Evaluation of pituitary microadenomas with dynamic MR imaging.

PURPOSE: To evaluate the use of keyhole dynamic magnetic resonance (MR) imaging in the evaluation of women with borderline hyperprolactinemia. PATIENTS AND METHODS: We investigated 30 patients (mean age 31.6+/-4.3 years) with moderate hyperprolactinemia and clinically suspected microadenomas on T1-weighted spin echo (SE) sequences (repetition time (TR)/echo time (TE) 625/15 ms) with keyhole dynamic imaging and contrast enhancement of the pituitary gland. The probability of lesion presence according to MR criteria was ranked on a five-grade scale and compared with standard examinations of the hypophysis before and after intravenous administration of contrast media. RESULTS: The probability for lesion presence showed a trend toward lower scores on standard SE sequences and higher scores with dynamic imaging (P=0.067). CONCLUSION: Dynamic keyhole imaging of the pituitary gland could help establish a diagnosis of microadenomas with a higher probability.

[Hormonal etiology of secondary amenorrhea]. / Die hormonellen Ursachen der sekundären Amenorrhoe.

Over a 12-month period we evaluated 185 patients who consulted our outpatient department with symptoms of secondary amenorrhoea. Hormonal levels and body mass index were determined and an assessment made, on the basis of specific questioning. of the occurrence of possible mental alterations in the patients before they became amenorrhoic. Of our collective, 36 patients (19.5%) showed normal hormonal values, 50 patients (26%) were hypoestrogenemic, 46 women (25%) had elevated androgens, 15 patients (8%) had increased gonadotropins, 4 patients (2%) suffered from hyperprolactinemia, and 2 women (1%) had thyroid dysfunction. The remaining 32 amenorrhoic patients (17.2%) demonstrated different combinations of altered hormone values. The hypoestrogenemic patients showed a significant difference (p < 0.043) in body mass index in comparison with patients demonstrating normal hormone values. In contrast to reports in the literature hypoestrogenemia was the most frequent cause of secondary amenorrhoea in our study.

MRI of microadenomas in patients with hyperprolactinaemia.

MRI is a sensitive tool for the investigation of pituitary microadenomas but cannot be used as a screening investigation. To establish a strategy for the use of MRI in patients with hyperprolactinaemia we investigated 74 women with serum prolactin levels above 52 ng/ml for the presence of microadenomas. We examined 55 premenopausal and 19 postmenopausal women, using a 1.5 T unit. We used T1-weighted spin-echo sequences, with coronal and sagittal images before and after intravenous gadolinium. We found microadenomas in 38 patients (51.3%), macroadenomas in 6 (8.1%) and an infundibular glioma in 1;29 patients had a normal pituitary gland (39.2%). The size of the adenomas was related to the prolactin level, and the mean level in patients with MRI evidence of adenomas was higher than in patients without microadenomas (155.72 +/- 131.01 ng/ml versus 110.14 +/- 80.86 ng/ml). The probability of the presence of an adenoma increased with rising serum prolactin levels. We suggest MRI in patients with prolactin levels more than 100 ng/ml. In patients on oestrogen therapy MRI should be performed with only slightly elevated prolactin levels. Evidence of a microadenoma should be considered in planning further therapy, especially concerning the use of hormone replacement therapy or of bromocriptine.

[Leiomyomatosis of the lung--a case report with immunohistochemical evaluation]. / Leiomyomatose der Lunge--Ein Fallbericht mit immuno-histochemischer Aufarbeitung.

A 56-year-old women who had undergone hysterectomy 15 years ago was found to have pulmonary leiomyomatosis. The occurrence of hormone receptors shows the influence of the ovary and of hormone-replacement-therapy to these tumors. In our case immunoperoxidase techniques indicate the expression of progesterone receptors.

The lipid peroxidation product 4-hydroxynonenal is formed by--and is able to attract--rat neutrophils in vivo.

4-Hydroxynonenal (HNE), a major aldehydic product of lipid peroxidation, is a chemoattractant for neutrophilic polymorphonuclear granulocytes in vitro. The question was studied, whether HNE is formed during the ingress of neutrophils in the Sephadex model of inflammation. The polydextrane Sephadex G-200, which causes an acute aseptic traumatic inflammation, was injected subcutaneously into rats. The implants were excised 6-36 hours later, and the neutrophils separated from the exsudate by centrifugation. After extraction with dichloromethane HNE was identified in the exsudate by non-derivative reversed phase HPLC in combination with on-line uv-spectroscopy. The concentration of HNE in the inflammatory focus did not correlate with the number of neutrophils present. While the peak of HNE coincided with the time point of the highest turnover rate of neutrophils (0.13 microM at 6 hrs after implantation), the highest number of neutrophils (about 100 million cells) occurred not earlier than 18 hrs later (24 hrs after onset of inflammation). When neutrophils were isolated from the inflammatory focus and stimulated with Zymosan, they were able to produce HNE in vitro depending on the time of isolation. The highest production of HNE (0.17 microM) by phagocyting neutrophils was observed at the shortest inflammation time studied (3 hrs). In order to compare these results with the oxidative burst of neutrophils the formation of superoxide was also measured by the cytochrome c reduction assay in vitro. The maximum of the production rate of superoxide anion was observed at the same inflammation time (6 hrs), when the HNE maximum occurred.(ABSTRACT TRUNCATED AT 250 WORDS)

Iron-induced lipid peroxidation and inhibition of proliferation in Ehrlich ascites tumor cells.

The purpose of this study was to find further experimental evidence for the postulated negative association between the extent of lipid peroxidation in tumor cells and their proliferative behavior. After incubation of Ehrlich ascites tumor cells at 37 degrees C for 30 min with increasing concentrations of Fe(II) histidinate (Fe/His) the following parameters were determined: the formation of lipid hydroperoxides was measured fluorimetrically after reaction with dichlorofluorescein; 4-hydroxynonenal was determined by reversed-phase high-pressure chromatography after derivatization with dinitrophenylhydrazine; as a third parameter of lipid peroxidation the formation of 2-thiobarbituric-acid-reactive substances was determined. The proliferative activity was determined by measuring the growth rate in vivo after reimplantation i.p. of the tumor cells into mice. Trypan-blue exclusion tests for viability were performed before reimplantation. The reliability of the trypan-blue exclusion tests was checked by comparing the results with another parameter of viability, the release of the cytosolic enzyme lactate dehydrogenase. The concentration both of lipid hydroperoxides and of 2-thiobarbituric-acid-reactive substances showed a biphasic dependence on the concentration of Fe/His with maximal increase at iron concentrations of 0.25 mM and 0.1 mM respectively. 4-Hydroxynonenal, in contrast, showed a continuous increase up to 41.1 nM (corresponding to 0.58 pmol/10(9) cells) with increasing iron concentration in the range from 0.1 mM to 0.6 mM. The total number of tumor cells, when determined 5 days after reimplantation, continuously decreased with increasing iron concentration, showing half-maximal inhibition at about 0.22 mM Fe. The exclusion of the trypan-blue dye was unaffected by the presence of iron at any concentration used. Similarly, iron had no influence on the release of lactate dehydrogenase. The results support the hypothesis that 4-hydroxynonenal may act as an inhibiting messenger between endogenic lipid peroxidation and proliferation.

Functional and morphological changes in the rat kidney after long-term adrenaline application.

A 24 h lasting long term adrenaline application in the form of subcutaneously implanted retard-tablets causes functional and morphological changes in the kidney, which are dose dependent and either reversible or irreversible. Animals in the V 15 group received one 15 mg and in the V 30 group two 15 mg adrenaline tablets resp. The tablets were removed after 24 h and a clearance depot capsule was implanted in the abdominal cavity. The test period extended from 22 h after removal of the retard tabl. to 21 d thereafter. Inulin (except the V 30 grp.), PAH and urea clearance are showing no significant differences. The data of urine gamma-GT activity, urea and urea-N in serum and urine, S-glucose, S-triglycerides, Combur-8-test, Na+ and K+ levels are in normal ranges. Morphological changes were found in the glomerula and tubular regions. Both the number of damaged nephrons and the extent of the damage depend upon the doses of adrenaline given. All glomerula with visible serious changes are irreversibly damaged; this was not true in case of the tubule. In the latter, after 7 d, the fatty deposits had diminished or disappeared.

Vasoconstriction of the vasa afferentia in the rat kidney after long-term adrenaline application.

Adrenaline applied in the form of a retard tablet was implanted subcutaneously under short ether anesthesia under the neck skin of rats. Animals in the V 15 group received one 15 mg adrenaline tablet and those in the V 30 group two 15 mg tablets. The tablets were removed after 24 h. Twenty-two h later plasma catecholamines with the exception of dopamine are elevated in accordance with the amount of adrenaline applied. Histological examination reveals hyalinization of the vasa afferentia and glomerula which is more expressed in the inner part of the renal cortex. Hyalinization begins in the vas afferents and juxtaglomerular cells and extends to the glomerulus. Electron microscopic examination of the vas afferents shows vasoconstriction and beginning cellular degeneration of this vessel. Vasoconstriction is considered to be responsible for the decrease in kidney function.