HIDRADENITIS SUPPURATIVA IN POSTMENOPAUSE.

BACKGROUND: Hidradenitis suppurativa (HS) is a chronic, debilitating disease with a profound impact on the quality of life of patients. OBJECTIVES: To describe a rare case of HS with postmenopausal onset, to review the literature data regarding late onset HS and to discuss the current knowledge on the role of endocrine abnormalities in the development of HS. CASE REPORT: We report the case of a 68-year-old patient in whom HS occurred 10 years after menopause. She was referred to our clinic for the presence of an open fistula on the left groin, fibrotic scars and visible alteration of the vulvar anatomy due to numerous surgical interventions. The patient shared features of the metabolic syndrome (obesity, arterial hypertension, dyslipidemia, aortic atherosclerosis), but showed no signs of virilism and no hormonal abnormality. HS was controlled using antiseptics, topical retinoids and antibiotics. CONCLUSIONS: This case is of particular interest given the late onset of HS, long time after menopause. The development of HS requires a complex interaction between genetic predisposing factors, endocrine dysregulation, metabolic alterations, bacterial overgrowth and an aberrant inflammatory response. Evidence points to an important role of sex-hormones in the emergence and progression of the disease, but the underlying mechanisms are still unclear. A better understanding of HS pathogenesis is needed to elucidate the precise way in which endocrine factors influence the disease onset and course. This would guide the way to novel therapies and a better control of this challenging disease.

Lessons learned from the first 50 thyroidectomies with Harmonic Focus Curved Shears - technical note.

Precise and safe hemostasis is necessary for successful thyroid surgery. In this respect, the advent of the ultrasonic surgical device Harmonic Focus Curved Shears (HFCS) from Ethicon Endo-Surgery constituted a major progress in the domain by its multiple capabilities of dissection, grasping, vessel sealing and transecting. The paper presents the initial experience of 50 cases with this device of a surgical team with special interest in endocrine surgery, mostly thyroid and parathyroid. The thyroid conditions for which surgery was indicated were: diffuse toxic goiter in 8 patients; multinodular toxic and nontoxic goiter in 30 patients; autonomous nodule in 2 patients; 2 patients with benign nodules at fine needle aspiration biopsy (FNAB); 4 patients with nodules positive for carcinoma at FNAB, among them 2 with unilateral cervical lymph nodes enlargement; 4 patients with highly suspect nodule on FNAB. The types of surgery performed were 4 hemithyroidectomies and 46 total thyroidectomies, 2 in association with unilateral functional neck dissections. We had 4 intraoperative hemorrhagic incidents, all in the first 15 cases and imputable to lack of expertise and improper usage of the device. We registered the following noticeable postoperative complications: 1 cervical hematoma from an arteriolar source in sternothyroid muscle demanding prompt reintervention; 8 hypocalcemias and 2 vocal cord paresis, none of which permanent. We remarked several advantages with HFCS: no necessity of changing instruments, fluentness of the intervention and more comfort for the operating team, reduced operating time, safe hemostasis. Some important tips and tricks with the usage of the instrument are presented.

Imaging techniques to evaluate the response to treatment in oncology: current standards and perspectives.

Response evaluation in solid tumours currently uses radiological imaging techniques to measure changes under treatment. Imaging requires a well-defined anatomical lesion to be viewed and relies on the measurement of a reduction in tumour size during treatment as the basis for presumed clinical benefit. However, with the development of anti-angiogenesis agents, anatomical imaging has became inappropriate as certain tumours would not reduce in size. Functional studies are therefore necessary and dynamic contrast enhanced magnetic resonance imaging (DCE-MRI), DCE-computed tomography (CT) and DCE-ultrasonography (US) are currently being evaluated for monitoring treatments. Diffusion-weighted MR imaging (DW-MRI) and magnetic resonance spectroscopy (MRS) are also capable of detecting changes in cell density and metabolite content within tumours. In this article, we review anatomical and functional criteria currently used for monitoring therapy. We review the published data on DCE-MRI, DCE-CT, DCE-US, DW-MRI and MRS. This literature review covers the following area: basic principles of the technique, clinical studies, reproducibility and repeatability, limits and perspectives in monitoring therapy. Anatomical criteria such as response evaluation criteria in solid tumours (RECIST) will require adaptation to employ not only new tools but also different complementary techniques such as functional imaging in order to monitor therapeutic effects of conventional and new anti-cancer agents.

Graves'-Basedow's disease--asthma association. Presentation of five cases.

Thyroid hormones have a non-selective permissive action on adrenergic receptors (including beta 2). Asthma is an immune disease in which some pathological pathways include beta 2 adrenergic receptor blockade. In theoretical terms, that would mean that in hyperthyroidism asthma would ameliorate. In 5 cases with Graves-Basedow's disease--asthma association this phenomenon has not appeared. The similar clinical features and follow-up of these patients suggest a narrow etiopathogenic group. In all cases, asthma has occurred previous to Graves-Basedow's disease, and the thyroid disease has been suspected because of paradoxical aggravation of asthma crises. In all cases the immune thyroid disease appeared in women over 40 years of age (two over 60 yrs). The thyromegaly was diffuse but small (and absent in one case), thyroid hormone levels have been expectedly high (T3 slightly higher than in other cases). No eye proptosis over Werner's 3rd degree has been recorded. The therapeutical problems have been as follows: contraindication of non-selective antitachycardia beta-blockers (we have administered reserpine), contraindication of non-selective adrenergic bronchodilatory agents (we have administered very low doses of aminophylline), early radical antithyroid therapy (we have administered 111-185 MBq of 131I). Thyroid function after 6 mos to 7 years follow-up have been within normal range (except one case who became hypothyroid). The asthma ameliorated early after 131I administration.

Immunochemical assays for an early diagnosis of endemic nephropathy.

Comparative studies aiming at the detection of certain tubular protein elements by means of Ouchterlony's immunodiffusion, in parallel with lysozyme and guanase assays, were carried out in the unconcentrated urines of 746 subjects, of whom 655 apparently healthy inhabitants (mostly children) from a region with endemic nephropathy (EN) and from Bucharest, as well as 91 adults with EN or various other diseases with renal involvement. The presence of light chains, of lysozymuria exceeding 2 microgram/ml, of beta2 microglobulin and of guanase in the urines of children and adults from the endemic area was significantly more frequent than in the control groups. These immunochemical changes are hence considered as valuable criteria for the detection of EN prior to the uremic stage. They should be looked for, first and foremost, in the young relatives of patients with this disease. In the stage of nitrogen retention the diagnostic value of these tests is reduced, since the same changes can also be found in the urines of patients suffering from other diseases with renal involvement, which show nitrogen retention as well.

Effects of DDAVP in cranial diabetes insipidus as compared to other antidiuretic drugs.

Five antidiuretic drugs were administered in each of twenty patients with cranial diabetes insipidus (DI). A daily intranasal dose of 10 microgram DDAVP (Adiuretin) produced longer and stronger antidiuretic effects than the posterior pituitary snuff, containing 100 microgram AVP, and than 12.5 microgram synthetic LVP spray, but a shorter antidiuresis than 12.5 microgram vasopressin tannate in oil, administered intramuscularly, antidiuresis lasting 14, 6, 4 and 36 hs respectively. Chlorpropamide produced an inconstant and less potent antidiuresis. 10microgram DDAVP given per nostril twice a day cancelled completely and without side effects DI in five patients with bronchospastic reaction to-pituitary snuff; the same daily dose was sufficient for the safe treatment of two DI women along pregnancy and lactation periods. It is recommended to use DDAVP as elective drug for the treatment of cranial DI.