[Primary empty sella syndrome. Report of 6 cases]. / La sindrome della sella vuota (empty sella sindrome) primitiva. Considerazioni a proposito di sei casi.

The extension of the suprasellar subarachnoid space through an incompetent diaphragma sellae into the sella turcica is defined as empty sella syndrome (ESS). The primary form arises in the absence of previous pituitary surgery or irradiation. Predominance of obese, middle aged, often multiparous women are generally observed; clinically headaches and slight endocrine alterations are frequent but not characteristic symptoms. Rarely liquor rhinorrhea or visual campimetric defects may occur. The authors report six cases observed in their Departments of Internal Medicine during the last two years; they discuss the aspecific symptoms of presentation and the associated pathologic conditions. Standard skull X rays were negative in half the cases showing the overall poor sensitivity of this examination in detecting ESS. According to the literature no evident abnormality of hypophyseal basal hormone levels was found. Diagnosis was done by high resolution TC or MR which now must be preferred to pneumoencephalography (PEG). Three patients had peculiar pathologic conditions associated with ESS: a very high suspicion of partial insipidus diabetes was made in a man with hypo-osmolar polyuria; one patient without related humoral symptoms had a duodenal carcinoid endoscopically removed and in another primary ESS was associated with Hashimoto thyroiditis. These last two pathologies were never related before associated to primary ESS. The authors conclude that primary ESS is most often a diagnosis made by serendipity, lacking specific signs and or symptoms, whenever an imaging technique (TC or MR) is employed for detecting an unrelated endocranic pathology or the content of an enlarged sella turcica.

[Seroprevalence of HIV-1 virus in Zaire. Analysis of 1404 subjects]. / Séroprévalence du VIH1 au Zaïre. Analyse chez 1,404 sujets.

Between January and December 1989, 1,404 subjects (mean age 26 years) admitted or seen at the out-patient clinic of the hospital of Goma, Northern Kivu, were investigated for anti-HIV 1 antibodies by the ELISA and Western blot techniques. Seventy-eight out of 808 men (10 percent) and 127 out of 596 women (21 percent) were seropositive. Anti-HIV1 antibodies were found in 14/631 blood donors (2 percent), 25/241 in-patients awaiting blood transfusion (10 percent), 3/42 women hospitalized for complications of pregnancy (7 percent), 130/388 subjects with signs and/or symptoms of HIV1 infection (33 percent) and 33/102 patients with tuberculosis (32 percent). The difference in seropositivity between men and women was statistically significant. A significantly high seroprevalence was found in men who were having regular sexual intercourse with prostitutes (42/167 = 25 percent, P less than 0.01) and in subjects with a history of sexually transmitted disease during the last 5 years (64/180 = 36 percent, P less than 0.01), compared with subjects who had none of these risk factors. The installation of a blood bank where blood products are controlled has contributed to the reduction of HIV1 transmission throughout the town. The foundation of an association of unpaid voluntary blood donors recruited among secondary school students has been another educative measure in the anti-AIDS national plan.