Adrenal pseudocyst presenting as acute abdomen during pregnancy

Pseudocysts of the adrenal gland are rare lesions, which are usually discovered as incidental findings. Since they are in the majority of cases non-functioning, they become symptomatic only when they are complicated with rupture, haemorrhage or infection. We present a case of a 28-year-old woman in the 26th gestational week, who developed an acute abdomen due to a haemorrhagic pseudocyst of the left adrenal. The patient was submitted to left adrenalectomy. The described case is the third reported case of cystic adrenal lesion discovered during pregnancy and only the first reported case of acute presentation of an adrenal pseudocyst during pregnancy.

Endoscopic snare resection of an intrapapillary pedunculated villous adenoma presenting as acute recurrent pancreatitis

Tumors of the papillary region are an unusual and heterogeneous group of neoplasms that arise from the major papilla, the ampulla of Vater, and the peripapillary duodenum. Benign adenomas of the papilla of Vater are an increasingly recognized condition in those with familial adenomatous polyposis syndromes as well as sporadic cases. Papillary adenoma is a recognized but rare cause of acute pancreatitis. We describe a patient who presented with acute recurrent pancreatitis that was attributed to an intrapapillary pedunculated villous adenoma. Following diagnosis by endoscopic needle knife sphincterotomy and endoscopic retrograde cholangiopancreatography, endoscopic snare resection of the adenoma resulted in symptomatic improvement.

Month of birth, atopic disease, and sensitization to common aeroallergens in Greece

The aim of the study was to evaluate the influence of the month of birth on the development of atopic disease and the rate of sensitization to common environmental allergens in Greece. Analysis of the month of birth of 1755 individuals with atopic disease (asthma, rhinitis, atopic dermatitis), out of whom 771 had positive skin tests/RAST to Dermatophagoides pteronyssinus and mixed grasses, in comparison to total live births (2,877,733) in Greece during 1968-88, was performed and showed significant correlation (p < 0.001) between month of birth and development of atopic disease in general. Months of birth May to August correlated best with bronchial asthma (p < 0.05) and rhinitis (p < 0.05), and July to August with atopic dermatitis (p < 0.05). Significantly greater than the expected frequency was found for D. pteronyssinus sensitivity for months of birth May to August (p < 0.01), for mixed grass pollen March to August (p < 0.01), and for Olea europaea pollen mainly March (p < 0.05). Our results indicate that in Greece high-risk birth months for development of atopy are May to August, whereas for sensitization to common aeroallergens they are March for O. europaea, March to August for mixed grasses, and May to August for D. pteronyssinus.

Pregnancy estrogens in relation to coffee and alcohol intake

Total estrogen (TE), estradiol (E2), estriol (E3), and human placental lactogen (hPL) levels were determined by radioimmunoassay in the blood of 141 pregnant women during their 26th and 31st weeks of pregnancy and the results were studied in relation to coffee and alcohol intake. After controlling for maternal age, maternal weight at the corresponding week of pregnancy, parity, and tobacco smoking, as well as for mutual confounding effects, coffee intake, ascertained at the 26th week, was found to be negatively related to pregnancy E2 levels (P = 0.04 during the 26th week, and P = .16 during the 31st week), whereas alcohol intake, also ascertained at the 26th week, was found to be positively related to pregnancy TE levels (P = .04 during the 26th week, and P = .18 during the 31st week). The negative relation between coffee consumption on the one hand and E2 (and possibly TE) levels on the other may be responsible for the inverse association between maternal coffee intake and birth weight; the latter association has been repeatedly confirmed in the literature, although it was neither strong nor statistically significant in the present study. The relations of maternal coffee and alcohol consumption with pregnancy estrogen levels, if confirmed, could be utilized in studies exploring the role of prenatal exposure to these hormones in the etiology of gonadal germ-cell tumors and possibly other diseases.

Maternal age, parity, and pregnancy estrogens

Total estrogens (TE), estradiol (E2), estriol (E3), and human placental lactogen (hPL) were determined by radioimmunoassay in the blood of 126 pregnant women during their 26th and 31st weeks of pregnancy and the results were studied in relation to maternal age and parity. Total estrogens and E2 were lowest among the youngest women (less than 20 years) and highest among women aged 20-24 years, whereas older women (25+ years) had, on the average, intermediate values. For E3 the pattern was qualitatively similar to that of TE and E2 but less striking, and no maternal age pattern was evident with respect to hPL. Within maternal age groups, TE and E2 were higher among women in the first, than among those in their second, full-term pregnancy; the difference was about seven percent for TE (P = 0.14) and about 14 percent for E2 (P = 0.05). No parity patterns were evident with respect to E3 and hPL. There were fairly strong correlations between the determinations of the same hormone in the same woman during the 26th and 31st weeks of pregnancy; Pearson correlation coefficients were 0.60 for TE, 0.78 for E2, 0.60 for E3, and 0.72 for hPL. Since the risk of breast cancer increases apparently monotonically with maternal age at birth, the present data are equivocal with respect to the hypothesis linking levels of pregnancy estrogens to risk of breast cancer in the offspring. However, the data are compatible with hypotheses linking excessive pregnancy-estrogen exposure to conditions more common among first-born individuals, including testicular cancer and cryptorchidism.

Tobacco smoking, pregnancy estrogens, and birth weight

It has been suggested that tobacco smoking during pregnancy reduces birth weight by lowering production rates or levels of total pregnancy estrogens. To evaluate this hypothesis, we examined total estrogen levels by radioimmunoassay in the blood of 141 pregnant women attending the maternity clinic of a major university hospital in Athens during their 26th week of pregnancy. Forty-nine of these women were regular smokers before and during their pregnancy, whereas the remaining 92 had never been regular smokers and did not smoke at all during their pregnancy. Birth weight of offspring was lower among smokers than among nonsmokers by 190.8 g, with a 90% confidence interval of 41.1 to 340.5 g, and higher among women with higher serum estrogen levels (slope b = 1.2 g per 1000 pg/ml with a 90% CI of 0.2 to 2.2 g). There was, however, only a small negative relation between tobacco smoking and serum estrogen levels; in smokers, total estrogen levels were reduced to 91% of the corresponding levels among nonsmokers.