Acromegalia por macroadenoma hipofisiario en paciente con síndrome de McCune-Albright. Reporte de caso y revisión de la literatura / Acromegaly due to pituitary macroadenoma in a patient with McCune-Albright syndrome. Case report and literature overview

Introducción: El síndrome de McCune-Albright (SMA) es una enfermedad rara caracterizada por la triada: manchas cutáneas de color café con leche, displasia fibrosa poliostótica y pubertad precoz. Puede afectar a diversos ejes hormonales, entre ellos el de la hormona de crecimiento (GH), pudiendo asociarse a acromegalia. Reporte de caso: describimos el caso de una mujer de 44 años, con pubertad precoz periférica, hemorragia uterina anormal, crecimiento de manos y pies, prognatismo, prominencia frontal, manchas café con leche y tumoraciones pétreas en cara y antebrazos. Resultados: Apoyados con exámenes laboratoriales y de imágenes, se llegaron a los diagnósticos de acromegalia, hipogonadismo hipogonadotropo y síndrome de McCune-Albright. La paciente fue sometida a tratamiento quirúrgico con persistencia de enfermedad clínica y laboratorial. Conclusión: El diagnóstico y tratamiento oportunos de la acromegalia y sus complicaciones brindará un mejor pronóstico a los pacientes con SMA.

Background: McCune-Albright syndrome (MAS) is a rare disease characterized by the triad: café-au-lait skin spots, polyostotic fibrous dysplasia, and precocious puberty. It can affect various hormonal axes, including growth hormone (GH), and may be associated with acromegaly. We describe the case Case report:of a 44-year-old woman with peripheral precocious puberty, abnormal uterinebleeding, growthof thehands and feet, prognathism, frontal prominence, café-au-lait spots, and stony tumorsonthefaceandforearms.Supportedby Results:laboratory and imaging tests, the diagnoses of acromegaly, hypogonadotropic hypogonadism and McCune-Albright syndrome were reached. The patient underwent surgical treatment with persistence of clinical and laboratory disease. Conclusion: Timely diagnosis and treatment of acromegaly and its complications will provide a better prognosis for patients with MAS

Sampling of the petrosal sinuses. Indications, results and usefulness / Muestreo de senos petrosos. Indicaciones, resultados y utilidad

Abstract Objectives: to analyze, evaluate and describe the usefulness of petrosal sinus sampling for diagnosing central Cushing's syndrome. Materials and methods: the technical aspects and results of bilateral venous sampling of the petrosal sinuses at the Hospital Universitario San Vicente de Paul in Medellín, Colombia, from January 1, 2012 to December 31, 2018, were analyzed. Results: the average age was 43.3 years, with a range from 19 to 69 years. Laterality could be shown in 68.2% of cases, with a tendency to be located on the left in 53.3%. The central source of ACTH production could be shown in 95.4% of cases, with a basal average central/peripheral ratio of 21.7, and 70.8 after stimulation. All samples at 3, 5 and 10 minutes were confirmatory following stimulation. Conclusion: in our retrospective study, petrosal sinus catheterization provided laboratory confirmation of the central source of ACTH production in a high percentage of patients, with no immediate complications.

Resumen Objetivos: analizar, evaluar y describir la utilidad del muestreo de senos petrosos para diagnóstico del síndrome de Cushing de origen central. Material y métodos: se analizaron los aspectos técnicos y resultados del muestreo bilateral venoso de senos petrosos, desde el 1° de enero de 2012 a 31 de diciembre de 2018 en el Hospital Universitario San Vicente de Paúl en Medellín, Colombia. Resultados: el promedio de edad fue 43.3 años con un rango de edad desde los 19 hasta los 69 años. La lateralidad pudo ser demostrada en 68.2% de los casos con una tendencia a la localización en el lado izquierdo en 53.3%. El origen central de producción de ACTH logró ser demostrado en 95.4% de los casos, con una relación central/periferia basal promedio de 21.7 y postestimulación de 70.8. Todas las muestras a los 3, 5 y 10 minutos fueron confirmatorias tras la estimulación. Conclusión: en nuestro estudio retrospectivo el cateterismo de senos petrosos confirmó la fuente central de producción de ACTH por laboratorio en un alto porcentaje de pacientes sin ninguna complicación inmediata.

Hidratos de carbono complejos en la leche materna: los oligosacáridos (Parte 1) / Complex carbohydrates in breast milk: oligosaccharides (Part 1)

Los oligosacáridos de la leche materna (HMOs) son unas 200 moléculas distintas sintetizadas y secretadas por la glándula mamaria a partir de lactosa a la que diversos enzimas unen monosacáridos simples (glucosa, galactosa, n-acetil galactosamina, fucosa y ácido siálico). Estas uniones y sus diferentes orientaciones espaciales generan una gran diversidad de estructuras químicas y de funcionalidades. La concentración de los HMOs es mayor en el calostro (± 25 g/L), está relacionada con la duración del embarazo y la lactancia: disminuyen progresivamente hasta la mitad de los niveles iniciales. La genética materna influye en el perfil de algunos HMOs; el gen FUT2, que codifica la síntesis de la fucosiltransferasa 2 (FUT2) condiciona el llamado carácter secretor en 75-85% de las mujeres y hace que los antígenos del grupo ABO(H) sean secretados en los líquidos orgánicos (saliva, lágrimas, semen). La ausencia de actividad del gen FUT2 condiciona el carácter no-secretor (15-25% de las mujeres). La actividad del gen FUT3 condiciona la actividad de la fucosiltransferasa 3 (FUT3) que se asocia con el grupo sanguíneo Lewis+ mientras que su ausencia caracteriza a los portadores como Lewis 0. Los HMOs son absorbidos a nivel del intestino como trazas (1%) pero incluso en esas cantidades ejercerían efectos sistémicos.

Human milk oligosaccharides (HMOs) are a family of some 200 different molecules synthesized by the mammary gland. At the core is a molecule of lactose, which is linked by different enzymes to glucose, galactose, n-acetyl galactosamine, fucose or sialic acid. These linkages and their different spatial orientation generate, besides the possibilities of numerous chemical structures, the potential for different spatial isomers. The concentration of HMOs in human milk depends on pregnancy and breastfeeding duration. They are highest in colostrum (± 25 g/L) and decrease over time to half this initial level. Maternal genetics modifies the concentration and profile of some oligosaccharides. For example, the FUT2 gene codifies the synthesis of fucosyltransferase 2 (FUT2) whose activity generates the secretor status for antigens of the ABO(H) blood group in organic fluids (saliva, milk, tears, semen) among 75-85% of the carriers of the trait. The absence of activity of the FUT2 gene conditions the non-secretor status (15-25% of women). The FUT3 gene regulates the activity of the fucosyltransferase 3 (FUT3) that is associated with the Lewis blood group. Traces of HMOs (1%) are absorbed in the intestinal tract, however, they exert important systemic effects even at low concentrations.

Perfil epidemiológico e clínico de uma amostra populacional de pacientes com acromegalia no estado de Alagoas / Clinical and epidemiological profile of a sample population of patients with acromegaly in the state of Alagoas

Objetivo: determinar o perfil epidemiológico e clínico de pacientes com acromegalia no Estado de Alagoas. Métodos: trata-se de um estudo descritivo, observacional, que foi realizado na Farmácia de Medicamentos Excepcionais do Estado de Alagoas, abrangendo 12 pacientes com acromegalia dessa instituição, correspondendo a 85% dos acromegálicos do Estado de Alagoas. Resultados: dos 12 pacientes estudados, a média de idade foi de 50,8 +/- 12,1 anos e, no momento do diagnóstico, uma média de idade de 44,5 +/- 11,6 anos. Foram realizados exames de imagem em 91,6% dos pacientes, em que se evidenciou macroademona hipofisário no momento do diagnóstico. A octreotida foi o medicamento principal, utilizado em 92% dos pacientes. Conclusão: O estudo corrobora, em boa parte dos dados, a literatura atual e revela a necessidade de maior precocidade de diagnóstico e início de terapêutica adequada, evitando o surgimento de comorbidades e complicações típicas da doença. (AU)

Objective: to determine the clinical and epidemiological profile of patients with acromegaly in the state of Alagoas. Method: This is a descriptive and observational study, which was held at the Exceptional Drug Pharmacy of the State of Alagoas. This study included 12 patients with acromegaly of this institution, corresponding to 85% of acromegaly in the State of Alagoas. Results: The mean age of the patients was 50.8 +/- 12.1 year and the mean age at diagnosis was 44.5 +/- 11, 6 years. Medical imaging exams were performed in 91.7% of patients, showing pituitary macroadenoma at the moment of diagnosis. Octreotide was the main medication, used in 91,7% of patients. Conclusion: The study corroborates, in most of the data, the current literature and reveals the need for earlier diagnosis and appropriate therapy, which avoids the appearance of typical comorbidities and complications of this disease. (AU)

Recidiva de macroadenoma hipofisario posterior a tratamiento estándar / Pituitary macroadenoma relapse after standard treatment

RESUMEN Introducción: la acromegalia es una patología de larga evolución y compromiso multisistémico, originada por un aumento en la liberación de hormona de crecimiento luego del cierre metafisario de los huesos largos. Su diagnóstico es complejo y suele presentarse entre la quinta y sexta década de la vida. El tratamiento incluye la resección quirúrgica y manejo mediante quimioterapia y radioterapia, así como control endocrino fármacológico. La enfermedad presenta una tasa de recidiva comprendida entre el 2 a 14%. Presentación de caso: paciente femenina de 67 años de edad con diagnóstico de acromegalia hace 15 años, quien luego de ser sometida a tratamiento estándar, presenta manifestaciones clínicas progresivas y compatibles con una función hipofisaria activa. Conclusiones: la paciente en efecto presentó recidiva de la enfermedad con persistencia del tumor benigno, debido a la interrupción del tratamiento y el insuficiente seguimiento del caso; por tanto, es fundamental el seguimiento estricto en el paciente que recibe manejo quirúrgico y tratamiento farmacológico por parte del equipo de salud. MÉD.UIS. 2017;30(2):89-93.

ABSTRACT Introduction: acromegaly is a disease of long evolution and multisystemic involvement, caused by an increased release of growth hormone after the metaphyseal closure of long bones. Diagnosis is often difficult and usually occurs between the fifth and sixth decade of life. The treatment is based on surgical resection, chemotherapy and radiotherapy, as on endocrine control by drugs. The disease has a low recurrence rate of from 2 to 14%. Case presentation: a 67 year old female patient with a diagnosis of acromegaly 15 years ago, who, after being subjected to standard treatment, presents progressive and clinical manifestations compatible with an active pituitary function. Conclusions: the patient relapsed effect of the disease with persistency of the benign tumor, due to the discontinuation of treatment and insufficient monitoring of the case; therefore strict monitoring is essential in patients receiving pharmacological therapy and surgical management by the health team. MÉD.UIS. 2017;30(2):89-93.

Long term follow-up of growth hormone-secreting pituitary adenomas submitted to endoscopic endonasal surgery / Seguimento de longo prazo de adenomas hipofisários secretores do hormônio do crescimento submetidos à cirurgia endoscópica endonasal

ABSTRACT Objective The aim of this study was to evaluate the results of the endoscopic transsphenoidal technique for growth hormone (GH)-secreting adenomas. Methods A retrospective analysis based on medical records of 23 acromegalic patients submitted to endoscopic transsphenoidal surgery. Biochemical control was defined as basal GH < 1ng/ml, nadir GH < 0.4ng/ml after glucose load and age-adjusted IGF-1 normal at the last follow-up. Results The overall endocrinological remission rate was 39.1%. While all microademonas achieved a cure, just one third of macroadenomas went into remission. Suprasellar extension, cavernous sinus invasion and high GH levels were associated with lower rates of disease control. The most common complication was diabetes insipidus and the most severe was an ischemic stroke. Conclusion The endoscopic transsphenoidal approach is a safe and effective technique to control GH-secreting adenomas. The transcavernous approach may increase the risk of complications. Suprasellar and cavernous sinus extensions may preclude gross total resection of these tumors.

RESUMO Objetivo O objetivo do estudo é analisar os resultados da cirurgia de ressecção endoscópica transesfenoidal para adenomas secretores do hormônio do crescimento (GH). Métodos Revisão retrospectiva baseada em análise de prontuários de 23 pacientes acromegálicos submetidos à cirurgia endoscópica. Remissão foi definida por GH < 1ng/ml, nadir de GH ≤ 0,4ng/ml no teste oral de tolerância a glicose e IGF-1 normal para idade. Resultados A taxa de remissão endocrinológica foi 39,1%. Enquanto todos microadenomas alcançaram controle hormonal, apenas um terço dos macroadenomas obtiveram remissão. Extensão suprasselar, invasão do seio cavernoso e altos níveis de GH foram associados a menores taxas de controle da doença. A complicação mais comum foi diabetes insipidus e a mais grave foi acidente vascular encefálico isquêmico. Conclusão A abordagem endoscópica transesfenoidal é segura e efetiva para controle de adenomas hipofisários secretores de GH. A abordagem ao seio cavernoso pode aumentar a morbidade da cirurgia. Extensões suprasselares e no seio cavernoso podem dificultar a ressecção completa e o controle da doença.

Structure and histology of extrafloral nectaries of tropical species in a mexican rain forest / Estrutura e histologia dos nectarios extraflorais de especies em uma floresta tropical no México

Although there is a large diversity of plant species with extrafloral nectaries, histological detail of these glands is poorly documented in tropical rain forest species. We characterized extrafloral nectaries using digital photographs, scanning electron microscopy and histological methods for eight plant species belonging to the Costaceae, Euphorbiaceae, Malvaceae and Salicaceae. To our knowledge, there are no previous reports on the structure of extrafloral nectaries for these species. Croton species exhibited reddish extrafloral nectaries on the petioles, surrounded by starshaped trichomes. Cnidoscolus multilobus and Omphalea oleifera showed green, elevated, extrafloral nectaries at the peduncle; C. multilobus showed abundant secretory tissue; O. oleifera revealed numerous cells with calcium oxalate crystals. Heliocarpus species showed extrafloral nectaries distributed at the base of the blade and possesses glands in the center of the extrafloral nectary surrounded by a series of parenchymatic cells. Pleuranthodendron lindenii has two extrafloral nectaries at the base of the leaves. Costus scaber has a hollow-type extrafloral nectary on the red-colored bracts of the inflorescence; nectar cavity is found in the center area of each bracts located on a yellow line. The extrafloral nectaries described in this study exhibited different morphologies and histological structures involved in the secretion of extrafloral nectar that could be related to biotic defenses, primarily by attracting ants.

Embora exista uma grande diversidade de espécies de plantas com nectários extraflorais, detalhes histológicos destas glândulas ainda é pouco documentado para espécies tropicais. Nós caracterizamos nectários extraflorais usando fotografias digitais, microscopia eletrônica de varredura e métodos histológicos para oito espécies de plantas das famílias Costaceae, Euphorbiaceae, Malvaceae e Salicaceae. Para nosso conhecimento, não há relatos anteriores sobre a estrutura dos nectários extraflorais para as espécies estudadas. Espécies de Croton exibiram nectários extraflorais avermelhadas nos pecíolos, rodeados por tricomas em forma de estrela. Cnidoscolus multilobus e Omphalea oleifera apresentaram nectários extraflorais verdes e elevados nos pedúnculos; C. multilobus apresenta tecido secretor abundante enquanto que O. oleifera apresentou numerosas células com cristais de oxalato de cálcio. Espécies de Heliocarpus apresentaram nectários extraflorais distribuídos na base da lâmina e possuíam glândulas no centro do nectário rodeadas por uma série de células de parênquima. Pleuranthodendron lindenii apresentou dois nectários extraflorais na base das folhas. Costus scaber apresenta um nectário extrafloral do tipo oco nas brácteas avermelhadas da inflorescência, e a cavidade do nectário se encontra na área central de cada bráctea localizados em uma linha amarela. Os nectários extraflorais descritos neste estudo apresentaram morfologia e estruturas histológicas diferentes envolvidas na secreção de néctar extrafloral que poderia estar relacionado com defesas bióticas, principalmente atraindo formigas.

Pituitary macroadenoma presenting as a nasal tumor: case report / Macroadenoma hipofisário, apresentando-se como um tumor nasal: relato de caso

CONTEXT: Pituitary macroadenomas are rare intracranial tumors. In a few cases, they may present aggressive behavior and invade the sphenoid sinus and nasal cavity, causing unusual symptoms. In this paper, we report an atypical case of pituitary adenoma presenting as a nasal mass. CASE REPORT: The patient was a 44-year-old woman who had had amenorrhea and galactorrhea for ten months, with associated nasal obstruction, macroglossia and acromegaly. Both growth hormone and prolactin levels were increased. Magnetic resonance imaging showed a large mass originating from the lower surface of the pituitary gland, associated with sella turcica erosion and tumor extension through the sphenoid sinus and nasal cavity. Histopathological analysis demonstrated a chromophobe pituitary adenoma with densely packed rounded epithelial cells, with some atypias and rare mitotic figures. There was no evidence of metastases. CONCLUSION: Macroadenoma invading the nasal cavity is a rare condition and few similar cases have been reported in the literature. This study contributes towards showing that tumor extension to the sphenoid sinus and nasopharynx needs to be considered and investigated in order to make an early diagnosis when atypical symptoms like nasal obstruction are present. .

CONTEXTO: Macroadenomas hipofisários são tumores intracraniais raros. Em alguns casos, podem apresentar comportamento agressivo e invadir o seio esfenoidal e a cavidade nasal, causando sintomas não usuais. Neste relato de caso, descrevemos um caso atípico de adenoma hipofisário manifestando-se como uma massa nasal. RELATO DE CASO: A paciente de 44 anos, do sexo feminino, apresentava amenorreia e galactorreia por 10 meses associando-se a obstrução nasal, macroglossia e acromegalia. Os níveis do hormônio de crescimento e de prolactina apresentaram-se aumentados. Ressonância magnética mostrou uma grande massa originada da superfície inferior da glândula hipofisária associada com erosão da sela túrcica e extensão do tumor através do seio esfenoidal e cavidade nasal. Análise histopatológica demonstrou adenoma hipofisário cromófobo com células epiteliais arrendondadas densamente agrupadas com algumas atipias e escassas figuras de mitose. Não houve evidências de metástase. CONCLUSÃO: O macroadenoma invasivo para a cavidade nasal é uma condição rara e há poucos relatos similares descritos na literatura. Este trabalho contribui para mostrar que, na presença de sintomas atípicos como a obstrução nasal, a extensão para o seio esfenoidal e para a nasofaringe deve ser considerada e investigada para um diagnóstico precoce. .

Anatomía y desarrollo de estambres y carpelos en Drimys granadensis (Winteraceae) / Anatomy and development of stamens and carpels of Drimys granadensis (Winteraceae)

Winteraceae has long been considered a family with early diversification among angiosperms, with characters such as: flowers with many spirally arranged parts and apocarpic ovary formed by plicated carpels with sessile stigma. In Drimys, the presence or absence of conspicuous glands on the connective of the stamens have been used as a taxonomic character, and it is considered a synapomorphy for the clade including Drimys angustifolia, D. brasiliensis, D. granadensis and D. roraimensis (Northeastern clade); however, the anatomy of stamens and carpels has only been studied in detail for D. winteri (Southwestern clade). In this research, the presence and the structure of glands on the connective of stamens was studied in seven species of the genus from herbarium specimens, and a detailed study of the anatomy and development of stamens and carpels was carried out by scanning electron and optic microscopy in Drimys granadensis. We found similarities between D. granadensis and D. winteri for the following characters: Basic type anther wall formation, secretory tapetum that collapses at maturity, intermediate type microsporogenesis with formation of a transient cell plate in telophase I, ascidiated carpel due to the formation of an adaxial lip during development, stigma closed by interdigitation of epidermal cells. We also determined that the large glands on anther mature connective are originated by an overgrowth of subepidermal oil cells; this character is a Northeastern Drimys clade synapomorphy, while it was absent in both Drimys of Southwestern clade (which includes D. andina, D. confertifolia and D. winteri), and the rest of the Winteraceae. We are proposing the hypothesis that the highly variable enviromental conditions in the tropics where Drimys Northeastern clade is distributed, with a wide range of pollinators, would be associated with the emergence of glandular conspicuously stamens; while, as a prediction to be confirmed, temperated Southwestern clade species, without conspicuous glands, should have a smaller range of visitors and/or pollinators, or even be anemophilous species as Drimys confertifolia. Rev. Biol. Trop. 62 (3): 1147-1159. Epub 2014 September 01.

La familia Winteraceae ha sido tradicionalmente considerada como de diversificación temprana entre las angiospermas por varios caracteres, entre ellos: flores con muchas partes distribuidas en espiral y ovario apocarpico formado por carpelos de tipo plicado con estigma sésil. En el género Drimys, la presencia o ausencia de glándulas conspicuas sobre el conectivo de los estambres ha sido usado como un carácter taxonómico, y su presencia se considera como una sinapomorfía del clado formado por Drimys angustifolia, D. brasiliensis, D. granadensis and D. roraimensis (clado nororiental); sin embargo, la anatomía de estambres o carpelos ha sido solamente estudiada en detalle en D. winteri (clado suroccidental). En esta investigación, la presencia y estructura de las glándulas del conectivo fue estudiada en las siete especies del género Drimys a partir de ejemplares de herbario, además, se realizó un estudio detallado de la anatomía y desarrollo de estambres y carpelos de Drimys granadensis empleando microscopía óptica y microscopía de barrido; y se compararon con los resultados previos en Drimys winteri. Se encontraron similitudes en los siguientes caracteres: formación de la pared de la antera de tipo básico, tapetum secretor que colapsa en la madurez, microsporogénesis de tipo intermedio con formación de una placa celular transitoria en telofase I, carpelo ascidiado debido a la formación de un labio adaxial durante el desarrollo, estigma cerrado por interdigitación de células epidérmicas. Se determinó que las glándulas de gran tamaño sobre el conectivo de la antera madura se originaron por sobrecrecimiento de células oleíferas subepidérmicas, siendo una sinapomorfía del clado nororiental, que esta ausente tanto en el clado suroccidental de Drimys (D. andina, D. confertifolia y D. winteri), como en el resto de la familia. Se propone la hipótesis de que las condiciones altamente variables en las zonas tropicales donde se distribuye el clado nororiental de Drimys, con una amplia gama de polinizadores, estarían asociadas al surgimiento de estambres conspicuamente glandulares; en tanto que proponemos como predicción que las especies circunscritas a la zona templada del Sur de Suramérica (Clado suroccidental), sin glándulas conspicuas, deberían presentar una menor variedad de visitantes y/o polinizadores, o incluso ser especies anemófilas como Drimys confertifolia.

Adenoma de hipófisis como forma infrecuente de insuficiencia suprarrenal secundaria. Presentación de un caso / Pituitary Adenoma as a Rare Form of Secondary Adrenal Insufficiency. A Case Report

Los adenomas de hipófisis son tumores benignos originados en uno de los cinco tipos celulares de la hipófisis anterior. La insuficiencia suprarrenal secundaria ocurre cuando las glándulas adrenales no producen hormonas por la falta de hormona adenocorticotrópica hipofisaria o del factor liberador de corticotropina hipotalámico. Se presenta el caso de una paciente de 37 años de edad, que un año atrás comenzó con fasciculaciones musculares de piernas y brazos, debilidad muscular, cansancio fácil, dolores musculares, cefalea hemicránea derecha, intensa y pulsátil, entre otros síntomas. Se le realizaron varios estudios (dosificación de cortisol en sangre, hormona adenocorticotrópica, calcio y fósforo en sangre y orina, resonancia magnética de cráneo) que permitieron el diagnóstico de adenoma de hipófisis con déficit aislado de hormona adenocorticotrópica e insuficiencia suprarrenal secundaria. El tratamiento con esteroides y suplementos de calcio garantizaron la evolución favorable.

Pituitary adenomas are benign tumors arising from one of the five cell types in the anterior pituitary. Secondary adrenal insufficiency occurs when the adrenal glands do not produce hormones due to the lack of pituary adrenocorticotropic hormone or hypothalamic corticotropin-releasing factor. The case of a 37-year-old female patient who started developing muscle twitching in legs and arms, muscular weakness, fatigue, muscle aches, severe and throbbing hemicrania on the right side, among other symptoms, a year ago is presented. Several tests were performed (cortisol level, adrenocorticotropic hormone, calcium and phosphorus in blood and urine, magnetic resonance imaging of the skull), leading to the diagnosis of pituitary adenoma with isolated adrenocorticotropic hormone deficiency and secondary adrenal insufficiency. Treatment with steroids and calcium supplements ensured a satisfactory recovery.

Postoperative structural complications after microscopic transsphenoidal surgery of GH secreting pituitary adenomas / Complicações estruturais pós-operatórias após microcirurgia transesfenoidal de adenomas pituitários produtores de GH

Objective: Analyzing the rate of structural complications after transsphenoidal surgery for removal of growth hormone (GH) secreting pituitary adenomas. Methods: Retrospective study of 58 patients who underwent microscopic transsphenoidal neurosurgery for GH secreting pituitary adenomas exeresis in Curitiba, Parana state, Brazil, between 1998 and 2011 by the same neurosurgeon. The Criteria for diagnosis of complications were clinical. Results: Five (8,6%) of the 58 patients who underwent transsphenoidal surgery developed postoperative anatomical complications, which was due to sixth cranial nerve palsy (3,4%), surgical wound infection (1,7%) and CSF fistula (3,4%). Conclusion: The rate of postoperative complications observed in the present study is likely the literature review. There is a drop in the rate of complications with increasing experience of the neurosurgeon.

Objetivo: Analisar a taxa de complicações anatômicas após cirurgia transesfenoidal para remoção de adenoma hipofisário produtor de hormônio do crescimento (GH). Métodos: Estudo retrospectivo de 58 pacientes operados por microcirurgia transesfenoidal para exérese de adenomas pituitários produtores de GH em Curitiba, Paraná, Brasil, entre 1998 e 2011, realizados pelo mesmo neurocirurgião. Diagnóstico das complicações foi clínico. Resultados: Dos 58 pacientes submetidos à cirurgia transesfenoidal, 5 (8,6%) desenvolveram complicações anatômicas, 3,4% foram em decorrência de paresia temporária do sexto nervo craniano, 1,7%, de infecção da ferida operatória, e 3,4%, de fístula liquórica. Conclusão: A taxa de complicações pós-operatórias observada no presente estudo está semelhante à da revisão literária. Há uma queda no índice de complicações conforme aumenta a experiência do neurocirurgião.

Carcinoma secretor de la mama en una anciana / Breast secreting carcinoma in an elderly

Se presenta el caso clínico de una anciana de 85 años de edad, de la raza negra, quien acudió a la consulta de Cirugía del Hospital General "Joseph N. France" de Saint Kitts y Nevis, con lesión nodular en el cuadrante superointerno de la mama izquierda. Los hallazgos anatomopatológicos confirmaron el diagnóstico de un carcinoma secretor en dicha mama.

The case report of a 85 year-old woman of the black race who visited the Surgery Department of "Joseph N. France" General Hospital from Saint Kitts and Nevis, with a nodular lesion in the upper inner quadrant of her left breast is presented. The pathological findings confirmed the diagnosis of a secreting carcinoma in the breast.

Role of the Lewis and ABO Blood Group Antigens in Helicobacter pylori Infection

Background: Helicobacter pylori infection is a major risk factor for chronic gastritis and gastric cancer. Some findings show increased frequencies of these diseases in individuals with type O blood and in secretors (expressing Leb antigen), but other studies have not found any relationship between blood groups and this infection. Given that H. pylori infection and gastric cancer are common in Iran, the assessment of the pathogenesis of this infection in relation to these blood groups could be valuable. Methods: In a cross-sectional study, we determined the ABO and Lewis blood groups of participants using the tube method and evaluated the level of anti-H. pylori immunoglobulin G using an enzyme-linked immunosorbent assay. This study included 171 Iranian blood donors from Mashhad, Iran, during 2010. The significance of the differences in the frequencies of the Lewis and ABO phenotypes between individuals infected with and without H. Pylori infection were tested using the chi-square test. A P-value < 0.05 was considered significant. Results: H. pylori infection was found in 76.6% of the study subjects (n = 131). The most common ABO blood group was O (33.9%), and the most common Lewis blood group was Le(a-b+) (54.7%). The frequencies of the ABO, Lewis, and secretion phenotypes were not significantly different between the infected and uninfected subjects. Conclusion: We did not find any significant relationship between the Lewis, ABO, and secretion phenotypes and H. pylori infection.

O Sistema do Hormônio de Crescimento: interações com a pele / Growth Hormone System: skin interactions

O artigo descreve o Sistema do Hormônio de Crescimento (GH), enfatizando suas possíveis ações nas células da epiderme, nas estruturas da derme e na cicatrização de feridas cutâneas. Para tanto, fez-se uma revisão dos conhecimentos sobre o hormônio do crescimento, seu receptor, a proteína carreadora deste hormônio e demais proteínas envolvidas no mecanismo que o GH utiliza para a sua manifestação nos tecidos cutâneos.

This paper describes the growth hormone system, emphasizing its possible effects on epidermal cells, dermal structures and wound healing. A review of the literature was conducted on studies concerning the growth hormone molecule, its receptor and carrier proteins and the other proteins involved in the mechanisms of its manifestation in dermal tissue.

ABO and Lewis Blood Grouping with ABH Secretor and Non-secretor Status: A Cross Sectional Study in Dhaka.

A cross sectional study was done with 42 apparently healthy persons aged 6 years and above from both sexes. Most of them are blood donors in the department of Transfusion Medicine, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh. Few, other than blood donor, were selected from the same locality. Five ml venous blood was collected with all aseptic precautions. ABO blood grouping and Lewis phenotyping were done by tube method. ABO reverse grouping was also done from serum. With all precautions 2 ml of saliva was collected from all subjects. Secretor status was detected from the saliva by haemagglutination inhibition method. ABO blood grouping shows 36% 'O' group, 24% 'A' group, 33% 'B' group and 7% 'AB' group. Distribution of Lewis phenotype are Le(a+b-) 19%, Le(a-b+) 53%, Le(a-b-) 26% and Le(a+b+) 2% only. 60% of study population was ABH secretor and 40% non-secretor.

Análise do gene AIP na acromegalia familial isolada / Analysis of the AIP gene in familial isolated acromegaly

A acromegalia é doença insidiosa e desfigurante caracterizada por um crescimento desproporcional dos ossos das mãos, pés e do crânio devido à exposição crônica a altos níveis de hormônio de crescimento (GH) e de seu efetor insuline growth factor 1 (IGF-1). Trata-se de uma doença rara, com incidência estimada de 3-4 casos por milhão, com prevalência de aproximadamente 50 casos por milhão de pessoas. A principal causa da acromegalia é a presença de um tumor hipofisário secretor de GH (somatotropinoma). Caso o somatotropinoma ocorra durante a infância ou adolescência, antes do fechamento das epífises dos ossos longos, a criança crescerá longitudinalmente de forma descontrolada, caracterizando a forma clínica gigantismo. Na grande maioria dos casos a acromegalia se apresenta na forma esporádica, entretanto casos familiais da doença podem ocorrer associados à Neoplasia Endócrina Múltipla tipo 1 (NEM-1), ao complexo de Carney (CNC) e à acromegalia familial isolada (IFS). Os genes responsáveis pela NEM-1 (MEN1) e CNC (PRKAR1A) foram clonados há mais 10 anos, entretanto etiologia molecular da IFS permaneceu desconhecida até recentemente. Vierimaa et al. (2006) combinaram estudos de ligação por análise de polimorfismos e estudos de expressão gênica e identificaram mutações no gene AIP em famílias com acromegalia não-NEM-1 e não-CNC; além de perda de heterozigose (LOH) nos somatotropinomas dos pacientes com mutação AIP. No presente estudo, investigamos o gene AIP em três famílias brasileiras com IFS e em seus tumores (hipofisários e não-hipofisários). Descrevemos uma nova mutação AIP (Y268X) em uma família brasileira com IFS, confirmando o papel desse novo gene na predisposição a tumores hipofisários. A partir de dados gerados em uma extensa revisão da literatura, sugerimos que os tumores hipofisários familiais isolados são doenças multigênicas que possuiriam um gene principal, mas que sofreriam influência de outros genes/loci ainda pouco caracterizados...

Acromegaly is a rare disfigurating and insidious disease characterized by enlargement of hands, feet and skull bones due to excess of growth hormone (GH) secreted by a pituitary tumor (somatotropinoma). The majority of the cases with acromegaly is sporadic, however it may occur in association with inherited disorders as Multiple Endocrine Neoplasia type 1 (MEN1), Carney complex (CNC) and Isolated Familial Somatotropinoma (IFS). The genes associated with MEN1 syndrome (MEN1) and CNC (PRKAR1A) have been described more than a decade ago, however until very recently the molecular etiology of IFS remained unknown. Using a combined strategy of single nucleotide polymorphism (SNP) analysis and gene expression analysis, Vierimaa et al. (2006) described mutations in the AIP gene occurring in families with acromegaly not associated with MEN1 and CNC. In the current study, we investigated three Brazilian families with IFS and were able to describe two germline mutations in the AIP gene, confirming the role of this new gene in the predisposition to familial somatotropinoma. We revised the literature of genetic studies of isolated pituitary adenoma syndromes, which indicated a genetic heterogeneity as well as possible multigenic inheritance for these diseases. Thus, we investigated the role of several genes/loci (SSTR2, SSTR5, CDKN1B, AHR, PRKAR1A, PTTG, PROP1, MEG3, RB1 and 2p16) selected as potentially acting as phenotypic modulators in IFS. Our data indicate that AIP-mutated patients are prone to pituitary disease, however it is necessary the co-segregation of markers located at oncogenic regions to the development of the pituitary tumors and manifestation of the disease. Herein, we also present the first somatic analysis of non-pituitary tumors of AIP-mutated patients. A potential role of AIP, which is implicated in the cAMP pathway, could not be excluded in the development of an adrenocortical carcinoma.

The Relationship between Lewis/Secretor Genotypes and Serum Carbohydrate Antigen 19-9 Levels in a Korean Population / 대한진단검사의학회지

BACKGROUND: The Lewis histo-blood group system consists of 2 major antigens-Lea and Leb-and a sialyl Lewis antigen-carbohydrate antigen (CA) 19-9. We investigated the distribution of Lewis genotypes and evaluated the relationship between the Lewis/Secretor genotypes and the serum level of CA 19-9 in a Korean population to identify whether the serum CA 19-9 levels are influenced by the Lewis/Secretor genotypes. METHODS: The study included 242 individuals who had no malignancies. Lewis genotyping was performed for the 59T>G, 508G>A and 1067T>A polymorphic sites. The Secretor genotype was determined through analysis of the 357C>T and 385A>T polymorphic sites and the fusion gene. Serum CA 19-9 level was analyzed using an electrochemiluminescence immunoassay. RESULTS: Individuals carrying the 3 common genotypes-Le/Le, Le/le(59,508), and Le/le(59,1067)-accounted for 95% of the study population. In the Korean population, the allelic frequencies of Le, Le(59), le(59,508), and le(59,1067) were 0.731, 0.010, 0.223, and 0.035, respectively. We found a significant difference in serum CA 19-9 concentrations among the 9 Lewis/Secretor genotype groups (P<0.001). The serum CA 19-9 levels in subjects with genotype groups 1 and 2 (Le/- and se/se) were higher than those with genotype groups 3-6 (Le/- and Se/-; 15.63 vs 6.64 kU/L, P<0.001). CONCLUSIONS: Le/Le, Le/le(59,508), and Le/le(59,1067) are frequent Lewis genotypes in Koreans. Because serum CA 19-9 levels are significantly influenced by the Lewis/Secretor genotypes, caution is suggested when interpreting the serum CA 19-9 levels.

Anatomy and ontogeny of the pericarp of Pterodon emarginatus Vogel (Fabaceae, Faboideae), with emphasis on secretory ducts

Discrepant and incomplete interpretations of fruits of Pterodon have been published, especially on the structural interpretation of the pericarp portion that remain attached to the seed upon dispersal. The present work clarified these doubts and analyzed ultrastructural aspects of the Pterodon emarginatus diaspores using light and transmission electron microscopes. Cell divisions are prevalent among the initial phases of development, and the subadaxial and adaxial meristems form the fibrous inner mesocarp and the endocarp composed of multi-seriate epidermis, respectively. At the median mesocarp, numerous secretory ducts differentiate between the lateral bundles, by lytic process. After lysis of the central cells and the formation of the lumen, the ducts show unistratified secretory epithelium with dense cells; oil droplets are observed on the secretory epithelium and the subadjacent tissues. At maturity, the uniseriate exocarp and the outer mesocarp slough off in an irregular fashion, leaving the diaspore composed of a papery and brittle wing linked to a seed chamber that includes the median mesocarp composed of lignified cells, bordering vascular bundles and many secretory ducts whose epithelial cells develop large vacuoles that accumulate oleoresins. The Pterodon emarginatus fruit is a cryptosamara.

Interpretações discrepantes e incompletas têm sido conferidas ao fruto de Pterodon, especialmente no que tange à determinação estrutural da porção pericárpica que acompanha a semente na dispersão. Assim, com o objetivo de dirimir tais dúvidas e analisar a organização ultra-estrutural das estruturas secretoras presentes no diásporo de Pterodon emarginatus, realizaram-se estudos convencionais aos microscópios de luz e eletrônico de transmissão. Nas fases iniciais de desenvolvimento do fruto, prevalecem divisões celulares; pela ação do meristema subadaxial e do adaxial, formam-se, respectivamente, o mesocarpo interno fibroso e o endocarpo composto por epiderme multisseriada. No mesocarpo mediano, entre os feixes vasculares laterais, diferenciam-se numerosos ductos secretores lisígenos. Após a lise das células centrais e formação do lume, os ductos apresentam epitélio secretor uniestratificado, com células densas; gotas de óleo são observadas no epitélio secretor e tecido subjacente. Na maturidade, o exocarpo unisseriado e o mesocarpo externo, ambos fenólicos, descamam irregularmente, sendo o diásporo constituído pela ala papirácea e quebradiça, ligada ao núcleo seminífero que abrange o mesocarpo mediano de células lignificadas, margeando feixes vasculares e muitos ductos secretores, que apresentam acúmulo de oleorresina e cujas células epiteliais tornam-se vacuoladas. O fruto de Pterodon emarginatus é, portanto, uma criptossâmara.

The analysis of Secretory Gene (Fucosyltransferase II): The relationship between the genotype of the Secretory Gene (Fucosyltransferase II) and the secretory phenotype of the saliva / 대한수혈학회지

BACKGROUND: The distinction between secretors and nonsecretors of ABH and Lewis substances is made by inhibiting an antiserum agglutinin reaction with saliva, but many variables such as ethnic group, Lewis and ABO genotype, saliva collection method and antiserum influence the detection of salivary substances. Human secretor (1,2) fucosyltransferase (FUT II) gene determines the ABH secretor status and influences the Lewis phenotype of an individual. The aim of this study is to comparison between the genotype of the secretory (FUT II) gene and the secretory phenotype of the saliva and evaluate the usefulness of genotyping secretory gene. METHOD: In order to explore the secretory genotypes, the 79 specimens were analyzed by the PCR-RFLP method designed for the detection of the A385T, the C357T and the G428A mutations of FUT II gene. Also, we performed secretory phenotyping of the saliva by hemagglutination inhibition test and compared between the genotype of FUT II gene and secretory phenotype of the saliva. RESULT: The frequencies of Se1, Se2 and sej among 158 alleles examined in a random sample were 11.1%, 40.5% and 48.4%. The frequencies of Se1/Se1, Se1/Se2, Se2/Se2, Se1/sej, Se2/sej and sej/sej among 158 genotypes were 3.2%, 3.2%, 20.3%, 12.7%, 37.3% and 23.4%. The frequencies of Secretor and nonsecretor phenotypes were 76.6% and 23.4%. There were 3 mismatch individuals between phenotype and genotype, all three cases were nonsecretor in phenotype but secretor (Se1/Se1, Se1/Se2, Se2/sej) in genotype. CONCLUSION: PCR-RFLP method can be effectively used for the genotyping of the FUT II gene and offer an attractive alternative to the phenotype of secretor state using saliva.

Molecular genetics analysis and frequency survey of H deficient phenotype / 中国输血杂志

Objective To survey the frequency of H deficient phenotype in blood donor population and analyze the serological and genetic characteristics of these individuals.Methods The H deficient phenotype was screened with anti-H monoclonal antibody.The ABO type was screened with serological method and with sequence specific primer polymerase chain reaction(PCR-SSP).FUT1 and FUT2 gene sequences were analyzed with direct sequencing of PCR products and gene cloning products.Result Of 85 390 blood donors,ten individuals were identified to be para-Bombay phenotype.Four h alleles were found in 14 para-Bombay phenotype individuals,h1(nt547-552?ag),h2(nt880-882?tt),h3(nt658c→t),and h_(new-2)(nt328g→a).The FUT1 genotypes of these para-Bombay individuals were h1/h1(6 individuals),h1/h2(7 individuals) and h3/h_(new2)(1 individual),and the frequency of 4 allele were 67.85%(h1),25%(h2),3.57%(h3),and 3.57%(h_(new-2)),respectively.FUT2 gene was analyzed in 12 para-Bombay phenotype individuals,and a mutation of nt357c→t was detected in all FUT2 gene,another mutation of nt716g→a were heterozygous in 5 individuals with h1/h2 genotype.No null FUT2 gene was detected.In serological analysis,all atypical anti-A or anti-B antibody of 14 para-Bombay individuals were inactive at 37℃,7 individuals had active anti-H antibody at 37℃.Conclusion The frequency of H deficient phenotype in Fujian population is about 1:8 500.The h1 and h2 alleles are predominant in Fujian H deficient individuals on h1-Se~(357) and h2-Se~(357,716) haplotype background.