Pegvisomant therapy during gestation was safe and effective in our patient. Transplacental passage of pegvisomant is either absent or minimal, with a concentration highly unlikely to convey any significant pharmacodynamic effects on the fetal GH and IGF-I system. In addition, there is no evidence of substantial secretion of pegvisomant into breast milk.

During lactation, calcium is mobilized from the maternal skeleton to supply the breast for milk production. This results in rapid but fully reversible bone loss. Prior studies have suggested that PTHrP, secreted from the breast, and estrogen deficiency, due to suckling-induced central hypogonadism, combine to trigger bone resorption. To determine whether this combination was sufficient to explain bone loss during lactation, we raised PTHrP levels and decreased levels of estrogens in nulliparous mice. PTHrP was infused via osmotic minipumps and estrogens were decreased either by using leuprolide, a long-acting GnRH agonist, or by surgical ovariectomy (OVX). Bone mineral density declined by 23.2 ± 1.3% in the spine and 16.8 ± 1.9% in the femur over 10 d of lactation. This was accompanied by changes in trabecular architecture and an increase in both osteoblast and osteoclast numbers. OVX and PTHrP infusion both induced a modest decline in bone mineral density over 10 d, but leuprolide treatment did not. The combination of OVX and PTHrP was more effective than either treatment alone, but there was no interaction between PTHrP and leuprolide. None of the treatments reproduced the same degree of bone loss caused by lactation. However, both forms of estrogen deficiency led to an increase in osteoclasts, whereas infusion of PTHrP increased both osteoblasts and osteoclasts. Therefore, although the combination of PTHrP and estrogen deficiency contributes to bone loss, it is insufficient to reproduce the full response of the skeleton to lactation, suggesting that other factors also regulate bone metabolism during this period.

No abstract

No abstract

No abstract

A 74-year-old hypertensive woman presented with abdominal discomfort and a pulsatile abdominal mass. Anterior abdominal angiography during cardiac blood pool, and renal scintigraphic imaging demonstrated a large abdominal aortic aneurysm. 1, 2 Before endovascular repair with an aortoiliac endograft, the abdominal aneurysm measured 7.5 x 7.0 cm on abdominal computed tomography. This study demonstrates that a suspected abdominal aortic aneurysm can be confirmed using the addition of anterior abdominal imaging with normal posterior imaging at the time of renal scintigraphy.

No abstract

BackgroundBrain death scintigraphy is used to objectively determine futility of care in patients who have sustained irreversible damage to the central nervous system (CNS). The appropriate use of the test and its effectiveness in the clinical setting are not well defined.ObjectiveTo determine for whom and under what circumstances brain death scintigraphy was used within a single institution to better understand how clinicians utilize the study.Design, Setting, and ParticipantsThis is a retrospective observational study of all patients who had brain death studies at a single institution between the dates of March 1999 and December 2002.ResultsThe charts of 45 patients were reviewed. None of the patients in this study survived. Most patients only lived an average of 2 days. Overall, 17% of the brain death scans revealed perfusion to the brain. Only 18% of the patients did not die on the same day of the brain death study, and of these, all but two were found to have perfusion to the brain. There were no significant differences between the numbers of days to death after a positive versus a negative brain death study.ConclusionsThis study examines the use of brain death scintigraphy at a single institution and raises the question as to whether it should be used earlier in the course of hospitalization, if at all, in order to better direct medical resources. Clinicians appear to order brain death scintigraphy on patients who are hopelessly ill and very near death. As it is currently used, the test adds nothing to determine prognosis.