Patients without VF deficits or whose visual deficits are stable or improving can be managed expectantly without negative impact on outcomes. Clinical severity based on a PAS ≥ 4 appeared to influence management towards emergency surgical intervention.

No abstract

Objective: To elucidate the long-term outcomes of pituitary adenomas diagnosed in childhood and adolescence, knowledge of which remains sparse. Design and methods: A retrospective review of patients aged %21 years at diagnosis of pituitary adenoma, attending a neuroendocrine service in Liverpool, UK, between 1984UK, between -2009. Results: There were 41 patients (33 female), mean age at diagnosis 17.3 years (range 11-21) and mean follow-up 9.6 years; 29 patients had prolactinomas (15 macroprolactinomas), 6 non-functioning pituitary adenomas (NFPAs), 5 Cushing's disease (CD) and 1 acromegaly. All prolactinoma patients received dopamine agonists (DAs) and three also underwent pituitary surgery. Furthermore, ten patients underwent surgery: five with CD, one with acromegaly and four with NFPA. Four received radiotherapy after surgery. Another ten patients received hormone replacement: nine hydrocortisone, five thyroxine, seven sex steroids and five GH; another seven had severe asymptomatic GH deficiency. Three female patients were treated for infertility (two successfully). Thirteen patients gained significant weight (body mass index (BMI) increase O2 kg/m 2 ) since diagnosis and 16 in total are now obese (BMIO30 kg/m 2 ). Five were treated with orlistat and one attended a weight management service. Two received antihypertensive medications, two had type 2 diabetes and four were treated for dyslipidaemia. Conclusions: This is one of the largest reviews of patients aged 21 or younger at diagnosis of pituitary adenoma followed up by a single service. Two-thirds had prolactinomas, all were treated with DAs and three underwent surgery. Increased cardiovascular risk factors (obesity and dyslipidaemia) and infertility are important sequelae and active identification and treatment are necessary.

Physicians provide different insulin dose recommendations based on the same datasets. The automated advice of the Advisor Pro did not differ significantly from the advice given by the physicians in the direction or magnitude of the insulin dosing.

Capybara might be a useful model for studying changes in cerebral circulation as the natural atrophy of the internal carotid artery (ICA) occurs in this animal at maturation. In this study, confocal and electron microscopy combined with immunohistochemical techniques were applied in order to reveal the changes in morphology and innervation to the proximal part of ICA in young (6-month-old) and mature (12-month-old) capybaras. Some features of the basilar artery (BA) were also revealed. The ICA of young animals degenerated to a ligamentous cord in mature animals. Immunolabelling positive for pan-neuronal marker protein gene product 9.5 but negative for tyrosine hydroxylase was observed in the proximal part of ICA at both ages examined. Axon varicosities positive for synaptophysin were present in the adventitia of ICA of young animals but were absent in the ligamentous cord of mature animals. In the ICA of young animals, adventitial connective tissue invaded the media suggesting that the process of regression of this artery began within the first 6 months of life. An increase in size of the BA was found in mature animals indicating increased blood flow in the vertebro-basilar system, possibly making capybara susceptible to cerebrovascular pathology (e.g. stroke). Capybara may therefore provide a natural model for studying adaptive responses to ICA regression/occlusion.

No abstract

Objective Remission rates in young people with Graves’ hyperthyroidism are <25% after two years of thionamide antithyroid drug (ATD). We explored whether rituximab, a B lymphocyte depleting agent, would increase remission rates when administered with a short course of ATD. Design This was an open label multi-centre single arm phase 2 trial in young people (12-20y) with Graves’ hyperthyroidism. An A’Hern design was used to distinguish an encouraging remission rate (40%) from an unacceptable rate (20%). Participants presenting with Graves’ hyperthyroidism received 500mg rituximab and 12 months of ATD titrated according to thyroid function. ATD were stopped after 12 months and primary outcome assessed at 24 months. Participants had relapsed at 24 months if: TSH was suppressed and FT3 was raised; they had received ATD between months 12 and 24; they had thyroid surgery/radioiodine. Results Twenty-seven participants were recruited and completed the trial with no serious side effects linked to treatment. Daily carbimazole dose at 12 months was <5mg in 21/27 participants. 13/27 participants were in remission at 24 months (48%, 90% one-sided confidence interval 35%, 100%); this exceeded the critical value (9) for the A’Hern design and provided evidence of a promising remission rate. B lymphocyte count at 28 weeks, expressed as a percentage of baseline, was related to likelihood of remission. Conclusions Adjuvant rituximab, administered with a 12 month course of ATD, may increase the likelihood of remission in young people with Graves’ hyperthyroidism. A randomised trial of adjuvant rituximab in young people with Graves’ hyperthyroidism is warranted.

SUMMARY Three patients with transient myopia following blunt injury are described with the aid of serial ultrasonography. The cause of refractive change is an increase in the anteroposterior thickness of the crystalline lens, which probably results from oedema of the ciliary body.