Thyroid hormone metabolism in pediatric cardiac patients treated by continuous povidone-iodine irrigation for deep sternal wound infection.

OBJECTIVE: The purpose of this study was to assess the influence of povidone-iodine mediastinal irrigation used for the treatment of deep sternal wound infection (DSWI) on thyroid function. METHODS: Thyroid function was studied in 18 pediatric cardiac patients treated with continuous povidone-iodine irrigation for DSWI. The median age of patients was 8 months (18 days-5.3 years). Serum concentrations of total triiodothyronine (TT3), total thyroxine (TT4), free triiodothyronine (FT3), free thyroxine (FT4), thyroid-stimulating hormone (TSH), reverse triiodothyronine (rT3) and thyroxine-binding globulin (TBG) were measured at three time points: (a) prior to mediastinal reexploration (before povidone-iodine exposure); (b) immediately after discontinuation of povidone-iodine irrigation; (c) 2 weeks after discontinuation of mediastinal irrigation. Urinary iodine excretion was examined on the last day of povidone-iodine exposure. RESULTS: Prior to the mediastinal reexploration, the median TT3 and TT4 levels were below the normal range, then increased significantly to concentrations within the normal range. The median serum FT3 levels were within the normal range throughout the observation period, though a significant increase of FT3 levels was observed after discontinuation of irrigation. The median serum FT4 concentrations were within the normal range prior to irrigation and did not change significantly. The median rT3 levels were within the normal range, close to upper normal limit. The median TBG levels were within the normal range throughout the observation period, though a significant increase of TBG levels was observed during the period of mediastinal irrigation. The median TSH level was within the normal range prior to mediastinal irrigation and did not change significantly. Urinary iodine concentrations in infants with povidone-iodine irrigation were significantly higher 6700 microg/l (range, 1600-15000 microg/l) than in the group of 53 healthy infants 200 microg/l (range, 20-780 microg/l, P<0,001). CONCLUSIONS: Our data showed that the use of povidone-iodine irrigation in the patients with DSWI has not lead to any significant alteration in thyroid function within the study period.

[Radical and selective removal of hyperfunctional hypophyseal adenomas using a transsphenoidal approach]. / Moznosti radikality a selektivity odstránenia hyperfunkcných adenómov hypofýzy transsfenoidálnym prístupom.

The authors investigated the possibility of radical removal of adenomas of the pituitary (AH), while preserving remnants of pituitary tissue, in 23 patients with primarily operated hyperfunctional AH producing PRL (14 patients), STH (8 patients) and ACTH (1 patient). Normalization of the pathologically elevated hormone level was achieved by the transsphenoid operation without supplementary treatment in 13 of 16 patients with defined and in 3 of 7 patients with invasively growing AH (PRL in 10, STH in 5 and ACTH in one patient), i.e. in 69.5% Identification and preservation of remnants of the pituitary was possible in 20 patients (in all 16 with defined and in 4 of 7 with invasive AH); 17 of them (73.9%) do not need hormonal substitution. Radical and at the same time selective adenomectomy was achieved in 14 patients (60.9%) incl. three patients with invasively growing tumours. The improved activity of the pituitary is manifested clinically after successful operation in particular in young patients by improved gonadal function.

Decreased apolipoprotein levels in women with hyperprolactinemia related to increased estradiol level: effect of hepatic lesion?

In 3 groups of women (1. with pathological hyperprolactinemia, but low estradiol level--19 patients; 2. with pathological hyperprolactinemia, but high estradiol level--17 patients; 3. 16 healthy control women) the level of prolactin, estradiol, cortisol, total cholesterol, triglycerides and apolipoproteins A-I, A-II and B in serum was estimated together with routine clinical examination. In both hyperprolactinemic groups a significant decrease of apolipoprotein A-I and A-II was found, while in the group with high estradiol also a significant decrease of apolipoprotein B was observed. It is suggested that the increased level of prolactin results in an impairment of apolipoprotein biosynthesis and, in addition, in a group with high estradiol level also a lesion of liver function might occur which results in its decreased degradation.