Evaluation of anterior pituitary function following traumatic brain injury

Neuroendocrine dysfunction following traumatic brain injury [TBI] is frequently missed due to the absence of major symptoms and very often, no appropriate management is prescribed, thus delaying the patient recovery. This study is aimed to determine the frequency and pattern of anterior pituitary dysfunction following TBI. From June to December 2009, over a period of seven months, a total of 156 cases were admitted to a trauma center following TBI. Of the seventy patients, [61 males and 9 females mean age 30 years] included in the study, 39 patients had moderate [GCS; 9 - 12] and 31 cases had severe [GCS < 8] TBI. Patients were tested 6 months after injury for possible secretory abnormalities of anterior pituitary hormones. Anterior pituitary secretary function was assessed by measurement of serum levels of FT4, TSH, basal GH, IGF-1, 8 am Cortisol, FSH, LH, total testosterone and prolactin. Dynamic tests of ACTH and glucagon stimulation were used to evaluate the pituitary-adrenal axis and GH secretory status. Forty-one patients [58.6%] were found to be suffering from at least one hormonal secretory abnormality, with patterns and frequencies of: Gonadotropins [LH, FSH], 12.9%, corticotrophin [ACTH], 12.9%, somatotropin [GH], 4.3%, and prolactin [PRL], 1.4%. There was no case with thyrotropin deficiency. Hyperprolactinemia was found to be present in 23 cases [31.5%]. The results of this study showed that anterior pituitary hormone deficiencies occur frequently, 6 months following traumatic brain injury. The two most commonly involved axes were the pituitary-gonadal and the pituitary-adrenal. Hypocortisolism may be particularly harmful for the patients' health

Gingival metastasis of renal cell carcinoma

Metastases of internal tumors to the oral cavity are unusual and in most cases involve maxilla and mandible. Metastases to the gingival soft tissue are extremely rare. Reporting a new clinical case of renal cell carcinoma [RCC] metastasis with an unusual site. Metastatic involvement of gingival tissue with renal cell carcinoma is an extremely rare clinical event. It is usually associated with involvement of an internal organ. We present a case of 47-year-old male patient diagnosed with RCC-associated gingival metastasis- who underwent radical nephrectomy. The wide range of localizations and forms of metastatic presentation of renal carcinoma should obligate physicians to be alert during the follow-ups

[ relationship between serum level of osteoprotegerin and post-laminectomy epidural fibrosis in rabbit]

Epidural fibrosis [EF] is part of natural physiological tissue response to laminctomy and it may be an important cause of failed back surgery syndrome [FBSS]. There is still no effective medical or surgical therapy for EF. Osteoprotegerin [OPG] is a soluble member of the tumor necrosis factor receptor family that might play a role in postoperative EF. The objective of this study was to evaluate the relationship between serum OPG level and EF after laminectomy. Sixty rabbits were employed and divided randomly into two groups. Group A contained 20 rabbits as controls and group B contained 40 rabbits that underwent bilateral laminecyomy at L4 and L5 lumbar levels under an approved surgical protocol. Serum sample was obtained after 8 weeks from all rabbits and then the animals in group B were killed in accordance with the guidelines for euthanasia. The spine segment from L3 to L6 was removed en bloc. The amount of scar tissue at the laminectomy defect was scored on an ordinal score from 0 to 3 with a scoring system similar to that of He et al. According to the amount of scar the rabbits in group B, were divided into two groups: B1 with low fibrosis [grade 0, 1] and B2 with high fibrosis [grade 2, 3]. The serum OPG level of groups A, B1 and B2 were determined using ELISA method. The one way ANOVA was used to assess significant difference among groups. Serum OPG level ranged from 0-4 Pmol/l with a median of 1.5 Pmol/l in group A, 0-6 Pmol/l with a median of 2.42 Pmol/l n group B1 and 0-6 Pmol/l with a median of 2.15 Pmol/l in group B2. There was not any significant difference in OPG levels among these 3 groups. This study showed no relation between OPG level and existence of postlaminectomy EF after 8 weeks