Pituitary apoplexy during pregnancy: a rare, but dangerous headache.

Pituitary apoplexy is a rare endocrine emergency that occurs in a small number of patients with a pituitary tumor. It is a clinical syndrome characterized by the sudden onset of headache, nausea, vomiting, visual impairment, and decreased consciousness, caused by hemorrhage and/or infarction of the pituitary gland. Pituitary apoplexy has very rarely been described during pregnancy, when it is potentially life-threatening to both the mother and the fetus, if unrecognized. Only a few cases have been published to date. The review of the existing literature underlines that pituitary apoplexy, although rare, should be borne in mind when a pregnant woman presents with severe headache and visual defects of sudden onset. After initial management, which includes intravenous glucocorticoid therapy, fluid and electrolyte replacement, the final selection of medical or surgical treatment should result from a multidisciplinary approach involving expert specialists, keeping into account both severity of clinical presentation and gestational week.

Chromoblastomycosis: a review of 100 cases in the state of Rio Grande do Sul, Brazil.

BACKGROUND: If not diagnosed earlier, chromoblastomycosis has a chronic evolutional course that may cause several problems, such as difficulty in managing therapy because of the recrudescent character of the disease, potential association with the growth of epidermoid carcinoma in affected regions, and poor quality of life and work incapacity to the patient. Although infrequent, new cases are reported in the state of Rio Grande do Sul every year, ratifying the necessity for further studies on this disease. OBJECTIVE: The purpose of this study was to review clinical features and response to therapy in patients with chromoblastomycosis and present data on the demography and history of this disease in the state of Rio Grande do Sul, Brazil. METHODS: We reviewed case records of 100 patients with skin lesions caused by chromoblastomycosis, who were treated between 1963 and 1998. The cases were confirmed by the histopathologic and mycologic analyses made by the Dermatology Service of the Universidade Federal do Rio Grande do Sul at the Santa Casa de Misericórdia Hospital. RESULTS: There was a predominance of male patients (4:1) and of white farmers whose ages ranged from 50 to 59 years, with lesions on their lower limbs. Most of them were from the northern regions of the state. The average time between the appearance of the disease and medical diagnosis was 14 years. The verrucous type proved to be the most frequently reported lesion (53%). Thorn wounds were associated with the disease in 16% of the cases. Lesions uncommon to some parts of the body were also reported. In two of the cases, cutaneous lesions caused by paracoccidioidomycosis and chromoblastomycosis were found in the same patient. Epidermoid carcinoma was found in the same parts of the body affected by chromoblastomycosis. Eumycotic mycetoma and chromoblastomycosis were associated. Fonsecaea pedrosoi was found in 96% of the cases, and Phialophora verrucosa in 4% of the cases. CONCLUSION: In our study, we observed a predominance of cases in the regions of Missões and Alto Uruguay, followed by the upper and lower northeastern slopes and the lowlands. Severe cases of chromoblastomycosis with intense skin involvement (eg, lesions with carcinoma) were observed. Statistical analysis showed recrudescence of the disease in 43% of cases despite the treatment used.

[The 3rd national workshop on defecography: the functional radiology of (neo) rectal ampullae (ileal reservoir, colo-anal anastomosis, continent perineal colostomy)]. / III workshop nazionale sulla defecografia: la fisioradiologia delle (neo)ampolle rettali (reservoir ileale, colo-ano-anastomosi, colostomia perineale continente).

A survey was made in 13 Italian centers with a questionnaire concerning the (a) indications, (b) postoperative complications, (c) functional results and (d) diagnostic imaging modalities related to the making of an ileal or colonic (neo) rectum. Ulcerative colitis (100%), familial polyposis (61.5%) and Crohn's disease (15.3%) were the most common indications for an ileal pouch; rectal cancer (7.96%), chronic inflammatory diseases (15.3%), diverticulosis, rectal prolapse, redundant colon and imperforate anus (7.6% each) were the most common indications for a colonic pouch. Postoperative complications included pelvic abscess (14%), sinus tract/dehiscence (10%) and bowel obstruction (9%). When compared with the S and W variants, the J-shaped ileoanal pouch proved superior because urgency and fecal retention rates were lower (18.4% vs. 44.4% and 23% vs. 28.6%, p < 0.01 and p < 0.05, respectively), despite slightly more frequent staining episodes (15.8% vs. 11.1%; p < 0.05). As for colonic ampullae, fecal retention and provoked evacuation were more frequent in the J pouch and after gracileplasty; urgency and incontinence in the straight colo-anal anastomosis (33.3% vs. 22.2% and 41.6% vs. 33.3%, respectively). The functional outcome was assessed by anal endosonography (available in 4/13 centers), defecography and anorectal manometry. Abnormal findings included: (a) reduced capacity, barium leakage, anal gaping, sphincter damage (urgency and incontinence); (b) barium retention, pouch dilatation, split evacuation, knobs and strictures (fecal retention).

[A method of image enhancement in the use of hydrosoluble uro-angiographic contrast media]. / Un metodo di ottimizzazione dell'immagine nell'impiego di mezzi di contrasto idrosolubili uro-angiografici.

The radiographic contrast, when using hydrosoluble uro-angiographic contrast media, depends on several factors. A phantom and a new method are proposed to assess and optimize the contrast. The phantom allows to simulate three pseudovessels with diameter of 2 mm, 5 mm, and 10 mm, placed in a water-equivalent layer of 20/cm thickness. The phantom is exposed to a photon beam produced by a conventional X ray tube, and the images are obtained using conventional screen film system. The aim of the study is to assess the radiographic contrast between the vessel and the background when modifying the optical density of the radiograph (by different settings of the mAs switching), the X-ray tube high voltage and the diameter of the vessels; the contrast was studied with four different contrast media (Uromiro 24%, Conray 36%, Iopamiro 300 and Iomeron 400) and three X-ray tube high voltages (60 kV, 80 kV, 100 kV). The curve fitting the contrast as a function of the optical density of the background (in each condition of high voltage, diameter of the vessel and contrast media used) is a parabola. A quite narrow distribution of abscissas of the maxima of the parabolas was found, ranging from the minimum optical density 1.21 in the case of 100 kV high voltage and 2 mm diameter to the maximum optical density 1.58 in the case 60 kV and 10 mm. The mean value (1.40) is proposed as the optical density of the background optimizing the contrast according to the screen-film system used. In conclusion, the authors suggest to optimize the use of contrast media, trying to obtain radiographs with an optical density approaching the optimal value in any clinical situation. Therefore tables of the settings of the X-ray tube and generator are required; the tables must take into account the main parameters influencing the settings, such as the source-film distance, the water-equivalent thickness of the patient and the film-screen system used.

[Neonatal encephalitis caused by herpes simplex: immunohistochemical diagnosis of a case]. / Encefalite neo-natal pelo vírus do herpes simplex: diagnóstico imuno-histoquímico de um caso.

The authors report the case of a female newborn infant, who had seizures and vesicles at the nose and inferior lip since the fifth day of life. CSF changes suggested an encephalitis. Signs of neurologic and respiratory deterioration were followed by death. Partial cranial autopsy showed a necrohemorrhagic temporal encephalitis without intranuclear inclusions. Immunohistochemical examination by the avidin-biotin-peroxidase technique with polyclonal antibodies against Herpes simplex type 1 and type 2 was positive to type 2 Herpes simplex virus.

[Diseases detected with defecographic examination in 300 patients]. / Malattie riscontrate tramite esame defecografico su 300 pazienti.

Defecography is a radiological examination providing morphological details of the anorectal tract. Over almost 3 years, 300 patients were examined. The authors report on the method and the pathologic conditions they observed. The patients were seated in latero-lateral position on a radiolucent water-filled commode: lead marks were taped to define perianal skin. 150 ml of high-density barium paste were introduced into the rectum and radiographs were then acquired, at rest and during squeezing and straining. All examination phases, especially the study of dynamic evacuation, were recorded on a videotape connected to a brilliance intensifier. From their experience, the authors conclude that defecography is a valuable tool in the diagnosis and evaluation of: rectocele, occult rectal prolapse, and elevator ani tone. The technique proved less useful in the evaluation of fecal incontinence. The authors strongly suggest that the patient be previously examined by a coloproctologist. Defecography is thought to help the surgeon in the choice of therapy, together with other diagnostic procedures and with clinical history.

[Comparison of the results obtained using 99mTc HM-PAO tomoscintigraphy and computer tomography in ischemic lesions of the brain]. / Confronto tra i risultati ottenuti con la tomoscintigrafia con 99mTc HM-PAO e con la TC nelle lesioni ischemiche cerebrali.

Fifty patients suffering from cerebral ischemic attacks, transient or not, were studied with both 99mTc HM-PAO single photon emission computed tomography (SPECT) and computed tomography (CT). In 31 patients both SPECT and CT showed pathologic areas, the max diameters of which were measured on CT images and SPECT orbitomeatal reconstructed sections, and then compared. We observed that: only SPECT images are positive for pathologic conditions in transient ischemic attacks and in the very early phases of infarctions; in recent infarctions (less than 15 days earlier) both SPECT and CT scans are positive but SPECT lesion areas are greater than CT ones; pathologic areas, with clear-cut outlines, having the same dimensions on both CT and SPECT images, are supposed to result from old static infarctions. A persistent perilesional hypoactive area on SPECT images means, in our opinion, a hypoperfusional area liable to new vascular troubles; in which case, medical/surgical therapy seems necessary.