New evidence of prefrontal lobotomy in the last months of the illness of Eva Perón.

OBJECTIVE: To give validity to the claim that Eva Perón underwent a prefrontal lobotomy and/or another neurosurgical procedure. METHODS: 1) Press interviews given by Dr. George Udvarhelyi, who passed away in 2010, were read and his statements were crosschecked with excerpts of his memoirs; 2) Searched for other oral and written evidence in Argentina; 3) Reviewed radiological evidence and recent revelations about her illness and death; and 4) Carried out historic review of prefrontal lobotomy as an accepted and established surgical treatment during the relevant time period and place. RESULTS: Udvarhelyi's assertion in a press interview that a prefrontal lobotomy was performed on Eva Perón is consistent with the history he penned in his memoirs. Interviews with individuals close to Eva conducted by historians, revealed a clinical picture compatible with side effects from such an operation. Comments from surgeon Dr. Ricardo Finochietto, leader of the group of physicians involved in Eva's medical care, provide further support that a neurosurgical procedure was performed. President Perón's orders and instructions to the medical team also support this allegation. Review of skull radiographs show findings compatible with burr holes. Photographs of the patient at the end of her illness show indentation at the coronal level. The alleged procedure was cutting edge of surgery in 1952. The Argentine neurosurgical establishment was up to par in psychosurgical developments and there were neurosurgeons close to Perón that could have performed the procedure in those circumstances. CONCLUSIONS: Evidence was found that gives validity to Dr. George Udvarhelyi's claim that Eva Perón underwent a neurosurgical prefrontal lobotomy in Buenos Aires, Argentina. This was done for treatment of pain, anxiety, and agitation secondary to uterine metastatic cancer before her death in 1952. Neurosurgeon Dr. James L. Poppen appears to have been involved in the case.

Labeling index in pituitary adenomas evaluated by means of MIB-1: is there a prognostic role? A critical review.

OBJECTIVE: The present article presents an overview of the literature, and analyses the methods and the primary questions related to assessment of proliferation index using the Ki-67/MIB-1 labeling index in pituitary adenomas. Although atypical adenomas are characterized by their atypical morphological features by an elevated mitotic index, a Ki-67 (MIB-1) labeling index greater than 3% and extensive nuclear staining for p53, use of the proliferation index (LI) of pituitary adenomas in assessing the degree of tumor aggressiveness is a controversial topic in the literature, and there are disparate results involving many studies. METHODS: A review of literature was carried out to correlate the role of Ki-67 LI and its correlation with clinical findings, tumor size, invasiveness, recurrence, adenoma subtype, adenoma doubling time, and pituitary carcinomas is addressed. RESULTS: The prognosis cannot be predicted on the basis of the Ki-67 LI alone. Although there is no direct relation between Ki-67 LI and some of these variables and controversial data were found regarding some topics, our review justify the use of Ki-67 in the analysis of pituitary adenomas as an additional information for clinical decision. CONCLUSION: Although assessment of proliferative may be helpful in predicting subsequent tumor recurrence or invasiveness, there are many other important and as yet unidentified factors pituitary tumors. It is clear that further research is needed to clarify these molecular mechanisms to predict those with a potentially poor clinical outcome.

The implications of microsurgical anatomy for surgical approaches to the sellar region.

The knowledge of the normal anatomy and variations regarding the management of tumors of the sellar region is paramount to perform safe surgical procedures. The sellar region is located in the center of the middle cranial fossa; it contains complex anatomical structures, and is the site of various pathological processes: tumor, vascular, developmental, and neuroendocrine. We review the microsurgical anatomy (microscopic and endoscopic) of this region and discuss the surgical nuances regarding this topic, based on anatomical concepts.