[Why aren't Leydig cell tumors of the ovary diagnosed in time?]. / Zasto se tumor Leydigovih celija ovarijuma ne dijagnostikuje na vreme?

INTRODUCTION: Leydig cell tumor is a rare sex-cord tumor with sex steroid secretion (mostly testosterone). All clinical symptoms and signs are the consequence of extremely high testosterone level. The diagnosis is confirmed using hormone analysis. CASE DESCRIPTION: A 46-year-old woman with previously normal reproductive function was admitted to the hospital due to hirsutism, temporal hair loss, hoarse voice, increased libido, amenorrhea and clitoromegaly. The examination revealed hirsutism score 36 and signs of defeminization and virilisation. Basal testosterone levels were extremely high before operation, while follicle stimulating hormone and luteinizing hormone were suppressed. Androstenedione was above normal level, while other hormones were normal. Testosterone increased twice in response to Pregnyl. In regard to dexamethasone test there was no response of testosterone, indicating a virilizing ovary tumor. The ultrasound of pelvis was normal. Intraoperatively, a solid 2.3 cm Leydig cell tumor was diagnosed. Testosterone decreased promptly. CONCLUSION: This study points to a long-term diagnostic procedure in Leydig cell tumor detection and effects of endogenous testosterone secretion on hypothalamic-pituitary-ovarian axis.

Pituitary adenomas secreting large amounts of prolactin may give false low values in immunoradiometric assays. The hook effect.

Immunoradiometric assay (IRMA) for serum prolactin (PRL) measurement can give falsely low values, leading to unnecessary surgery in patients with prolactinomas. We studied clinical and biochemical features of patients with pituitary macroprolactinomas in whom plasma PRL levels had been underestimated due to the so-called "high dose PRL hook effect". This phenomenon was observed in four (14.2%) out of 28 patients with pituitary macroadenomas (13 macroadenomas) and 15 non-functioning macroadenomas) reffer during one-year period. Undiluted median (range) PRL levels were 11.3 (3.0-48.7), 983.9 (194.4-1959.4), and 96.9 (66.6-147.7) micrograms/l in patients with non-functioning macroadenomas, macroprolactinomas and the hook effect adenomas, respectively. In all patients assay was performed after serum dilution, and only in patients with the hook effect the median PRL levels increased significantly to 5795.0 (2097.2-12722.2) micrograms/l. The mean age at diagnosis was 38 +/- 6.5, 45 +/- 6, and 53 +/- 3 yr, for the patients with the hook effect, macroprolactinoma and non-functioning adenoma, respectively. Males were predominant (75%) in the hook effect adenoma group. Patients with the hook effect macroprolactinomas were all treated successfully with dopamine agonists, and all patients had significant shrinkage of the tumor mass (more than 50% shrinkage). In conclusion, this study suggests that patients with high dose PRL hook effect are generally younger, more frequently males with very large pituitary adenomas (grade III-IV according to Hardy). It is necessary, whenever performing IRMA for serum prolactin measurement, to dilute samples routinely (1:1 and 1:10 dilutions) in every patient with pituitary tumor.

A simple morphological score for the quality control of platelet concentrates.

The percentage of platelets that retain discoid form correlate with their post-transfusion viability and therefore they may act as a simple indicator for the quality of the stored platelet concentrates (PCs). The morphological score (MS) of platelets, given by Kunicki, requires the index of different forms of platelets: discoid, spherical, starlike and bizarre. In the present study, we intended to clarify whether the morphological score of discoid platelets alone could serve as a method for the estimation of PCs quality. During the first five days after preparation, samples of standard platelet concentrates (SPCs) and of leucodepleted platelet concentrates (LDPCs) were analyzed morphologically by immersion light microscopy using smears stained by the May-Grünwald-Giemsa method. In addition to the MS, an original Modified Morphological Score (MMS), for a population of 200 platelets, was used to count platelets with the discoid shape. The mean MMS ranged (first to fifth day) from 192.6 to 166.6 with SPCs and from 197.2 to 185.4 with LDPCs. There is a significant difference (ANOVA) between: (a) PCs prepared by different techniques (p < 0.01); (b) the quality of the same PCs during the storage (p < 0.0001).

[Monitoring the nutritional status in patients on hemodialysis]. / Pracenje stanja uhranjenosti kod bolesnika na hemodijalizi.

In order to monitor changes of the nutritive status of hemodialyzed patients, antropometric and laboratory parameters of the population of hemodialyzed patients in 1988 vs. 1994 have been compared. Antropometric parameters were measured by the same investigator. The results show absence of significant difference between antropometric parameters (body weight after hemodialysis, body mass index, triceps fold, circumference of upper arm and percentage of fat) in the patients hemodialyzed in 1988. The laboratory parameters (albumin and transferrin), however, show significant increase in the 1994 group. In the group of patients subjected to hemodialysis in 1988 as well, albumin was significantly elevated. Nevertheless, no differences in laboratory parameters in healthy populations of 1988 and 1994 were noted (controls). It was concluded that no significant changes in the nutritive status were present among either the population or the same patients, while elevation of laboratory parameters necessitate further investigation.

[The effect of captopril on the development of adriamycin nephropathy in rats with spontaneous arterial hypertension]. / Uticaj kaptoprila na razvoj adriamicinske nefropatije kod pacova sa spontanom arterijskom hipertensijom.

The effects of captopril on morphologic changes and clinical course of adriamycin (ADR) nephropathy in spontaneously hypertensive rats (SHR) were examined. After ADR infections rats were divided into two groups: ADR-C group (n = 20) given captopril (60 mg/kg per day) and ADR group (n = 19) receiving no antihypertensive treatment. SHR were examined every 6 weeks. Captopril normalized systemic blood pressure, but failed to prevent proteinuria. It slowed down renal function deterioration in the early stage of ADR nephropathy (weeks 6 and 12), but at the end of the study both groups had the same degree of renal failure irrespectively of whether blood pressure was well controlled with captopril or hypertension persisted. Captopril slowed down mesangial expansion in the early stages of ADR nephropathy, but at the end of the study there was no statistically significant difference between these two groups. Treatment with captopril also reduced the development of glomerular sclerosis.

Treatment of secondary hyperparathyroidism with intermittent oral high doses of 1-alpha-OHD3 plus pharmacological dose of 24,25(OH)2D3.

The present study examined the effect of intermittent oral high doses of 1-alpha-OHD3 in combination with a pharmacological dose of 24,25(OH)2D3 on parathyroid hormone (PTH) secretion. Twenty hemodialysis (HD) patients (10 males, aged 26-72 years, on regular hemodialysis for 7-128 months) with secondary hyperparathyroidism resistant to long-term low-dose 1-alpha-OHD3 therapy were studied for 24 weeks. At the outset of the study they were randomly divided into two groups: group 1 received high-dose 1-alpha-OHD3 plus 24,25(OH)2D3 (2 x 5 micrograms/day) and group 2 was on monotherapy with 1-alpha-OHD3. 1-alpha-OHD3 was given three times a week in the evening before each HD in gradually increased doses from 1 to 4 micrograms adjusted to keep serum calcium levels below 2.6 mmol/L. During the therapy mean serum calcium and ionized calcium levels increased but remained in the normal ranges without differences between the two groups. However, the frequency of hypercalcemia episodes was different in the two groups. In the first 12 weeks the number of hypercalcemia episodes was significantly lower in group 1 than in group 2 (6 vs. 12; p < .05), allowing the use of significantly higher 1-alpha-OHD3 doses in group 1. In the second 12 weeks of the study the 1-alpha-OHD3 dose in group 1 had to be reduced due to more frequent appearance of hypercalcemia. So, the 1-alpha-OHD3 doses became similar in the two groups during the second 12 weeks of the study.(ABSTRACT TRUNCATED AT 250 WORDS)