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• The storage facilities for animal manure determine ammonia and odour emissions. • These emissions cause environmental problems and annoyance to inhabitants. • The determination of emission rates is useful to quantify these problems. • Ammonia and odours have been detected studying four storage facilities during two years. • Both ammonia and odour emitted depended upon slurries' characteristics and environmental parameters. Ammonia and odour emissions from one lagoon (Lagoon 1: pig slurry) and three tanks (Tank 2: cow slurry; Tank 3: digestate from pig slurry and energy crops; Tank 4: digestate from pig and cow slurries plus energy crop) used for slurry storage were sampled for two years (2015–2017) in livestock farms that differed for animal breeding and manure management (anaerobic digestion). On average, the ammonia emission rate (AER) was higher for Tank 3 (AER of 30.68 ± 28.1 g N-NH 3 m−2 d−1) than for Lagoon 1 and Tank 2 and 4, i.e. 9.29 ± 14.89 gN-NH 3 m−2 d−1, 9.38 ± 13.75 g N-NH 3 m−2 d−1, 15.74 ± 21.91 g N-NH 3 m−2 d−1, respectively. PLS regression analysis (R2 = 0.544; R2 Adj. = 0.484) indicated that temperature was the main predictor of ammonia emitted, followed by concentration in the slurry of total ammonia and the relative percentage of volatile solids (VS). On the other hand, PLS analysis (R2 = 0.529, R2adj. = 0.417) indicated that odour emissions from animal slurry storages depended similarly upon total solids and VS (both referred to fresh weight) slurry contents, TAN/TKN ratio and degrees of biological stability (measured by anaerobic biogas potential – ABP), resulting in the Specific Odours Emission Rates (SOER) of 12,124 ± 7,914 and 35,207 ± 41,706 OUE m−2 h−1, 65,430 ± 45,360 and 43,971 ± 53,350 OUE m−2 h−1, for Lagoon 1 and Tanks 2, 3 and 4. These results suggest covering the tanks to limit both ammonia and odour emissions. [ABSTRACT FROM AUTHOR]

Central adrenal insufficiency (CAI) in acromegaly may be related to pituitary adenoma or induced by various medical treatments, transsphenoidal neurosurgery (TNS) or radiotherapy (RT), alone or combined. We assessed the role of all available treatments for acromegaly in inducing CAI. We retrospectively studied 97 patients. CAI was diagnosed if morning serum cortisol was < 138 nmol/l, or if its response was inadequate in the low-dose short synacthen test. Seventy-four subjects underwent TNS (and 17 of whom also underwent RT), and 23 were on primary medical therapy: overall we diagnosed 21 cases of CAI. Duration of acromegaly, invasion of cavernous sinus, disease control, and type of medical treatment were much the same for patients with and without CAI, which was identified in 18 % of patients (10/57) after one TNS, and in 53 % (9/17) after RT (p = 0.01); repeat surgery increased the risk of CAI (p = 0.02). The risk of CAI onset during the follow-up was lower among patients treated with TNS or medical therapy than after RT (p = 0.035). Medical treatment did not raise the risk of CAI, whereas a 5- and 4-fold higher risk of CAI was associated with repeat TNS and RT, respectively. Basal or stimulated cortisol levels were similar among acromegalic patients without CAI and matched controls with nonsecreting pituitary lesions. A significant proportion of patients with acromegaly developed CAI over time. While primary or secondary medical treatment did not contribute to the risk of CAI, repeat TNS and RT correlated with pituitary-adrenal axis impairment. [ABSTRACT FROM AUTHOR]

Context Bilateral macronodular adrenal hyperplasia ( BMAH) is a rare form of Cushing's syndrome ( CS). A variety of in vivo tests to identify aberrant receptor expression have been proposed to guide medical treatment. Unilateral adrenalectomy ( UA) may be effective in selected patients, but little is known about recurrence during follow-up. Objective To describe a series of patients with BMAH and CS treated by different approaches, with a particular focus on the benefit of UA. Design and patients We retrospectively assessed 16 patients with BMAH and CS (11 females, five males), analysing the in vivo cortisol response to different provocative tests. Twelve of the 16 patients underwent UA and were monitored over the long term. Results Based on in vivo test results, octreotide LAR or propranolol was administered in one case of food-dependent CS and two patients with a positive postural test. A significant improvement in biochemical values was seen in all patients but with limited clinical response. UA was performed in 12 patients, producing long-term remission in three (106 ± 28 months; range: 80-135), recurrence in eight (after 54 ± 56 months; range 12-180) and persistence in one other. Four patients subsequently underwent contralateral adrenalectomy for overt CS, one received ketoconazole, and four other patients remain under observation for subclinical CS. Conclusions Medical treatment based on cortisol response to provocative tests had a limited role in our patients, whereas UA was useful in some of them. Although recurrence is likely, the timing of onset is variable and close follow-up is mandatory to identify it. [ABSTRACT FROM AUTHOR]

Perioperative management of patients with sellar lesion submitted to endoscopic transsphenoidal neurosurgery (TSS) lacks standardization and therefore it is committed to each center clinical practice. Although neurosurgical procedure remains the same for all sellar lesions, perioperative approach can require different measures depending on the underlying disease. With the aim of standardizing our perioperative procedures and sharing our experience with other centers involved in the management of pituitary disease, we developed a clinical care path for patients with sellar lesions candidate to endoscopic TSS. For the drafting of the following protocol, the national and international guidelines published in the last 5 years have been evaluated and integrated with our center experience accumulated in decades of clinical practice. A steering committee including medical doctors involved in management of patients with pituitary masses at the Padua Hospital reviewed current knowledge on this topic. The committee developed a first draft which was shared with a broader group of medical doctors to reach a preliminary consensus; when it was reached, the clinical care assistance pathway was confirmed, validated, and published in the local web-based health service. We want to present and share our experience with colleagues involved in the perioperative management of pituitary diseases in other centers. [ABSTRACT FROM AUTHOR]