Idiopathic central diabetes insipidus in a large cohort of patients: the hypopituitarism ENEA rare observational (HEROS) study.

Central Diabetes Insipidus (CDI) is mainly associated with structural pathologies of the hypothalamic-pituitary area. Etiologies underlying CDI are identified in most patients, however idiopathic CDI is reported in 13-17% of cases after excluding other etiologies. The Hypopituitarism ENEA Rare Observational Study (HEROS study) retrospectively collected data of patients with idiopathic CDI from 14 pituitary centers in 9 countries. The cohort included 92 patients (59 females 64%), mean age at diagnosis was 35.4 ± 20.7 years, and a mean follow up of 19.1 ± 13.5 years following CDI diagnosis. In 6 women, diagnosis was related to pregnancy. Of 83 patients with available data on pituitary imaging, 40(48%) had normal sellar imaging, and 43(52%) had pathology of the posterior pituitary or the stalk, including loss of the bright spot, posterior pituitary atrophy or stalk enlargement. Anterior pituitary hormone deficiencies at presentation included hypogonadism in 6 (6.5%) patients (5 females), and hypocortisolism in one; during follow-up new anterior pituitary deficiencies developed in 6 patients. Replacement treatment with desmopressin was given to all patients except one, usually with an oral preparation. During follow up, no underlying disease causing CDI was identified in any patient. Patients with idiopathic CDI following investigation at baseline are stable with no specific etiology depicted during long-term follow-up.

PATHOLOGICALLY-CONFIRMED ISOLATED HYPOTHALAMO-PITUITARY SARCOIDOSIS REFRACTORY TO PULSE-DOSE GLUCOCORTICOIDS AND SUCCESSFULLY TREATED WITH METHOTREXATE.

Isolated sarcoidosis of the hypothalamic-pituitary system is a very rare form of neurosarcoidosis. A high index of suspicion is required for diagnosis and the choice of therapy embodies another challenge due to lack of standardized protocols. Glucocorticoids are the mainstay of initial treatment, whereas the second and third-line therapy include immunomodulators and cytotoxic drugs, in addition to monoclonal antibodies. This report presents an unusual case of panhypopituitarism in a 32-year-old previously healthy male patient due to isolated hypothalamo-pituitary sarcoidosis confirmed histologically, refractory to pulse-dose glucocorticoids and then successfully treated by methotrexate. Based on our report, in patients requiring additional therapy usage of the methotrexate as the second line agent should be considered, however the time frame and the dosing schedule of methotrexate are still unknown and deserve further investigation.

Effect of neonatal exposure to endocrine-active compounds on plasma lipid and steroid concentrations, and morphology of luteal tissue in the adult pig.

To study the long-term impact of neonatal exposure to endocrine-active compounds (EACs) on plasma lipid profiles, steroid concentrations, and morphology of porcine luteal tissue, piglets were injected with testosterone propionate (TP), flutamide (FLU), 4-tert-octylphenol, ICI 182,780 (ICI), methoxychlor, or corn oil (controls) between postnatal days 1 and 10 (n = 5/group). Blood samples and corpora lutea were obtained from sexually mature gilts. The investigated compounds differentially affected plasma lipid and steroid concentrations. Moreover, we demonstrated hypertrophy of luteal cells after neonatal EAC administration. In addition, a predominant abundance of lipid droplets was found in luteal cells of TP-, FLU-, and ICI-treated animals. It seems that the pathways leading to changes in the plasma lipid profile may contribute to the development of long-term alterations that have the potential to affect luteal steroidogenic capability in pigs.

Raman and FTIR spectroscopy in determining the chemical changes in healthy brain tissues and glioblastoma tumor tissues.

Glioblastoma, also called glioblastoma multiforme (GBM), is a particularly malignant form of primary brain tumor. This cancer accounts for 12-15% of all brain tumors. Despite the advances in neurosurgery, radio and chemotherapy the average survival rate is only 12.1-16.6 months. This is due not only to the late diagnosis of the disease, but also to ineffective treatment methods which result from the still low knowledge about the causes of glioblastoma development. Therefore, it is very important to look for new diagnostic methods of detection of the smallest features of cancer. Raman and infrared spectroscopy (FTIR) can be such methods. In this paper we discuss the chemical composition of sample glioblastoma brain tissues and marginal brain tissues using these two spectroscopy methods. Raman and FTIR spectra of cancer brain tissues showed that the highest differences in the chemical composition, compared to the control brain tissue, occur in the areas corresponding to lipids, collagen and proteins. Moreover, Raman spectroscopy also showed significant changes in the cancer tissues in the phosphatidylcholine and sphingomyelin. Interestingly, FTIR spectra after Kramers-Kronig transformations showed signals only for three peaks which corresponded to the vibrations of lipid function groups. Adjustment of the Lorenz function for these three peaks showed that only in the case of cancerous tissues the number of matching lines is different, compared to the control and marginal tissues. Therefore, we assume that lipids could be a spectroscopic marker for brain tumor. Furthermore, principal component analysis (PCA) showed that chemical changes seen between cancer and control tissues are significant and it is possible to differentiate the infected tissue from the healthy one. Interestingly, the PCA analysis also showed that adjacent brain tissues have different chemical composition than the control tissues.

Negative-pressure wound therapy for management of chronic neuropathic noninfected diabetic foot ulcerations - short-term efficacy and long-term outcomes.

PURPOSE: Negative pressure wound therapy (NPWT) is an adjunct method used in the treatment of diabetic foot ulceration (DFU). Real world data on its effectiveness and safety is scarce. In this prospective observational study, we assessed the short-term efficacy, safety, and long-term outcomes of NPWT in patients with type 2 diabetes (T2DM) and neuropathic, noninfected DFUs. METHODS: Based on wound characteristics, mainly area (>1 vs. ≤1 cm2), 75 patients with DFUs treated in an outpatient clinic were assigned to NPWT (n = 53) or standard therapy (n = 22). Wound area reduction was evaluated after 8 ± 1 days. Long-term outcomes assessed included complete ulceration closure and recurrence rate. RESULTS: Patients assigned to NPWT were characterized by greater wound area (15.7 vs. 2.9 cm2). Reduction in wound area was found in both the NPWT (-1.1 cm2, -10.2%, p = 0.0001) and comparator group (-0.3 cm2, -18.0%, p = 0.0038). No serious adverse events related to NPWT were noted. Within 1 year, 55.1% (27/49) of DFUs were closed in the NPWT group and 73.7% (14/19) in the comparator group (p = 0.15). In the logistic regression, wound duration and smaller initial area, but not treatment mode, were associated with closure. One-year follow-up after DFU resolution revealed an ~30.0% recurrence rate in both groups (p = 0.88). CONCLUSIONS: NPWT is a safe treatment for neuropathic, nonischemic, and noninfected DFU in patients with T2DM, although this observational study did not prove its effectiveness over standard therapy. Additionally, we report a high rate of both closure and recurrence of ulcers, the latter irrespective of initial ulcer area.

Pituitary apoplexy: managing the life-threatening condition associated with pituitary adenomas.

Pituitary tumor apoplexy is one of a few life-threatening conditions in patients with pituitary adenomas. The very low incidence of this complication hinders formulation of widespread guidelines on diagnostic and therapeutic management. This article presents current opinions on epidemiology, risk factors, clinical signs and symptoms, also the difficulties in selecting appropriate therapeutic management. The paper has focused particularly on making decisions regarding surgical or conservative treatment in pituitary tumor apoplexy. Also the consequences of these decisions based on the key literature references. The article presents endocrine and neuro-ophthalmic consequences of previous pituitary tumor apoplexy with the key management principles for the follow-up period.

Management of prolactinomas during pregnancy.

Prolactinomas constitute approximately 40% of hormone-secreting pituitary tumors. In women the main clinical features are menstrual disorders and infertility. Successful treatment with dopamine agonists restores the normal function of the pituitary-gonadal axis, ovulation, and fertility. Adequate management of pregnant prolactinoma patients from the moment of conception is of particular importance for both the mother and the developing fetus. This review article presents current opinions on the course and management of pregnancies in patients with prolactin-secreting pituitary tumors. The introduction contains background information on clinical aspects of the condition, including prolactinoma treatment in women of reproductive age. Physiological changes in the pituitary during normal pregnancy are also described. The next part presents current knowledge on the effect of pregnancy on prolactinoma size, including especially the high risk of prolactinoma growth in patients with pituitary macroadenomas. Safety issues concerning the use of dopamine receptor agonists during pregnancy are also discussed, especially in terms of the risk of congenital defects in the fetus. Moreover, the article presents principles of prolactinoma management in pregnant patients, rare indications for surgical treatment during pregnancy, and the issues concerning pituitary tumor apoplexy in pregnant women, the last being a life-threatening condition. The final part of the article discusses the possible effects of pregnancy on hyperprolactinemia remission as well as on the issue of breastfeeding by mothers with prolactinoma.

Physical, photophysical and structural properties of ruthenium(II) complexes containing a tetradentate bipyridine ligand.

The focus of this report is the synthesis and properties of two new analogues of ruthenium(ii) tris-bipyridine, a monomer and dimer. The complexes contain the ligand 6,6'-(ethan-1,2-diyl)bis-2,2'-bipyridine (O-bpy) which contains two bipyridine units bridged in the 6,6' positions by an ethylene bridge. Crystal structures of the two complexes formulated as [Ru(bpy)(O-bpy)](PF6)2 and [(Ru(bpy)2)2(O-bpy)](PF6)4 reveal structures of lower symmetry than D3 which affects the electronic properties of the complexes as substantiated by density functional theory (DFT) and time dependent density functional theory (TDDFT) calculations. The HOMO lies largely on the ruthenium center; the LUMO spreads its electron density over the bipyridine units, but not equally in the mixed O-bpy-bpy complexes. Calculated Vis/UV spectra using TDDFT methods agree with experimental spectra. The lowest lying triplet excited state for [Ru(bpy)(O-bpy)](PF6)2 is 3MC resulting in a low emission quantum yield and a large chloride ion photosubstitution quantum yield.

[Silent myocardial ischemia]. / Nieme niedokrwienie miesnia sercowego.

Nowadays the cardiovascular diseases particularly ischaemic heart disease (IHD) are the most frequent causes of death in Poland. Some of patients with IHD are completely asymptomatic. These subjects are more susceptible to sudden coronary events due to lack of diagnosis and treatment. Cohn divided patients with asymptomatic ischaemia (AI) into three groups: completely asymptomatic, asymptomatic patients after myocardial infarction, patients with painful angina who have some ischaemic events asymptomatic. Some causes of AI are: increased pain threshold, increased beta-endorphin levels, impairment of pain pathways, smaller ischaemic regions in comparison with painful angina, psychological factors, transient platelet microaggregates. Estimated prevalence of AI is about 2-4% of total population and is larger in the group of patients with multiple coronary disease risk factors especially with diabetes mellitus (autonomic neuropathy). In the patients after myocardial infarction the prevalence of AI is between 30-70% and it is associated with poorer prognosis. In subjects with painful angina 70-80% of total ischaemic episodes detected by 24-hour ECG monitoring is asymptomatic. The most useful methods for diagnosis of AI are ECG exercise test and ambulatory 24-hour ECG monitoring, although they may sometimes produce false positive results. Other tests are not widely performed and their use is restricted to specific circumstances. Some cases are finally solved by coronary angiography. Although screening in whole population is not cost-effective, but in some groups is necessary (people with many risk factors of IHD, people of certain professions--plane pilots, etc.). Treatment of AI does not vary from treatment of symptomatic IHD. Basic drugs used are: aspirin, beta-blockers, calcium channel blockers, long time acting nitrates. Positive effect of statins is also observed. The most beneficial is invasive treatment--CABG is more efficient than PTCA. Moreover the treatment of symptomatic IHD should be oriented not only to eliminate the symptoms but also to withdraw episodes of silent ischaemia confirmed by 24-h ECG monitoring or ECG exercise test.