Primary sellar esthesioneuroblastoma.

We describe an extremely rare case of a primary intrasellar esthesioneuroblastoma.

Sequential IV/PO moxifloxacin treatment of patients with severe community-acquired pneumonia.

BACKGROUND: IV/PO moxifloxacin was evaluated in the treatment of hospitalized patients with severe community-acquired pneumonia (CAP). METHODS: Data were pooled from two prospective, randomized studies. In the multinational study, patients received 7-14 days IV/PO moxifloxacin 400 mg QD or IV/ PO amoxicillin clavulanate 1200/625 mg TID +/- IV/PO clarithromycin 500 mg BID. In the North American study, patients received 7-14 days IV/PO moxifloxacin 400 mg QD, IV/ PO alatrofloxacin/trovafloxacin 200 mg QD, or IV/PO levofloxacin 500 mg QD. The primary endpoint was clinical success at the test-to-cure visit. Severe CAP was defined according to the 1993 ATS criteria. RESULTS: In the clinically valid population, clinical success rates were 88% (167/190) for moxifloxacin- and 83% (155/186) for comparator-treated patients (95% CI = -1.9%, 12.2%). Corresponding clinical success rates for the microbiologically valid population were 87% (59/68) and 84% (54/64), respectively (95% CI = 8.6%, 15.0%). A switch from IV to PO therapy was made by day 5 of therapy for 73% of moxifloxacin- vs. 60% of comparator-treated patients (P < 0.01). Clinical success rates were similar in a retrospective analysis using the revised 2001 ATS definition of severe CAP. Mortality rates were 6% (15/241) and 10% (24/238) in the moxifloxacin and comparator treatment groups, respectively. The incidence of drug-related adverse events was similar in both treatment groups. CONCLUSION: Sequential IV/PO moxifloxacin 400 mg QD is as safe and effective as other fluoroquinolones and a beta-lactam/macrolide combination for treating hospitalized patients with severe CAP.

Epidemiological, forensic, clinical, and imaging characteristics of head injuries acquired in the suicide attempt with captive bolt gun.

The captive bolt gun (slaughterer's gun) is a tool used in the meat industry for "humane killing" of animals. Used with the intent of suicide, the captive bolt gun causes very serious injuries. We analysed 19 self-inflicted head injuries with captive bolt gun during the past 20 years. Autopsy of 20 pigs killed by this method was also performed. All 19 cases were middle-aged men from rural areas, with low level of education, and without a previous psychiatric history. Five of them used the captive bolt gun daily in their professional activities, while the remaining 14 handled it only sometimes. In seven cases suicide was primarily successful, while in five patients, despite intensive medical care, serious craniocerebral injuries eventually resulted in death. Total mortality was 63.2%. The clinical appearance of the entrance wound and the imaging characteristics of the cranial trauma are very specific, and can be easily differentiated from firearm or other penetrating injuries. These wounds were always primarily infected with mixed bacterial flora from the skin. Therefore, besides radical primary wound care, especially of the wound canal with removal of foreign bodies, it is important to administer high doses of wide spectrum antibiotics.

Neuroendocrinological aspects of primary empty sella.

Neuroendocrinological aspects of 42 patients (33 women, 9 men) with primary empty sella confirmed by CT, cysternography and/or MR imaging were analyzed. The prominent symptoms were headache, visual disturbances and hypertension, occurring primarily in obese women (84.5%). Patients underwent dynamic endocrine testing consisting of insulin-induced hypoglycemia and anterior pituitary stimulation tests GnRH and TRH. Variable degree of pituitary dysfunction was observed in 28 (66.6%) patients. In this study 20 (47.6%) patients were presented with latent hypopituitarism, while manifest hypopituitarism, requiring replacement therapy, occurred in 8 (19%) patients. Mild hyperprolactinaemia was found in 3 patients. Even 14 (33.3%) patients had no evidence of endocrine dysfunction. Often mentioned diabetes insipidus and rhinoliquorrhea were not reported in this study.

Chiasma syndrome in acromegalic patients--correlation of neuroradiologic and neuroophthalmologic findings.

The study evaluated neuroophthalmologic and computerized tomography (CT) findings in 100 patients with somatotrophic adenoma and clinical picture of acromegaly, who underwent transsphenoidal adenomectomy. Prior to the surgery, visual field was normal in 77 patients. The diameter of adenoma in these patients ranged from 8 to 30 mm on CT, and the average value was 13.5 mm. Various kinds of visual field disturbances were present in 23 patients. The diameter of their adenomas ranged between 18 to 35 mm, with the average of 24.7 mm. Compared to visual field defects, CT findings of suprasellar adenoma extension were better correlated with chiasma syndrome (p < 0.001). All patients with suprasellar mass greater than 10 mm had chiasma syndrome. Degenerative adenoma changes (hemorrhagic necrosis), which precipitate abrupt increase in size of the tumor, were more frequently seen in patients with chiasma syndrome. The incidence of chiasma syndrome directly correlates with the degree of suprasellar extension of the tumor.

Lymphocytic adenohypophysitis simulating a pituitary adenoma in a pregnant woman.

The lymphocytic hypophysitis, appearing in women during the third trimester of pregnancy or early post-partum period, is a rare cause of hypopituitarism and pituitary enlargement. A 39 year-old woman presented in the 37th week of pregnancy with bilateral heteronymous quadrantanopsia, CT indicative of tumorous mass and symptoms of hypopituitarism with decreased thyroid hormone and thyrotrophin levels, and low normal level of cortisol. After the birth of a healthy male child the patient breastfed for 10 days, sight disturbances disappeared, but amenorrhea persisted. Upon admittance the visual field showed no abnormalities. MR of the sellar region confirmed previous CT findings. Endocrinological testing confirmed secondary hypothyroidism and cortisol deficiency, normal levels of prolactin with satisfactory reaction to thyroliberin. Histology showed mononuclear infiltration, and immunohistochemistry revealed T-cells (CD3) at the borders, and B-cells (CD20) in the follicular center. Due to enlargement of the pituitary associated with hypopituitarism, an incorrect diagnosis of a tumor could be made.

Comparative immunohistochemical analysis of estrogen receptor and chromogranin-A reactivity in plurihormonal human prolactinomas.

The aim of the study was to compare the immunoreactivity of estrogen receptors (ER) and chromogranin-A (CHR-A) in human prolactinomas with verified plurihormonality. Eleven cases of prolactinomas, nine found in women aged from 15-32 and two found in two men both aged 54 years, were analyzed for possible colocalization of other hormones produced by adenohypophysis, i.e. growth hormone (GH), thyroid-stimulating hormone (TSH), follicle-stimulating hormone (FSH) and adrenocorticotropic hormone (ACTH). All evaluated cases of prolactinomas were clinically manifested by elevated values of prolactin (PRL) in patient serum, while the values of other assayed hormones were within the normal range. Although biopsy material is not routinely submitted to immunohistochemical analysis for plurihormonality, these eleven cases of operated prolactinomas were randomly examined to the presence of plurihormonality. In six cases of prolactin-producing adenomas, the coexistence of growth hormone was detected. Colocalization of follicle-stimulating hormone and weak expression of adrenocorticotropic hormone were found in two cases each. Thus, bihormonal activity (PRL + GH) was found in six, and trihormonal activity (PRL + GH + FSH and PRL/GH + ACTH) in three cases of prolactinoma. In addition, the presence of prolactin and growth hormone was demonstrated in morphologically different cells. Eight of these eleven pituitary adenomas were tested for estrogen receptors (ER), which play an important role as growth stimulating factors and secretory factors for prolactin-producing cells. We tried to determine if there was a difference in the intensity of expression of estrogen receptors and chromogranin-A between pure prolactinomas and mixed, plurihormonal prolactinomas. By use of monoclonal antibodies, chromogranin-A found to be reactive in seven of eleven prolactinomas, i.e. in plurihormonal prolactinomas. Estrogen receptors were markedly expressed in all the eight prolactinomas analyzed, which may prove significant in the treatment of these hypophyseal tumors.

Dexamethasone partially protects the myometrium against beta-adrenergic agonist-induced desensitization in vivo in the rat.

OBJECTIVE: Our purpose was to determine the ability of dexamethasone to prevent the onset of myometrial desensitization to beta-adrenergic agonists in vivo. STUDY DESIGN: On day 5 post partum chronically catheterized rats were randomized to receive either dexamethasone or corn oil (vehicle), followed 12 hours later by a continuous infusion of either isoproterenol or saline solution (vehicle). Uterine contractions were monitored throughout. We measured myometrial glucocorticoid receptor levels in chronically catheterized and sham-operated rats and beta 2-adrenergic receptor densities in the experimental rats before and during the infusions. RESULTS: Surgery did not lead to any decrease in glucocorticoid receptor number. Dexamethasone significantly increased the duration of myometrial responsiveness to isoproterenol compared with vehicle-pretreated rats, although agonist-induced down-regulation of beta-adrenergic receptor number was not prevented. CONCLUSION: Dexamethasone partially protects the rat myometrium from desensitization induced by the continuous infusion of beta-adrenergic agonists through mechanisms independent of the beta 2-receptor.

[Phagocytic activity in rheumatoid arthritis]. / Fagocitna aktivnost u reumatoidnom artritisu.

The phagocytic activity of leukocytes was studied in 41 patients with active rheumatoid arthritis, 24 of whom were treated with gold compounds and the remaining 17 with non-steroidal anti-inflammatory drugs. The control group comprised 137 patients with no signs of inflammatory rheumatic diseases. The mean age of patients was 54.8 years (range: 32-75) and that of the controls, 53.5 years (range: 32-75). Spontaneous mobility (P < 0.001), phagocytic activity (P < 0.001) and antibody-dependent cytotoxicity (P < 0.001) of leukocytes were significantly lower in patients with rheumatoid arthritis compared to the control group. No significant differences were observed between patients treated with gold compounds and those receiving nonsteroidal anti-inflammatory drugs with respect to mean spontaneous mobility (U = 198, P = 0.44), phagocytic activity (U = 185, P = 0.31) and antibody-dependent cytotoxicity (U = 183, P = 0.29) of leukocytes. Among patients treated with gold compounds phagocytic activity was significantly lower in those receiving TauredonR compared to those receiving AuropanR (U = 33.5, P = 0.05). The antibody-dependent cytotoxicity was comparable in patients receiving Tauredon and Auropan, respectively (U = 58.5, P = 0.48).

Relationship between finger and wrist deformities in rheumatoid arthritis.

Ulnar deviation of fingers in rheumatoid arthritis is known to be very frequently associated with the radial deviation of the hand. The present study was undertaken to test the hypothesis that there is a significant correlation between the position of the wrist and metacarpophalangeal angulation in common rheumatoid hand deformities. Measurements were carried out on standard radiographs of the hands from two comparative groups: 50 adult patients (100 hands) with classical or definite rheumatoid arthritis and the control group of 40 adults (80 hands) suffering from no rheumatoid arthritis but coming for routine check up relating to some degenerative diseases. The results showed a statistically significant relationship between finger and wrist deformities in patients with rheumatoid arthritis but not in normal controls.

[Evaluation of the use of the CO2 laser in 134 patients with expansive processes in the central nervous system]. / Evaluacija primjene CO2--lasera na 134 bolesnika s ekspanzivnim procesima CNS-a.

The laser began to be used in neurosurgery towards the end of the 60s. The early experience of their clinical use did not promise much; but from the first half of the 70s with the improvement of the laser and the accumulation of laboratory and clinical experiences, the new technology began irrepressibly to spread throughout the world. Three lasers are in use today: CO2, ND.YAG and Argon laser. Each one of them, due to their different wave length and electromagnetic radiation, gave separate characteristics of employment, i.e., the interaction between the biologic tissues and the radiation is different. Depending upon the type of intraoperative needs we will choose one of the lasers. Presently the CO2-laser is the most used in neurosurgery due to its characteristics of low penetration into the tissue and the vaporization of the tissue which is exposed to the radiation. That is why such a laser (Sharplan 1060) has been acquired by our clinic. During one year we performed 134 operations due to expansive processes in the CNS with a partial or complete use of the laser during every phase of the operation. The accumulated experiences showed that the laser is a fairly useful new tool during the various surgical situations with a wide use of the everyday work of the neurosurgeon; with its implementation we have significantly improved the surgical technique in the tumors of the CNS, both in terms of radicality as well as in sparing the healthy tissue. We believe that the laser has an absolute indication in all the glioma tumors regardless of the localization, thereafter in all remaining tumors which are not extremely supplied by blood, while at the same time reducing the time needed for the surgical procedure. In time we spread the use of the laser on arteriovenous malformations as well, which, until now, has not been suggested in literature. Our results on 4 smaller superficial angiomas fully justified the use of a laser in such cases. But it also showed us that generally the laser is still a fairly unresearched surgical innovation, and that in the future wil bring about the wider implementation of this technology in the neurosurgical operating rooms. The final results of our operations and the experiences the other neurosurgical centers in the world that use the laser, regardless of which kind have justified investment of this new surgical technology.