Divorce and remarriage in a 65-year-old male following transphenoidal surgery and bromocriptine of hyperprolactinemic impotence: a dilemma

Hyperprolactinemia, hypogonadotropinism, and subnormal plasma testosterone were found in a 65-year-old patient who had an enlarged sella turcica, complained of fatigue, and addmitted to decreased sexual interest and potency. Selective nontotal tumorectomy followed by bromocriptine therapy resulted in normoprolactinemia, increased plasma testosterone, and "rejuvenation difficult to follow" according to his wife. This patient described his sexual status as comparable to that of age 24 when he fathered his only child. Both wife and husband attributed the changes to bromocriptine and requested discontinuation (wife) and continuation (husband) of the treatment; because of the clinical indications, treatment was continued. Legally, a medical certification of a normal state of health was required before divorce--and subsequent marriage to a young woman--were permitted.

[Hashimoto's thyroiditis and monoclonal gammapathy (two cases) (author's transl)]

The authors describe two cases of Hashimoto's thyroiditis with a monoclonal dysproteinemia (IgG lambda in one case and IgG kappa in the other). They show that the antithyroid activity (anti-microsomial in the first case, anti thyroglobulin in the second case) is not carried by the abnormal gammaglobulin. The two diseases, therefore, appear to be separate but can both be considered as the consequence of a particular immunological state.

Studies on the cytodynamics of human endometrial regeneration. III. In vitro short-term incubation historadioautography

The proliferation kinetics of endometrial regeneration were assessed by tracing nucleoprotein precursor, radiothymidine. Increased isotope uptake occurred by cycle day 3 and was confined to the gland cells of denuded stratum basale (basal layer) and persistent uterine lining, bordering peripheral areas of denudation. This increase resulted in the formation of flattened surface epithelial cells, which initially were devoid of significant deoxyribonucleic acid synthesis. Such alterations are consistent with changes in cells involved in ameboid migration. Maturation of migrating cells was accompanied by a significant rise in labeling indices and replication at cycle days 3 and 4. By cycle day 5, endometrial repair was complete. The findings indicate that, following physiologic loss of stratum functionale, endometrial healing involves both migration and replication of surface cells, which originate from the gland stumps of the residual basal layer and the persistent surface epithelium adjacent to the periphery of denuded endometrium.

Proliferation kinetics of human endometrium during the normal menstrual cycle

A radioautographic analysis of the number and distribution of labeled nuclei after in vitro incorporation of radiothymidine was carried out in human endometrium during the normal menstrual cycle. The highest rates of proliferation were recorded on cycle days 8 to 10 in the upper one third of the functionalis layer. Coinciding with intraglandular secretory activity on cycle day 19, the rate of proliferation of gland cells decreased near zero levels and remained unchanged thereafter. Midsecretory phase arteriolar coiling and stromal predecidualization were associated with increased isotope incorporation. DNA synthesis in premenstrual endometrium was limited to the surface epithelium, predecidua, and vascular endothelium. The endometrium of the isthmus and cornual regions and of the basalis zone demonstrated relatively constant and comparatively lower rates of proliferation throughout the cycle. Regional and cellular variations in nucleic acid synthesis in cyclic endometrium are likely to reflect differences in physiologic functions in target cells in response to cyclic hormonal stimuli.

[Erythema gyratum repens (Gammel's syndrome)]

A case of erythema gyratum repens is reported in 78 year old woman. The particularly typical eruption, mainly affecting the trunk, was associated with a squamous cell carcinoma of the esophagus. The paraneoplastic dermatosis cleared after radiotherapy of the cancer.

Position of the medial internal capsular border in relation to third-ventricular width

The position of the medial internal capsular border (lateral thalamic border) in relation to the width of the third ventricle is of considerable importance to stereotactic surgeons. Close estimation of its position from anteroposterior roentgenograms diminishes the possibility of multiple brain penetrations in an attempt to find it by electrophysiological methods. By correlating the position of the medial capsular border found by a stimulation technique, with the width of the third ventricle, in a series of 130 patients, reliable ranges of its position were obtained.

Organization and topography of sensory responses in the internal capsule and nucleus ventralis caudalis found during stereotactic surgery

With the aid of a computer graphic technique, data gathered from exploratory stimulation of the diencephalon in 130 stereotactic operative procedures indicate that some sensory fibers in the capsule are parallel to motor fibers at basal thalamic levels and occupy a position medial to motor fibers. In addition, stimulus responses which probably represent thalamocortical projections from S II somesthetic thalamus were found to lie in a capsular zone rostral to the motor bundle. The organization of S I somesthetic thalamus was found to agree with the previous finding of Tasker et al. and some of these fibers project within the motor bundle to cortical motor areas.

The position and organization of motor fibers in the internal capsule found during stereotactic surgery

Data gathered from exploratory stimulation of the diencephalon in 130 stereotactic operative procedures have been studied, with the aid of a computer graphic technique, to show the position and topography of motor responses in the internal capsule. The results obtained indicate that pyramidal fibers are organized into a rostral-caudal face-arm-leg sequence and occupy a short compact band in the caudal third of the posterior limb of the internal capsule. This is in contrast to previous concepts of the position of these fibers in the capsule.

[Report of a case of Gaucher's disease in adult]

The authors report a case of Gaucher's disease in an adult. This is a rare disease due to the accumulation of a glucoceramide in the reticulo-endothelial cells and may remain for long clinically symptomless, as in this case. The diagnosis suggested by the biological disturbance, viz. moderate thrombopenia, hypergammaglobulinemia, increase in SGPT, was conformed by the presence of Gaucher's cells in the liver and in the bone marrow, and by the existence of an intraleukocytic glucosidase deficiency. The authors recall the clinical forms of this disease, and recent clinical trials.

[Amyloid tumors of the lung. Apropos of a new case]

The authors report a new case of pseudo-tumoral nodular amyloidosis of the lungs. The amyloid nodules being discovered during a surgical procedure for an adenocarcinoma of the lower oesophagus. The histopathological study of the nodules confirmed their amyloid origin and allowed to precise their histochemical features.

Acromegaly and galactorrhea-amenorrhea with two pituitary adenomas secreting growth hormone or prolactin. A case report

A prolactinoma was removed from a nulliparous woman who had acromegaly, galactorrhea-amenorrhea, elevated serum growth hormone and prolactin, and hypogonadotropinism. Postoperatively galactorrhea decreased and cyclic vaginal bleeding ensued; serum prolactin concentration was normal but growth hormone remained elevated and the acromegalic complex was unchanged, even after subsequently administered bromocriptine. At a second transsphenoidal operation, an adenoma of somatotropes was removed; improvement in symptoms and signs and normalisation of pituitary function, including growth hormone, followed. The possible presence of distinctly separate pituitary adenomas should be considered in patients with galactorrhea associated with acromegaly.

[beta2-Microglobulin in cancer patients (author's transl)]

Cancerembryonic antigen (CEA) and beta2-microglobulin (beta2m) have been measured in cancer patients and patients with benign diseases. Of 168 patients with intestinal cancer, almost 90% had increasing concentrations of either CEA or beta2m or both. In 29 patients at different stages of pancreatic cancer there was a high incidence of increased values in the more severe cases. In 60 patients with histologically classified colorectal cancer the TNomegaMomega group of 19 patients had 47% and 42% of elevated beta2m and CEA respectively. A significant correlation of beta2m or CEA to extension of disease was noted. In benign intestinal disease like cirrhosis and pancreatitis both beta2m and CEA is commonly elevated. Of 26 breast cancer patients, seven had elevated CEA and five had elevated beta2m values before treatment. In the patients with extraganglionary metastasis almost 90% had high beta2m or CEA or both. Of 40 patients with uterine cancer, 26 were found to have increased values of beta2m or CEA or both. Finally, 140 colorectal cancer patients, 62 patients with breast cancer and 10 patients with uterine cancer have been followed longitudinally.

Pituitary hyperthyroidism. Case report and review of the literature

A 58 year old woman with an enlarged sella turcica was found to have hyperthyroidism with a supranormal concentration of serum thyrotropin. Transsphenoidal microsurgery resulted in the removal of a chromophobe adenoma comprised mainly of thyrotropes. Postoperatively, serum thyrotropin, thyroxine and triiodothyronine levels fell within normal limits, and the patient maintained normal thyroid and pituitary function.

Parkinsonism--dementia complex, hydrocephalus and Paget's disease

A 65-year-old female patient with Paget's disease displayed dementia, a bilateral Parkinsonian syndrome, gait ataxia, bilateral grasp reflex of the feet, urinary incontinence and a left hemicerebellar syndrome. She had a marked basilar impression; the radionuclide cisternogram was suggestive of a communicating hydrocephalus with ventricular dilatation. After a shunting procedure there was improvement in both neurological and mental function.

Double-blind evaluation of glucagon and propantheline bromide (pro-banthine) for hypotonic duodenography

The hypotonic effect of glucagon (2 mg) and propantheline bromide (Pro-Banthine, 30 mg) on the upper gastrointestinal tract was compared in a double-blind study in 12 healthy volunteers and 36 patients. The solvent solution for the two drugs was used as a placebo. Both drugs and placebo were administered intramuscularly. The time of onset of the hypotonic effect was similar for both drugs, with maximum effect achieved 10 min after injection. Effects of glucagon dissapeared rapidly after 30 min, while Pro-Banthine still retained 50% of its maximum effect 2 1/2 hr after injection. Side effects of Pro-banthine were related to the long duration of the hypotonic effect (4-6 hr). A significant placebo effect on the duodenal C loop was observed. Glucagon appears to be the drug of choice since its hypotonic and hypomotile effects on the gastrointestinal tract are comparable to propantheline bromide while having the advantage of shorter duration and practically no side effects.