of Endoscopic Endonasal Approach for Giant Pituitary Adenomas: Analysis of Predictive Factors.

BACKGROUND: Giant pituitary adenomas (GPAs) are defined as tumors with ≥40 mm in any maximum diameter, and these tend to invade multiple intracranial compartments. Hence, treatment remains a surgical challenge. OBJECTIVE: To describe the clinical and surgical outcomes of the endoscopic endonasal approach (EEA) for GPA in a pituitary referral center in Latin America and to analyze associated predictive factors. METHODS: 37 patients with histologically-confirmed GPA treated solely through the EEA between a 2-year period were included. Preoperative and postoperative clinical and neuroimaging findings; surgical morbidity and mortality; and binary logistic regression analysis to assess predictive factors were analyzed. RESULTS: Preoperative visual impairment prevalence was 97.3%. Mean tumor volume was 32 cc and gross total resection rate was 40.5%. Favorable visual acuity and visual fields outcome rate was 75% and 82.9%, respectively. In the multivariate analysis, bilateral cavernous sinus invasion (P = 0.018) and postoperative cerebrospinal fluid (CSF) leak (P = 0.036) were associated with an unfavorable visual acuity outcome, while radiation therapy (P = 0.035) was for visual fields. Similarly, intraoperative CSF leak was a predictive factor for postoperative CSF leak (10.8%) (P = 0.042) and vascular injury (13.5%) (P = 0.048). CONCLUSIONS: In this first Mexican clinical series, we demonstrated that the EEA is a safe and effective technique for GPA, although early diagnosis and prompt intervention may promote further visual function preservation without significant endocrine morbidity.

Impacts of workplace verbal aggression classified via text mining on workers' mental health.

BACKGROUND: Exposure to workplace aggression adversely affects workers' health; however, little is known regarding the impact of specific types of verbal content. AIMS: We aimed to examine the relationship between exposure to several types of aggressive words at work and the victim's depressive symptoms and sleep disturbance using text mining. METHODS: We conducted a longitudinal survey with 800 workers in wholesale and retail companies; of which, 500 responded to the follow-up survey. The Centre for Epidemiologic Studies-Depression Scale and Pittsburgh Sleep Quality Index were filled out by the participants, and their responses were analysed by logistic regression to evaluate the risk of depression or sleep problems. We collected exact aggressive words encountered at work over the past year as a dependent variable and classified it into four types using text mining, such as words criticizing one's performance. RESULTS: The follow-up rate was 63%. Exposure to words threatening one's life showed a significant relationship with the risk of depression (odds ratio [OR] = 13.94, 95% confidence interval [CI] = 1.76-110.56). The exposure to words criticizing one's job performance is significantly related to the risk of sleep disturbance (OR = 5.56, 95% CI = 2.08-14.88). CONCLUSIONS: These findings suggest that different contents of verbal aggression can have different impacts on workers' health. This indicates that not only overtly threatening and abusive language but also words related to one's performance can be a risk factor for workers, depending on how they are delivered. To mitigate the adverse effects, promoting effective communication and cultivating psychological detachment from work may be beneficial.

Síndrome 3-M: descripción clínica-radiológica: caso clínico / 3-M syndrome: clinical and radiological description. Case report

Introducción: El síndrome 3M combina retardo de crecimiento prenatal y postnatal severo, dismorfias faciales (semeja facies "melancólica") y anomalías radiológicas. Es una enfermedad infrecuente de la que hasta el momento se han descrito alrededor de 200 casos. "3M" se refiere a las iniciales de los tres autores que describieron este síndrome. Los rasgos faciales característicos son: cabeza relativamente grande, dolicocefalia, abombamiento frontal, cara triangular, mentón prominente, nariz antevertida, labios gruesos, cejas gruesas, surco nasolabial largo e hipoplasia de tercio medio de cara. Los hallazgos radiológicos, que van apareciendo con la edad son costillas y huesos largos finos y delgados, y cuerpos vertebrales altos. El síndrome 3M se transmite como un rasgo autosómico recesivo y es genéticamente heterogéneo. Objetivo: Descripción del caso clínico de una nina actualmente de 10 años de edad en el que se confirmó este síndrome. Caso clínico: Nina referida a Genética a los 15 meses de vida, por talla baja severa, dismorfias y malformaciones. Su seguimiento clínico y radiológico permitió plantear y confirmar este diagnóstico. Conclusión: En ocasiones sólo el seguimiento longitudinal de pacientes con talla baja severa permite que se evidencien alteraciones sugerentes de un diagnóstico específico. La certificación del diagnóstico favorece un adecuado manejo clínico y consejería genética a los padres.

Introduction: 3M syndrome combines severe prenatal and postnatal growth delay, facial dysmorphism (resembles melancholy facies) and radiological abnormalities. It is a rare disease with 200 cases reported so far. "3M" refers to the initials of the three authors who first described this syndrome. The characteristic facial features are: relatively large head, dolichocephaly, frontal bossing, a triangular face, pointed chin, upturned nose, full lips, full eyebrows, long philtrum and hypoplastic midface. radiological findings which appear with age, include slender long bones and ribs and tall vertebral bodies. 3M syndrome is transmitted as an autosomal recessive trait and is genetically heterogeneous. Objective: Report the clinical case of a girl, now 10 years of age, diagnosed with the syndrome. Case report: An infant girl, 15 months old, was referred to Genetics Clinic due to severe short stature, dysmorphic features and malformations. Her clinical and radiological follow-up led to propose and confirm this diagnosis. Conclusion: Sometimes only longitudinal monitoring of patients with severe short stature evidence abnormalities suggesting a specific diagnosis. The right diagnosis results in suitable clinical care and genetic counseling to parents.

The relationship between suicide and five climate issues in a large-scale and long term study in Japan / La relación entre el suicidio y cinco problemas climáticos en un estudio a gran escala y a largo plazo en Japón

OBJECTIVE: Suicide rates in Japan were high in 1998 and have remained high since then. Many researchers have discussed the current state of suicide in Japan and the world; however, there are various opinions about the relationship between suicide and climate. SUBJECTS AND METHOD: In the present study, we report on long-term data of suicide and examine five climatic issues in Japan as a whole and in 10 selected prefectures: the five with the highest suicide rates in 2006 (Akita, Iwate, Shimane, Yamagata and Miyazaki Prefectures) and the five with the lowest (Nara, Tokushima, Okayama, Kanagawa and Kyoto Prefectures). RESULTS: Annual age-adjusted suicide rates were found to have a significant inverse correlation with annual mean air temperature in the five prefectures with the highest suicide rates and in the three prefectures with the lowest suicide rates among women. Annual age-adjusted suicide rates were significantly correlated with annual mean relative humidity in the three prefectures with the highest suicide rates among women and with the annual total sunshine duration in the three prefectures with the highest suicide rates among women. CONCLUSION: It is important that these associations between suicide and climatic factors be discussed further from various viewpoints, including those of many researchers and relevant organizations.

OBJETIVO: Las tasas de suicidio en Japón eran altas en 1998, y han permanecido altas desde entonces. Muchos investigadores han discutido el estado actual del suicidio en Japón y el mundo, Como parte de esa discusión, existen diversas opiniones acerca de la relación entre el suicidio y el clima. SUJETOS Y MÉTODO: El presente estudio presente constituye un reporte de datos a largo plazo sobre el suicidio y examina cinco problemas climáticos del Japón en su conjunto así como en 10 prefecturas seleccionadas: las cinco con las más altas tasas de suicidio en 2006 (las prefecturas de Akita, Iwate, Shimane, Yamagata y Miyazaki) y las cinco con las tasas más bajas (Nara, Tokushima, Okayama, Kanagawa y Kyoto). RESULTADOS: Se halló que las tasas de suicidio ajustadas por edad anualmente presentaban una correlación inversa significativa con la temperatura promedio anual del aire en las cinco prefecturas con las tasas de suicidio más altas y en las tres prefecturas con las tasas de suicidio más bajas entre las mujeres. Las tasas de suicidio anual ajustadas por edad guardaban una correlación significativa con la humedad relativa promedio anual en las tres prefecturas con las tasas del suicidio más altas entre las mujeres y con la duración total anual de sol en las tres prefecturas con las tasas del suicidio más altas entre las mujeres. CONCLUSIÓN: Es importante continuar analizando estas asociaciones entre el suicidio y los factores climáticos desde varios puntos de vista, incluyendo aquéllos de muchos investigadores y organizaciones pertinentes.