ACTA ENDOCRINOLOGICA (BUC)

We report a case of an infant with syndromic 46,XY disorder of sexual development. The subject was born at term, to unrelated parents with no relevant medical history. At birth the infant was assigned female. Physical examination showed dysmorphic features and ambiguous external genitalia. Cytogenetic analysis of cultured peripheral blood lymphocytes revealed a male karyotype. The result of the chromosomal investigation showing male genetic sex, together with the ambivalent aspect of the external genitalia (Prader IV) and gonads that are exclusively testes led to the diagnosis of 46,XY disorder of sexual development. The clinical management will help the child and the family deal effectively with this condition A multidisciplinary approach to this problem involving pediatricians, specialists in the field of endocrinology, genetics, surgery and psychiatry is necessary in order to reach a prompt and correct diagnosis and treatment.

Obesity is a worldwide public health problem (both in developed and developing countries), the most frequent nutritional disease in the world, with considerable morbiditymortality and high costs for the public healthcare systems. Bariatric surgery has been found to be the only method capable of maintaining proper and long-lasting weight loss for morbid obesity. Laparoscopy is the gold standard for bariatric procedures. We studied a group of 341 patients who underwent different types of laparoscopic bariatric surgical procedures: laparoscopic adjustable gastric banding (LAGB), laparoscopic sleeve gastrectomy (LSG), laparoscopic gastric bypass (LGB) and laparoscopic biliopancreatic diversion (LBPD). They were evaluated preoperative (weight, BMI, comorbidities) and followed-up for 1 year: 238 patients LAGB, 46 LSG, 49 LGB and 8 LBPD. Mortality and conversion rate were nil for all groups. A significant reduction in patients’ weight was shown at 12 months postoperatively. BMI decreased from 45.6 kg/m2 to 37.9 for LAGB, from 54.12 to 40.8 kg/m2 for LGB and from 49.1 to 31.2 kg/m2 for LSG. The excess weight loss for LBPD was 63%. A significant improvement of co-morbidities was noticed; all patients with type 2 diabetes have normal serum glucose levels at 1 year after surgery. Bariatric surgery is safe with a low complication rate and the outcome was similar to literature data. Although we do not benefit of a long time follow-up, the favorable results allow us to state that minimally invasive surgical techniques deserve an important place in the efforts of struggling against obesity and its consequences.

The stress response is mediated by the hypothalamo-pituitary-adrenal (HPA) system.\r\nActivity of the hypothalamic paraventricular nucleus (PVN) forms the basis of the HPAaxis.\r\nBehavioral and endocrine responsivity to threat and their ontogenetic changes may be\r\nmediated by PVN.\r\nMethods. 6-hydroxydopamine (6-OHDA) remains the most widely used substance in\r\nanimal models for inducing highly reproducible brain lesions. In our study, parvocellular neurons\r\nfrom the PVN of male Wistar rats were chemical lesioned by right-unilateral stereotaxic injection\r\nof two different doses of 6-OHDA (8μg/3μl and 16μg/3μl) and were subjected to a battery of\r\nbehavioral tests designed to assess spatial memory formation (radial arm-maze task) and anxiety\r\n(elevated plus maze). Further, we were interested in knowing whether a 6-OHDA lesion of the\r\nPVN would result in an imbalance in neuronal oxidative stress levels.\r\nResults. 6-OHDA-induced PVN lesions significantly increased the number of\r\nworking memory errors, suggesting effects on short-term memory, without affecting longterm\r\nmemory, explored by number of reference memory errors in radial arm-maze task. In\r\nelevated plus maze measuring anxiety, 6-OHDA significantly diminished anxiety-like\r\nbehavior in a dose-dependent manner. In addition, the neurotoxin induced a reduction in\r\nsuperoxide dismutase (SOD) and glutathione peroxidase (GPX) specific activities, while\r\nmalondialdehyde (MDA) level was found increased in the temporal lobe of rat brain, the\r\nmost vulnerable cortical area to oxidative stress effects.\r\nConclusion. Results suggest that 6-OHDA lesion of the PVN affects behavioral\r\nperformance via interactions with systems governing arousal level and possibly by\r\nincreasing neuronal oxidative stress.

Today therapeutic options for obesity include miniinvasive methods. The authors present the results of a prospective study regarding a lot of 224 obese patients treated between January 2003 ? January 2005 with laparoscopic adjustable gastric banding (LAGB) (n=184) and endogastric balloon (n=40). The medium body mass index (BMI) of admission for LAGB was 46.08 kg/m2 (extremes between 36 ? 71 kg/m2), 42 patients being super obese (BMI over 50 kg/m2). There were no conversions to open techniques. Postoperative evaluations were at 1, 6 and 12 months. Medium BMI was 39.1 kg/m2 (115 patients) at six months after surgery and 38.78 kg/m2 (59 patients) at one year after surgery. Comorbidities were remitted at 72% of patients at 6 months postsurgery. The patients treated with endogastric balloon endoscopically introduced (40 cases) were followed 6 months, after that they were extracted (26 cases). The medium BMI of admission was 33 kg/m2 (extremes between 21 ? 43 kg/m2) and at 6 months the medium BMI was 26.8 kg/m2. Although we do not benefit of a long time follow-up, the favorable initial results allow us to state that miniinvasive techniques deserve an important place in the efforts of struggling against obesity and its consequences.

A 20-year-old woman was studied because of lack of spontaneous pubertal development and primary amenorrhea. At the moment of examination in the Medical Genetics Department she had normal height, sparse axillary and pubic hair, but breasts were well developed (she already had some estrogen therapy). She had normal but infantile external genitalia, normal vagina and small uterus. Laparoscopic investigation suggested the presence of gonadoblastoma in the dysgenetic gonads and histopathologic examination confirmed the diagnosis. The karyotype revealed a 46, XY chromosome constitution in lymphocytes, without structural defects of X or Y chromosomes. Because of the risk of malignancy, gonadectomy was performed.