Эндогенный гиперкортизолизм: достижения и перспективы в диагностике и лечении

The results of examination and treatment of 647 patients with endogenous hypercortisolism were studied: pituitary corticotropinoma was detected in 494 (76.4%) patients, corticosteroma and pre corticosteroma of the adrenal gland in 142 (21.9%), bilateral macro-nodular hyperplasia of the adrenal glands of primary adrenal origin-in 11 (1.7%). Differential diagnosis of clinical forms of endogenous hypercortisolism was based on the assessment of the level of adrenocorticotropic hormone and cortisol, both in peripheral blood, and with selective bilateral blood sampling from the adrenal veins and lower stony sinuses, and the study of the nature of samples with 8 mg of dexamethasone. Topical diagnostics consisted in assessing the state of the adrenal glands and pituitary gland during computed tomography and magnetic resonance imaging with the use of contrast agents, and the use of special software 3D-Volume Rendering Technique allowed optimizing tactical and technical approaches to performing surgical interventions. Of the operated patients with adrenocorticotropic hormone dependent endogenous hypercortisolism, total removal according to the control magnetic resonance imaging was achieved in 92.3% of cases, subtotal in 7.7%. However, hormonal remission was achieved only in 82.4% of cases. All patients with corticosteroma and pre-corticosteroma of the adrenal gland underwent adrenalectomy: in 6 patients by open method, in 136 patients by endovideosurgical method (in 11 patients by laparoscopic method, in 124 patients by retroperitoneoscopic method, and in 1 patient by thoracoscopic transdiaphragmatic adrenalectomy). In all patients, the operation led to recovery. Patients with benign macronodular hyperplasia of the adrenal glands needed conservative treatment with steroidogenesis blockers. Indications for surgical treatment in the volume of unilateral adrenalectomy occurred only in 2 patients.

Hypofractioned skull base meningioma radiosurgery (case report)

The objective is to describe a case of hypofractioned skull base meningioma radiosurgery.Clinical case. For 5 years, female patient S., 55 years old, suffered from headaches. In 2012, magnetic resonance imaging of the brain showed petroclival meningioma on the left actively and homogenously accumulating the contrast agent. The patient refrained from any type of treatment. Control magnetic resonance imaging showed an increase in tumor size up to 24 × 45 × 27 mm; at the lateral margin it spread to the left temporal area, at the medial margin it grew around the left optic nerve, chiasm spreading into the left maxillary sinus. We performed three-fraction radiosurgery for skull base meningioma according to hypofractionation scheme (7 Gr / fraction with 2 day interval). 37 months postoperatively, tumor volume had complete regression. There are no optic disturbances.Conclusion. This case report demonstrates treatment results of difficult structure tumor and describe radiosurgical possibilities in big size meningiomas.

Percutaneous image guided electrochemotherapy of hepatocellular carcinoma: technological advancement

BackgroundElectrochemotherapy is an effective treatment of colorectal liver metastases and hepatocellular carcinoma (HCC) during open surgery. The minimally invasive percutaneous approach of electrochemotherapy has already been performed but not on HCC. The aim of this study was to demonstrate the feasibility, safety and effectiveness of electrochemotherapy with percutaneous approach on HCC.Patient and methodsThe patient had undergone the transarterial chemoembolization and microwave ablation of multifocal HCC in segments III, V and VI. In follow-up a new lesion was identified in segment III, and recognized by multidisciplinary team to be suitable for minimally invasive percutaneous electrochemotherapy. The treatment was performed with long needle electrodes inserted by the aid of image guidance.ResultsThe insertion of electrodes was feasible, and the treatment proved safe and effective, as demonstrated by control magnetic resonance imaging.ConclusionsMinimally invasive, image guided percutaneous electrochemotherapy is feasible, safe and effective in treatment of HCC.

The corellation between somatostatin receptors expression and octreotide treatment in non-functioning pituitary adenomas

Introduction. Neurosurgery, which is the treatment of choice of non-functioning pituitary adenomas (NFPA), is often incurative. It usually leaves tumour residue that can regrow in the future. There is no established management for the postoperative period of NFPA, however, some data suggest that somatostatin analogues (SSA) can be effective, especially regarding somatostatin receptors (SSTR) presence in NFPA. SSTR scintigraphy and immunohistochemistry are used to assess SSTR expression in NFPA.Aim: to analyse the outcome of SSA treatment in NFPA and to correlate it with the results of SSTR scintigraphy and immunohistochemistry.Material and methods. Twenty six NFPA patients after incomplete neurosurgery with positive results of scintigraphy and immunohistochemistry were included in the study. All patients were treated with octreotide LAR 20mg intramuscular every 4 weeks. The tumour size was evaluated in control magnetic resonance imaging after 2 years of SSA therapy.Results. Tumour size remained stable in the majority of NFPA. Adenoma size reduction was observed in 2 patients with strong expression of SSTR2 in both scintigraphy and immunohistochemistry. Increase of tumour size was noticed in 4 patients whose tumours were characterised not only by the presence of SSTR2 and SSTR5 but also by strong expression of SSTR1 in immunohistochemistry.Conclusions. Only strong expression of SSTR2 can predict patients response to SSA treatment in NFPA. However, strong expression of SSTR1 observed in some of NFPA gives hope that introduction of new broad spectrum SSA like pasireotide would be more effective, especially in tumour shrinkage.

A Case Report of Occupational Middle Ear Tuberculosis in a Nurse

A Case Report of Occupational Middle Ear Tuberculosis in a NurseThis article presents a case of a 40-year-old female patient with a right-side middle ear tuberculosis. The patient was a nurse, who had worked at the Department of Pulmology, Clinical Hospital Rijeka for 17 years. The cause was infection with Mycobacterium tuberculosis while she assisted in bronchoscopy. The patient was referred to occupational medicine (OM) for confirmation of occupational disease immediately after surgery. The disease was confirmed as occupational by the Croatian Institute for Health Insurance of Health Protection at Work.During surgery a sample was taken for microbiological analysis. We did initial and control multislice computed tomography (MSCT) and control magnetic resonance imaging (MRI) of temporal bones 6 months after the surgery. The initial MSCT showed total mastoid cell shadowing without destruction, while the control image showed almost full recovery save for a few remaining shadowed cells. Adequately taken occupational history by an OM specialist can significantly shorten the time to diagnosis of a rare occupational illness that is often manifested by non-specific symptoms.

Removal of an Anterior Spinal Dermoid Cyst with Fenestra Corpectomy in Klippel-Feil Syndrome: Technical Case Report

OBJECTIVE AND IMPORTANCE A spinal cord tumor occurring in association with Klippel-Feil syndrome is quite rare. The removal of an anteriorly located spinal cord tumor at the level of block vertebrae creates a surgical challenge. CLINICAL PRESENTATION A case of an intradural extramedullary dermoid cyst located anterior to the spinal cord and a syringomyelic cavity at the level of block vertebrae in a 43-year-old woman with Klippel-Feil syndrome is presented. She experienced pain and numbness in both shoulders and in her neck, and she had a slight weakness in both arms before the operation. Her weakness and the clinical symptoms completely disappeared after the operation, and the resolution of the syringomyelic cavity was observed at control magnetic resonance imaging. INTERVENTION An anterior approach creating a fenestra corpectomy to the block vertebrae was performed, and the tumor was removed totally. No fusion or fixation was performed. CONCLUSION To our knowledge, this is the first report of an anteriorly located intradural extramedullary cervical spine tumor in association with Klippel-Feil syndrome treated with this surgical technique. A three-dimensional computed tomographic control scan obtained 1 year after the operation did not show any instability.