Pulsatility of glucocorticoid hormones in pregnancy: Changes with gestation and obesity.

OBJECTIVE: Hypothalamic-pituitary-adrenal axis (HPA) activity is decreased in obese pregnancy and associates with increased foetal size. Pulsatile release of glucocorticoid hormones regulates their action in target tissues. Glucocorticoids are essential for normal foetal growth, but little is known about glucocorticoid pulsatility in pregnancy. We aimed to investigate the ultradian rhythm of glucocorticoid secretion during obese and lean pregnancy and nonpregnancy. DESIGN: Serum cortisol, cortisone, corticosterone and 11-dehydrocorticosterone were measured by LC-MS/MS from samples obtained at 10-minute intervals between 08.00-11.00 hours and 16.00-19.00 hours, from 8 lean (BMI <25 kg/m2 ) and 7 obese (BMI > 35 kg/m2 ) pregnant women between 16-24 weeks gestation and again at 30-36 weeks), and nonpregnant controls (lean n = 3, obese n = 4) during the luteal phase of their menstrual cycle. Interstitial fluid cortisol was measured by ELISA, from samples obtained using a portable microdialysis and automated collection device at 20-minute intervals over 24 hours. RESULTS: Serum cortisol AUC, highest peak and lowest trough increased significantly with gestation in lean and obese pregnant compared with nonpregnant subjects. Pulsatility of cortisol was detected in interstitial fluid. In pregnant subjects, interstitial fluid pulse frequency was significantly lower with advancing gestation in obese, but not in lean. CONCLUSIONS: We demonstrate cortisol pulsatility in interstitial fluid. Pulse frequency is altered with increased gestation and BMI. This may be a novel mechanism to explain decreased HPA activity in obese pregnancy.

[Tracheotomy as a bedside procedure in the Intensive Care Unit: is it safe?]. / Czy tracheotomia wykonywana na oddziale Intensywnej Opieki Medycznej (IOM) jest procedura bezpieczna?

BACKGROUND: The authors would like to present the problem of performing bedside tracheotomy in the Intensive Care Unit. The tracheotomy have been done in the highly specific group in poor or fatal general condition, so the complication rate according to the general status of the patients is discussed. MATERIAL: 92 patients were treated with tracheotomy between I 2003-XII 2005 and in this number 13 complications occurred. The general status of the patients (shock, stroke, sepsis, pneumonia, hypoalbuminemy) in the time of procedure was taken into consideration. RESULTS: In early complications dominated the bleeding--in 7 patients (7.9%) and wound infections--in 4 patients. Tracheal strictures, the only late complication found in our group, were stated during the follow up period in 2 patients (1.1%). The time of performing the tracheotomy i.e. day of the intubation (range from 0-13; mean--5.7) and day of the decaniulation (range from 3-65; mean--16) were analyzed. CONCLUSION: Tracheotomy performed in the Intensive Care Unit as a bedside procedure is safe, quick and effective. Complication rate in the group of patients in poor general condition is comparable both to the average population and to the percutaneous technique.

Pigmented villonodular synovitis of the temporomandibular joint: differential diagnosis of the parotid mass.

Pigmented villonodular synovitis (PVNS) is a benign, locally invasive lesion of the synovium of joints, bursae, and tendon sheaths. Its occurrence in the temporomandibular joint is very rare. We report two cases of PVNS involving temporomandibular joint (TMJ), not only for its unusual location but also to underscore how its clinical presentation can mimic a parotid mass. Treatment requires total TMJ synovectomy whereas multiple recurrences or aggressive clinical behavior may require postoperative radiation therapy following complete surgical extirpation.