Magnetic resonance imaging of the pituitary gland in patients with secondary hypogonadism due to transfusional hemochromatosis

To identify pituitary iron overload in patients with transfusional hemochromatosis causing secondary hypogonadism, we prospectively evaluated signal intensity abnormalities of the anterior lobe of the pituitary gland of 18 patients affected by transfusion-dependent thalassemia major and secondary hypogonadism. Magnetic resonance (MR) imaging is useful to assess pituitary iron overload in patients with transfusional hemochromatosis and secondary hypogonadism by detection of a significant decreased signal intensity of the anterior lobe of the pituitary gland on GRE T2^*-weighted images. The decreased signal intensity of the anterior lobe of the pituitary gland on GRE T2^*-weighted images was correlated to increasing serum ferritin level (r=−0.84,r ²=−0.70,P<0.001). Indeed, the lower the signal intensity of the pituitary gland the greater the serum ferritin level. However an exact quantification of pituitary iron overload by correlation with serum ferritin level is not allowed. No correlation was found between MR imaging results and hormonal status; however, the detection of pituitary iron overload on GRE T2^*-weighted images is consistent with the hypothesis of hypogonadotrophic pituitary insufficiency due to iron-induced cellular damage.     

MR imaging technique for the diagnosis of pituitary iron overload in patients with transfusion-dependent beta-thalassemia major

To identify the optimal MR imaging technique for diagnosing pituitary iron overload, we compared spin-echo and gradient-echo MR imaging with measurements of pituitary T2 relaxation times in 30 patients with secondary hemochromatosis due to transfusion-dependent beta-thalassemia major and in 10 healthy volunteers. We found that the optimal MR imaging technique to evaluate pituitary iron overload is the gradient-echo T2*-weighted technique, as it best demonstrated signal reduction in the anterior lobe of the pituitary gland.     

Magnetic resonance findings in scuba diving-related spinal cord decompression sickness

Scuba diving is associated with risk of severe decompression sickness (DCS type II), which results from rapid reduction of the environmental pressure sufficient to cause the formation into tissue or blood of inert gas bubbles previously loaded within tissues as a soluble phase. DCS type II constitutes a unique subset of ischemic insults to the central nervous system (CNS) with primarily involvement of the spinal cord. Ten patients with diving-related barotrauma underwent neurologic examination. Two of them presented progressive sensory and motor loss in the extremities at admission and were presumed affected by spinal cord DCS. Magnetic resonance imaging (MRI) demonstrated abnormalities in the white-matter tracts of the spinal cord in these patients, in each case corresponding to an area of the cord believed to be clinically involved. After a course of therapeutic recompressions, one patient was able to stand and walk a short distance,and MRI revealed a decreased extension of areas of spinal cord abnormalities. MRI has proved to be reliable in the detection of pathologic changes of spinal cord decompression sickness that were previously undetectable by other neuroimaging methods and also has proved to be useful in the follow-up during therapeutic hyperbaric recompressions.     

Hamartoma of the urinary bladder: case report and review of the literature

In this first article for the feature Humanism and Medicine, Rita Charon introduces an excerpt from Richard Selzer's introduction to his latest book, The Doctor Stories. In her introductory and concluding comments, Charon contemplates the role of stories in medicine and how both truth and healing can be found in both listening to and telling stories. In the excerpt presented, surgeon and writer Selzer muses on his twin crafts. As a writer, Selzer can fully appreciate that which he witnesses in his life as a doctor. His ruminations on his own dual citizenship suggests that all doctors, perhaps, can deepen their commitment to medicine, to their patients, and to themselves by strengthening their capacity to behold their patients and to grasp their predicaments. Selzer also traces his origins and, by implication, projects his future. As practicing physicians and medical educators, readers of Academic medicine might be inspired to do the same.