Biomedical subjects
Publications and source records attributed to B J Synek.
A 72 yr-old man presented with clinical features suggestive of disseminated malignancy, and at autopsy was found to have hemosiderosis and multiple liver abscesses due to Yersinia enterocolitica. The literature is reviewed, with emphasis on the role of abnormal iron metabolism in disseminated infection with this organism.
Electroencephalograms with a dominant rhythmic areactive 5Hz theta activity are reported in two comatose patients with fatal outcome. This pattern was followed by isoelectric EEG and death in the first patient, who suffered multiple injuries including severe cerebral concussion and later tentorial herniation. The second patient died eight hours after the second EEG recording, both EEGs having shown a very rhythmic 5-6 Hz activity which was maximal anteriorly. He died two days after a severe cerebral hypoxic episode due to acute respiratory failure. Both patients were in their late sixties. It is suggested that the dominant areactive theta activity is a variant of malignant "alpha pattern coma".
A 49-year-old man with acromegaly underwent the apparently complete removal of a pituitary microadenoma by the transsphenoidal route. There was complete remission of the biochemical abnormalities for 2 1/2 years, with basal plasma growth hormone (GH) levels of less than 1 ng/ml and normal somatomedin levels. The patient then died after the rupture of a cerebral aneurysm. Serial sections of the pituitary fossa showed persistent tumor with a volume of about 6% of the remaining normal gland. It is concluded that current endocrine tests are limited in their ability to detect residual GH-secreting tumor. Their sensitivity is likely to depend on the mass of tumor and on the GH secretion rate. Predictions of long term cure based on these tests are only tentative.
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The clinical and autopsy findings are described in two patients with Crushing's disease who died five days and 18 years following bilateral adrenalectomy. In each case tomography of the pituitary fossa was normal but examination of the pituitary revealed a 5 to 6 mm basophilic adenoma in the antero-inferior aspect of the gland. The first patient failed to show suppression of urinary oxogenic steroids during administration of high dose dexamethasone. The second patient had functioning adrenal autografts in skeletal muscle 18 years after adrenalectomy. The clinico-pathological correlation of these two patients supports modern re-emphasis on the aetiology of Cushing's disease as a primary pituitary tumour and its treatment by selective trans-sphenoidal hypophysectomy.
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