Pituitary abscess presenting two years after the diagnosis of a pituitary lesion in a patient with panhypopituitarism.

Pituitary abscess is a rare condition. Here, we present the case of a young male patient who was initially found to have a pituitary lesion following the diagnosis of panhypopituitarism. Two years later, he presented with severe headache and was subsequently diagnosed intraoperatively with pituitary abscess. At a follow-up of 6 years after surgery, the patient was continuing to do very well. We discuss the differential diagnosis and demonstrate the evolution of the pituitary lesion on magnetic resonance imaging at four different time points: at the time of the detection of the initial lesion; two years later at the time of the diagnosis of the pituitary abscess; at 7 weeks post operatively; and finally after six years from the pituitary surgery.

Quality of life in epilepsy at Jordan University Hospital.

OBJECTIVE: To study the quality of life (QOL) and psychiatric symptoms in epilepsy patients at the Jordan University Hospital (JUH), and to compare these findings with those from Middle Eastern and Western literature. METHODS: Fifty epilepsy patients, aged 18 years, or older, attending the Neurology Clinic at Jordan University Hospital, Amman, Jordan over a 6-month-period from March to September 2009, were requested to complete a questionnaire on QOL in epilepsy, as well as a neuropsychiatric inventory, both translated into Arabic. RESULTS: The patients' mean age was 37.6 years, with 26 males, and 24 females. Only 2 patients were divorced and 3 lost their job due to epilepsy. During the year prior to the study, 40% of patients had less than one attack/month and 32% were seizure-free. Two-thirds of patients had tonic-clonic seizures. Most (84%) did not sustain injuries due to the seizures. Approximately 3/4 of patients (73.4%) stated that their seizures were very well controlled with antiepileptic drugs, which did not lead to major side effects. Forty-two patients (84%) did not have any restriction of daily activities due to epilepsy and substantial proportions (range 52-88%) did not perceive any impact of epilepsy on aspects of daily living. Feelings of stigma were noticed in only 7 patients. Mild depression was noted in 42% of patients. CONCLUSION: Compared with others, this study shows a good QOL in patients with epilepsy, less stigma, and little impact of epilepsy on daily living with, however, similar to other reports, a significant rate of depression, which could have been alleviated by better family and social support.

Potential mechanisms connecting asthma, esophageal reflux, and obesity/sleep apnea complex--a hypothetical review.

Obstructive sleep apnea (OSA) and asthma are potentially linked at several levels. The pathophysiology of these two conditions seems to overlap significantly, as airway obstruction, inflammation, obesity, and several other factors are implicated in the development of both diseases. Gastroesophageal reflux disease (GERD), cardiovascular complications, obesity itself, and the underlying inflammatory processes are all complex contributory factors that provide hypothetical links. Furthermore, a collateral rise in prevalence of both OSA and asthma has been noticed during the past few years, occurring in association with the emerging epidemic of obesity, a common risk factor for both conditions. OSA and asthma share many other risk factors as well. We propose a hypothetical OSA-asthma relationship that has implications on the diagnosis and management of patients presenting with either condition singly. Clinicians should be aware that OSA might complicate asthma management. Based on this hypothesis, we suggest that the treatment of the individual patient who experiences both asthma and OSA needs to be multidisciplinary and comprehensive. This hypothetical association of asthma and OSA, though described anecdotally, has not been systematically studied. In particular, the influence of continuous positive airway pressure therapy (for sleep apnea) on asthma outcomes (such as quality of life, steroid utilization, emergency room visits) and fatality needs to be studied further.