Systemic inflammation and sympathetic activation in gestational diabetes mellitus with obstructive sleep apnea.

BACKGROUND: Although some evidence suggests an association between obstructive sleep apnea (OSA) and gestational diabetes mellitus (GDM), its consequences still remain largely unknown. We sought to determine whether OSA is associated with higher inflammation and sympathetic levels in GDM, and to relate them with insulin resistance and perinatal outcomes. METHODS: OSA was identified by polysomnography and defined as an apnea-hypopnea index of ≥ 5 h-1. Plasma cytokines (TNF-α, IL-1ß, IL-6, IL-8, IL-10), metanephrine, and normetanephrine were determined by immunoassays. RESULTS: We included 17 patients with GDM and OSA and 34 without OSA. Women with GDM and OSA had higher normetanephrine concentrations [81 IQR (59-134) vs. 68 (51-81) pg/mL]. No differences in the inflammatory profile were found, while IL-1ß was higher in patients with mean nocturnal oxyhemoglobin saturation ≤ 94%. We found positive correlations between increased sympathetic activation and IL-1ß, with obstructive apneas, while time in REM showed an inverse relationship with IL-1ß and metanephrine. Furthermore, IL-10 was inversely related with time in sleep stages 1-2, and with the arousal index, and it was positively related with time in slow-wave sleep. Significant correlations were also found between IL-1ß and insulin resistance. There were no significant differences in neonatal characteristics; however, we found inverse relationships between IL-10 and birth weight (BW), and percentile of BW. CONCLUSIONS: OSA increased sympathetic activity, and IL-1ß concentration was higher in patients with GDM with lower nocturnal oxygenation, all of which were related with obstructive events, and time in REM. Moreover, IL-1ß was related with insulin resistance, and IL-10 inversely correlated with neonatal BW.

[Testicular microlithiasis: unusual ultrasound finding]. / Microlitiasi testicolare: un reparto ecografico inconsueto.

OBJECTIVES: In our work we evaluate the incidence of testicular microlithiasis (TM) on more than 500 scrotal echoes we performed in our hospital in a period of three years, from 1998 to 2001. MATERIALS AND METHODS: Ultrasound sonography (USS) was performed by a 5.5-7.5 double scanned Mhz probe (Ansaldo AU 560 degrees). RESULTS: We found only 2 cases of TM (0.4%); our percentage of such pathology is lower when compared to percentages we can find in literature. In only one case we performed a testicular biopsy, because the patient had teratospermia; we found intra tubular seminific calcification associated with haematoxilim positive bodies. DISCUSSION: Testicular microlithiasis has an echographic characteristic appearance, more than a clinical pathological issue. Referred literature shows how this pathology can be associated with criptorchidysm (20%) and can correlate (40%) with probability of clinical evolution in testicular malign neoplasms, mainly germinal ones. This pathology is characteristic in its showing multiple microcalcification, (not less than for testis), 1-3 mm in diameter and not always regularly distributed in testis parenchyma. Often associated with testicular microlithiasis is dyspermia. CONCLUSIONS: In patients in which microlithiasis of the testis is diagnosed, USS and bio-humoral follow-up is of major importance. Literature shows how high can be the risk that this pathology can evolve to germinal tumor. It must be recommended regular evaluation of alpha-fetoprotein, beta chronic gonadotropin. USS must be performed almost once a year. Biopsy is rarely suggested, and only in case of teratospermia. At the moment no therapy is referred.

[Adenomatoid tumor of the epididymis. Ultrasonographic diagnosis and review of the literature]. / Tumore adenomatoide dell'epididimo. Diagnosi ecografica e revisione della letteratura.

UNLABELLED: Epididymal adenomatoid tumor is a rare genital neoplasm of mesotelial origin. OBJECTIVES: In our work we show our experience about three cases of epididymal adenomatoid tumor we observed in four years. We describe our clinical experience in which these cases seem to be peculiar for clinical insurgence and localization, mainly, in our clinical report, on the head of epididymis. A review of few cases reported in literature is presented above. MATERIALS AND METHODS: In a period of four years we evaluated more than 600 scrotal echoes. Ultrasound sonography was performed by a 5.5-7.5 double scanned MHz probe. RESULTS: USS of the scrotum revealed, in two cases, an anechoid-hypoechoid mass, localized on the epididymal tail. One patient was admitted to the hospital with clinical symptoms of acute torsion of the testis, but no torsion was found at surgical examination. The gross examination, in every cases, showed a nodular, tight, encapsulated mass, with yellowish and homogeneous cut surface. DISCUSSION: Epididymal adenomatoid tumor is a rather rare form of benign neoplasm of genitalia. This is deducted from the rare cases reported in the literature. The origin of that neoplasm is controversial. The main hypothesis is, nowadays, that these tumors could arise from mesemchima. Epididymal adenomatoid tumor is a neoplasm mostly reported in young patients. USS is always of main importance to permit a pre-operatory differential diagnosis with malignant tumors of the testis. It shows, in facts, characteristical echo patterns that permitted, in all cases, a conservative surgery, with direct access through the scrotum. CONCLUSIONS: Our experience shows the mainly importance of USS in differential diagnosis between scrotal masses. Characteristic echo pattern permits overall sure rapid surgical access and a conservative approach.