Successful treatment of Cushing's disease using yttrium-90 rods.

Interstitial irradiation using yttrium-90 (90Y) rods implanted by needle into the pituitary gland was used as primary treatment in 16 patients with pituitary dependent Cushing''s disease. Clinical and biochemical remission was observed within three or six months in 13 and in the remaining three after a supplementary implant. There was no perioperative morbidity. Follow-up from the time of definitive operation ranged from six to 123 months (mean 39). No recurrence has been observed. The return of a normal diurnal cortisol rhythm has been observed in 10/12 patients studied after remission. Some form of long-term pituitary hormone replacement therapy was required in only the six patients who had received the largest irradiation dose. Implantation of 90Y is safe and effective treatment for patients with Cushing''s disease, comparing favourably with selective trans-sphenoidal pituitary surgery.     

Characterization of the effect of LPS on dendritic cell subset discrimination in spleen

The Gram‐negative bacterial endotoxin lipopolysaccharide (LPS) is a potent inflammatory mediator and a leading cause of bacterial sepsis. While LPS is known to activate antigen‐presenting cells, here we find that LPS down‐regulates expression of CD11c and CD11b on splenic dendritic cell subsets, thus confounding the ability to identify these subsets following treatment. This has implications with regard to tracking the response to LPS in terms of the cell subsets involved, and should be considered whenever such studies are undertaken.     

Post-partum Hypercalcaemia in Treated Hypoparathyroidism

Two patients with post-thyroidectomy hypoparathyroidism were observed throughout three pregnancies. Their normal maintenance treatment with vitamin D remained unaltered. Serum calcium levels remained normal until shortly before delivery but rose rapidly in the immediate postpartum period to peak levels of 7·8, 6·0, and 6·8 mEq/l. while still on normal or reduced maintenance treatment. This apparent increased sensitivity to vitamin D after delivery persisted for as long as three months.