SURGICAL MANAGEMENT OF THE ADRENAL GLAND TUMORS - SINGLE CENTER EXPERIENCE.

CONTEXT: Incidentally discovered solid adrenal tumors must be evaluated from two points of view: the risk of malignancy and the secretory feature. OBJECTIVE: Our aim was to evaluate the surgical technique option in relation with clinical and histopathologic features. DESIGN: We performed a retrospective study that included patients with adrenal gland tumors. SUBJECTS AND METHODS: All patients were operated between 2012 and 2019 by the same surgical team in a single center. RESULTS: The batch included 102 patients with adrenal tumors operated through open surgery (OS, n=41) and laparoscopic surgery (LS, n=61). Tumor localization was especially on the right adrenal gland (n=52, 50.98%). Primary origin of the adrenal gland tumors was in 82 cases (80.39%) and a metastatic origin in 16 cases. Average dimension for surgical resected tumors was 4.02 cm (0.9-12 cm) for the LS group as compared to 7.22 cm (1.3-19 cm) for OS group with a predominant type of surgery represented by adrenalectomy and a conversion rate of 2.94%. The hospital stay was 7.22 days (5-12 days) in the LS group versus 12.72 days (6-57 days) in OS group with significant differences (p<0.01). Also, the postoperative recovery was significantly different (6.5 days versus 2.62 days, p<0.01). CONCLUSION: Laparoscopic approach represents the gold standard in adrenal gland tumors less than five centimeters in size. Adrenalectomy is mostly performed by LS and adenoma is the most frequent histopathologic type, while pheochromocytoma is operated through OS. LS has a significantly reduced hospitalization and postoperative stay compared to OS.

Cortical activation and lamina terminalis functional connectivity during thirst and drinking in humans.

The pattern of regional brain activation in humans during thirst associated with dehydration, increased blood osmolality, and decreased blood volume is not known. Furthermore, there is little information available about associations between activation in osmoreceptive brain regions such as the organum vasculosum of the lamina terminalis and the brain regions implicated in thirst and its satiation in humans. With the objective of investigating the neuroanatomical correlates of dehydration and activation in the ventral lamina terminalis, this study involved exercise-induced sweating in 15 people and measures of regional cerebral blood flow (rCBF) using a functional magnetic resonance imaging technique called pulsed arterial spin labeling. Regional brain activations during dehydration, thirst, and postdrinking were consistent with the network previously identified during systemic hypertonic infusions, thus providing further evidence that the network is involved in monitoring body fluid and the experience of thirst. rCBF measurements in the ventral lamina terminalis were correlated with whole brain rCBF measures to identify regions that correlated with the osmoreceptive region. Regions implicated in the experience of thirst were identified including cingulate cortex, prefrontal cortex, striatum, parahippocampus, and cerebellum. Furthermore, the correlation of rCBF between the ventral lamina terminalis and the cingulate cortex and insula was different for the states of thirst and recent drinking, suggesting that functional connectivity of the ventral lamina terminalis is a dynamic process influenced by hydration status and ingestive behavior.

Reduced connectivity of the auditory cortex in patients with auditory hallucinations: a resting state functional magnetic resonance imaging study.

BACKGROUND: Previous research has reported auditory processing deficits that are specific to schizophrenia patients with a history of auditory hallucinations (AH). One explanation for these findings is that there are abnormalities in the interhemispheric connectivity of auditory cortex pathways in AH patients; as yet this explanation has not been experimentally investigated. We assessed the interhemispheric connectivity of both primary (A1) and secondary (A2) auditory cortices in n=13 AH patients, n=13 schizophrenia patients without auditory hallucinations (non-AH) and n=16 healthy controls using functional connectivity measures from functional magnetic resonance imaging (fMRI) data. METHOD: Functional connectivity was estimated from resting state fMRI data using regions of interest defined for each participant based on functional activation maps in response to passive listening to words. Additionally, stimulus-induced responses were regressed out of the stimulus data and the functional connectivity was estimated for the same regions to investigate the reliability of the estimates. RESULTS: AH patients had significantly reduced interhemispheric connectivity in both A1 and A2 when compared with non-AH patients and healthy controls. The latter two groups did not show any differences in functional connectivity. Further, this pattern of findings was similar across the two datasets, indicating the reliability of our estimates. CONCLUSIONS: These data have identified a trait deficit specific to AH patients. Since this deficit was characterized within both A1 and A2 it is expected to result in the disruption of multiple auditory functions, for example, the integration of basic auditory information between hemispheres (via A1) and higher-order language processing abilities (via A2).

[Liquid medium for culturing Neisseria gonorrhoeae]. / Mediul lichid pentru cultivarea Neisseriei gonorrhoeae.

An original fluid medium, containing lactalbumin hydrolysate, developed for the cultivation of gonococci is described. The medium is cheap, readily prepared, efficient insuring appraisable multiplication of the microorganism, and can be stored for a long time. In the authors' experience subculture in fluid medium is preferable to other methods used for testing sensitivity to antibiotics.

Complete atrio-ventricular block due to cardiac echinococcosis.

A 33-year-old man presented a complete antrio-ventricular block due to two hydatid cysts localized in the interventricular septum and interrupting both bundle branches. Intracardiac rupture within the right ventricle led to extensive pulmonary hydatidosis and death.

[Thyroid radiography and thyroid lymphography]. / Tiroidografia si tiroidolimfografia.

A detailed representation is made of the technique used in the performance of thyroidography and an analysis is carried out of the authors' personal experience Thyroidography and thyroido-limphography have been applied in 40 patients with various diseases of the thyroid gland. The authors evaluate the method as being simple to perform, accessible, well tolerated and capable to provide significant morphological data (size of the lobes, the presence of retrosternal thyroid tissue, structure of the gland), also allowing for visualization of the cervical limph-nodes.

Accelerated atrioventricular conduction during acute myocardial infarction.

Three cases are described in which accelerated atrioventricular conduction occurred during an acute myocardial infarction. The first patient, an 82-year-old woman, developed a WPW syndrome suggesting posterior right ventricular preexcitation, a pattern which persisted for four months until her death. An accessory bundle was found on autopsy. Fibrotic changes, associated with acute lesions (hemorrhage, polymorphonuclear infiltrates) were present in the atrioventricular node and His-Purkinje system. Two men, of 47 and 74 years, developed a short PR interval associated with supraventricular tachycardia during the course of an acute myocardial infarction. The PR interval returned to its initial value in one case and remained unchanged for three months in the other. Accessory atrioventricular connections which became functional during myocardial ischemia may explain the various electrocardiographic patterns of preexcitation.

[Immunopathological circumstances in the structure of complications appearing after smallpox vaccination]. / Circumstante imunopatologice în structura accidentelor survenite dupa vaccinarea antivariolica

Investigations were carried out concerning the dynamics of antivaccinal antibodies and the structure of serum proteins in relation to the clinical manifestations following upon smallpox vaccination. In general, immunity is not apparently influenced by postvaccinal complications may be associated with immunoprotein perturbations, manifested by an increase in the alpha2-globulin fraction and, inconstantly, in the gamma-globulin fraction. Immunoelectrophoretic determinations revealed a relatively constant IgM and IgG deficiency. Postvaccinal dysglobulinemia may accompany various clinical forms, suggesting a temporary deficient immunological response. In one case of agammaglobulinemia, revaccination produced a deep vaccinal ulcer, with extensive necrosis (giant necrotic vaccinia). In order to decipher the substrate of the reaction in the clinical forms with distal manifestations or generalized vaccinia, skin biopsies were performed. The lesional vasculoallergic substrate of the skin lesions does not exclude the local aggression of the vaccinal virus, which was isolated by viral determinations.

An unusual case of reno-vascular hypertension with multiple arterial stenosis.

A case of juvenile reno-vascular hypertension is presented. Extensive involvement of aorta and its branches was found. The possible inflammatory or congenital origin of the arterial lesion is discussed.