Tumor Carcinoide de testículo / Testicular carcinoid tumor

Los tumores carcinoides de testículo son extremadamente raros, representando el 0.23% de los tumores de dicha localización. Se dividen en tres grupos: tumor carcinoide primario de testículo, teratoma de testículo con áreas de carcinoide y tumor carcinoide metastásico de otra localización. Presentamos un paciente de 52 años que consultó por dolor y tumefacción testicular. Se realizó orquiectomía derecha. LDH, alfa feto proteína y beta HCG: normales. Anatomía patológica: tumor blanco amarillento, constituido por células neoplásicas. Inmunohistoquímica: inmunofenotipo correspondiente a tumor neuroendocrino. 5HIAA urinario: normal. Centellografía con (Tc99) octreotide: normal. Se decidió control. Los tumores carcinoides primarios de testículo son infrecuentes, es fundamental descartar localizaciones primarias intestinales para confirmar el diagnóstico. Las herramientas diagnósticas más utilizadas son 5HIAA en orina y centellografía con (TC99) octreotide. El tumor carcinoide primario de testículo presenta un pronóstico favorable luego de la orquiectomía (AU)

Testicular carcinoid tumors are extremely rare. They are divided into three groups: primary testicular carcinoid tumor, testicular teratoma with areas of carcinoid and metastatic carcinoid tumor from another location. We present a 52 years old patient that was admitted with testicular pain and swelling. Right orchiectomy was performed. Serum LDH and alpha, fetoprotein and beta human chorionic gonadotropin were normal. Pathology: white yellowish tumor consisting of neoplastic cells. Immunohistochemistry: immunophenotype corresponding to neuroendocrine tumor. 5HIAA urinary and somatostatin receptor scintigraphy were normal. It was decided to control the patient. Primary testicular carcinoid tumors are uncommon. It is essential to rule out intestinal primary locations to confirm the diagnosis. The diagnostic tools used are 5 HIAA urinary and somatostatin receptor scintigraphy. The primary carcinoid tumor of the testis presents a favorable prognosis after orchiectomy (AU)

Diagnosis of metastatic carcinoid in mesenteric lymph node by fine needle aspiration cytology.

Although carcinoid tumor is a relatively common neoplasm in surgical pathology, fine needle aspiration cytology (FNAC) as a method of primary diagnosis has only been reported a few times. We report the case of a 55-year-old male patient who presented with colicky pain in the abdomen and a vague mass in the right lumbar region. Ultrasonographic study showed an enlarged mesenteric lymph node. Ultrasonography-guided FNAC revealed cellular smears with neuroendocrine cellular arrangement and morphology. The cytomorphologic characteristics of carcinoid tumors are distinctive enough for diagnosis. A diagnosis of metastatic carcinoid was given. 5-hydroxyindolacetic acid in 24-hour urine turned out to be high. Histopathology and immunohistochemistry studies also confirmed the diagnosis. Thus, FNAC can be a useful and safe tool in the diagnosis of carcinoid tumors.

Different modalities in early diagnosis of acute appendicitis in children

Acute appendicitis [AA] is a common surgical problem that is associated with an acute-phase reaction. Previous studies have shown that cytokines and acute-phase proteins are activated and may serve as indicators for the severity of appendicitis. During inflammation, enterochromaffin cells in the appendix secrete serotonin, and 5-hydroxy indole acetic acid [5-HIAA]; a serotonin metabolite excreted in urine, has been found to be elevated in patients presenting with acute appendicitis. As there is no reliable single laboratory marker to assist in diagnosis of acute appendicitis so the aim of this study was to compare diagnostic values of different serum inflammatory markers in acute appendicitis in children. A total of 90 children were admitted in the emergency unit with suspected acute appendicitis. Fourteen children were excluded as they were diagnosed with pneumonia [4], urinary tract infection [3], tonsillopharyngitis [5] and gastroenteritis [2]. According to required treatment, patients were divided into two groups. One group comprised 46 children with acute appendicitis who had surgical intervention while the other group comprised 30 children with non-specific abdominal pain. All patients were subjected to history, clinical examination, abdominal ultrasound, white cell count, C- reactive protein, interleukin-6 and urinary 5-hydroxy indole acetic acid. Ultrasonography and urinary 5-HIAA showed the highest diagnostic accuracy [91.1% and 87.8% respectively], followed by serum IL-6 concentration [70%], white blood cell count [67.8%], clinical signs [66.7%], and serum C-reactive protein concentration [61%]. Ultrasonography and 5-HIAA achieved also the highest specificity [90.9%] and positive [91.1% and 90.7%] and negative [88.9% and 85.1%] predictive values, whereas clinical signs showed the highest sensitivity [91.3%] followed by ultrasonography [89.1%] and urinary 5-HIAA [84.8%]. Combination of ultrasonography and urinary 5-HIAA increase the diagnostic accuracy of acute appendicitis and provide surgeons with complementary information in discerning the necessity for urgent operation

Serotonin and 5-hydroxy indole a cetic acid in infertile males with normal accessory sex gland function

To clarify the role of serotonin in the process of male infertility, thirty infertile males were studied. The duration of infertility was 4 +/- 3.2 years. Other factors known to be incriminated in the pathogenesis of infertility were excluded by clinical and laboratory investigations. They were twenty-two oligospermic and eight azoospermic patients. Fourteen fertile males were included as a control group. Serum blood serotonin was estimated in both infertile groups. Serum serotonin levels were significantly higher in infertile males [102.7 +/- 6 ng/ml] than those of fertile subjects [55.5 +/- 4.9 mug/ml]. Twenty-four-hour urinary 5-HIAA levels were also significantly higher in infertile males [11.5 +/- 1.15 mg/day] than those of controls [5.1 +/- 0.36 mg/day]. It was assumed that hyperserotoninemia might be one of the causes of infertility in males who had normal accessory sex gland function. Administration of antiserotoninergic drugs may be of benefit in this category of infertile males. Moreover, estimation of 5-HTAA might be valuable in monitoring the response of these patients to antiserotoninergic drugs

Separación de aminas biogénicas mediante cromatografía líquida de alta resolución / High-performance liquid chromatographic determination of biogenic amines

En este trabajo se han compilado los distintos modos cromatográficos y sistemas de detección utilizados en la cromatografía líquida de alta resolución de aminas biogénicas. Se indican las características generales del intercambio catiónico, fase reversa, fase reversa de pares iónicos y cromatografía de partición con fase reversa de pares iónicos. También se analizan comparativamente la detección UV, detección fluorimétrica usando fluorescencia nativa o bien derivatización pre- y postcolumna y detección electroquímica de gran utilidad para esta extensa familia de compuestos. Se dan ejemplos de aplicación de interés en el campo bioquímico-clínico, con el análisis de ácido homovainillínico, ácido 3,4-dihidroxifenilacético y ácido 5-hidroxiindolacético en líquido cefalorraquídeo, metanefrinas, ácido 3,4-dihidroxifenilacético, catecolaminas, ácidos urinarios y 3-metoxi-4-hidroxifenilglicol en orina, catecolaminas y 3-metoxi-4-hidroxifenilglicol en plasma, catecolaminas, 3-metoxi-4-hidroxifenilglicol y otros neurotransmisores en cerebro de rata. Se discuten, también, los tratamientos previos requeridos especialmente para orina y plasma, así como las condiciones de conservación y su incidencia en los resultados obtenidos

Migraine in children.

A descriptive study was carried out to find out the clinical profile, and electroencephalographic (EEG) changes in children with migraine. Screening for urinary excretion of 5-hydroxy indole acetic acid (5-HIAA) was carried out. Fifty children suffering from migraine as per Prensky's criteria were recruited over a period of 1 year. Forty six children were suffering from common migraine and 4 had classic migraine. The most common precipitating factors were physical strain and psychological stress like examination fear, fear of teacher and fights with friends. Abnormal EEG recordings were seen in 35 out of 50 patients. Urine samples taken during the headache free period were negative for 5 HIAA. Among the samples taken during the episode of headache, only 1 was positive for 5-HIAA. It is concluded that common migraine is more prevalent than classic migraine. Clinical criteria is the only way of diagnosing migraine. Since EEG changes are non-specific, this cannot be used as a diagnostic test. Biochemical analysis is expensive and less sensitive.

Biochemical correlate of depression in children

O grau de depressäo em 88 crianças abandonadas foi analisado por escala de avaliaçäo de depressäo adaptada para crianças na pré-puberdade. Os itens da escala foram agrupados em três dimensöes: sociológico-relacional, psicológica e biológica. Em 46 crianças desta amostra foram dosados o cortisol plasmático e a excreçäo urinária de catecolomina, VMA, HVA e 5-HIAA. Pela análise dos principais componentes, mostraram-se mais importantes, na amostra, as dimensöes sociológica e psicológica, seguidas dos componentes idade e catecolomina. O grupo de crianças do sexo masculino com depressäo apresentava maior nível de excreçäo urinária de catecolomina e menor pico de cortisol plasmático que o grupo sem depressäo. A variável idade, em ambos os sexos, correlacionava-se à variável catecolomina. Alteraçöes bioquímicas estäo presentes em crianças com depressäo, mas é difícil demonstrar correlaçäo de dependência entre elas e aspectos fenomenológicos da depressäo

O ecocardiograma na síndrome do coraçäo carcinóide: relato de caso / The echocardiogram in carcinoid heart syndrome: a case report

Mulher de 42 anos, portadora de prótese mecânica em posiçäo aórtica, começou a apresentar sinais de insuficiência cardíaca direita, associados a diarréia, sensaçäo de "sufoco" e eritema facial. O estudo ecocardiográfico revelou sinais típicos de comprometimento cardíaco por síndrome do coraçäo carcinóide (SCC): sinais de sobrecarga de volume das câmaras direitas e espessamento da valva tricúspide que permanecia em posiçäo semi-aberto durante todo o ciclo cardíaco. A valva pulmonar também apresentou aspecto semelhante. O estudo com "Doppler Pulsátil" registrou acentuada insuficiência tricúspide e discreta incompetência pulmonar. Com base nos achados ecocardiográficos, foi sugerida dosagem de ácido 5-hidroxiindolacético na urina de 24 e os níveis elevados confirmam o diagnóstico daquela síndrome. Conclui-se que a ecocardiografia permite avaliar com detalhes o comprometimento cardíaco na SCC, apresentando imagens típicas, quase patognomônicas da afecçäo

Acido 5-hidroxindolacético y vanillilmandélico en pacientes con depresión endógena / 5-hydroxindol acetic and vainilline mandelic acid in patients with endogenous depression

Se estudiaron 17 pacientes, mujeres, con diagnóstico clínico de depresión endógena (D.E), en las cuales se midió el ácido vanillilmandélico (VMA) y el ácido 5-hidroxindolacético (5-HIAA). Estos resultados fueron comparados con sus correspondientes controles, mostrando un incremento significativo en la excreción urinária del 5-HIAA, no observándose diferencias significativas en la eliminación del VMA. Estos datos sugieren una clasificación bioquímica de las depresiones agrupándolas como serotoninérgicas

Hypothermia dn alphamethyldopa treatment.

The hypotensive drug alphamethyldopa, an inhibitor of serotonin synthesis, caused significant hypothermia ranging from 33.4 to 34.8 degrees C (t=3.09 at P less than 0.05) in four out of nine hypertensive patients, with evidence of cerebral atherosclerosis. The anti-serotonin effect of alphamethyldopa correlated with statistically significant (t=6.8 at P less than 0.001) fall in the 24 hour urinary 5-hydroxyindoleacetic acid on the third day of the therapy. The possible mode of hypothermic side effect is discussed.