Abscesos hipofisarios: estudio de siete casos / Pituitary abscesses: study of seven cases

Introducción Los abscesos hipofisarios son una causa rara de disfunción hipofisaria, cuyo diagnóstico prequirúrgico es difícil. Pacientes y métodos Describimos a 7 pacientes (3 varones y 4 mujeres)estudiados entre 1990 y 2000, con una edad media de 32 años (rango, 20-46). A todos se les realizó analítica hormonal preoperatoria con triple estímulo y/o basal, campimetría y resonancia magnética nuclear. Todos fueron operados por vía transesfenoidal. Resultados Ningún paciente tenía enfermedad hipofisaria previa, y en4 casos hubo antecedentes infecciosos. Todos los pacientes tenían algún déficit hormonal, incluyendo diabetes insípida en 3 casos. Cuatro pacientes tenían defectos en el campo visual. En la resonancia magnética nuclear se observaban masas iso-intensas, con expansión supraselar en6 pacientes, engrosamiento del tallo en 1, realce periférico en 2 y signos de hemorragia en otros 2. En la cirugía se visualizó material purulento, y se confirmó la existencia de absceso en la anatomía patológica. Los cultivos fueron positivos en 3 pacientes: se halló Staphylococcus epidermidis en 2 y S. aureus en 1. Los déficit visuales se resolvieron en 3pacientes y mejoraron en otro. Las alteraciones endocrinas fueron permanentes. Conclusiones Los abscesos son raros pero deben tenerse en cuenta en el diagnóstico diferencial de las masas selares. Aunque su diagnóstico preoperatorio es difícil, la diabetes insípida, el engrosamiento del tallo y la captación periférica del contraste ayudan a diferenciarlos de los adenomas. El tratamiento es quirúrgico y algunos pacientes precisan más de una intervención. La función visual suele recuperarse, y las alteraciones endocrinas son permanentes (AU)

Introduction Pituitary abscesses are an unusual cause of pituitary dysfunction andpresurgical diagnosis is difficult. Patients and methods We describe7 patients (3 men and 4 women) who were studied between 1990 and 2000. The mean age was 32 years (range: 20-46). All patients underwent preoperative hormone analysis with baseline determinations and/or triple-stimulation tests, campimetryand magnetic resonance imaging (MRI)scans. All patients underwent surgery through the transsphenoidal route. Results None of the patients had a history of pituitary disease. Four patients had a history of infection. All patients had some type of hormone deficiency, including diabetes insipid us in 3 patients. Four patients had visual field defects. MRI showed iso intense masses, with suprasellar growth in 6 patients, thickening of the stalk in one, peripheral enhancement in 2 and signs of bleeding in a further 2. During surgery, purulent material was visualized and the existence of the abscess was confirmed by pathological analysis. Cultures were positive in 3 patients; Staphylococcus epidermidis was found in 2 patients and S. aureus in 1. Visual field defects resolved in 3 patients and improved in 1. Endocrine alterations were permanent. Conclusions Pituitary abscesses arerare but should be included in the differential diagnosis of sellar masses. Although preoperative diagnosis is difficult, diabetes insipidus, thickening of the stalk and peripheral contrast uptake help to differentiate these abscesses from adenomas. Treatment is surgical and some patients require more than one intervention. Visual function usually returns to normal. Endocrine alteration sare permanent (AU)

[The importance of parenteral nutrition via the peripheral route in patients with inflammatory bowel diseases (IBD)]. / Importancia de la nutrición parenteral por vía periférica en pacientes con enfermedades inflamatoria intestinal (EEI).

The objective of the present study is to evaluate the effects of peripheral parenteral nutrition (PNN) in a homogeneous group of patients who had not had surgery, and to determine whether the deterioration of the nutritional state can be avoided while keeping the advantages of the administration of a peripheral route. We have included 7 patients (4 male and 3 female) with an acute episode of inflammatory bowel disease (IBD). Each received 1780 kcal/day (1500 non-protein kcal 66% as fats, and 33% as glucose), with a kcal/g of N ratio of 160 by means of the preparation technique of "all in one". The anthropometric parameters: initial and final weight (58.5 +/- 12 vs. 57.3 +/- 11); triceps skin fold (14.1 +/- 4 vs. 14.1 +/- 4), and mean circumference of the arm (25.1 +/- 3 vs. 25.0 +/- 3), did not give any significant differences during the treatment period. In the biochemical data there were no significant differences either, except for the final level of serum albumin (3.44 +/- 0.28), which was significantly higher than the initial value (3.11 +/- 0.38) (p < 0.05). The mean duration of the treatment was 12 days (range 6-18). There was no case of phlebitis.(ABSTRACT TRUNCATED AT 250 WORDS)