Obstetrics and gynecology.

Prolactinomas account for approximately 40% of all pituitary adenomas and are an important cause of hypogonadism and infertility. The ultimate goal of therapy for prolactinomas is restoration or achievement of eugonadism through the normalization of hyperprolactinemia and control of tumor mass. Medical therapy with dopamine agonists is highly effective in the majority of cases and represents the mainstay of therapy. Recent data indicating successful withdrawal of these agents in a subset of patients challenge the previously held concept that medical therapy is a lifelong requirement. Complicated situations, such as those encountered in resistance to dopamine agonists, pregnancy, and giant or malignant prolactinomas, may require multimodal therapy involving surgery, radiotherapy, or both. Progress in elucidating the mechanisms underlying the pathogenesis of prolactinomas may enable future development of novel molecular therapies for treatment-resistant cases. This review provides a critical analysis of the efficacy and safety of the various modes of therapy available for the treatment of patients with prolactinomas with an emphasis on challenging situations, a discussion of the data regarding withdrawal of medical therapy, and a foreshadowing of novel approaches to therapy that may become available in the future.

/pdf/advances-in-the-treatment-of-prolactinomas-5a8n14833q.pdf

Advances in the treatment of prolactinomas.

Objective: This guideline summarizes the quality of the evidence to date and provides a reasonable approach to the diagnosis, evaluation, and treatment of the hypertensive disorders of pregnancy (HDP). Evidence: The literature reviewed included the original HDP guidelines and their reference lists and an update from 1995. Using key words, Medline was searched for literature published between 1995 and 2007. Articles were restricted to those published in French or English. Recommendations were evaluated using the criteria of the Canadian Task Force on Preventive Health Care (Table 1).

https://www.mcgill.ca/anesthesia/files/anesthesia/wk_5b_sogc_guidelines.pdf

Diagnosis, Evaluation, and Management of the Hypertensive Disorders of Pregnancy

Clinical use of quantitative computed tomography and peripheral quantitative computed tomography in the management of osteoporosis in adults: the 2007 ISCD Official Positions.

BACKGROUND. Symptomatic neonatal hypoglycemia may be associated with later neurodevelopmental impairment. Brain injury patterns identified on early MRI scans and their relationships to the nature of the hypoglycemic insult and neurodevelopmental outcomes are poorly defined. METHODS. We studied 35 term infants with early brain MRI scans after symptomatic neonatal hypoglycemia (median glucose level: 1 mmol/L) without evidence of hypoxic-ischemic encephalopathy. Perinatal data were compared with equivalent data from 229 term, neurologically normal infants (control subjects), to identify risk factors for hypoglycemia. Neurodevelopmental outcomes were assessed at a minimum of 18 months. RESULTS. White matter abnormalities occurred in 94% of infants with hypoglycemia, being severe in 43%, with a predominantly posterior pattern in 29% of cases. Cortical abnormalities occurred in 51% of infants; 30% had white matter hemorrhage, 40% basal ganglia/thalamic lesions, and 11% an abnormal posterior limb of the internal capsule. Three infants had middle cerebral artery territory infarctions. Twenty-three infants (65%) demonstrated impairments at 18 months, which were related to the severity of white matter injury and involvement of the posterior limb of the internal capsule. Fourteen infants demonstrated growth restriction, 1 had macrosomia, and 2 had mothers with diabetes mellitus. Pregnancy-induced hypertension, a family history of seizures, emergency cesarean section, and the need for resuscitation were more common among case subjects than control subjects. CONCLUSIONS. Patterns of injury associated with symptomatic neonatal hypoglycemia were more varied than described previously. White matter injury was not confined to the posterior regions; hemorrhage, middle cerebral artery infarction, and basal ganglia/thalamic abnormalities were seen, and cortical involvement was common. Early MRI findings were more instructive than the severity or duration of hypoglycemia for predicting neurodevelopmental outcomes.

Patterns of cerebral injury and neurodevelopmental outcomes after symptomatic neonatal hypoglycemia.

OBJECTIVE. The purpose of our study was to evaluate the diagnostic value of an imaging protocol that combines dynamic contrast-enhanced MRI (DCE-MRI) and diffusion-weighted imaging (DWI) in patient...

https://www.ajronline.org/doi/pdf/10.2214/AJR.10.4258

Contribution of diffusion-weighted imaging to dynamic contrast-enhanced MRI in the characterization of breast tumors.

Purpose: Our purpose was to clarify and further characterize the changes in height, length, width, volume, and shape in the normal pituitary gland and in width in the infundibulum during pregnancy and the first 6 months post partum.Material and Methods: Cranial MR imaging was performed in 78 women who were pregnant in the second or third trimester or who were post partum, and in 18 age-matched control subjects who were not pregnant. Volume measurements were performed in 2 ways; volume 1=1/2xheightxlengthxwidth; and volume 2=area (measured by trackball)xslice thicknessResults: Gland volume, height, width, length, and convexity, and infundibular width increased during pregnancy. the highest values were seen during the 3 days immediately post partum. When compared with volunteers, volumes 1 and 2 showed the largest increase (120%) among the parameters. Gland height showed the best correlation (r=0.94, p>0.00001) with gestational age. the mean height of the gland was 8.76 mm in the third trimester. None of th...

Pituitary dimensions and volume measurements in pregnancy and post partum: MR assessment

OBJECTIVE. The purpose of this study was to investigate the potential use of low-tube-current MDCT virtual bronchoscopy for the evaluation of children with suspected foreign body aspiration.SUBJECTS AND METHODS. Low-tube-current MDCT was performed in 23 patients (10 girls, 13 boys) with a mean age of 3.3 years (9 months–13 years) with suspicion of foreign body aspiration. Chest radiographs were obtained before CT was performed. MDCT was performed using 25- to 50-mA tube currents. MDCT virtual bronchoscopy images were obtained. Neither sedation nor IV contrast medium was used during CT scanning. All patients underwent endoscopic evaluation within 24 hr after MDCT was performed. MDCT virtual bronchoscopy findings were retrospectively compared with the results of rigid bronchoscopy.RESULTS. The mean tube current was 35 mA (range, 25–50 mA). Imaging quality was excellent in nine studies (39%), good in 12 studies (52%), and poor in two studies (9%). Motion artifacts were present on several slices in five exami...

Low-dose MDCT and virtual bronchoscopy in pediatric patients with foreign body aspiration.

PURPOSE: To evaluate midterm results of percutaneous drainage (PD) with image guidance in 21 patients with tuberculous iliopsoas abscesses with or without spondylodiskitis. MATERIALS AND METHODS: Computed tomography (CT)–guided PD was performed in 21 patients with 26 tuberculous iliopsoas abscesses. Nineteen patients had bone involvement of two or more vertebrae. Eleven patients with spondylodiskitis had intradiskal abscesses. Five patients had bilateral psoas abscesses. Easily and safely accessible well-circumscribed abscesses larger than 3 cm were selected for PD. Catheters were inserted into the abscess cavities with Seldinger technique in all cases. In conjunction with PD, all patients had antituberculous drug therapy and underwent clinical and imaging follow-up for at least 1 year. RESULTS: Percutaneous catheter placement was successful in all cases without procedural complications. On the basis of CT findings, complete evacuation of all abscesses was achieved initially. During follow-up, six (29%) o...

Hasan Dinç

Papers

Contribution of diffusion-weighted imaging to dynamic contrast-enhanced MRI in the characterization of breast tumors.

Pituitary dimensions and volume measurements in pregnancy and post partum: MR assessment

Low-dose MDCT and virtual bronchoscopy in pediatric patients with foreign body aspiration.

Image-guided percutaneous drainage of tuberculous iliopsoas and spondylodiskitic abscesses: midterm results.

Percutaneous catheter drainage of tuberculous and nontuberculous psoas abscesses