Patricia Gadelha

Interdigital skin lesions of the lower limbs among patients with lymphoedema in an area endemic for bancroftian filariasis

Objectives  An estimated 15 million persons suffer from lymphoedema of the leg in filariasis‐endemic areas of the world. A major factor in the progression of lymphoedema severity is the incidence of acute dermatolymphangioadenitis (ADLA), which is triggered by bacteria that gain entry through damaged skin, especially in the toe web spaces (‘interdigital skin lesions’). Little is known about the epidemiology of these skin lesions or about patients’ awareness of them.

The Role of Isotretinoin Therapy for Cushing's Disease: Results of a Prospective Study.

Objective. This prospective open trial aimed to evaluate the efficacy and safety of isotretinoin (13-cis-retinoic acid) in patients with Cushings disease (CD). Methods. Sixteen patients with CD and persistent or recurrent hypercortisolism after transsphenoidal surgery were given isotretinoin orally for 6–12 months. The drug was started on 20 mg daily and the dosage was increased up to 80 mg daily if needed and tolerated. Clinical, biochemical, and hormonal parameters were evaluated at baseline and monthly for 6–12 months. Results. Of the 16 subjects, 4% (25%) persisted with normal urinary free cortisol (UFC) levels at the end of the study. UFC reductions of up to 52.1% were found in the rest. Only patients with UFC levels below 2.5-fold of the upper limit of normal achieved sustained UFC normalization. Improvements of clinical and biochemical parameters were also noted mostly in responsive patients. Typical isotretinoin side-effects were experienced by 7 patients (43.7%), though they were mild and mostly transient. We also observed that the combination of isotretinoin with cabergoline, in relatively low doses, may occasionally be more effective than either drug alone. Conclusions. Isotretinoin may be an effective and safe therapy for some CD patients, particularly those with mild hypercortisolism.

Spontaneous remission of hypercortisolism presumed due to asymptomatic tumor apoplexy in ACTH-producing pituitary macroadenoma

Cushings disease (CD) is usually caused by secretion of ACTH by a pituitary corticotroph microadenoma. Nevertheless, 7%-20% of patients present with ACTH-secreting macroadenomas. Our aim is to report a 36-year-old female patient with CD due to solid-cystic ACTH-macroadenoma followed up during 34 months. The patient presented spontaneous remission due to presumed asymptomatic tumor apoplexy. She showed typical signs and symptoms of Cushings syndrome (CS). Initial tests were consistent with ACTH-dependent CS: elevated urinary free cortisol, abnormal serum cortisol after low dose dexamethasone suppression test, and elevated midnight salivary cortisol, associated with high plasma ACTH levels. Pituitary magnetic resonance imaging (MRI) showed a sellar mass of 1.2 x 0.8 x 0.8 cm of diameter with supra-sellar extension leading to slight chiasmatic impingement, and showing hyperintensity on T2-weighted imaging, suggesting a cystic component. She had no visual impairment. After two months, while waiting for pituitary surgery, she presented spontaneous resolution of CS. Tests were consistent with remission of hypercortisolism: normal 24-h total urinary cortisol and normal midnight salivary cortisol. Pituitary MRI showed shrinkage of the tumor with disappearance of the chiasmatic compression. She has been free from the disease for 28 months (without hypercortisolism or hypopituitarism). The hormonal and imaging data suggested that silent apoplexy of pituitary tumor led to spontaneous remission of CS. However, recurrence of CS was described in cases following pituitary apoplexy. Therefore, careful long-term follow-up is required.

Effects of Bariatric Surgery on Left Ventricular Structure and Function

Background: Obesity is associated with changes in left ventricular (LV) structure and function. Bariatric surgery can favorably improve cardiac remodeling. The effects of the procedure in LV diastolic and systolic function have not been clearly defined. The aim of this study was to evaluate the changes in left ventricular structure, systolic and diastolic function in obese patients who have undergone bariatric surgery. Methods: We evaluated 23 patients (16 women, seven men; age, 32.9 ± 8.9 years) with body mass index > 40 kg/m2 who underwent Roux-en-Y gastric bypass (RYGB). Clinical and echocardiographic evaluations were performed preoperatively and 3–7 months after surgery. Results: After a mean follow-up of 4.7 months, significant reductions were observed in body mass index (from 46.7 ± 5.3 to 36.2 ± 4.7 kg/m2; p< 0.001); thickness of the interventricular septum (from 10.3 ± 1.4 to 8.9 ± 1.2 mm); LV posterior wall (from 9.3 ± 1.3 to 8.4 ± 1.1 mm; p < 0.001) and LV mass (absolute value: from 168.7 ± 35.2 to 149.8 ± 40.7 g, p = 0.008; indexed by height: from 45.1 ± 11.3 to 39.7 ± 10.3, p = 0.006). Normal LV geometry was observed in 60.9% of patients before surgery and in 91.3% at follow-up. Tissue Doppler imaging revealed improved LV diastolic function (mitral E’ lateral 0.16 ± 0.03 preoperatively vs. 0.17 ± 0.03 m/s at follow-up; p = 0.026). Postoperatively, there was no significant difference in LV systolic function. Conclusions: After a mean follow-up of 4,7 months, bariatric surgery promoted improvement in left ventricular structure and in one of the parameters of diastolic function (E’ velocity). There were no changes in left ventricular systolic parameters. (Arq Bras Cardiol: Imagem cardiovasc. 2016;29(4):118-123)