Plasma 11b,17a,21-Trihydroxypregn-4-ene-3,20-dione as Blood Biomarker Assay. A controlled study

11b,17a,21-Trihydroxypregn-4-ene-3,20-dione or cortisol (C21H30O5) represents the product of adrenal glands and in humans its assessment is a useful tool for evaluation of glucocorticoid axes. Our purpose is to evaluate the profile of morning plasma cortisol/ACTH/ionogram in menopausal women with non-functioning adrenal tumours. A controlled study of 193 menopausal women found that BMI is statistically significant higher versus control in subjects with unilateral, respective bilateral adrenal non-secretor tumours. Baseline C21H30O5 is similar between the groups while ACTH is decreased when compare with control group indicating a potential persistent cortisol tumour-related exposure. Glycated haemoglobin A1c is increased in group with single adrenal mass (versus control) while serum sodium is higher in group with double adrenal masses (versus control).

Download Full-text

Plasma 11b,17a,21-Trihydroxypregn-4-ene-3,20-dione as Blood Biomarker Assay. A controlled study

Revista de Chimie ◽

10.37358/rc.19.10.3515 ◽

2019 ◽

Vol 70 (10) ◽

pp. 3515-3517

Keyword(s):

Adrenal Mass ◽

Plasma Cortisol ◽

Adrenal Glands ◽

Glycated Haemoglobin ◽

Controlled Study ◽

Control Group ◽

Haemoglobin A1c ◽

Blood Biomarker ◽

Menopausal Women ◽

Adrenal Masses

Download Full-text

A Case Report on Bilateral Adrenal Histoplasmosis

Bangladesh Journal of Urology ◽

10.3329/bju.v23i2.50317 ◽

2020 ◽

Vol 23 (2) ◽

pp. 210-212

Author(s):

Md Sazzad Hossain ◽

Mohammad Zahid Hasan ◽

Mir Ehteshamul Haque ◽

Mostakim Maoya

Keyword(s):

Adrenal Mass ◽

Adrenal Glands ◽

Histoplasma Capsulatum ◽

Needle Aspiration ◽

Immunosuppressed Patient ◽

Aspiration Cytology ◽

Fine Needle ◽

Disseminated Histoplasmosis ◽

Adrenal Masses ◽

Needle Aspiration Cytology

Disseminated histoplasmosis affecting the adrenal glands is a very rare infection and an uncommon cause of adrenal insufficiency. We present a case of bilateral adrenal histoplasmosis in a 77 years old immunosuppressed patient who presented with bilateral adrenal masses. The fine needle aspiration cytology of the adrenal mass was positive for Histoplasma capsulatum. Bangladesh Journal of Urology, Vol. 23, No. 2, July 2020 p.210-212

Download Full-text

Approach to an incidental adrenal mass

Companion Animal ◽

10.12968/coan.2019.0060 ◽

2020 ◽

Vol 25 (1) ◽

pp. 26-30

Author(s):

Vicki Black

Keyword(s):

Adrenal Gland ◽

Adrenal Mass ◽

Adrenal Glands ◽

Treatment Options ◽

Logical Approach ◽

Endocrine Organs ◽

Adrenal Masses

Adrenal glands represent important endocrine organs. Disorders of these can present in many vague, often non-specific ways; this presents a dilemma for the clinician when an abnormal adrenal gland is detected on imaging. This article aims to explore the evidence for approach to adrenal masses in the dog and cat, including defining an adrenal gland mass, the logical approach to the mass, and treatment options.

Download Full-text

Effect of surgical pleth index-guided analgesia versus conventional analgesia techniques on fentanyl consumption under multimodal analgesia in laparoscopic cholecystectomy: a prospective, randomized and controlled study

BMC Anesthesiology ◽

10.1186/s12871-021-01366-x ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Jian Guo ◽

Weigang Zhu ◽

Qinye Shi ◽

Fangping Bao ◽

Jianhong Xu

Keyword(s):

Laparoscopic Cholecystectomy ◽

Blood Glucose ◽

Plasma Cortisol ◽

Adverse Reactions ◽

Multimodal Analgesia ◽

Controlled Study ◽

Control Group ◽

Extubation Time ◽

Fentanyl Consumption ◽

Glucose Plasma

Abstract Background The Surgical Pleth Index (SPI) is an objective tool that can reflect nociception-antinociception balance and guide the use of intraoperative analgesics. Multimodal analgesia has been neglected in many previous studies. The aim of this study was to compare fentanyl consumption using SPI-guided analgesia versus conventional analgesia techniques under multimodal analgesia in laparoscopic cholecystectomy. Methods A total of 80 patients aged 18–65 years with American Society of Anaesthesiologists (ASA) grade I-II and a body mass index (BMI) of 18.5 to 30 kg/m2 who were scheduled for laparoscopic cholecystectomy under total intravenous anaesthesia from March 2020 to September 2020 were selected. Multimodal analgesia, including local infiltration of the surgical incision, nonsteroidal anti-inflammatory drugs and opioids, was adopted perioperatively. Fentanyl boluses of 1.0 µg/kg were administered to maintain the SPI value between 20 and 50 in the SPI group. By contrast, fentanyl boluses of 1.0 µg/kg were administered whenever the heart rate (HR) or mean arterial pressure (MAP) increased to 20 % above baseline or when the HR was greater than 90 beats per minute (bpm) in the control group. Preoperative and postoperative blood glucose, plasma cortisol and interleukin-6 (IL-6) levels were evaluated. Intraoperative haemodynamic events and propofol and fentanyl doses were noted. The extubation time, postoperative visual analogue scale (VAS) score, use of remedial analgesics and opioid-related adverse reactions were recorded. Results In total, 18 of 80 patients withdrew for various reasons, and data from 62 patients were finally analysed. Intraoperative fentanyl consumption was significantly lower in the SPI group than in the control group (177.1 ± 65.9 vs. 213.5 ± 47.5, P = 0.016). The postoperative extubation time was shorter in the SPI group than in the control group (16.1 ± 5.2 vs. 22.1 ± 6.3, P < 0.001). Preoperative and postoperative blood glucose, plasma cortisol and IL-6 levels, intraoperative haemodynamic changes, postoperative VAS scores, remedial analgesic consumption and opioid-related adverse reactions were comparable in the two groups. Conclusions Lower doses of fentanyl are required intraoperatively with shorter extubation times when SPI is used to guide intraoperative analgesia compared to conventional analgesia techniques under multimodal analgesia in laparoscopic cholecystectomy. Trial registration Chictr.org.cn ChiCTR2000030145. Retrospectively Registered (Date of registration: February 24, 2020).

Download Full-text

Chronic Disseminated Histoplasmosis in an Immunocompetent Man Presented as Bilateral Adrenal Masses with Partial Adrenocortical Insufficiency - A Rare Condition

Journal of Bangladesh College of Physicians and Surgeons ◽

10.3329/jbcps.v29i4.11345 ◽

2012 ◽

Vol 29 (4) ◽

pp. 235-240

Author(s):

ABM Sarwar E Alam ◽

Z Hasan ◽

MAI Khan ◽

MA Zulkifl ◽

ATM Samdani ◽

...

Keyword(s):

Adrenal Mass ◽

Plasma Cortisol ◽

Histoplasma Capsulatum ◽

Rare Condition ◽

Maximum Temperature ◽

Low Grade ◽

Acth Stimulation ◽

Ct Guided ◽

First Case ◽

Adrenal Masses

Bilateral adrenal masses caused by histoplasmosis is a rare condition. To our knowledge this is the first case report of bilateral adrenal enlargement by histoplasmosis in Bangladesh. We report a case of 75 years old man who presented with low grade fever, night sweating, anorexia and progressive weight loss for 9 months prior to admission in Square Hospital. Clinical profile was unremarkable apart from low grade fever (with maximum temperature recorded up to 101ºF) and low blood pressure with significant postural drop. Plasma cortisol (morning and evening) and glucose were normal but short ACTH stimulation test revealed low plasma cortisol response. Abdominal ultrasound gave a definite clue of left adrenal mass which was later found as bilateral adrenal masses of significant size by abdominal CT scan. Initially Gomoris Methenamine Silver (GMS) stain of CT guided FNAC of the left adrenal mass showed small budding yeast morphologically consistent with histoplasmosis. A second CT guided FNAC of both adrenal masses also showed similar findings which was finally confirmed by fungus culture as Histoplasma capsulatum. The patient was then treated with injection amphotericin-B followed by oral itraconazole and fludrocortisone and he responded well DOI: http://dx.doi.org/10.3329/jbcps.v29i4.11345 J Bangladesh Coll Phys Surg 2011; 29: 235-240

Download Full-text

Bilateral Adrenal Incidentalomas, Uncommon Presentation and Very Rare Pathology

Journal of the Endocrine Society ◽

10.1210/jendso/bvab048.239 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. A119-A119

Author(s):

Mohammad Khair Ahmad Ibraheem Hamad ◽

Ahmed Osman Saleh ◽

Emad Naem

Keyword(s):

Ct Scan ◽

Adrenal Insufficiency ◽

Adrenal Mass ◽

Adrenal Glands ◽

Adrenal Incidentaloma ◽

B Cell Lymphoma ◽

Primary Adrenal Lymphoma ◽

Adrenal Lymphoma ◽

History Of ◽

Adrenal Masses

Abstract Background: Adrenal incidentaloma is an adrenal mass larger than 1cm accidentally discovered by radiological examination. The incidentalomas should be evaluated for malignancy and functionality. The prevalence of adrenal incidentaloma is 4–10%,1 and around 10–15% of incidentally discovered adrenal masses can be bilateral.2 We present a patient with bilateral adrenal masses due to primary adrenal lymphoma. Clinical Case: 74-year-old gentleman, with past medical history of type-2 Diabetes mellitus, hypertension, presented to our hospital with 2 months history of right-sided flank pain, 20 kg weight loss, loss of appetite and dizziness. Otherwise, no fever, night sweats, bleeding per rectum or urinary symptoms. On physical examination, vital signs were within normal, no remarkable findings other than tenderness over the right flank. Complete blood count and chemistry panel were within normal. Abdominal CT scan was done for evaluation of the abdominal pain which showed two large masses replacing the adrenal glands measure about 10cm in diameter with patchy areas of enhancement. Adrenal insufficiency was suspected based on the symptoms and the CT scan findings. Short syncatin test (high-dose test 250mcg) was done, which showed a cortisol baseline 152nmol/L, 30 minutes 168nmol/L, and 60 minutes 169nmol/L. This was suggestive of adrenal insufficiency, so he was started on hydrocortisone. Screening for pheochromocytoma was done as the patient developed uncontrolled BP readings prior to a scheduled adrenal biopsy. 24-hour urine metanephrines and normetanephrine were negative. CT-guided adrenal mass biopsy showed findings suggestive of large B-cell lymphoma. FDG PET-CT scan showed huge bilateral intense FDG uptake in the adrenal glands with no extra-abdominal manifestations noted. He was started on R-CHOP chemotherapy and after 4cycles, a PET scan showed a significant decrease in the size of previous adrenal masses. Conclusion: Bilateral adrenal incidentaloma should be evaluated the same as unilateral adrenal mass. Although adrenal involvement is common in non-Hodgkin lymphoma, primary adrenal lymphoma is extremely uncommon. References 1.Bovio S, Cataldi A, Reimondo G, Sperone P, Novello S, Berruti A, Borasio P, Fava C, Dogliotti L, Scagliotti GV, Angeli A, Terzolo M. Prevalence of adrenal incidentaloma in a contemporary computerized tomography series. J Endocrinol Invest. 2006 Apr;29(4):298–302. doi: 10.1007/BF03344099. PMID: 16699294. 2.Angeli A, Osella G, Alì A, Terzolo M. Adrenal incidentaloma: an overview of clinical and epidemiological data from the National Italian Study Group. Horm Res. 1997;47(4–6):279–83. doi: 10.1159/000185477. PMID: 9167965.

Download Full-text

Morphometric analysis of peroxisomes in hepatocytes of alcohol-fed rats

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s0424820100157486 ◽

1989 ◽

Vol 47 ◽

pp. 1100-1101

Author(s):

D.C. Dominguez ◽

J.T. Ellzey

Keyword(s):

Caloric Intake ◽

Volume Density ◽

Controlled Study ◽

Control Group ◽

Numerical Density ◽

Cacodylate Buffer ◽

Paired Control ◽

Experimental Group ◽

Liver Peroxisomes ◽

Single Lesion

Peroxisomes which participate in 1ipid metabolism have been shown to be altered in several metabolic disorders and toxic conditions. In alcoholic liver disease, the single lesion most frequently found is lipid accumu1ation in hepatocytes. However, the mechanisms for this 1ipid accumu1ation are not clear. The occurrence of modifications of liver peroxisomes due to excess alcohol consumption has not been subjected to a controlled study. We utilized a combination of cytochemica1 and morphometrictechniques to study the size and number of liver peroxisomes in rats fed an alcohol-supplemented diet compared to those of matched-paired control animals.Male Sprague-Daw1ey rats (400-500 g) received a liquid diet. The experimental group (N = 5/group) was fed a diet containing 30% ethanol-derived calories (EDC) and the control group was fed an isocaloric diet to 30% EDC. A pair feeding procedure was employed to control for caloric intake. Small pieces of liver randomly selected, were fixed in 2.3% -glutaraldehyde in 0.1 M sodium cacodylate buffer, pH 7.2, incubated in a DAB medium and postfixed with. 2% aqueous osmium tetroxide. EM photographs were taken from sections of 3 tissue blocks from each sample (7,200X) with a Zeiss EM10-A (60 kV). With the use of a point counting method and a digital planimeter the volume density (Vv) and numerical density (Nv) were determined.

Download Full-text

Deep Vein Thrombosis and Fibrinolysis

Thrombosis and Haemostasis ◽

10.1055/s-0038-1646432 ◽

1991 ◽

Vol 66 (04) ◽

pp. 426-429 ◽

Cited By ~ 16

Author(s):

Marcel Levi ◽

Anthonie W A Lensing ◽

Harry R Büller ◽

Paolo Prandoni ◽

Gerard Dooijewaard ◽

...

Keyword(s):

Deep Vein Thrombosis ◽

Plasminogen Activator ◽

Plasminogen Activator Inhibitor ◽

Tissue Type ◽

Controlled Study ◽

First Episode ◽

Control Group ◽

Vein Thrombosis ◽

Type Plasminogen Activator ◽

Deep Vein

SummaryIn the present study 57 consecutive patients with a first episode of venographically proven deep vein thrombosis were investigated to evaluate the release of tissue-type plasminogen activator (t-PA) and of urokinase-type plasminogen activator (u-PA) in response to DDAVP stimulation as well as the resting plasminogen activator inhibitor (PAI) concentration, comparing this to the results obtained in 66 similar patients with a clinical suspicion of thrombosis but with a normal venogram. All assays were performed without knowledge of the patient's status.Four patients in the deep vein thrombosis-group (7%) had an absent u-PA antigen response upon DDAVP infusion, while a normal response was observed in all control subjects. Patients and controls showed similar increases in t-PA antigen level upon DDAVP. High resting PAI antigen levels were encountered in 5 patients in the deep vein thrombosis-group (9%) and in 6 subjects in the control group (9%).The results from this controlled study indicate that a defective release of u-PA may occur in patients with deep vein thrombosis and may have pathogenetic significance. Furthermore it is concluded that elevation of PAI levels cannot be considered as a specific risk factor for venous thrombosis.

Download Full-text

Natural Oestrogen in the Female Climacteric - Influence on Blood Coagulation and Fibrinolysis

Thrombosis and Haemostasis ◽

10.1055/s-0038-1648686 ◽

1978 ◽

Vol 40 (02) ◽

pp. 532-541 ◽

Cited By ~ 2

Author(s):

Anders Lagrelius ◽

Nils-Olov Lunell ◽

Margareta Blombäck

Keyword(s):

Blood Coagulation ◽

Antithrombin Iii ◽

Coagulation Factors ◽

Control Group ◽

Blood Coagulation Factors ◽

Excessive Bleeding ◽

Oestrone Sulphate ◽

Menopausal Women ◽

History Of ◽

Coagulation And Fibrinolysis

SummaryThe aim of the present study was to investigate the effect on blood coagulation and fibrinolysis of a natural oestrogen preparation, piperazine oestrone sulphate, prospectively in menopausal women. Scopolamine was given to the control group.The women were investigated before and during treatment with regard to factors VIII, VII, X, V, fibrinopeptide A, antithrombin III, plasminogen, rapid antiplasmin and α1-antitrypsin. There was no significant change towards hypercoagulability or decreased fibrinolysis in any group. In the oestrogen group, however, a tendency towards an increased level of plasminogen and a decreased level of antiplasmin was demonstrated. In the scopolamine group there was an unexpected fall in factors X and V and also in plasminogen and α1,-antitrypsin. A low level of some blood coagulation factors in some of the women before treatment is somewhat astonishing; none of them had any history of excessive bleeding.

Download Full-text

A Randomized Controlled Study of the Effectiveness of Electrophysiological Monitoring of Dexmedetomidine in Patients with Brain Damage of Various Origins

Annals of the Russian academy of medical sciences ◽

10.15690/vramn1271 ◽

2020 ◽

Vol 75 (5) ◽

pp. 490-499

Author(s):

Yuri Y. Kiryachkov ◽

Marina V. Petrova ◽

Bagautdin G. Muslimov ◽

Sergey A. Bosenko ◽

Mikhail M. Gorlachev

Keyword(s):

Intervention Group ◽

Clinical Effectiveness ◽

Protective Role ◽

Digital Data ◽

Controlled Study ◽

Control Group ◽

Average Dose ◽

Autonomic Nervous System Dysfunction ◽

Sympathetic Hyperactivity ◽

Starting Dose

Background.At the same time, the main effect of the use of this drug is the elimination of the autonomic nervous system dysfunction and sympatholysis. It seems important to search for a method of indications and selection of a dose of dexmedetomidine in intensive care.Aims to improve the clinical effectiveness of the electrophysiological navigation of the prolonged use of dexmedetomidine in patients with brain pathology of various origins.Methods.The study included 83 patients 2050 days after the traumatic brain injury, anoxic damage; consequences of acute disorders of cerebral. 37 patients comprised the 1st intervention group with a clinical course of dexmedetomidine (male 28; female 9; average age 49.62.3 years) and 46 patients comprised the 2nd control group without pharmacological correction with dexmedetomidine (male 23; female 23, average age 512.5 years). Criteria for the inclusion of prolonged infusion of the drug dexmedetomidine (Orion Pharma, Finland) are based on heart rate variability (HRV) indicators characteristic of sympathetic hyperactivity, the target task of titration of doses of dexmedetomidine served as the parameters for achieving normal HRV indicators, the appearance of parasympathetic hyperactivity served as the basis for reducing the dosage of the drug or stopping it of application. HRV parameters were recorded before dexmetomedine infusion-initially, on 13; 45; 910; 1520 days of drug administration.Results.The starting dose of dexmedetomidine with sympathetic hyperactivity in patients was 0.12 to 0.24 g.kg1.hr1(average dose 0.160.01; total 200 mg/day). According to digital data from HRV, the effective dose of dexmedetomidine ED50 was 0.260.03 g.kg1.hr1(total daily 353.835.1 g) and was achieved on day 910 using dexmedetomidine.Conclusions.The protective role of dexmedetomidine with correction of sympathetic hyperactivity based on electrophysiological navigation according to the HRV is reliable in the following indicators: The improvement of consciousness; a significant decrease in the incidence of distress lung syndrome; septic shock; mortality.

Download Full-text