Unusual early peaks of airborne ragweed (Ambrosia L.) pollen in the Pannonian Biogeographical Region.

Early peaks of airborne ragweed (Ambrosia L.) pollen concentrations were observed at several monitoring stations in Hungary in June 2017 and 2018, one month before the usual start of the pollen season at the end of July. Backward trajectories were calculated to simulate potential sources of pollen collected at different locations in the Pannonian Biogeographical Region. In a collaboration between aerobiological and phenological networks, a nationwide campaign was conducted to collect field data of ragweed blooming. During field surveys, ragweed plants having extremely early blooming were found most abundantly in a rural site near Vaja (North-East Hungary) and other locations in Hungary. Field observations matched with source areas identified by trajectory analyses; i.e., early-flowering ragweed plants were found at some of these locations. Although similar peaks of airborne pollen concentrations were not detected in other years (e.g., 2016, 2019-2021), alarming results suggest the possibility of expanding seasons of ragweed allergy.

Transfer Entropy in Artificial and Cardiovascular Environment in Stress.

The paper examines the influence of acute and chronic stress on the relationship between systolic blood pressure (SBP) and pulse interval (PI) recorded from laboratory rats with different genetic predispositions for the development of the hypertensive disease. Transfer entropy (TE) was used to examine the direction of information flow between SBP and PI, spontaneous baroreflex sensitivity (BRS) was used to evaluate the ability of adaptation of PI time series to changes in SBP, and the cross-approximate entropy (XApEn) to quantify the SBP-PI synchronization. The effects of the time series length on TE estimation was also investigated in an artificial environment for the time series without a strong causal relation. The consistency of the TE estimation was achieved only for extremely long time series. The results showed that chronic stress influence on the increase in information transmission between SBP and PI (TE) while changes of (BRS) and XApEn were not noticed.

[Importance of the CRH (corticotropin releasing hormone) test in the differential diagnosis of Cushing's syndrome]. / Vrijednost CRH-testa u diferencijalnoj dijagnozi Cushingova sindroma.

In the group of 13 patients with Cushing's syndrome (CS) CRH test was performed by sampling the blood from peripheral vein and in eight patients also after inferior petrosal sinus catheterization (IPSC) to resolve the disease etiology. In the group of patients with Cushing's disease (CD, n = 11), which was proven by surgery and adenoma immunohistochemistry, 10/11 had in CRH test the significant increase of cortisol and ACTH in the peripheral blood. Among two patients with ectopic ACTH syndrome one had the significant increase of both hormones in CRH test. After IPSC the ratio of ACTH in the petrosal sinus and in the peripheral vein was significant in 4/8 patients before, and in 6/8 after CRH administration. The intersinus gradient was significant in 3/8 patients before, and in 4/8 after CRH test. According to our results we can conclude that the determination of ACTH in the blood from peripheral veins after CRH administration is a very sensitive method for differential diagnosis of CS, while the results after IPSC were less sensitive in our conditions than those described in the literature.

Evolution of clinical symptoms in a young woman with a recurrent gonadotroph adenoma causing ovarian hyperstimulation.

OBJECTIVE: To demonstrate the clinical course in a young female with gonadotroph adenoma causing ovarian stimulation. PATIENT AND METHODS: Our patient was a 23-year-old woman with a history of oligomenorrhea who had previously undergone bilateral ovarian wedge resection owing to the clinical appearance of polycystic ovaries. Two years later, she sought treatment for headache, galactorrhea, history of spotting and lower abdominal distension. FSH, LH, beta-LH, inhibin A and B, estradiol, prolactin (PRL), and beta-chorionic gonadotrophin (beta-CG) were measured, and the responses of FSH, LH and beta-LH to thyrotrophin-releasing hormone (TRH) were documented. Immunohistochemical analysis of the tumor tissue was performed after surgery. Five years after the trans-sphenoidal surgery, the patient again became oligomenorrheic. A large recurrent adenoma was diagnosed on CT one year later. Transvaginal ultrasound showed ovaries of normal size with multiple small cystic formations simulating a polycystic pattern, While the patient was awaiting surgery, a pituitary apoplexy occurred. Emergency decompressive surgery was performed and the patient fully recovered. RESULTS: Enlarged ovaries were found on ultrasound examination simulating a hyperstimulation-like pattern. At that time, elevated levels of FSH (13.4IU/l) and marginally elevated levels of beta-LH (1.43ng/ml) were found, whereas the level of LH (0.5IU/l) was subnormal. Plasma estradiol was markedly supranormal (6150pmol/l). Levels of inhibin A and B were elevated (326pg/ml and 588pg/ml respectively). The prolactin level (70ng/ml) was increased, whereas beta-chorionic gonadotrophin (beta-CG) was normal. Significantly increased FSH, LH, and beta-LH responses to TRH stimulation were documented. Pituitary macroadenoma was found on MRI scan and removed by trans-sphenoidal surgery. Immunohistochemical examination showed high positivity for beta-CG and LH, and slight positivity for FSH. Five years after the surgery, estradiol was elevated (1160pmol/l), whereas basal levels of LH (4.65IU/l) and FSH (3.98IU/l) were not suppressed. After the second operation, immunostaining of the adenoma tissue confirmed the previous findings. CONCLUSIONS: Measurement of gonadotrophins in our case did not prove to be a method for identifying a large recurrent gonadotroph pituitary adenoma. The sonographic ovarian imaging varied from a polycystic- to an ovarian hyperstimulation-like pattern during the evolution of the tumour.

Clinical and morphological features of undifferentiated monomorphous GH/TSH-secreting pituitary adenoma.

A 41-year-old male presented with progressive visual defects, acromegaly and hyperthyroidism. After clinical evaluation a giant GH/TSH-secreting pituitary adenoma was diagnosed. Administration of the somatostatin analog octreotide at doses of 150 microg s.c. per day inhibited the secretion of both GH and TSH. A three-week treatment with octreotide prior to surgery led to slight visual improvement and CT scan showed some new necrotic areas within the tumor mass. Transcranial surgery was performed. By immunohistochemical analyses of the adenoma tissue GH, prolactin and beta-chorionic gonadotropin were detected; TSH was negative. Electron microscopy revealed an undifferentiated, monomorphous adenoma with morphological features of an acidophil stem cell adenoma such as the presence of misplaced exocytoses, fibrous bodies and mitochondrial gigantism. However, the tumor cells contained small secretory granules (up to 250 nm) accumulated along the cell membrane characteristic of thyrotrope cells. Furthermore, some adenoma cells were fusiform with long cytoplasmic processes resembling thyrotropes. Two months after the operation CT scan revealed a large residual tumor. Serum GH and TSH levels had increased again and the TSH level was even higher than before the treatment. The patient died suddenly, most probably of lethal arrhythmia. Specimens of the adenoma tissue obtained at autopsy confirmed the previous findings with the exception of positive immunostaining for TSH which was found in less than 1% of the adenoma cells. This undifferentiated, monomorphous GH/TSH-secreting pituitary adenoma represents an entity that is unusual both in its ultrastructural features and clinical manifestations suggesting a cytogenesis from an early, undifferentiated stem cell.

Post-traumatic hormonal disturbances: prolactin as a link between head injury and enhanced osteogenesis.

Traumatic brain injury (TBI) combined with fractures of long bones or large joints is often associated with enhanced osteogenesis (early fracture healing accompanied by hypertrophic callus formation and/or heterotopic ossifications). Humoral factors that cause enhanced osteogenesis in patients with TBI are not yet identified. The aim of this study was to reveal if post-traumatic change(s) of hormone levels in patients with TBI and bone fractures could be associated with the phenomenon of enhanced osteogenesis. The blood values of adrenocorticotropic hormone (ACTH), cortisol, growth hormone (GH), parathyroid hormone (PTH) and prolactin (PRL) were studied weekly over a period of three months after injury in patients with bone fractures only, those with TBI only or combined bone fractures and TBI (patients exerting enhanced osteogenesis). Stress-hormones, ACTH and cortisol, or the hormones related to the bone growth (GH and PTH) did not show any particular post-traumatic changes in the blood of patients with combined injury that could be associated with the enhanced osteogenesis. On the other hand, patients with combined bone fractures and TBI accompanied by enhanced osteogenesis had significantly elevated PRL levels in blood during the 5th week of the post-traumatic period. Thus, the maximal PRL values were measured at the time when in this group of patients fractures were in consolidation and hypertrophic callus or heterotopic ossifications were developing (as verified by x-ray imaging). Hence, PRL does not only influence physiology of the bone metabolism but also seems to be one of the humoral factors involved in the phenomenon of enhanced osteogenesis in patients with TBI.

Fibromatosis of male breast.

Fibromatosis is a relatively benign, though locally invasive neoplasm. About 100 cases of fibromatosis of the breast have been reported to date, none of them in a male. We present a 60-year-old man who was admitted to the University Hospital for Tumors in Zagreb, Croatia, on May 25, 1992, with a 3-month history of gradually enlarging, painless subcutaneous mass, 6 x 5 cm, that was located in the upper outer quadrant and partly beneath the areola of his left breast. The diagnosis was confirmed by immunoperoxidase studies, that showed positivity for vimentin, whereas the staining for cytokeratin AE1, glial fibrillar acid protein (GFAP) and collagen IV was negative. The tumor was removed by en bloc resection, and the greater pectoral muscle was spared. Today, 3 years after the operation, the patient is alive and in good health.

Breast cancer prognosis. I. Prognostic factors in patients with node-negative (N0) breast cancer.

Predictors of breast cancer survival were investigated among 196 node-negative (N0) breast cancer patients treated at the Department of Surgery of the University Hospital for Tumors in Zagreb between 1969-1988. Selected prognostic factors included patient age, delay in treatment, tumor size, histologic grade of malignancy, estrogen receptor status, progesterone receptor status, tumor site, and type of surgical treatment. Among these predictors, only tumor size (p < 0.001) and pathohistologic grade of malignancy (p < 0.001) caused significant differences in 5-year overall survival rates (T1-92.1%, T2-89.8%, T3-64.1% and T4-45.4%; grade I-95.0%; II-80.6%; III-63.6%). The authors conclude that among eight selected clinical characteristics, only tumor size and pathohistological malignancy grade can serve as helpful predictors in determination of the probability of 5-year overall survival among node-negative breast cancer patients.

Breast cancer prognosis. II. Prognostic factors in patients with node-positive (N1-3) breast cancer.

Predictors of breast cancer survival were investigated among 282 node-positive (N1-3) breast cancer patients treated at the Department of Surgery of the University Hospital for Tumors in Zagreb between 1969-1988. Selected prognostic factors included patient age, delay in treatment, tumor size, type of lymph-node affection, pathohistological grade of malignancy, estrogen receptor status, progesterone receptor status, tumor site, and type of surgical treatment. Among these predictors, only tumor size (p < 0.001), type of lymph-node affection (p < 0.001), malignancy grade (p < 0.001), and progesterone receptor status (p < 0.001) revealed a significant impact on a 5-year overall survival rates (T1-100%, T2-64.5%, T3-54.5% and T4-23.7%; N1-60.2%, N2-20.8%, N3-30.3%; grade I-85.5%, II-59.4%, III-30.5%; PgR+ 63.8%, PgR--26.4%). The authors conclude that among nine selected characteristics, only tumor size, type of lymph-node affection, pathohistological malignancy grade, and progesterone receptor status can be helpful predictors in the determination of the probability of 5-year overall survival among node-positive breast cancer patients.

Breast cancer prognosis. III. Prognostic factors in patients with distant metastases (M1) at the time of diagnosis.

Predictors of breast cancer survival were investigated among 66 patients who had distant metastases at the time of diagnosis (M1). All of these patients were treated at the Department of Surgery of the University Hospital for Tumors in Zagreb between 1969-1988. Selected prognostic factors included patient age, delay in treatment, tumor size, type of lymph node affection, response to palliative surgical treatment and administered chemotherapy or hormonal therapy, and site of metastasizing. Among these predictors, several of them revealed a significant impact on a median survival (in months) of these patients: the most important was the response to chemotherapy (p < 0.001), followed by site of metastasizing (p < 0.05) and primary tumor size (p < 0.05). Palliative surgical treatment, apart from improvement of life quality, played no role in determining the survival among breast cancer patients with a distant disease.